Subgroup Of Individuals Research Articles

Heart rate response and recovery in bicycle exercise testing - reference values and association with mortality

Abstract Introduction Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific recommendations for reference values on HR recovery assessment. Purpose To define normal values for HR response and recovery in individuals referred for a bicycle exercise stress test and to relate these factors to risk of mortality. Methods We included 9,917 subjects (46% females) aged 18–85 years who performed a bicycle exercise test. We defined age- and sex-specific reference equations for peak HR, HR reserve, and HR recovery at 1 and 2 minutes (HRR1 and HRR2) using a subgroup of individuals without apparent cardiovascular (CV) risk nor comorbidities (N=2,774). Associations between blunted HR indices (<5thpercentile) and mortality were analysed using Cox regression in all subjects and in individuals with normal exercise capacity (N=8,070). Results All HR indices were age-dependent. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with previously reported reference values. During median follow-up of 8.6 years 1,110 (11%) died. HR recovery variables were the strongest predictors of all-cause (HRR1, hazard ratio 1.66 (95% confidence interval, 1.45–1.90)) and CV mortality (HRR2, 1.59 (1.26–2.00)) after adjustments for potential confounders. Blunted HR response (peak HR) increased risk of all-cause (1.32 (1.14–1.53)) and CV mortality (1.41 (1.09–1.83)). Combined blunted HRR1 and HRR2 or HR response and HRR1 further increased risk of all-cause (1.92 (1.64–2.24) and 1.85 (1.55–2.22), respectively) and CV mortality (1.95 (1.50–2.54) and 1.94 (1.42–2.65), respectively). HR recovery variables (HRR1, 1.97 (1.63–2.39) and HRR2, 1.76 (1.46–2.12)) remained stronger predictors of mortality than peak HR (1.38 (1.10–1.72)) in individuals with normal exercise capacity. Conclusions All HR variables were age-dependent and associated with mortality. Blunted HR recovery was more strongly related to mortality than chronotropic incompetence, and their combination added prognostic value. Furthermore, blunted HR recovery variables, rather than blunted HR response, remained strongly associated with mortality even in the presence of normal exercise capacity.

Body weight variability as a predictor of cardiovascular outcomes in type 1 diabetes: A nationwide cohort study.

Intraindividual body weight variability (BWV), that is, the degree of weight fluctuations over time, is associated with an increased risk of cardiovascular diseases (CVDs) in multiple settings. The impact of BWV on cardiovascular risk in type 1 diabetes (T1D) remains unclear, despite the issues relative to weight management in individuals with this condition. Using data from the Swedish National Diabetes Register, we identified individuals with T1D and without CVD at baseline with at least three measurements of body weight taken over three consecutive years. We estimated BWV as quartiles of the standard deviation of weight measures and explored its longitudinal association with the incidence of CVD during a 12.7 ± 4.6 year follow-up through adjusted Cox regression models. The primary endpoint was the composite of nonfatal myocardial infarction, nonfatal stroke and all-cause mortality. We modelled the function of risk in relation to the magnitude of BWV, testing also whether weight trends, that is, increasing, stable or decreasing, age, sex and glycaemic control modified the association between BWV and the outcome. Among the 36 333 individuals with T1D in the register, we identified 19 373 individuals with at least three measures of body weight and without CVD at baseline. Participants with the highest BWV had a 42% increased risk of reaching the primary endpoint compared to those with the lowest BWV (hazard ratio [HR] = 1.42, 95% confidence interval [CI]: 1.24-1.62). In addition, high BWV was significantly associated with a 51% increased risk of all-cause mortality (HR = 1.51, 95% CI: 1.28-1.78), a 37% increased risk of peripheral artery disease (HR = 1.37, 95% CI: 1.06-1.77) and a 55% increased risk of hospitalization for heart failure (HR = 1.55, 95% CI: 1.20-2.01). BWV showed a quasi-linear association with the primary endpoint. No interaction was observed when comparing subgroups for weight trends, sex or degree of glycaemic control. In the subgroup of elderly individuals, the association of BWV with the primary endpoint was no longer significant. High BWV is associated with an increased risk of CVD and all-cause mortality in individuals with T1D, independently of canonical risk factors. Weight trends, sex and glycaemic control do not modify such association while older age attenuates it.

