Standardized Odds Ratio Research Articles

Extracted step parameters during the timed up and go test discriminate between groups with different levels of cognitive ability-a cross-sectional study.

Identifying cognitive impairment at an early stage is important to enable preventive treatment and lifestyle changes. As gait deviations precede cognitive impairment, the aim of this study was to investigate if step parameters during different Timed Up and Go (TUG) conditions could discriminate between people with different cognitive ability. Participants (N = 304) were divided into the following groups: (1) controls, n = 50, mean age:73, 44% women; (2) Subjective cognitive Impairment (SCI), n = 71, mean age:67, 45% women; (3) Mild Cognitive Impairment (MCI), n = 126, mean age: 73, 42% women; and (4) dementia disorders, n = 57, mean age: 78, 51% women. Participants conducted TUG and two motor-cognitive TUG-conditions: TUG while naming animals (TUGdt-NA) and reciting months in reverse order (TUGdt-MB). Tests were video recorded for data extraction of valid spatiotemporal parameters: step length, step width, step duration, single step duration and double step duration. Step length was investigated with the step length/body height ratio (step length divided by body height). Logistic regression models (adjusted for age, sex and education) investigated associations between step parameters and dichotomous variables of groups adjacent in cognitive ability: dementia disorders vs. MCI, MCI vs. SCI, and SCI vs. controls. Results were presented as standardized odds ratios (sORs), with 95% confidence intervals (CI95) and p-values (significance level: p < 0.05). The areas under the Receiver Operating Characteristic curves were presented for the step parameters/conditions with the highest sORs and, where relevant, optimal cutoff values were calculated. Step length showed greatest overall ability to significantly discriminate between adjacent groups (sOR ≤ . 67, CI95: .45-.99, p = ≤ . 047) during all group comparisons/conditions except three. The highest sOR for step-length was obtained when discriminating between SCI vs controls during TUGdt-MB (sOR = .51, CI95:.29- .87, p = .014), whereby the area under the curve was calculated (c-statistics = .700). The optimal cut-off indicated a step length of less than 32.9% (CI95 = 22.1-43.0) of body height to identify SCI compared with controls. The results indicate that step length may be important to assess during TUG, for discrimination between groups with different cognitive ability; and that the presented cut-off has potential to aid early detection of cognitive impairment. NCT05893524 (retrospectively registered 08/06/23).

Abstract 4144992: Ambient Air Pollution Heightens Prevalence and Adverse Impacts of Clonal Hematopoiesis of Indeterminate Potential

Background: Clonal hematopoiesis of indeterminate potential (CHIP), characterized by the expansion of somatic leukemogenic variations in hematopoietic stem cells, has been linked to atherosclerotic cardiovascular disease. While particulate matter with aerodynamic diameter ≤2.5 micrometers (PM2.5) is known to elevate major adverse cardiovascular event (MACE) risk, potentially through enhanced leukopoietic activity, the specific connection between PM2.5 and CHIP and their combined role in MACE risk, remains unclear. Hypothesis: We hypothesized that high levels of PM2.5 exposure are associated with increased CHIP prevalence, which in turn mediates the relationship between PM2.5 exposure and MACE risk. Methods: We analyzed data of 7015 participants from the Mass General Brigham Biobank, who had undergone genotyping and had their PM2.5 exposure quantified (for the year prior to consent) based on residential addresses. CHIP detection utilized whole-exome sequencing of blood DNA. MACE diagnosis and risk factors were assessed using ICD codes and health surveys. Multivariable logistic regressions and mediation analysis were employed. Results: Of the participants (mean age of 64 (SD 0.2) years and 47.8% male), 972 exhibited CHIP. High PM2.5 exposure was associated with an increased risk of CHIP (standardized odds ratio [OR] 1.140 [95% CI: 1.031, 1.262], p=0.011; Fig 1A) and a higher number of CHIP mutations (OR:1.403 [95% CI: 1.123, 1.753], p=0.003; Fig 1B) after adjusting for covariables related to CHIP*. Further, CHIP mediated the relationship between PM2.5 exposure and MACE risk (p&lt;0.05). Notably, MACE risk was greatest among individuals with CHIP who were exposed to higher PM2.5 (OR:1.405 [95% CI: 1.104,1.786], p=0.006*; Fig 2). Conclusion: Our findings suggest that ambient air pollution exposure not only associates with the CHIP prevalence but also exacerbates the risk of adverse cardiovascular events through these genetic mutations. This study highlights the importance of addressing air quality as a modifiable risk factor in the prevention of cardiovascular diseases, particularly among individuals with or at risk for CHIP.

