Strong Predictor Of Risk Research Articles

Continuous NHANES survey data for environmental ambient and occupational hazard identification—feasibility and preliminary findings for osteoporosis and kidney disease

The Continuous NHANES Survey provides detailed health and environmental chemical burden information on the U.S. population. As of 2012, there were data for 72,000 participants. Based on single biomarker determinations, cumulative burdens were estimated. Because age distributions would differ comparing ambient environmental and occupational exposures, a procedure to distinguish ambient from likely occupational exposures was applied. Associations are reported for osteoporosis and kidney disease-related outcomes with cadmium, lead, and other metals. Cumulative cadmium burden (from blood cadmium, ambient and occupational) was a strong predictor of bone fracture risk and ambient tungsten also had a positive association. Cumulative lead (ambient and occupational) had a negative (“protective”) association with fractures as did mercury (occupational). Bone mineral density was statistically significant and similarly predicted by metal exposures. Kidney disease was significantly associated with cumulative lead burdens from both the estimated ambient and occupational sources and with ambient blood cadmium but was most strongly associated with cumulative occupational uranium burden. Systolic blood pressure statistically significantly increased with cumulative ambient and occupational lead (blood) burden and with ambient cadmium and cobalt. Diastolic blood pressure was significantly associated with several cadmium and cobalt metrics along with ambient and occupational cumulative burdens for lead. For environmental substances with burden half-lives measured in years, NHANES offers opportunities for hypothesis generation and confirmation.

Exploring the Path of Mediterranean Diet, Non-Alcoholic Fatty Liver Disease (NAFLD) and Inflammation towards 10-Year Cardiovascular Disease (CVD) Risk: The ATTICA Study 10-Year Follow-Up (2002-2012).

Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease, affecting ~30% of the population and increasing CVD. This study aimed to explore the direct, indirect and combined effects of Mediterranean diet, NAFLD and inflammation on the 10-year CVD risk in a healthy adult population. Methods: Using baseline and 10-year follow-up data from the ATTICA study, adherence to Mediterranean diet was measured using MedDietScore, and presence of NAFLD at baseline was assessed using the fatty liver index (FLI). Participants’ 10-year CVD outcomes were recorded and C-reactive protein (CRP) was used as a surrogate marker for inflammation. The direct and indirect roles of these factors were explored using logistic regression models and the pathways between them were analysed using a structural equation model (SEM). Results: NAFLD prevalence was 22.9% and its presence was 17% less likely for every unit increase in MedDietScore. NAFLD presence at baseline was associated with increased 10-year CVD incidence (39.4% vs. 14.5%, p = 0.002), but when adjusted for MedDietScore, NAFLD was not an independent predictor of 10-year CVD risk. MedDietScore was an independent protective factor of 10-year CVD risk (OR = 0.989, 95% CI: 0.847, 0.935), when adjusted for NAFLD at baseline, age, gender, sedentary lifestyle and other confounders. Further exploration using SEM showed that MedDietScore was associated with CVD risk directly even when inflammation as CRP was introduced as a potential mediator. Conclusion: FLI as a proxy measure of NAFLD is a strong predictor of 10-year CVD risk, and this prognostic relationship seems to be moderated by the level of adherence to Mediterranean diet. Adherence to Mediterranean diet remained an independent and direct CVD risk factor irrespective of NAFLD status and CRP.

458-P: Inflammatory Markers and Cardiovascular Autonomic Neuropathy in Type 1 Diabetes

