Significant Effect Modification Research Articles

Heterogeneity in the association between social support and mental distress in old-age retirees – a computational approach using longitudinal cohort data

BackgroundMental distress among retirees and older people is a severe public health challenge, and information on new risk groups is needed. This study aims to identify subgroups of old-age retirees with varying associations between low social support and mental distress by applying model-based recursive partitioning (MOB).MethodsWe used the Helsinki Health Study follow-up survey data of old-age retired former municipal sector employees of the City of Helsinki, Finland. Phase 1 data were collected in 2000–2002, when all participants were employed, Phase 2 in 2007, Phase 3 in 2012, Phase 4 in 2017, and Phase 5 in 2022 (n = 4,466, 81% women). Social support and covariates were measured at each Phase 1–5 and the outcome, mental distress (Depression Anxiety Stress Scales [DASS-21]) was measured at a single occasion, during Phase 5. The three subscales and the common factor of general distress were analysed separately. An approach rooted in computational statistics was used to investigate risk factor heterogeneity in the association of low social support and mental distress. MOB combines decision trees with regression analysis to identify subgroups with the most significant heterogeneity among risk factors.ResultsMedian (IQR) general distress score from DASS-21 was 5.7 (3.0, 9.0), while Social Support Questionnaire number-score (SSQN) was 1.5 (1.15, 2.05). The primary effect modifier for the association between social support and general distress was education (p < 0.001). Those with high education had a different association of low social support and general distress than those with low or medium education. Additionally, the subgroup with low and medium education had a significant effect modification for age (p = 0.01). For the association between low social support and depressive symptoms, the moderating effect of education was dependent on gender, as men with medium–high education had the weakest association, while for women with medium–high education the association was strongest.ConclusionsOur results suggest that stratification by sociodemographic variables is justifiable when investigating risk factors of mental distress in old-age retirees. The incongruent association of low social support and depressive symptoms in men with medium–high education compared to women with medium–high education is a promising target for confirmatory research.

Variations in the association between polygyny and experience of intimate partner violence by husband’s alcohol consumption: a cross-sectional study among postpartum women in Thailand

BackgroundIntimate partner violence is more common in polygynous couples than monogamous couples, but the extent that this association is modified by the husband’s alcohol consumption is unknown. The objectives of this study are: (1) To describe the extent to which polygyny is associated with self-reported experience of intimate partner violence among women receiving postpartum care; (2) To describe the extent to which the mentioned association is modified by the husband’s alcohol consumption.MethodsWe conducted a hospital-based cross-sectional study among women age 18 years or older receiving postpartum care at 8 public hospitals in 3 provinces in Northern and Northeastern Thailand using self-administered questionnaires. We analyzed data using descriptive statistics, logistic regression, and stratified analyses.ResultsA total of 1207 women agreed to participate in the study, 8% of whom reported that their husbands practiced polygyny. Women in a polygynous relationship were more likely than women in monogamous relationships to experience intimate partner violence (11.7% vs. 3.6%, Adjusted OR = 2.23; 95% CI = 0.94, 5.26). The prevalence of intimate partner violence was relatively low in both groups among women whose husbands did not drink (2.9% vs. 0%, Adjusted OR = N/A), and very high in both groups among those whose husbands binge-drank (46.2% vs. 20.8%, Adjusted OR = 9.54; 95% CI = 1.10, 82.54). However, the Breslow-Day Test of Homogeneity suggested that there was no statistically significant effect modification (p-value = 0.259).ConclusionStakeholders in intimate partner violence should consider both alcohol use (particularly binge-drinking) and polygyny as risk factors for intimate partner violence. However, caveats regarding study design, misclassification and potential information bias, and lack of generalizability should be considered in the interpretation of the study findings.

Association between family history with lung cancer incidence and mortality risk in the Asia Cohort Consortium.

