Chronic Disease Status Research Articles

Features of the immune status in occupational chronic obstructive pulmonary disease of varying severity in coal mine workers

Introduction. The peculiarities of the clinical course of bronchopulmonary diseases, which occupy a large place in the structure of occupational diseases in coal mine workers, are largely due to a violation of immune reactivity, which is important to take into account for the development of effective preventive and therapeutic measures.
 The study aims to explore the features of the immune status in occupational chronic obstructive pulmonary disease of varying severity in coal mine workers.
 Materials and methods. The scientists have conducted a survey of 110 miners, who worked in underground conditions with an average concentration of aerosols of predominantly fibrogenic action at the workplace up to ten or more times higher than the maximum permissible concentrations, with an established diagnosis of occupational chronic obstructive pulmonary disease. The control group consisted of 89 trained miners who also worked in dust conditions above the maximum permissible concentrations, without bronchopulmonary pathology. The above groups had no statistical differences among themselves in age and work experience in dusty conditions. The authors also conducted an immunological examination.
 Results. Researchers have identified the features of the immune status in occupational chronic obstructive pulmonary disease — the development of combined immune insufficiency with damage to the humoral link of immunity (decrease in serum immunoglobulin G) and phagocytic activity of neutrophils. At the same time, we have an increased level of proteins of the acute phase of inflammation (C-reactive protein and haptoglobin) and an increased level of circulating immune complexes as an indicator of a high antigenic load. In patients with severe occupational chronic obstructive pulmonary disease, the suppression of the humoral link of immunity increases (a decrease in the relative and absolute amount of CD20+ and the level of serum immunoglobulin G), as well as the phagocytic activity of neutrophils compared with patients with chronic obstructive pulmonary disease of moderate severity and a comparison group that can contribute to the development and recurrence of the infectious and inflammatory process not only in the lungs, but also in other organs.
 Conclusion. The authors revealed the development of combined immune insufficiency with damage to the humoral link of immunity (decrease in serum immunoglobulin G) and phagocytic activity of neutrophils in miners with chronic obstructive pulmonary disease. With a severe degree of the disease, there are more pronounced violations of the humoral link of immunity and phagocytic activity of neutrophils.
 Ethics. This medical study with the participation of a person as a subject was carried out in compliance with the Ethical principles presented in the latest version of the Helsinki Declaration, developed by the World Medical Association.

Development of an Attitude Scale for the Use of Telemedicine Services.

Abstract Introduction: This study aimed to develop a scale to assess attitudes toward the use of telemedicine services, to study the reliability and validity of the developed scale, and to determine the characteristics that may be associated with the scores obtained from the scale. Methods: This study, which was conducted with 600 people older than 18 years, who applied to Family Health Centers in Meram district of Konya province, was designed in a methodological type. The sociodemographic characteristics form and the candidate scale form designed in a 5-point Likert structure were used to collect data in the study. The data collection forms were applied to the participants under observation. SPSS and R programs were used for data analysis. Statistically, cases with p < 0.05 were considered significant. Results: Two hundred fifty people (n = 250) for reliability and explanatory factor analysis and 350 people for confirmatory factor analysis, 600 people in total, were included in the study. The results of all reliability and validity analyses of the candidate scale were found to be sufficient. The explained variance of the one-dimensional 18-item scale was 53.8% and the Cronbach's alpha coefficient was 0.947. There was a significant difference between the score obtained from the scale and work status and presence of chronic disease (p < 0.05). Conclusion: As a result of the research, a new measurement tool called "Attitude Scale Towards the Use of Telemedicine Services" consisting of 18 questions was developed, reliability and validity analyses were performed, and it was shown that it is suitable for use in individuals older than 18 years.

