Population Sample Research Articles

Peak oxygen pulse response during maximal cardiopulmonary exercise testing on a treadmill: applicability analysis of the FRIEND registry prediction equation in a Brazilian healthy sample

Abstract Background Peak oxygen uptake (VO2peak), measured by cardiopulmonary exercise test (CPET), is an established variable for prognostic assessment. Other VO2peak-derived variables, such as the peak oxygen pulse (peakO2pulse), also provide valuable information for risk stratification in patients with cardiac diseases. For individualized assessment, the measured peakO2pulse can be compared to reference standards using predictive equations, such as the FRIEND Registry [peakO2pulse = 23.2 – (0.09 × Age) – (6.6 × Sex (female:1; male: 0)]. However, the applicabilty of this equation in a Brazilian population sample has never been evaluated. Purpose To conduct an external validation of the FRIEND registry prediction equation for treadmill peakO2pulse in a sample of healthy Brazilian individuals. Methods Cross-sectional study involving subjects assessed by treadmill CPET in the Brazilian Midwest region from January 2011 to March 2020. Inclusion criteria: healthy individuals aged ≥ 20 years with a peak respiratory exchange ratio ≥ 1.00. Exclusion criteria: history of cardiovascular or pulmonary disease, presence of cardiovascular risk factors (hypertension, diabetes mellitus, current smoking, and obesity), and abnormalities on CPET. Variables were described as median and interquartile range (IQR). Statistical comparisons between measured and predicted values were conducted using the Wilcoxon signed rank test, including the calculation of the median differences and the 95% confidence interval (CI). Furthermore, Bland-Altman agreement analysis was utilized to assess the concordance between measured and estimated values. Results A total of 7,843 CPETs were performed. After applying inclusion and exclusion criteria, 3,544 assessments were included (1,574 females and 1,970 males) aged between 20 to 80 years. In the females, the median and IQR of measured peakO2pulse and predicted values were 10.4 (9.0; 12.1) and 13.1 (12.3; 13.7) ml/beat, respectively. This difference was statistically significant (p < 0.001), with a median difference of 2.54 mL/beat (95% CI: 2.40; 2.69). For males, the measured and predicted values were 17.3 (15.1; 19.7) and 19.7 (19.0; 20.2) ml/beat, respectively. The median difference was statistically significant at 2.26 mL/beat (95% CI: 2.11; 2.46) (p < 0.001) (Figure 1). Bland-Altman agreement analysis indicated a bias of 2.33 mL/beat (95% limits of agreement: -2.17 to 6.83) in females and 2.15 mL/beat (95% limits of agreement: -4.34 to 8.65) in males (Figure 2). Conclusions The study reveals that measured median peakO2pulse values are consistently lower than predicted across both sexes, highlighting a significant bias, which limits the applicability of the FRIEND registry prediction equation in the Brazilian population and underscores the international heterogeneity of the variable. The findings advocate for the development of region-specific reference standards to enhance accuracy in predicting peakO2pulse values.

Individual fluidity of sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual fluidity is key to understanding the size of sexual minority populations and analyzing the socioeconomic disparities these populations face. This study explores the stability and changes in sexual identity over time, and identifies key demographic factors that predict shifts in sexual identity. Methods We analyzed longitudinal data from the Stockholm Public Health Cohort, following 36,398 participants from 2010 to 2021. Sexual identity was measured using a self-administered questionnaire in 2010, 2014, and 2021. Demographic data from 2010 were collected from the Swedish national registers. Multivariate Poisson regression with robust variance estimators was used to identify demographic factors that predicted identity changes. Results were presented as proportion or risk ratio (RR) with 95% confidence interval (CI). Results Overall, 12.1% (95% CI 11.8%-12.5%) changed sexual identity at least once in 2010-2021, including 10.4% (10.0%-10.7%) among those initially identifying as heterosexual in 2010, 41.3% (37.1%-45.6%) as homosexual, 59.6% (55.0%-64.0%) as bisexual, and 65.0% (59.4%-70.3%) as uncertain. Multivariate analyses showed that sexual minorities (homosexual: RR 5.00, 95% CI 4.45-5.61; bisexual: 6.68, 6.04-7.38; uncertain: 3.88, 3.30-4.55), females (1.28, 1.21-1.35), younger (18-29 years: 1.49, 1.30-1.70) and older ( > =60 years: 2.07, 1.92-2.22) ages, born outside Sweden (Europe: 1.21, 1.11-1.32; Outside Europe: 2.90, 2.62-3.21), and lower education ( < =9 years: 2.14, 1.98-2.31; 10-12 years: 1.43, 1.34-1.53) and income (100 SEK/year) ( < =2,500: 1.83, 1.66-2.02; (2,500, 3,500]: 1.32, 1.19-1.46) independently predicted a higher probability of identity changes. Conclusions This study provides the first insights into sexual identity fluidity in a large general population sample in Sweden, highlighting its fluid nature. Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity. Key messages • This study provides the first insights into sexual identity fluidity in Sweden, highlighting its fluid nature. • Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity.