Family history of lung cancer (FHLC) has been widely studied but most prospective cohort studies have primarily been conducted in non-Asian countries. We assessed the association between FHLC with risk of lung cancer (LC) incidence and mortality in a population of East Asian individuals. A total of 478,354 participants from 11 population-based cohorts in the Asia Cohort Consortium were included. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 7,785 LC incident cases were identified. FHLC (any LC subtype) was associated with an increased risk of LC incidence (HR = 1.45, 95% CI = 1.30-1.63). The positive association was observed in men and women (HR = 1.44, 95% CI = 1.26-1.66 in men; HR = 1.47, 95% CI = 1.22-1.79 in women), and in both never-smokers and ever-smokers (HR = 1.43, 95% CI = 1.18-1.73 in never-smokers; HR = 1.46, 95% CI =1.27-1.67 in ever-smokers). FHLC was associated with an increased risk of lung adenocarcinoma (HR = 1.63, 95% CI: 1.36-1. 94),squamous cell carcinoma (HR = 1.88, 95% CI: 1.46-2.44), and other non-small cell LC (HR = 1.94, 95% CI: 1.02-3.68). However, we found no evidence of significant effect modification by sex, smoking status, and ethnic groups. In conclusion, FHLC was associated with increased risk of LC incidence and mortality, and the associations remained consistent regardless of sex, smoking status and ethnic groups among the East Asian population.

Predicted vitamin D levels and risk of depression in the SUN Project: A prospective cohort study

The current study aimed to investigate the association between predicted vitamin D status and depression in a prospective Spanish cohort of university graduates. The SUN Project is a dynamic cohort study designed to investigate multiple aspects of health and lifestyle. Participants were asked to complete a comprehensive questionnaire consisting of 556 items, that included a validated food-frequency questionnaire. Participants initially free of depression were classified as incident cases if they reported a medical diagnosis of depression during follow-up. Serum vitamin D levels were predicted by a previously validated equation. Vitamin D deficiency was defined as vitamin D levels below 20 ng/mL. Cox models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We included 15,175 Spanish university graduates [mean (SD) age: 36.9 year (11.5)] followed-up for a median of 12.7 years. Among 192,976 person-years of follow-up, we identified 753 incident cases of depression. Participants with vitamin D deficiency had a 27% higher risk of depression as compared to those with vitamin D sufficiency (HR: 1.27, 95% CI: 1.09–1.48; p = 0.002) after adjusting for potential confounders. Furthermore, a significant effect modification by female sex was observed with higher depression risks associated with vitamin D deficiency in women than in men (p for interaction = 0.034). In educated middle-aged Spanish adults, we observed a direct association between vitamin D deficiency and the risk of depression, that was stronger among women.

Effect modification of glycemic control on association of lung function with all-cause and cardiovascular mortality in persons with type 2 diabetes – A retrospective cohort study

BackgroundPoor glucose control might deteriorate the impaired pulmonary function, which can ultimately lead to mortality. However, few studies have examined the effect modification of glucose control on the association between pulmonary function and mortality. This study aimed to examine the association of pulmonary function with mortality and determine the effect modification of glycemic level on the association of pulmonary function with mortality in persons with type 2 diabetes (T2DM). MethodsA retrospective cohort study included 3846 persons with T2DM with pulmonary function testing in Taiwan during 2002–2020. Expiratory volume in 1 s (FEV1) was measured as pulmonary function. Cox proportional hazards models were used and the effect modification of pulmonary function parameters and glucose control was assessed by their product terms. ResultsThere were 733 deaths during an average follow-up of 7.83 years. Significant associations of FEV1 and mortality were found (hazards ratio [HR] for FEV1 Z-scores of <0 to −1, <-1 to −2 and <−2: 1.47 [1.20, 1.80], 2.48 [1.95, 3.14] and 3.07 [1.74, 5.44] compared with participants with Z-score ≥0, respectively. All p for trend<0.001). Significant effect modifications were found and the association between FEV1 and mortality was stronger in persons with good glycemic control compared with poor glycemic control (FEV1–FPG effect modification, P = 0.01; FEV1–HbA1c effect modification, P = 0.03). ConclusionPulmonary function, measured by FEV1, is significantly associated with mortality in persons with T2DM. Significant effect modification of glucose control on the association between pulmonary function parameters and mortality was found.

Association of EPA and DHA with age-related macular degeneration: a cross-sectional study from NHANES.

