Self-reported Diagnosis Research Articles

"Broken fragments or a breathtaking mosaic": A mixed methods study of self-reported attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions.

Siblings of individuals with neurodevelopmental conditions (NDCs) experience distinct challenges and have unique strengths compared to siblings of individuals without NDCs. The present study examined attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions, and analyzed the association between qualitative responses and quantitative measures of growth mindset, positive and negative valence, and mental health diagnoses. A novel mixed methods thematic analysis was employed to explore the experiences of 166 siblings (75 NDC and 91 controls, aged 14-26, 66.27% female) completing an online survey as part of a larger study on sibling mental health. The overarching theme described The Process of Self-Actualization and Integration, reflecting the journey siblings undergo in seeking to understand themselves and others amidst psychological challenges. It encompassed three subthemes: Personal Growth and Identity Formation; Connection and Belonginess; and Societal Perspective and Global Consciousness. Qualitative responses were analyzed within a Research Domain Criteria (RDoC) framework, and associations between phenomenology and mental health diagnoses examined. NDC siblings had higher negative valence and lower positive valence embedded in their responses, and quantitatively lower self-reported growth mindset (i.e., beliefs about the capacity for personal growth), compared to control siblings, which correlated with self-reported mental health diagnoses. Findings suggest clinical practice may focus on optimizing self-identified strengths and offer opportunities for self-actualization of hopes and ambitions, while providing support for families to attenuate bioecological factors impacting mental health.

Obesity, psychological well-being related measures, and risk of seven non-communicable diseases: evidence from longitudinal studies of UK and US older adults

BackgroundWe examined the role of psychological well-being related measures in explaining the associations between obesity and increased risk of non-communicable diseases (NCDs: hypertension, heart disease, stroke, diabetes, arthritis, cancer, and memory-related disease) in older adults.MethodsData were from the English Longitudinal Study of Ageing (ELSA), UK (baseline: Wave 4—2008/2009; n = 8127) and the Health and Retirement Study (HRS), US (baseline: Waves 9 and 10—2008/2010; n = 12,477). Objective body mass index was used to define obesity. A range of psychological well-being related measures (e.g., depressive symptoms, life satisfaction) was available in ELSA (n = 7) and HRS (n = 15), and an index of overall psychological well-being was developed separately in each study. NCDs were from a self-reported doctor diagnosis and/or other assessments (e.g., biomarker data) in both studies; and in ELSA, NCDs from linked hospital admissions data were examined. Longitudinal associations between obesity status, psychological well-being measures, and NCDs were examined using Cox proportional hazard models (individual NCDs) and Poisson regression (a cumulative number of NCDs). Mediation by psychological well-being related measures was assessed using causal mediation analysis.ResultsObesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Worse overall psychological well-being (index measure) and some individual psychological well-being related measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of overall psychological well-being nor any individual psychological well-being related measures explained (mediated) why obesity increased the risk of developing NCDs in both studies.ConclusionObesity and psychological well-being may independently and additively increase the risk of developing NCDs.

Sleep duration and the risk of new-onset arthritis in middle-aged and older adult population: results from prospective cohort study in China.

The pain and sleep disorders caused by arthritis are health issues that have been re-emphasized with the aging population. However, the majority of research on arthritis and sleep disorders has focused on cases that have already been diagnosed with arthritis. This research aims to explore the correlation between sleep duration and new-onset arthritis in middle-aged and older adult individuals. Utilizing data from the China Health and Retirement Longitudinal Study from baseline (2011) to the Wave 3 follow-up (2018), we conducted a 7-year longitudinal investigation targeting populations with valid sleep questionnaire records and without arthritis. Sleep duration was assessed from nighttime sleep and daytime nap records. The new-onset of arthritis was determined based on self-reported diagnosis. We employed different logistic regression models to consider the potential impact of sleep duration on arthritis and conducted mediation analyses to assess the involvement of BMI in the association between sleep duration and the new-onset risk of arthritis. Out of the 6,597 individuals analyzed in the cohort, 586 (8.9%) were diagnosed with new-onset arthritis. Median sleep duration was notably shorter in the new-onset arthritis group (6.63 vs. 6.41 h, p < 0.05). There was a notable negative correlation found between new-onset risk of arthritis and sleep duration, with each Interquartile Range (IQR) increment in sleep leading to a 16% risk reduction (OR: 0.864; 95% CI: 0.784-0.954). Stratified analyses revealed BMI as a potential modifier in the sleep-arthritis relationship (P for interaction = 0.05). Mediation analyses further showed that about 3.5% of the association was mediated by BMI. Additionally, the inclusion of sleep duration improved the arthritis predictive power of our model, with an IDI of 0.105 (0.0203, 0.1898) and an NRI of 0.0013 (0.0004, 0.0022) after adding sleep duration to the basic model. In the middle-aged and older adult demographic of China, increased sleep duration is associated with a decreased new-onset risk of arthritis, with BMI potentially playing a role in mediating this connection.

