Separate Multivariable Linear Regression Models Research Articles

Impact of COVID-19 on women living with HIV who are survivors of intimate partner violence

BackgroundWomen living with HIV (WLWH) experience higher rates of intimate partner violence (IPV) compared to women without HIV, but there has been minimal research to date on the impact of the COVID-19 pandemic on the lived experiences of WLWH who are IPV survivors.MethodsThis is a secondary analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study of HIV care engagement among WLWH who have experienced lifetime IPV. We measured the impact of COVID-19 along key domains (i.e., physical health, day-to-day life, sexual/relationship behavior, substance use, HIV care, mental health, financial status, and having conflict with partners). Using independent t-tests or Fisher’s exact tests, and Pearson’s chi-squared tests, we compared women with and without ongoing IPV across sociodemographic characteristics, psychiatric disorders, substance use, and COVID-19 impact domains. We then built separate multivariate linear regression models for each of the different COVID-19 impact domains; ongoing IPV exposure was the primary explanatory variable of interest.ResultsEnrolled participants (n = 84) comprised a group of women (mean age 53.6y; SD = 9.9) who were living with HIV for a mean 23.3 years (SD = 10), all of whom had experienced lifetime IPV. Among 49 women who were currently partnered, 79.6% (n = 39) reported ongoing IPV. There were no statistically significant differences between those experiencing ongoing IPV and those who were not (or not partnered) in terms of demographic characteristics, substance use, or mental health. In multivariate models, ongoing IPV exposure was not associated with any COVID-19 impact domain. Anxiety and depression, however, were associated with COVID-19-related physical health, HIV care, and relationship conflict. Hispanic ethnicity was significantly associated with COVID-19-related physical health. More severe cocaine and opioid use were also significantly associated with COVID-19-related impact on day-to-day life.ConclusionsAmong this sample of WLWH who are all lifetime IPV-survivors, nearly half had ongoing IPV exposure. The COVID-19 public health emergency period affected WLWH in varied ways, but impacts were most profound for women experiencing concurrent mental health and substance use problems. Findings have important implications for future interventions to improve women’s health and social outcomes.

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study

BackgroundThe potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.MethodsThis was a prospective pilot cohort of pregnant people between 23 to 36 weeks’ gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.ResultsAmong the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.ConclusionsWhen including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1–9.6 mmHg higher SBP, 6.1–8.1 mmHg higher DBP, and 6.2–8.8 mmHg higher MAP than people without anxiety.

Differences in maternal and paternal pressure to eat and perception of household responsibilities.

Controlling feeding practices, such as pressure to eat, are associated with a child's disinhibited eating and extremes in bodyweight. We aimed to explore which factors are associated with parent dyads' pressuring feeding practices, including how mothers and fathers perceive the sharing of household tasks such as mealtime and child feeding responsibilities. In this cross-sectional study, parent dyads (mother and father) of healthy preschool-aged children completed an identical questionnaire consisting of measures of picky eating (food fussiness subscale of Child Eating Behavior Questionnaire), parental concern for undereating, and pressure to eat (Child Feeding Questionnaire). We used separate multivariable linear regression models for mothers and fathers to assess correlates associated with pressure to eat subscale score, including slowness of eating and enjoyment of food, child BMI z-score and race/ethnicity, and household income. Separate unadjusted linear regression models for mothers and fathers were used to report the association of pressure to eat with household responsibilities. Parents (N = 88) had similar mean picky eating, concern for undereating, and pressure to eat scores; more fathers had high pressure to eat scores (36% vs 27%). Higher pressure to eat was significantly associated with lower income, non-Hispanic Black or Black race/ethnicity, slow eating, and lower enjoyment of food. Pressure was not associated with household responsibilities. While there were similar maternal and paternal perceptions of child eating behaviors, more fathers reported pressuring their child to eat. Identifying differences in parental feeding practices may assist in intervention development to improve feeding practices.

Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV.

Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.