This cross-sectional study conducted in the general US population investigated the association between dietary intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the prevalence of AMD. Data from the National Health and Nutrition Examination Survey (NHANES) were utilized, including 4,842 participants aged 40 years and older. Dietary EPA and DHA intake data were collected through two 24-h dietary recall interviews and adjusted for weight. AMD was determined by a standardized grading system based on the presence of key features of AMD in color photographs of the macula. Multivariate logistic regression and restricted cubic spline models evaluated the associations between dietary EPA and DHA intake and AMD. Subgroup analysis and interaction analysis explored the influence of covariates. A total of 4,842 participants were included. In the multivariate-adjusted model 2, the odds ratios (ORs) with 95% confidence intervals (CIs) for AMD were 0.86 (0.75, 0.99) and 0.88 (0.80, 0.97) per unit increase in dietary EPA and DHA intake, respectively. Interaction testing revealed significant effect modification by age, education, and BMI on the EPA-AMD association, indicating these factors significantly impacted this inverse relationship (p-interaction < 0.05). Similarly, age, education, BMI, and cataract surgery history modified the inverse DHA-AMD association (p-interaction < 0.05). Dose-response analyses demonstrated a negative correlation between dietary EPA and DHA intake with AMD prevalence (p-nonlinearity = 0.184 and 0.548, respectively). Our findings suggested that higher dietary EPA and DHA intake could be associated with lower AMD risk in older US adults. Age, education level, BMI, and history of cataract surgery may influence this inverse association.

Association of Polymorphic Cytochrome P450 Enzyme Pathways with Falls in Multimedicated Older Adults

ObjectivesDose exposure is considered relevant for drug-associated falls in older adults, pointing to an importance of drug metabolism. Aim was to analyze individual factors altering drug metabolism such as enzyme saturation by drug exposure and pharmacogenetics in the context of drug-associated falls. DesignProspective population-based study (ActiFE-Ulm study). Setting and ParticipantsCommunity-dwelling older adults. MethodsFocus was laid on the metabolism by polymorphic cytochrome P450 (CYP) enzymes CYP2C19, 2C9, and 2D6. Relevant variants of pharmacogenes were analyzed. Logistic binary regression analysis was used to calculate odds ratios (ORs) and 95% CIs for falls observed prospectively over a 1-year period with drug metabolism characteristics. ResultsIn total, 1377 participants were included in the analysis. Although the phenotype predicted by the genotype was not, the use of drugs metabolized by CYP2C19 was associated with falls. Drugs not known as fall risk–increasing drugs (FRIDs; ie, non-FRIDs), but metabolized by CYP2C19, showed an OR of 1.46 (1.11-1.93) in adjusted analysis. Significant effect modification was observed for a reduced CYP2C19 activity phenotype with non-FRIDs metabolized by CYP2C19. Conclusions and ImplicationsThis study suggests an association between the occurrence of falls in older adults and the metabolic capacity of CYP2C19. Thus, an important step toward prevention of falls might be to personalize dosage and treatment length of the main drug classes known to be CYP2C19 substrates, such as many antidepressants, opioids, and sedatives, but also proton pump inhibitors in particular in poor and intermediate metabolizers.

Arc-shaped air layer bioinspired by ginkgo nut to resist high humidity environment for PET fabrics

Developing simple processes and significant effect modification method for polyester (PET) fabrics to resist hygrothermal aging is a formidable challenge. In this study, inspired by the silver mirror phenomenon of natural ginkgo nut, we utilized the pea pod-shaped nanoparticles that zinc oxide (ZnO) was encapsulated in polyhedral oligomeric silsesquioxane (ZnO@POSS), and polydimethylsiloxane (PDMS) to construct stabilized arc-shaped air layer on the PET fabric surface to resist high humidity environment. The round belly structures of pea pod-shaped ZnO@POSS and interlaced physical networks assisted by PDMS on the PET fabrics surface served as the crucial roles to capture and retain air, resulting in the capacity of the arc-shaped air layer was significantly larger than other microstructures underwater. The water vapor was prevented from entering the fabric interstices that the self-catalytic hydrolysis behavior of PET macromolecular chains was efficiently restrained, and the strength retention of PET fabric was significantly improved from 45% to 89% after accelerated hygrothermal aging test (60°C, 80% RH, 600 h). This work represents a simple and effective approach to improve the durability for PET fabrics in high humidity environments.

