Proportional Method Research Articles

GAMBARAN PELAKSANAAN PROGRAM SANITASI TOTAL BERBASIS MASYARAKAT PASCA DEKLARASI DESA NELELAMAWANGI WILAYAH KERJA PUSKESMAS ILE BOLENG

Community-Based Total Sanitation is the leading example of community-based sanitation in Indonesia. It upholds the non-subsidy principle by enlisting the help of the community to create sanitary and hygienic infrastructure. The problem is the lack of clean water supply facilities and the level of public awareness so that STBM pillars II, IV and V have not yet been implemented. The present analysis is useful research is to get receiving a picture implementation of the Post-Declaration Community-Based Total Sanitation Program in Nelelamawangi Village. This paper was written as a quantitative desk study using survey methods. The sampling technique used in this study uses the propotional sampling method to determine the sample size.Using a proportional sampling method. The population in this study was the people of Nelelamawangi Village, aged 17-60 years, totaling 384 and 196 people were sampled in this study. Study findings demonstrate that it is accurate. that post-declaration STBM Pillar I had been implemented, Post-declaration STBM Pillar II had not been implemented, Post-declaration STBM Pillar III had been implemented, Post-declaration STBM Pillar IV had not been implemented and Post-declaration STBM Pillar V had not been implemented. The conclusion is that pillars in the STBM program have been implemented in pillars I and III and have not been implemented in pillars II, IV and V.

Biosafety Training and Introduction to Livestock Diseases Using Participatory Rural Appraisal Method in Pade Angen Livestock Group East Lombok Regency

The community service aims to introduce the application of biosafety and biosecurity and provide the ability to recognize livestock diseases simply with the participatory rural appraisal (PRA) method in reducing the transmission of livestock diseases in East Lombok Regency. The implementation methods of the activities include a survey of the service location to identify problems, socialization of the program activity to the target community, education about biosecurity and biosafety, and an introduction to simple livestock disease detection based on community participation with PRA, then continued with training on applying simple biosecurity and biosafety and simple livestock disease detection methods with PRA proportional piling and matrix scoring methods. The data of PRA proportional piling and matrix scoring based on disease symptom data will be mapped and ranked using descriptive analysis. The results of this community service were obtained from members of The Pade Angen II Livestock Group could use personal protective equipment (PPE) correctly by 80%. The detection of disease based on symptoms using the proportional piling and matrix scoring methods obtained repeat breeding events with symptoms of repeated mating of 21%, helminthiasis with symptoms of worms of 14%, itching of 4%, diarrhea of 4%, and scabies with symptoms of itching of 8%. Foot and mouth disease was also still found with symptoms of wounds on the feet and salivation of 11%, miscarriage of 4% and fever of 1%, coccidiosis with symptoms of bloody diarrhea of 10%, colibacillosis with symptoms of diarrhea of 6%, bloat with symptoms of bloating of 3% and fever of 1%.

Sports Injuries in Germany – A Pilot Study

Problem: Sports accidents are omnipresent in all areas of sport. However, due to a lack of data, conclusions cannot be drawn about how many sports accidents occur in Germany each year. This study aims to provide an initial overview of sports injuries and the types of sports involved, serving as a foundation for a larger survey. Methods: From September 12th-16th, 2022, a representative survey was conducted via telephone (forsa.omniTel®), interviewing 2002 individuals in Germany aged 14 and older about their sports activities and injuries in the past 12 months. Results were analyzed using 95% confidence intervals (CI) and logistic regression to assess the impact of age and gender on injury probability (α=0.05). The distribution of injuries across sports was calculated using an iterative proportional fitting method and Bonferroni correction for significance levels. The original document was internally reviewed, contains no personal data, and is approved for publication, with no further ethics committee review required, as forsa, a member of ADM, complies with all legal and ethical standards, including GDPR. Results: It is estimated that 12.2% (CI=10.5 to 14.0%; CIadj=9.8 to 14.7%) of athletes in Germany have been injured during sport in the past 12 months, requiring medical treatment or a break from sport. Younger and male athletes were more likely to be injured than older and female athletes (age: p<0.001, padj<0.001; gender: p<0.001, padj<0.01). Most injuries occurred during running/walking/hiking (16%) and cycling (14%). Soccer (11%) and tennis (4%) had the highest injury rates among sports games. Conclusion: This pilot study offers crucial insights into sports injury prevalence in Germany. Future studies should include detailed injury types, severity and exposure times for more individualized preventive programs.