Objective: We aimed to assess the role of chronic inflammation in the pathogenesis of cardiovascular autonomic neuropathy (CAN) , a serious complication of type 1 diabetes (T1D) . Methods: We leveraged an ongoing randomized, placebo-controlled clinical trial targeting inflammation with salsalate in individuals with T1D, to measure a panel of 40 inflammatory markers (Figure) in baseline samples. Measures of CAN included standardized cardiovascular autonomic reflex tests (CARTs) (E/I, Valsalva, 30/15 ratios) and indices of heart rate variability (HRV) . We used Spearman-rank to assess the correlations between inflammatory markers and CAN measures, and linear regression to adjust for age and hemoglobin A1c. Results: The Figure displays the correlation between biomarkers and CAN measures in 58 T1D participants (mean age 51 ± 13 years, and HbA1c 8.4 ± 1.8%) . Amongst all biomarkers, we noted a singular negative correlation between soluble urokinase plasminogen activator receptor (suPAR) and measures of CAN, which remained significant in multivariable analysis (E/I ratio p=0.005, Valsalva p=0.037, RFA p=0.019, LFA p=0.023) . Conclusion: Amongst a large panel of inflammatory markers, we found suPAR to have a notable association with CAN. SuPAR is an immune-mediated signaling glycoprotein which levels are strong predictors of risk in patients with diabetes, thus its role in CAN warrants further exploration. Disclosure L.Ang: None. L.Zhao: None. E.L.Feldman: None. S.Hayek: n/a. R.Pop-busui: Advisory Panel; Averitas Pharma, Inc., Boehringer Ingelheim International GmbH, Nevro Corp., Novo Nordisk, Reata Pharmaceuticals, Inc., Regenacy Pharmaceuticals, Inc. S.V.G.Gunaratnam: None. Y.Huang: None. K.R.Mizokami-stout: None. C.Martin: Advisory Panel; Nevro Corp. J.Reiss: n/a. A.Burant: None. A.Vasbinder: None. C.Launius: None. Funding NIH/NIDDK-1-R01-DK-107956-01

1368-P: Skeletal Muscle Mitochondrial Dysfunction Contributes to Increased GDF15 Levels in Aged Mice with Insulin Resistance and Sarcopenia

Growth differentiation factor 15 (GDF15) is a secreted protein whose cellular expression increases in response to a variety of stimuli, including mitochondrial dysfunction. Plasma GDF15 levels increase with advanced age and positively associate with sarcopenia. The prevalence of type 2 diabetes (T2D) increases with age and the incidence of sarcopenia is elevated in patients with T2D. Despite these established associations, the relationship between skeletal muscle mitochondrial function and changes in GDF15 expression, as well as how they may contribute to sarcopenia and T2D in the context of aging, remain poorly defined. We hypothesized that mitochondrial dysfunction in skeletal muscle would be positively associated with increased GDF15 expression and plasma levels in aged mice, and that muscle function and insulin sensitivity would be impaired also. Lean mass as a percentage of body weight was significantly reduced in aged (52 months) male C57BL6 compared with young (4 months) mice. Skeletal muscle function and mobility, assessed as peak and max sustained speeds achieved during voluntary wheel running, were significantly impaired in aged mice. Hyperinsulinemic euglycemic clamps demonstrated impaired insulin sensitivity in skeletal muscle, adipose and liver of aged mice. High-resolution respirometry studies using permeabilized muscle fibers detected significant reductions in the respiratory control ratio (RCR) in aged mice that was due to increased state 4 or leak respiration. Muscle GDF15 gene expression was significantly elevated in old mice, as were plasma levels of circulating GDF15. Our data suggests that skeletal muscle is a significant contributor to increased plasma GDF15 levels seen during aging, and that changes in mitochondrial function may contribute to increased skeletal muscle GDF15 expression. Elevated GDF15 may therefore serve as a strong predictor of mitochondrial pathology and subsequent risk of T2D in aging. Disclosure J.Chen: None. F.Bello: None. J.Kastroll: None. A.Vandevender: None. M.Pangburn: None. A.A.Gil silva: None. I.J.Sipula: None. J.Alder: None. M.J.Jurczak: None.