Relations Between Social Camouflaging, Life Satisfaction, and Depression Among Polish Women with ADHD.

This study investigated the relationship between social camouflaging, life satisfaction, and depression symptoms in Polish women with ADHD. It aimed to fill a research gap in understanding ADHD manifestations in women, particularly focusing on social camouflaging-a concept known in autism, referring to strategies used to mask symptoms in social interactions. A total of 329 women with ADHD took part in an online survey. The survey measured ADHD symptoms using the ADHD Self Report Scale (ASRS-vI.I), life satisfaction with the Satisfaction With Life Scale (SWLS), and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Additionally, a novel set of questions, inspired by the Camouflaging Autistic Traits Questionnaire (CAT-Q) but tailored for ADHD, was utilized to assess social camouflaging. Results indicated a significant negative association between social camouflaging and life satisfaction and a positive correlation with depressive symptoms, even after controlling for demographic variables. Additionally, factors like being in a relationship and having a positive subjective financial situation correlated with higher well-being. Reliance on self-report measures, the cross-sectional design, and participants' self-reported ADHD diagnosis are the main limitations of the study. The research underscores the importance of social camouflaging in understanding ADHD in women, suggesting that efforts to mask symptoms and meet societal expectations may link to lower life satisfaction and increased depressive symptoms. These findings advocate for continued research into these dynamics to develop more effective support for women with ADHD.

The risk of asthma in singletons conceived by ART: a retrospective cohort study.

Do singleton children conceived by ART have a higher asthma risk than naturally conceived (NC) singletons? The asthma risk was similar for ART-conceived singletons and NC singletons, and there were no clear differences between the various types of ART. Whether ART increases asthma risk in offspring is questionable. The evidence is inconsistent and limited by ethnicity, geographic distribution, inadequate confounder adjustment, unsatisfactory control groups, and specific methods of ART. Furthermore, the mediating effects of obstetric and neonatal outcomes on the association between ART and asthma remain unclear. This observational, single-centre study was conducted at a reproductive centre of an affiliated university hospital between September 2009 and April 2023. A total of 3227 singletons aged 3-6 years conceived by IVF versus ICSI or fresh versus frozen embryo transfer were retrospectively enrolled, and a total of 1206 NC singletons of the same age were subsequently recruited. Asthma was defined as a self-reported physician diagnosis or wheezing in the past 12 months. We performed multivariable logistic regression analyses to examine associations between asthma in offspring and ART use, adjusting for parental characteristics (age, education level, occupation type, BMI, asthma), smoking exposure, residence type, child sex, child age, and year of follow-up. Mediating effects were explored using longitudinal mediation structural equation modelling. Asthma was reported for 51 (4.2%) of the 1206 NC singletons (median [interquartile range] age 5 [4-5] years; 48.1% females) and 169 (5.2%) of the 3227 ART-conceived singletons (5 [5-5] years; 47.6% females). We found that risks of childhood asthma in singletons conceived by ART were, overall, similar to those of NC singletons before (odds ratio [OR], 1.25 [95% CI, 0.92-1.74]; P = 0.170) and after adjustment (adjusted OR [aOR], 0.66 [95% CI, 0.44-1.03]; P = 0.126). The results were similar in multiple sensitivity analyses, and there were no clear differences in asthma risks according to the method of ART. Mediation analysis revealed a significant positive indirect effect of neonatal intensive care unit (NICU) admission (standard path coefficient, b = 0.025, P < 0.05) and a negative indirect effect of breastfeeding (b = -0.012, P < 0.05) on the association between ART and asthma in singleton offspring. This study is limited to singletons only and cannot be generalized. The study is also limited by its retrospective observational single-centre nature and sample size. Mediation analyses were exploratory. Therefore, the findings need to be interpreted with caution. These findings can help infertile couples undergoing ART be reassured about the risk of childhood asthma in singleton offspring. Breastfeeding is recommended as a potentially feasible intervention to reduce the asthma risks in ART-conceived children who are at increased potential risk of asthma, such as those with NICU admissions. This work was supported by the Key Research and Development Program of Zhejiang Province (2021C03100), the National Key Research and Development Program of China (2021YFC2700603), and the Program for Key Subjects of Zhejiang Province in Medicine and Hygiene to Y. Z., the Zhejiang Province Natural Science Foundation (No. LQ22H040006) and the National Natural Science Foundation of China (No.82101759) to M.T., and the National Natural Science Foundation of China (No. 82201860) to J.Y. The authors declare no competing interests. ChiCTR2300069906.

Machine learning identifies factors most associated with seeking medical care for migraine: Results of the OVERCOME (US) study.