The Impact of the Dietary Inflammatory Index, Fasting Blood Glucose, and Smoking Status on the Incidence and Survival of Pancreatic Cancer: A Retrospective Case-Control Study and a Prospective Study.

Pancreatic cancer (PC), a highly malignant cancer with a poor diagnosis, may be influenced by diet-related inflammation. This study examined the association between dietary inflammatory index (DII) scores and the incidence and prognosis of PC in Korea. A total of 55 patients with PC were matched with 280 healthy controls (HCs) by age and sex. We also analyzed the combined effects of DII scores and fasting blood glucose (FBG) levels or smoking status on the risk of PC and performed a survival analysis using the Cox proportional hazards method. The DII scores were higher in the patients with PC than those in HCs (odds ratio [OR] = 3.36, confidence interval [CI] = 1.16-9.73, p = 0.03), and the effect was larger in women (OR = 6.13, CI = 1.11-33.82, p = 0.04). A high DII score was jointly associated with FBG ≥ 126 mg/dL in raising PC risk [OR = 32.5, relative excess risk due to interaction/synergy (RERI/S) index = 24.2/4.34, p-interaction = 0.04], indicating a multiplicative interaction. A high DII score combined with ex/current smoker status increased PC risk through an additive interaction (RERI/S = 1.01/1.54, p-interaction = 0.76). However, DII scores did not influence disease-free survival. The consumption of an anti-inflammatory diet, coupled with maintaining normal FBG levels and abstaining from smoking, may help reduce the risk of PC by mitigating pancreatic inflammation.

Position–Force Control of a Lower-Limb Rehabilitation Robot Using a Force Feed-Forward and Compensative Gravity Proportional Derivative Method

The design and control of lower-limb rehabilitation robots for patients after a stroke has gained significant attention. This paper presents the dynamic analysis and control of a 3-degrees-of-freedom lower-limb rehabilitation robot using combined position–force control based on the force feed-forward and compensative gravity proportional derivative methods. In the lower-limb rehabilitation robot, the interaction force between the patient with the joints and links of the robot is uncertain and nonlinear due to the disturbance effect of Coriolis force, centrifugal force, gravitational force, and friction force. During recovery stages, the forces exerted by the patient’s lower limbs are also considered disturbances. Therefore, to meet the quality requirements in using the rehabilitation robot with different recovery stages of patient training, combining position control and force control is essential. In this paper, we proposed a combination of proportional–derivative gravity compensation motion control and force feed-forward control to form an advanced combined controller (position–force feed-forward control—PFFC) for a 3 DOF lower-limb functional rehabilitation robot. The forces can be sensed using a 3-axis force sensor. In addition, the robot’s position parameters are also measured by encoders. The control algorithm is implemented on the STM32F4 Discovery board. A verified test of the proposed control method is shown in the experiments, showing the good performance of the system.

Abstract 4137484: Clinical implications of combined midodrine and pulmonary vasodilator therapy in Portopulmonary Hypertension