Impacts from air pollution on respiratory disease outcomes: a meta-analysis.

Air pollution is widely acknowledged as a significant factor in respiratory outcomes, including coughing, wheezing, emergency department (ED) visits, and even death. Although several literature reviews have confirmed the association between air pollution and respiratory outcomes, they often did not standardize associations across different studies and overlooked other increasingly impactful pollutants such as trace metals. Recognizing the importance of consistent comparison and emissions of non-exhaust particles from road traffic, this study aims to comprehensively evaluate the standardized effects of various criteria pollutants and trace metals on respiratory health. We conducted a comprehensive meta-analysis of peer-reviewed journal articles on air pollution and respiratory outcomes published between 1 January 2000, and 1 June 2024. The study included children (age < 18 years), adults (age ≥ 18 years), and all age groups exposed to criteria pollutants established by the US Environmental Protection Agency National Ambient Air Quality Standards and over 10 trace metals. Using databases, such as PubMed, MEDLINE, Web of Science Core Collection, and Google Scholar, we identified 579 relevant articles. After rigorous screening and quality assessment using the Newcastle-Ottawa Scale, 50 high-quality studies were included. We converted various reported outcomes (e.g., odds ratios, relative risk, and percent increase) to a standardized odds ratio (OR) for comparability and performed meta-analyses using R 4.4.0 and related packages, ensuring the robustness of our findings. Our meta-analysis indicated significant associations between air pollutants and respiratory outcomes. For particulate matter with diameter ≤ 2.5 μm (PM2.5), the overall ORs for children, adults, and combined age groups were 1.31, 1.10, and 1.26, respectively, indicating a consistent positive association. Similar positive associations were observed for particulate matter with diameter ≤ 10 μm (PM10) and other pollutants, with children showing higher susceptibility than adults. The analysis of trace metals also showed significant associations; however, these findings require cautious interpretation due to the small number of studies. Our study supports associations between air pollutants, including non-exhaust trace metals, and respiratory outcomes across different age groups. The findings underscore the need for stringent environmental health policies and further research, especially in regions with higher pollution levels. The future studies should consider long-term and short-term exposures separately and include diverse populations to improve the accuracy and generalizability of the results.

What are the perspectives of patients with hand and wrist conditions, chronic pain, and patients recovering from stroke on the use of patient and outcome information in everyday care? A Mixed-Methods study

PurposeTo evaluate the patients’ perspectives on the use of patient- and outcome information tools in everyday care and to investigate which characteristics affect general understanding and perceived value of patient- and outcome information.MethodsThis mixed-methods study included surveys and interviews on understanding, experience, decision-support, and perceived value in patients with hand and wrist conditions and chronic pain. We synthesized our quantitative and qualitative findings using a triangulation protocol and identified factors independently associated with general understanding and perceived value of patient- and outcome information using hierarchical logistic regression.ResultsWe included 3379 patients. The data triangulation indicated that patients understand the outcome information, they find it valuable, it supports decision-making, and it improves patient-clinician interaction. The following variables were independently associated with better general understanding: having more difficulty with questionnaires (standardized odds ratio 0.34 [95%-CI 031–0.38]), having a finger condition (0.72 [0.57–0.92]), longer follow-up (0.75 [0.61–0.91]), and undergoing surgical treatment (ref: non-surgical treatment, 1.33 [1.11–1.59]). For more general value, these were: having more difficulty with questionnaires (0.40 [0.36–0.44]), having a wrist condition (0.71 [0.54–0.92]), better hand function (1.12 [1.02–1.22]), and requiring help with questionnaires (1.65 [1.33–2.05]).ConclusionPatients value the use of patient- and outcome information tools in daily care and find it easy to understand. The factors associated with understanding and value can be targeted to personalized and value-based healthcare. We recommend using outcome information to improve patient independence, empowerment, and involvement in decision-making.