Association of socioeconomic status measures with physical activity and subsequent frailty in older adults

BackgroundDespite increased recognition, frailty remains a significant public health challenge. Objectivewe aimed to assess the role of education and income, as well as neighborhood socioeconomic status, on physical activity and subsequent frailty in older adults. MethodsUsing a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], 74.6 (6.2), 53.3% female) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005–2006. A follow-up interview was performed 12–14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Self-reported leisure-time physical activity (LTPA) was measured at both baseline and follow-up. SES measures were assessed at baseline. Frailty was measured at follow-up, using the Fried's Phenotype Model.ResultsAll SES measures were strongly and positively associated with LTPA (all p < 0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR = 2.77, 95% CI: 1.57–4.90, for inactivity; OR = 1.41, 95% CI: 0.75–2.68, for insufficient activity, compared with sufficient activity, Ptrend < 0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity.ConclusionAmong older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.

Soluble suppression of tumorigenesis-2 is a strong predictor of all-cause, cardiovascular and infection-related mortality risk in haemodialysis patients with diabetes mellitus

ABSTRACTBackgroundSoluble suppression of tumorigenesis-2 (sST2) is a strong prognostic biomarker of cardiovascular (CV) disease. End-stage kidney disease (ESKD) patients are at high risk of CV events and infections. Herein we investigated the utility of sST2 to predict all-cause and cause-specific mortality in haemodialysis (HD) patients with diabetes mellitus.MethodssST2 concentrations were measured in plasma samples of 1196 participants of the German Diabetes and Dialysis (4D) study who had type 2 diabetes mellitus and received maintenance HD for ESKD. Hazard ratios (HRs) for prespecified, adjudicated endpoints were determined according to sST2 levels at baseline by multivariate Cox proportional hazards analysis.ResultsParticipants (mean age 66 years, 54% male) had a median sST2 concentration of 25 ng/mL and were followed up for 4 years. After adjustment for possible confounders, participants with sST2 concentrations in the highest (>32.6 ng/mL) compared with the lowest (<20.1 ng/mL) quartile exhibited a 2-fold higher all-cause mortality risk {[HR 2.06 95% confidence interval (CI) 1.61–2.61]; P < .001}. High sST concentrations (fourth versus first quartile) were strongly associated with the risk of cardiac death [HR 2.29 (95% CI 1.55–3.39); P < .001]. Analysis of individual components of cardiac causes of death showed an increased risk of sudden death [HR 2.24 (95% CI 1.33–3.77); P < .001], death due to myocardial infarction [HR 2.12 (95% CI 0.9–5.0); P = .087] and heart failure [HR 3.34 (95% CI 1.15–9.75); P = .027] in participants with sST2 levels in the highest compared with the lowest quartile. Likewise, participants with the highest sST2 levels had an increased risk of fatal stroke [HR 1.92 (95% CI 1.17–3.14); P = .009] and fatal infections [HR 2.01 (95% CI 1.2–3.37); P = .008]. In contrast to fatal CV events, sST2 was not associated with the risk of non-fatal myocardial infarction [HR 0.68 (95% CI 0.41–1.12); P = .132] or non-fatal stroke [HR 1.28 (95% CI 0.64–2.53); P = .485].ConclusionsIn HD patients with diabetes mellitus, high concentrations of sST2 were strongly and independently associated with an increased risk of all-cause mortality, CV mortality and death due to infection but not non-fatal CV events.

Association of socioeconomic status measures with physical activity and subsequent frailty in older adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite increased recognition, frailty remains a significant public health challenge. Methods Using a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], age 75[6]; 53% women) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005-2006. A follow-up interview was performed 12-14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Extensive data including self-reported leisure time physical activity (LTPA) and SES measures were assessed at baseline. Frailty was measured at follow-up. Results All SES measures were strongly and positively associated with LTPA (all p&amp;lt;0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR=2.77, 95% CI: 1.57-4.90, for inactivity; OR=1.41, 95% CI: 0.75-2.68, for insufficient activity, compared with sufficient activity, Ptrend&amp;lt;0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity. Conclusion Among older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.

Diabetic Retinopathy Is a Predictor of Progression of Diabetic Kidney Disease: A Systematic Review and Meta-Analysis.

