Significant Positive Association Research Articles

Association of METS-IR index with Type 2 Diabetes: A cross-sectional analysis of national health and nutrition examination survey data from 2009 to 2018.

With rising global diabetes prevalence, precise early identification and management of diabetes risk are critical research areas. The metabolic score for insulin resistance (METS-IR), a novel non-insulin-based tool, is gaining attention for quantifying insulin resistance using multiple metabolic parameters. Despite its potential in predicting diabetes and its precursors, evidence on its specific relationship with diabetes is limited, especially in large-scale population validation and mechanistic exploration. This study aims to analyze the association between METS-IR and type 2 diabetes (T2DM) in American adults. We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2018. Participants aged 20 years and above were included, excluding individuals with missing data on BMI, fasting blood glucose, high-density lipoprotein cholesterol glycated hemoglobin and diabetes status. Logistic regression analysis, subgroup analysis, and restricted cubic spline analysis were used to assess the association between METS-IR and T2DM, controlling for potential confounding factors. After adjusting for age, gender, race, education level, smoking status, drinking habits, depression, physical activity, hypertension, and hyperlipidemia, we found a positive association between METS-IR and the risk of T2DM. Specifically, each unit increase in METS-IR was associated with a 7% increase in the risk of T2DM (OR = 1.07, 95% CI: 1.06, 1.08). Subgroup analysis showed that the association between METS-IR and T2DM incidence was significantly positive in the highest quartile group, particularly among Mexican Americans over 40 years old and those diagnosed with depression, hypertension, or hyperlipidemia. Our study revealed a significant positive association between METS-IR and the prevalence of T2DM, indicating that this relationship persists even after controlling for various confounding factors. Therefore, monitoring METS-IR may provide a valuable tool for the early identification of individuals at risk of glucose metabolism disorders. Further research should focus on the applicability of METS-IR in different populations and its potential impact on clinical practice.

The correlation between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with non-alcoholic fatty liver disease: an analysis of the population-based NHANES (2017–2018)

Background/objectiveNon-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver disorders, from benign steatosis to more severe conditions like non-alcoholic steatohepatitis, with risks of progressing to fibrosis, cirrhosis, and hepatocellular carcinoma. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) indicates lipid metabolic dysregulation and is associated with increased risks of various diseases. This study examines the relationship between NHHR and NAFLD to evaluate NHHR as a potential predictive biomarker for NAFLD.MethodsData from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) were used for cross-sectional analysis. After excluding individuals with incomplete data, hepatitis infections, heavy alcohol use, and those under 18, the study included 2,757 adults. The relationship between NHHR and NAFLD was analyzed using multivariable logistic regression, including subgroup analysis and interaction testing.ResultsAmong the 2,757 participants (mean age 49.91 years), 44.9% had NAFLD. NHHR showed a significant positive association with NAFLD, with an unadjusted odds ratio (OR) of 1.71 and a fully adjusted OR of 1.45. Quartile analysis revealed a 228% higher prevalence of NAFLD in the highest NHHR quartile, with an OR of 3.28. This positive association was consistent across various subgroups.ConclusionOur findings suggest that elevated NHHR is positively correlated with the prevalence of NAFLD and possesses predictive value. We recommend that future research validate the clinical utility of NHHR, particularly for early detection of high-risk individuals and guiding personalized interventions.

Associations Between Callous-Unemotional (CU) Traits and EmotionRecognition Abilities in School Children: The Influence of ConductProblems and Age.

Callous-unemotional (CU) traits are associated with severe conduct problems (CP) in youth. Causal theories for CU traits focus on emotion processing deficits that interfere with empathy development. However, though CU traits are consistently associated with deficits in affective empathy (i.e., emotional reactivity), the association between CU traits and cognitive empathy, which requires accurate emotion recognition, is less clear. We hypothesize that past inconsistencies in the associations between CU traits and emotion recognition may be due to interactions with conduct problems (CP) and age. To test this, a sample (N = 258) of school children in the 3rd, 6th, and 8th grades completed a computer task that assessed facial expression recognition, while caregivers and teachers reported on CU traits and CP. Results from hierarchical linear regression analyses indicated significant interactions between CU traits and CP in their associations with overall emotion recognition and with recognition of fearful and sad faces. In each case, CP showed a non-significant negative association with emotion recognition at high levels of CU traits. However, for fear and sadness recognition, CP was positively associated with accuracy at low levels of CU traits. Significant interactions between CU traits and age also emerged for recognition of fear and sadness, such that there were non-significant negative associations between CU traits and recognition accuracy in younger children, but significant positive associations in 8th grade students. These results have multiple implications as they help to clarify past inconsistencies on the association between CU traits and emotion recognition and can aid in the development of more effective interventions to prevent or treat conduct problems in young children.

