Group Status Research Articles

Abstract 4138482: The burden of ischemic heart disease, hypertension, diabetes mellitus, and obesity among older Latino and Chinese adults with and without limited English proficiency

Background: An estimated 15% of Latinos and 34% of Chinese in the US have limited English proficiency (LEP). However, there is limited information on whether ischemic heart disease (IHD) and its risk factors (hypertension, HTN; diabetes mellitus, DM; and obesity) vary by LEP vs. non-LEP status in these ethnic groups. This information may be valuable for targeting healthcare interventions. METHODS: This cross-sectional study used data for Latino (79,588 men, 85,560 women), and Chinese (25,944 men, 32,586 women) adults aged 50-79 years who were members of a northern California health plan in 2018-2019. Age, sex, language preference, obesity (BMI ≥30 for Latino and ≥27.5 kg/m2 for Chinese), and IHD, HTN, and DM diagnoses were abstracted from electronic health records. LEP was defined as Spanish/Chinese vs. English (non-LEP) language preference. Prevalence was compared by LEP status within age-sex groups. Modified Poisson regression was used to estimate age-adjusted prevalence ratios. RESULTS: Among Latino men aged 50-64 (57,835, 39% LEP) and 65-79 (21,753, 30% LEP) and Chinese men aged 50-64 (14,751, 42% LEP) and 65-79 (11,193, 40.3% LEP) years, IHD prevalence was lower in LEP vs. non-LEP (Latino: 3.5% vs. 6.0% and 13.8% vs. 19.0%; Chinese: 3.6% vs. 5.8% and 11.9% vs. 14.5%). Similar trends were observed in women, but IHD prevalence was much lower. Among Latino and Chinese men, HTN and obesity prevalence was lower, but DM was similar. For women, HTN was similar, but DM was higher in LEP Latina (age 50-79) and Chinese adults (age 65-79), while obesity was lower in LEP Chinese but not Latina adults. Differences remained after adjusting for age (aPR). CONCLUSION: The burden of IHD, HTN, and obesity is similar or lower among LEP vs. non-LEP Latino and Chinese adults, while the burden of DM is higher for LEP vs. non-LEP Latina and Chinese women. These findings suggest that while DM prevalence is already high, acculturation is associated with higher risk of developing some chronic CVD conditions, underscoring the need for targeted healthcare interventions. Further research is needed to explore mechanisms driving these disparities and to develop culturally appropriate strategies to improve health outcomes.

Abstract 4127792: Age-stratified Monogenic and Polygenic Contributions for Atrial Fibrillation in the All of Us Research Program

Background: Rare and common genetic variation both contribute to atrial fibrillation (AF), but the effects may not be uniform across ages. The All of Us Research Program contains whole-genome sequencing of 100,574 adult participants with electronic health records. Hypothesis: Rare genetic variants are associated with early-onset AF; common genetic variants are associated with late-onset AF. Aims: To quantify the diagnostic yield provided by rare and common genetic variation in AF across age. Methods: The clinical, monogenic, and polygenic contributions to AF were assessed in a cross-sectional group of participants in the NIH-funded All of Us Research Program, stratified by three age groups: <45 years (n=22,290), 45-60 years (n= 26,805), >60 years (n=51,659). Variant discovery was performed for pathogenic or likely pathogenic (P/LP) variants among 145 candidate cardiac genes with dominant inheritance for cardiomyopathy and arrhythmia. A previously established polygenic risk score (PRS) was calculated. After adjusting for known clinical factors, multivariable analysis quantified the associations between monogenic and polygenic factors versus AF status in each age group. Results: There were 100,574 participants: 7,811 with AF and 92,763 without AF. The presence of ≥1 P/LP variant(s) were associated with AF across all age groups, with stronger associations in the age <45 group (OR 2.3 [95% CI 1.4-4.1]) compared older groups (OR 1.5 [95% CI 1.1-2.1] in age 45-60, and OR 1.4 [95% CI 1.2-1.7] in age >60). In contrast, PRS was not associated with AF in participants <45 years (OR 1.02 [95% CI 0.88-1.17]) but was associated with AF in the older groups: OR 1.54 [95% CI 1.31-1.80] in age 45-60 and OR 1.49 [95% CI 1.40-1.59] for age >60. Overall, clinical risk factors are highly associated with AF (AUC 0.84 [0.83-0.85]); adding polygenic and monogenic factors contribute only marginal improvement (AUC 0.86 [0.85-0.87]). Conclusion: In this cross-sectional dataset, monogenic and polygenic factors have opposite associations with AF. Monogenic variants are associated with early-onset AF, whereas PRS has no association with AF at younger ages. Clinical risk factors continue to explain the majority of the variation in AF status.