Lipoprotein Combine Index as a Better Marker for NAFLD Identification Than Traditional Lipid Parameters.

The association between traditional lipid parameters and non-alcoholic fatty liver disease (NAFLD) has been extensively discussed. This study aims to evaluate and compare the lipoprotein combine index (LCI) and traditional lipid parameters [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] to identify NAFLD. The analysis included 14,251 participants from the NAfld in the Gifu Area, Longitudinal Analysis (NAGALA). Logistic regression models were employed to calculate standardized odds ratios (ORs) and 95% confidence intervals (CIs) for assessing and comparing the association of LCI and traditional lipid parameters with NAFLD. Additionally, receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) for LCI and traditional lipid parameters in identifying NAFLD. After adjusting for various confounders, we found that LCI was positively associated with NAFLD (OR=2.25, 95% CI 1.92-2.63), and this association was stronger than that of traditional lipid parameters [OR: TC1.23, TG1.73 LDL-C1.10]. Further subgroup analyses revealed that the association of LCI with NAFLD was stronger than other traditional lipid parameters in all subgroups, including men and women, overweight/obese [body mass index (BMI)≥25 kg/m2] and non-obese (BMI<25 kg/m2), and older (age≥45 years) and younger (age<45 years) participants. Additionally, ROC analysis indicated that LCI (AUC=0.8118) had significantly higher accuracy (All DeLong P<0.05) in identifying NAFLD compared to traditional lipid parameters (AUC: TC0.6309; TG0.7969; LDL-C0.6941); HDL-C0.7587). Sensitivity analysis further confirmed the robustness of the study findings. This study revealed for the first time a positive correlation between LCI and NAFLD. Compared to traditional lipid parameters, LCI has a higher correlation with NAFLD. Additionally, further ROC analysis demonstrated that LCI had higher accuracy in identifying NAFLD compared to traditional lipid parameters, suggesting that LCI may be a better marker for NAFLD identification than traditional lipid parameters.

Abstract 769: Incorporating a cross-ancestry polygenic risk score into a clinical model improved breast cancer risk prediction in women with pathogenic variants

Abstract Introduction. We previously developed and validated a cross-ancestry polygenic risk score (caPRS) to predict risk of developing breast cancer (BC) in women who do not carry pathogenic variants (PVs) in BC susceptibility genes. Here we aimed to expand upon that study by integrating the caPRS with the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model to combine the effects of genetic and clinical factors in carriers of PVs in BRCA1, BRCA2, PALB2, CHEK2 and ATM. Methods. We explored the association of caPRS among 12,525 women from the UK Biobank and the Consortium of Investigators of Modifiers of BRCA1/2. The effect size of the caPRS was evaluated separately for individuals carrying PVs in BRCA1, BRCA2, CHEK2, ATM and PALB2. We used a logistic regression model adjusted for age, first-degree BC family history (FHx) and cohort for BRCA1 and BRCA2 to examine the association of the caPRS with BC. The effect sizes were expressed as standardized odds ratios (ORs) with 95% confidence intervals (CIs). The estimated absolute risks to age 80 of developing BC were calculated for unaffected women by combining the caPRS-based risk with gene-specific clinical risk estimates from the BOADICEA model based on U.S. incidences. Results. The caPRS was significantly associated with BC risk across all PV carrier groups. Using BOADICEA alone, the estimated absolute BC risk by age 80 for an average unaffected 20-year-old female in the U.S. with an unknown FHx ranged from 23.8% for CHEK2 carriers to 79.4% for BRCA2 carriers. Integration of caPRS into BOADICEA, yielded the distribution of risk for each gene. (Table) Gene N OR per SD (95% CI) Absolute risk by BOADICEA Median absolute risk by BOADICEA + caPRS (Range) ATM 2,037 1.46 (1.25 - 1.71) 24.9% 27.1% (0.1 - 70.5) BRCA1 5,794 1.24 (1.18 - 1.31) 76.1% 75.6% (55.6 - 87.7) BRCA2 4,018 1.40 (1.31 - 1.49) 79.4% 78.7% (45.2 - 92.1) CHEK2 372 1.88 (1.41 - 2.55) 23.8% 28.2% (0.0 - 78.4) PALB2 304 1.81 (1.37 - 2.43) 53.9% 56.3% (2.9 - 90.9) Conclusions. The caPRS significantly modified BC risk for carriers of PVs and could help tailor guidelines for women with PVs, particularly in moderate penetrance genes. More data is needed to increase the precision and reach of risk assessment in diverse populations. Citation Format: Placede Tshiaba, Monika Sun, Dariusz Ratman, Jeffrey N. Weitzel, Premal Shah, Matthew Rabinowitz, Akash Kumar, Kate Im. Incorporating a cross-ancestry polygenic risk score into a clinical model improved breast cancer risk prediction in women with pathogenic variants [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 769.