Precarious employment expectancy by history of mental-health-related sickness absence in Finland

Abstract Background Poor mental health may lead to labour market insecurity including precarious employment and vice versa. Less is known of how mental health is associated with cumulative engagement in precarious employment over the working career. We examined how the working career is expected to be distributed into precarious and other types of employment by history of mental-health-related sickness absence. Methods We used a register-based 70% population sample to examine wage-earners living in Finland in 2018. Applying the Sullivan method, we calculated the expectancy of precarious and non-precarious employment between age 25 and 63 (N = 1268666) based on a novel measure (score with items on temporariness, agency employment, multijob holding, underemployment and income level) and limited employment (due to which precariousness could not be assessed) among those with and without compensated (granted after 10 weekdays) sickness absence due to mental disorders in the past five years (mental SA history). Results Precarious employment expectancy was higher among those with than among those without a mental SA history (2.5 vs. 1.5 among men and 3.5 vs. 2.8 years among women). The difference in the limited employment expectancy was in the same direction, but much larger among men (6.5 vs. 3.3 among men and 4.4 vs. 3.4 years among women). Men with a mental SA history were expected to spend almost a fourth of their working career with either precarious or limited employment, whereas for men without such a history the number was 13%. Conclusions Individuals with mental disorders have notable accumulation of precarious employment over the working career. They also spend excessive time with limited employment, which may have similar elements as precarious employment and reflect broader labour market insecurity. Attempts should be made to ensure that insecure employment conditions among people with mental health problems do not further deteriorate their health and work ability. Key messages • People with mental disorders spend a disproportionate part of their working career either precariously employed or facing other insecurities in the labour market. • Interventions aiming to promote health and work ability should take into account the interplay between poor mental health and poor employment conditions.

Total sugar intake significantly associated with systolic blood pressure in small sample population

Abstract Background Hypertension contributes to 45% of all deaths from heart disease and up to 51% of deaths from strokes. Dietary factors, such as sodium (Na+) and potassium (K+) can play a role, but recent studies have also highlighted the importance of sugar intake on blood pressure. Very few studies have evaluated the impact of these factors and their ratio on cardiometabolic biomarkers. This study aims to assess the impact of dietary sugar intake, Na+, K+ and NA+/K+ ratio on hypertension and cardiometabolic biomarkers. Methods Fasting venous blood was collected to measure glucose, triacylglycerols (TAG), total cholesterol, HDL-c, ApoA1, ApoB, or hs-CRP, with enzymatic and turbidimetric techniques, and oxidized LDL by ELISA, and IL-6 and TNFa by Luminex system, the latter’s in a subset sample. Blood pressure (SBP, DBP, and HR) was measured at least twice with an automatic recorder. Dietary intake was obtained using semi-quantitative FFQ, comprising 82 items, and reported to the previous year. Data was analysed using R software through descriptive analysis and partial correlations adjusted to the participant’s BMI. A significant level of 0.05 was used. Results 78 participants, aged from 19 to 80 years old (M = 48,5±13,5) were evaluated, with 47% taking hypertensive medication. BMI ranged from 19,7 to 41,1 Kg/m2 (M = 29,2±5,4). The average intake of Na+, K+ and NA+/K+ ratio were 3805±1397 mg, 3980±1300 mg and 1.65±0,38, respectively. Total mean sugar intake (% energy) represents 21,4%. No significant correlation was found between Na+ or K+ with SBP, HR, and the cardiometabolic biomarkers (p > 0.05). A positive correlation was found between % sugar intake and SBP (rs = 0,29, p < 0,05), which remains significant after adjusting for BMI, and a positive correlation, in the borderline of significance, with TAG (rs = 0,23, p = 0,0561). Conclusions N+, K+, and their ratio do not associate with SBP, HR and cardiometabolic biomarkers. However, % of sugar intake is positively associated with SBP. Key messages • Sodium and potassium may not always be associated with changes in blood pressure. • Sugar intake might have an important role in the etiopathology of hypertension.

