Strong Predictor Of Risk Research Articles

Analyzing Urban Crime Through Street View Imagery: Insights from Urban Micro Built Environment and Perceptions

Understanding the relationship between urban crime and the built environment is crucial for developing effective crime prevention strategies, particularly in the context of rapid urban development and city planning. As cities grow, urbanization leads to environments that either promote or inhibit criminal activity, making it essential to explore the interactions between urban design and crime. This study investigates the impact of micro built environment (MBE) elements and place perceptions on crime occurrences in Toronto using street view imagery (SVI) data and machine learning models. We used logistic regression models and an XGBoost (Version 1.7.5) classifier to assess the significance of MBE and perception variables in classifying crime and non-crime intersections. Our findings reveal that intersections with criminal activity tend to be related to more mobility-related features, such as roads and vehicles, and fewer natural elements, such as vegetation. The “beautiful” and “depressing” perceptions emerged as the most significant variables in explaining crime events, surpassing the commonly studied “safety” perception. The XGBoost model achieved 86% accuracy, indicating that MBE and perception variables are strong predictors of crime risk. These findings suggest that enhancing vegetation and improving street aesthetics could serve as effective crime prevention measures in urban environments. However, limitations include the general nature of the perception model and the reliance on aggregated crime data. Future research should incorporate local perceptions and fine-scale crime data to provide more tailored insights for urban planning and crime prevention

Association of baseline remnant cholesterol independent of LDL-cholesterol with newly diagnosed diabetes in the Chinese population.

Remnant cholesterol (RC) is highly regarded in the cardiovascular field; however, its relationship with new-onset diabetes remains unclear. This study aimed to investigate the relationship between RC and the risk of developing diabetes, as well as its interaction with low-density lipoprotein cholesterol (LDL-c). This was a secondary analysis of a retrospective cohort study based on a Chinese population. A multivariate Cox proportional hazards regression was initially employed to assess the relationship between RC and newly diagnosed diabetes. This was followed by a subgroup analysis to explore intergroup heterogeneity. A clinical prediction model was then developed. Finally, the study further analyzed the interactions between LDL-c and RC. After adjusting for confounding factors, RC was significantly associated with an increased risk of diabetes (HR = 1.46, 95% CI 1.36-1.57). Furthermore, this relationship was nonlinear, with an inflection point of 0.48 identified through the piecewise model. Subgroup analysis indicated that the association was more pronounced in individuals under 60 years and those with a BMI <24 kg/m2 (P for interaction=0.0004, <0.0001, respectively). RC proved to be a more effective predictor of diabetes compared to other lipid profiles, and the clinical prediction model was successfully constructed. Notably, individuals in the low LDL-c/high RC group were found to have a 1.41-fold (95% CI 1.28-1.55) greater risk compared to those in the low LDL-c/low RC group. Significant correlations were observed between baseline RC levels and the risk of new-onset diabetes. Elevated RC was a strong predictor of diabetes risk, irrespective of LDL-c levels.

The geriatric nutritional risk index predicts blood transfusion risk in elderly patients undergoing posterior lumbar interbody fusion: a retrospective study

BackgroundMalnutrition can lead to an increased risk of blood transfusion in elderly patients. The Geriatric Nutritional Risk Index (GNRI) is a tool used to assess nutritional status, but its predictive value for blood transfusion in elderly patients undergoing posterior lumbar interbody fusion (PLIF) is not well established. This study aimed to investigate the association between GNRI and the risk of perioperative blood transfusion in this population.MethodsA retrospective cohort study was conducted on elderly patients aged 60 and above who underwent PLIF at Qingdao University Affiliated Hospital. Preoperative GNRI was calculated using height, weight, and serum albumin levels. The primary outcome was perioperative blood transfusion. Logistic regression analysis was performed, adjusting for potential confounders such as demographic characteristics, comorbidities, surgical factors, and laboratory tests.ResultsA total of 1,246 elderly patients were included, with 144 (11.6%) requiring blood transfusion. After adjusting for all confounders, a lower GNRI was associated with a significantly higher risk of blood transfusion (OR = 2.4, 95% CI: 1.9–3.1, p < 0.001). Patients with a GNRI score below 92 had a significantly increased transfusion risk compared to those with normal GNRI scores (OR = 5.8, 95% CI: 3.7–9.1, p < 0.05). RCS analysis revealed a linear negative relationship between GNRI and transfusion risk.ConclusionThe GNRI is a strong predictor of perioperative blood transfusion risk in elderly patients undergoing PLIF. Preoperative nutritional assessment using GNRI may help identify high-risk patients, enabling tailored interventions to optimize outcomes.