Abstract WP172: A Novel Score to Predict Early Time From Symptom Onset to Hospital Arrival in Patients With Intracerebral Hemorrhage

Introduction: Up to 40% of ICH patients have unknown onset time, leading to uncertainty regarding the use of hyperacute ICH treatments and their exclusion from acute ICH treatment trials. We aimed to develop a prediction score that can reliably identify ICH patients presenting within 3 hours of symptom onset. Methods: Spontaneous ICH patients participating in the iDEF trial with available prerequisite data were analyzed. A stepwise multivariable logistic regression model was used to determine predictors of early presentation (symptom onset-to-baseline CT scan time ≤3 hours) with a p-value &lt; 0.15. To develop the prediction score, we allocated scores proportional to the standardized odds ratio (OR) of each binary variable. Continuous variables were dichotomized using the lowest threshold above which there was no additional gain in the positive predictive value (PPV) for early presentation. Results: Of 291 iDEF participants, 132 (45%) presented early. Baseline NIHSS (OR 1.05 per 1-score increase; 95% CI, 0.99-1.11), Glasgow Coma Scale (1.18 per 1-score increase; 1.01-1.39), ICH volume (1.17 per 10-ml increase; 0.98-1.39), absolute perihematomal edema volume (0.81 per 10-ml increase; 0.66-1.00), irregular hematoma shape (2.24; 1.12-4.48), blend sign (0.45; 0.21-0.97), white blood cell count (0.89 per 10 3 cell/ml increase; 0.82-0.96), and blood glucose levels (0.91 per mmol/l increase; 0.82-0.99) were associated with early presentation (c-statistic=0.71). The PPV for an early ICH presentation score (Figure) of &gt;7 was 69%. Conclusion: This novel early ICH presentation score using readily available clinical, neuroimaging, and laboratory data has good performance for identification of ICH patients presenting within 3 hours of symptom onset. If validated in external datasets, the early ICH presentation score can be used to improve recruitment feasibility in acute ICH trials and support clinical decision-making in ICH patients with an unknown symptom onset time.

Predicting ranger attrition

ABSTRACT Elite military programs such as the 75th Ranger Regiment’s Ranger Assessment and Selection Program (RASP) see rates of attrition often in excess of 50%, and amplify the need to identify and screen candidates based on their probability of successful matriculation. Models were developed (and cross-validated) to predict attrition from RASP using the physical abilities, cognitive abilities, and personality scores collected during candidate admissions screening. We report both regression weights and standardized odds ratios for optimum models of candidate success over three program timeframes to enable an understanding of the relative importance of each predictor. In spite of physical abilities scores being used to select RASP candidates, they were the strongest predictors of RASP attrition. Personality scores accounted for more variance in predicting candidate success than cognitive ability scores. Personality predictors, especially dimensions related to Openness, were better at predicting week one attrition than attrition in later weeks. The use of a single, aggregated candidate probability score for making admissions decisions is discussed, along with additional practical and scientific implications.

Metabolite Signature of Life's Essential 8 and Risk of Coronary Heart Disease Among Low-Income Black and White Americans.