Abstract 4135746: Assessing Coronary Artery Disease Severity: Leveraging Inflammatory Markers As a Prognostic Indicators

Introduction: Cardiovascular disease continues to be the leading cause of death and a significant cause of morbidity in the United States. In recent years, there has been increased interest in the role of inflammation in predicting and modifying the risk of coronary artery disease. Of the multitude of inflammatory markers studied subsequently, two of the most easily and widely obtained is the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR), which can be calculated from a complete blood count with differential. Multiple retrospective studies have demonstrated that the NLR and MLR have been used to diagnose ACS, predict mortality at a year after ACS, and risk stratify patients prior to percutaneous coronary intervention. Research Question: Are the NLR/MLR useful tools in predicting the severity of coronary artery disease (CAD) in patients admitted to a tertiary medical center in Southern Nevada for ACS between 2021 and 2023? Methods: A sample of n=344 patients was used to examine the potential significance of NLR/MLR to diagnose ACS and for predicting CAD severity. Traditional diagnostic test evaluation was used for determining CAD with a ratio of NLR=3.5 + MLR=0.35 (data medians) as the cut-off value. Patient risk group status (1:low risk to 4:high risk) was used as a binary outcome to test NLR/MLR between low and high risk groups using a nonparametric MWW test of medians. Additionally, ROC analysis was used to estimate an optimized cut-off for NLR/MLR as determined by AUC. Results: Results demonstrate for predicting ACS using the median NLR, sensitivity=88.07; specificity=14.88; PPV=52.01; NPV=54.35), LR(+)=1.03 and LR(-)= 0.80, using the median MLR results showed sensitivity=87.28; specificity=14.11; PPV=50.84; NPV=52.17, LR(+)=1.01 and LR(-)= 0.90. Subpopulation analysis demonstrated a statistically significant difference in NLR between “high risk ACS” vs “Low Risk ACS” (p<0.001). Examination of the ROC curve for predicting the high-risk group suggested an optimized cutoff of NLR=3.7; however, AUC was only 0.617, and sensitivity and specificity were not improved compared to using the median NLR. Conclusion: Our findings suggest that an NLR greater than 3.7 may indicate multivessel involvement or proximal/left main disease in CAD patients. However, due to its low specificity and AUC, NLR alone cannot reliably distinguish between single-vessel and multivessel CAD.

Pregnancy detection based on blood serum sample Raman spectroscopy.

In this research, women were diagnosed as pregnant based on blood serum samples Raman spectroscopy. Raman spectroscopy is a vibrational technique that provides information on the chemical composition of samples. The Raman techniques have significantly impacted the study of various degenerative diseases, particularly cancer detection, using less invasive methods such as the analysis of blood serum samples. Additionally, these techniques have been used to study the health status of patients, which is often difficult to monitor using conventional techniques. This study obtained serum samples from 12 women diagnosed as pregnant and 11 non-pregnant volunteers (controls). Spectra were collected using a LabRAM HR800 Raman Spectrometer (Horiba Jobin-Yvon) with an 830 nm wavelength laser. For each serum sample, 10 Raman spectra were obtained by focusing the laser, using a microscope objective, on different points of the sample with an exposure time of 40 seconds and an irradiation power of 17 mW. The raw spectra were processed using baseline correction and smoothing to remove noise, fluorescence, and shot noise. Subsequently, the spectra were normalized and analyzed using the multivariate statistical method of Principal Component Analysis (PCA). In these spectra, the characteristic bands of main blood serum biomolecules such as phenylalanine (Phe), tyrosine (Tyr), glutathione, amide III, phospholipid, carotene, and tryptophan (Trp) can be observed. Nevertheless, when analyzing the average spectra of pregnant and non-pregnant women, the main spectral differences were associated with variations in molecules like glutathione, tryptophan (Trp), tyrosine, and phenylalanine, which occur during the first trimesters of pregnancy. This aligns with findings previously reported by other studies. Furthermore, the serum samples from pregnant and non-pregnant patients can be effectively discriminated using PCA applied to the Raman spectra, revealing two distinct clusters in the PCA plot corresponding to each group's status. The results demonstrate that pregnancy can be determined based on blood serum samples Raman spectroscopy with sensitivity and specificity. Although there are very effective devices on the market to determine pregnancy based on the Human Chorionic Gonadotropin (HCG) hormone detection in urine samples, these preliminary results indicate an alternative method known as Raman spectroscopy. On the other hand, the results could also suggest the possibility of carrying out other gynecological or fetal-related studies in women using these Raman techniques.