Methods A systematic search was conducted on PubMed, Embase, and the Google scholar for eligible studies through September 2021. The quality of selected articles was assessed using JBI checklist. Higgins and Thompson's I2 statistic was used to see the degree of heterogeneity. Based on degree of heterogeneity, fixed or random effects model was used to estimate pooled effect using inverse variance method. Results were expressed as hazard ratios and odds ratios with 95% CIs. Results After scrutinizing 18017 articles, data from ten relevant studies (seven prospective and three retrospective) was extracted. DR was significantly associated with DKD progression with a pooled HR of 2.42 (95% CI: 1.70–3.45) and a pooled OR of 2.62 (95% CI: 1.76–3.89). There was also a significant association between the severity of DR and risk of progression of DKD with a pooled OR of 2.13 (95% CI: 1.82–2.50) for nonproliferative DR and 2.56 (95% CI: 2.93–.33) for proliferative DR. Conclusion Our study suggests that presence of DR is a strong predictor of risk of kidney disease progression in DKD patients. Furthermore, the risk of DKD progression increases with DR severity. Screening for retinal vascular changes could potentially help in prognostication and risk-stratification of patients with DKD.

Dynamical indicators in time series of healthcare expenditures predict mortality risk of older adults following spousal bereavement

BackgroundThe process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms, including humans. We investigated the ability of system-based indicators in capturing the dynamics of resilience in humans who suffer the adversity of spousal bereavement and tested their predictive power in mortality as a finite health transition.MethodsUsing longitudinal register data on weekly healthcare consumption of all Danish citizens over the age of 65 from January 1st, 2011, throughout December 31st, 2016, we performed statistical comparisons of the indicators ‘average’, ‘slope’, ‘mean squared error’, and ‘lag-1 autocorrelation’ one year before and after spousal bereavement, stratified for age and sex. The relation between levels of these indicators before bereavement and mortality hazards thereafter was determined by time to event analysis. We assessed the added value for mortality prediction via the time dependent area (AUC) under the receiver operating characteristic curve.ResultsThe study included 934,003 citizens of whom 51,890 experienced spousal bereavement and 2862 died in the first year thereafter. Healthcare consumption is increased, more volatile and accelerating with aging and in men compared to women (all p-values < 0.001). All dynamic indicators before bereavement were positively related with mortality hazards thereafter (all p-values < 0.001). The average discriminative performance for the 1-year mortality risk of the model with only age as a predictor (AUC: 68.9% and 70.2%) was significantly increased with the addition of dynamical indicators (78.5% and 82.4%) for males and females, respectively.ConclusionsDynamic indicators in time series of health care expenditures are strong predictors of mortality risk and could be part of predictive models for prognosis after life stressors, such as bereavement.

Association Between Platelet Levels and 28-Day Mortality in Patients With Sepsis: A Retrospective Analysis of a Large Clinical Database MIMIC-IV.

BackgroundThis research focused on evaluating the correlation between platelet count and sepsis prognosis, and even the dose-response relationship, in a cohort of American adults.MethodPlatelet counts were recorded retrospectively after hospitalization for patients admitted to Beth Israel Deaconess Medical Center’s intensive care unit between 2008 and 2019. On admission to the intensive care unit, sepsis patients were divided into four categories based on platelet counts (very low < 50 × 109/L, intermediate-low 50 × 109–100 × 109/L, low 100 × 109–150 × 109/L, and normal ≥ 150 × 109/L). A multivariate Cox proportional risk model was used to calculate the 28-day risk of mortality in sepsis based on baseline platelet counts, and a two-piece linear regression model was used to calculate the threshold effect.ResultsThe risk of 28-day septic mortality was nearly 2-fold higher in the platelet very low group when compared to the low group (hazard ratios [HRs], 2.24; 95% confidence interval [CI], 1.92–2.6). Further analysis revealed a curvilinear association between platelets and the sepsis risk of death, with a saturation effect predicted at 100 × 109/L. When platelet counts were below 100 × 109/L, the risk of sepsis 28-day death decreased significantly with increasing platelet count levels (HR, 0.875; 95% CI, 0.84–0.90).ConclusionWhen platelet count was less than 100 × 109/L, it was a strong predictor of the potential risk of sepsis death, which is declined by 13% for every 10 × 109/L growth in platelets. When platelet counts reach up to 100 × 109/L, the probability of dying to sepsis within 28 days climbs by 1% for every 10 × 109/L increase in platelet count.