Life's essential 8 (LE8) is a comprehensive construct of cardiovascular health. Yet, little is known about the LE8 score, its metabolic correlates, and their predictive implications among Black Americans and low-income individuals. In a nested case-control study of coronary heart disease (CHD) among 299 pairs of Black and 298 pairs of White low-income Americans from the Southern Community Cohort Study, we estimated LE8 score and applied untargeted plasma metabolomics and elastic net with leave-one-out cross-validation to identify metabolite signature (MetaSig) of LE8. Associations of LE8 score and MetaSig with incident CHD were examined using conditional logistic regression. The mediation effect of MetaSig on the LE8-CHD association was also examined. The external validity of MetaSig was evaluated in another nested CHD case-control study among 299 pairs of Chinese adults. Higher LE8 score was associated with lower CHD risk (standardized odds ratio, 0.61 [95% CI, 0.53-0.69]). The MetaSig, consisting of 133 metabolites, showed significant correlation with LE8 score (r=0.61) and inverse association with CHD (odds ratio, 0.57 [0.49-0.65]), robust to adjustment for LE8 score and across participants with different sociodemographic and health status ([odds ratios, 0.42-0.69]; all P<0.05). MetaSig mediated a large portion of the LE8-CHD association: 53% (32%-80%). Significant associations of MetaSig with LE8 score and CHD risk were found in validation cohort (r=0.49; odds ratio, 0.57 [0.46-0.69]). Higher LE8 score and its MetaSig were associated with lower CHD risk among low-income Black and White Americans. Metabolomics may offer an objective measure of LE8 and its metabolic phenotype relevant to CHD prevention among diverse populations.

Cumulative burden and trajectories of body mass index and blood pressure from childhood and carotid intima-media thickness in young adulthood

Cumulative burden and trajectories of body mass index and blood pressure from childhood and carotid intima-media thickness in young adulthood

Evaluating Data Product Exposure Metrics for Use in Epidemiologic Studies of Dust Storms.

Dust storms are increasing in frequency and correlate with adverse health outcomes but remain understudied in the United States (U.S.), partially due to the limited spatio-temporal coverage, resolution, and accuracy of current data sets. In this work, dust-related metrics from four public areal data products were compared to a monitor-based "gold standard" dust data set. The data products included the National Weather Service (NWS) storm event database, the Modern-Era Retrospective analysis for Research and Applications-Version 2, the EPA's Air QUAlity TimE Series (EQUATES) Project using the Community Multiscale Air Quality Modeling System (CMAQ), and the Copernicus Atmosphere Monitoring Service global reanalysis product. California, Nevada, Utah, and Arizona, which account for most dust storms reported in the U.S., were examined. Dichotomous and continuous metrics based on reported dust storms, particulate matter concentrations (PM10 and PM2.5), and aerosol-type variables were extracted or derived from the data products. Associations between these metrics and a validated dust storm detection method utilizing Interagency Monitoring of Protected Visual Environments monitors were estimated via quasi-binomial regression. In general, metrics from CAMS yielded the strongest associations with the "gold standard," followed by the NWS storm database metric. Dust aerosol (0.9-20μm) mixing ratio, vertically integrated mass of dust aerosol (9-20μm), and dust aerosol optical depth at 550nm from CAMS generated the highest standardized odds ratios among all metrics. Future work will apply machine-learning methods to the best-performing metrics to create a public dust storm database suitable for long-term epidemiologic studies.

Brachial and central hypertension in relation to coronary stenosis in patients with coronary angiography.

The clinical significance of central beyond brachial blood pressure (BP) remains unclear. In patients who underwent coronary angiography, the authors explored whether elevated central BP would be associated with coronary arterial disease (CAD) irrespective of the status of brachial hypertension. From March 2021 to April 2022, 335 patients (mean age 64.9 years, 69.9% men) hospitalized for suspected CAD or unstable angina were screened in an ongoing trial. CAD was defined if a coronary stenosis of ≥50%. According to the presence of brachial (non-invasive cuff systolic BP ≥140mmHg or diastolic BP ≥90mmHg) and central (invasive systolic BP ≥130mmHg) hypertension, patients were cross-classified as isolated brachial hypertension (n=23), isolated central hypertension (n=93), and concordant normotension (n=100) or hypertension (n=119). In continuous analyses, both brachial and central systolic BPs were significantly related to CAD with similar standardized odds ratios (OR, 1.47 and 1.45, p<.05). While categorical analyses showed that patients with isolated central hypertension or concordant hypertension had a significantly higher prevalence of CAD and the Gensini score than those with concordant normotension. Multivariate-adjusted OR (95% confidence interval [CI]) for CAD was 2.24 (1.16 to 4.33, p=.009) for isolated central hypertension and 3.02 (1.58 to 5.78, p<.001) for concordant hypertension relative to concordant normotension. The corresponding OR (95% CI) of a high Gensini score was 2.40 (1.26-4.58) and 2.17 (1.19-3.96), respectively. In conclusion, regardless of the presence of brachial hypertension, elevated central BP was associated with the presence and severity of CAD, indicating that central hypertension is an important risk factor for coronary atherosclerosis.