The association between circulating short-chain fatty acids and blood pressure in Chinese elderly population

The gut microbiome primarily generates short-chain fatty acids (SCFAs) by fermenting dietary fibers. Though previous studies have linked SCFAs to blood pressure, there remains a lack of research on the relationship between SCFAs levels in the serum of elderly individuals and blood pressure. Based on this, we investigated the associations of serum SCFAs with blood pressure in Chinese older adults in a cross-sectional study. In this report, we recruited 1013 older adults over 60 years of age from June to September 2016 in Lu 'an City, China. Using Ultra High Performance Liquid Chromatography-Quadrupole-Exactive-Orbitrap-Mass Spectrometry (UHPLC-QE-Orbitrap MS), we measured the level of various SCFAs, including acetic acid (AA), propanoic acid (PA), butyric acid (BA), isobutyric acid (iso-BA), valeric acid (VA), isovaleric acid (iso-VA), and caproic acid (CA), in serum samples collected from Chinese elderly adults. The study recruited 1013 older adults in total. Multiple logistic regression analysis shows that AA (OR = 0.696, 95%CI: 0.501–0.966) and VA (OR = 0.713, 95%CI: 0.516–0.985) are negatively associated with hypertension. Linear regression analysis shows a negative correlation between AA (β = -3.89, 95% CI: -7.12 – -0.66) and the systolic blood pressure (SBP) levels, and a significant negative association between iso-VA (β = -2.11, 95% CI: -3.94 – -0.29) and diastolic blood pressure (DBP) levels. Whether in unadjusted or adjusted linear regression models, we all observe significant positive associations between CA and blood pressure levels. In the Bayesian kernel-machine regression (BKMR) models, the trends between the mixture of SCFAs and hypertension, SBP are inverse, but not significant; we also observe a significant negative correlation between AA and SBP, and a significant negative association between iso-VA and DBP levels, while CA is significantly positively correlated with SBP and DBP. Collectively, our results advocate for considering SCFA as a potential intervention to lower blood pressure, and especially AA may be a possible target for research. This may provide new perspectives for understanding the role of SCFAs in hypertension.

Value-based reimbursement under the inpatient prospective payment system in Japan: a review of Japan’s diagnosis procedure combination/per-diem payment system

Aim The aim of this study is to review the influence of functional evaluation coefficient (FEC) II adjustments on reimbursement for hospitals in Japan operating under the diagnosis procedure combination/per-diem payment (DPC/PDPS) system. Methods Publicly available information was used to describe the FEC II adjustment system and to consider its influence on reimbursement for fiscal years (FY) 2018, 2020, and 2022. Moreover, descriptive statistics and multivariate regression analysis were used to consider how the adjustment differed based on hospital and treatment-related characteristics in FY 2022. Results In FY 2022 there were 1764 hospitals operating under the DPC/PDPS system and the FEC II adjustment was highest, on average, for hospitals in the Hokkaido/Tohoku and Chubu regions with a mean adjustment in reimbursement of 0.1033 (+10.33%), respectively, and lowest for hospitals in the Kyushu/Okinawa region with a mean adjustment of only 0.0921 (+9.21%). Based on the results of a multivariate regression analysis, hospitals in the Hokkaido/Tohoku, Kinki, or Chugoku/Shikoku regions and those that had more cases related to the nervous system, the circulatory system, hematological disorders, and traumas, burns, and poisoning had a statistically significant positive association with the FEC II adjustment. Conversely, University or Specified DPC/PDPS hospital and those having more cases related to eye, ENT, breast, mental, and musculoskeletal system/connective tissue disorders had a statistically significant negative association with the FEC II adjustment. Conclusion The FEC II adjustment varies by hospital region, hospital type, and the kind of conditions treated by DPC/PDPS hospitals in Japan. New technologies to support DPC/PDPS hospitals that focus on the treatment of musculoskeletal system and connective tissue disorders, for example, and to allow for a reduction in the length of stay of patients may lead to a higher reimbursement for some DPC hospitals.