Importance of risk adjusting central line-associated bloodstream infection rates in children.

Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time. We conducted a prospective cohort study using electronic health record data at a quaternary Children's Hospital. We included hospitalized children with central catheters. Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates. Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12-1.37). Although not statistically different, observed rates were lower than expected rates for later years. Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.

Bridging the gap: Mechanistic-based cyclist injury risk curves using two decades of crash data

Objective Injury risk curves are vital in quantifying the relative safety consequences of real-world collisions. Previous injury risk curves for bicycle-passenger vehicle crashes have predominantly focused on frontal impacts. This creates a gap in cyclist injury risk assessment for other geometric crash configurations. The goal of this study was to create an “omnidirectional” injury risk model, informed by known injury causing mechanisms, that is applicable to most geometric configurations. Methods We used data from years 1999–2022 of the German In-Depth Accident Study (GIDAS). We describe the pattern of injuries for cyclists involved in collisions with passenger vehicles, and we developed injury risk functions at various AIS levels for these collisions. A mechanistic-based approach accounting for biomechanically-relevant variables was used to select model parameters a priori. Cyclist age (including children) and sex were regarded as relevant predictors of injury risk. Speed and impact geometry were captured through a novel predictor, Effective Collision Speed, which transforms the vehicle and cyclist speeds into a single value and incorporates frictional considerations observed during side engagements. Cyclist engagement with the vehicle was captured with a variable demonstrating the potential for a normal projection. We additionally present analyses weighted toward German nationwide data. Results We identified 6,576 cyclists involved in collisions with passenger vehicles. AIS3+ cyclist injuries occurred most often in the head, thorax, and lower extremities. Effective Collision Speed was a strong predictor of injury risk. Collisions with a potential for a normal projection were associated with increased risk, though this was only significant at the MAIS2+F severity level. Younger children had slightly higher injury risk compared to young adults, while elderly cyclists had the highest risk of AIS3+ injury. Sex was a significant predictor only for the MAIS2+F injury risk curves. Significance U.S. cyclist fatalities increased 55% from 2010 to 2021. To reduce injuries and fatalities, it is crucial to understand cyclist injury risk. This study builds on previous analyses by including children, incorporating additional mechanistic predictors, broadening the scope of included crashes, and using weighting to generalize these estimates toward national German statistics.

Predictors of Anterior Cruciate Ligament Tears in Adolescents and Young Adults.

