Multivariate Stepwise Linear Regression Analysis Research Articles

Prevalence and associated factors of healthy aging among community-dwelling older adults in Lishui city, China: a cross-sectional study

BackgroundIdentifying the level of healthy aging and exploring its associated factors are prerequisites in the planning of effective measures among the elderly population. Thus, this study aimed to investigate the prevalence of healthy aging and determine its associated factors among community-dwelling older adults from mountain areas in Lishui, China.MethodsA multicenter cross-sectional survey was conducted. Participants were recruited by a multi-stage stratified cluster-sampling procedure from a mountainous region in Lishui City, Zhejiang Province, China. A validated questionnaire of Healthy Aging Instruments (HAI), Basic Psychological Needs Satisfaction (BPNS), Patient Health Questionnaire (PHQ-9), Ascertain Dementia 8 questionnaire (AD8), Family Adaption Scale (FAS), Community-Based Health Promotion Activity Questionnaires (HPAQ), Social Function Questionnaire for Chinese Older Adults (SFQCOA), Adult Health Self-Management Skills (ability) Rating Scale (AHSMSRS) was incorporated. The questionnaire also captured sociodemographic characteristics, lifestyle behaviors, and Self-Perceived Healthy Ageing (SPHA). Multivariate stepwise linear regression analysis was performed.ResultsThe mean score of the Healthy Aging index was 136.5 (18.22). The majority of the participants have a high level of healthy aging (65.5%). Regression analysis showed 12 predictors of healthy aging: self-perceived economic independence, lifestyle-related behaviors, subjective physical health, psychological health, better competence of BPNS, frequency of community-based HPA participation, lower HPA-perceived barriers, social support, social engagement, and Health Self-Management (HSM) ability with two dimensions HSM-Consciousness and HSM-Behavior, as well as SPHA (P < 0.05).ConclusionsThis study contributed to the existing gap in both subjective and objective understanding of healthy aging, especially in terms of its relationship with sociodemographic factors, lifestyle-related behaviors, individual health conditions, environmental coverage, as well as family, community and social support. Both individual-environment interaction factors as better HSM ability as well as SPHA might help predict older adults’ healthy aging in mountainous areas in China. Developing an accurate, reliable health promotion program that provides insights may improve healthy aging changes in mountainous regions for community healthcare staff, especially nurses.

Delta corticomedullary apparent diffusion coefficient on MRI as a biomarker for prognosis in IgA nephropathy

Objectives To explore the association of the cortico-medullary difference in apparent diffusion coefficient (ΔADC) with clinicopathological parameters of disease activity at the time of biopsy, and with the prognositic risk stratification in IgA nephropathy (IgAN) patients. Methods We included 112 patients with biopsy-proven IgAN who measured ΔADC. Patients underwent a kidney biopsy and diffusion-weighted magnetic resonance imaging within one week of the biopsy. Clinicopathological characteristics were compared according to different ΔADC levels. The effect of ΔADC on eGFR and kidney fibrosis was explored using multivariate regression and ROC analysis. An individual’s 5-year risk probability of progressing to ESKD or decreasing of eGFR > 50% was calculated by the guidelines-recommended international risk-prediction tool in IgAN. The effect of ΔADC on prognostic risk stratification was assessed. Net reclassification improvement (NRI) was used to evaluate the model performance. Results The average ΔADC was 168.89 ± 85.1 x10−6 mm2/s. ΔADC levels decreased significantly with increasing chronic kidney disease (CKD) stages (p = 0.0038). Spearman correlation analysis revealed that ΔADC was positively correlated with eGFR, hemoglobin, serum albumin, while negatively correlated with levels of serum creatine (Scr), blood urea nitrogen (BUN), T score of Oxford classification and Lee grades (p < 0.05). Moreover, we showed that ΔADC was independently associated with eGFR (β = 0.04, 95% CI = [0.003, 0.077], p = 0.033) demonstrated by a backward stepwise multivariate linear regression analysis. Besides, ΔADC, a combination of ΔADC and eGFR showed an AUC of 0.776 (60% sensitivity and 85.3% specificity) and an AUC of 0.875 (100% sensitivity and 69.6% specificity) respectively for evaluating kidney interstitial fibrosis (IF) severity. Furthermore, ΔADC showed an AUC of 0.792 (95% CI 0.677-0.906) for differentiating higher progression risk categories from lower categories (specificity = 91.6%, sensitivity = 58.8%). The low-ΔADC group (≤ median value 167.1 × 10−6 mm2/s) was associated with 7.509-fold higher likelihood of higher progression risk compared to the high-ΔADC group (>167.1 × 10−6 mm2/s) in a fully-adjusted model. And reclassification analyses confirmed that the final adjusted model improved NRI. Conclusions ΔADC was significantly associated with kidney function and enabled a reliable evaluation of kidney IF severity in IgAN patients. Low ΔADC can predict a high 5-year kidney progression risk in IgAN, independent of important clinical factors. Moreover, the predictive ability to identify patients at high risk of severe kidney fibrosis and adverse progression estimates with satisfactory accuracy, facilitating ΔADC a promising and noninvasive tool in complementarily evaluating disease activity and the prognostic risk stratification in patients with IgAN.