Interaction between subclinical carotid atherosclerosis endotype and biological sex: a study from IMPROVE cohort

Abstract Background Carotid-intima media thickness (c-IMT) is a measure of subclinical carotid atherosclerosis and a predictor of future atherosclerotic cardiovascular events (ASCVD). We have recently generated, using an artificial intelligence approach, four endotypes (E) of subclinical atherosclerosis, i.e. subgroups of individuals predisposed to both c-IMT progression and ASCVD. Each E is defined by a set of demographic, clinical, and molecular data and characterize individuals with a low (E1), intermendiate (E2), high (E3) and very high (E4) cardiovascular risk profile. We observed an unbalanced distribution of males and females across the 4 endotypes, with a higher prevalence of female in the low risk E1. Purpose To estimate the interaction between biological sex and the 4 endotypes on measures of c-IMT progression and ASCVD risk. Methods We performed our study on 3121 individuals from the IMPROVE cohort, which includes participants with at least three ASCVD risk factors. We estimated the interaction between biological sex and the endotypes generated in the IMPROVE on (1) c-IMT and carotid plaque measurements after 30 months of follow-up (c-IMTfastest-progr, Area of plaquesbulb-progr) by linear regression (β, SE) and (2) with the 3-year ASCVD risk by Cox [hazard ratio (HR), 95% confidence interval (CI)] regression model. Crude estimates were adjusted by batch effect for biomarker measurement, geographical region and/or baseline ultrasonographic measures. Adjusted models further included ASCVD common risk factors. Results As shown in Figure 1, we did not observe any significant interaction between endotypes and biological sex on 30-month carotid ultrasound progression measures, and 3-year-ASCVD risk. In both the crude and adjusted models on c-IMTfastest-progr, Area of plaquesbulb-progr, and 3-year ASCVD, the p-value for interaction ranged from 0.18 to 0.98. While E4 was associated with the strongest cardiovascular risk profile in both males and females. Conclusions Our results indicate that the association between endotypes and progression of subclinical atherosclerosis and ASCVD risk mirrors a specific risk profile not entirely explained by differences in biological sex.

CMR characterisation of patients with heart failure and left bundle branch block

Abstract Introduction Cardiac magnetic resonance (CMR) is recommended internationally for tissue characterisation, volumetric assessment and assessment of prior myocardial infarction (1). Patients with left bundle branch block (LBBB) form a significant sub-group of individuals, however, there is limited data available to accurate determine whether LBBB is associated with any CMR-definable phenotypes. Aim We aimed to identify the distinctive cardiac magnetic resonance (CMR) features of patients with left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology. Methods Participants from the MATCH (MyocArdial Tissue CHaracteristics in patients with heart failure according to glycaemic status) registry were prospectively enrolled. Exclusion criteria included: LVEF >40% at initial evaluation, established diagnosis of coronary artery disease, known presence of structural heart disease, suspected myocarditis, congenital heart disease and significantly impaired renal function. Following identification of HF, guideline-directed medical therapy was initiated based on the decision of the treating physician. LV recovery was defined as achieving ≥10% absolute improvement to a level of 40% or greater of LVEF from baseline evaluation upon the date of CMR quantification. Electrocardiograms were analysed to establish the presence or absence of LBBB. Results A total of 391 patients were recruited including 115 (29.4%) presenting with LBBB. Compared to controls, LBBB patients exhibited larger left ventricles and smaller right ventricles, but no differences were observed with respect to LVEF (35.8±12 vs. 38± 12 %, p=0.105) or right ventricular ejection fraction (RVEF). The prevalence of ischaemic scar (18.3% vs 21%, p=0.54), non-ischaemic fibrosis (25.2% vs 32.6%, p=0.15) and inducible ischaemia (6.1% vs. 7.6%, p=0.6) was comparable in patients with LBBB and those without. The overall rate of LV recovery was not significantly different between LBBB and non-LBBB patients (27.8% vs. 33%, p=0.32) from their baseline evaluation to the time of CMR assessment (70 [42 - 128] days). In the multivariate logistic regression, reduced LVEF remained an independent predictor of LV non-recovery in patients with LBBB, even after adjusting for gender and QRS duration (OR 0.93, 95%CI 0.87 – 0.99, p=0.03). In contrast, this association was not observed among patients without LBBB, whereas ischaemic scar was the primary predictor of LV non-recovery (OR 4.31, 95%CI 1.85 – 10.04, p=0.0007). Conclusion In this study patients presenting with a combination of HFrEF and LBBB had a larger LV cavity and smaller RV cavity than those without LBBB. However, there were no differences in the prevalence of ischaemic scar, non-ischaemic scar of inducible ischaemia according to the presence of absence of LBBB. Rates of LV recovery were similar between LBBB and non-LBBB patients.Clinical CMR ParametersSegmental Distributions