Anterior cruciate ligament (ACL) injury in youth can lead to expensive treatment, lengthy rehabilitation, and long-term impairment. Injuries to the ACL are more common in adolescents who participate in organized sports. To examine whether there is an association between age, physical activity patterns, pubertal timing (Tanner stage), or body mass index (obesity/overweight status) and the risk of developing an ACL injury in youth. Cohort study; Level of evidence, 2. Data from the Growing Up Today Study (GUTS), a prospective cohort study of youth throughout the United States, were used in this study. From 1996 to 2003, questionnaires were sent to GUTS participants every 12 to 18 months to assess a variety of self-reported factors; in a related 2004 questionnaire, ACL tears and other diagnoses among the participants were reported. Cox proportional hazard models were run to determine the sex-specific association of activity patterns and pubertal timing with risk of developing an ACL tear. A total of 4519 boys and 5622 girls (age: 9-15 years) were included, with 2.4% and 2.0% sustaining an ACL injury, respectively. Age was found to be a significant risk factor for ACL injury in both sexes (male: hazard ratio [HR] = 1.30 [95% CI, 1.14-1.48]; female: HR = 1.23 [95% CI, 1.10-1.38]). Mean hours per week engaged in vigorous activity was also predictive of a higher risk of ACL injury (male: HR = 1.04 [95% CI, 1.01-1.08]; female: HR = 1.10 [95% CI, 1.07-1.14]). The sports that were the most predictive of injury were running, basketball, soccer, and cheerleading/gymnastics in girls and running, football, and karate/martial arts in boys. Additionally, in boys, overweight/obese status was found to be a significant predictor of ACL injury (HR = 2.61 [95% CI, 1.60-4.26]). Furthermore, among 9- to 13-year-old girls, advanced Tanner stage was a strong predictor of injury risk (HR = 2.43 [95% CI, 1.10-5.36]). Age, time engaged in vigorous activity, overweight/obese status, and advanced Tanner stage were associated with an increased risk of ACL injury in young adults and adolescents. Further research with follow-up data will help complement this study and continue to highlight the risk factors associated with ACL reconstruction in adolescents and young adults.

Is Family History for the Management of Cardiovascular Health in Youth Still Relevant in Clinical Practice?

Family history of premature cardiovascular disease is a strong predictor of individual cardiovascular risk. However, family history is not always available and not always reliable. Roughly 80% of health outcomes are influenced not by genetic risk but by societal factors, including adverse health behaviors and environment. Furthermore, in the present age of genetic testing, laboratory evaluations, and imaging, a key question remains: What is the contemporary relevance of family history screening in the management of cardiovascular disease in youth? Knowledge of an individual's family history can help clinicians identify not only inherited risk but also familial clustering of unhealthy behaviors and environmental adversity contributing to enhanced cardiovascular disease risk in youth. For those at greatest risk, prevention strategies can be applied sooner and more conservatively. Integrating family history into clinical practice is crucial for cardiovascular risk assessment and for optimizing outcomes, but, in some cases, is more reflective of social factors.

Individualized MRI-based stroke PRediction scOre using plaque Vulnerability for symptomatic carotid artEry disease patients (IMPROVE).

In TIA and stroke patients with carotid stenosis, estimations of future ipsilateral ischemic stroke risk and treatment decisions are currently primarily based on the degree of stenosis. Intraplaque hemorrhage (IPH), which can be readily visualized on carotid MRI, is increasingly established as an easy to assess and a very strong and independent predictor for ipsilateral stroke risk, stronger than any clinical risk factor. We developed a clinical prediction model (IMPROVE) incorporating IPH, degree of stenosis, and clinical risk factors to select patients with symptomatic carotid stenosis at high risk for stroke. IMPROVE was developed on pooled clinical and MRI data from five cohort studies of 760 recent TIA or minor stroke patients with carotid plaque who received optimal medical treatment. We used Cox proportional hazards models to determine the coefficients of IMPROVE. IMPROVE was internally validated using bootstrapping and converted to one- and three-year ipsilateral ischemic stroke risk. The development dataset contained 65 ipsilateral incident ischemic strokes that occurred during a median follow-up of 1.2 years (IQR: 0.5-4.1). The IMPROVE model includes five predictors, which are in order of importance: degree of stenosis, presence of IPH on MRI, classification of last event (cerebral vs ocular), sex, and age. Internal validation revealed a good accuracy (C-statistic: 0.82; 95% CI: 0.77-0.87) and no evidence for miscalibration (calibration slope: 0.93). Using presence of IPH on MRI and only four conventional parameters, the IMPROVE model provides accurate individual stroke risk estimates, which may facilitate stratification for revascularization.