Utilize machine learning models to identify factors associated with seeking medical care for migraine. Migraine is a leading cause of disability worldwide, yet many people with migraine do not seek medical care. The web-based survey, ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (US), annually recruited demographically representative samples of the US adult population (2018-2020). Respondents with active migraine were identified via a validated diagnostic questionnaire and/or a self-reported medical diagnosis of migraine, and were then asked if they had consulted a healthcare professional for their headaches in the previous 12 months (i.e., "seeking care"). This included in-person/telephone/or e-visit at Primary Care, Specialty Care, or Emergency/Urgent Care locations. Supervised machine learning (Random Forest) and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms identified 13/54 sociodemographic and clinical factors most associated with seeking medical care for migraine. Random Forest models complex relationships (including interactions) between predictor variables and a response. LASSO is also an efficient feature selection algorithm. Linear models were used to determine the multivariable association of those factors with seeking care. Among 61,826 persons with migraine, the mean age was 41.7 years (±14.8) and 31,529/61,826 (51.0%) sought medical care for migraine in the previous 12 months. Of those seeking care for migraine, 23,106/31,529 (73.3%) were female, 21,320/31,529 (67.6%) were White, and 28,030/31,529 (88.9%) had health insurance. Severe interictal burden (assessed via the Migraine Interictal Burden Scale-4, MIBS-4) occurred in 52.8% (16,657/31,529) of those seeking care and in 23.1% (6991/30,297) of those not seeking care; similar patterns were observed for severe migraine-related disability (assessed via the Migraine Disability Assessment Scale, MIDAS) (36.7% [11,561/31,529] vs. 14.6% [4434/30,297]) and severe ictal cutaneous allodynia (assessed via the Allodynia Symptom Checklist, ASC-12) (21.0% [6614/31,529] vs. 7.4% [2230/30,297]). Severe interictal burden (vs. none, OR 2.64, 95% CI [2.5, 2.8]); severe migraine-related disability (vs. little/none, OR 2.2, 95% CI [2.0, 2.3]); and severe ictal allodynia (vs. none, OR 1.7, 95% CI [1.6, 1.8]) were strongly associated with seeking care for migraine. Seeking medical care for migraine is associated with higher interictal burden, disability, and allodynia. These findings could support interventions to promote care-seeking among people with migraine, encourage assessment of these factors during consultation, and prioritize these domains in selecting treatments and measuring their benefits.

Characterising paroxysmal supraventricular tachycardia episodes by patient-perceived episode duration, symptoms, and severity: longitudinal patient-reported outcomes

Abstract Background/Information Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythms that are often associated with clinical symptoms. The duration and symptoms a patient experiences during a PSVT episode are variable. The impact of episode duration and symptom type on a patient’s perceived severity of an episode of PSVT has not been well defined. Purpose To characterise the relationship between duration, symptom type, and patient-perceived episode severity in a longitudinal study of patient-reported outcomes in the US and UK. Methods The survey included patients &amp;gt;18 years of age with a self-reported diagnosis of PSVT, without a history of ablation. Surveys included a 30-minute baseline survey (Mar 2019), 5-minute weekly tracking surveys (Mar 2019 to Dec 2019), and a 15-minute closing survey (Dec 2019). Patients were asked during the baseline survey to rate the severity of their PSVT (mild/moderate/severe). Weekly episode surveys assessed patient-reported episode duration, symptoms, severity, and interventions. If multiple episodes occurred, characteristics of the most recent episode were assessed. Results Among 117,252 patients screened, 368 met the inclusion criteria and completed the baseline survey, while 247 patients in the final cohort met the quality control checks. Most patients were White (92%), female (70%), and from the US (80%) and had a mean age of 52 years. At baseline, 47% of patients described their PSVT as moderate severity, while 39% reported mild and 14% reported severe. Overall, 5277 longitudinal weekly surveys were completed, of which 48% captured a PSVT episode (n=2518). Median reported duration of an episode was 15 minutes, with severe episodes having numerically longer duration (71 minutes) than moderate (20 minutes) or mild (6 minutes) episodes. Among severe episodes, 57% lasted 1 hour or longer; only 9% of mild episodes lasted 1 hour or longer (Figure 1). Among all assessed episodes of PSVT, 89% had palpitations, 35% shortness of breath, 26% dizziness, and 17% chest pain; mean number of symptoms per episode was 3.1, while numerically more symptoms were reported with severe episodes (mean 6.0) than with moderate (mean 3.5) or mild (mean 2.1) episodes. Shortness of breath was more frequently reported with severe episodes (81%) than with moderate (43%) or mild (17%) episodes. Similar findings were seen with dizziness and chest pain (Figure 2). Overall, approximately half of the reported episodes during follow-up were classified as moderate severity (47%), followed by mild (44%) and severe (9%). Conclusions Episodes of PSVT of longer duration and/or accompanied by a greater number of symptoms are reported by patients to be more severe. However, heterogeneity of symptoms and episode duration is substantial within a given classification of PSVT severity. Additional studies are needed to better understand how the optimal treatment of patients with PSVT may vary by duration, symptoms, and severity.