Characterising the contribution of auditory and somatosensory inputs to TMS-evoked potentials following stimulation of prefrontal, premotor and parietal cortex

Abstract Transcranial magnetic stimulation (TMS) results in a series of deflections in electroencephalography (EEG) recordings known as a TMS-evoked potential (TEP). However, it remains unclear whether these responses reflect neural activity resulting from transcranial stimulation of the cortex, the sensory experiences of TMS, or a combination of the two. Across three experiments (total n = 135), we recorded EEG activity following TMS to the dorsolateral prefrontal cortex, premotor cortex, and parietal cortex as well as a sensory control condition (stimulation of the shoulder or electrical stimulation of the scalp with a click sound). We found that TEPs showed a stereotypical frontocentral N100/P200 complex following TMS of all cortical sites and control conditions, regardless of TMS intensity or the type of sensory control. In contrast, earlier TEPs (<60 ms) showed site-specific characteristics which were largest at the site of stimulation, although TEP topographies were distorted in a subgroup of individuals due to residual TMS-evoked muscle artifact despite cleaning with independent component analysis. Self-reported sensory experiences differed across sites, with prefrontal stimulation resulting in stronger auditory (click sound perception) and somatosensory input (scalp muscle twitch, discomfort) than premotor or parietal stimulation, a pattern that was reflected in the amplitude of later (N100/P200), but not earlier (<60 ms) TEP peak amplitudes. Later TEPs were also larger in individuals who experienced stronger click sound perception and, to a lesser extent, TMS-evoked scalp muscle twitches. Increasing click sound perception by removing auditory masking increased N100/P200 amplitudes without altering earlier peaks, an effect which was more prominent at sites with more successful masking. Together, these findings suggest that the frontocentral N100/P200 complex primarily represents a generalised sensory response resulting from TMS-related auditory and somatosensory input when present. In contrast, early TEP peaks likely primarily reflect activity resulting from transcranial stimulation of the cortex when artifacts were adequately accounted for. The results have important implications for designing and interpreting TEP studies, especially when comparing TEPs between stimulation sites and participant groups showing differences in sensory experiences following TMS.

Could the Suboccipital Release Technique Result in a Generalized Relaxation and Self-Perceived Improvement? A Repeated Measure Study Design.

Background: Musculoskeletal disorders such as cervicogenic headaches present with suboccipital muscle hypertonicity and trigger points. One manual therapy intervention commonly used to target the suboccipital muscles is the suboccipital release technique, previously related to positive systemic effects. Therefore, this study aimed to determine the immediate and short-term effects of the Suboccipital Release Technique (SRT) on brainwave activity in a subgroup of healthy individuals. Methods: Data were collected from 37 subjects (20 females and 17 males, with a mean age of 24.5). While supine, the subjects underwent a head hold followed by suboccipital release. A total of four 15 s electroencephalogram (EEG) measurements were taken and a Global Rating of Change Scale was used to assess self-perception. Results: There was a statistically significant difference (p < 0.005) in various band waves under the following electrodes: AF3, F7, F3, FC5, T7, P7, O1, O2, P8, T8, and FC6. An 8-point range in the Global Rating of Change Scores with a mean score of 1.649 (SD = 1.719 and SE = 0.283) supported the hypothesis of a self-perceived benefit from the intervention. Conclusions: The results of this study indicate that the suboccipital release technique significantly affects brain wave activity throughout different brain regions. This change is likely not the result of any placebo effect and correlates highly with the subject's self-perception of a change following the intervention. These findings support the clinical use of the suboccipital release technique when a centralized effect is desired.

The gut microbiome without any plant food? A case study on the gut microbiome of a healthy carnivore

Objective The carnivore diet is a ketogenic diet based exclusively on the consumption of food of animal origin. While the impact of various diets on the gut microbiome is extensively documented, the effects of a carnivore diet remain unclear. To address this gap, we conducted a pilot study on the gut microbiome of an individual following a carnivore diet and compared it with that of a subgroup of healthy individuals. Methods A stool sample was collected from a healthy 32-year-old male adhering to a carnivore diet and was sequenced using 16S DNA Amplicon Sequencing. The results were then compared to those from three control groups possessing similar anthropometric characteristics and differing in their frequency of meat consumption. Results The gut microbiome of the carnivore was dominated by the phylum Firmicutes and the genera Faecalibacterium, Blautia, unspecific Lachnospiraceae, Bacteroides, and Roseburia—bacteria known for fiber degradation. Furthermore, neither alpha- nor beta-diversity, nor the functional capacity of the gut microbiome, showed differences when compared to the control groups. Additionally, the gut microbiome of the carnivore showed the least similarities with the microbiome of the cohort consuming meat on a daily basis. Conclusions In our study, we showcase the compositional and functional characteristics of the gut microbiome in an individual on a carnivorous diet, finding no differences in comparison to a control cohort. Further research is needed to investigate the short- and long-term impacts of a carnivorous diet on gut health through cross-sectional and longitudinal studies. Significance statement To the best of our knowledge this is the first study to report on the composition of the gut microbiome of a person adhering long-term to the carnivore diet.