Introduction: Portopulmonary hypertension (POPH) and associated pulmonary vascular resistance (PVR) elevation is seen in the context of underlying portal hypertension and liver disease. In the systemic circulation, liver cirrhosis can cause inappropriate splanchnic and systemic vasodilation with decreased systemic vascular resistance (SVR). Midodrine is used to maintain blood pressure in the setting of low SVR. Pulmonary vasodilators have systemic vasodilatory effects; the implications of combined midodrine and pulmonary vasodilator use in POPH are unanswered questions. Hypothesis: We hypothesized that SVR would decrease over time in patients with POPH started on pulmonary vasodilators, and that use of midodrine (as a surrogate for depressed SVR), may be associated with increased risk of mortality in patients with POPH starting pulmonary vasodilator therapy. Methods: Patients from the 3 Mayo Clinic sites (Rochester, MN; Jacksonville, FL; Scottsdale, AZ) diagnosed with POPH from 1988-2020 were included in the database. Patients met hemodynamic criteria for POPH via right heart catheterization (RHC). Hemodynamics were obtained from echocardiography and RHC at initial and subsequent visits. The hazard ratio for risk of death was estimated using Cox proportional hazards method. SVR was calculated using mean arterial pressure and cardiac output. Results: Analysis included 147 POPH patients, 34 (23%) on midodrine and 113 (77%) not requiring midodrine. There were 116 patients with longitudinal SVR data. The mean initial SVR was 1224 Dyne sec cm-5 and decreased 251 Dyne sec cm-5 [95% CI -337 to -165 251 Dyne sec cm-5, p<0.0001] with no difference between midodrine groups (p=0.57). Patients in the midodrine POPH group had an increased risk of mortality compared to those without midodrine use (HR 1.51, 95% CI: 1.02-2.21, p=0.0371). Conclusions: Patients with POPH starting pulmonary vasodilator have a reduction in SVR related to vasodilator therapy. Midodrine use with pulmonary vasodilator therapy is associated with increased mortality in the POPH population. Further study of the safety of combined midodrine and pulmonary vasodilator use in POPH is needed along with exploration of more selective pulmonary vasodilators.

Differences in Physical Activity and Self-Rated Health Levels Based on Satisfaction with Physical Environment of Local Communities: From School to Lifelong Physical Education.

In Korea, substantial disparities exist in physical environments across regions, exacerbating the polarization between metropolitan and provincial areas and urban and rural regions. This study examines the differences in the physical activity and self-rated health of local communities in relation to satisfaction with the physical environment. By identifying and addressing these underlying causes of health disparities, the study provides foundational data to inform policy efforts. The study utilized data from the 2023 Community Health Survey conducted by the Korea Disease Control and Prevention Agency. It included 231,752 individuals aged 19 and older (105,754 men and 125,998 women) selected through a two-stage probability proportional systematic sampling method. One-on-one online interviews were conducted from 16 May to 31 July 2023. The physical environment was assessed based on public satisfaction with safety, natural and living environments, public transportation, and medical services. Study variables included subjective health status and physical activity, with subvariables for physical activity encompassing the duration of vigorous and moderate physical activity, walking, and flexibility exercises. For data analysis, MANOVA and ANOVA were conducted, with Bonferroni correction for multiple comparisons. Considerable variations in physical activity were observed based on satisfaction with the local community environment. Regarding self-rated health, significant differences were found in safety levels, living environment, and medical services. Satisfaction with the physical environment positively influenced physical activity and self-rated health. Therefore, it is imperative to reduce disparities in the physical environment between regions and enhance residents' satisfaction.

Diastolic Dysfunction and the Risk of Stroke and Major Bleeding.

Left ventricular diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes including atrial fibrillation. Whether DD is independently associated with incident stroke and transient ischemic attack (TIA) and with bleeding events is not known. We performed this observational cohort analysis to examine the impact of DD on the risk of stroke/TIA and major bleeding. Patients who underwent at least 1 cardiac echocardiogram and were followed for at least 3 months were included in this study. Patients with a prior history of stroke, TIA, or major bleeding, as determined by International Classifications of Diseases codes, were excluded. Smart key-phrase search was applied to echocardiographic reports to classify patients into 4 groups based on the most severe DD assessment. Patients in whom the presence of DD could not be determined were excluded. The final study cohort was followed to the end point of hospital admission for stroke/TIA and major bleeding, and independent predictors of these events were evaluated using the multivariable Cox proportional hazards method. The final study cohort (age, 56±18 years; 56% women) had 96 702 patients with no DD and 18 164, 5881, and 1340 patients with DD grades I, II, and III, respectively. Over a median follow-up of 3.4 years, 2938 (2.4%) patients were hospitalized for stroke/TIA and 5567 (4.6%) for major bleeding. After adjusting for age, the CHA2DS2-VASc score, chronic kidney disease, use of antiplatelet agents, use of anticoagulation agents, the year of echocardiographic testing, household income, and history of atrial fibrillation, DD remained a strong predictor of incident stroke/TIA (hazard ratio, 1.22 per grade increase in DD [95% CI, 1.16-1.29]; P<0.001) and major bleeding (hazard ratio, 1.20 per grade increase in DD [95% CI, 1.16-1.25]; P<0.001). DD is independently associated with a higher risk of cerebrovascular accidents and major bleeding. DD should be considered when counseling patients regarding their risk profile and management options.