Recurrent Aphthous Stomatitis and Sleep Quality Factors: A Comprehensive Analysis.

Due to the unclear etiology of recurrent aphthous stomatitis (RAS), a painful and distressing condition with a high prevalence, the researchers have hypothesized a connection between sleep quality and RAS. The cross-sectional study enrolled 10,138 Fasa Cohort Study participants aged 35-70 years. Various sleep quality factors were calculated and categorized based on the Pittsburgh Sleep Questionnaire. Among 9030 subjects finally included with RAS prevalence of 20.2%, adjusted logistic regression showed significant odds ratios (ORs) in subjects who sleep < 5 h (OR = 1.44, 95%CI 1.25, 1.66), have sleep latencies of more than 60 min (OR = 1.37, 95%CI 1.11, 1.69), have sleep efficiencies of 65%-75% (OR = 1.55, 95%CI 1.21, 1.98), or regularly go to bed after 11 p.m. (OR = 1.23, 95%CI 1.11, 1.37). Subgroup analyses indicated no significant associations between RAS and various sleep factors in individuals who worked night shifts, and stronger associations were observed in men than women. The study found a significant positive association between RAS and sleep quality factors such as shorter duration, lower efficiency, longer latency, later bedtime, and regular sleeping pill use. Establishing early and sufficient sleep and addressing sleep onset disturbances by adhering to sleep hygiene principles should be prioritized in individuals with RAS.

Psychometric Properties of Social Climate in the Classroom Scale for University Students in Chile

Background: Classroom social climate is a significant phenomenon within educational contexts; however, it has predominantly been studied among high school students, with limited evidence available at the university level and, consequently, in the psychometric properties of measurement instruments. This study aimed to analyze the psychometric properties of the University Classroom Social Climate Scale (ECSA-U) among Chilean students from the La Araucanía region. Method: 422 students participated, responding to the adapted version of the ECSA-U and the Motivation subscale of the Motivation and Learning Strategies Questionnaire. Exploratory structural equation modeling (ESEM), reliability analyses, and correlation analyses were conducted to provide valid evidence for the Chilean University Classroom Social Climate Scale (ECSA-UCL). Results: The scale demonstrated a three-factor structure with good fit indicators, excellent reliability indices, and significant positive associations between the ECSA-UCL and the Motivation Subscale. Conclusions: The ECSA-UCL has proven valid and reliable for measuring the perception of Classroom Social Climate among Chilean university students, making it suitable for use as a measurement tool in studies or interventions that include this variable.

The Impact of Hospital Competition on the Quality of Care in Europe: A Systematic Review

Objectives This study analyzes the results of empirical studies on the impact of hospital competition (rivalry and market pressure) on the quality of care in European countries. Methods A systematic review has been conducted according to the Preferred Reporting Items for Systematic Reviewing and Meta-Analysis (PRISMA) guidelines, using the following online databases: PubMed, ScienceDirect, Wiley Online Library, and Google Scholar. The search protocol covers studies published in English between January 2015 and mid-April 2024. Results Eight out of 14 eligible studies document significant positive associations, at least in the short term, between hospital competition and the quality of care measured through objective outcome indicators. Of the other six, one study demonstrates a negative relationship in a specific context. The findings of the remaining five studies are heterogeneous and context-dependent (two out of five) or suggest no discernible association between the two examined phenomena (three out of five). The respective contexts with positive, negative, or no statistically significant associations have been identified. Conclusions The most essential impacts of competition on the quality of hospital care have been summarized, and avenues for future research and policy implications have been discussed.

Magnesium depletion score and depression: a positive correlation among US adults

BackgroundThe Magnesium depletion score (MDS) serves as a novel metric for quantifying magnesium deficiency in the human body, comprehensively assessing four indicators: diuretic use, proton pump inhibitor use, estimated glomerular filtration rate, and alcohol abuse. However, there have been no studies examining the potential association between MDS and depression.MethodsThe study population for this cross-sectional study comprised adults from the National Health and Nutrition Examination Survey database from 2009 to 2018. Participants with a score of 10 or above on the Patient Health Questionnaire-9 were defined as having depression. We employed multivariable logistic regression models to investigate the association between MDS and depression. Furthermore, subgroup analyses were conducted to assess potential differences in this association among populations with diverse characteristics.ResultsA total of 13,197 participants were included in this study. After adjusting for all covariates, a significant positive correlation was observed between MDS and depression. Specifically, for every unit increase in MDS, the likelihood of developing depression increased by 13% (OR = 1.13, 95% CI: 1.04–1.22, p = 0.0025). This positive correlation was consistent across MDS groups, with a 19% increase in depression likelihood in the medium group (OR = 1.19, 95% CI: 1.01–1.41, p = 0.0404) and a 58% increase in the high group (OR = 1.58, 95% CI: 1.21–2.07, p = 0.0007), using the low subgroup as a reference. Subgroup analyses revealed significant differences in the relationship between MDS and depression across races, marital statuses, and hypertension status.ConclusionOur study has uncovered a significant positive association between MDS and depression. Reducing MDS in individuals may play a positive role in both the prevention and treatment of depression.