The effect of whole blood resuscitation on in-hospital mortality: A propensity score weighted analysis of patients treated at a Level I trauma center.

Whole blood (WB) transfusion, compared with blood component therapy (CT), has been shown to have superior outcomes in the military population. However, whether this translates to the civilian population remains understudied. This study sought to determine the effect of WB on short-term in-hospital outcomes. This retrospective cohort study included trauma patients at a Level I trauma center who received either WB or CT upon massive transfusion protocol activation between January 2021 and June 2023. The primary outcome was in-hospital mortality, and secondary outcomes included 24-hour mortality, 7-day mortality, 30-day mortality, trauma-induced coagulopathy, and the number of transfusion events required. The effect of transfusion type on patient outcomes was evaluated using a propensity-weighted modified Poisson regression. Of 1,027 massive transfusion protocol-activated patients, 480 (46.8%) received any WB. The propensity score weighting balanced the covariate distribution between the transfusion groups. Significant effect modification (p < 0.05) by injury type (blunt vs. penetrating) on mortality outcomes was observed. Compared with CT recipients, penetrating trauma patients who received WB had a significantly lower adjusted risk of in-hospital (risk ratio [RR], 0.36; 95% confidence interval [CI], 0.15-0.89), 7-day (RR, 0.37; 95% CI, 0.15-0.94), and 30-day (RR, 0.36; 95% CI, 0.15-0.89) mortality but not significantly different 24-hour mortality (RR, 0.39; 95% CI, 0.15-1.00; p = 0.05). An elevated risk of trauma-induced coagulopathy was observed among WB recipients than CT recipients with blunt trauma (RR, 1.59; 95% CI, 1.07-2.36) but not among patients with penetrating injury (RR, 0.65; 95% CI, 0.30-1.40). Compared with CT recipients, WB recipients had reduced transfusion rates for both penetrating (RR, 0.59; 95% CI, 0.36-0.95) and blunt-related injuries (RR, 0.73; 95% CI, 0.58-0.91). The effect of WB on in-hospital mortality is modified by injury type, suggesting the need to consider penetrating injury as an important indication for WB resuscitation. In addition, WB reduces transfusion requirements across both injury types, decreasing patient exposure to transfusion events. Therapeutic; Level III.

Biological Sex Is an Effect Modifier of Allergen-Mediated Alteration of the Lung Proteome.

Asthma exhibits a distinct sex bias in the disease prevalence, severity, and response to therapy. However, sex-related differences in alterations of the lung proteome mediated by aeroallergens critical in asthma, such as house dust mites (HDM), remain unknown. In this study, we define sex-related differences in the lung proteome using an HDM-challenged mouse model by 1D LC-MS/MS. Sex-disaggregated data analysis showed that 406 proteins were uniquely altered in females, 273 proteins were uniquely altered in males, and 414 proteins were altered in both females and males in response to HDM. In a linear mixed model analysis, sex modified the HDM exposure effect for 163 proteins, i.e., a significant sex:exposure interaction was identified in 84 proteins in females and 35 proteins in males. Of these, 12 proteins showed a significant sex effect in both female and male lungs. We further selected 3 proteins Tjp1, Lamtor1, and G3BP2 for independent confirmation studies. Our findings detail the sex-specific lung proteome in response to an aeroallergen critical in asthma and demonstrate that sex is a significant effect modifier of HDM response. These results will serve as a valuable resource for delineating sex-specific mechanisms in aeroallergen-driven responses in asthma research.