Mechanical thrombectomy is associated with worse outcomes in infective endocarditis: a retrospective cohort study

Abstract Background Acute Ischaemic stroke (AIS) is a common complication in infective endocarditis (IE) and associated is with high mortality. There is a paucity of data evaluating mechanical thrombectomy (MT) in patients with AIS secondary to IE. Our retrospective cohort study aimed to quantify the efficacy and safety of MT in this patient population. Methods The National Inpatient Sample (NIS) was utilised. We obtained data from 2004 – 2019. We included all patients who had AIS and IE. We excluded patients who received thrombolysis. Those who received mechanical thrombectomy were compared to those who did not. Odds ratios were calculated using logistic regressions. We adjusted for multiple confounders. Outcomes included inpatient mortality, long length of stay (> 4 days), discharge status (normal vs ‘other’) and intracranial haemorrhage. Results The sample population consisted of 22,6390 patients (mean age 69, 52.3% female). ME was performed on 496 (2.2%). Patients with IE who received MT had a greater odds of death compared to those who did not (OR 1.91 95% CI 1.00 – 3.67). In addition, they had a greater odds of intracranial bleeding (OR 4.47 95% CI 2.78 – 7.20). Length of stay and neurological outcome did the significantly differ. We performed a sub-analysis, which included patients who had received thrombolysis in addition to MT. This did not modify the results for mortality and intracranial bleeding outcomes. Conclusion Mechanical thrombectomy was associated with increased mortality and intracranial bleeding in patients who have AIS associated with IE. While acknowledging the limitations of observational data, we therefore advise caution when considering mechanical thrombectomy in this patient population.

Engineering Academics and Students’ Views on the Phases of Teaching and Learning of Engineering Mathematics in an Antenna Design Course

An antenna design course, naturally, aims to teach students to produce an antenna device, which is a vital tool in technological development. Typically, this course is taught and designed in an abstract manner, which may be an inappropriate approach to teaching it. This approach could be due to engineering academics and students’ poor understanding of how to model mathematics concepts. As a result, antennae experts suggest that antenna technology is a difficult device when it comes to mathematical descriptions, which has resulted in a sudden loss of interest among students in a school of engineering. Thus, this paper reports on the four phases of teaching antenna design using mathematical modelling approaches, with the specific aim of resolving the difficulties encountered in teaching an antenna design course. In achieving this teaching, the study explains the approaches and impact of teaching Mathematical Modelling (MM) in antenna design among engineering academics. In this study, the sample population included one engineering academic and four engineering students. The data were collected using a qualitative research approach, utilising an interview guide and an open-ended questionnaire. Finally, the results of this study confirmed the four major phases of teaching antenna design using engineering mathematics.

Validation of the Warwick-Edinburgh Mental Well-Being Scale for the Mental Health Surveillance (MHS) of German adults

BackgroundMental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany.MethodsUsing data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18–79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity.ResultsMeans of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups.ConclusionsBoth versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health.

Testing the psychometric characteristics of EQ-5D-5L and respiratory bolt-ons using a sample of the Australian population.

The EQ-5D has been used to assess health related quality of life (HRQoL) in respiratory conditions. However, the core descriptive system may not be sensitive to all the HRQoL impacts of these conditions. To increase the sensitivity of the descriptive system, two respiratory specific bolt-ons, have been developed. Psychometric assessment of the bolt-ons in comparison to other validated instruments is required to facilitate their use. Therefore, the aim of this study is to test the psychometric characteristics of the EQ-5D-5L + R using a large dataset collected in Australia. A cross-sectional online survey was used to recruit adult respondents (≥ 18 years) representative of the Australian population. Descriptive and psychometric analyses were used to understand the performance of the EQ-5D-5L and bolt-ons in comparison to other validated instruments. The construct validity was estimated using correlations. Known-group validity was tested to determine the sensitivity of the instruments to differences across different severity groups. Overall 10,033 respondents (52% female) completed the survey, of which 300 had a respiratory condition. There were moderate to high correlation between bolt-ons with EQ-5D-5L and WHODAS. The EQ-5D-5L + bolt-ons slightly reduced the ceiling effect in comparison to the EQ-5D-5L. The effect size was larger for people with respiratory conditions than people who did not have a respiratory condition. The results show that adding the respiratory bolt-on to the EQ-5D-5L might slightly improve the instruments descriptive sensitivity. The choice of bolt-on may be driven by whether overall problems or limitations are being measured.