Comparative Analysis of Influencing Factors of Health Service Utilization Among Urban and Rural Residents in Tibet

To examine the differences and commonalities of factors influencing the utilization of health services among urban and rural residents in Tibet and to identify vulnerable populations in the utilization of health services, thereby providing references for the formulation of local health policies and the allocation of health resources. Using the Tibetan area data from the Sixth National Health Service Survey, we conducted statistical analysis of the health service utilization status of 8 297 residents of agro-pastoral areas and 2 179 residents of urban areas with χ 2 test and logistic regression model. The two-week outpatient visit rates of residents in agro-pastoral areas and that of the urban residents were 65.3% and 57.1%, respectively, and the one-year hospitalization rates were 8.3% and 8.9%, respectively. The influencing factors of two-week outpatient visits for rural and pastoral residents included urban and rural health insurance coverage, Three Guarantees in One coverage, distance to medical facilities, chronic disease status, physical examination, family doctor contract status, employment status, and health status self-assessment. The influencing factors of two-week outpatient visit for urban residents included chronic disease status, urban and rural medical insurance coverage, health status self-assessment, health records, and physical examination. The factors influencing hospitalization for agro-pastoral residents were sex, age, marital status, urban and rural medical insurance coverage, Three Guarantees in One coverage, critical illness insurance, health self-assessment, mobility, health records, physical examination, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The urban and rural residents in Tibet have relatively poor health and their awareness of seeking early medical help after they fall ill is relatively weak. The health institutions concerned should dedicate more attention to the vulnerable populations who have difficulty accessing health services, focus on the commonly shared influencing factors of health service utilization among urban and rural residents, take into account the differences, rationally allocate health resources, and improve the effective utilization rate of health services among residents in Tibet.

Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study

BackgroundNationwide data for children for short-stay hospitalisation (SSH) and associated factors are scarce. This retrospective study of children in France < 18 years of age followed after their birth or birthday in 2018 focused on at least one annual SSH, stay < 1 night or ≥ 1 night, or 30-day readmission ≥ 1 night.MethodsChildren were selected from the national health data system (SNDS), which includes data on long-term chronic disease (LTD) status with full reimbursement and complementary universal coverage based on low household income (CMUC). Uni and multivariate quasi-Poisson regression were applied for each outcome.ResultsAmong 13.211 million children (94.4% population, 51.2% boys), CMUC was identified for 17.5% and at least one LTD for 4% (0-<1 year: 1.5%; 14-<18 year: 5.2%). The most frequent LTDs were pervasive developmental diseases (0.53%), asthma (0.24%), epilepsy (0.17%), and type 1 diabetes (0.15%). At least one SSH was found for 8.8%: SSH < 1 night (4.9%), SSH ≥ 1 night (4.5%), readmission (0.4%). Children with at least one SSH were younger (median 6 vs. 9 years) and more often had CMUC (21%), a LTD (12%), an emergency department (ED) visit (56%), or various primary healthcare visits than all children. Those with a SSH ≥1 night vs. < 1 night were older (median: 9 vs. 4 years). They had the same frequency of LTD (13.4%) but more often an ED visit (78% vs. 42%). Children with readmissions were younger (median 3 years). They had the highest levels of CMUC (29.3%), LTD (34%), EDs in their municipality (35% vs. 29% for the whole population) and ED visits (87%). In adjusted analysis, each outcome was significantly less frequent among girls than boys and more frequent for children with CMUC. LTDs with the largest association with SSH < 1 night were cystic fibrosis, sickle cell diseases (SCD), diabetes type 1, those with SSH ≥1 night type 1 diabetes epilepsy and SCD, and those for readmissions lymphoid leukaemia, malignant neoplasm of the brain, and SCD. Among all SSH admissions of children < 10 years, 25.8% were potentially preventable.ConclusionHigher SSH and readmission rates were found for children with certain LTD living in low-income households, suggesting the need or increase of specific policy actions and research.

Testing a single item screener to support family doctors in identifying patients with limited health literacy: convergent validity of the SILS and the HLS-EU-Q16