Recurrence score-predicted value derived from estrogen receptor, tumor-infiltrating lymphocytes, progesterone receptor, and Ki-67 may substitute for the Oncotype DX recurrence score in estrogen receptor (ER)+/human epidermal growth factor receptor 2 (HER2)− breast cancer

Oncotype DX is the only multigene assay supported by the National Comprehensive Cancer Network (USA) with Level 1 evidence for use on node-negative and postmenopausal node-positive patients with estrogen receptor (ER)+/human epidermal growth factor receptor 2 (HER2)-breast cancer to predict the prognosis and to estimate chemotherapy add-on effects. However, the test's high cost prevents its use in most cases. Therefore, we aimed to obtain an alternative recurrence score (RS) prediction formula using the optimal clinicopathological factors. We retrospectively reviewed data of 81 patients with ER+/HER2− primary breast cancer in our hospital where Oncotype DX RS was measured. Stepwise multivariate linear regression analysis was conducted with several selected clinicopathological factors of 60 consecutive cases in the training group. The obtained RS-predicted values were validated against Oncotype DX RS using 21 additional consecutive cases. The RS prediction formula derived from the combination of ER, tumor-infiltrating lymphocytes (TILs), progesterone receptor (PgR), and Ki-67-labeling index produced a favorable model with a correlation coefficient (r) of 0.731103 for the Oncotype DX RS (p = 0.0002) and an adjusted R2 coefficient of 0.510013. The RS-predicted values and the actual Oncotype DX RS were classified into four 2 × 2 groups, by using an RS of 26 as a threshold for adding chemotherapy with a concordance rate of 95.2 % (20/21) and a kappa coefficient of 0.829. RS-predicted values of combined ER, TILs, PgR, and Ki-67 may be an appropriate substitute for Oncotype DX RS in certain situations.

Determinants of right ventricular - pulmonary arterial uncoupling in hypertrophic cardiomyopathy

Abstract Background Right ventricular (RV) – pulmonary arterial (PA) coupling, assessed by echocardiography, is a non-invasive surrogate on how the RV is adapted to an increased afterload in the pulmonary circulation. In cases of exhaustion of compensatory RV remodeling, the ratio decreases and there is RV-PA uncoupling. Our objective was to identify what are the determinants of this parameter in patients with hypertrophic cardiomyopathy (HCM). Methods This prospective cohort study enrolled patients with HCM without obstructive epicardial coronary artery disease, that underwent a comprehensive evaluation. Echocardiography was used to assess RV-PA coupling as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). In addition, coronary flow reserve in the left anterior descending artery (CFR_LAD) was also evaluated: diastolic coronary flow velocity was measured in basal conditions and in hyperemia and CFR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. This was used as a surrogate marker of coronary microvascular dysfunction. Cardiac magnetic resonance (CMR) was also performed to evaluate RV function (volumes and ejection fraction), and the extent of late gadolinium enhancement (LGE) in the left ventricle (LV). Results We enrolled 62 patients, with a mean age of 55 (15) years, 64% males. In 64% it was an asymmetrical septal hypertrophy phenotype, in 31% an apical hypertrophy, and in 27%, it was an obstructive HCM. Mean TAPSE/PASP was 0.556 (0.23) and median was 0.50. All patients had a normal LV ejection fraction. Univariable linear regression analysis showed that age, maximal wall thickness, E/E’, indexed left atrial volume (LAVi), CFR-LAD, %LGE and % hypoperfusion (by CMR) were correlated with RV-PA uncoupling. The HCM phenotype or the presence of obstruction were not associated with uncoupling. Multivariable stepwise linear regression analysis showed that the independent predictors of RV-PA uncoupling were age (b-estimate: - 0.180, p=0.009), LAVi (b-estimate: -0.645, p=&amp;lt;0.001), CFR-LAD (b-estimate: 0.183, p=0.011) and %LGE (b-estimate: -0.270, p=&amp;lt;0.001). Conclusion In patients with HCM, the presence of coronary microcirculation abnormalities and the extent of LGE in the LV are independent predictors of RV-PA uncoupling.

Serum Malondialdehyde-Modified Low-Density Lipoprotein Level May Be a Biomarker Associated with Aortic Stiffness Among Patients Undergoing Peritoneal Dialysis.