A derived honey bee stock confers resistance to Varroa destructor and associated viral transmission

The ectoparasite Varroa destructor is the greatest threat to managed honey bee (Apis mellifera) colonies globally. Despite significant efforts, novel treatments to control the mite and its vectored pathogens have shown limited efficacy, as the host remains naïve. A prospective solution lies in the development of Varroa-resistant honey bee stocks, but a paucity of rigorous selection data restricts widespread adoption. Here, we characterise the parasite and viral dynamics of a Varroa-resistant honey bee stock, designated ‘Pol-line’, using a large-scale longitudinal study. Results demonstrate markedly reduced Varroa levels in this stock, diminished titres of three major viruses (DWV-A, DWV-B, and CBPV), and a two-fold increase in survival. Levels of a fourth virus that is not associated with Varroa—BQCV—do not differ between stocks, supporting a disruption of the transmission pathway. Further, we show that when decoupled from the influence of Varroa levels, viral titres do not constitute strong independent predictors of colony mortality risk. These findings highlight the need for a reassessment of Varroa etiology, and suggest that derived stocks represent a tractable solution to the Varroa pandemic.

Analysis of C reactive protein and other inflammatory markers in the cardiovascular risk prediction in women

Objective: To evaluate the role of C Reactive Protein and other inflammatory markers in cardiovascular risk prediction. Study Design: A prospective case-control study. Place and Duration: At Cardiology Department of Nishtar Medical University &amp; Hospital Multan from 5th Oct 2020 to 5th Oct 2021. Methodology: A total of 150 postmenopausal women were studied and divided into CVD patients (n=50) and control patients (n=100). The analyzed markers of inflammation included Interleukin-6, high-sensitivity C-reactive Protein, Soluble ICAM-1 (slCAM-1), and Amyloid-A. The Homocysteine, Lipid Profile, and Low and High-density lipoprotein levels were also evaluated. Cardiovascular events considered in our study were death after coronary artery disease, non-fatal heart attack or stroke, or requiring coronary-revascularization methods. Results: In univariate analysis, it was observed that high-sensitivity C-reactive protein levels were the strongest risk predictor of cardiovascular diseases. Amyloid-A, High-density lipoprotein, Cholesterol, Low-density lipoprotein cholesterol, Soluble lCAM-1, Interleukin-6, Apolipoprotein B-100, Homocysteine, total cholesterol, and the ratio of total cholesterol to high-density lipoprotein cholesterol also contributed to predicting cardiovascular diseases. High-sensitivity C-reactive protein (95% Cl: 1.4(1.0-2.0)) and Amyloid-A (95% Cl: 0.9(0.7-1.5)) were also strong risk predictors in women. On the other hand, in multivariate analyses, only High-sensitivity C-reactive protein and the ratio of total cholesterol to high-density lipoprotein cholesterol were independent risk predictors. Conclusion: As high-sensitivity CRP is an independent cardiovascular risk predictor, adding it to lipid screening may be a good procedure for identifying women at risk of cardiovascular diseases. Keywords: High sensitivity C-reactive protein, Cardiovascular events, Amyloid-A, Lipids, Inflammatory markers

In postmenopausal women, lower limb peripheral arterial disease, assessed by ankle-brachial index, may be a strong predictor of cardiovascular risk