Perceived Stress, Mindfulness, and Clinical Concussion Outcomes in Adults with a Concussion History

ABSTRACT Introduction Higher perceived stress negatively impacts concussion recovery, but there are limited data examining connections between perceived stress and concussion. Additionally, higher mindfulness is associated with lower perceived stress, but there is limited research on how mindfulness impacts concussion outcomes. Therefore, this study aimed to estimate the associations among perceived stress, mindfulness, and clinical concussion outcomes. Methods This was a cross-sectional, observational study in 80 young adults with a concussion history. Participants completed a single study visit measuring the following: 1) demographics, concussion history, and current mindfulness practice; 2) perceived stress (Perceived Stress Scale); 3) mindfulness (Five Facet Mindfulness Questionnaire); and 4) clinical concussion outcomes/symptoms (Rivermead Post-Concussion Symptoms Questionnaire), balance performance (Balance Error Scoring System (BESS) and center of mass), autonomic nervous system function (heart rate variability), vestibular/ocular function (vestibular ocular motor screening), and exertion tolerance (step test). Separate multivariable linear regression models were used to determine the associations among 1) perceived stress and clinical concussion outcomes and 2) mindfulness and clinical concussion outcomes. Next, a perceived stress and mindfulness interaction term was included to test the potential moderation effect of mindfulness on clinical concussion outcomes. Results Higher perceived stress was significantly associated with higher concussion symptom severity (P &lt; 0.001) and higher number of concussion symptoms reported as worse than before injury (P &lt; 0.001). Higher mindfulness was associated with lower concussion symptom severity (P &lt; 0.001), and fewer concussion symptoms reported as worse than before injury (P = 0.002). There were no clinically significant models where the interaction effect was also significant, but the BESS parameter estimate did show statistical significance in the interaction model. Conclusions Our results provide a novel understanding of the association among perceived stress, mindfulness, and clinical concussion outcomes. These data are necessary to inform mechanistic concussion rehabilitation interventions.

NODDI May Be More Sensitive to Neurodegenerative Changes Than Structural MRI

AbstractBackgroundNeurite orientation dispersion and density imaging (NODDI) measures from diffusion MRI provide information about tissue microstructure. Our goal was to compare the sensitivity of NODDI to structural MRI (sMRI) in capturing neurodegenerative changes in the gray matter due to aging and dementia.MethodWe included 815 participants [644 cognitively unimpaired (CU), 103 MCI, 68 AD] from the Mayo Clinic Study of Aging (MCSA) and Mayo ADRC with sMRI and multi‐shell diffusion MRI. We assessed gray matter volumes scaled by head size and cortical thicknesses from sMRI and neurite density index (NDI) and isotropic volume fraction (ISOVF) from NODDI. Pairwise Spearman correlations were calculated between imaging measures and Tau‐PET SUVRs in Braak I‐II, III‐IV, and V‐VI regions of interest (ROI) in participants = 60 years. Separate multivariable linear regression models were fit for the prediction of brain age using sMRI and NODDI in 515 CU participants. The predicted age gaps were calculated as chronological age minus predicted age in the remaining participants. We compared age gaps computed by sMRI and NODDI using disease surrogates (APOE4 genotype, AD pathologies via PET, WMH via FLAIR‐MRI, vascular risk, cognition via MMSE).ResultBraak ROIs, sMRI, and NODDI measures were correlated. The correlations between ISOVF and Tau‐PET SUVRs were stronger than correlations between NDI, volume, and thickness and Tau‐PET SUVR (Fig.1). MMSE was more associated with ISOVF than Tau‐PET and other imaging measures. The sMRI regression models had a higher mean absolute error (MAE) of 4.13 years than NODDI models with an MAE of 4.02 years. The NODDI model better predicted age gap separation between CU, MCI, and AD compared to the sMRI model (Fig.2). The NODDI predicted age gap showed stronger correlations with global amyloid‐PET SUVR, meta‐ROI Tau‐PET SUVR, CMC, APOE4, and MMSE (Fig. 3).ConclusionNODDI, especially ISOVF, had stronger correlations with MMSE and Tau‐PET SUVRs across all Braak ROIs. The brain age prediction model trained using NODDI was more sensitive in detecting neurodegeneration changes than sMRI based on associations with disease surrogates. Our work suggests that NODDI in gray matter may be a more sensitive surrogate of neurodegeneration compared to sMRI.