Serum malondialdehyde-oxidized low-density lipoprotein (MDA-oxLDL) is associated with atherosclerosis and increased risk of cardiovascular disease (CVD). Vascular calcification frequently occurs with arterial stiffness in patients on peritoneal dialysis (PD). This cross-sectional study aimed to elucidate the correlation between aortic stiffness and MDA-oxLDL levels in patients on PD. Overall, 92 patients on PD were included. The carotid-femoral pulse wave velocity (cfPWV) was evaluated using cuff-based volumetric displacement, and blood samples were obtained from all patients. Aortic stiffness was classified based on cfPWV values (>10 m/s indicating aortic stiffness). Serum MDA-ox-LDL levels were quantified using commercial enzyme-linked immunosorbent assay kits. In total, 33 (35.9%) patients were classified into the aortic stiffness group. Factors, including systolic blood pressure (SBP), serum triglyceride levels, C-reactive protein levels, age, weight, body mass index (BMI), waist circumference, MDA-oxLDL levels, and diabetes mellitus (DM) prevalence, were significantly higher in the aortic stiffness group. Multivariable logistic regression analysis revealed significant associations between aortic stiffness and MDA-oxLDL levels, BMI, and SBP. Furthermore, multivariable forward stepwise linear regression analysis revealed serum MDA-oxLDL levels as a significant independent predictor of cfPWV values. Serum MDA-oxLDL levels correlate positively with cfPWV values and may predict aortic stiffness among PD patients, highlighting its potential role in assessing CVD risk in this population.

Age-related analysis of corneal biomechanical parameters in healthy Chinese individuals

To report the correlation between corneal biomechanical parameters and age in healthy Chinese individuals. This cross-sectional study was conducted on 864 eyes of 543 healthy participants. A comprehensive ophthalmic examination and corneal biomechanics examination using Corneal Visualization Scheimpflug Technology (Corvis ST) were conducted. Based on age, all participants were further divided into five age groups (n) as follows: group A, 11–20 years (105); group B, 21–30 years (112); group C, 31–40 years (113); group D, 41–50 years (100); and group E, > 50 years (113). Using Corvis ST, we examined 35 corneal biomechanical parameters and compared them across the different age groups. Spearman’s correlation coefficients and stepwise multivariate linear regression models were used to investigate whether the corneal biomechanical parameters were related to demographic and ocular characteristics. A correlation analysis between the left and right eyes revealed that 13 parameters were significantly associated with eye differences. Among the 35 corneal biomechanical parameters, 28 exhibited significant differences across the age groups, with stiffness parameter at applanation 1(SPA1) showing an upward trend after the age of 30 and stress–strain index (SSI) demonstrates a statistically significant upward trend when comparing the five age groups in the study. Additionally, Spearman’s correlation analysis and stepwise multivariate linear regression analysis revealed that 11 corneal biomechanical parameters were positively correlated with age and 10 were negatively correlated with age. Corvis biomechanical index (CBI) was significantly negatively correlated with intraocular pressure (IOP) and central corneal thickness (CCT), SSI was significantly positively correlated with age and IOP, and SPA1 were positively correlated with IOP and CCT. In conclusion, most corneal biomechanical parameters showed a significant correlation with age, with corneal stiffness progressively increasing alongside advancing age, IOP, or CCT.

Impaired insulin sensitivity measured by estimated glucose disposal rate is associated with decreased myocardial mechano-energetic efficiency in non-diabetic individuals

Background and aimsImpaired myocardial mechano-energetic efficiency (MEE) has been associated with cardiac insulin resistance measured by dynamic positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) combined with euglycemic–hyperinsulinemic clamp. Estimate glucose disposal rate (eGDR) index has a good correlation with whole-body insulin sensitivity. It remains unsettled whether eGDR index is a suitable proxy of cardiac insulin sensitivity as well as its association with myocardial MEE. The aims of this study were: 1) to compare eGDR index with HOMA-IR, QUICKI and FIRI indexes for association with myocardial glucose metabolic rate (MrGlu); and 2) to determine the association of eGDR index with myocardial MEE. MethodsWe evaluated MrGlu using PET with 18F-FDG combined with euglycemic–hyperinsulinemic clamp in 50 individuals without history of coronary heart disease. Myocardial MEE per gram of left ventricular mass (MEEi) was measured in 1181 subjects by echocardiography. eGDR (mg kg-1/min) was calculated as: 21.158 - (0.09 × waist circumference in cm) - (3.407 × hypertension, 1 = yes 0 = no) - (0.551 × HbA1c%). ResultseGDR index was more strongly associated with myocardial MrGlu than HOMA-IR, QUICKI, and FIRI indexes (r = -0.662, r = -0.492, r = 0.570, and r = -0.492, respectively). Individuals in the lower tertiles of eGDR exhibited a significant reduction of MEEi as compared to those in the highest tertile (P < 0.001). In a stepwise multivariate linear regression analysis eGDR index was the major determinant of MEEi independently of well-established cardio-metabolic risk factors. ConclusionsThese data suggest that the eGDR index may be a useful marker to identifying individuals at high cardiovascular risk.