Variation of All-Cause Mortality with Fat-Free Mass Index (FFMI) and Fat Mass Index (FMI) in Individuals with Asthma: Results from the NHANES Database Retrospective Cohort Study.

The relationship between fat-free mass index (FFMI), fat mass index (FMI), and mortality in patients with asthma remains unknown. This study aimed to examine the associations between FFMI and FMI and all-cause mortality in a cohort of American adults diagnosed with asthma. This study included 15,200 adults from NHANES. To assess mortality, we linked participant records to the National Death Index. FMI and FFMI were measured and evaluated using dual-energy X-ray absorptiometry (DXA). Survival differences across quintiles of FFMI and FMI were explored using Kaplan-Meier plots and log-rank tests, with the proportional hazards assumption assessed using Schoenfeld residuals. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for mortality associated with FFMI and FMI, adjusting for potential confounders including age, sex, smoking status, physical activity, and other relevant factors. Additionally, stratified analyses based on theoretical considerations were conducted to identify subgroups of individuals exhibiting an elevated risk of mortality. This study also examined the nonlinear relationships between FFMI, FMI, and mortality using restricted cubic splines (RCS). After a median follow-up of 184 months, 12.11% of individuals had died. Kaplan-Meier plots revealed significant differences in all-cause mortality among patients with asthma across the FFMI and FMI quintiles. Specifically, individuals in the lowest FFMI quintile (Q1, 10.4-16.0, representing the range of FFMI values) exhibited a significantly increased risk of all-cause mortality (HR: 4.63; 95% CI: 1.59, 13.5; p < 0.01). Similarly, elevated risks of all-cause mortality were observed in the upper three quintiles of FMI, with Q3 (4.8-6.1) having an HR of 2.9 (95% CI: 1.20, 7.00; p < 0.05), Q4 (6.2-8.3) having an HR of 3.37 (95% CI: 1.41, 8.03; p < 0.01), and Q5 (8.4-22.8) having an HR of 4.6 (95% CI: 1.31, 16.2; p < 0.05). Moreover, the risk of all-cause mortality increased with increasing FMI and decreasing FFMI (p for non-linearity < 0.001 in both cases). Subgroup analyses further elucidated these associations across different categories. In examining the association between FMI and all-cause mortality among asthma patients across various subgroups, a heightened mortality risk found among males, individuals with medium education levels, medium income levels, and those who consume alcohol. The study shows that both high FMI and low FFMI are associated with increased mortality in patients with asthma. These findings underscore the critical role of FMI and FFMI in the health management of asthma patients. Therefore, it is recommended that clinicians proactively monitor and adjust these indices to improve patient prognosis and enhance health outcomes for individuals with asthma..

Exploring the longitudinal association between stress and unhealthy eating behaviors: The role of physical activity, BMI, and loneliness

Previous cross-sectional research indicates a link between stress and unhealthy eating, but the longitudinal association remains unknown. This study examined the longitudinal association between perceived stress over a longer time period and unhealthy eating (i.e., sweet and savory snack intake, uncontrolled eating) in a student population. Moreover, we examined whether physical activity buffers such association, and examined whether this buffering effect is stronger for individuals with higher Body Mass Index (BMI) or greater loneliness. Two timepoints of online survey data (Time 1 Oct–Nov 2021, Time 2 May–July 2022) of Dutch university students (n = 1325, 74.7 % female, mean age 22.45 (SD = 2.31)) were used. Results revealed no longitudinal link between stress and snack intake in the total sample, but this association was found in a subgroup of individuals with a higher BMI. Stress at Time 1 was associated with later uncontrolled eating. Physical activity did not moderate the link between stress and unhealthy eating. However, we found a negative longitudinal link between physical activity and uncontrolled eating among individuals with a higher BMI. Our findings suggest that stress does not play an important role in explaining snack intake in university students, but may be associated with uncontrolled eating. Physical activity seems to be linked with a reduction in uncontrolled eating among individuals with a higher BMI specifically. Replication and extension of current findings in a more diverse (e.g., eating disordered) sample would increase insights into the (combined) effects of stress, BMI and physical activity on uncontrolled eating.