Associations between muscle quality and N-terminal pro-B-type natriuretic peptide (NT-proBNP): The multi-ethnic study of atherosclerosis

IntroductionN-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used in clinical settings to identify cardiac stress, diagnose, and manage heart failure (HF). We explored the associations between NT-proBNP and both muscle area and density. MethodsA cross-sectional analysis including 1,489 participants from the MESA. Plasma NT-proBNP concentrations and inflammatory biomarkers and health history questionnaires were analyzed. Computed tomography quantified abdominal body composition. Separate multivariable linear regression models were used to assess the associations between both muscle (MA) area and density (MD) and NT-proBNP. ResultsIn models adjusted for sociodemographic characteristics, risk factors for cardiovascular disease, anthropometric variables, and subcutaneous and visceral adiposity, NT-proBNP was inversely associated with total abdominal and psoas MAs. Adjustment for inflammatory markers and MD attenuated these associations to the null. Stabilization MA and NT-proBNP were not significantly associated. Analyses per quartiles of MA confirmed lack of a consistent association between stabilization and total abdominal MAs and NT-proBNP. While the third and fourth quartiles of psoas MA were inversely associated with NT-proBNP, adding inflammation biomarkers and MD to the model attenuated the association to the null. Conversely, after full adjustment, NT-proBNP was inversely and significantly associated with total abdominal, stabilization and psoas MDs. For psoas MD, but not the other muscle density variables, the addition of MA to the model attenuated the association to the null. The quartiles of MD were consistently inversely associated with NT-proBNP, where higher MDs showed larger estimates of the association compared to the lowest quartiles, for all muscle groups investigated. ConclusionMuscle density is inversely associated with NT-proBNP, while muscle area is not after adjustment for inflammation and muscle density.

Walking energetics and white matter hyperintensities in mid-to-late adulthood.

White matter hyperintensities (WMHs) increase with age and contribute to cognitive and motor function decline. Energy costs for mobility worsen with age, as the energetic cost of walking increases and energetic capacity declines. We examined the cross-sectional associations of multiple measures of walking energetics with WMHs in mid- to late-aged adults. A total of 601 cognitively unimpaired adults (mean age 66.9±15.3 years, 54% women) underwent brain magnetic resonance imaging scans and completed standardized slow- and peak-paced walking assessments with metabolic measurement (V̇O2). T1-weighted scans and fluid-attenuated inversion recovery images were used to quantify WMHs. Separate multivariable linear regression models examined associations adjusted for covariates. Lower slow-paced V̇O2 (B=0.07; P=0.030), higher peak-paced V̇O2 (B=-0.10; P=0.007), and lower cost-to-capacity ratio (B=.12; P < 0.0001) were all associated with lower WMH volumes. The cost-to-capacity ratio, which describes the percentage of capacity required for ambulation, was the walking energetic measure most strongly associated with WMHs.

The Association of Resilience with Psychosocial Outcomes in Teenagers and Young Adults with Cancer.