Association between physical activity & sedentary time on frailty in adults with chronic kidney disease: Cross-sectional NHANES study

ObjectiveA considerable percentage of individuals with chronic kidney disease (CKD) are reported to be frail. Lower physical activity and higher sedentary time are most consistently associated with frailty among the potentially alterable risk factors. Although the single effect of physical activity or sedentary time on suppressing frailty have been widely studied, whether physical activity can mitigate or counteract the detrimental consequences of higher sedentary time on frailty among CKD population has never been explored. This study aims to explore whether and to what extent the correlation between sedentary time and frailty was diminished by physical activity among CKD population. Study design and settingData were acquired from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2018 cycles. Frailty index was assessed using 49-item deficit model. Physical activity and sedentary time were measured using the Global Activity Questionnaire. Weighted binary logistic regression models, restricted cubic spline models and sensitivity analyses were performed to investigate the aforementioned relationship. ResultsThe final sample included 2551 adults aged ≥20 years with CKD, which is represented a weighted number of 4.98 million noninstitutionalized US population. In the fully adjusted model, the group with low physical activity was 1.56 (95 % CI:1.19, 2.03) times more likely to develop frailty than the group with high physical activity and each unit of increase of sedentary time was associated with an 41 % increased risk of frailty (OR = 1.41, 95 % CI = 1.04–1.89). Our findings also indicated that engaging in 1240–6200 MET-min/week of high physical activity was associated with a decreased risk of frailty related to moderate-to-high sedentary time among CKD population (OR = 0.69, 95 % CI = 0.49–0.99, P = 0.044). In subgroup analyses, high physical activity was associated with a 0.43-fold (95%CI: 0.24, 0.77) decreased risk of moderate-to-high sedentary time associated with frailty in female groups and a significant modification effect of gender was uncovered (Pinteraction = 0.024). ConclusionHigh physical activity was associated with a decreased risk of frailty related to moderate-to-high sedentary time in adults with CKD, especially in females subgroups.

Influenza Vaccination in Adults in the United States with COPD before and after the COVID-19 Pandemic (2017-2022): A Multi-Year Cross-Sectional Study.

There is limited literature regarding seasonal influenza vaccination (SIV) among those with a history of chronic obstructive pulmonary disease (HCOPD) prior to the COVID-19 pandemic, and no information on the topic assessing the years following the pandemic. This cross-sectional study used the Behavioral Risk Factor Surveillance Survey (BRFSS) data from the years 2017 to 2022 (n = 822,783 adults ages 50-79 years; 50.64% males). The exposure was a HCOPD, and the outcome was SIV within the past year. Weighted and adjusted logistic regression models were conducted overall and by the significant effect modifiers: smoking status, sex, and year. Having an HCOPD significantly increases the weighted adjusted odds (WAO) of SIV when compared to not having an HCOPD overall and by smoking status, sex, and year. For 2017 through 2022, among all current, former, and never smokers with an HCOPD, the WAO of SIV were: 1.36 (1.28, 1.45), 1.35 (1.27, 1.43), and 1.18 (1.09, 1.27), respectively. Among males with an HCOPD who were current, former, and never smokers, the WAO of SIV were: 1.35 (1.23, 1.48), 1.45 (1.33, 1.58), and 1.23 (1.05, 1.44), respectively. Among females with an HCOPD who were current, former, and never smokers, the WAO of SIV were: 1.31 (1.20, 1.43), 1.24 (1.15, 1.35), and 1.13 (1.04, 1.23), respectively. Study findings suggest males had significantly greater WAO ratios of receiving SIV than females in 2020 and 2022, during and after the COVID-19 pandemic. More specifically, males with an HCOPD who were former smokers had significantly greater WAOR of receiving SIV than females in 2020 and 2022. Understanding the potential barriers to SIV receipt by smoking status and sex, especially during a pandemic, and especially for individuals impacted by an HCOPD, is essential for better health interventions in times of a national crisis such as a pandemic. Additionally, SIV receipt is low among those with an HCOPD, and efforts should be made to improve this.

Non-Linear Association of Dietary Polyamines with the Risk of Incident Dementia: Results from Population-Based Cohort of the UK Biobank.