The association between aberrant salience and psychotic experiences in general population twins, and genetic vulnerability as a modifier

BackgroundPrevious studies assessing the hypothesis that the construct of ‘aberrant salience’ is associated with psychosis and psychotic symptoms showed conflicting results. For this reason, the association between measures to index aberrant salience and subclinical psychotic symptoms in a general population sample was analysed. In addition, genetic vulnerability was added to the analysis as a modifier to test the hypothesis that modification by genetic vulnerability may explain variability in the results.MethodsThe TwinssCan project obtained data from general population twins (N = 887). CAPE (Community Assessment of Psychic Experience) scores were used to index psychotic experiences. Aberrant salience was assessed with white noise task and ambiguous situations task.ResultsMeasures of aberrant salience were not associated with psychotic experiences, nor was there evidence for an interaction with genetic predisposition in this association (Z = 1.08, p = 0.282).ConclusionsVarious studies including the present could not replicate the association between aberrant salience and psychotic experiences in general population samples. The conflicting findings might be explained by moderation by genetic vulnerability, but results are inconsistent. If there was evidence for a main effect or interaction, this was in the positive symptom scale only. On the other hand, the association was more robust in so-called ‘ultra-high risk’ patients and first episode psychosis patients. Thus, this association may represent a state-dependent association, present only at the more severe end of the psychosis spectrum.

The association between dietary polyphenol intake and the odds of metabolic syndrome

Oxidative stress plays a role in the pathophysiology of metabolic syndrome (MetS), and one of the most important features of polyphenols is their antioxidant properties. However, there is no universal consensus on the effectiveness of polyphenols in treating Mets. Therefore, the present study aimed to investigate the association between polyphenols and MetS in an Iranian sample. This cross-sectional study was conducted on an adult population sample from Shiraz, in southern Iran. MetS was calculated using the criteria of the Adult Treatment Panel III (ATP III), which defines MetS as the presence of three or more of the specified risk factors. A validated food frequency questionnaire (FFQ) was used to measure the participant’s food intake. The association between polyphenol intake and the odds on MetS and its components was assessed using logistic regression. In both univariate and multivariate models, the association between polyphenol intake and the risk of MetS was not significant. However, after adjusting for potential confounders in the multivariate model, each unit change in flavonol, flavanone and isoflavones intake was associated with a lower, higher, and higher odds of MetS, respectively (flavonols: odds ratio (OR) = 0.926, 95% confidence interval (CI) 0.891–0.963, P < 0.001—flavanones: OR = 1.007, 95% CI: 1.001–1.014, P = 0.034—isoflavones: OR = 4.920, 95% CI: 1.057–22.894, P = 0.042). Additionally, no significant association was found between polyphenol intake and the risk of MetS components. However, in the multivariate model, after adjusting for potential confounders, a significant association was observed between polyphenol intake and lower odds of high waist circumference (OR = 0.998, 95% CI: 0.996–0.999, P = 0.032). The present study did not reveal a significant association between overall polyphenol intake and the odds of MetS. However, certain subclasses of polyphenols appear to be associated with the likelihood of MetS and its components.

PB-MNSGA-II algorithm and its application for multi-objective optimization design of under-vehicle equipment