BackgroundLower limb peripheral arterial disease (PAD) is a leading atherosclerotic disease in the elderly. However, awareness of the disease is poor, particularly in women. MethodsIn this retrospective, cross-sectional study, postmenopausal women referred to our Angiology Division were tested for PAD, defined as an “ankle-brachial index” (ABI) ≤0.9 or ≥1.4 (in the latter case with a “toe-brachial index” <0.7), or a history of lower limb arterial revascularization. Aim of our study was to assess cardiovascular (CV) risk profile in postmenopausal women with and without PAD, and to evaluate the role of PAD and six classic CV risk factors (CVRFs), namely age, current smoking, hypertension, dyslipidaemia, severe chronic renal failure, and diabetes in predicting CV disease (CVD), defined as coronary artery disease and/or cerebrovascular disease. ResultsOverall, 850 patients were included, 39.4% of whom with PAD. Compared with women without PAD, those with PAD were older (75.2 vs 66 years, respectively; p <0.001), and displayed higher rates of other CVRFs (p <0.001 for each). A personal history of CVD was reported in 18.8% of women with PAD and in 6.1% of those without PAD (p <0.001). At multivariate regression analysis, PAD (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.33–3.47), and hypertension (OR: 2.20; 95%CI: 1.24–3.88) were the strongest factors associated with CVD presence. ConclusionsPAD is a strong marker of CVD in this selected series of postmenopausal women. If confirmed in the general population, PAD screening through ABI calculation may be considered for CV risk assessment in postmenopausal women.

Matrix condition mediates the effects of habitat fragmentation on species extinction risk

Habitat loss is the leading cause of the global decline in biodiversity, but the influence of human pressure within the matrix surrounding habitat fragments remains poorly understood. Here, we measure the relationship between fragmentation (the degree of fragmentation and the degree of patch isolation), matrix condition (measured as the extent of high human footprint levels), and the change in extinction risk of 4,426 terrestrial mammals. We find that the degree of fragmentation is strongly associated with changes in extinction risk, with higher predictive importance than life-history traits and human pressure variables. Importantly, we discover that fragmentation and the matrix condition are stronger predictors of risk than habitat loss and habitat amount. Moreover, the importance of fragmentation increases with an increasing deterioration of the matrix condition. These findings suggest that restoration of the habitat matrix may be an important conservation action for mitigating the negative effects of fragmentation on biodiversity.

Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study.

PurposeOsteoporotic hip fracture surgery is associated with a risk of morbidity and mortality. Admission hemoglobin levels <10 g/dL have been documented as a strong predictor of mortality risk. This study aimed to investigate the mortality outcome between osteoporotic hip fracture patients who had preoperative hemoglobin levels raised to ≥10 g/dL and those with hemoglobin levels were <10 g/dL.Patients and MethodsThis 5-year retrospective observational study included 226 participants with osteoporotic hip fractures that required surgery and who had admission hemoglobin levels <10 g/dL. Patients were categorized into two groups: those with corrected preoperative hemoglobin ≥10 g/dL and those with either corrected or uncorrected preoperative hemoglobin <10 g/dL. Outcomes were analyzed using Cox proportional hazard regression adjusted for confounders. Results are presented as hazard ratio (HR) and 95% confidence interval (95% CI).ResultsAmong 226 the patients, the overall mortality rate was 17.25% (n=39/226) of the 226 patients, 93 (41.15%) had their hemoglobin levels raised to ≥10 g/dL by red blood cell transfusion. Multivariable analysis after adjustment for confounders showed a 50% lower incidence of mortality among patients with preoperative hemoglobin levels ≥10 g/dL than among those with hemoglobin levels <10 g/dL (HR 0.50, 95% CI (0.25–0.99), p=0.048).ConclusionIn osteoporotic hip fracture patients with admission hemoglobin <10g/dL, raising preoperative hemoglobin levels to ≥10 g/dL can significantly reduce the risk of mortality. Testing for and correction of low preoperative hemoglobin levels is of value in hip surgery patients.

