Survey Date Research Articles

Treatment patterns and clinical profile in progressive pulmonary fibrosis: a Japanese cross-sectional survey

BackgroundThere is a paucity of real-world data on patients with interstitial lung diseases (ILDs) that are progressive, other than idiopathic pulmonary fibrosis (IPF), including treatment patterns and attitudes toward treatment. This study aimed to investigate the diagnosis, clinical characteristics, treatment paradigm and current decision-making practices of IPF and progressive pulmonary fibrosis (PPF) in a Japanese real-world setting.MethodsData were drawn from the Adelphi Real World PPF-ILD Disease Specific Programme™, a cross-sectional survey with retrospective data collection of pulmonologists and rheumatologists in Japan from April to October 2022. Physicians provided data for up to 12 consecutive patients with a physician-confirmed diagnosis of progressive ILD; patients were also invited to complete patient self-completion forms. Analyses were descriptive.ResultsA total of 63 physicians (43 pulmonologists and 20 rheumatologists) provided data on 312 patients with PPF and 70 patients with IPF. Patients had a mean (standard deviation [SD]) age at survey date of 68.0 (11.6) years, 43.5% were female, 50.3% were former smokers and 18.1% were employed full time. For breathlessness, 26.5% of patients had Grade 2 physician-reported breathlessness; this was 16.7% when reported by patients themselves. A total of 81.4% of patients were currently receiving treatment for ILD. Mean (SD) duration of current treatment was 1.5 (1.4) years. Slowing disease progression was the primary reason influencing physicians’ choice of current ILD treatment (48.5%). A total of 16.0% had never been treated (most frequent physician-reported reason: disease was manageable without treatment, 55.7%) and 2.6% had treatment discontinued (most frequent reason: patient request, 70.0%). Physicians reported 82.3% of patients as fully compliant with their treatment regimen. As reported by patients themselves (n = 53), 49.1% never and 37.7% rarely missed a dose.ConclusionThis analysis of real-world data from Japan provides insights into the clinical profile of patients with IPF and PPF in Japan, and highlights differences between physicians and patients in perception of symptom severity and attitudes to treatment.

Factors associated with ABCDEF bundle implementation for critically ill patients: An international cross-sectional survey in 54 countries.

This study investigated the implementation of the ABCDEF bundle and the factors associated with its implementation according to national income levels. This study is cross-sectional research. We conducted a secondary analysis of an international 1-day point-prevalence study that investigated the implementation of the ABCDEF bundle in critically ill patients. All patients admitted to the ICU were eligible. This study was conducted across 135 ICUs in 54 countries, including data from 664 patients. Outcomes were categorized according to the income level of the country (high-income, middle-income, and low-income countries) in which each ICU was located. A multilevel generalized linear model was developed to identify the factors associated with ABCDEF bundle implementation for each income level. We identified 664 patients in 79 high-income countries, 278 in 26 middle-income countries, and 287 in 30 low-income countries ICUs. Implementation rates of the ABCDEF bundle were low for all income levels but varied. Few individuals completed the entire bundle on the survey date. Common factors associated with the implementation among all income levels were a multidisciplinary team approach for Element A (pain) and mechanical ventilation use for Element C (sedation), which were also associated with lower Element E (mobility). The existence of a protocol was frequently identified as a promoting factor associated with ABCDEF bundle implementation. The associated factors varied by income level; for example, dedicated intensivists were only identified in high-income countries, but not in middle-income countries or low-income countries. The overall low ABCDEF bundle implementation rates necessitate action. As factors associated with its implementation vary according to national income level, tailored strategies are essential for improving ICU care quality. NA.

CHURN: TRANSITIONS OUT OF HEALTH SECTOR EMPLOYMENT FOR LOW-PREPARATION WORKERS, 2017–2022

Abstract Shortages and turnover for front-line paid caregivers and support staff in long-term services and supports for older adults undermine quality of care. These workers are part of the health sector workforce, and also participate in a larger labor market of jobs requiring minimal formal education and brief training. The Brandeis Front-line Health Worker Survey queried a random sample of U.S. residents screened for holding patient-facing jobs in the health sector between the survey date (Summer 2022) and five years prior (2017), generating information on a retrospective longitudinal cross section of US health sector workers. Respondents reporting occupations in Bureau of Labor Statistics Job Zones 1 and 2 were identified as participating in low-preparation labor markets. About half of low-preparation health sector workers reported work in nursing homes, residential settings, or home care. We estimated annual rates of transition into and out of heath sector employment for all low-preparation health workers for years prior to and during the pandemic. Descriptive logistic regressions showed the relationship of job churn to gender, caregiver status, and previous employment pattern. Despite concerns about health workforce stability as the pandemic wound down, low-preparation workers exhibited about the same year-to-year transition rates out of (and back into) the health sector throughout the period. This suggests that the Great Resignation in healthcare is a continuing pattern rather than a pandemic phenomenon. Employers and public policy makers setting wages and working conditions should recognize that front-line workers have, and have always had, alternatives beyond the health sector.