Exploring the retrospective and prospective associations between the big five personality traits and clinical diagnosis of angina in middle-aged and older adults

ObjectiveThe goal of the present research was to test the retrospective and prospective associations between the Big Five personality traits and clinical diagnosis of angina while controlling for demographic characteristics. MethodsData from middle-aged and older adults from a cohort study Understanding Society: the UK Household Longitudinal Study (UKHLS) were extracted and analyzed using binary logistic regressions (N = 10,124 for the retrospective study and N = 5485 for the prospective study). Personality was measured using a self-report 15-item version of the Big Five inventory between 2011 and 2012. Angina was measured by a self-report clinical diagnosis history question in each wave from until 2019. Covariates in our models included age, sex, income (monthly), education, and marital status. ResultsNeuroticism was positively related to the likelihood of clinical angina diagnosis in both the retrospective (OR = 1.22, 95% C.I. [1.11, 1.34]) and the prospective (OR = 1.52, 95% C.I. [1.19, 1.94]) study whereas Extraversion had a positive association with odds of angina (OR = 1.52, 95% C.I. [1.17, 1.97]) in the prospective study only. The negative association between Openness and clinical angina diagnosis in the cross-sectional analysis is borderline significant (OR = 0.91, p = 0.048, 95% C.I. [0.83, 1.00]). ConclusionOur research indicated that personality traits are associated with the risk of angina. These findings emphasize the importance of considering personality traits in understanding the etiology of angina and potentially informing personalized prevention and intervention strategies.

The relationship between low prolactin and type 2 diabetes.

Prolactin (PRL) is secreted throughout life in men and women. At elevated levels, its physiological role in pregnancy and lactation, and pathological effects, are well known. However clinical implications of low circulating PRL are not well established. We conducted a meta-analysis to examine the relationship between low PRL levels and type 2 diabetes. Five papers included cross-sectional studies comprising 8,720 men (mean age range 51.4-60years) and 3,429 women (49.5-61.6years), and four papers included cohort studies comprising 2,948 men (52.1-60.0years) and 3,203 women (49.2-60.1years). Individuals with pregnancy, lactation and hyperprolactinemia, drugs known to alter circulating PRL levels, or pituitary diseases had been excluded. Although most studies used quartiles to categorize PRL groups for analysis, PRL cut-off values (all measured by chemiluminescence immunoassay) were variably defined between studies: the lowest PRL quartiles ranged from 3.6ng/ml to 7.2ng/ml in men and between 4.5ng/ml to 8ng/ml in women; and the highest PRL quartiles ranged from 6.9ng/ml to 13ng/ml in men and 9.6ng/ml to 15.8ng/ml in women. Type 2 diabetes was defined variably using self-reported physician's diagnosis, fasting blood glucose, oral glucose tolerance test or glycated hemoglobin (HbA1C). In cross-sectional studies, compared to individuals in the highest PRL groups (reference), those in the lowest PRL groups had greater risk of type 2 diabetes both in men: odds ratio (OR) and 95% confidence interval = 1.86 (1.56-2.22) and in women: OR = 2.15 (1.63-2.85). In cohort studies, women showed a significant association between low PRL and type 2 diabetes: OR = 1.52 (1.02-2.28) but not men: OR = 1.44 (0.46-4.57). Relatively low heterogeneity was observed (I2 = 25-38.4%) for cross-sectional studies, but higher for cohort studies (I2 = 52.8-79.7%). In conclusion, low PRL is associated with type 2 diabetes, but discrepancy between men and women in the relationship within cohort studies requires further research.

Comparison of Sleep Apnea Questionnaires and Reported Diagnosis in Neurological Disorders of Aging.

Obstructive sleep apnea (OSA) is associated with worse outcomes in stroke, Alzheimer's disease (AD) and Parkinson's disease (PD), but diagnosis is challenging in these groups. We aimed to compare the prevalence of high risk of OSA based on commonly used questionnaires and self-reported OSA diagnosis: 1. within groups with stroke, AD, PD and the general population (GP); 2. Between neurological groups and GP. Individuals with stroke, PD and AD were identified in the Canadian Longitudinal Study of Aging (CLSA) by survey. STOP, STOP-BAG, STOP-B28 and GOAL screening tools and OSA self-report were compared by the Chi-squared test. Logistic regression was used to compare high risk/self-report of OSA, in neurological conditions vs. GP, adjusted for confounders. We studied 30,097 participants with mean age of 62.3 years (SD 10.3) (stroke n = 1791; PD n = 175; AD n = 125). In all groups, a positive GOAL was the most prevalent, while positive STOP was least prevalent among questionnaires. Significant variations in high-risk OSA were observed between different questionnaires across all groups. Under 1.5% of individuals self-reported OSA. While all questionnaires suggested a higher prevalence of OSA in stroke than the GP, for PD and AD, there was heterogeneity depending on questionnaire. The wide range of prevalences of high risk of OSA resulting from commonly used screening tools underscores the importance of validating them in older adults with neurological disorders. OSA was self-reported in disproportionately small numbers across groups, suggesting that OSA is underdiagnosed in older adults or underreported by patients, which is concerning given its increasingly recognized impact on brain health.