A novel surgical risk predictor combining frailty and hypoalbuminemia - A cohort study of 9.8m patients from the ACS-NSQIP database.

The functional decline seen in frail patients is associated with significant morbidity and mortality. The modified frailty index 5 (mFI-5) score is an accepted risk predictor score in surgery. Hypoalbuminemia has been correlated with poor postoperative outcomes.There exists, however, a gap in the literature regarding the combined assessment of frailty and hypoalbuminemia and the predictive power of this combined assessment. This retrospective cohort study aimed to investigate the association of preoperative albumin and frailty, as assessed with the mFI-5 score, and its ability to predict surgical outcomes. We queried the ACS-NSQIP database (2008-2021) to identify all surgical patients. Perioperative data, including demographics and preoperative laboratory values, including albumin, were collected. The predictive power of the mFI-5 and hypoalbuminemia (Alb) independently, and in combination (mFI-5+Alb), was assessed using multivariable linear and logistic regression models 30-day outcomes were assessed including mortality, length of hospital stay, reoperation, medical and surgical complications, and discharge destination. A total of 9,782,973 patients were identified of whom 4,927,520 (50.4%) were non-frail (mFI=0), 3,266,636 had a frailty score of 1 (33.4%), 1,373,968 a score of 2 (14.0%), 188,821 a score of 3 (1.9%) and 26,006 a score greater or equal to 4 (0.3%). Albumin levels were available for 4,570,473 patients (46.7%), of whom 848,315 (18.6%) had hypoalbuminemia. The combined assessment (mFI-5+Alb) was found to be a more accurate risk predictor than each factor independently for all outcomes. A weak negative correlation between serum albumin levels and mFI scores was established (Spearman R: -0.2; <0.0001). Combined assessment of frailty and albumin was the strongest risk predictor. Therefore, for patients undergoing surgery, we recommend consideration of both serum albumin and frailty in order to optimally determine perioperative planning, including multi-disciplinary care mobilization and pre- and posthabilitation.

Dietary protein, amino acids and type 2 diabetes mellitus: a short review.

Diabetes is a widespread metabolic disorder and results from insulin resistance and impaired insulin secretion. Modifiable factors like diet, physical activity, and body weight play crucial roles in diabetes prevention, with targeted interventions reducing diabetes risk by about 60%. High-protein consumption, above the recommended intake of 0.8 g/kg body weight per day, have often explored in relation to diabetes risk. However, the relationship between dietary protein and diabetes is multifaceted. Observational studies have linked high total and animal protein intake to an increased risk of type 2 diabetes, particularly in obese women. Elevated levels of branched-chain amino acids (BCAA), which can result from dietary intake, protein breakdown, as well as an impaired catabolism, are strong predictors of cardiometabolic risk and insulin resistance. With several mechanism linking BCAA to insulin resistance. On the other hand, intervention studies suggest that high-protein diets can support weight loss and improve cardiometabolic risk factors. However, the impact on insulin sensitivity and glucose homeostasis is not straightforward. Proteins and amino acids stimulate both insulin and glucagon secretion, influencing glucose levels, but chronic effects remain uncertain. This short narrative review aims to provide an update on the relationship between increased dietary protein intake, amino acids, insulin resistance and type 2 diabetes, and to describe protein recommendations for type 2 diabetes.

High-Density Lipoprotein Particle Concentration and Size Predict Incident Coronary Artery Disease Events in a Cohort With Type 1 Diabetes.