Mental illness and COVID-19 vaccination: a multinational investigation of observational & register-based data

Individuals with mental illness are at higher risk of severe COVID-19 outcomes. However, previous studies on the uptake of COVID-19 vaccination in this population have reported conflicting results. Using data from seven cohort studies (N = 325,298) included in the multinational COVIDMENT consortium, and the Swedish registers (N = 8,080,234), this study investigates the association between mental illness (defined using self-report measures, clinical diagnosis and prescription data) and COVID-19 vaccination uptake. Results from the COVIDMENT cohort studies were pooled using meta-analyses, the majority of which showed no significant association between mental illness and vaccination uptake. In the Swedish register study population, we observed a very small reduction in the uptake of both the first and second dose of a COVID-19 vaccine among individuals with vs. without mental illness; the reduction was however greater among those not using psychiatric medication. Here we show that uptake of the COVID-19 vaccine is generally high among individuals both with and without mental illness, however the lower levels of vaccination uptake observed among subgroups of individuals with unmedicated mental illness warrants further attention.

Relations between trauma-based subgroups and posttrauma health outcomes: A latent class analysis.

In trauma research, it is common for researchers to characterize participants as either "trauma exposed" or "not trauma exposed" regardless of nuanced differences of the potentially traumatic event (PTE). To our knowledge, no study has simultaneously examined differences across both PTEs and exposure types. Using latent class analysis, we investigated latent homogeneous subgroups of individuals following experiences of 16 PTEs via three exposure types (i.e., direct, indirect, and/or occupational). We further examined class differences regarding posttraumatic stress disorder (PTSD) symptom clusters, event centrality, depression, and anxiety. Our sample included 2,663 participants (Mage = 22.33; 56.0% female). Results indicated four latent subgroups: (a) occupational trauma (OT), (b) direct interpersonal trauma (DIT), (c) indirect trauma (IT), and (d) low trauma exposure (LTE). Individuals in the OT class reported the highest levels of all symptoms except for PTSD avoidance and event centrality (which were highest in the DIT class), and individuals in the LTE class reported the lowest levels of all symptoms. Several nuanced between-class differences were found regarding posttrauma outcomes. Findings further support the notion that dichotomizing participants as "trauma exposed" or "not trauma exposed" is overly simplistic and ignores important variability in trauma research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Brain-body mitochondrial distribution patterns lack coherence and point to tissue-specific and individualized regulatory mechanisms.

Energy transformation capacity is generally assumed to be a coherent individual trait driven by genetic and environmental factors. This predicts that some individuals should have high and others low mitochondrial oxidative phosphorylation (OxPhos) capacity across organ systems. Here, we test this assumption using multi-tissue molecular and enzymatic activities in mice and humans. Across up to 22 mouse tissues, neither mitochondrial OxPhos capacity nor mtDNA density were correlated between tissues (median r = -0.01-0.16), indicating that animals with high mitochondrial capacity in one tissue can have low capacity in other tissues. Similarly, the multi-tissue correlation structure of RNAseq-based indices of mitochondrial gene expression across 45 tissues from 948 women and men (GTEx) showed small to moderate coherence between only some tissues (regions of the same brain), but not between brain-body tissue pairs in the same person (median r = 0.01). Mitochondrial DNA copy number (mtDNAcn) also lacked coherence across organs and tissues. Mechanistically, tissue-specific differences in mitochondrial gene expression were attributable in part to i) tissue-specific activation of canonical energy sensing pathways including the transcriptional coactivator PGC-1 and the integrated stress response (ISR), and ii) proliferative activity across tissues. Finally, we identify subgroups of individuals with high mitochondrial gene expression in some tissues (e.g., heart) but low expression in others (e.g., skeletal muscle) who display different clinical phenotypic patterns. Taken together, these data raise the possibility that tissue-specific energy sensing pathways may contribute to the idiosyncratic mitochondrial distribution patterns associated with the inter-organ heterogeneity and phenotypic diversity among individuals.

Biological markers of brain network connectivity and pain sensitivity distinguish low coping from high coping Veterans with persistent post-traumatic headache.