Natural polyamines, including spermidine (SPD), spermine (SPM) and putrescine (PUT), are evolutionarily conserved endogenous molecules crucially involved in central cellular processes. Their physiological importance may extend to the maintenance of cognitive function during aging. However, limited population-based epidemiological studies have explored the link between dietary polyamines and dementia risk. This study was a prospective analysis of 77,092 UK Biobank participants aged ≥ 60 years without dementia at baseline. We used Cox proportional hazard regression models to explore the associations between dietary polyamines and the risk of dementia, and restricted cubic splines to test the non-linear relationships. During a median follow-up of 12 years, 1087 incidents of all-cause dementia cases occurred, including 450 Alzheimer's disease (AD) cases and 206 vascular dementia (VD) cases. The fully adjusted hazard ratios (HRs) for the upper fourth quintile of dietary SPD, in comparison with the lowest quintile of intake, were 0.68 (95% confidence interval [95% CI]: 0.66-0.83) for the risk of all-cause dementia, 0.62 (95% CI: 0.45-0.85) for AD and 0.56 (95% CI: 0.36-0.88) for VD, respectively. A 26% reduction in dementia risk [HR: 0.74, (95% CI: 0.61-0.89)] and a 47% reduction in AD [HR: 0.53, (95%CI: 0.39-0.72)] were observed comparing the third with the lowest quintiles of dietary SPM. Dietary PUT was only associated with a reduced risk of all-cause dementia in the fourth quintile [HR (95% CI): 0.82 (0.68-0.99)]. Reduced risk was not found to be significant across all quintiles. There were 'U'-shaped relationships found between dietary polyamines and all-cause dementia, AD and VD. Stratification by genetic predisposition showed no significant effect modification. Optimal intake of polyamines was linked to a decreased risk of dementia, with no modification by genetic risk. This potentially suggests cognitive benefits of dietary natural polyamines in humans.

Do greenspaces really reduce heat health impacts? Evidence for different vegetation types and distance-based greenspace exposure

BackgroundWhile vegetation type, population density and proximity to greenspaces have been linked to human health, what type and location of greenspace matter most have remained unclear. In this context, there are question marks over investment-style metrics. ObjectivesThis paper aims at establishing what vegetation type may matter most in modifying heat-mortality associations, and what the optimal buffer distances of total and specific types of greenspace exposure associated with reduced heat-related mortality risks are. MethodsWe conducted small-area analyses using daily mortality data for 286 Territory Planning Units (TPUs) across Hong Kong and 1 × 1 km gridded air temperature data for the summer months (2005–2018). Using a case time series design, we examined effect modifications of total and specific types of greenspaces, as well as population-weighted exposure at varying buffer distances (200–4000 m). We tested the significance of effect modifications by comparing relative risks (RRs) between the lowest and highest quartiles of each greenspace exposure metric; and explored the strength of effect modifications by calculating the ratio of RRs. ResultsForests, unlike grasslands, showed significant effect modifications on heat-mortality associations, with RRs rising from 0.98 (95 %CI: 0.92,1.05) to 1.06 (1.03, 1.10) for the highest to lowest quartiles (p-value = 0.037) The optimal distances associated with the most apparent effects were around 1 km for population-weighted exposure, with the ratio of RRs being 1.424 (1.038,1.954) for NDVI, 1.191 (1.004,1.413) for total greenspace, and 1.227 (1.024,1.470) for forests. A marked difference was observed in terms of the paired area-level and optimal distance-based exposure to total greenspace and forests under extreme heat (p-values < 0.05). DiscussionOur findings suggest that greenspace, particularly nearby forests, may significantly mitigate heat-related mortality risks.

The effect of antibiotic premedication on postoperative complications following dental extractions.

We aimed to evaluate the association between antibiotic prophylaxis and adverse outcomes following tooth extraction within the Veterans Affairs Healthcare System. We conducted a retrospective cohort study of patients undergoing dental extractions in 2015-2019. The primary exposure was antibiotic prophylaxis. The primary outcome was post-extraction complication within 7 days (e.g., alveolar osteitis and surgical site infection); the secondary outcome was subsequent medical care relating to a post-extraction oral complication within 7 days. Multivariable logistic regression models assessed the independent effect of antibiotic prophylaxis on each outcome. Of 385,880 visits with a dental extraction, 122,810 (31.8%) received antibiotic prophylaxis. Overall, 3387 (0.9%) experienced a post-extraction complication and 350 (0.09%) received medical care relating to a post-extraction oral complication within 7 days. In multivariable regression, diabetes was a statistically significant (p = 0.01) effect modifier of the association between antibiotic prophylaxis and post-extraction complication. Among visits for patients without diabetes, antibiotic prophylaxis was significantly associated with an increased odds of post-extraction complication (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.13-1.38), but among visits for patients with diabetes no significant effect was observed (OR = 1.03, 95% CI: 0.92-1.15). Antibiotic prophylaxis was not significantly associated with post-extraction medical care (OR = 1.04; 95% CI: 0.83-1.30). In this large retrospective cohort, we observed no significant protective effect of antibiotic prophylaxis on post-extraction complications or subsequent medical care utilization in a setting with low complication rates. These data suggest that use of antibiotic prophylaxis in similar settings may need to be re-evaluated to minimize unnecessary antibiotic use.