Validation of the Difficulties in Emotion Regulation Scale-Short Form in a sample of Italian adolescents.

The primary objective of the present study is to validate the Difficulty in Emotion Regulation Scale-Short Form (DERS-SF) in a sample of Italian adolescents. Additionally, we aim to evaluate its factorial structure by examining the contribution of each subscale (i.e., Nonacceptance, Clarity, Awareness, Goals, Impulse, Strategy) on the general factor using bi-factor models by replicating a past study. The sample comprises N = 704 adolescents aged 11-17 years (M = 13.38, SD = 1.37; 53.12% females). To establish external validity, correlation and path analyses were conducted between the DERS-SF sub-scales, the total score, and measures of internalizing and externalizing symptoms, as well as Problematic Smartphone Use (PSU). Measurement invariance was tested comparing males versus females and pre-adolescents and adolescents. Overall, results supported the multidimensional nature of the DERS-SF, confirming its original six-factor structure. However, bi-factor models analysis revealed that the Awareness subscale should be excluded when calculating the total score. Furthermore, findings indicated that the Strategy subscale variance is largely accounted for by the general factor rather than the specific subscale. In terms of external validity, significant positive associations between the DERS-SF sub-scales, the total score, and PSU, internalizing and externalizing symptoms were observed. Measurement invariance was supported. Altogether, findings support the validity of the DERS-SF among Italian Adolescents and provide insights relevant to the understanding of the multifaceted facets of emotion regulation, emphasizing its relevance as a transdiagnostic process.

Factors Influencing Political Brand Coolness and Voting Intention

ABSTRACTEstablishing a voter connection requires political parties to prioritize providing the electorate with pleasurable experiences, treating them as consumers, and incorporating the “coolness factor” as a key ingredient. Consequently, the perceived coolness of a political brand is a characteristic that develops and evolves independently within society. The current empirical research aims to explore the various factors that contribute to the perceived coolness of political brands and its influence on voting intention. The study's participants are selected from India, a vibrant and diverse nation known as the world's largest democracy. In order to analyze the data, researchers employ the technique known as Structural Equation Modeling (SEM). The results of the analysis highlight the considerable impact of political party brand meaning on its coolness, indicating a positive relationship between the two. The coolness of the political party brand is heavily influenced by the leader's image, which has a significant positive impact. It is further revealed that political party brand coolness has a significant positive association with voting intention and party brand engagement. Our investigation shows that political brand engagement serves as a mediator in the association between political brand coolness and voting intention, besides the direct influence of political brand coolness on voting intention. A comprehensive understanding of the study's findings enables political marketers to identify more effective strategies for cultivating political brand coolness and leveraging them to create memorable experiences that resonate with voters. Those factors ultimately affect how people vote.

LAG-3 Expression, γδ-T cell/MHC-I Interactions and Prognosis in Merkel Cell Carcinoma