Cardiorespiratory Fitness Is an Indicator of Arterial Stiffness and Aortic Blood Pressure in Healthy Adolescents.

Background/Objectives: We aimed to investigate the influence of cardiorespiratory fitness (CRF) and body composition on arterial stiffness. Methods: Carotid-to-femoral pulse wave velocity (cfPWV) and aortic systolic (ASBP) and diastolic (ADBP) blood pressure were compared between upper and lower tertiles of oxygen consumption at the aerobic threshold (VO2AerT), peak oxygen consumption (VO2peak), percentage of fat mass (FM%), and body mass index (BMI) in sixty adolescents (30 males and 30 females, 14.9 ± 2.1 years old). A stepwise multivariable linear regression analysis was performed to investigate the independent associations between VO2AerT and VO2peak and cfPWV, and between BMI and FM% and cfPWV with adjustments for age, sex, ASBP, and ADBP. Results: cfPWV and ADBP were lower in the second and third VO2AerT tertiles compared to the first tertile (cfPWV, 4.7 ± 0.5 and 4.7 ± 0.5 vs. 5.3 ± 0.8 m/s, p < 0.01; ADBP, 62 ± 7 and 62 ± 7 vs. 70 ± 8 mmHg, p < 0.01). ASBP was lower in the third VO2AerT tertile compared to the first tertile (94 ± 7 vs. 101 ± 12 mmHg, p = 0.05). ADBP was lower in the second VO2peak tertile compared to the first tertile (62 ± 7 vs. 68 ± 9 mmHg, p = 0.03). ASBP was lower in the first and second BMI tertiles compared to the third tertile (95 ± 8 and 95 ± 7 vs. 102 ± 11 mmHg, p = 0.02). The eight-variable model significantly contributed to the variance of cfPWV (F(8, 51) = 7.450, p < 0.01), accounting for 47% of the variance. Individually, age (p < 0.05) and ADBP (p < 0.01) significantly predicted cfPWV. Conclusions: Submaximal indicators of CRF such as VO2AerT should be considered as a part of the risk stratification of cardiovascular disease in healthy adolescents.

Relationship between circulating thrombospondin-1 messenger ribonucleic acid and microribonucleic acid-194 levels in Chinese patients with type 2 diabetic kidney disease: The outcomes of a case-control study.

We investigated the relationship of circulating TSP-1 mRNA and miR-194 with diabetic kidney disease's degree. We enrolled 167 hospitalized type 2 diabetes patients in the endocrinology department. Patients were split into three groups according to urinary microalbumin: A, B and C. The control group comprised healthy outpatients (n = 163). The quantities of microribonucleic acid (miR)-194 and thrombospondin-1 (TSP-1) messenger ribonucleic acid (mRNA) in the participants' circulation were measured using a quantitative real-time polymerase chain reaction. Circulating TSP-1 mRNA (P = 0.024) and miR-194 (P = 0.029) expressions significantly increased in type 2 diabetes patients. Circulating TSP-1 mRNA (P = 0.040) and miR-194 (P = 0.007) expression levels differed significantly among the three groups; circulating TSP-1 mRNA expression increased with urinary microalbumin. However, miR-194 declined in group B and increased in group C. Circulating TSP-1 mRNA was positively correlated with cystatin-c (r = 0.281; P = 0.021) and microalbumin/creatinine ratio (UmALB/Cr; r = 0.317; P = 0.009); miR-194 was positively correlated with UmALB/Cr (r = 0.405; P = 0.003). Stepwise multivariate linear regression analysis showed cystatin-c (β = 0.578; P = 0.021) and UmALB/Cr (β = 0.001; P = 0.009) as independent factors for TSP-1 mRNA; UmALB/Cr (β = 0.005; P = 0.028) as an independent factor for miR194. Areas under the curve for circulating TSP-1 mRNA and miR194 were 0.756 (95% confidence interval 0.620-0.893; sensitivity 0.69 and specificity 0.71, P < 0.01) and 0.584 (95% confidence interval 0.421-0.748; sensitivity 0.54 and specificity 0.52, P < 0.01), respectively. Circulating TSP-1 mRNA and miR-194 expressions significantly increased in type 2 diabetes patients. The microalbumin group had lower levels of miR-194 (a risk factor that is valuable for type 2 diabetes kidney disease evaluation).