Abstract A017: Patient-reported experience related to aspects of quality of life after cystectomy from an exploratory focus group

Abstract Purpose: These exploratory focus groups examined patient experiences after having a cystectomy following bladder cancer. Methods: US individuals aged &amp;gt;50 years with self-reported diagnosis of non-muscle invasive bladder cancer (NMIBC) or muscle invasive bladder cancer (MIBC) who had undergone partial or radical cystectomy were recruited through a Patient Engagement Research Council program and invited to participate in an exploratory focus group (October 2022). Patients completed a prework survey on initial diagnosis, treatments, and how aspects of their life changed over time from pre-diagnosis, around the time of decision to undergo cystectomy, 90 days after cystectomy, and at present day. Patients attended gender-specific focus group sessions to discuss their patient journey, support needs, and how having a cystectomy affected their lives. Discussions were facilitated by a gender-matched moderator using a semi-structured discussion guide. Patients provided written informed consent and were compensated for their time. Key themes were identified by coding of audio transcripts and direct observations via the qualitative research analysis software MAXQDA. Results: Patients were six White adults (female n=3, male n=3, median age 68 years) with NMIBC (n=2) or MIBC (n=4) who underwent radical cystectomy between 2000 and 2020. Patients reported that bladder-sparing approaches were rarely introduced or discussed by their care team during their diagnostic journey, instead identifying disease eradication and pain improvement as primary drivers for choosing cystectomy. In the first 90 days post-surgery, patients reported that cystectomy negatively affected their ability to perform daily activities, mental health, and physical intimacy while adapting to a “new normal,” citing challenges with urinary diversion routes. Female patients cited a general lack of female-centric support (e.g. feminine hygiene and care education) as their support groups were mostly comprised of male patients focusing on male-centric issues (e.g., erectile dysfunction). In the present day, patients reported lower sex drive, satisfaction with body image, and physical intimacy. Patients called for more privacy consideration during medical examinations, better ostomy care support, increased awareness among healthcare professionals about the struggles patients face throughout their cystectomy journey, and improved education about available treatment options (including bladder preservation) and possible ramifications of cystectomy on all aspects of life (including sexual health and female-centric needs). Conclusions: Cystectomy can negatively affect patients’ lives, affecting their ability to participate in daily activities, mental health, and physical intimacy among those with NMIBC and MIBC. Patients expressed the need for holistic, long-term support (including awareness of treatment options, emotional support, and ostomy care) before, during, and after cystectomy. Citation Format: Nida Imran, Wesley Peters, Karen Fixler, Priyanka Madireddi, Lisa M. Shea, Andrea Ireland. Patient-reported experience related to aspects of quality of life after cystectomy from an exploratory focus group [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr A017.

Non-linear associations of serum spermidine with type 2 diabetes mellitus and fasting plasma glucose: a cross-sectional study.

Previous animal experiments have demonstrated the potential of spermidine to mitigate glucose intolerance, insulin resistance, and hyperinsulinemia. However, there remains a scarcity of epidemiological evidence supporting these findings. Therefore, we aimed to elucidate the associations of serum spermidine with T2DM and FPG. The cross-sectional study was conducted from June to August 2019 in the rural areas of Fuxin County, Liaoning Province, China. A total of 4,437 participants were included in the study. The serum spermidine was detected using high-performance liquid chromatography with a fluorescence detector. FPG was measured using the hexokinase method. T2DM was defined as participants with a FPG level of 7.0 mmol/L or greater, or self-reported diagnosis of diabetes by a doctor. Restricted cubic spline model and piecewise linear regression model were used to explore the associations of serum spermidine with T2DM and FPG, respectively. The mean (SD) age of the participants was 59.3 (10.0) years, with 622 out of 4,437 participants being defined as T2DM. The serum spermidine in participants stratified by age and BMI categories was significantly different, with p values of 0.006 and 0.001, respectively. Among all the participants, the association of serum spermidine with T2DM was J-shaped. The log (spermidine) was negatively associated with T2DM (OR = 0.68, 95% CI: 0.52 to 0.92, p = 0.01) below the inflection point, while log (spermidine) was not significantly associated with T2DM (OR = 1.97, 95% CI: 0.93 to 4.15, p = 0.07) above the inflection point. Among the participants without T2DM, the association of serum spermidine with FPG was inverted J-shaped. The log (spermidine) was positively associated with FPG (β = 0.13, 95% CI: 0.05 to 0.21, p = 0.001) below the inflection point, while log (spermidine) was negatively associated with FPG (β = -0.29, 95% CI: -0.42 to -0.16, p < 0.001) above the inflection point. In conclusion, non-linear associations of serum spermidine with T2DM and FPG were found in the cross-sectional study in Chinese rural adults. This provided insights into the use of spermidine for the prevention of T2DM, highlighting the potential role in public health prevention strategies of spermidine.