BackgroundLow health literacy (HL) is associated with reduced disease self-management skills, worse health outcomes, an increased number of hospitalizations, more frequent use of the emergency room and less utilization of preventive services. To support patients with low HL it is crucial to identify affected patients. HL is a multidimensional construct, which covers different skills and abilities to make informed health decisions. Validated brief screening tools to assess health-literacy-related skills or abilities in primary care settings are currently not available in German. This study aimed to validate a single item screener developed in the US for the German primary care setting.MethodsOur study used cross-sectional data from a survey among mainly chronically ill patients (n = 346) conducted in family practices in the state of North Rhine-Westphalia. We explored the convergent validity between a single item literacy screener (SILS) and the HLS-EU-Q16. The SILS measures functional HL by asking patients about their need for help when reading information materials. The HLS-EU-Q16 is a multidimensional HL measure frequently used for research purposes in Germany. Associations between the two instruments were examined using Spearman’s correlations and regression analyses. The diagnostic performance of the SILS relative to the HLS-EU-Q16 was assessed using receiver operator curves (ROC).ResultsThe SILS had a statistically significant correlation with the HLS-EU-Q16 (Spearman ρ: 0.35) and explained 26% of its total variance. Stratified analyses of the convergent validity between both instruments by age, sex, migration background, education level and chronic disease status showed moderate statistically significant correlations in all subgroups (range: 0.223 to 0.428). With an area under the curve of 0.66, the receiver operator curve indicated a satisfactory diagnostic performance of the SILS relative to the HLS-EU-Q16.ConclusionsThe SILS provided an acceptable initial assessment of HL limitations among a heterogeneous population of mainly chronically ill patients in a primary care setting. With only one item, the SILS can be a short and effective tool for routine use in primary care and specialized care settings. Future research should test the SILS in other populations and pilot applications of the SILS in routine care.

Coronavirus-related health literacy levels among school administrators and influencing factors.

Our study aimed to determine the level of coronavirus-related health literacy among school administrators and the factors that influence this. The sample of this cross-sectional study consisted of 402 school administrators serving in primary, secondary and high schools in Ankara. The data were collected between September 2021 and February 2022 using the descriptive characteristics questionnaire and the Coronavirus-Related Health Literacy Questionnaire (HLS-COVID-Q22). It was seen that 64.4% of the participants were male, 34.6% were 40 years old or younger and 35.6% were working in primary schools; 77.6% of the participants had a sufficient, 16.2% had a problematic and 6.2% had an inadequate level of coronavirus-related health literacy. Age, gender, chronic disease status, type of school they work in, level of knowledge about coronavirus, level of confusion due to knowledge about coronavirus, willingness to be vaccinated, believing that vaccines are safe/effective/compatible with their religious beliefs were found to affect coronavirus-related health literacy (p < 0.05). Gender, age, information satisfaction on coronavirus, confusion due to information on coronavirus and 'Overall, I believe that vaccinations are effective' explained 24.9% of HLS-COVID-Q22 variance (Adjusted R2 = 0.249, F = 13.080, p < 0.001). This study found the coronavirus-related health literacy level among school administrators to be sufficient. It found that their level of health literacy was affected by gender, age, chronic disease status, type of school they worked at, level of knowledge about coronavirus, level of confusion due to information about coronavirus, desire to be vaccinated and their thoughts about vaccines.

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

To assess the ability of a modified frailty index (mFI-5) score, which includes the presence of congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status, and to identify patients at increased risk of complications after surgical treatment of long-bone nonunions/malunions. Retrospective. Hospitals participating in the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program. Patients in the American College of Surgeons National Surgical Quality Improvement Program database with upper extremity and lower extremity fractures were enrolled. Surgical repair of nonunions/malunions of upper and lower extremity long bones. Postoperative complications after long-bone nonunion/malunion surgery. Respective univariate analysis of the 2964 UE [1786 (60.3%) with mFI-5 of 0 and 386 (13.0%) with mFI-5 ≥2] and 3305 LE [1837 (55.6%) with mFI-5 of 0 and 498 (15.1%) with mFI-5 ≥2] showed that increasing mFI-5 score was associated with medical complications, extended longer length of stay, adverse discharge, and readmission. Binomial logistic regression showed that UE patients with mFI-5 ≥2 had increased risk of wound complications [odds ratio (OR) 2.512, 95% (confidence interval) CI: 1.037-6.086, P = 0.041), adverse discharge (OR 1.735, 95% CI: 1.204-2.499, P = 0.003), and unplanned readmission (OR 2.102, 95% CI: 1.038-4.255, P = 0.039), while LE patients with mFI-5 ≥2 had an increased risk of medical complications (OR 1.847, 95% CI: 1.307-2.610, P = 0.001), cumulative morbidity (OR 1.835, 95% CI: 1.342-2.510, P < 0.001), extended longer length of stay (OR 1.809, 95% CI: 1.233-2.654, P = 0.002), and adverse discharge (OR 1.841, 95% CI: 1.394-2.432, P < 0.001). mFI-5 score ≥2 is associated with significant increase in postoperative complications after surgical repair of long-bone nonunions/malunions. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Role of mFI-5 in predicting geriatric outcomes in laparoscopic cholecystectomy