The cholesterol efflux capacity of high density lipoprotein (HDL) is negatively associated with cardiovascular risk. Small HDL particles account almost quantitatively for cholesterol efflux capacity, perhaps mediated through efflux of cholesterol and outer leaflet plasma membrane phospholipids by ABCA1 (ATP binding cassette subfamily A member 1). People with type 1 diabetes are at increased coronary artery disease (CAD) risk despite normal HDL-cholesterol concentrations. We therefore tested the hypothesis that small HDL particles (HDL-P)-rather than HDL-cholesterol-predict incident CAD in type 1 diabetes. Incident CAD (CAD death, myocardial infarction, or coronary revascularization) was determined in 550 individuals with childhood-onset type 1 diabetes. HDL-P was quantified by calibrated ion mobility analysis and cholesterol efflux capacity was quantified with validated assays. During a median follow-up of 26 years, 36.5% of the participants developed incident CAD, for an incidence density of 181.3 per 10 000 person-years. In multivariable Cox models, neither HDL-cholesterol nor apolipoprotein A1 concentration was significantly associated with CAD risk. In contrast, higher extra-small HDL-P concentrations were significantly associated with decreased CAD risk (hazard ratio [HR], 0.26 [95% CI, 0.14-0.50]). Weaker associations were observed for total HDL-P (HR, 0.88 [95% CI, 0.83-0.93]), small HDL (HR, 0.83 [95% CI, 0.68-1.02]), medium HDL (HR, 0.79 [95% CI, 0.71-0.89]), and large HDL (HR, 0.72 [95% CI, 0.59-0.89]). Although cholesterol efflux capacity was negatively associated with incident CAD, this association was no longer significant after adjustment for total HDL-P. Lower concentrations of total HDL-P and HDL subpopulations were positively associated with incident CAD independently of HDL-cholesterol, apolipoprotein A1, and other common CVD risk factors. Extra-small HDL was a much stronger predictor of risk than the other HDLs. Our data are consistent with the proposal that extra-small HDL plays a critical role in cardioprotection in type 1 diabetes, mediated by macrophage cholesterol efflux by the ABCA1 pathway.

Different deployments of attentional breadth selectively predict UFOV task performance in older adults

The Useful Field of View task (UFOV) is a strong and reliable predictor of crash risk in older drivers. However, while the functional domain of attention is clearly implicated in UFOV performance, the potential role of one specific attentional process remains unclear: attentional breadth (the spatial extent of the attended region around the point of visual fixation). The goal of the present study was to systematically test the role of two distinct aspects of attentional breadth, maintaining a specific breadth of attention and resizing the attended region, in UFOV performance. To this end, 135 older adults completed the UFOV and modified Navon tasks to measure their efficiency in maintaining, contracting, and expanding the breadth of attention. We then examined individual-difference associations between these aspects of attentional breadth deployment and UFOV performance. We found that performance on UFOV Subtask 2 was associated with efficient contraction of attentional breadth (i.e., resizing the attended region to a smaller area), while Subtask 3 performance was associated with the efficiency of expanding attentional breadth (i.e., resizing the attended region to a larger area). The selectivity of these relationships appears to implicate these specific deployments of attentional breadth in how people complete the task, as it suggests that these relationships are not simply attributable to shared variance in a broader domain of cognitive functioning. The implications of these results for our understanding of UFOV, as well as future research directions that test the relative contributions of different cognitive processes in predicting task performance, are discussed.

Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study

ABSTRACT Background Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. Methods This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. Results Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. Conclusion We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.

A Concurrent Analysis of Drug Relapse Risk, Drug Avoidance Self-Efficacy, and Aftercare Experiences among Aftercare Program Clients