Merkel Cell Carcinoma (MCC) is an aggressive cutaneous malignancy with a poor prognosis. One of the major mechanisms of immune evasion in MCC involves downregulation of MHC-I. Anti-PD-1/PD-L1 checkpoint inhibitors (CKIs) have revolutionized treatment for MCC, producing objective responses in ∼50% of patients, and are now standard of care; however, a substantial proportion of patients either fail to respond or develop resistance to CKIs. Given these recent successes, identification of other targetable immune checkpoints in the MCC tumor microenvironment (TME) is of great interest. Additionally, γ-delta (γδ) T cells may play critical roles in the response to MHC-I deficient cancers; therefore, evaluating γδ-T cells as a prognostic biomarker is warranted. We characterized the expression of PD-L1, PD-1, CD3, CD8, LAG-3, MHC-I, and γδ-T cells by IHC in a pre-immunotherapy retrospective cohort of 54 cases of MCC, and quantified expression levels and marker density via HALO. The increased density of LAG-3 and γδ-T cells correlated with other markers of an inflamed TME, with significant positive associations across all six markers (p<.002). Reflective of their putative role in the response to MHC-I suppressed cancers, cases with low HLA-I density showed a trend towards a higher ratio of γδ-T cells:CD3+ T cells (Spearman's r=-0.1582, p=0.21). Importantly, high CD3 density (HR=0.23, p=0.002), LAG-3 density (HR=0.47, p=0.037), γδ-T cell density (HR=0.26, p=0.02), and CD8 density (HR=0.27, p=0.03) showed associations with improved progression-free survival. Conditional tree analysis demonstrated that high CD8 and TCRδ expression were non-significant predictors of improved PFS and OS. Overall, LAG-3 is expressed in MCC infiltrates and is prognostic in pre-immunotherapy MCC, suggesting a potential role for LAG-3 inhibition in MCC. Additionally, CD8 and γδ-T cells may play a critical role in the response to MCC, and γδ-T cell density may represent a novel biomarker in MCC.

The association between N-nitrosamines exposure and lipid metabolism in the high incidence area of esophageal cancer: A case-control analysis

Environmental carcinogens such as N-nitrosamines are high-risk factors for the development of esophageal cancer (EC). However, the association between nitrosamines exposure and lipid metabolism disorders in human EC remained largely obscure. Therefore, we conducted a population-based case-control study established with esophageal inflammation (BCH), esophageal heterotrophic hyperplasia (DYS), patients with primary EC and matched controls in high prevalence area of EC in China. Our prospective work investigated the joint and independent effects of N-nitrosamines co-exposure on the risk of EC development. Lipidomics analysis was employed to screen differential lipid biomarkers in serum, and the mediating effects of key lipid metabolites in the association between nitrosamines exposure and EC were evaluated. After adjustment for confounders, N-nitrosodimethylamine (NDMA, 1.79 (95% CI: 1.35, 2.39)), N-nitrosodi-n-propylamine (NDPA, 1.55 (95%CI: 1.15, 2.09)), N-nitrosodiethylamine (NDEA, 1.82 (95%CI: 1.36, 2.45)), N-nitrosodibutylamine (NDBA, 1.60 (95%CI: 1.20, 2.13)), N-nitrosomethylethylamine (NMEA, 1.81 (95%CI: 1.36, 2.41)) and N-nitrosomorpholine (NMOR, 1.84 (95%CI: 1.38, 2.45)) exposure all elevated the risks of EC development. The Bayesian kernel machine regression (BKMR) with hierarchical variable selection showed significant positive joint associations of urinary NDMA, NDPA, NMOR, NDEA and EC development, when all nitrosamines were at the 55th percentiles or above, compared with the median. Lipidomic screening of serum samples from the stages of BCH, DYS and EC suggested the perturbation in the biosynthesis of unsaturated fatty acid metabolism pathway, of which myristic acid (FFA 14:0), palmitoleic acid (FFA 16:1), docosahexaenoic acid (FFA 22:6) exerted remarkable mediation effects in the association between N-nitrosamines exposure and EC development. These findings provided new sights for screening early lipid biomarkers and intervention targets in human EC.

Triglyceride-glucose Index and Its combination with obesity indicators mediating the association between 2-hydroxyfluorene and the prevalence of cardiovascular disease: Evidence from the NHANES (2005–2018)