Factors associated with nursing students' mental health-related stigma: A multisite cross-sectional study

BackgroundMental health-related stigma remains a complex and pervasive issue globally. It not only inhibits individuals from seeking help but also influences the quality of healthcare they receive. Despite extensive research on mental health-related stigma, there is still limited understanding of factors influencing mental health-related stigma among nursing students. ObjectivesThis study aimed to assess the level of mental health-related stigma among Chinese nursing students and investigate possible associated factors. MethodsData were collected from the 2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) survey. A total of 967 nursing students were included in the study. Multivariate stepwise linear regression analysis was conducted to examine the influencing factors of mental health stigma. ResultsThe mean mental health-related stigma score among nursing students was 15.31 ± 5.23 (range = 0–27). Perceived stress (β = 0.14, P = 0.001), self-efficacy (β = 0.22, P < 0.001), academic stage (β = 0.17, P < 0.001), depression (β = 0.15, P < 0.001), and adverse life events (β = 0.06, P = 0.044) were significantly associated with mental health-related stigma among nursing students (R2 = 0.147, adjusted R2 = 0.143, F = 33.214, P < 0.001). ConclusionsNursing students in China exhibit a moderate level of mental health-related stigma, suggesting room for improvement. Perceived stress, self-efficacy, academic stage, depression, and adverse life events emerged as significant influencing factors for mental health-related stigma. These findings provide valuable insights for developing interventions to reduce mental health-related stigma among nursing students, ultimately enhancing their well-being and preparing them for becoming competent healthcare professionals in the future.

The right ventricular dysfunction and ventricular interdependence in patients with T2DM and aortic regurgitation: an assessment using CMR feature tracking

BackgroundPatients with concomitant type 2 diabetes mellitus (T2DM) and aortic regurgitation (AR) can present with right ventricular (RV) dysfunction. The current study aimed to evaluate the impact of AR on RV impairment and the importance of ventricular interdependence using cardiac magnetic resonance feature tracking (CMR‑FT) in patients with T2DM.MethodsThis study included 229 patients with T2DM (AR−), 88 patients with T2DM (AR+), and 122 healthy controls. The biventricular global radial strain (GRS), global circumferential strain (GCS), and global longitudinal peak strain (GLS) were calculated with CMR‑FT and compared among the healthy control, T2DM (AR−), and T2DM (AR+) groups. The RV regional strains at the basal, mid, and apical cavities between the T2DM (AR+) group and subgroups with different AR degrees were compared. Backward stepwise multivariate linear regression analyses were performed to determine the effects of AR and left ventricular (LV) strains on RV strains.ResultsThe RV GLS, LV GRS, LV GCS, LV GLS, interventricular septal (IVS) GRS and IVS GCS were decreased gradually from the controls through the T2DM (AR−) group to the T2DM (AR+) group. The IVS GLS of the T2DM (AR−) and T2DM (AR+) groups was lower than that of the control group. AR was independently associated with LV GRS, LV GCS, LV GLS, RV GCS, and RV GLS. If AR and LV GLSs were included in the regression analyses, AR and LV GLS were independently associated with RV GLS.ConclusionAR can exacerbate RV dysfunction in patients with T2DM, which may be associated with the superimposed strain injury of the left ventricle and interventricular septum. The RV longitudinal and circumferential strains are important indicators of cardiac injury in T2DM and AR. The unfavorable LV-RV interdependence supports that while focusing on improving LV function, RV dysfunction should be monitored and treated in order to slow the progression of the disease and the onset of adverse outcomes.

Serum 25-Hydroxyvitamin D Level Is Positively Associated with Vascular Reactivity Index in Patients with Type 2 Diabetes Mellitus.

Circulating 25-hydroxyvitamin D (25(OH)D) significantly influences endothelial function. This study assessed the correlation between serum 25(OH)D and endothelial function using the vascular reactivity index (VRI) in patients with type 2 diabetes mellitus (T2DM). Fasting blood samples from 102 T2DM participants and VRI were assessed. Patients were divided into three categories based on VRI: low (VRI < 1.0), intermediate (1.0 ≤ VRI < 2.0), and good (VRI ≥ 2.0). Among these patients, 30 (29.4%) had poor, 39 (38.2%) had intermediate, and 33 (32.4%) exhibited good vascular reactivity. Higher serum fasting glucose (p = 0.019), glycated hemoglobin (p = 0.009), and urinary albumin-to-creatinine ratio (p = 0.006) were associated, while lower prevalence of hypertension (p = 0.029), lower systolic blood pressure (p = 0.027), lower diastolic blood pressure (p < 0.001), and lower circulation 25(OH)D levels (p < 0.001) were associated with poor vascular reactivity. Significant independent associations between diastolic blood pressure (p = 0.002) and serum 25(OH)D level (p < 0.001) and VRI were seen in T2DM patients according to multivariable forward stepwise linear regression analysis. Serum 25(OH)D positively correlated with VRI values, and lower levels of serum 25(OH)D were linked to endothelial dysfunction in T2DM patients.