BackgroundFrailty is the age-related decline contributing to adverse outcome vulnerability. This study assesses the modified 5-factor frailty index's (mFI-5) ability to predict geriatric cholecystectomy outcomes. MethodsLaparoscopic cholecystectomy patients ages ≥65 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program database (2018–2020). MFI-5 variables include hypertension, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and functional status. Groups were stratified according to the number of comorbidities: mFI ​= ​0, mFI ​= ​1, mFI≥2. Results32,481 cases included 27.6% mFI ​= ​0, 46.4% mFI ​= ​1, 26.0% mFI≥2. Highest frailty correlated with increased discharges to not home (OR 1.88, p ​< ​0.01). Non-independent functional status was associated with mortality (OR 7.32), prolonged length of stay (LOS) (5.69), pneumonia (4.90), sepsis (3.78), readmission (2.60) (p ​< ​0.01). AUCs were calculated for prolonged LOS (0.89), discharges to not home (0.85), mortality (0.83), pneumonia (0.76), sepsis (0.76). ConclusionsHealthcare teams can use mFI-5 to target at-risk cholecystectomy patients and proactively intervene to avoid complications.

The Conceptual Independence of Health Status, Respiratory Symptoms and Dyspnea in Chronic Obstructive Pulmonary Disease in Real Clinical Practice.

The hypothesis that health status is the highest ranking concept, followed by respiratory symptoms and dyspnea as the lowest ranking concepts in subjects with chronic obstructive pulmonary disease (COPD) was tested in a real clinical setting with 157 subjects with stable COPD. Spearman's rank correlation coefficients for scores of health status using the COPD Assessment Test (CAT), respiratory symptoms using the COPD Evaluating Respiratory Symptoms (E-RS) and dyspnea using Dyspnea-12 (D-12) between any two were 0.6 to 0.7. Upon categorizing the patients as "abnormal" or "normal" according to the threshold, it was found that 30 patients (19.1%) had dyspnea, respiratory symptoms and impaired health status. Dyspnea was considered an important part of respiratory symptoms, though seven patients had dyspnea but no respiratory symptoms. There were 10 patients who had respiratory symptoms without dyspnea but without health status problems. Furthermore, there were six patients who had both dyspnea and respiratory symptoms but whose health status was classified as fine. Thus, the hypothesis was correct in approximately 85% of cases.

Influence of nutritional status and body mass index of patients on the prognosis and course of chronic obstructive pulmonary disease

The problem of the relationship of nutritional status with the risk of development, course features and prognosis of chronic obstructive pulmonary disease is of considerable scientific and practical interest, but remains poorly understood. However, in clinical practice, it is customary to calculate only the body mass index, but this indicator cannot provide a complete characterization of the nutritional status. We have reviewed the data of publications indicating the conditionality of the course of chronic obstructive pulmonary disease by the value of the body mass index, the amount of muscle mass of the body and such parameters of adipose tissue as its distribution in the body, hormonal activity and production of systemic chronic inflammation markers. To assess the dynamics of body mass index and spirometric parameters in patients with chronic obstructive pulmonary disease, 76 publications that were selected by the keywords COPD, BMI in the Scopus, PubMed, eLibrary databases for 19952022, were analyzed. Correlation analysis was carried out using Spearman's test. As a result, there was a trend towards an increase in body mass index in patients with chronic obstructive pulmonary disease in different countries and an improvement in spirographic parameters in a cohort of patients with chronic obstructive pulmonary disease over time. The data of the reviewed studies indicate the presence of a relationship between chronic obstructive pulmonary disease and nutritional status. At the same time, the mechanisms of the relationship between the pathogenesis of chronic obstructive pulmonary disease and adipose tissue dysfunction, as well as the role of adipose tissue and body composition in the course of the disease and its prognosis, have not been sufficiently studied.

Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS.

With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population. Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models. After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese. The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Association between periodontal disease status and risk of atrial fibrillation: a nationwide population-based cohort study

BackgroundPeriodontal disease can activate an immune process linked to systemic diseases, including atrial fibrillation. However, the relationship between periodontal disease and atrial fibrillation remains unclear.AimThis study aimed to investigate whether changes in periodontal disease status are associated with the risk of atrial fibrillation.MethodsUsing the National Health Insurance Database Korea, participants who underwent the first oral health examination in 2003 and a second examination in 2005–2006 without a history of atrial fibrillation were included. Participants were grouped according to changes in periodontal disease status during two oral examinations: periodontal disease-free, periodontal disease-recovered, periodontal disease-developed, and periodontal disease-chronic. The outcome was the incidence of atrial fibrillation.ResultsThe study included 1,254,515 participants, with a median follow-up of 14.3 years and 25,402 (2.02%) cases of atrial fibrillation occurred. During follow-up, the risk of atrial fibrillation was highest in the periodontal disease-chronic group, followed by the periodontal disease-developed, periodontal disease-recovered, and periodontal disease-free groups (p for trend < 0.001). Moreover, recovery from periodontal disease was associated with a reduced risk of atrial fibrillation compared to a chronic periodontal disease status (Hazard ratio: 0.97, 95% Confidence interval: 0.94—0.99, p = 0.045). The development of periodontal disease was associated with an increased risk of atrial fibrillation compared to being periodontal disease-free (Hazard ratio: 1.04, 95% Confidence interval: 1.01—1.08, p = 0.035).ConclusionOur findings suggest that changes in periodontal disease status impact the risk of atrial fibrillation. Management of periodontal disease may help prevent atrial fibrillation.

Association between chronic disease and substance use among older adults in Tennessee.

Substance use and misuse have a negative impact on health care outcomes, specifically in the older adult population. Older adults are at risk due to several factors occurring toward the end of life such as changing family dynamics, loss of friends and loved ones, and chronic diseases. Substance use in older adults with chronic diseases in rural areas remains poorly studied. This study examines older adults greater than 55 of age in the state of Tennessee, U.S.A. Data was extracted from the 2019 National Behavioral Risk Factor Surveillance System (BRFSS) with a subsample for the State of Tennessee (N = 6242) and individuals over age 55 (N = 3389). At least 33.7% (N = 1143) of older adults have a chronic disease, and 24.4% (N = 828) have at least two or more chronic diseases. Alcohol use in the past month was reported in 29.4% of older adults; however, chronic disease status was not associated with alcohol use. Marijuana use and smoking in the past month were significant for older adults with two or more chronic diseases. Low income and less high school education were associated with chronic disease and smoking. Marijuana use and smoking were found to be significant in older adults with chronic disease, but not with alcohol use. Preventative measures such as screening tools, education, and providing resources to patients should be targeted to populations at risk to promote overall health outcomes.

Sleep quality and related factors in older adults: A cross-sectional study

This study aimed to evaluate sleep quality and related factors in hospitalized older adults. In this cross-sectional study, 390 older adults were admitted to the medical and surgical departments of Musa Ibn Jafar Hospital in Quchan. The data was collected from October to March 2017. Data collection tools were the demographic information questionnaire and Pittsburgh Sleep Quality Questionnaire (PSQI). A total of 390 older adults participated in this study. The mean age of participants was 71.73 (SD=8.05) years. Of the participants, 54.6% were male, 73.8% were married, 31.5% had a diploma, and 77.4% lived in the city. Also, 67.4% of the individuals had never been hospitalized before, and 69.0% of them had a history of chronic disease. The mean sleep quality score based on PSQI in the elderly was 7.40 (SD=4.02). Among the participants, 63.8% of them had undesirable sleep quality. The age of elderly people who had undesirable sleep was significantly higher than people with desirable sleep (P=0.03). Also, there was a significant difference between undesirable and desirable sleep quality with education level (P=0.05), marital status (P&lt;0.001), hospitalization frequency (P&lt;0.001), and history of chronic disease (P&lt;0.001). In sum, considering that the results of the research showed that the elderly did not have a good quality of sleep, it is recommended to provide nursing care in the inpatient wards as well as teach it to the elderly and their families to prevent sleep problems and related problems.