Purpose: There is limited research on the psychological impact of cancer for teenagers and young adults (TYAs) and the role of protective factors such as resilience. This study investigated associations between resilience and psychosocial outcomes in this group. Methods: Data were collected from TYAs (aged 16-24) who attended the TYA cancer clinic at Guy's Hospital between 2013 and 2021. Participants (N = 63) completed psychosocial questionnaires within 4 weeks of their treatment start date (T1) and again between 9 and 15 months later (T2). We used separate multivariable linear regression models to analyze associations of resilience (Brief Resilience Questionnaire) with outcomes measured at T2, including symptoms of depression (Patient Health Questionnaire [PHQ]-9), anxiety (Generalized Anxiety Disorder [GAD]-7), and subjective quality of life. Models were adjusted for age, gender, ethnicity, and T1 outcome assessments. Results: Higher resilience at T1 was associated with increased anxiety (β = 1.68; bootstrapped confidence interval [95% CI -0.28 to 3.19]), depression (β = 1.24; [-0.85 to 2.90]), and quality of life (5.76; [-0.88 to 15.60]). In contrast, an increase in resilience over time was associated with decreases in the same period in anxiety (β = -3.16; [-5.22 to -1.47]) and depression (β = -2.36, [-4.41 to -0.58]), and an increase in quality of life (β = 9.82, [-0.24 to 21.13]). Conclusion: Increases in resilience during cancer treatment were associated with reduced symptoms of depression and anxiety in TYAs. We discuss factors likely to influence these outcomes, the implications for psychosocial interventions in this population, and identify further research to explore the impact of other factors such as diagnosis and treatment type.

A Pilot Study Examining the Association of Parental Stress and Household Food Insecurity with Dietary Quality in Pre-School-Aged Children.

Adequate dietary quality is necessary for children's appropriate development and may be influenced by family factors. This study with 24 healthy 3-5-year-old children assessed the associations of parental stress and household food insecurity (HFI) with a child's dietary quality. Parents completed three 24 h dietary recalls, and the Healthy Eating Index was calculated to assess dietary quality. Parents also completed a questionnaire, including The Perceived Stress Scale (assessing overall parental stress) and the Hunger Vital Sign screen (assessing HFI). Children's height/weight were measured, and BMIz was calculated. Separate multivariable linear regression models assessed the association of dietary quality components with HFI and parental stress, adjusting for household income, child sex, and child BMI z-score. In bivariate analyses, children with HFI consumed more added sugars, and parental stress was associated with the child's greens/beans intake. In multivariable analysis, HFI was associated with lower total protein scores and higher added sugar intake, while parental stress was associated with lower greens/beans intake. Higher household income was associated with higher total vegetable and sodium intake, and children with a higher BMIz had a lower total protein intake. Parental stress and HFI can impact a child's dietary quality; providers should counsel families on strategies to improve diet quality.

Racial Discrimination and Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Adolescents With Overweight and Obesity: Does Context Matter?

In adolescents at higher risk for chronic disease, the role that context of a discriminatory event may play on cortisol dysregulation is unclear. The purpose of this study was to perform a cross-sectional analysis examining the association between racial discrimination context (peer, educational, institutional, and cumulative) and diurnal cortisol patterning in adolescents with overweight and obesity. One hundred adolescents (13-19 years; 49% non-Hispanic Black; 65% female; body mass index percentile = 93.9% [4.14%]) were included in this analysis. Racial discrimination context was measured using the self-reported Adolescent Discrimination Distress Index. Salivary cortisol, collected across 3 days at five time points during the day, was used to calculate Δ 0-30 minutes, diurnal slope, and average total diurnal cortisol area under the curve. Sixteen separate multivariable linear regression models were performed to analyze the relationship between racial discrimination and diurnal cortisol patterns. Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004, p = .03; peer: β = 0.023 ± 0.010, p = .026). Findings from this study identified cross-sectional associations between racial discrimination experienced among peers and diurnal cortisol patterns in adolescents with overweight/obesity. If our findings were to be confirmed in longitudinal analyses, evidence-based programs should be considered to buffer the effects of discrimination on adolescent health, and more importantly, policy makers should work to eliminate discrimination exposure.

Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes

BackgroundBoth long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes.MethodsThis cross-sectional study included 673 adults (305 men, 368 women) with type 1 diabetes and combined available retrospective laboratory data on HbA1c from the preceding 10 years with outcome data on arterial stiffness and clinical variables from a comprehensive study visit. HbA1c variability was calculated as adjusted standard deviation (adj-HbA1c-SD), coefficient of variation (HbA1c-CV) and average real variability (HbA1c-ARV). As measures of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV; n = 335) and augmentation index (AIx; n = 653) were assessed using applanation tonometry.ResultsThe study population had a mean age of 47.1 (± 12.0) years and a median duration of diabetes of 31.2 (21.2–41.3) years. The median number of HbA1c assessments per individual was 17 (12–26). All three indices of HbA1c variability were significantly correlated with both cfPWV and AIx after adjustment for sex and age (p < 0.001). In separate multivariable linear regression models, adj-HbA1c-SD and HbA1c-CV were significantly associated with cfPWV (p = 0.032 and p = 0.046, respectively) and AIx (p = 0.028 and p = 0.049, respectively), even after adjustment for HbA1c-mean. HbA1c-ARV was not associated with cfPWV or AIx in the fully adjusted models.ConclusionsAn association independent of HbA1c-mean was found between HbA1c variability and arterial stiffness, suggesting a need to consider multiple HbA1c metrics in studies assessing cardiovascular risk in type 1 diabetes. Longitudinal and interventional studies are needed to confirm any causal relationship and to find strategies for reducing long-term glycaemic variability.

IMPACT OF EHR IMPLEMENTATION IN NURSING HOMES ON FINANCIAL PERFORMANCE

Abstract Nursing homes (NHs) are a critical part of the US healthcare system providing care to the sick and fragile elderly, and research suggests that they can benefit from the implementation of health information technology (HIT). However, for multiple reasons—exclusion from HITECH incentives; limited financial wherewithal; hazy return on investments (ROI), they have lagged in HIT implementation compared to other significant components of the US healthcare system. Utilizing the resource-based view (RBV) of the firm, the purpose of this study was to examine the longitudinal impact of HIT on NH financial performance potentially building a sustainable economic argument for its implementation. To examine this relationship, we merged data from five different sources between the years 2009-2013-: Health Information and Management Systems Society, LTCFocus, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting, Area Health Resource Files, and Medicare Cost Reports. The outcome variable was financial performance which was measured in four ways: operating cost and revenue, operating margin, and total margin. The independent variable of interest was HIT implementation and was measured using a novel HIT Adoption Score (HAS) reflecting NH implementation of five different HIT applications. Four separate multivariate linear regression models were estimated, and we included a series of organizational and market characteristics in the analyses. We report a positive association between NH implementation and improved profitability (operating margin) (p≤0.01), and lower operating cost (p≤0.05). Our results, suggesting a potential business case for EHR implementation within NHs, have important policy and managerial implications that are discussed.

Associations of lifetime concussion history and repetitive head impact exposure with resting-state functional connectivity in former collegiate American football players: An NCAA 15-year follow-up study.

The objective of this study was to examine associations of lifetime concussion history (CHx) and an advanced metric of lifetime repetitive head impact exposure with resting-state functional connectivity (rsFC) across the whole-brain and among large-scale functional networks (Default Mode; Dorsal Attention; and Frontoparietal Control) in former collegiate football players. Individuals who completed at least one year of varsity collegiate football were eligible to participate in this observational cohort study (n = 48; aged 36-41 years; 79.2% white/Caucasian; 12.5±4.4 years of football played; all men). Individuals were excluded if they reported history/suspicion of psychotic disorder with active symptoms, contraindications to participation in study procedures (e.g., MRI safety concern), or inability to travel. Each participant provided concussion and football playing histories. Self-reported concussion history was analyzed in two different ways based on prior research: dichotomous "High" (≥3 concussions; n = 28) versus "Low" (<3 concussions; n = 20); and four ordinal categories (0-1 concussion [n = 19]; 2-4 concussions [n = 8]; 5-7 concussions [n = 9]; and ≥8 concussions [n = 12]). The Head Impact Exposure Estimate (HIEE) was calculated from football playing history captured via structured interview. Resting-state fMRI and T1-weighted MRI were acquired and preprocessed using established pipelines. Next, rsFC was calculated using the Seitzman et al., (2020) 300-ROI functional atlas. Whole-brain, within-network, and between-network rsFC were calculated using all ROIs and network-specific ROIs, respectively. Effects of CHx and HIEE on rsFC values were examined using separate multivariable linear regression models, with a-priori α set to 0.05. We observed no statistically significant associations between rsFC outcomes and either CHx or HIEE (ps ≥ .12). Neither CHx nor HIEE were associated with neural signatures that have been observed in studies of typical and pathological aging. While CHx and repetitive head impacts have been associated with changes in brain health in older former athletes, our preliminary results suggest that associations with rsFC may not be present in early midlife former football players.