The impact of breast density notification on rescreening rates within a population-based mammographic screening program

BackgroundHigh participation in mammographic screening is essential for its effectiveness to detect breast cancers early and thereby, improve breast cancer outcomes. Breast density is a strong predictor of breast cancer risk and significantly reduces the sensitivity of mammography to detect the disease. There are increasing mandates for routine breast density notification within mammographic screening programs. It is unknown if breast density notification impacts the likelihood of women returning to screening when next due (i.e. rescreening rates). This study investigates the association between breast density notification and rescreening rates using individual-level data from BreastScreen Western Australia (WA), a population-based mammographic screening program.MethodsWe examined 981,705 screening events from 311,656 women aged 40+ who attended BreastScreen WA between 2008 and 2017. Mixed effect logistic regression was used to investigate the association between rescreening and breast density notification status.ResultsResults were stratified by age (younger, targeted, older) and screening round (first, second, third+). Targeted women screening for the first time were more likely to return to screening if notified as having dense breasts (Percentunadjusted notified vs. not-notified: 57.8% vs. 56.1%; Padjusted = 0.016). Younger women were less likely to rescreen if notified, regardless of screening round (all P < 0.001). There was no association between notification and rescreening in older women (all P > 0.72).ConclusionsBreast density notification does not deter women in the targeted age range from rescreening but could potentially deter younger women from rescreening. These results suggest that all breast density notification messaging should include information regarding the importance of regular mammographic screening to manage breast cancer risk, particularly for younger women. These results will directly inform BreastScreen programs in Australia as well as other population-based screening providers outside Australia who notify women about breast density or are considering implementing breast density notification.

Influence of Smoking on The Location of Acute Myocardial Infarctions

Objective: To determine the frequency of smokers and to compare the frequency of smokers among patients with inferior and anterior acute myocardial infarction amongst patients presenting with acute myocardial infarction at a Tertiary Care Hospital. Subjects And Methods: This cross-sectional study was conducted on 226 at the Adult Cardiology Department of the National Institute of Cardiovascular Disease (NICVD), Karachi for six months from 20-07-2019 till 20-01-2020. After obtaining verbal consent, researchers prospectively collected data from the participants. The study included 226 patients who were diagnosed with the appropriate conditions. Frequency and percentages were used to present qualitative data, while mean and standard deviation were used to present quantitative data. To see how to effect modifiers affected the outcome, researchers used stratification to keep track of them. For statistical significance, the post-stratification chi-square test was used. Results: A total of 226 presenting with acute myocardial infarction were included in this study. The mean age in our study was 55.92±10.49 years. Out of 226 patients with acute myocardial infarction, 130 (57.5%) and 96 (42.5) smoked and did not smoke respectively. Comparison of smoking status in patients who had anterior and inferior myocardial infarction showed that 39 (53.4%) and 51 (51%) smoked respectively. Conclusion: Smoking is a well-recognized strong modifiable risk factor and predictor of multivessel disease. Smoking cessation has been consistently associated with a mortality benefit in both stable coronary artery disease and post-acute coronary syndromes. Consequently, smoking cessation is one of the cornerstones of secondary prevention despite the improvement in the management of ACS with PCI and pharmacotherapy Keywords: Smoking, coronary vessels, territory and ST elevated myocardial infarction.

Metabolic dysfunction-associated fatty liver disease and liver fibrosis: Prevalence and associated factors in the middle-aged and older US population.

The global burden of chronic liver disease is substantial. Limited studies have reported the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and liver fibrosis among middle-aged and older people. Therefore, we aimed to determine the nationwide prevalence of and associated factors for MAFLD and fibrosis in adults aged 45-79years from the United States. This cross-sectional study utilized data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey conducted with a nationally representative sample of the civilian, noninstitutionalized US population. Hepatic steatosis and fibrosis were assessed by transient elastography with controlled attenuation parameter and liver stiffness measurement, respectively. A total of 1186 eligible participants aged 45-79years were finally included in the analyses. The estimated prevalence of MAFLD, significant fibrosis (F≥F2), and advanced fibrosis (F≥F3) was 48.6% (95% confidence interval [CI], 43.1%-54.0%), 9.5% (95% CI, 6.8%-12.7%), and 6.7% (95% CI, 4.1%-10.1%), respectively. Multivariable logistic regression revealed an increased MAFLD predisposition in subjects with metabolic disorders including overweight/obesity, abdominal obesity, hypertension, and diabetes mellitus. Moreover, the presence of depression was an independent and strong predictor of MAFLD risk (odds ratio=3.23; 95% CI, 1.37-7.11). Elevated liver enzymes, hypertension, diabetes mellitus, hepatitis virus infection, and steatosis were associated with a high risk of significant fibrosis. Newly defined MAFLD is highly prevalent in the US middle-aged and older population. Approximately 1 in 10 people has significant liver fibrosis. In addition to metabolic disorders, the presence of depression potentially increases the risk of MAFLD.