Predictors of Early Mortality After Traumatic Spinal Cord Injury in South Africa.

Retrospective cohort study. To identify predictors for early mortality following traumatic spinal cord injury (TSCI), as recognition of factors associated with early mortality is essential for public resource allocation and optimized acute care. Retrospective Analysis of SCI patients admitted to the acute SCI ward from 2003 to 2022 was performed. Days elapsing from the date of injury to date of death established the survival time. Early mortality was defined as survival time ≤ 365days. Multivariable logistic regression was used in modeling of early death following TSCI with age, gender, neurologic deficit, type of neurologic injury, ventilation status, and count of complications as covariates. Simple logistic regression indicated a significant association of early mortality with the number of complications (P < .0001), neurological deficit (P < .0001), complete neurological injury (P < .0001), ventilation status (P < .0001), and age group (P < .0003). After adjusting for other covariates, complete neurological injury (OR: 1.75, P < .0001), ventilation (OR: 2.80, P < .0001), and Age group (over 60 OR: 17.71, P < .0001) were significantly associated with early mortality. The multivariable model showed a good overall fit (Hosmer-Lemeshow P = .315; AUC 0.85). Predictors of early mortality after TSCI are high complete spinal cord injury, age, number of complications, and the need for ventilation. Identification of high-risk patients is crucial to rationalize and improve acute care to potentially reduce mortality rates.

Proportional Trends in Pediatric Opioid Prescribing Between 2005 and 2016 by Age Group, Sex, Ethnicity, Race, Language, and Payer Status from a Large Children’s Hospital in the Southwest United States

Background/Objectives: Prescription opioid use before adulthood is typically effective for acute pain control and is also associated with adverse short- and long-term consequences. Methods: This study examined pediatric opioid prescribing trends over time across different age groups (early childhood, school age, adolescence, young adult) and sociodemographic subgroups (sex, ethnicity, race, language, payer type) from 2005 to 2016. Results: Utilizing 42,020 first outpatient opioid prescriptions for youth aged 0–21 years from a large US children’s hospital, this research found notable trends and disparities. Prescription rates increased by 35% from 2005–2007 to 2008–2010, then decreased by 14% from 2008–2010 to 2011–2013, and decreased again by 22% from 2011–2013 to 2014–2016. Chi-squared tests indicated significant changes in prescription rates across all sociodemographic subgroups, though only age group, ethnicity, and payer type (i.e., the party responsible for payment for hospital services) had changes with non-negligible effect sizes (Cramer’s V). Specifically, age group showed small to medium effects (V = 0.16), while ethnicity and payer demonstrated small effects (V = 0.10 each). This study highlights variations in opioid prescribing trends, particularly among different age groups, ethnicities, and payer statuses up to 2016. Conclusions: These findings reveal differing trends in pediatric opioid prescribing during the peak of the opioid epidemic, highlighting the importance of considering age and sociodemographic variables for understanding prescribing patterns fully and raising potential concerns about inequities in pain management. Future studies should explore similar trends from 2016 onward.

Acute phase responses in clinically healthy multiparous Holsteins with and without calcium dysregulation during the early postpartum period