Presence of Persistent Parent Reported Emotional and Behavioral-Related Concussion Symptoms Is Associated with Lower Health-Related Quality of Life in Adolescent Athletes

Persistent concussion symptoms in adolescents are associated with lower health-related quality of life (HRQOL). The association between persistent emotional and behavioral-related concussion symptoms (EBS) and HRQOL is unknown, however. This study was a prospective cohort of adolescent athletes presenting to a concussion clinic within three days post-concussion and completing a one-month follow-up. The independent variable in these analyses was parent reported EBS symptom presence grouped as: (1) no EBS; (2) EBS present at pre-concussion levels; and (3) EBS worse than pre-concussion. The EBS included the following concussion symptoms: feeling irritable, depressed, frustrated/impatient, restless, reduced tolerance to stress/emotion, poor concentration, and fear of permanent symptoms. Dependent variables were parent reported psychosocial, physical, and total HRQOL. Separate multi-variable linear regression models controlling for age, sex, and concussion history were used to assess the association between EBS and HRQOL. Estimated adjusted mean differences (MD) and 95% confidence intervals (CI) were used to assess associations; MDs with a 95%CI excluding 0.0 were considered statistically significant. Overall, n = 245 presented to the study clinic three days post-concussion and completed the one-month follow-up (Mage = 14.28 ± 2.09 years, 59.02% male, 90.64% Caucasian, 31.84% with concussion history). At one-month post-concussion, adolescents with pre-concussion EBS levels had significantly lower psychosocial, physical, and total HRQOL than those with no EBS. In addition, those with EBS worse than pre-concussion had significantly lower psychosocial, physical, and total HRQOL than those with no EBS and EBS at pre-concussion levels. These findings highlight the importance of HRQOL assessments and that targeted interventions may be needed for those with EBS at one-month post-concussion to improve HRQOL.

Contribution of Lean Mass Distribution on Aerobic Fitness and Performance in NCAA Division I Female Rowers.

Haraldsdottir, K, Sanfilippo, J, Dawes, S, and Watson, A. Contribution of lean mass distribution on aerobic fitness and performance in NCAA division I female rowers. J Strength Cond Res 36(7): 1956-1960, 2022-The purpose of this study was to determine the relative influence of total lean body mass (LBM), body fat percentage (BF%), upper extremity lean mass (ULM), lower extremity lean mass (LLM), and trunk lean mass (TLM) on maximal aerobic capacity (V̇o2max) and time to exhaustion (Tmax) in female collegiate rowers. One hundred seven female collegiate rowers (aged 18-22 years) performed maximal progressive rowing ergometer testing to determine V̇o2max and Tmax. Body mass, LBM, BF%, ULM, LLM, and TLM were determined by using dual-energy x-ray absorptiometry. Separate multivariable linear regression models were performed to predict V̇o2max and Tmax by using LBM and BF% as predictors. In addition, separate linear regression models were used to predict V̇o2max and Tmax with ULM, LLM, and TLM as covariates. Subjects were aged 20 ± 3 years. V̇o2max was significantly predicted by LBM (r2 = 0.29, p < 0.001), but not BF% (r2 = 0.002, p = 0.79). Similarly, Tmax was significantly predicted by LBM (r2 = 0.25, p < 0.001), but not BF% (r2 = 0.003, p = 0.19). V̇o2max was significantly predicted by LLM (r2 = 0.12, p < 0.01), but not ULM (r2 = 0.08, p = 0.68) or TLM (r2 = 0.09, p = 0.17), and Tmax was significantly predicted by TLM (r2 = 0.09, p = 0.02), but not ULM (r2 = 0.07, p = 0.89) or LLM (r2 = 0.08, p = 32). Among female collegiate rowers, whole body LBM is a significant predictor of both V̇o2max and Tmax. However, LLM is a stronger predictor of V̇o2max while TLM is a stronger predictor Tmax, although each of these relationships has a low coefficient of determination. These findings suggest that aerobic fitness and performance may be influenced by regions of lean mass differently.