Effects of stigma on the quality of life in patients with epilepsy

BackgroundThis study was aimed to evaluate the stigma and quality of life (QoL) in adult patients with epilepsy (PWEs) and explore the relationship between stigma and QoL.MethodsTwo hundred and ninety-eight PWEs admitted to the Epilepsy Center of the First Affiliated Hospital of Chongqing Medical University during September 2020 and March 2021 were enrolled in this study. All participants completed self-reported questionnaires including the Stigma Scale for Epilepsy and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31).ResultsA total of 146 (49%) PWEs reported an experience of stigma. The total score of QOLIE-31 and the individual scores of seven subscales (worry about new seizures, emotion, well-being, energy and fatigue, cognitive impairment, medication effect, and social function) were significantly decreased in these patients (P < 0.001). Multivariate stepwise linear regression analysis showed that the annual household income per capita, the number of antiseizure medications and stigma had statistically significant effects on QoL (P < 0.05). Among them, stigma had the most significant negative effect.ConclusionsNearly half of PWEs have experienced stigma. Stigma, lower household income per capita, and polypharmacy treatment are associated with poorer QoL. Stigma has the most obvious negative impact.

Exposure to Violent Contexts and Psychosocial Functioning of Adolescents: A Cross-sectional Study

Objective: The aim is to examine the relationship between exposure to violence at home and at school on the psychosocial functioning of school-going adolescents. Materials and Methods: A total of 306 adolescents (mean = 15.28 years, standard deviation = 1.04) were recruited from two schools (one government and one private) in a North Indian city. A semi-structured form elicited information on demographic and socioeconomic variables and the extent to which students were exposed to violence at home and school. Based on the students’ responses to the victimization questions at home and school, they were categorized into four groups: those who faced overt and/or covert violence at both home and school; overt and/or covert violence only at home; overt and/or covert violence only at school; and those who faced no violence (control group). The preadolescent adjustment scale (PAAS) was used to assess the student’s self-reported adjustment at home, school, and with teachers, and peers. The main outcome measure was the self-reported total score on the Strengths and Difficulties Questionnaire (SDQ). Results: Nearly one-fifth (20.3%) of the students’ total score on the SDQ was in the borderline or abnormal range. The students who had been exposed to one or more contexts of violence were significantly more likely to report higher total SDQ scores (χ² = 33.94, P = 0.0001) and show scores in the abnormal range on the subdomains of hyperactivity/inattention (χ² = 15.75, P = 0.015) and conduct problems (χ² = 27.70, P = 0.0001) on the SDQ. Stepwise multivariate linear regression analyses indicated that overall, 17.4% of the variance in the SDQ total difficulties score was explained by the total score on the index of violence score, adjustment score on the teacher subdomain of PAAS, and the age of the adolescent (F = 20.88, P = 0.0001). Conclusions: Exposure to violence in different settings plays a critical role in determining the mental health of adolescents. Professionals need to be sensitive to the issues of parenting, disciplining practices, and school connectedness with school teachers while working with adolescents.

Correlation between habits of using online health information and e-health literacy in middle-aged and older Chinese adults

BackgroundAlong with increased online dependency of supplying and obtaining health knowledge, e-health literacy emerges as one of essential skills for people with chronic diseases. ObjectiveThis study aimed to explore the current experience and challenges associated with online health information use behaviors and e-health literacy in middle-aged and older adults, and offer insights for improving e-health literacy level and developing tailored Internet-based health knowledge dissemination services. MethodsFrom June to September 2021, a questionnaire survey was administered to 1 061 middle-aged and older adults in Shanghai communities, using a multi-stage sampling method. The survey instruments included General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS). These tools helped measure participants' online health information use behavior and their e-health literacy levels. Multilinear stepwise regression analysis was employed to explore the relationship between internet health information use habits, other potential influencing factors, and e-health literacy levels. ResultsOf the distributed questionnaires, 1,019 were returned, yielding a 96.04 % response rate. In terms of approaches accessing online health information, 40.33 % (411 participants) used health media platform accounts, 32.97 % (336 participants) used search engines, 24.93 % (254 participants) engaged with health management apps or mini programs, and a smaller number, 65 cases participated in online health group. Regarding information sources, a relatively small number of residents relied on medical institutions (38.96 %, 397 participants) and medical personnel (18.35 %, 187 participants). The average eHEALS score was 27.62 ± 8.57. Participants demonstrated limited awareness in using online health information to solve their health problems (item 2 of eHEALS, 3.36 ± 1.27) and in discerning reliable from unreliable health information on Internet (item 6 of eHEALS, 3.38 ± 1.23). Multiple linear regression analysis indicated that e-health literacy was influenced by several factors, including age, coverage of both social and commercial medical insurances, the use of at least two online health information sources and search approaches, behaviors of forwarding and sharing online health information, and holding positive attitude of accepting online health information. ConclusionThe e-health literacy of these middle-aged and older adults is moderate and influenced by various factors, including online health information use behaviors. To help them make better use of online health information and improve their e-health literacy, the authors recommended to provide authoritative information integration and retrieval platform, to strengthen regulation and supervision of health information providers, to develop older people friendly health information online platforms, and to help middle aged and older adults to better use online health information by mobilizing the resources of communities, families, health associations, and medical and insurance institutions.