Patterns of calcium dysregulation resulting in low total serum calcium concentrations (tCa) at 4 DIM, known as dyscalcemia, commonly occur in multiparous Holsteins. Dyscalcemia is associated with risk of disease, decreased production, and poor reproductive performance. Inflammation is well-documented early in lactation and is associated with similarly suboptimal outcomes. The acute phase response produces markers and mediators of inflammation; therefore, the objective of our case-control study was to evaluate postpartum patterns of 3 positive acute phase proteins in cows with and without dyscalcemia. We hypothesized that dyscalcemic cows would experience more activated inflammation than eucalcemic cows and that inflammation would precede dyscalcemia diagnosis. Multiparous Holstein cows at 2 commercial dairy farms in central New York were enrolled from a parent study based on tCa at 4 DIM, at a 2:1 ratio of eucalcemic (tCa >2.3 mmol/L; n = 32) to dyscalcemic cows (tCa <2.2 mmol/L; n = 16). Blood was collected 1 to 3 d before parturition and once every 24 h postpartum through 4 DIM. Samples were analyzed for 3 acute phase proteins, serum amyloid A (SAA), haptoglobin and lipopolysaccharide binding protein (LBP). Patterns of protein concentrations in blood over time were compared using linear mixed effects models including fixed effects of calcium status group, time, parity group, farm, relevant 2-way interactions, and the random effect of cow. Overall, dynamics of acute phase proteins showed that dyscalcemic cows experienced increased acute phase responses compared with eucalcemic cows, and that these responses preceded dyscalcemia diagnosis at 4 DIM. Dyscalcemic cows had elevated concentrations of SAA beginning at 2 DIM (eucalcemic: mean = 13.88 µg/mL, 95% CI = 11.34 to 16.99 µg/mL; dyscalcemic: mean = 32.95 µg/mL, 95% CI = 24.55 to 44.21 µg/mL). and continuing through 4 DIM (eucalcemic: mean = 8.14 µg/mL, 95% CI = 6.66 to 9.95 µg/mL; dyscalcemic: mean = 30.01 µg/mL, 95% CI = 22.60 to 39.83 µg/mL). Haptoglobin concentrations were also elevated in the blood of dyscalcemic cows from 2 DIM (eucalcemic: mean = 0.39 g/L, 95% CI = 0.31 to 0.49 g/L; dyscalcemic: mean = 1.11 g/L, 95% CI = 0.79 to 1.56 g/L) through 4 DIM (eucalcemic: mean = 0.27 g/L, 95% CI = 0.21 to 0.34 g/L; dyscalcemic: mean = 1.65 g/L, 95% CI = 1.19 to 2.28 g/L). Concentrations of LBP exhibited a different pattern with a small difference between groups at 3 DIM (eucalcemic: mean = 4.67 µg/mL, 95% CI = 4.02 to 5.42 µg/mL; dyscalcemic: mean = 7.91 µg/mL, 95% CI = 6.49 to 9.63 µg/mL) that became larger at 4 DIM (eucalcemic: mean = 4.88 µg/mL, 95% CI = 4.22 to 5.64 µg/mL; dyscalcemic: mean = 10.79 µg/mL, 95% CI = 8.84 to 13.17 µg/mL). Our work supports the hypothesis that dyscalcemia and inflammatory activity are associated in dairy cows under naturally occurring postpartum conditions. While the causal structure of this relationship remains unknown, improved understanding of inflammation and dyscalcemia may provide insight into mechanisms by which some cows experience maladaptation during the early postpartum period.

Addressing epistemic violence and methodological nationalism through a meta-analytical review on intergroup contact and conflict studies in Turkey

This paper provides an examination of intergroup contact research in the context of the Turkish-Kurdish ‘conflict’ through a meta-analytical scoping review. By doing so, we discuss how dominant biases in the literature such as methodological nationalism and epistemic violence influence research practices and knowledge-production systems in conflict and contact studies conducted under colonial rule. Through a thematic investigation, we found four variables that were commonly tested in intergroup contact studies: i) attitudes towards outgroup, ii) support for minority rights or multiculturalism, iii) perception of discrimination against the minority group, and iv) ethnic identity. We conducted four meta-analyses using a pool of 28 studies conducted in Turkey to unpack the associations of intergroup contact with: i) outgroup attitudes (r = .42; n = 5,624), ii) support for minority rights and multiculturalism (r = -.06ns; n = 1,567), iii) perception of discrimination against Kurds (r = .22; n = 2,431), and iv) ethnic identity (r = -.13; n = 4,636). The results demonstrated a moderate to strong relationship between intergroup contact and positive outgroup attitudes, while the findings were less robust for support for minority rights, perception of discrimination against Kurds, and ethnic identity. Furthermore, the group status and sample characteristics of the studies moderate the relationships between variables. Based on the findings and a critical analysis of the current literature, we discuss the limitations of the existing research and critical points for future studies.

Socioeconomic Status and Age at Menarche in Türkiye.

The trend in declining age at menarche (AAM) largely continues while body size increases globally. The aim was to investigate trends in AAM, menstrual characteristics, and post-menarcheal anthropometric parameters in adolescents living in an urban area in Türkiye between 1999 and 2018. Female adolescent high school students in the Manisa region were asked about menarche and socioeconomic status (SES). There were 1017 girls in the first study (1999-2001) and 1304 (2016-2018) in the second study. Height and weight were measured. Body mass index (BMI) was calculated. Adolescent girls were grouped into three socioeconomic status (SES) groups based on parental education and occupation, and all parameters were evaluated using SES. The mean ± standard deviation for AAM in the first period was 12.82 ± 1.07 years and 12.83 ± 0.9 years in the second. AAM did not differ between the two periods nor between SES groups in either period. Post-menarcheal height, weight, and BMI increased in the second period compared to the first study and across all SES groups (p < 0.05). The whole group AAM was similar in both periods, only 3 months earlier in the second period than in the first period. However, the AAM in girls with a post-menarcheal BMI indicating being overweight or obese was significantly earlier than that of those with a normal post-menarcheal BMI in both periods (p < 0.05). Despite changing sociodemographic characteristics and an increasing trend in height, weight, and BMI in all socioeconomic groups, no change was observed in mean AAM in an urban region of Western Türkiye over 18 years. While the inverse relationship between BMI and postmenarcheal BMI continued in both periods, the decline in AAM became more pronounced over the years in the presence of high postmenarcheal BMI.