The cases of drug use and abuse have predominantly increased globally. This issue has become the most significant challenge among mental health professionals, the national government, and the general population. With the absence of substantial research about drug relapse and avoidance in the Philippines, this mixed-method research seeks to find out the relationship between drug relapse risk and drug avoidance self-efficacy among substance users who participated in the aftercare program. This study employed a concurrent mixed method design, combining both quantitative and qualitative approaches. In the quantitative phase, the Advance Warning of Relapse (AWARE) Questionnaire and Drug Avoidance Self-Efficacy Scale (DASES) were administered to 66 participants from the Aftercare Program (ACP) at the Department of Health Treatment and Rehabilitation Center in Eastern Visayas. The aim was to establish a correlation between the risk of drug relapse and drug avoidance self-efficacy. In the qualitative phase, interviews were conducted with five participants who met the study's inclusion criteria. Purposive sampling was used to select these participants. Quantitative findings revealed that ACP clients had low drug relapse risk and high drug avoidance self-efficacy. Moreover, Pearson product-moment correlation shows an inverse relationship between lower drug relapse risk and high drug avoidance self-efficacy, and vice-versa. However, the correlation between these variables is weak, indicating that drug avoidance self-efficacy is not a strong predictor of relapse risk in aftercare program clients. Similarly, qualitative results exposed the client’s experiences in the After Care Program. Six themes emerge from their experiences, such as their various reasons for taking the drugs, the effects of substance use, their effective coping mechanisms, the treatment of their communities, their accomplishment of recovery goals, and overcoming challenges in their recovery. The study suggests that individuals who participate in the aftercare programs are trying their best to recover and increase their self-efficacy to avoid using drugs. This strong self-efficacy, in combination with various factors such as family support, the acceptance of the community, and continued reminders of the consequences of substance abuse, decreased their vulnerability to use drugs in high-risk situations. The findings will increase the awareness of Filipinos in the prevention and treatment of substance use among their loved ones, relatives, and friends. Likewise, the findings recommend improving the aftercare program to increase its effectiveness and efficiency in preventing relapse among individuals in recovery.

The influence of hematological profiles on the transfusion management and mortality risk of mothers presenting to the obstetric unit of a South African tertiary medical facility.

Laboratory results are frequently abnormal in pregnant mothers. Abnormalities usually relate to pregnancy or associated complications. Hematological abnormalities and age in pregnancy may increase the likelihood for transfusion and mortality. Hematological profiles and transfusion history of pregnant mothers presenting to a tertiary hospital, were evaluated over 2 years. Age, anemia, leukocytosis and thrombocytopenia were assessed for transfusion likelihood. Iron deficiency and coagulation were assessed in transfused patients. Anemia, leukocytosis, thrombocytopenia, human immunodeficiency virus (HIV) and transfusion were assessed for mortality likelihood. There were 12,889 pregnant mothers included. Mothers <19-years-old had the highest prevalence of anemia (31.5%) and proportion of transfusions (19%). The transfusion likelihood was increased in mothers with anemia (odds ratios [OR] = 6.41; confidence intervals at 95% [95% CI] 5.46-7.71), leukocytosis (OR = 2.35; 95% CI 2.00-2.76) or thrombocytopenia (OR = 2.71; 95% CI 2.21-3.33). Mothers with prolonged prothrombin times received twice as many blood products as their normal counterparts (p = .03) and those with iron deficiency anemia five times more blood products (p < .001). Increased likelihood for mortality was seen in patients with anemia (OR = 4.15, 95% CI 2.03-8.49), leukocytosis (OR = 2.68; 95% CI 1.19-6.04) and those receiving blood transfusion (OR = 3.6, 95% CI 1.75-7.47). Adolescence, anemia, leukocytosis and thrombocytopenia expose mothers to a high risk for transfusion and/or mortality. These risk factors should promptly trigger management and referral of patients. Presenting hematological profiles are strong predictors of maternal outcome and transfusion risk.

Disentangling the relationships of body mass index and circulating sex hormone concentrations in mammographic density using Mendelian randomization.