Complete Revascularization and Angina-Related Health Status in the ISCHEMIA Trial

BackgroundThe impact of complete revascularization (CR) on angina-related health status (symptoms, function, quality of life) in chronic coronary disease (CCD) has not been well studied. ObjectivesAmong patients with CCD randomized to invasive (INV) vs conservative (CON) management in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), we compared the following: 1) the impact of anatomic and functional CR on health status compared with incomplete revascularization (ICR); and 2) the predicted impact of achieving CR in all INV patients compared with CON. MethodsMultivariable regression adjusting for patient characteristics was used to compare 12-month health status after independent core laboratory-defined CR vs ICR in INV patients who underwent revascularization. Propensity-weighted modeling was then performed to estimate the treatment effect had CR or ICR been achieved in all INV patients, compared with CON. ResultsAnatomic and functional CR were achieved in 43.3% and 57.8% of 1,641 INV patients, respectively. Among revascularized patients, CR was associated with improved Seattle Angina Questionnaire Angina Frequency compared with ICR after adjustment for baseline differences. After modeling CR and ICR in all INV patients, patients with CR and ICR each had greater improvements in health status than CON, with better health status with CR than ICR. The projected benefits of CR were most pronounced in patients with baseline daily/weekly angina and not seen in those with no angina. ConclusionsAmong patients with CCD in ISCHEMIA, health status improved more with CR compared with ICR or CON, particularly in those with frequent angina. Anatomic and functional CR provided comparable improvements in quality of life. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)

Renal Doppler ultrasonography for predicting non-diabetic kidney disease in patients with diabetes.

This study was conducted to assess the role of renal Doppler ultrasonography (US) in predicting non-diabetic kidney disease (NDKD) in patients with diabetes, using histologic findings as the reference standard. Fifty-nine consecutive patients with diabetes who underwent renal Doppler US and native kidney biopsy were included in this retrospective, single-institutional study. Based on histologic findings, patients were classified as having diabetic nephropathy (DN) or NDKD. Renal Doppler US findings, including cortical echogenicity, corticomedullary differentiation, and the resistive index (RI), were compared between DN and NDKD. A subgroup analysis according to chronic kidney disease (CKD) status was also performed. Cortical echogenicity and corticomedullary differentiation showed no significant differences between DN and NDKD (P=0.887 and P>0.99, respectively), whereas the RI was significantly higher in patients with DN than in those with NDKD (P=0.032). The subgroup analysis revealed a significant difference in the RI between DN and NDKD in patients with diabetes and CKD (P=0.010), but a significant difference was not found in those without CKD (P=0.713). When limited to patients with diabetes and CKD, the RI had an area under the curve value of 0.759, sensitivity of 57.1%, specificity of 81.0%, positive likelihood ratio of 3.0, and negative LR of 0.5 for predicting NDKD, using a cutoff value of ≤0.69. Renal Doppler US may be useful in predicting NDKD in patients with diabetes and CKD.

Depression and Hand-Grip: Unraveling the Association.

This review article explores the association between hand-grip strength and depression. A total of 14 studieswere carefully considered to provide a comprehensive analysis of the topic. The studies reveal a consistent association between low hand-grip strength and depressive symptoms, independent of age, gender, and chronic disease status. The evidence suggests that hand-grip strength assessment could be a useful tool for identifying individuals at risk of depression, particularly older adults and those with chronic diseases. Incorporating physical activity and strength training into treatment plans can contribute to better mental health outcomes. Hand-grip strength assessment can also be used as a monitoring tool to track changes in physical and mental health over time in individuals with depression. Healthcare professionals should consider the relationship between hand-grip strength and depression when evaluating patients and developing treatment plans. The findings from this comprehensive clinical review have important clinical implications and highlight the importance of considering physical health factors in the context of mental health.

A STUDY TO ASSESS THE LEVEL OF DEPRESSION AMONG THE ELDERLY LIVING IN SELECTED COMMUNITY AREA AT BHOPAL, (M.P.)