Assessment of Key Factors Affecting Farmers' Migration Intentions Due to the Syrian Conflict

This study aims to identify the migration patterns of Syrian farmers in northern Aleppo and to investigate the main factors affecting their migration patterns. In this context, the study data were obtained through face-to-face surveys with a total of 210 farmers from 17 villages in three administrative districts of Aleppo Governorate using a proportional sampling method. The data were analyzed using descriptive statistics and a logistic regression model. According to the results of the study, education level, land size, and household income were found to decrease the tendency to migrate. On the other hand, the factors that increase the tendency of farmers to migrate include being temporarily settled in the region and having family members abroad as refugees. As the war-induced environment has reduced participation in non-agricultural work, more farmers consider agriculture as their main source of livelihood.

Analisis Tingkat Kesejahteraan Rumah Tangga Petani Padi di Desa Cadaskertajaya Kecamatan Telagasari Kabupaten Karawang

Agricultural development in rural areas not only increases production, but also increases people's income, opens up more job opportunities, and improves welfare. This research aims to analyze farmer household income, farmer household expenditure, and the level of welfare of rice farmer households in Cadaskertajaya Village, Telagasari District, Karawang Regency. The research method used is Mix Method, with primary and secondary data types. Primary data was collected through interviews using questionnaires from 47 rice farmers. Secondary data was obtained from the Central Statistics Agency, Karawang Regency Agricultural Service, Cadaskertajaya Village, and other institutions. Samples were taken using the proportional random sampling method, with the criteria being farmer owners and farm workers. Data analysis uses the Directorate of Land Use's criteria poverty line for household income, the Sayogyo criteria poverty line for household expenditure, and welfare indicators from BPS. The research results show that the average household income of rice farmers in Cadaskertajaya Village is IDR 34,582,351.69 per year and IDR 8,124,446.81 per capita per year. The household expenditure of rice farmers is IDR 25,380,255.32 per year and IDR 8,413,937.59 per capita per year. Based on the poverty line criteria of the Directorate of Land Use, 53.19% of farmers are not poor, and according to the Sayogyo criteria, 82.61% are not poor. The welfare level is calculated using 11 indicators from BPS, with the highest score being 33 and the lowest score being 27, which is still included in the high welfare category.

Effects of aspirin and omega-3 fatty acids on composite and subdomain scores from the NEI-VFQ-25 questionnaire: the ASCEND-Eye randomized controlled trial

BackgroundThe double-blind, 2 × 2 factorial design, placebo-controlled ASCEND randomized trial compared the effects of 100 mg aspirin daily and, separately, 1 g omega-3 fatty acids (FAs) daily on the primary prevention of cardiovascular disease in 15,480 UK adults with diabetes. We report the effects of these randomized treatment allocations on scores derived from the National Eye Institute’s Visual Function Questionnaire-25 (NEI-VFQ-25) in a subset of participants involved in the ASCEND-Eye sub-study.MethodsOrdinal data from the NEI-VFQ-25 were analyzed using proportional odds regression methods. A common odds ratio with a 95% confidence interval was used to interpret the average effect size of randomization to each study treatment on composite and subdomain scores from the questionnaire.ResultsNeither randomization to aspirin nor omega-3 FAs for 7.5 years significantly affected composite or subdomain scores from the NEI-VFQ-25.ConclusionApplying the NEI-VFQ-25 in ASCEND-Eye represents one of the largest surveys of vision-targeted health-related quality of life in people with diabetes. Further observational analyses of these data are planned, to identify the clinical and demographic characteristics associated with lower composite and subdomain scores in a diabetic population.Trial registrationEudract No. 2004–000991-15; Multicentre Research Ethics Committee Ref No. 03/8/087 (29th December 2003); ClinicalTrials.gov No. NCT00135226 (24th August 2005); ISRCTN No. ISRCTN60635500 (1st September 2005).