Associations of lipoprotein particle profile and objectively measured physical activity and sedentary time in schoolchildren: a prospective cohort study

BackgroundOur understanding of the mechanisms through which physical activity might benefit lipoprotein metabolism is inadequate. Here we characterise the continuous associations between physical activity of different intensities, sedentary time, and a comprehensive lipoprotein particle profile.MethodsOur cohort included 762 fifth grade (mean [SD] age = 10.0 [0.3] y) Norwegian schoolchildren (49.6% girls) measured on two separate occasions across one school year. We used targeted proton nuclear magnetic resonance (1H NMR) spectroscopy to produce 57 lipoprotein measures from fasted blood serum samples. The children wore accelerometers for seven consecutive days to record time spent in light-, moderate-, and vigorous-intensity physical activity, and sedentary time. We used separate multivariable linear regression models to analyse associations between the device-measured activity variables—modelled both prospectively (baseline value) and as change scores (follow-up minus baseline value)—and each lipoprotein measure at follow-up.ResultsHigher baseline levels of moderate-intensity and vigorous-intensity physical activity were associated with a favourable lipoprotein particle profile at follow-up. The strongest associations were with the larger subclasses of triglyceride-rich lipoproteins. Sedentary time was associated with an unfavourable lipoprotein particle profile, the pattern of associations being the inverse of those in the moderate-intensity and vigorous-intensity physical activity analyses. The associations with light-intensity physical activity were more modest; those of the change models were weak.ConclusionWe provide evidence of a prospective association between time spent active or sedentary and lipoprotein metabolism in schoolchildren. Change in activity levels across the school year is of limited influence in our young, healthy cohort.Trial registrationClinicalTrials.gov, #NCT02132494. Registered 7th April 2014

Frailty Syndrome Is Associated with Poorer Self-Reported Sleep Quality Among Older Persons with Human Immunodeficiency Virus.

Older people with HIV (PWH) experience heightened risk for the acquisition of cumulative, multisystem decline, that is, frailty syndrome. Frailty relates to poorer sleep quality in the general older adult population; however, this association has yet to be explored among PWH. A cross-sectional analysis of 285 PWH ≥50 years of age (mean age 60.5 ± 7.0) examined the relationship between frailty (Fried frailty phenotype) and self-reported sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Three separate multivariable linear regression models examined global PSQI as a function of (1) frailty phenotype, (2) total number of frailty symptoms, or (3) specific individual frailty symptoms. Models covaried for demographic and biopsychosocial risk factors, including age, sex, race/ethnicity, education, premorbid verbal IQ estimate, current depressive symptoms, and diagnosis of a substance abuse disorder. Compared to nonfrail (B = 0.151; p = .021) and prefrail (B = 0.144; p = .021), frail phenotype was related to poorer sleep quality (increased global PSQI; F(5,278) = 11.34, p < .001; R2 = 0.17). Increased number of frailty symptoms (B = 0.144; p = .019; F(4,276) = 12.719, p < .001; R2 = 0.16) and exhaustion was associated with increased global PSQI scores (B = 0.218, p < .001; F(6,247) = 10.436, p < .001; R2 = 0.19). In all models, older age, female sex, and elevated current depressive symptoms were associated with poorer sleep quality. In older PWH, greater frailty symptoms related to poorer sleep quality, independent of psychosocial risk factors for poor sleep. Frailty and poor sleep individually have adverse effects on health and everyday functioning; thus, establishing this association may better aid providers to screen for and treat problems with sleep quality and/or frailty among PWH.