BackgroundPolycyclic aromatic hydrocarbons (PAHs) were increasingly recognized as a group of environmental pollutants associated with various health issues. The rise in their prevalence in the environment was concerning. Yet, the effects of PAH exposure on cardiovascular diseases (CVDs) were still not well understood. PurposeThis study investigated the impact of exposure to 2-hydroxyfluorene on CVDs prevalence, with a special focus on the mediating role of triglyceride-glucose (TyG) index and its combination with obesity indicators. MethodUsing National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, this study assessed how 2-hydroxyfluorene affects CVDs prevalence through various statistical techniques. The investigation began with restricted cubic spline (RCS) analysis to explore the relationship between 2-hydroxyfluorene levels and CVDs prevalence. Logistic regression was then used to examine associations within PAH mixtures, alongside the Bayesian Kernel Machine Regression (BKMR) model. Furthermore, the Quantile G-Computation (QG-comp) model was used to evaluate the influence of weights and directions. A mediation analysis was also performed to assess the mediating role of TyG-related indicators on the relationship between 2-hydroxyfluorene and CVDs prevalence. Besides, the association between 2-hydroxyfluorene and the prevalence of each specific CVDs, congestive heart failure, myocardium infarction, angina pectoris and coronary heart disease, was also assessed and so was the mediated effect. Finally, the subgroup analysis was conducted to assess the association in each specific subgroup. ResultThe study, involving 3645 participants, found a significant positive association between 2-hydroxyfluorene exposure and CVD (OR (95 %CI) = 115.8013 (5.0521 ∼ 2654.3248), P=0.0029), with 2-hydroxyfluorene showing the positive contribution to CVDs prevalence within the phthalate mixture. The positive association also existed between 2-hydroxyfluorene and the prevalence of each specific CVDs. TyG and TyGWC (Triglyceride Glucose-Waist Circumference) were identified as mediators in the link between 2-hydroxyfluorene exposure and the prevalence of total CVD and each specific CVD, while TyGBMI (Triglyceride Glucose-Body Mass Index) can only mediate the association between 2-hydroxyfluorene and the prevalence of total CVD, congestive heart failure and angina pectoris ConclusionThe findings highlighted a significant association between 2-hydroxyfluorene exposure and CVDs prevalence, with TyG-related indicators acting as mediators.

Association of relationship satisfaction with blood pressure: a cross-sectional study of older adults in rural Burkina Faso

ObjectivesThe objective of this study is to examine the association between relationship satisfaction and blood pressure (BP) in a low-income setting and to screen for gender moderation in this context....

Ambivalent ageism and the pains and gains of informal caregiving for older adults: Findings from Germany

Background and ObjectivesWe analyzed the associations between ambivalent ageism, burden and positive experiences of care among informal caregivers of older adults (aged ≥60 years), to advance understanding of its role as psychosocial risk or resilience factor for informal caregivers. Design and MethodsData of 433 informal caregivers (≥18 years) of adults with care needs (≥60 years) from the Attitudes towards Informal Caregivers (ATTIC) project was used. The Ambivalent Ageism Scale, Positive Aspects of Care Scale and the Burden Scale for Family Caregivers were used. Linear regression analyses adjusted for context and personal factors were conducted, with age and gender included as moderators in additional tests. ResultsHigh ageism (total score) was significantly associated with a high level of positive aspects of care and burden. Further analyses showed a significant positive association between benevolent ageism and positive aspects of care, while stronger hostile ageism was associated with less positive aspects of care. Hostile ageism was also significantly associated with more burden, while benevolent ageism and burden were not associated. Additional analyses indicated no moderation by gender, but by age. The association between hostile ageism and burden was weaker with caregivers’ higher age. Discussion and ImplicationsWhile hostile ageism and worse caregiver burden were associated, positive care experiences seemed to benefit from benevolent ageism. This highlights the complex associations between ageism and caregivers’ well-being, which need to be taken into account in theory and practice focused on improving the care situation for both caregivers and care recipients.

Association between sarcopenic obesity and osteoarthritis: The potential mediating role of insulin resistance

BackgroundSarcopenic obesity (SO) and osteoarthritis (OA) are highly prevalent musculoskeletal conditions that significantly impair health-related quality of life. AimThis study investigated the association between SO and OA, and explored the potential mediating role of insulin resistance in this relationship. We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. MethodsThis cross-sectional analysis employs NHANES data collected from 1999 to 2018, including participants aged 18 years and older. SO was assessed using dual-energy X-ray absorptiometry (DXA) measurements. Insulin resistance was estimated using the triglyceride-glucose (TyG) index. OA status was based on self-reported physician diagnosis. Statistical analyses included weighted logistic regression, restricted cubic spline (RCS) interaction analysis, mediation analysis using structural equation modeling (SEM), and receiver operating characteristic (ROC) curve analysis. Subgroup analyses were conducted based on age, sex, and diabetes status. ResultsThe sarcopenic obese group demonstrated the highest prevalence of OA (23.4 %), hypertension (47.8 %), and diabetes (12.0 %). Additionally, they exhibited elevated levels of triglycerides, cholesterol, glucose, blood urea nitrogen (BUN), creatinine, and uric acid. Logistic regression revealed significant positive associations between sarcopenic obesity, the TyG index, and OA risk. RCS analysis identified significant non-linear relationships and interactions of the TyG index with age, sex, and diabetes status on OA risk. Mediation analysis indicated that the TyG index mediated approximately 4.9 % of the effect of sarcopenic obesity on OA risk. ROC curve analysis demonstrated moderate diagnostic accuracy for the TyG index (AUC = 0.65), which improved when incorporated into the multivariate model (AUC = 0.78). Subgroup analyses confirmed significant associations between the TyG index and sarcopenic obesity with OA risk across different age, sex, and diabetes status categories. ConclusionOur findings suggest a significant correlation between insulin resistance, as measured by the TyG index, and elevated OA risk in individuals with sarcopenic obesity. Targeting insulin resistance through future research may be a promising avenue to lower OA risk in this population.