Association between triglyceride-glucose related indices and all-cause and cause-specific mortality in the general population: a cohort study

BackgroundAlthough triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance and cardiometabolic disease, its effectiveness in predicting mortality risk has not been adequately validated. We aimed to investigate the association between the TyG-related indices and all-cause and cause-specific mortality in the general population.MethodsA total of 27,642 individuals were included from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. Three indicators were constructed, including the TyG index, TyG combined with waist-to-height ratio (TyG-WHtR), and TyG combined with waist circumference (TyG-WC). Mortality data was acquired through the linkage of NHANES data with National Death Index records. Weighted Cox proportional hazards models were used to estimate the independent association between the TyG-related indices and mortality. Nonlinear associations were explored using restricted cubic splines.ResultsMultivariable adjusted models showed a progressive increase in all-cause and cause-specific mortality across quartiles of the TyG-related indices. Compared with the lowest quartile of the TyG index, the highest quartile had adjusted hazard ratios of 1.26 (95% CI 1.04–1.52) for all-cause mortality, 1.38 (1.04–1.74) for cardiovascular mortality, and 1.23 (1.01–1.50) for non-cardiovascular mortality, respectively. For the TyG-WHtR index, the corresponding hazard ratios were 1.60 (1.25–2.05), 1.86 (1.26–2.50), and 1.48 (1.10–1.99), respectively. For the TyG-WC index, the corresponding hazard ratios were 1.42 (1.11–1.75), 1.48 (1.04–1.96), and 1.38 (1.05–1.72), respectively. The associations between the three TyG-related indices and all-cause, cardiovascular and non-cardiovascular mortality were J-shaped. Interaction tests revealed significant effect modification by age, low-density lipoprotein cholesterol (LDL-C) level, and statin use (all P values < 0.05).ConclusionsThe TyG-related indices were independent predictors of all-cause and cause-specific mortality in the general population. Young individuals should be particularly vigilant, whereas low LDL-C levels and statin use are potentially protective.

J-shaped associations of pan-immune-inflammation value and systemic inflammation response index with stroke among American adults with hypertension: evidence from NHANES 1999-2020.

Stroke, a leading cause of death and disability worldwide, is primarily ischemic and linked to hypertension. Hypertension, characterized by systemic chronic inflammation, significantly increases stroke risk. This study explores the association of novel systemic inflammatory markers (SII, PIV, SIRI) with stroke prevalence in hypertensive U.S. adults using NHANES data. We analyzed data from hypertensive participants in the NHANES 1999-2020 survey, excluding those under 20, pregnant, or with missing data, resulting in 18,360 subjects. Systemic inflammatory markers (SII, PIV, SIRI) were calculated from blood counts. Hypertension and stroke status were determined by self-report and clinical measurements. Covariates included sociodemographic, lifestyle, and medical history factors. Weighted statistical analyses and multivariate logistic regression models were used to explore associations, with adjustments for various covariates. Ethical approval was obtained from the NCHS Ethics Review Board. In a cohort of 18,360 hypertensive individuals (mean age 56.652 years), 7.25% had a stroke. Stroke patients were older, had lower PIR, and were more likely to be female, single, less educated, smokers, non-drinkers, physically inactive, and have diabetes and CHD. Multivariate logistic regression showed that SII was not significantly associated with stroke. However, PIV and SIRI were positively associated with stroke prevalence. Each unit increase in lnPIV increased stroke odds by 14% (OR = 1.140, p = 0.0022), and lnSIRI by 20.6% (OR = 1.206, p = 0.0144). RCS analyses confirmed J-shaped associations for lnPIV and lnSIRI with stroke. Stratified analyses identified gender and smoking as significant effect modifiers. Smoking was significantly associated with elevated PIV, SIRI, and SII levels, especially in current smokers. Elevated PIV and SIRI levels significantly increase stroke prevalence in hypertensive individuals, notably among males and smokers. A predictive model with PIV, SIRI, and sociodemographic factors offers strong clinical utility.