Structural damage caused to under-vehicle equipment under adverse working conditions affects the safe operation of high-speed electric multiple units (EMUs). To address the low optimization efficiency and take into account vibration fatigue in traditional under-vehicle equipment design, herein, a multi-objective optimization design method (PB-MNSGA-II) that combines particle swarm optimization-back propagation (PSO-BP) neural network and modified non-dominated sorting Genetic Algorithm II (MNSGA-II) was proposed. It can help engineers choose better equipment component thickness and achieve efficient and accurate design. First, MNSGA-II, the core content of PB-MNSGA-II, was proposed, which improved four aspects of NSGA-II: Latin hypercube sampling population initialization, adaptive crossover and mutation probability, mutation interference of Levy flight strategy, and optimal elite strategy. Then, zero-ductility transition (ZDT) series functions were employed to test MNSGA-II, thereby verifying its convergence and computational efficiency. Subsequently, utilizing the frame structure of the traction transformer (TTR) as an illustrative example, the PB-MNSGA-II approach was employed to enable multi-objective optimization. During this optimization process, the focus was on random vibration fatigue damage, thus enhancing the rationality of the optimization outcomes. After structural optimization, the mass of the TTR decreased by 20.1 kg, and the maximum vibration fatigue damage value decreased from 1.09 to 0.808, verifying the effectiveness and feasibility of the proposed method. The findings of this study provide important insights for the multi-objective optimization design of under-vehicle equipment under complex operating conditions.

Raman spectroscopy reveals oxidative stress-induced metabolic vulnerabilities in early-stage AR-negative prostate-cancer versus normal-prostate cell lines

Quantitative Raman spectroscopy provides information-rich imaging of complex tissues. To illustrate its ability to characterise early-stage disease, we compared live P4E6, a low-grade Gleason-3 prostate-cancer cell line, to PNT2-C2, a normal prostate cell-line equivalent, thereby elucidating key molecular and mechanistic differences. Spectral changes from statistically relevant population sampling show P4E6 is defined by reduced DNA/RNA signatures (primarily base-pair modifications), increased protein-related signatures (synthesis), decreased whole-cell measured saturated and unsaturated fatty acids, and increased cholesterol and cholesterol ester (lipid storage). Signatures in the live-cell disease state point to the Warburg effect for aerobic glycolysis as the mechanism for cellular energy generation. A follow-on study involving catastrophic desiccation showed a key survival pathway in the cancer state in the structural robustness of DNA/RNA. Metabolic changes, namely in Warburg-to-oxidative-phosphorylation rerouting and reduced protein synthesis, were also shown. Such modifications limit cancer’s resistance to oxidative damage, and thus its ability to utilise a higher redox homeostasis for metabolic advantage. The results demonstrate the ability of quantitative Raman spectroscopy to uncover, with full molecular-heterogeneity capture, mechanistic vulnerabilities in lowest-grade tumorigenic prostate cancer, thereby revealing underlying targets for disease disruption at early stage.

Cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitudes Examination (VAX-U) scale.

Martin and Petrie developed the Vaccine Attitudes Examination (VAX) scale with an aim to document general vaccination attitudes. Vaccine acceptance plays an important role in curbing COVID-19 infections. Thus, it was important to assess vaccination attitudes of Pakistani people towards novel COVID-19 vaccines. The VAX scale was not available in Urdu language for Pakistani population. The study aimed to carry out cross-cultural adaptation and validation of an Urdu version of the Vaccine Attitude Examination (VAX) scale in a selected population sample from Pakistan. A cross sectional study was conducted in September 2021 in an outpatient department of a healthcare facility in Karachi, Pakistan. Adult visitors, eligible for COVID-19 vaccine and spoke Urdu as first language were invited. Convenient sampling was used, and sample size was based on an item response ratio of 1:20. An Urdu version of the VAX scale was developed. The reliability was assessed using Cronbach's alpha (α) and intraclass correlation coefficient (ICC). The model fitness was evaluated using confirmatory factor analysis (CFA) and fit indices namely goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). A structural equation model (SEM) was also developed. IBM SPSS and AMOS were used to analyse the data. The study had ethical clearance. A total of 211 responses were analysed. The reliability (Cronbach's α) was 0.821. The ICC was 0.831 (95% CI: 0.795-0.863). CFA using a 4-factor model revealed the following values for fit indices; GFI = 0.944, AGFI = 0.909, TLI = 0.953, CFI = 0.966, and RMSEA = 0.051. All values reported were in the acceptable range. The VAX Urdu version is a reliable and valid instrument for use in an Urdu speaking population and will enable clinicians to assess the public's attitude towards general vaccination including COVID-19 vaccination. Clinicians can use the VAX-U to document a person's vaccine hesitancy and tailor their counselling to address the issues in vaccine uptake.