A Bayesian approach to estimate the probability of resistance to bedaquiline in the presence of a genomic variant.

Bedaquiline is a core drug for treatment of rifampicin-resistant tuberculosis. Few genomic variants have been statistically associated with bedaquiline resistance. Alternative approaches for determining the genotypic-phenotypic association are needed to guide clinical care. Using published phenotype data for variants in Rv0678, atpE, pepQ and Rv1979c genes in 756 Mycobacterium tuberculosis isolates and survey data of the opinion of 33 experts, we applied Bayesian methods to estimate the posterior probability of bedaquiline resistance and corresponding 95% credible intervals. Experts agreed on the role of Rv0678, and atpE, were uncertain about the role of pepQ and Rv1979c variants and overestimated the probability of bedaquiline resistance for most variant types, resulting in lower posterior probabilities compared to prior estimates. The posterior median probability of bedaquiline resistance was low for synonymous mutations in atpE (0.1%) and Rv0678 (3.3%), high for missense mutations in atpE (60.8%) and nonsense mutations in Rv0678 (55.1%), relatively low for missense (31.5%) mutations and frameshift (30.0%) in Rv0678 and low for missense mutations in pepQ (2.6%) and Rv1979c (2.9%), but 95% credible intervals were wide. Bayesian probability estimates of bedaquiline resistance given the presence of a specific mutation could be useful for clinical decision-making as it presents interpretable probabilities compared to standard odds ratios. For a newly emerging variant, the probability of resistance for the variant type and gene can still be used to guide clinical decision-making. Future studies should investigate the feasibility of using Bayesian probabilities for bedaquiline resistance in clinical practice.

Control status of ambulatory blood pressure and its relationship with arterial stiffness in the China nationwide registry of treated hypertensive patients: the REACTION-ABP study.

The control rate of ambulatory blood pressure (BP) is unclear in Chinese hypertensive patients, and whether it would be associated with the ambulatory arterial stiffness indices is also unknown. From June 2018 until December 2022, 4408 treated hypertensive patients (52.8% men, average age 58.2 years) from 77 hospitals in China were registered. Ambulatory BPs were measured with validated monitors and analyzed with a web-based standardized Shuoyun system ( www.shuoyun.com.cn ). The BP control rate was the highest in the office (65.7%), moderate in the daytime (45.0%), low in the morning (34.1%), and the lowest in the nighttime (27.6%, P < 0.001). Only 21.0% had their 24 h BP perfectly controlled. The stepwise regression analyses identified that the factors associated with an imperfect 24 h BP control included male sex, smoking and drinking habits, a higher body mass index, serum total cholesterol and triglycerides, and the use of several specific types of antihypertensive drugs. After adjustment for the above-mentioned factors, the 24 h pulse pressure (PP) and its components, the elastic and stiffening PPs, were all significantly associated with an uncontrolled office and ambulatory BP status with the standardized odds ratios ranging from 1.09 to 4.68 (P < 0.05). The ambulatory arterial stiffness index (AASI) was only associated with an uncontrolled nighttime and 24 h BP status. In conclusion, the control rates of 24 h ambulatory BP, especially that in the nighttime and morning time windows, were low in Chinese hypertensive patients, which might be associated with arterial stiffness in addition to other common risk factors.