Evaluation of Treatment Strategies for Patients with Stage IIIA Non-Small Cell Lung Cancer in the Immunotherapy Era

BackgroundOptimal treatment for patients with stage IIIA NSCLC is controversial. Growing evidence indicates surgery with adjuvant or neoadjuvant chemotherapy (SC) may be superior to non-surgical treatments. Direct comparisons have not been performed between SC and chemoradiation with immunotherapy (CRI) among patients diagnosed with stage IIIA NSCLC since consolidation immunotherapy was added to treatment guidelines. MethodsThis retrospective study compared surgical and systemic non-surgical treatments (except targeted therapy) among adults diagnosed with stage IIIA NSCLC 2017-2021. Data was from ConcertAI's curated EHR Patient360™ NSCLC real-world care product. Real-world progression-free survival (rwPFS) and overall survival (rwOS) were evaluated among patients treated with SC or CRI using Kaplan-Meier and Cox proportional hazard methods. Baseline differences were balanced using propensity score-derived inverse probability treatment weights (IPTW). ResultsAmong 1718 eligible, the two main comparator groups (SC and CRI) had 431 (25%) and 576 (34%) patients; 711 patients received chemoradiation or monotherapy. A wide range of treatment strategies was observed across included oncology clinics (e.g., 0–67% clinic patients received surgery). IPTW-adjusted analyses showed reduced hazards in the SC group vs. CRI for rwPFS (HR 0.78, 95% CI: 0.63–0.97) and rwOS (HR 0.63, 95% CI: 0.49–0.82). SC was similarly beneficial for patients across nodal status groups and appeared especially beneficial for patients with resectable squamous-cell tumors. ConclusionStage IIIA NSCLC treatment is highly variable. Real-world studies can provide valuable evidence to support surgery as a treatment option for stage IIIA patients, who currently may only be offered chemoradiation with or without immunotherapy.

The Relationship Between Attitudes Towards Academic Self-Efficacy and Self and Peer Assessment in Turkish Nursing Students: A Cross-Sectional Study.

Academic self-efficacy (ASE), as well as self (SA) and peer assessment (PA), is associated with the subjective judgements of the individual. The correlation among these concepts merits further research. This study aims to examine the correlation between nursing students' attitudes towards ASE and SA and PA. This is a correlational cross-sectional study. The sample consisted of 1401 nursing students from five universities in Istanbul, Turkey. The study employed the proportional quota sampling method. The data were collected using a Personal Information Form, View Scale for Peer and Self-Assessment and ASE Scale. Descriptive statistics and multiple linear regression model (stepwise) tests were used to analyse the data. Descriptive statistics revealed that 82.2% of the participants were female and their Academic Grade Point Average was 3.00 ± 0.48. As a result of the regression analysis, it was determined that students' age, gender, perception of academic achievement, status of receiving PA training and attitudes towards doing PA and self-assessment significantly predicted their ASE score. Students' ASE was found to be medium-level, their attitudes towards peer and self-assessment were high and SA and PA attitudes was associated with ASE. A total of 1401 undergraduate nursing students from five undergraduate universities participated in the study and responded to questions on ASE, peer assessment, self assessment, etc.

Brain morphometrics correlations with age among 352 participants imaged with both 3T and 7T MRI: 7T improves statistical power and reduces required sample size.