Prognostic impact of switching to the 2021 chronic kidney disease epidemiology collaboration creatinine-based equation in Caucasian patients with type 2 diabetes: the Renal Insufficiency and Cardiovascular events (RIACE) Italian Multicenter Study

BackgroundA Chronic Kidney Disease (CKD) Epidemiology Collaboration (EPI) formula not including a Black race coefficient has been recently developed and is now recommended in the US. The new (2021) equation was shown to yield higher estimated glomerular filtration rate (eGFR) values than the old (2009) one in a non-Black general population sample, thus reclassifying a significant number of individuals to a better eGFR category. However, reclassified individuals were previously shown to have a lower risk of progression to end-stage kidney disease, but higher adjusted risks for all-cause death and morbidity and mortality from cardiovascular disease than those not reclassified. This study evaluated the prognostic impact of switching from the 2009 to the 2021 CKD-EPI equation in non-Black individuals with type 2 diabetes.MethodsThe Renal Insufficiency And Cardiovascular Events (RIACE) was a prospective cohort study enrolling 15,773 Caucasian patients in 19 Italian centers in 2006–2008. Cardiometabolic risk profile, treatments, complications, and comorbidities were assessed at baseline and eGFR was calculated with the two equations. Vital status was retrieved on 31 October 2015 for 15,656 participants (99.3%).ResultsWith the 2021 equation, the eGFR value increased in all patients, except for 293 individuals with a 2009 eGFR ≥ 105 ml·min− 1·1.73 m− 2. The median difference was 4.10 ml·min− 1·1.73 m− 2 and was higher in males, older individuals and those in the G2 category. Reclassification decreased the percentage of patients with reduced eGFR from 17.28 to 13.96% and with any CKD from 36.23 to 34.03%. Reclassified individuals had better cardiometabolic risk profile and lower prevalence of complications and use of medications than non-reclassified individuals. Risk of death versus the 2009 G1 category was lower for reclassified than non-reclassified participants in all eGFR categories and, particularly, in each 2009 eGFR category, though difference was significant only in the G4-G5 category. The Receiver Operator Characteristic curves were statistically, but not clinically different with the two equations.ConclusionChanging from the 2009 to the 2021 CKD-EPI equation results in higher eGFR and lower CKD prevalence, with a lower risk of death in reclassified patients with an eGFR < 30 ml·min− 1·1.73 m− 2, but virtually no impact on mortality prediction.Trial registration: ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

73 Predictors of neurodevelopmental impairment in extreme preterm infants with unremarkable cranial ultrasound: A Canadian population-based cohort

Abstract Background Extreme preterm infants are at high-risk of brain injury and neurodevelopmental impairment (NDI). Previous studies reported significant NDI (sNDI) in preterm infants with no abnormalities on routine cranial ultrasound screening (CUS), traditionally perceived to have favorable outcomes. Recent data from population-based outlining clinical predictors of sNDI in those infants are lacking. Objectives (1) to describe the incidence, perinatal and neonatal characteristics of NDI and sNDI in a large population-based cohort of extreme preterm infants with unremarkable CUS; (2) to develop a prediction model of sNDI (any of: CP ≥ GMFCS stage 3, Bayley III &amp;lt; 70 in any domain, deafness requiring aids, or bilateral blindness) in those infants. Design/Methods A retrospective review of a national cohort of preterm infants born at &amp;lt;29 weeks’ gestation between April 2009 and December 2018. We included surviving infants with unremarkable routine CUS (no hemorrhage, periventricular leukomalacia or ventricular dilatation) who had neurodevelopmental assessment at 18-24 month corrected age at one of participating centres in the Canadian Neonatal Follow Up Network. We compared the baseline characteristics between infants with no NDI and those with any NDI and sNDI. The population sample was then randomly split into training and testing datasets in 70:30 ratio for prediction model’s development and validation, respectively. Multivariate logistic regression with GEE accounting for clustering within site was used, adjusted for variables with p-value&amp;lt;0.1 using backward selection procedure. The AUC and the diagnostic properties of the model developed using training dataset was then validated in the testing dataset. Results Out of 7463 eligible infants, 4327 (58%) were included. Of those, 2501 (59%) had no NDI and 1736 (41%) had NDI. sNDI accounted for 14% of the cohort and one third of those with NDI. Perinatal and neonatal characteristics of the three groups are shown in Table 1. On internal validation, maternal hypertension, maternal level of education, gestational age, male sex, ROP≥ stage 3 and systemic steroids were predictive of sNDI (Table 2). The prediction model had Sensitivity 0.91, NPV 0.90, and AUC 0.69 (95% CI 0.64-0.73). Conclusion In this national cohort, 2 out of 5 extreme preterm infants with unremarkable CUS had NDI and 1 in 7 had sNDI. The developed prediction model had high sensitivity and NPV, but poor discrimination. The findings of this study can help clinicians to identify at-risk infants who may benefit from early targeted interventions.