A Combined Approach Using Water Quality Indexes and Statistical Analyses to Assess the Urban Surface Runoff: a Case Study in São Paulo Coastal Zone, Brazil

Although the most conventional methods to determine the quality of an aquatic ecosystem are aimed to evaluate its physicochemical, microbiological and ecotoxicological characteristics, the monitoring of a large number of environmental variables can represent a high cost for developing countries like Brazil. However, a combined approach using water quality indexes and statistical analyses may help us to monitor water quality through a previous selection of a few key environmental variables. In this context, the objective of this study was to highlight the set of environmental variables most useful to assess the urban channels water quality of Guarujá, Brazil, whose diffuse loads flow continuously into four tourist beaches (Tombo, Enseada, Perequê and Iporanga). For this purpose, three different methods were applied: (i) an existent published large data set (30 environmental variables: 28 physicochemical/microbiological, plus 2 ecotoxicological) obtained during a previous monitoring of the urban drainage channels of these beaches; (ii) the potential risks for the aquatic local fauna and flora through established water quality indexes, such as IMPC, TSI and ALPI; and (iii) through statistical methods such as Cohen D test, Standardized Odds Ratio and Logistic Regression, the set of environmental variables with the greatest potential to cause acute and chronic toxicity in urban channels waters. This combined approach using water quality indexes and statistical analyses was effective to successfully reduce the number of environmental variables needed to assess the ecological status of this coastal area. Moreover, this combined approach was useful to gather intuitive and user-friendly environmental information that could help decision makers (i.e., public authorities and environmental agencies) to plan and perform low-cost and effective monitoring plans in different coastal zones worldwide, namely in developing countries such as Brazil.

Visualization and Quantification of the Association Between Breast Cancer and Cholesterol in the All of Us Research Program.

Epidemiologic evidence for the association of cholesterol and breast cancer is inconsistent. Several factors may contribute to this inconsistency, including limited sample sizes, confounding effects of antihyperlipidemic treatment, age, and body mass index, and the assumption that the association follows a simple linear function. Here, we aimed to address these factors by combining visualization and quantification a large-scale contemporary electronic health record database (the All of Us Research Program). We find clear visual and quantitative evidence that breast cancer is strongly, positively, and near-linearly associated with total cholesterol and low-density lipoprotein cholesterol, but not associated with triglycerides. The association of breast cancer with high-density lipoprotein cholesterol was non-linear and age dependent. Standardized odds ratios were 2.12 (95% confidence interval 1.9-2.48), P = 5.6 × 10-31 for total cholesterol; 1.99 (1.75-2.26), P = 2.6 × 10-26 for low-density lipoprotein cholesterol; 1.69 (1.3-2.2), P = 9.0 × 10-5 for high-density lipoprotein cholesterol at age < 56; and 0.65 (0.55-0.78), P = 1.2 × 10-6 for high-density lipoprotein cholesterol at age ⩾ 56. The inclusion of the lipid levels measured after antihyperlipidemic treatment in the analysis results in erroneous associations. We demonstrate that the use of the logistic regression without inspecting risk variable linearity and accounting for confounding effects may lead to inconsistent results.

Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study.

Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. However, methods to efficiently process and use continuously measured vital sign data remain unclear. The aim of this study was to explore methods to summarize continuously measured vital sign data and evaluate their association with respiratory insufficiency in COVID-19 patients at the general ward. In this retrospective cohort study, we included patients admitted to a designated COVID-19 cohort ward equipped with continuous vital sign monitoring. We collected continuously measured data of respiratory rate, heart rate, and oxygen saturation. For each patient, 7 metrics to summarize vital sign data were calculated: mean, slope, variance, occurrence of a threshold breach, number of episodes, total duration, and area above/under a threshold. These summary measures were calculated over timeframes of either 4 or 8 hours, with a pause between the last data point and the endpoint (the "lead") of 4, 2, 1, or 0 hours, and with 3 predefined thresholds per vital sign. The association between each of the summary measures and the occurrence of respiratory insufficiency was calculated using logistic regression analysis. Of the 429 patients that were monitored, 334 were included for analysis. Of these, 66 (19.8%) patients developed respiratory insufficiency. Summarized continuously measured vital sign data in timeframes close to the endpoint showed stronger associations than data measured further in the past (ie, lead 0 vs 1, 2, or 4 hours), and summarized estimates over 4 hours of data had stronger associations than estimates taken over 8 hours of data. The mean was consistently strongly associated with respiratory insufficiency for the three vital signs: in a 4-hour timeframe without a lead, the standardized odds ratio for heart rate, respiratory rate, and oxygen saturation was 2.59 (99% CI 1.74-4.04), 5.05 (99% CI 2.87-10.03), and 3.16 (99% CI 1.78-6.26), respectively. The strength of associations of summary measures varied per vital sign, timeframe, and lead. The mean of a vital sign showed a relatively strong association with respiratory insufficiency for the majority of vital signs and timeframes. The type of vital sign, length of the timeframe, and length of the lead influenced the strength of associations. Highly associated summary measures and their combinations could be used in a clinical prediction score or algorithm for an automatic alarm system.