Magnetic resonance imaging (MRI) at 7 Telsa (7T) has superior signal-to-noise ratio to 3 Telsa (3T) but also presents higher signal inhomogeneities and geometric distortions. A key knowledge gap is to robustly investigate the sensitivity and accuracy of 3T and 7T MRI in assessing brain morphometrics. This study aims to (a) aggregate a large number of paired 3T and 7T scans to evaluate their differences in quantitative brain morphological assessment using a widely available brain segmentation tool, FreeSurfer, as well as to (b) examine the impact of normalization methods for subject variability and smaller sample sizes on data analysis. A total of 452 healthy participants aged 29 to 68 were imaged at both 3T and 7T. Structural T1-weighted magnetization-prepared rapid gradient-echo (MPRAGE) images were processed and segmented using FreeSurfer. To account for head size variability, the brain volumes underwent intracranial volume (ICV) correction using the Residual (regression model) and Proportional (simple division to ICV) methods. The resulting volumes and thicknesses were correlated with age using Pearson correlation and false discovery rate correction. The correlations were also calculated in increasing sample size from 3 to the whole sample to estimate the sample size required to detect aging-related brain variation. 352 subjects (210 females) passed the image quality control with 100 subjects excluded due to excessive motion artifacts on 3T, 7T, or both. 7T MRI showed an overall stronger correlation between morphometrics and age and a larger number of significantly correlated brain volumes and cortical thicknesses. While the ICV is consistent between both field strengths, the Residual normalization method shows markedly higher correlation with age for 3T when compared with the Proportional normalization method. The 7T results are consistent regardless of the normalization method used. In a large cohort of healthy participants with paired 3T and 7T scans, we compared the statistical performance in assessing age-related brain morphological changes. Our study reaffirmed the inverse correlation between brain volumes and cortical thicknesses and age and highlighted varying correlations in different brain regions and normalization methods at 3T and 7T. 7T imaging significantly improves statistical power and thus reduces required sample size. Compared to 3T, 7T has stronger inverse correlations of total grey matter, subcortical grey matter, and white matter volumes, and mean cortical thickness with age.Compared to 3T, 7T shows a greater number of brain volumes and cortical thicknesses that have statistically significant correlations with age.For comparable statistical power at 3T, the required sample size for 7T is reduced for cortical and subcortical volumes, and substantially reduced for cortical thicknesses.

Thresholds for the value judgement of health technologies in the United Arab Emirates: a consensus approach through voting sessions

BackgroundIn the evolving healthcare landscape of the United Arab Emirates (UAE), establishing cost-effectiveness thresholds (CETs) is pivotal to informing decision-makers about the value of health technologies.ObjectiveThis study aimed to establish...

Differential Fast Fourier Transform Based Recovery Algorithm for Electricity Metering Data

Abstract Accurate electricity data is the foundation for time-of-use pricing. However, for various reasons, some data may be incorrect or lost. To address this issue, this paper proposes a recovery algorithm based on differential Fourier transform to restore missing metering data. First, the total electricity consumption data is differentiated and up-sampled as the interpolation sequence. Next, a Fourier transform is performed on the interpolated sequence to convert it from the time domain to the frequency domain. Zero-padding is applied in the high-frequency regions to enhance time-domain resolution. Then, the sequence is converted back to the time domain through an inverse Fourier transform, yielding the missing power consumption sequence. Finally, a proportional scaling method is applied to satisfy the non-decreasing characteristic. Numerical experiments demonstrate that the method proposed in this paper exhibits high reliability and accuracy in restoring missing electricity data.