Maternal and Cord Blood Levels of Metals and Fetal Liver Function

Exposure to metals during pregnancy has been associated with adverse birth outcomes, but its impact on fetal liver function remains poorly understood. This study for the first time aimed to investigate the association between maternal and umbilical cord blood Metals levels and umbilical liver enzymes. A comprehensive analysis was conducted on 450 mother-newborn pairs in 2022, measuring 13 Metals in serum samples from pregnant women during the third trimester and umbilical cord blood samples. Regression analyses were utilized to examine the relationship between levels of maternal and umbilical cord blood Metals and the levels of gamma-glutamyl transferase (GGT), umbilical alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). G-comp analyses evaluated the combined effect of metals exposure on umbilical liver enzymes. Elevated levels of certain Metals in cord blood and maternal samples were positively linked with increased umbilical GGT, ALP, ALT, and AST levels. Notably, zinc (Zn) levels in cord blood exhibited an inverse correlation with umbilical liver enzyme levels. Furthermore, g-comp analyses revealed significant positive associations between exposure to metals mixtures and umbilical liver enzyme levels. An increase of one quartile in the mixture of maternal and umbilical Metals was linked with 99.45 U/L (95% CI:37.72, 161.19, p < 0.01), 2.79 (95% CI: 0.92, 4.65, p < 0.01), and 87.17 (95% CI: 53.96, 120.38, p < 0.01) increase in ALP, ALT and GGT levels. Further examination of the weight of Metals revealed As, Cd, Ni, Pb, Hg and Cr with the highest positive effects and Zn with the highest negative effect in the mixture effect on the umbilical liver enzyme. In summary, our results underscore the potential influence of prenatal heavy metal exposure on fetal liver function.

Factors influencing health-promoting behavior among single mothers in Northeastern Malaysia: a cross-sectional study.

Health-promoting behaviors (HPB) play a vital role in maintaining and enhancing overall well-being. Single mothers are at higher risk of cardiovascular disease (CVD) and less involvement in HPB due to psychosocial disadvantages. This study aimed to determine the HPB scores and factors influencing HPB among single mothers in Kelantan (Northeastern, Malaysia). This study employed a cross-sectional design, selecting 242 single mothers from Kelantan through proportional stratified sampling. Data were gathered through questionnaires covering sociodemographic details, the Health-Promoting Lifestyle Profile-II (HPLP-II), the Malay Version of Health Beliefs Related to Cardiovascular Disease (HBCVD-M), and Multidimensional Perceived Social Support (MPSS). The relationships between the dependent variable (HPB) and independent variables were analyzed using multivariable linear regression models. The respondents achieved an average HPB score of 118.03 (SD = 19.2), with the highest mean scores in spiritual growth (22.46 [SD = 3.70]) and interpersonal relationships (22.05 [SD = 3.67]). Physical activity had the lowest mean score at 15.09 (SD = 4.62). Significant positive associations were found between HPB and perceived severity of CVD (adjusted β = 1.60; 95% CI [0.68-2.53]; p<0.001) as well as perceived social support (adjusted β = 0.63; 95% CI [0.37-0.90]; p<0.001). Conversely, educational level (adjusted β = -10.36; 95% CI [-16.06 to -4.67]; p<0.001) and perceived benefits of reducing CVD risk (adjusted β = -1.43; 95% CI [-2.37 to -0.48]; p<0.001) were negatively associated with HPB. The findings highlight the importance of health beliefs, social support, and education in shaping HPB among single mothers. Community health initiatives targeting this population should develop strategies to strengthen individuals' health beliefs and promote a supportive environment.

Patterns of referral to interprofessional services among frail older adults presenting to emergency departments in Canada.

Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics. We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression. We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures. The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.