Headache is the most common type of pain following mild traumatic brain injury. Roughly half of those with persistent post-traumatic headache (PPTH) also report neck pain which is associated with greater severity and functional impact of headache. This observational cohort study aimed to identify biological phenotypes to help inform mechanism-based approaches in the management of PPTH with and without concomitant neck pain. Thirty-three military Veterans (mean (SD) = 37±16 years, 29 males) with PPTH completed a clinical assessment, quantitative sensory testing, and magnetic resonance imaging of the brain and cervical spine. Multidimensional phenotyping was performed using a Random Forest analysis and Partitioning Around Medoids (PAM) clustering of input features from three biologic domains: 1) resting state functional connectivity (rsFC) of the periaqueductal gray (PAG), 2) quality and size of cervical muscles, and 3) mechanical pain sensitivity and central modulation of pain. Two subgroups were distinguished by biological features that included forehead pressure pain threshold and rsFC between the PAG and selected nodes within the default mode, salience, and sensorimotor networks. Compared to the High Pain Coping group, the Low Pain Coping group exhibited higher pain-related anxiety (p=0.009), higher pain catastrophizing (p=0.004), lower pain self-efficacy (p=0.010), and greater headache-related disability (p=0.012). Findings suggest that greater functional connectivity of pain modulation networks involving the PAG combined with impairments in craniofacial pain sensitivity, but not cervical muscle health, distinguish a clinically important subgroup of individuals with PPTH who are less able to cope with pain and more severely impacted by headache.

Association between non-injection drug use and hepatitis C infection among HIV-negative men who have sex with men

BackgroundPrior research predominantly examined the association between HIV-positive men who have sex with men (MSM) or those using injection drugs and hepatitis C virus (HCV) infection. However, limited attention has been given to understanding the association among HIV-negative MSM who do not inject drugs. This gap leaves apportion of the population unexamined, potentially overlooking important factor that may contribute to the transmission and prevalence of HCV. This study aims to investigate the relationship between non-injection drug use and HCV infection in this population.MethodsIn this cross-sectional study, we analyzed data on 118 MSM who reported use of non-injection drugs. The participants were recruited from two inner-city communities in Houston, TX, between 2004 and 2007 and were negative for both HIV and hepatitis B virus infection. Latent class analysis (LCA) was used to identify drug use latent classes. Multinomial logistic regression analysis was used to evaluate the association between drug use latent class and HCV infection.ResultsFour distinct latent classes of drug use were identified: class 1, persons ≥ 42 years of age who used only crack cocaine; class 2, persons approximately 42 years of age who used > 2 drugs; class 3, persons < 42 years of age who used > 5 drugs; and class 4, persons ≥ 42 years of age who used > 6 drugs. Class 4 was significantly associated with HCV infection. The odds of HCV infection in members of class 4 was 17 times higher than in class 2 members (adjusted odds ratio [aOR] = 16.9, 95% confidence interval [CI]: 1.4–205.4) and almost 22 times higher than in class 3 members (aOR = 21.8, 95% CI: 1.5–322.8).ConclusionsAmong MSM with non-injection drug use, the subgroup of individuals who were ≥ 42 years of age and used multiple drugs (including heroin, speedball, methamphetamine, crack cocaine, and marijuana) had a high probability of HCV infection. Public health and education programs, as well as drug treatment and rehabilitation programs, should be developed for this high-risk subgroup of individuals to prevent HCV acquisition and transmission.

Characterizing within-person variance in, and menstrual cycle associations with, event-related potentials associated with positive and negative valence systems: The reward positivity and the error-related negativity

Event-related potentials (ERPs) are widely employed as measures of transdiagnostic cognitive processes that are thought to underlie various clinical disorders (Hajcak et al., 2019). Despite their prevalent use as individual difference measures, the effects of within-person processes, such as the human menstrual cycle, on a broad range of ERPs are poorly understood. The present study leveraged a within-subject design to characterize between- and within-person variance in ERPs as well as effects of the menstrual cycle in two frequently studied ERPs associated with positive and negative valence systems underlying psychopathology—the Reward Positivity (RewP) and the Error- Related Negativity (ERN). Seventy-one naturally-cycling participants completed repeated EEG and ecological momentary assessments of positive and negative affect in the menstrual cycle's early follicular, periovulatory, and mid-luteal phases. We examined the mean degree of change between cycle phases in both ERPs, the between-person variability in the degree of change in both ERPs, and whether an individual’s degree of cyclical change in these ERPs show coherence with their degree of cyclical change in positive and negative affect recorded across the cycle. Results revealed no significant changes in positive and negative affect across the cycle and rather small changes in ERP amplitudes. Significant random slopes in our model revealed larger individual differences in trajectories of change in ERP amplitudes and affect, in agreement with prior evidence of heterogeneity in dimensional hormone sensitivity. Additionally, state-variance in these ERPs correlated with positive and negative affect changes across the cycle, suggesting that cycle-mediated ERP changes may have relevance for affect and behavior. Finally, exploratory latent class growth mixture modeling revealed subgroups of individuals that display disparate patterns of change in ERPs that should be further investigated.