Mammographic density phenotypes, adjusted for age and body mass index (BMI), are strong predictors of breast cancer risk. BMI is associated with mammographic density measures, but the role of circulating sex hormone concentrations is less clear. We investigated the relationship between BMI, circulating sex hormone concentrations, and mammographic density phenotypes using Mendelian randomization (MR). We applied two-sample MR approaches to assess the association between genetically predicted circulating concentrations of sex hormones [estradiol, testosterone, sex hormone-binding globulin (SHBG)], BMI, and mammographic density phenotypes (dense and non-dense area). We created instrumental variables from large European ancestry-based genome-wide association studies and applied estimates to mammographic density phenotypes in up to 14,000 women of European ancestry. We performed analyses overall and by menopausal status. Genetically predicted BMI was positively associated with non-dense area (IVW: β = 1.79; 95% CI = 1.58, 2.00; p = 9.57 × 10-63) and inversely associated with dense area (IVW: β = - 0.37; 95% CI = - 0.51,- 0.23; p = 4.7 × 10-7). We observed weak evidence for an association of circulating sex hormone concentrations with mammographic density phenotypes, specifically inverse associations between genetically predicted testosterone concentration and dense area (β = - 0.22; 95% CI = - 0.38, - 0.053; p = 0.009) and between genetically predicted estradiol concentration and non-dense area (β = - 3.32; 95% CI = - 5.83, - 0.82; p = 0.009), although results were not consistent across a range of MR approaches. Our findings support a positive causal association between BMI and mammographic non-dense area and an inverse association between BMI and dense area. Evidence was weaker and inconsistent for a causal effect of circulating sex hormone concentrations on mammographic density phenotypes. Based on our findings, associations between circulating sex hormone concentrations and mammographic density phenotypes are weak at best.

Handgrip strength and mortality in a cohort of kidney failure patients: Comparative analysis of different normalization methods

ObjectivesReduced handgrip strength (HGS) is associated with adverse clinical outcomes. We analyzed and compared associations of HGS with mortality risk in dialysis patients, using different normalization methods of HGS. MethodsHGS and clinical and laboratory parameters were measured in a cohort of 446 incident dialysis patients (median age 56 y, 62% men). The area under the receiver operating characteristic curve (AUROC) was used to compare different normalization methods of HGS as predictors of mortality: absolute HGS in kilograms; HGS normalized to height, weight, or body mass index; and HGS of a reference population of sex-matched controls (percentage of the mean HGS value [HGS%]). Multivariate linear regression analysis was used to assess HGS predictors. Competing risk regression analysis was used to evaluate 5-year all-cause mortality risk. Differences in survival time between HGS% tertiles were quantitated by analyzing the restricted mean survival time. ResultsThe AUROC for HGS% was higher than the AUROCs for absolute or normalized HGS values. Compared with the high HGS% tertile, low HGS% (subdistribution hazard ratio [sHR] = 2.36; 95% CI, 1.19–3.70) and middle HGS% (sHR = 1.79; 95% CI, 1.12–2.74) tertiles were independently associated with higher all-cause mortality and those with high HGS% tertile survived on average 7.95 mo (95% CI, 3.61–12.28) and 18.99 mo (95% CI, 14.42–23.57) longer compared with middle and low HGS% tertile, respectively. ConclusionsHGS% was a strong predictor of all-cause mortality risk in incident dialysis patients and a better discriminator of survival than absolute HGS or HGS normalized to body size dimensions.

(29) - Social Work Evaluation Domains Related to Caregiver Support and Mental Health are Strong Predictors of Risk of Readmission or Driveline Infection After HeartMate 3 (HM3)

(29) - Social Work Evaluation Domains Related to Caregiver Support and Mental Health are Strong Predictors of Risk of Readmission or Driveline Infection After HeartMate 3 (HM3)

Abstract 3429: Using metabolomics to identify biomarkers mediating the associations of adiposity in childhood and early adulthood with mammographic breast density in premenopausal women