Background: Depression in old age is an emerging public health problem leading to morbidity and disabling effect on the quality of life. Depression in elderly is not yet perceived as a public health problem and is grossly underdiagnosed and undertreated. The physical and social environment plays an important role on the mental health of the elderly. Hence the present study was undertaken to assess and compare the depression among elderly residing in selected community area. A descriptive study was done Methods: among 100 elderlies. A pre tested, externally validated short form geriatric depression scale with fteen points is used for the assessment of level of depression after taking informed consent Prevalence of depression was high among elderly. On anal Results: yzing the association between sociodemographic factors and depression among the elderly residing in the community, it was found that marital status and presence of chronic disease were signicantly associated with depression. High prevalence of Conclusions: depression observed among the elderly indicates the need of screening for depression

Investigation and Analysis of Risk Factors and Psychological Status of Chronic Obstructive Pulmonary Disease in Permanent Residents Aged 40 or Older in Hongyuan County, Aba Prefecture, Sichuan Province.

COPD is an important public health problem worldwide, and there is a lack of epidemiological data on COPD in high-altitude areas in Sichuan province. Thus, we aimed to investigate the prevalence, risk factors and psychological status of COPD in Hongyuan County, Aba Prefecture, Sichuan Province, which is located at an average altitude of 3507 meters. The 40 years old or greater permanent residents of Hongyuan County were selected by random sampling method, and the lung function test and questionnaires were conducted to determine the disease situation of COPD. The prevalence of COPD was compared among different factors of investigation, and multivariate logistic regression analysis was used for different factors to determine the independent influencing factors of COPD disease. A total of 456 permanent residents aged 40 years or older in Hongyuan County, 436 qualified for quality control, among which 53 cases confirmed COPD, the total prevalence was 12.16%, among which the prevalence was 14.55% for men and it was 8.07% for women. There were significant differences in different gender, ethnicity, age, smoking status, smoking years, educational level, heating style, history of tuberculosis, and prevalence of BMI (P <0.05). Binary logistic regression analysis showed that age ≥60 years (OR = 2.810, 95% CI: 1.0457.557), Han Nationality (OR: 3.238, 95% CI: 1.290-8.127), the heating method including biofuels (OR: 18.119, 95% CI: 4.140-79.303) and coals (OR: 6.973, 95% CI: 1.856-26.200), medical history of pulmonary tuberculosis (OR: 2.670, 95% CI: 1.278-5.578), the education level including junior high school (OR: 3.336, 95% CI: 1.2259.075), high school and above (OR: 5.910, 95% CI: 1.796-19.450), and smoking (OR: 10.774, 95% CI: 3.622-32.051) were independent risk factors for COPD disease. The prevalence of anxiety was 16.98%, and the prevalence of depression was 13.2%. The prevalence of COPD in Hongyuan County was higher than the national level; age, ethnic group, education, smoking, heating method, and history of tuberculosis are the independent influencing factors of COPD in Hongyuan County. The prevalence of anxiety and depression is low.

Impact of SARS-CoV2 infection on mortality and hospitalization in nursing home residents during the "Omicron era".

Widespread vaccination and emergence of less aggressive SARS-CoV2 variants may have blunted the unfavourable outcomes of COVID-19 in nursing home (NH) residents. We analysed the course of COVID-19 epidemic in NHs of Florence, Italy, during the "Omicron era" and investigated the independent effect of SARS-CoV2 infection on death and hospitalization risk. Weekly SARS-CoV2 infection rates between November 2021 and March 2022 were calculated. Detailed clinical data were collected in a sample of NHs. Among 2044 residents, 667 SARS-CoV2 cases were confirmed. SARS-CoV2 incidence sharply increased during the Omicron era. Mortality rates did not differ between SARS-CoV2-positive (6.9%) and SARS-CoV2-negative residents (7.3%, p = 0.71). Chronic obstructive pulmonary disease and poor functional status, but not SARS-CoV2 infection independently predicted death and hospitalization. Despite that SARS-CoV2 incidence increased during the Omicron era, SARS-CoV2 infection was not a significant predictor of hospitalization and death in the NH setting.