Association between Sensation-Seeking Behaviors and Concussion-Related Knowledge, Attitudes, Perceived Norms, and Care-Seeking Behaviors among Collegiate Student-Athletes

There are limited data connecting personality and behavioral tendencies and traits related to concussion care-seeking/disclosure behaviors and minimal research exists surrounding the relationship between risky behaviors, sensation-seeking, and concussion-related outcomes. This study examined the association between sensation-seeking and a student-athlete's concussion-related knowledge, attitudes, perceived social norms, and concussion care-seeking/disclosure behaviors (intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury). The current study utilized a retrospective cohort of collegiate student-athletes at a single National Collegiate Athletic Association Division I institution. Separate multivariable linear regression models estimating mean differences (MD) and 95% Confidence Intervals (CI) estimated the association between sensation-seeking and concussion knowledge, concussion attitudes, and perceived social norms. Separate multivariable binomial regression models estimating adjusted prevalence ratios (PR) and 95%CI estimated the association between sensation-seeking and intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury. All models were adjusted for sex, sport participation, and concussion history. Higher sensation-seeking was significantly associated with less favorable concussion attitudes (adjusted MD = -1.93; 95%CI = -3.04,-0.83), less favorable perceived social norms surrounding concussion (adjusted MD = -1.39; 95%CI = -2.06,-0.72), and continuing to play while experiencing concussion symptoms (adjusted PR = 1.50; 95%CI = 1.10, 2.06). Student-athletes with increased sensation-seeking could be at risk for failing to disclose a concussion, decreasing athlete safety and resulting in less optimal care post-injury. Results will inform future theory-based concussion education programs which consider behavioral tendencies and traits as well as sport culture to promote concussion care-seeking/disclosure and individualized interventions based on risky behavior engagement.

Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-Segment elevation acute coronary syndrome (NSTE-ACS).

Introduction: Considering the role of inflammation in pathogenesis of atherosclerosis, we aimed to investigate the association of presentation neutrophil to lymphocyte ratio (NLR) with complexity of coronary artery lesions determined by SYNTAX score in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: From March 2018 to March 2019, we recruited 202 consecutive patients, who were hospitalized for NSTE-ACS and had undergone percutaneous coronary intervention in our hospital. The association of presentation NLR with SYNTAX score was determined in univariate and multivariate linear regression analysis. Results: Higher NLR was significantly associated with higher SYNTAX score (beta = 0.162, P = 0.021). In addition, older age, having hypertension, higher TIMI score, and lower ejection fraction on echocardiographic examination were significantly associated with higher SYNTAX score. TIMI score had the largest beta coefficient among the studied variables (TIMI score beta = 0.302, P < 0.001). In two separate multivariate linear regression models, we assessed the unique contribution of NLR in predicting SYNTAX score in patients with NSTE-ACS. In the first model, NLR was significantly contributed to predicting SYNTAX score after adjustment for age, sex, and hypertension as covariates available on patient presentation (beta = 0.142, P = 0.040). In the second model, NLR was not an independent predictor of SYNTAX score after adjustment for TIMI score (beta = 0.121, P = 0.076). Conclusion: In NSTE-ACS, presentation NLR is associated with SYNTAX score. However, NLR does not contribute significantly to the prediction of SYNTAX score after adjustment for TIMI score. TIMI risk score might be a better predictor of the SYNTAX score in comparison to NLR.