Outcomes in clinical subgroups of patients with alcohol-related hospitalizations: a population-based retrospective cohort study

ObjectiveIndividuals who experience alcohol-related hospitalizations are at a high risk of recurrent harm and premature mortality. This project characterized the clinical subgroups of individuals who experience alcohol-related hospitalizations to understand who is at the highest risk of recurrent harm following discharge. ApproachPopulation-based retrospective cohort study of individuals with an alcohol-related hospitalization between 2017-2018 in two Canadian provinces (Ontario and Manitoba) using linked provincial health administrative databases. Clinical subgroups were identified with latent class analysis based on the type and frequency of alcohol-related health service use in the two-years preceding the index hospitalization. Associations between subgroup membership, readmission, and mortality in the year following discharge were evaluated using multivariable time-to-event regression. ResultsIn cohorts of 4,753 (Manitoba) and 29,290 (Ontario) individuals, seven subgroups were identified. These followed a severity gradient from low-frequency service use for acute intoxication to high-frequency service use for alcoholic liver disease. Individuals in the ‘liver disease’ subgroup had the highest risk of 1-year mortality relative to the rest of the cohort (adjusted hazard ratio [aHR]: 3.83, 95% confidence interval (CI): 2.80-5.24). A small subgroup of individuals with a history of high-frequency alcohol-related health service had the highest hazard of readmission (aHR: 5.09, 95% CI: 4.11-6.31). Conclusions and ImplicationsThere are distinct clinical subgroups of individuals who experience alcohol related hospitalizations and individuals with high-frequency health service use and alcohol-related liver disease are at the highest risk of readmission and mortality. These subgroups merit consideration in strategies aimed at reducing the risk of post-discharge harm.

Sudden sensorineural hearing loss: audiological profile during the COVID-19 pandemic.

Sudden sensorineural hearing loss (SSNHL) is an otological emergency that requires prompt recognition and intervention to prevent devastating impacts on people's lives. During the COVID-19 pandemic, sensory deprivations have been reported in patients positive for SARS-CoV-2 virus, including deleterious effects on the auditory pathway. This study aims to describe the audiological profile of individuals with SSNHL during the COVID-19 pandemic and to correlate hearing recovery in subgroups of individuals with or without COVID-19. Prospective cohort including patients diagnosed with SSNHL evaluated in a tertiary care center between March 2020 and September 2022. Hearing loss was confirmed with pure-tone and speech audiometry, with Speech Recognition Threshold (SRT) and word recognition score (WRS). Audiometric testing was performed at the moment of diagnosis, then 7, 30 and 120 days after diagnosis. The average degree of hearing loss was assessed by calculating the 4-frequency pure tone average (4fPTA). The investigation of COVID-19 included RT-PCR technique for the SARS-CoV-2 virus and collection of information regarding disease severity. A statistical analysis was performed using an analysis of covariance (ANCOVA) model to compare the 4fPTA between the four groups (with and without a history of COVID-19, unilateral and bilateral cases) at the end of the follow-up period. Fifty-two patients with SSNHL were assessed, 40 (76.9%) with unilateral and 12 (23.1%) with bilateral hearing loss, totaling 64 ears included. Of those, 15 (28.8%) patients tested positive for SARS-CoV-2 and were symptomatic for COVID-19. Of all unilateral cases, 22.5% were seropositive and showed symptoms of COVID-19, a number that increased to 50% for bilateral cases. Comparing the COVID-19 positive groups, individuals with unilateral SSNHL went from 40 dB as their average 4fPTA at onset to 20 dB as their average 4fPTA after 120 days, whereas those with bilateral SSNHL went from an initial average of 60 dB to a final average of 66 dB. Although the 4fPTA value of individuals with unilateral SSNHL improved in 7 days, the mean values showed no significant difference between positive and negative groups. There was a higher incidence of bilateral simultaneous SSNHL in patients who had not been vaccinated against COVID-19 and who presented with symptoms of severe COVID-19. Infection with SARS-CoV-2 resulted in more severe SSNHL, in bilateral SSNHL, and in poorer recovery from SSNHL in bilateral cases. Bilateral SSNHL was seen more frequently in patients who had not received vaccination against COVID-19.

Dual trajectories of social participation and frailty in Chinese older adults: a longitudinal study based on CLHLS from 2008 to 2018.