Trends in Toddler Diet Quality in the United States: 1999 to 2018.

Diet quality has improved over time for US adults and youth aged ≥2 years. Trends over time and disparities in the diet quality of toddlers 12 through 23 months old have not been documented. Our objective was to investigate the direction and magnitude of toddler diet quality trends from 1999 to 2018 overall and by household socioeconomic status. This serial cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data was performed with 2541 toddlers from 10 NHANES cycles from 1999 to 2018. Dietary intake was measured by NHANES study staff using proxy-reported 24-hour recalls. Healthy Eating Index-Toddlers-2020 total scores (0-100 points, higher scores indicate healthier diets) and component scores were calculated from the 24-hour dietary recalls using the population ratio method. Multivariable linear regression was used to evaluate the association between time in years (measured as the midpoint of each NHANES cycle) and diet quality. Toddler diet quality improved significantly from 1999 to 2018 (P < .001), from 63.7 points on average in 1999-2000 to 67.7 points in 2017-2018. A significant positive linear trend in total diet quality was observed for all socioeconomic status groups (P < .05). Several dietary component scores improved, as follows: Whole Fruits (P < .001), Whole Grains (P = .016), Fatty Acids (P = .002), Refined Grains (P = .009), and Added Sugars (P < .001). Scores did not significantly change for Total Fruit, Total Vegetables, Greens and Beans, Dairy, Total Protein Foods, Seafood and Plant Proteins, Sodium, or Saturated Fats. From 1999 to 2018, toddler diet quality improved significantly, but mean scores still fell short of dietary guidance.

Things seen and unseen: 2. Anaemia affects urban rich Nigerian adolescents more than other socio‑economic status groups.

Background: Anaemia is very prevalent globally and is thought to be linearly associated with wealth and to affect females and rural residents more than males and urban residents. Objectives: This study was designed to investigate this thought in a population of adolescents in Ebonyi State, Nigeria. Methods: Standard clinical protocols were used. A total of 362 adolescents (63.5% females) were studied. Anaemia was diagnosed on the basis of the World Health Organization (WHO) criteria. Results: Aggregate anaemia was found in 50.0% of the general population (43.9% males, 53.5% females) and was most prevalent in the urban upper socio‑economic status (SES) group (62.3%; 70.0% females, 52.2% males). Severe anaemia was present in 7.2% of the general population (9.1% males, 6.1% females). It was most prevalent amongst the 10-11 years age bracket (15.6%). Moderate and mild anaemia were found in 22.4% and 20.4% of the general population and in 13.0%, 11.4%, 8.3% and 6.0% of the urban upper, rural, urban low and middle SES groups, respectively. But in the rural area group, severe anaemia existed without wide sex variations. Moderate anaemia was most prevalent in the urban middle and upper SES groups (29.0% and 26.4%, respectively) with a clear female preponderance. Mild anaemia was the least prevalent (15.3%) in the urban middle SES group. Conclusions: The higher prevalence of severe anaemia in boys and the higher burden in the urban higher SES group warrant a rethink of the public health interventions used in Nigeria. Adolescent boys and urban upper SES groups should be targeted in nutrition interventions related to anaemia.

Hardiness personality and mental health of financially-struggling medical students in private universities in China: the intervening roles of coping styles and gender

BackgroundChinese adolescents are at higher risk of depression, especially the mental health problems of financially disadvantaged medical students, which are significantly higher than those in other age groups, which brings great challenges to the mental health workers in universities.Methods1,280 medical students with a family poverty background in China completed a questionnaire on hardiness personality, coping style and mental health. After descriptive statistics and Pearson correlation analysis between hardiness personality, coping style and mental health levels, we tested the mediation of coping style and the moderating effects of gender.ResultsHardiness personality significantly positively affected the financially-struggling medical student’s mental health level. Positive coping style had a significant positive impact on hardiness personality and mental health level, while negative coping style had a significant negative effect on mental health level. Positive coping and negative coping are the mediators between financially-struggling medical students’ hardy personalities and mental health levels. In medical students with a family poverty background, gender plays a regulatory role in coping style and mental health levels. In medical students with a family poverty background, gender plays a moderate role in coping style and mental health levels.ConclusionThis study adds some knowledge about the effects of hardiness personality on individual mental health. It makes new recommendations for improving the mental health status of vulnerable groups, while it can support future investigations by scholars and educators on how to improve the mental health of students under learning and financial-related stress.