Polychlorinated biphenyls and incident coronary heart disease-related outcomes in Great Lakes fish consumers

BackgroundExposure to polychlorinated biphenyls (PCBs) has been linked to risk factors for cardiovascular disease such as increased inflammation, accelerated atherosclerosis, diabetes, and sex hormone dysregulation. Furthermore, there is increasing evidence suggesting associations between internal dose of PCBs and cardiovascular outcomes. ObjectivesThe purpose of this study is to investigate longitudinal associations of PCBs with coronary heart disease (CHD)-related outcomes in a cohort of Great Lakes sport fish consumers. MethodsThe Great Lakes Sport Fish Consumer cohort was established in the early 1990's. Eight hundred nineteen participants were followed from 1993 to 2017. Serum PCBs were measured in 1994/1995 (baseline), in 2001, and in 2004, while health history questionnaires were administered in 1996, 2003, 2010, and 2017. Cox models were used to prospectively investigate associations of total PCBs and PCB groupings, based on aryl hydrocarbon receptor activity, with incident self-reported physician diagnosis of coronary heart disease (CHD), myocardial infarction (MI), and angina pectoris. ResultsA 2-fold increase in phenobarbital-type PCBs was associated with a 72% increase in likelihood of self-reported incident diagnosis of CHD (HR=1.72, 95% CI: 1.06–2.81; p=0.0294). Similar results were observed for total PCBs (HR=1.68, 95% CI: 1.05–2.69; p=0.0306) and mixed methacholine/phenobarbital type (mixed-type) PCBs (HR=1.60, 95% CI: 1.02–2.52; p=0.0427), but not methacholine-type PCBs. PCBs were not strongly associated with risk of MI or angina. ConclusionsThis study presents evidence that exposure to PCBs increases the risk of developing coronary heart disease. Given the large number of risk factors and causal pathways for CHD, future research is required to better understand biological mechanisms of action for PCBs on CHD.

Health literacy in patients with gout: A latent profile analysis

Objectives Understanding the health literacy status of patients with gout diagnosis is essential for improving the health of this population. Our study aimed to investigate the latent profiles of health literacy in patients with gout and to analyze differences in characteristics across potential profiles. Methods This was a cross-sectional study. Eligible participants attended the Shandong Gout Medical Center, from March 2023 to May 2023 and self-reported gout diagnosis. We used the Health Literacy Scale for Patients with Gout designed and validated by our team. The scale had good reliability and validity among patients with gout. 243 patients completed the Demographic Information Questionnaire and the Health Literacy Scale for Patients with Gout. We used latent profile analysis to identify the latent profiles of gout patients’ health literacy. We used Chi-square tests with Bonferroni correction to analyze differences in demographics and illness characteristics across identified profiles. Results Three profiles of patients with gout emerged (prevalence): the low literacy-low critical group (21.81%), the moderate literacy group (42.79%), and the high literacy-stable group (35.39%). The three groups differed in age, education level, monthly income, disease duration, and place of residence (P&lt;0.01). Conclusions The health literacy of patients with gout was heterogeneous. Healthcare professionals should adopt targeted interventions based on the characteristics of each latent health literacy profile to improve the health literacy level of patients with gout.

Relationship between dietary live microbe intake and the prevalence of COPD in adults: a cross-sectional study of NHANES 2013–2018

ObjectiveTo explore the potential association between dietary live microbes and the prevalence of Chronic Obstructive Pulmonary Diseases (COPD).MethodsIn this cross-sectional study, data of 9791 participants aged 20 years or older in this study were collected from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018. Participants in this study were classified into three groups according to the Sanders’ dietary live microbe classification system: low, medium, and high dietary live microbe groups. COPD was defined by a combination of self-reported physician diagnoses and standardized medical status questionnaires. Logistic regression and subgroup analysis were used to assess whether dietary live microbes were associated with the risk of COPD.ResultsThrough full adjustment for confounders, participants in the high dietary live microbe group had a low prevalence of COPD in contrast to those in low dietary live microbe group (OR: 0.614, 95% CI: 0.474–0.795, and p < 0.001), but no significant association with COPD was detected in the medium and the low dietary live microbe groups. This inverse relationship between dietary live microbe intake and COPD prevalence was more inclined to occur in smokers, females, participants aged from 40 to 59 years old and non-obese participants.ConclusionA high dietary live microbe intake was associated with a low prevalence of COPD, and this negative correlation was detected especially in smokers, females, participants aged from 40 to 59 years old and non-obese participants.