This study aimed to identify the dual trajectories of social participation (SP) and frailty index (FI) among Chinese older adults, and investigate common influential factors of both trajectories. Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008-2018 surveys, 1,645 individuals were analyzed. A group-based dual trajectory model and logistic regression were used to examine trajectories, their interrelations and shared influencing factors. This study identified three SP, two FI trajectories and six distinct sub-groups of individuals. The study confirmed a long-term, interrelated relationship between two outcomes and identified some common factors. Compared to participants in the lower SP trajectory, those who followed the middle SP trajectory and higher SP trajectory had increased probabilities of belonging to the slow-growth FI trajectory (90.28 and 99.71%, respectively). And the participants in the slow-growth FI exhibited higher probabilities of belonging to the middle SP and the higher SP trajectory (37.64 and 25.34% higher, respectively) compared with those in the rapid-growth FI trajectory. Age, marital status, and drinking status were mutual factors associated with the dual trajectories. The results showed significant associations between higher levels of frailty and lower levels of social participation. Related intervention policies should consider the dual trajectories and the common factors that underlie these trajectories of SP and FI.

Recovery capital profiles among a heterogeneous sample of individuals in recovery from alcohol problems.

Recovery capital (RC) is a framework for conceptualizing the resources individuals use to support alcohol and other drug recovery across social, physical, human, and cultural domains. The goal of this study was to identify subgroups of individuals in recovery with distinct combinations of RC across domains and characteristics of individuals with unique RC patterns. Latent profile analyses investigated patterns in both within-domain amount and variability of RC across each of the four domains using the Multidimensional Inventory of Recovery Capital, a theoretically and psychometrically sound RC measure. The sample included U.S. participants closely reflecting 2020 Census demographics (n = 482, 49% female, 38% racial/ethnic minority, Mage = 42.57) identifying as having resolved a prior problem with alcohol (alone or with other drugs). Latent profile analyses distinguished four RC profiles: Low/Inconsistent (23%), Moderate/Consistent (43%), Moderate/Inconsistent (12%), and High/Consistent (22%). Females and individuals who were unemployed, nonabstinent, and had greater alcohol problem severity were more likely to belong to the Low/Inconsistent profile. Individuals in unassisted recovery were more likely to belong to the Moderate/Inconsistent profile. Older age and more time in recovery were associated with High/Consistent profile membership. Race/ethnicity was not associated with profile membership. These person-oriented analyses elucidate complex patterns of resources that individuals utilize during recovery and individual characteristics underpinning differences across RC patterns. The empirically derived subgroups in this heterogeneous sample highlight multiple combinations of resources that individuals leverage to achieve recovery and indicate characteristics of individuals who may need greater amounts and/or consistency of RC to continue sustaining recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Blood coagulation in Prediabetes clusters–impact on all-cause mortality in individuals undergoing coronary angiography

BackgroundMetabolic clusters can stratify subgroups of individuals at risk for type 2 diabetes mellitus and related complications. Since obesity and insulin resistance are closely linked to alterations in hemostasis, we investigated the association between plasmatic coagulation and metabolic clusters including the impact on survival.MethodsUtilizing data from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, we assigned 917 participants without diabetes to prediabetes clusters, using oGTT-derived glucose and insulin, high-density lipoprotein cholesterol, triglycerides, and anthropometric data. We performed a comprehensive analysis of plasmatic coagulation parameters and analyzed their associations with mortality using proportional hazards models. Mediation analysis was performed to assess the effect of coagulation factors on all-cause mortality in prediabetes clusters.ResultsPrediabetes clusters were assigned using published tools, and grouped into low-risk (clusters 1,2,4; n = 643) and high-risk (clusters 3,5,6; n = 274) clusters. Individuals in the high-risk clusters had a significantly increased risk of death (HR = 1.30; CI: 1.01 to 1.67) and showed significantly elevated levels of procoagulant factors (fibrinogen, FVII/VIII/IX), D-dimers, von-Willebrand factor, and PAI-1, compared to individuals in the low-risk clusters. In proportional hazards models adjusted for relevant confounders, elevated levels of fibrinogen, D-dimers, FVIII, and vWF were found to be associated with an increased risk of death. Multiple mediation analysis indicated that vWF significantly mediates the cluster-specific risk of death.ConclusionsHigh-risk prediabetes clusters are associated with prothrombotic changes in the coagulation system that likely contribute to the increased mortality in those individuals at cardiometabolic risk. The hypercoagulable state observed in the high-risk clusters indicates an increased risk for cardiovascular and thrombotic diseases that should be considered in future risk stratification and therapeutic strategies.Graphical