Natural Language Processing of Clinical Documentation to Assess Functional Status in Patients With Heart Failure

Serial functional status assessments are critical to heart failure (HF) management but are often described narratively in documentation, limiting their use in quality improvement or patient selection for clinical trials. To develop and validate a deep learning natural language processing (NLP) strategy for extracting functional status assessments from unstructured clinical documentation. This diagnostic study used electronic health record data collected from January 1, 2013, through June 30, 2022, from patients diagnosed with HF seeking outpatient care within 3 large practice networks in Connecticut (Yale New Haven Hospital [YNHH], Northeast Medical Group [NMG], and Greenwich Hospital [GH]). Expert-annotated notes were used for NLP model development and validation. Data were analyzed from February to April 2024. Development and validation of NLP models to detect explicit New York Heart Association (NYHA) classification, HF symptoms during activity or rest, and frequency of functional status assessments. Outcomes of interest were model performance metrics, including area under the receiver operating characteristic curve (AUROC), and frequency of NYHA class documentation and HF symptom descriptions in unannotated notes. This study included 34 070 patients with HF (mean [SD] age 76.1 [12.6] years; 17 728 [52.0]% female). Among 3000 expert-annotated notes (2000 from YNHH and 500 each from NMG and GH), 374 notes (12.4%) mentioned NYHA class and 1190 notes (39.7%) described HF symptoms. The NYHA class detection model achieved a class-weighted AUROC of 0.99 (95% CI, 0.98-1.00) at YNHH, the development site. At the 2 validation sites, NMG and GH, the model achieved class-weighted AUROCs of 0.98 (95% CI, 0.96-1.00) and 0.98 (95% CI, 0.92-1.00), respectively. The model for detecting activity- or rest-related symptoms achieved an AUROC of 0.94 (95% CI, 0.89-0.98) at YNHH, 0.94 (95% CI, 0.91-0.97) at NMG, and 0.95 (95% CI, 0.92-0.99) at GH. Deploying the NYHA model among 182 308 unannotated notes from the 3 sites identified 23 830 (13.1%) notes with NYHA mentions, specifically 10 913 notes (6.0%) with class I, 12 034 notes (6.6%) with classes II or III, and 883 notes (0.5%) with class IV. An additional 19 730 encounters (10.8%) could be classified into functional status groups based on activity- or rest-related symptoms, resulting in a total of 43 560 medical notes (23.9%) categorized by NYHA, an 83% increase compared with explicit mentions alone. In this diagnostic study of 34 070 patients with HF, the NLP approach accurately extracted a patient's NYHA symptom class and activity- or rest-related HF symptoms from clinical notes, enhancing the ability to track optimal care delivery and identify patients eligible for clinical trial participation from unstructured documentation.

Impact of Long COVID symptoms on individuals in Hong Kong: Implications for occupational therapy practices

Introduction: From occupational therapy perspective, this study investigates the nature and impact of Long COVID symptoms on individuals in Hong Kong according to their gender, age, and occupation and to understand their treatment needs Method: A total of 193 participants with an acute COVID-19 episode 3 months ago and having recovered from it who were experiencing subjective symptoms of Long COVID were recruited through snowball sampling from local COVID-19 support groups and healthcare facilities to participate in a cross-sectional design via an online survey assessing their symptoms and the impact on daily activities, and exploring their treatment preferences. Findings: Respiratory, systemic, sleep, and cognitive symptoms were found to be the most prevalent, with significant variations in symptom severity and impact on daily life across different age and occupational status groups. The treatment preference was quite strongly inclined to traditional Chinese medicine. Conclusion: This study has uncovered the critical and yet recognized roles of occupational therapy in managing Long COVID impact by identifying the potential gaps of occupational therapy in its management and calling for advocating promotion in the community and interdisciplinary collaboration with traditional Chinese medicine. Implications about occupational therapy management and the healthcare policies for tailoring treatment programs are discussed.