Maternal metabolic conditions as predictors of breastfeeding outcomes: Insights from an Australian cohort study.

Breastfeeding represents an important opportunity to optimize health outcomes for both mother and infant, particularly in the context of maternal metabolic conditions such as diabetes and polycystic ovary syndrome. However, evidence suggests that women affected by these conditions breastfeed at reduced rates and durations. Our aim was to use the large, prospective, community-based Australian Longitudinal Study on Women's Health (ALSWH) to conduct an in-depth exploratory analysis of breastfeeding outcomes in Australian women affected by key maternal metabolic conditions. Data from 12 920 pregnancies to 5605 women from the 1973-1978 birth cohort of the ALSWH were examined. Univariable and multivariable regression using generalized estimating equation models were applied to assess breastfeeding initiation and duration (outcome measures) in relation to key self-reported maternal metabolic diagnoses (pre-gestational type 1 and type 2 diabetes, gestational diabetes, and polycystic ovary syndrome; main explanatory variables). Key sociodemographic and clinical covariates were also considered. Results showed no significant association between specific maternal metabolic diagnoses (pre-gestational or gestational diabetes, or polycystic ovary syndrome) and breastfeeding outcomes. However, maternal body mass index emerged as a key predictor of suboptimal breastfeeding outcomes. Pregnancies affected by maternal obesity were associated with a 2.1-fold increase in the odds of not initiating breastfeeding, after adjusting for other key variables (95% CI 1.67 to 2.60, p < 0.01). Maternal overweight and obesity were, respectively, associated with an adjusted 1.4-fold (95% CI 1.20 to 1.55, p < 0.01) and 1.8-fold increase (95% CI 1.60 to 2.10, p < 0.01) in the odds of a breastfeeding duration less than 6 months. Maternal obesity, rather than any specific maternal metabolic condition, appears to be a key predictor of breastfeeding outcomes in Australian women.

Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality

BackgroundCholine, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S.MethodsThis study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations.ResultsIn our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60–0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk.ConclusionElevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.

The association of hypertension among married Indian couples: a nationally representative cross-sectional study

Mounting evidence demonstrates that intimate partners sharing risk factors have similar propensities for chronic conditions such as hypertension. The objective was to study whether spousal hypertension was associated with one’s own hypertension status independent of known risk factors, and stratified by socio-demographic subgroups (age, sex, wealth quintile, caste endogamy). Data were from heterosexual married couples (n = 50,023, women: 18–49 years, men: 21–54 years) who participated in the National Family Health Survey-V (2019–2021). Hypertension was defined as self-reported diagnosis of hypertension or average of three blood pressure measurements ≥ 140 systolic or 90 mmHg diastolic BP. Among married adults, the prevalence of hypertension among men (38.8 years [SD 8.3]) and women (33.9 years [SD 7.9]) were 29.1% [95% CI 28.5–29.8] and 20.6% [95% CI 20.0–21.1] respectively. The prevalence of hypertension among both partners was 8.4% [95% CI 8.0–8.8]. Women and men were more likely to have hypertension if their spouses had the condition (husband with hypertension: PR 1.37 [95% CI 1.30–1.44]; wife with hypertension: PR 1.32 [95% CI 1.26–1.38]), after adjusting for known risk factors. Spouse’s hypertension status was consistently associated with own status across all socio-demographic subgroups examined. These findings present opportunities to consider married couples as a unit in efforts to diagnose and treat hypertension.

Irregular Cycles, Ovulatory Disorders, and Cardiometabolic Conditions in a US-Based Digital Cohort