The Levels and Associated Factors for Participation and Autonomy Among People with Parkinson´s Disease: A Cross-Sectional Study.

Promoting participation and autonomy (PA) in society has been highlighted as an ultimate goal of rehabilitation for people with chronic diseases by the World Health Organization, but few studies have focused on PA in people with Parkinson's disease (PD). Therefore, this study aimed to determine the level of PA in PD patients and investigate the associated psychological and behavioural factors. PD patients were recruited from the Department of Neurology of the First Hospital Affiliated with Dalian Medical University using convenience sampling for this cross-sectional study. A questionnaire covering social-demographic and disease-related characteristics, Chinese version of Impact on Participation and Autonomy (IPA) Questionnaire, Connor-Davidson Resilience Scale (CD-RISC), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Medical Coping Modes Questionnaire (MCMQ), Social Support Rating Scale (SSRS), Hoehn-Yahr Staging System and Unified Parkinson's Disease Rating Scale (UPDRS) were used for investigation. A multivariate stepwise linear regression analysis was used to determine the factors that influence IPA. A total of 326 PD patients responded to all the questionnaires. The patients had a mean IPA score of 46.6 (SD 21.79). Multiple linear regression analyses revealed that UPDRS II (β = 0.35, p < 0.001) had the strongest correlation with IPA, followed by tenacity, which was the second strongest factor (β = -0.25, p < 0.001). Hoehn-Yahr stage (β = 0.19, p < 0.001) and availability of social support (β =-0.12, p =0.001) were also strong factors. The average level of PA among PD patients was at the lower middle-level. Among PD patients, physical function, psychological resilience and social support were the strongest factors associated with PA. These findings provide valuable insights into PD patients' PA and can help medical professionals identify the early risks of restricted PA among PD patients, implement interventions to promote PA and ultimately achieve rehabilitation.

Food Insecurity Prevalence and Its Demographic, Anthropometric, and Nutritional Determinants Among Overweight and Obese Patients with Diabetes and Coronary Artery Disease

Background: Food insecurity is a common health problem in both developing and developed countries and is associated with various chronic diseases such as hyperlipidemia, heart disease, hypertension, and metabolic syndrome. This study aimed to investigate the demographic and nutritional factors influencing food insecurity among individuals with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Methods: The current cross-sectional study included 647 patients from outpatient clinics at Tabriz University of Medical Sciences, Tabriz, Iran. Among them, 275 patients had T2DM, and 310 patients had CAD. Demographic data, including age, gender, employment status, household size, household income, and education, were collected by a questionnaire. Anthropometric assessments were carried out, and food insecurity was investigated using a validated questionnaire. Moreover, a food frequency questionnaire (FFQ) was used for dietary assessment. Statistical assays were performed using SPSS 16 software. Results: The total prevalence of low food security among patients with T2DM and CAD was 69.81% and 32.58% respectively. The corresponding values for very low food insecurity were 19.27% and 36.45%, respectively. Among the CAD group, food-insecure patients were more likely to be male and belonged to low-income families (P&lt;0.05). Moreover, 81.2% of food-insecure patients had low educational attainments compared to 57.5% of food-secure patients (P&lt;0.001). Furthermore, stepwise multivariate linear regression analysis revealed that being male gender was a potent predictor of food insecurity among CAD patients. Higher body mass index (BMI) and higher income had protective roles against food insecurity in these patients. Additionally, no differences were found in demographic or anthropometric parameters among patients with diabetes. Conclusion: The current study indicated the role of age, gender, income, and education in developing food insecurity in patients with cardiovascular disease (CVD). However, none of these parameters were determinants of food insecurity in our sample of diabetic patients. Further studies are needed to confirm these results.