Comparative prognostic value of tumor volume in IOIO and IOTKI treatment for metastatic renal cancer

ObjectivesWe aimed to investigate the prognostic significance of tumor size in metastatic renal cell carcinoma (mRCC) by comparing the effectiveness of dual immune checkpoint inhibitor (IOIO) and immune checkpoint inhibitor combined with tyrosine kinase inhibitor (IOTKI) therapies. MethodsThis retrospective observational study included patients with mRCC diagnosed between October 2014 and February 2024 who received IOIO or IOTKI treatment at Kobe University Hospital and 5 affiliated hospitals. Clinical and imaging data were collected, and target lesions were measured according to RECIST v.1.1 criteria. Time-dependent ROC curve analysis was performed to evaluate the prognostic value of tumor size, nephrectomy status, and IMDC risk criteria for progression-free survival (PFS) and overall survival (OS). ResultsThe study included 180 mRCC patients, consisting of 99 receiving IOIO therapy and 81 receiving IOTKI therapy. Time-dependent AUC analysis showed that tumor size had a higher predictive ability for PFS and OS in the IOIO group than the IOTKI group. In multivariate analysis, tumor size was a significant independent prognostic factor for PFS (HR: 1.010, 95% CI: 1.004–1.016, P < 0.001) in the IOIO group. Moreover, the AUC for tumor size was consistently superior in predicting outcomes compared to nephrectomy status and IMDC risk classification in the IOIO group. Kaplan-Meier curves indicated that tumor size effectively stratified PFS in both nephrectomized and non-nephrectomized cases. ConclusionTumor size significantly impacts the prognosis of mRCC patients treated with IOIO therapy, demonstrating greater predictive ability than nephrectomy status and IMDC risk classification. These findings suggest that tumor volume should be considered a critical factor in treatment decision-making for renal cancer, particularly in patients undergoing IOIO therapy.

Clinical and Structural Results Following Arthroscopic and Open Repair of Isolated Subscapularis Tears.

Objective: With advances in techniques, arthroscopic repair of isolated subscapularis tendon tears has become increasingly popular in recent years. The aim of this study was to analyze the clinical and structural results of arthroscopic repair versus the gold standard of open repair. It is a prospective cohort study with a control group; evidence level III. Methods: In a prospective study performed at two centers, 18 patients with an isolated subscapularis tear were treated with arthroscopic repair (ARG) and 16 patients with open repair (ORG) using a uniform single-row suture anchor repair technique in both groups. The subscapularis function was assessed using specific clinical tests (belly-press and lift-off tests), strength testing and shoulder function with the use of the Constant-Murley score (CMS). Standardized magnetic resonance imaging (MRI) was used to evaluate the postoperative subscapularis muscle-tendon status. Results: At a minimum follow-up of 48 months, the CMS increased from a mean of 54 points preoperatively to a mean of 86 points postoperatively in the ARG (p < 0.01) and from 50 points to 85 points postoperatively in the ORG (p < 0.01). Specific subscapularis tests (belly-press test and lift-off test) were significantly improved from the preoperative to the postoperative status in both repair groups (p < 0.05). Despite a subscapularis tendon healing rate of over 90% on MRI scans in both repair groups, the incomplete correction of specific muscle tests was a frequent postoperative finding. Conclusions: Arthroscopic repair of isolated subscapularis tears achieved equivalent clinical and structural results compared to the gold standard of open repair.

Supporting the status quo is weakly associated with subjective well-being: A comparison of the palliative function of ideology across social status groups using a meta-analytic approach.

Research has suggested that the endorsement of ideologies supporting the status quo leads to higher subjective psychological well-being-an idea labeled as the palliative function of ideology within system justification theory. Furthermore, this approach has suggested that this association should be moderated by social status. Specifically, the association between the endorsement of ideologies supporting the status quo and well-being should be positive among high-status groups and negative among low-status groups-mainly as a function of the existence of a unique motivation to justify the status quo. Given contradictory evidence in previous studies, we conducted a meta-analysis to test these ideas. Across 1,627 studies and 1,856,940 participants, we observed a meta-analytic association between endorsement of ideologies supporting the status quo and well-being of r = .07, p < .001. Nonetheless, we did not find evidence supportive of the moderator role of social status. These results provide partial evidence supporting the main tenets of system justification theory, and they are inconsistent with the idea of the existence of a unique motivation to justify the status quo. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Projecting Untruncated Climate Change Effects on Species' Climate Suitability: Insights From an Alpine Country.