Intrapartum antibiotics and childhood asthma and allergic rhinitis: a retrospective cohort study.

This study aimed to evaluate the association between intrapartum antibiotics (IABX) and asthma and allergic rhinitis among children by ages 6, 8 and 10 years. Retrospective cohort. Data were collected though Kaiser Permanente Northern California's (KPNC) integrated healthcare system. Children were eligible if they were born in a KPNC hospital between 1997 and 2012 and stayed enrolled through age 6. Modified Poisson regressions with robust error variances were used to estimate risk ratios for IABX and each outcome at each follow-up age during two separate time periods: 1997-2004 (n = 91 739) and 2005-2012 (n = 108 314). Asthma and allergic rhinitis by ages 6, 8 and 10. The proportion of women receiving IABX increased drastically over the study period (from 4% in 1997 to 49% in 2011), while the incidence of asthma (8%) and allergic rhinitis (6%) stayed relatively stable. In adjusted models, risk ratios for the association between IABX and asthma and allergic rhinitis were largely compatible with the null, with some slightly elevated risk ratios observed. For births from 1997 to 2004, risk ratios for asthma were 1.08 (95% CI 1.00-1.17) at age 6, 1.05 (95% CI 0.97-1.15) at age 8, and 1.08 (95% CI 0.99-1.18) at age 10. For births from 2005 to 2012, risk ratios were 1.00 (95% CI 0.95-1.04) at age 6, 1.07 (95% CI 1.01-1.12) at age 8, and 1.11 (95% CI 1.03-1.20) at age 10. Exposure to intrapartum antibiotics is not a strong predictor of childhood asthma or allergic rhinitis risk. Exposure to intrapartum antibiotics is not a strong predictor of childhood asthma or allergic rhinitis risk.

The Interpersonal-Psychological Theory of Suicide in Medical Students: Comparisons of Individuals without Suicidality, Ideators, and Planners.

The aim of this study was to explore the interpersonal–psychological theory of suicide (IPTS) in medical students. Higher levels of thwarted belongingness and perceived burdensomeness were expected in medical students with suicidality compared with medical students without suicidality, and a high level of acquired capability was expected in planners compared with ideators. Recruited for the study were 178 undergraduate medical students at the Université Libre de Bruxelles (ULB): 95 subjects without suicidality, 24 subjects with lifetime suicidality, 28 subjects with recent suicidal ideation, and 26 planners. An ad hoc questionnaire evaluated the risk of suicide as well as the “Suicidal thoughts and wishes” item of the BDI-II. The Interpersonal Needs Questionnaire (INS) measured thwarted belongingness (TB) and perceived burdensomeness (PB). The Acquired Capability for Suicide Scale (ACSS) measured notably fearlessness of death or pain tolerance and depression was rated using the revised version of the Beck Depression Inventory (BDI). Cognitive–affective symptoms of depression (CA-BDI) were assessed using six items of the BDI. Analyses of variance showed significant differences between groups for TB and PB but not for ACSS. Analyses of covariance, controlling for the CA-BDI scores, confirmed the significance of differences in TB and PB. Post hoc tests showed that (1) high levels of TB were characteristic of subjects with recent suicidal ideation and planners compared with subjects without suicidality; and (2) high levels of PB were characteristic of planners compared with the three other groups. Among the three characteristics of the IPTS, PB could be a strong predictor of severe suicide risk in medical students.