Polycystic ovary syndrome (PCOS), characterized by irregular menstrual cycles and hyperandrogenism, is a common ovulatory disorder. Having an irregular cycle is a potential marker for cardiometabolic conditions, but data are limited on whether the associations differ by PCOS status or potential interventions. To evaluate the association of PCOS, time to regularity since menarche (adolescence), and irregular cycles (adulthood) with cardiometabolic conditions. This cross-sectional study used a large, US-based digital cohort of users of the Apple Research application on their iPhone. Eligibility criteria were having ever menstruated, living in the US, being at age of consent of at least 18 years (or 19 years in Alabama and Nebraska or 21 years in Puerto Rico), and being able to communicate in English. Participants were enrolled between November 14, 2019, and December 13, 2022, and completed relevant surveys. Self-reported PCOS diagnosis, prolonged time to regularity (not spontaneously establishing regularity within 5 years of menarche), and irregular cycles. The primary outcome was self-reported cardiometabolic conditions, including obesity, prediabetes, type 1 and 2 diabetes, high cholesterol, hypertension, metabolic syndrome, arrhythmia, congestive heart failure, coronary artery disease, heart attack, heart valve disease, stroke, transient ischemic attack (TIA), deep vein thrombosis, and pulmonary embolism measured using descriptive statistics and logistic regression to estimate prevalence odds ratios (PORs) and 95% CIs. Effect modification by lifestyle factors was also estimated. The study sample (N = 60 789) had a mean (SD) age of 34.5 (11.1) years, with 12.3% having PCOS and 26.3% having prolonged time to regularity. Among a subset of 25 399 participants who completed the hormonal symptoms survey, 25.6% reported irregular cycles. In covariate-adjusted logistic regression models, PCOS was associated with a higher prevalence of all metabolic and several cardiovascular conditions, eg, arrhythmia (POR, 1.37; 95% CI, 1.20-1.55), coronary artery disease (POR, 2.92; 95% CI, 1.95-4.29), heart attack (POR, 1.79; 95% CI, 1.23-2.54), and stroke (POR, 1.66; 95% CI, 1.21-2.24). Among participants without PCOS, prolonged time to regularity was associated with type 2 diabetes (POR, 1.24; 95% CI, 1.05-1.46), hypertension (POR, 1.09; 95% CI, 1.01-1.19), arrhythmia (POR, 1.20; 95% CI, 1.06-1.35), and TIA (POR, 1.33; 95% CI, 1.01-1.73), and having irregular cycles was associated with type 2 diabetes (POR, 1.36; 95% CI, 1.08-1.69), high cholesterol (POR, 1.17; 95% CI, 1.05-1.30), arrhythmia (POR, 1.21; 95% CI, 1.02-1.43), and TIA (POR, 1.56; 95% CI, 1.06-2.26). Some of these associations were modified by high vs low body mass index or low vs high physical activity. These findings suggest that PCOS and irregular cycles may be independent markers for cardiometabolic conditions. Early screening and intervention among individuals with irregular menstrual cycles may be beneficial.

Abstract PO4-16-09: Enhancing Research on Inflammatory Breast Cancer through Count Me In: Assessing the Accuracy of Self-Reported Diagnoses

Abstract Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer that relies on clinical identification of specific breast changes for diagnosis, in addition to pathological confirmation of invasive breast cancer. There is a clear need to increase participation of patients with IBC in research to better understand its clinical course and optimal treatment strategy. Count Me In (CMI) is a nonprofit research initiative that enables patients across the United States and Canada to accelerate cancer research by sharing their clinical data and biospecimens. The Metastatic Breast Cancer Project (MBCProject) was the first CMI initiative and is a prospective longitudinal cohort designed to capture these data from patients with metastatic breast cancer. Methods: We reviewed available medical records of patients participating in the MBCProject and who self-reported as having IBC. Records were reviewed by a study team member to identify documentation by a provider of an IBC diagnosis. For records without a documented IBC diagnosis, the clinical symptoms were assessed using a novel quantitative IBC scoring system (Mason G et al. BCRF 2022) currently being validated. Finally, records were also assessed by a physician for final determination of an IBC diagnosis. Records were classified as “concordant” or “not concordant”. Concordant is defined as “review of medical records confirms IBC using the unifying set of specific diagnostic criteria”. We desired the rate of concordant cases to be ≥90%; if ≤ 85% it would be considered as unacceptable to rely solely on patient self-report of IBC diagnosis in future research. Results: We reviewed records of 79 patients participating in the MBCProject who self-identified as having IBC and had medical records collected. Of these, 51 (64.5%) had IBC stated in providers’ notes. Of the remaining 28 patients, 6/28 met criteria for IBC using the new IBC diagnostic criteria, 17/28 didn’t have evidence of IBC based on the records available and 6/28 we were unable to make a final determination due to lack of records at the time of initial diagnosis. In total, 57/79 (72%; 95% CI 61-82%) patients had a concordant diagnosis. Conclusion: Patient self-report registries such as CMI are invaluable for the collection of clinical information and biospecimens for research of patients with rare diseases, however, a self-reported diagnosis of IBC may not be reliable. To improve the accurate identification of IBC, optimization of the questions asked to patients on these registries is warranted. This may include additional screening questions such as specific skin findings and timing of onset of symptoms. Focusing on patients with stage III IBC may also provide a better patient population to test this strategy. Citation Format: Elizabeth Troll, Sean Ryan, Virginia (Ginny) Mason, Mariesa D. Powell, Aditi Hazra, Nikhil Wagle, Mary McGillicuddy, Sara Tolaney, Meredith Regan, Filipa Lynce. Enhancing Research on Inflammatory Breast Cancer through Count Me In: Assessing the Accuracy of Self-Reported Diagnoses [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-16-09.