Effect of classical prolotherapy technique in knee osteoarthritis for a sample of Egyptian population: clinical and imaging study

BackgroundKnee osteoarthritis (KOA) is a progressive musculoskeletal disease that leads to physical impairment and disability. Several nonoperative therapeutic options have been proposed to reduce symptoms, improve physical function, and prevent disability. One of these therapeutic options is dextrose prolotherapy (DPT). The current study aimed to investigate the efficacy of DPT in the treatment of symptomatic KOA and to evaluate its potential proliferative role as assessed by musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI).ResultsSeventeen knees (21.25%) dropped out, leaving 63 knees in the final analysis (57 females and 6 males, aged 41–74 years) with KOA. At 24-week follow-up, the visual analogue scale and overall Western Ontario and McMaster Universities scores showed significant improvement (P < 0.001). Moreover, a highly significant increase in cartilage thickness with a decrease in effusion grade and meniscal extrusion was observed by MSUS (P < 0.001). By MRI, there was a statistically significant decrease in effusion grade (P = 0.013) and meniscal extrusion (P = 0.005) and a highly significant increase in cartilage thickness (P < 0.001). Logistic analysis showed that lower patients’ body mass index (BMI) at baseline was a significant predictor for clinical improvement following DPT.ConclusionDPT might be considered a relatively safe minimally invasive intervention for the treatment of KOA with high adherence and satisfaction. It may lead to significant clinical and structural improvement in patients with KOA. Furthermore, lower BMI is a predicting factor for better clinical response to DPT.Trial registrationThe study was registered prospectively in ClinicalTrials.gov: clinical trial registration number NCT04178304 on 21 November 2019, https://register.clinicaltrials.gov/XXX.

The Prevalence of Polycystic Ovary Syndrome and Fibromyalgia in Women with Borderline Personality Disorder and Their Association with Childhood Abuse

Childhood abuse is a significant factor in the development of borderline personality disorder (BPD) and many physical health disorders, including polycystic ovary syndrome (PCOS) and fibromyalgia. This study aimed to examine the prevalence of PCOS and fibromyalgia in women with BPD compared to the general population. Additionally, it compared the prevalence of these conditions in women who experienced different types of childhood abuse (emotional, physical, or sexual). Participants were identified from the Multidisciplinary Alfred Psychiatry research centre’s Women’s Mental Health Clinic database, including 150 women diagnosed with BPD. Clinicians collected information on PCOS, fibromyalgia, and trauma history. Results showed higher rates of PCOS (17.3%) and fibromyalgia (8.7%) in women with BPD compared to general population samples. Emotional abuse was associated with the highest PCOS prevalence (22.8%), while co-occurring physical, sexual, and emotional abuse was linked to the highest fibromyalgia prevalence. These findings highlight the significant prevalence of PCOS and fibromyalgia in women with BPD and their association with childhood abuse.

MIGRATION RISK OF DEVELOPING PSYCHOSOMATIC DISORDERS IN SOCIALLY PROSPEROUS YOUNG PEOPLE WITH INCREASED NEUROPSYCHIC AND INTELLECTUAL LOAD