Are they functional hypogonadal men? Testosterone serum levels unravel male idiopathic infertility subgroups

PurposeTo evaluate total testosterone distribution in male idiopathic infertility.MethodsA retrospective, real-world case-control clinical study was conducted. Cases consisted of men evaluated for couple infertility, specifically those with alterations in semen parameters and normal gonadotropin levels, and after excluding all known causes of male infertility. Controls were male subjects who underwent semen analysis for screening purposes, without any abnormality detected. The total testosterone distribution was evaluated in cases and controls. Further analyses were performed subgrouping cases according to total testosterone reference threshold suggested by scientific societies (i.e., 3.5 ng/mL).ResultsCases included 214 idiopathic infertile men (mean age 38.2 ± 6.2 years) and controls 224 subjects with normozoospermia (mean age 33.7 ± 7.5 years). Total testosterone was not-normally distributed in both cases and controls, with positive asymmetric distribution slightly shifted on the left in cases. The rate of subjects with testosterone lower than 3.5 ng/mL was higher in cases (23.8%) than controls (4.5%) (p < 0.001). In cases with testosterone lower than 3.5 ng/mL, a significant direct correlation between testosterone and the percentage of normal morphology sperms was highlighted, also applying multivariate stepwise linear regression analysis (R = 0.430, standard error = 0.3, p = 0.020).ConclusionAlthough idiopathic infertile men show by definition altered semen analysis and gonadotropins within reference ranges, testosterone serum levels are widely variable in this population. Approximately a quarter of these patients present some sort of functional hypogonadism. Our data support the need to better classify idiopathic male infertility and total testosterone serum levels could be a supportive parameter in tracing the patient’s therapeutic profile.

Hydronephrosis severity as a predictor of postoperative renal function decline following laparoscopic radical nephroureterectomy.

This study aimed to investigate factors, including the degree of hydronephrosis, that may be associated with decreased renal function after radical nephroureterectomy (RNU). This study included 252 patients who underwent laparoscopic RNU with an estimated glomerular filtration rate (eGFR) ≥ 30ml/min/1.73 m2 in three institutions. We assessed the association between hydronephrosis grade and perioperative renal function and performed a stepwise multivariate linear regression analysis to identify factors associated with postoperative eGFR. Patients with preoperative eGFR ≥ 50ml/min/1.73 m2 were divided into a training set and an independent external validation set to develop a predictive model for postoperative renal function. The median preoperative and postoperative eGFR were 61.1 and 46.4ml/min/1.73 m2, respectively. The eGFR preservation rates were 66.9%, 66.6%, 88.1%, and 100.0% in groups without, with mild, moderate, and severe hydronephrosis, respectively, and this difference was statistically significant (p < 0.001). Multivariate analysis revealed that factors predictive of postoperative eGFR included sex, preoperative eGFR, clinical T stage (cT3-4), and the presence of moderate or severe hydronephrosis. Our predictive model, based on these factors, positively correlated with actual postoperative renal function, and the similarity in categories with or without renal function insufficiency between predicted and actual postoperative renal functions was 78% in both training and validation sets. Moderate or severe hydronephrosis is associated with a modest postoperative decline in renal function, while mild hydronephrosis is not. Our predictive model may be useful in predicting postoperative renal function insufficiency and guiding decision-making for perioperative medical treatment.

Serum Elabela expression is decreased in hypertensive patients and could be associated with the progression of hypertensive renal damage

BackgroundElabela, a recently discovered hormonal peptide containing 32 amino acids, is a ligand for the apelin receptor. It can lower blood pressure and attenuate renal fibrosis. However, the clinicopathological relationship between Elabela level and renal damage caused by benign hypertension (BHT) and malignant hypertension (MHT) has not been elucidated. Therefore, we investigated the clinicopathological correlation between serum Elabela level and renal damage caused by BHT and MHT.MethodsThe participants comprised 50 patients and 25 age-matched healthy adults. The 50 patients were separated into two groups: MHT (n = 25) and BHT groups (n = 25). We analyzed their medical histories, demographics, and clinical examinations, including physical and laboratory tests. ResultsThe results showed that serum Elabela level decreased gradually with a continuous increase in blood pressure from the healthy control group, BHT, to MHT. Moreover, Elabela levels negatively correlated with BMI (R = − 0.27, P = 0.02), SBP (r = − 0.64, P < 0.01), DBP (r = − 0.58, P < 0.01), uric acid (r = − 0.39, P < 0.01), bun (r = − 0.53, P < 0.01), and Scr (r = − 0.53 P < 0.01) but positively correlated with eGFR (r = 0.54, P < 0.01). Stepwise multivariate linear regression analysis showed that SBP was the variable most related to Elabela (t = − 5.592, P < 0.01).ConclusionsSerum Elabela levels decreased in patients with hypertension, especially malignant hypertension, and has the potential to be a marker of hypertension-related kidney damage.