STRES KERJA DAN MOTIVASI KERJA PENGARUHNYA TERHADAP KINERJA KARYAWAN BANK SYARIAH MANDIRI DI KOTA MAKASSAR

This study aims to determine the effect of work stress, work motivation, and the effect of both simultaneously on the performance of Bank Syariah Mandiri employees in Makassar City. This research was conducted at the Bank Syariah Mandiri Office in Makassar City with a research unit of permanent employees aged 20-40 years with a minimum work period of 1 year and a high school educational background and a maximum of Master degree (S2). The total population is 409 employees spread across 8 branch offices and sub-branches. The method chosen to determine the sample is purposive sampling and proportional sampling method and the results obtained are 202 samples. Furthermore, data collection was carried out using questionnaire, observation, and interview methods. The research hypothesis was tested through multiple regression analysis using the SPSS program. The research shows that work stress and work motivation have a significant influence on the performance of Bank Syariah Mandiri employees in Makassar City. Unmanaged work stress can reduce productivity, loyalty, and increase employee turnover, while good work motivation tends to improve performance.

Integrasi Kewirausahaan dan Pendidikan Islam dalam Peningkatan Kesejahteraan Masyarakat

The integration of Islamic education with entrepreneurship is an effort to bring about changes in people's quality of life, attitudes and decision making. Especially for students studying at Islamic boarding schools, this knowledge is very important to learn. In this research, researchers used a qualitative descriptive approach using observation, interviews and documentation. Determining informants using the proportional sampling method. This research found: 1) integration of entrepreneurship and Islamic education is needed to improve the welfare of the community in that location because: a) community leaders are very steeped in religion so they always prioritize religion in everything. b) portrait of the diversity of livelihoods of the surrounding community; c) to establish social, religious and entrepreneurial relations with the surrounding community; 2) implementation of the integration of entrepreneurship and Islamic education in improving the welfare of the Sangen Modern Islamic Boarding School community is carried out by implementing entrepreneurship programs in the fields of fisheries, agriculture and cooperatives/canteens within the Islamic boarding school. Keywords: Integration; Entrepreneurship; Islamic education; Well-being Public

Left ventricular mass index and prognosis of symptomatic severe aortic stenosis in women and men

Abstract Background Symptomatic severe aortic stenosis (AS) requires surgical (SAVR) or transcatheter aortic valve replacement (TAVR), and many patients are on the procedure waiting list. The diagnosis of severe AS is based on clinical and echocardiographic criteria, such as left ventricular ejection fraction (LVEF), aortic valve area (AVA), mean transvalvular gradient, and peak aortic jet velocity. However, there is a gap in knowledge regarding the influence of left ventricular mass on the prognosis of these patients, especially considering differences between women and men. Purpose To evaluate the influence of left ventricular mass index (LVMi) on the mortality of women and men with severe AS awaiting SAVR or TAVR. Methods A prospective study analysed the death rate in 531 outpatients with symptomatic severe AS with mean transvalvular gradient ≥40 mmHg, AVA ≤1.0 cm2, or peak aortic jet velocity ≥4.0m/s at echocardiography with the indication for TAVR or SAVR in the period from April 2020 to February 2024. Baseline data included analysis of clinical characteristics, echocardiographic variables, and the presence of coronary artery disease (CAD). Statistical analyses were performed using the Kaplan-Meier (K-M) and Cox proportional hazards methods to analyze mortality rates in women and men. Results The mean age was 74.7±11.6 years, with 283 (53.3%) men. Over a follow-up period of 2.67±1.22 years, death occurred in 165 (31.1%), 148 (86%) due to cardiovascular disease, and 152 (92%) had heart failure (HF) NYHA II to IV, 51 (9,6%) had angina, and syncope in 11 (2.1%) of the patients. Patients who died had lower LVEF (61.4%±8.9% vs. 58.8%±10.8%; p=0.008) and higher LVMi (125.3±32.5 g/m2 vs. 115.5±29.3 g/m2; p=0.001). Angina, syncope, hypertension, dyslipidemia, diabetes, smoking, atrial fibrillation, and CAD prevalence were similar in living patients and in those who died. Both groups had similar echocardiographic data, such as left atrial volume, mean transvalvular gradient, and peak jet velocity. TAVR and SAVR were done in 111 (20.9%) and 162 (30.5%) patients. Of these, 21 (18.9%) and 20 (12.4%) died during follow-up, respectively. Cumulative mortality of all patients was higher with LVMi &amp;gt;115 g/m2 compared to ≤115 g/m2 (p=0.008)(Figure). In women but not in men, cumulative mortality was higher with LVMi &amp;gt;115 g/m2 compared to ≤115 g/m2 (p=0.046). Cox multivariate analysis, adjusted for LVEF, LVMi, CAD, and age, showed LVMi as an independent variable for death [HR=1.50 (95%CI: 1.10-2.05); p=0.011]. LVEF [HR=0.97 (95%CI: 0.95-0.99); p=0.009] and LVMi [HR=1.75 (95%CI: 1.10-2.79); p=0.016] were independent variables for death in women, but not in men. Conclusion Women with higher LVMi and lower LVEF should have valve intervention prioritized.Figure