Abstract Introduction: Mammographic breast density (MBD), a strong predictor of breast cancer risk, is highly influenced by body mass index (BMI) in childhood and early adulthood, but the mechanisms elucidating this relationship are undetermined. To our knowledge, no study has explored the mediating role of biomarkers on the relationship between early-life adiposity and MBD. The goal of this study is to discover metabolites that mediate the relationship between BMI at ages 10 and 18 with MBD in premenopausal women. Methods: This study includes premenopausal women who had their screening mammogram at Washington University in St. Louis, MO, and provided a fasting blood sample. Metabolon performed untargeted metabolomic profiling, detecting 1,074 metabolites. Metabolites missing &amp;gt;300 observations were excluded, leaving 828 metabolites; the other missing values were imputed using the nearest neighbor method. To mitigate batch effect, we normalized the metabolite peak area data using ComBat. Volumetric percent density (VPD) was calculated in 700 women using Volpara software. BMI at age 10 was estimated using the Stunkard pictogram, and BMI at age 18 was calculated from self-reported weight at 18 and height at study initiation. To assess the mediating role of the 828 metabolites, we performed high dimensional mediation analysis using the hima R package adjusting for potential confounders. Missing values in the covariates and BMI measures included in the mediation analysis were imputed using multivariate imputation by chain equations. Associations were considered significant if FDR p-value &amp;lt;0.1. Results: Four metabolites (glutamate, beta-cryptoxanthin, phytanate, and cortolone glucuronide (1)) mediated the relationship between BMI at age 10 and VPD; and 2 metabolites (glutamate, beta-cryptoxanthin) mediated the relationship between BMI at age 18 and VPD. Glutamate and beta-cryptoxanthin significantly mediated the relationship between both BMI measures and VPD, but glutamate was the strongest mediator across both time points. Glutamate mediated 6.7% (FDR p-value=0.06) and 9.3% (FDR p-value=0.008) of the total effect between BMI at age 10 and 18, respectively, on VPD. Beta-cryptoxanthin mediated 4.1% (FDR p-value=0.06) and 6.3% (FDR p-value=0.04), of the total effect between BMI at age 10 and 18, respectively, on VPD. Additionally, phytanate mediated 2.6% (FDR p-value=0.06) and cortolone glucuronide (1) mediated 2.0% (FDR p-value=0.07) of the total effect between BMI at age 10 and VPD. Conclusion: Amino acid, lipid, cofactor/vitamin, and xenobiotic metabolites mediated the associations of BMI in early-life and VPD in premenopausal women. This innovative study offers insight into the biological mechanisms underlying the link between early-life adiposity and MBD, which can support future research into breast cancer prevention. Citation Format: Kayla R. Getz, Myung Sik Jeon, Lili Liu, Lei Liu, Chongliang Luo, Jingqin Luo, Adetunji T. Toriola. Using metabolomics to identify biomarkers mediating the associations of adiposity in childhood and early adulthood with mammographic breast density in premenopausal women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3429.

Ethnic and Gender Differences in Sun-Related Cognitions Among College Students: Implications for Intervention.

Skin cancer incidence and prognosis vary by ethnicity and gender, and previous studies demonstrate ethnic and gender differences in sun-related cognitions and behaviors that contribute to this disease. The current study sought to inform skin cancer interventions tailored to specific demographic groups of college students. The study applied the prototype willingness model (PWM) to examine how unique combinations of ethnic and gender identities influence sun-related cognitions. Using data from a survey of 262 college students, the study tested whether self-reported sun-related cognitions were different for White women, Hispanic women, White men, and Hispanic men. Path modeling was also used to identify which PWM cognitions (e.g., prototypes, norms) were the strongest predictors of risk and protection intentions and willingness in each demographic group. Several differences in sun-related cognitions and PWM pathways emerged across groups, emphasizing the need for tailored skin cancer education and interventions. Results suggest that, for White women, interventions should primarily focus on creating less favorable attitudes toward being tan. Interventions for Hispanic women may instead benefit from manipulating perceived similarity to sun-related prototypes, encouraging closer personal identification with images of women who protect their skin and encouraging less identification with images of women who tan. For White men, skin cancer interventions may focus on creating more favorable images of men who protect their skin from the sun. Lastly, interventions for Hispanic men should increase perceived vulnerability for skin cancer.