Climate projections for continental Europe indicate drier summers, increased annual precipitation, and less snowy winters, which are expected to cause shifts in species' distributions. Yet, most regions/countries currently lack comprehensive climate-driven biodiversity projections across taxonomic groups, challenging effective conservation efforts. To address this gap, our study evaluated the potential effects of climate change on the biodiversity of an alpine country of Europe, Switzerland. We used a state-of-the art species distribution modeling approach and species occurrence data that covered the climatic conditions encountered across the full species' ranges to help limiting niche truncation. We quantified the relationship between baseline climate and the spatial distribution of 7291 species from 12 main taxonomic groups and projected future climate suitability for three 30-year periods and two greenhouse gas concentration scenarios (RCP4.5 and 8.5). Our results indicated important effects of projected climate changes on species' climate suitability, with responses varying by the taxonomic and conservation status group. The percentage of species facing major changes in climate suitability was higher under RCP8.5 (68%) compared to RCP4.5 (66%). By the end of the century, decreases in climate suitability were projected for 3000 species under RCP8.5 and 1758 species under RCP4.5. The most affected groups under RCP8.5 were molluscs, algae, and amphibians, while it was molluscs, birds, and vascular plants under RCP4.5. Spatially, by 2070-2099, we projected an overall decrease in climate suitability for 39% of the cells in the study area under RCP8.5 and 10% under RCP4.5, while projecting an increase for 50% of the cells under RCP8.5 and 73% under RCP4.5. The most consistent geographical shifts were upward, southward, and eastward. We found that the coverage of high climate suitability cells by protected areas was expected to increase. Our models and maps provide guidance for spatial conservation planning by pointing out future climate-suitable areas for biodiversity.

Multisystem Inflammatory Syndrome in Children (MIS-C) in a Lithuanian Paediatric Tertiary Care Center

Background and Objectives: Due to its link with the SARS-CoV-2, Multisystem Inflammatory Syndrome in Children (MIS-C) gained global attention as a serious condition that requires hospital care. Our study aimed to present the clinical and laboratory characteristics of MIS-C patients by age group and intensive care unit (ICU) admission status and assess early echocardiographic changes. Materials and Methods: A single-center partly retrospective, partly prospective observational cohort study was performed from December 2020 to June 2024. The study included 42 patients aged between 1 month and 18 years who were diagnosed with MIS-C and gave informed consent. Results: The median age was 6.5 years (IQR 2.0–9.3). The predominant symptoms were cardiovascular (88.1%), mucocutaneous (85.7%) and gastrointestinal (76.2%). Five children (11.9%) developed shock. About two-thirds of patients (66.7%) were admitted to the ICU. Adolescents (≥12 years) were less likely to exhibit mucocutaneous or cardiovascular symptoms and thus less frequently having Kawasaki—like disease symptoms compared with other age groups (&lt;5 years or 5–11 years). Lymphopenia was more common among patients aged 5 years and older. Adolescents had higher procalcitonin (PCT) and a lower estimated glomerular filtration rate. Troponin I and B-type natriuretic peptide (BNP) levels were higher in children aged 5–11 years, while ferritin levels were lower among the youngest (&lt;5 years). Patients treated at the ICU were more likely to have cardiovascular and respiratory symptoms, as well as a history of symptomatic COVID-19, higher C-reactive protein (CRP), PCT, BNP and lower albumin levels. Echocardiographic abnormalities were found in 71.4% of cases. During hospitalization, left ventricular ejection fraction values increased significantly (p &lt; 0.001) over 12 (IQR 9.0–14.0) days. Conclusions: Symptoms and laboratory markers of MIS-C vary according to age. Higher CRP, PCT, BNP and hypoalbuminemia are predictors of MIS-C severity. Cardiovascular involvement is common and might be severe, but rapid resolution is encouraging.

Exploring the Relationship Between NOD2 Risk Variants and First Decompensation Events in Cirrhotic Patients With Varices.

NOD2 mutations are associated with impaired gut mucosal barrier function. According to the systemic inflammation hypothesis, bacterial translocation is central in the development of decompensation. The aim was to evaluate whether the presence of NOD2 variants is associated with the development of first decompensation. Secondary analysis of prospectively collected consecutive patients with compensated cirrhosis, who were screened between 2014 and 2018. Patients with and without NOD2 variants were compared and stratified analysis according to the presence of varices was performed. 360 patients [239 (66%) men, median age 61 (53-69) years, 70 (19%) with NOD2 variants, 90 (25%) with varices] were followed for a median of 9 (4-16) months. Similar baseline characteristics were observed across NOD2 status groups, except for beta-blocker use (45% vs. 32% amongst variant carriers vs. non-carriers, p = 0.05). During follow-up, 34 patients (12%) developed their first decompensation, with no differences according to NOD2 status [HR 1.75 (95% CI 0.84-3.67)]. On multivariate analysis, only MELD remained an independent predictor of decompensation. Amongst patients with varices (n = 90), 18 (24.4%) carried a NOD2 variants, with a higher incidence of first decompensation [HR 3.00 (95% CI 1.08-8.32)], primarily due to ascites [HR 3.32 (95% CI 1.07-10.32)]. In this subgroup, MELD [HR 1.18 (95% CI 1.06-1.32)] and NOD2 variants [HR 2.91 (95% CI 0.95-8.89)] were determined to be independent predictors of decompensation. The presence of NOD2 risk variants leads to a greater incidence of first decompensation only in compensated patients with varices.