Influence of persistent atrial fibrillation on the prognosis of heart failure with preserved, mildly reduced, and reduced ejection fraction in women and men

Abstract Introduction Heart failure (HF) is one of the leading causes of death from cardiovascular disease. Persistent atrial fibrillation (PAF) is associated with a worse prognosis in HF. However, little is known about the influence of AF on mortality in women and men with heart failure with preserved (HFpEF ≥50%), mildly reduced (HFmrEF 41% to 49%), and reduced ejection fraction (HFrEF ≤40%). Purpose to analyze the characteristics and influence of PAF on the prognosis of different HF phenotypes. Methods From February 2017 to September 2020, we analyzed hospitalizations, emergency admissions, and mortality of different HF phenotypes with and without PAF. Baseline data included clinical features and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) and Cox proportional hazards methods to analyze mortality rates. Results We studied 11,543 patients, with a mean of 64.1±14.0 years: 55.1% male, 42% with HFrEF, 12.8% with HFmrEF, and 45.1% with HFpEF. PAF was associated with higher mean age (67.6±14.3 vs. 62.8±13.4 years, p&amp;lt;0.001) and more prevalent in men (21% vs. 19%; p=0.019) and in patients with valvular and Chagas etiologies, chronic kidney disease (CKD), stroke, and anemia. The prevalence of PAF in women and men was, respectively, 12.4% vs. 18.3% (p&amp;lt;0.001) in HFrEF, 18.1% vs. 22.2% (p=0.029) in HFmrEF, and 23.3% vs. 23.9 (p=NS) in HFpEF. The overall mortality was 21.6%, with mortality being 2.4 times higher in patients with PAF (40.9% vs. 16.7%, p&amp;lt;0.001) compared to sinus rhythm but similar in women and men with PAF (39.5% vs. 41.9%; p=NS), respectively. The hospitalization (30.3% vs 19.4%, p&amp;lt;0.001) and emergency admissions (38.4% vs 25.7%, p&amp;lt;0.001) were higher in patients with AF. Cumulative mortality was higher in patients with PAF in all HF phenotypes: HFrEF (36.6%), HFmrEF (16.8%), HFpEF (46.6%; p&amp;lt;0.001). Men had higher cumulative mortality in HFrEF (18.3% vs. 12.4%; p&amp;lt;0.001) and in HFmrEF (22.2% vs. 18.09%; p=0.029), but not for HFpEF (23.9% vs. 23.3%; p=NS). In the multivariate analysis, adjusted for age, sex, previous myocardial infarction and stroke, diabetes, CKD, PAF, Cardiac surgery, and electronic device implantation, PAF was an independent predictor of death in all HF phenotypes: HFrEF [HR=1.78(95%CI:1.57-2.02); p&amp;lt;0.001], HFmrEF [HR=2.14(95%CI:1.74-2.65); p&amp;lt;0.001], HFpEF [HR=2.08(95%CI:1.82-2.37); p&amp;lt;0.001]. Conclusion PAF is a frequent comorbidity in HF and is associated with a worse prognosis in all HF phenotypes. Women with PAF had a better prognosis than men with AF in HFrEF and HFmrEF. Sex-specific strategies to maintain sinus rhythm in HF patients on the overall risk of death are needed.