School-based racial segregation, social support, and late-life cognitive function in the Study of Healthy Aging in African Americans (STAR).

School-based social support for Black students may mediate or modify the association between school segregation and late-life cognition. Study of Healthy Aging in African Americans participants (n=574) reported segregated school attendance and school-based social support. Associations of segregated schooling with domain-specific cognitive outcomes and effect modification or mediation by school-based social support were evaluated with linear mixed models. Segregated school attendance was associated with increased likelihood of school-based social support. Segregated (vs. desegregated in 6th grade) school attendance was associated with lower executive function (β =-0.18 [-0.34, -0.02]) and semantic memory z-scores (β =-0.31 [-0.48, -0.13]). Social support did not mediate these associations. Estimates for segregated school attendance were attenuated among those who felt supported, although there was limited evidence of statistically significant effect modification. Early-childhood school segregation was associated with poorer cognitive function. Sources of resilience within racialized educational experiences should be further evaluated to bridge inequities. School segregation is a form of structural racism that affected the educational experiences of Black youth with potentially lasting consequences for healthy brain aging. Black students who attended a segregated school experienced greater school-based social support, which may highlight a potential source of resilience and resistance against the effects of racism-related stressors on cognitive function. The estimated adverse association between attending a segregated school on cognition was larger for students without an adult at school who cared about them versus those with an adult at school who cared about them, but estimates were imprecise.

Associations of cerebral amyloid beta and tau with cognition from midlife.

Understanding early neuropathological changes and their associations with cognition may aid dementia prevention. This study investigated associations of cerebral amyloid and tau positron emission tomography (PET) retention with cognition in a predominately middle-aged community-based cohort and examined factors that may modify these relationships. 11C-Pittsburgh compound B amyloid and 18F-flortaucipir tau PET imaging were performed. Associations of amyloid and tau PET with cognition were evaluated using linear regression. Interactions with age, apolipoprotein E (APOE) ε4 status, and education were examined. Amyloid and tau PET were not associated with cognition in the overall sample (N=423; mean: 57±10 years; 50% female). However, younger age (<55 years) and APOE ε4 were significant effect modifiers, worsening cognition in the presence of higher amyloid and tau. Higher levels of Aβ and tau may have a pernicious effect on cognition among APOE ε4 carriers and younger adults, suggesting a potential role for targeted early interventions. Risk and resilience factors influenced cognitive vulnerability due to Aβ and tau. Higher fusiform tau associated with poorer visuospatial skills in younger adults. APOE ε4 interacted with Aβ and tau to worsen cognition across multiple domains.

Age as an Effect Modifier of the Effects of Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) on Heart Rate Variability in Healthy Subjects.

Background: Evidence suggests that vagus nerve stimulation can modulate heart rate variability (HRV). However, there is a lack of mechanistic studies in healthy subjects assessing the effects of bilateral transcutaneous auricular vagus nerve stimulation (taVNS) on HRV. Our study aims to investigate how taVNS can influence the HRV response, including the influence of demographic variables in this response. Methods: Therefore, we conducted a randomized controlled study with 44 subjects, 22 allocated to active and 22 to sham taVNS. Results: Our results showed a significant difference between groups in the high-frequency (HF) metric. Active taVNS increased the HF metric significantly as compared to sham taVNS. Also, we found that age was a significant effect modifier of the relationship between taVNS and HF-HRV, as a larger increase in HF-HRV was seen in the older subjects. Importantly, there was a decrease in HF-HRV in the sham group. Conclusions: These findings suggest that younger subjects can adapt and maintain a constant level of HF-HRV regardless of the type of stimulation, but in the older subjects, only the active taVNS recipients were able to maintain and increase their HF-HRV. These results are important because they indicate that taVNS can enhance physiological regulation processes in response to external events.