Excess pressure but not pulse wave velocity is associated with cognitive function impairment: a community-based study.

Carotid-femoral pulse wave velocity (cf-PWV), an index of mainly distal aortic stiffness, has been inconsistently associated with cognitive function. Excess pressure, derived from the arterial reservoir-excess pressure analysis, may integrate the pulsatile load of the proximal aorta. The present study examined whether increased excess pressure is associated with cognitive function impairment in community adults. A total of 992 community participants (69.5% females; mean age: 67.3 years; education 13.6 years) without cerebrovascular disease or dementia received the Montreal Cognitive Assessment (MoCA) to evaluate global cognition. Arterial reservoir and excess pressure, arterial stiffness, and wave reflections were assessed, using carotid tonometry and aortic Doppler flowmetry. Excess pressure integral (XSPI), percentage XSPI, cf-PWV, characteristic impedance (Zc), and forward and backward pressure amplitude (Pf, Pb, respectively) were significantly higher in 197 participants (19.9%) with a low MoCA score (<26 or <25, depending on level of education). In multivariable analyses, XSPI (standardized odds ratio, 95% confidence interval, 1.30, 1.06-1.59), and percentage XSPI (1.27, 1.06-1.52) but not cf-PWV (1.04, 0.85-1.26) were significantly associated with a low MoCA. Further analysis revealed that Pf and Zc were the major determinants of XSPI (partial R2: Pf = 0.656, Zc = 0.467) and percentage XSPI (Pf = 0.459, Zc = 0.371). In contrast, age, instead of Pf and Zc, was the major determinant of cf-PWV (partial R2: age = 0.187). Excess pressure (XSPI/percentage XSPI), mainly determined by the pulsatile hemodynamics of the proximal aorta, was significantly associated with cognitive function impairment in middle-aged and elderly community adults.

Short Daily-Life Walking Bouts and Poor Self-Reported Health Predict the Onset of Depression in Community-Dwelling Older People: A 2-Year Longitudinal Cohort Study.

Short Daily-Life Walking Bouts and Poor Self-Reported Health Predict the Onset of Depression in Community-Dwelling Older People: A 2-Year Longitudinal Cohort Study.

Prevalence and Risk Factors for Postoperative Complications Following Open A1 Pulley Release for a Trigger Finger or Thumb

Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pulley release. Patients completed baseline questionnaires, including patient characteristics, clinical characteristics, and the Michigan Hand outcomes Questionnaire. We retrospectively reviewed medical records to identify complications classified using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions tool. Grade 1 complications comprise treatment with additional hand therapy, splinting, or analgesics, grade 2 treatment with antibiotics or steroid injections, grade 3A minor surgical treatment, grade 3B major surgical treatment, and grade 3C complex regional pain syndrome. Logistic regression analyses were performed to examine the contribution of patient characteristics, clinical characteristics, and patient-reported outcome measurement scores to complications. Of the included 3,428 patients, 16% incurred a complication. The majority comprised milder grades 1 (6%) and 2 (7%) complications, followed by more severe grades 3B (2%), 3C (0.1%), and 3A (0.1%) complications. A longer symptom duration (standardized odds ratio [SOR], 1.09), ≥3 preoperative steroid injections (SOR, 3.22), a steroid injection within 3 months before surgery (SOR, 2.02), and treatment of the dominant hand (SOR, 1.34), index finger (SOR, 1.65), and middle finger (SOR, 2.01) were associated with a higher complication rate. This study demonstrates that ≥3 preoperative steroid injections and a steroid injection within 3 months before surgery were the most influential factors contributing to complications. These findings can assist clinicians during patient counseling and may guide preoperative treatment. We recommend that clinicians should consider avoiding steroid injections within 3 months before surgery and to be reluctant to perform >2 steroid injections. Prognostic II.