RELEVANCE: The relevance of the study is due to the lack of systematic data on the cause-and-effect relationships between the territorial remoteness of the initial and final settlements when changing place of residence with the risk of developing psychosomatic disorders in a person with increased neuropsychic and intellectual stress. AIM: To develop an integrative indicator of the risk of developing psychosomatic disorders in young people when changing their place of residence. MATERIAL AND METHODS: The study involved students of the Volgograd State Medical University, 97 men and 99 women aged 18-22 years. Nonresident respondents accounted for 44% (45 people) of the sample population of men and 60% (61 people) of the sample population of women. The cross-sectional study was carried out in June 2023, during the spring session, 9 months after the start of university studies, and, accordingly, from the moment nonresident students changed their place of residence. The level of systemic maladjustment of respondents was assessed using the I.N. Gurvich test. The indicators of the Giessen Somatic Complaints Questionnaire and indicators of anxiety-depressive disorders (HADS scale) were taken into account, and the presence of suicidal ideation was determined - according to the suicidal ideation module of the Columbia Suicidal Severity Scale (C-SSRS). The distances (km) between the initial and final settlements of the respondents’ place of residence were calculated. RESULTS: A systemic direct statistically significant relationship was identified between the severity of psychosomatic disorders and the distance of migration movement of young people from the place of previous residence to the final point of residence. Four degrees of migration risk have been identified with zero (up to 20 km) and subsequent three (up to 400, up to 800 and over 800 km) territorial ranges of somatization risk. The control critical values of the migration risk indicator for the development of psychosomatic disorders for men and women were calculated, determining that the migration risk of somatization in young people occurs when the territorial distance of the place of residence from the place of previous residence is 400 km or more. CONCLUSION: The connections between the territorial remoteness of the initial and final settlements when changing place of residence, with the risk of developing psychosomatic disorders in a person under conditions of an intense educational process, are characterized.

Knowledge and Perspective regarding Adolescent Sexual and Reproductive Health Among Adolescents in Selected Schools of Birendranagar Mucinipality of Surkhet, Karnali Province

Introduction: Adolescence is the period of transition and opportunity in which physical, psychological, and social changes occur. Adolescents have various sexual and reproductive health problems like teenage pregnancy, abortions, sexually transmitted infections, etc. This study was designed to investigate the adolescence’s knowledge and perspective towards sexual and reproductive health in Birendranagar Municipality of Surkhet, Nepal. Methods: A descriptive cross-sectional study was designed to investigate the adolescence’s knowledge and perspective towards sexual and reproductive health in Birendranagar Municipality of Surkhet, Nepal. Structured questionnaires were developed in close-ended form and administered to a selected sample population. The questionnaire contained questions in five domains: social-demographic data, knowledge regarding adolescents’ sexual life, knowledge on reproductive health and safe sexual behavior, practices of sexual behaviors, and other contextual factors. In this study, a total of 328 respondent’s questionnaires were issued, and 312 were valid. The response rate was 95%. Results: There were a total of 312 participants, 174 boys, 137 girls, and 1 third gender involved in the study. Around 80% of adolescents were from secondary level education, and only 20% were from basic level education. Nearly half of the adolescents had inadequate knowledge of adolescents’s sexual and reproductive health. Sexual abuse, unwanted pregnancy, early marriage, and STIs were the common reproductive health problems faced by adolescents. Conclusion: So, based on the above findings, government of Nepal should make different plans and policies to solve the adolescent’s sexual and reproductive health problems.

Intergovernmental Relations and the Financial Resource Allocation for the Healthcare Sector in Nairobi City County, Kenya

Since the beginning of devolution of health sector in Kenya in 2013, there have been several concerns regarding heath care service delivery ineffectiveness, which have been attributed to strained ties between the national and county governments. There have been issues with service delivery and medical supply shortages in Nairobi City County's healthcare sector. This study sought to investigate how intergovernmental interactions have affected healthcare in in Nairobi City County. Specifically, the study examined how intergovernmental relations affect the financial allocation for the sector. The study was anchored on resource-based theory. A descriptive research design was employed involving a census for all the 7 administrators working at level 4 and level 5 health facilities in Nairobi City County as well as 78 employees working in the health department of Nairobi City County Government, constituted the sample population. Descriptive analysis was done using the standard deviation and the mean while inferential analysis was done using regression, F-test and ANOVA. The analyzed data was provided as frequency tables, percentages, and charts. Before the data collection, respondents were asked to provide informed consent, and anonymity and secrecy were assured to boost the response rate. The most critical relationship was between intergovernmental relations and financial resource allocation for the healthcare sector in Nairobi City County accounting to 39.4%. The findings suggested that in order to guarantee that financial resources are allocated appropriately, the national and the county government should work to enhance intergovernmental ties. This also helps in ensuring timely release of financial resources to health facilities by the national government. The study recommends that the financial allocation for healthcare should be enhanced so as to improve service delivery. There is also need to enhance own source revenue for the City County so as supplement the shareable revenue from the national government, which collectively will increase the finances available for utilisation in the healthcare sector