The impact of climate change on morphological patterns of river floodplains in cryolithozone

Fluvial processes are highly variable and their dynamics under the influence of modern climate change are of both scientific and practical interest. The present work is an attempt to assess the impact of the modern climate change on the morphological pattern development in cryolithozone flood plains using modelling based on the methods of mathematical morphology of landscapes. The flood plains are territories of free channel meandering with topography formed by fluvial processes at different stages of development; so they represent a complex “patchwork” landscape morphological pattern occurring in the dynamic balance state. Our research involves fragments of the flood plains, for which there were two survey dates with a fairly large interval between them (about 50 years). As a climate change characteristic, the trends of surface air temperature anomalies for the same period (1956—2019) were calculated. An analysis of the calculated trends in surface temperature anomalies showed their heterogeneity both by seasons and by location, with a steady increase in surface temperature in general over the studied period. For all key sites, the mathematical model of the landscape morphological pattern of alluvial plains was tested. The analysis shows the correspondence of empirical data to theoretical ones, which allows us to obtain the model parameters to assess the change in the morphological pattern under the influence of climate change. It was suggested that climate change may lead to a change of the parameters of the corresponding distribution for the model variables due to the violation of dynamic balance. This statement was tested using the Smirnov test for two independent samples. The study of the relationship between distribution parameters and temperature trends includes assessing the correlation between them. Our analysis showed that the influence of modern temperature changes on the development of the morphological pattern of the flood plains over the past 40–50 years is manifested in a change of the distribution parameters for the forming flood plain segments, but it is not significant enough to change greatly the statistical distributions in the mathematical model of the morphological pattern of floodplains in general.

Purchase, consumption, and ownership of chickens and chicken products among households in Maputo, Mozambique: A cross-sectional study

BackgroundChickens are an important source of animal protein, nutrition, and income in many low- and middle-income countries (LMICs). They are also a major reservoir of enteropathogens that contribute to the burden of illnesses among children. Food systems present a risk for transmission of enteropathogens from poultry to humans, but there is a lack of population-level data on the pattern of purchase, ownership, and consumption of live chickens and their products in LMICs to better characterize that risk. MethodsTo assess chicken purchase, ownership, and consumption practices, we conducted a population-based survey using a structured questionnaire in Maputo, Mozambique in 2021. Multi-stage cluster sampling was used to obtain a representative sample of households in our study area. To minimize sampling bias and ensure a representative sample, we applied survey weighting using district-level population data and estimated weighted population-level values. ResultsHeads of 570 households in Maputo completed our survey. Approximately half of these households purchased broiler chicken meat (weighted percentage of households: 44.8 %) and eggs (46.5 %) in the previous week of the survey date, while indigenous chicken meat was less popular (1950, 1.1 %). The most common source of chicken products was corner stores (i.e., small convenience shops on streets), followed by wet markets. Live chickens were raised by 15.6 % of households, and chicken feces were observed on the floor or ground at the majority of these households during house visits. DiscussionOur findings suggest that poultry provides a major source of animal protein in this setting. Given the predicted growth of poultry farming in LMICs in the coming decades, implementing One Health-based food safety measures at primary sources of chicken products, such as corner stores and wet markets, will be critical to controlling zoonotic pathogen transmission risks.

Association of serum creatinine-cystatin C ratio with all-cause, cardiovascular and cancer mortality in US adults: a nationwide cohort study

ObjectiveTo investigate the association of serum creatinine-cystatin C ratio (Cr/CysC) with long-term all-cause mortality and cause-specific (cardiovascular and cancer) mortality among US general adults.MethodsThis nationally representative cohort study included adults in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Participants were linked to National Death Index data from the survey date through December 31, 2019. Weighted Cox proportional hazards regression models were used to calculate hazard ratios and 95% confidence intervals (CIs), and restricted cubic splines and stratified analyses were also performed.ResultsA total of 12,914 participants were included in this study (mean [SD] age, 45.3 [17.3] years; males, 48.9%). During a median follow-up of 17.9 years (maximum follow-up, 20.8 years), 3439 total deaths occurred, including 1098 cardiovascular deaths and 736 cancer deaths. Cumulative incidence curves revealed that increased Cr/CysC ratio had lower risk of all-cause (P < 0.001), cardiovascular (P < 0.001) and cancer (P < 0.001) mortality. Cox regression an Fine-Gray hazards models demonstrated that the multivariable-adjusted hazard ratios comparing the highest vs. lowest quartile of Cr/CysC ratio were 0.40 (95% CI, 0.34–0.47; P < 0.001) for all-cause mortality, 0.68 (95% CI, 0.52–0.88; P < 0.001) for cardiovascular mortality, and 0.51 (95% CI, 0.36–0.71; P < 0.001) for cancer mortality. Nonlinear association was observed for Cr/CysC ratio and all-cause mortality (P = 0.018 for nonlinearity), and linear associations were observed for Cr/CysC ratio and cardiovascular (P = 0.212 for nonlinearity) and cancer (P = 0.550 for nonlinearity) mortality. Besides, a series of sensitivity analyses ensured the robustness of the results.ConclusionsIn this cohort of US adults, Cr/CysC ratio was negatively associated with all-cause, cardiovascular, and cancer mortality. Our study suggests that Cr/CysC ratio may serve as a simple and effective predictor of long-term health outcomes.

Assessment of the Communicable Disease Status of Children in Türkiye: A Community-Based Cross-Sectional Study.

Assessment of children's communicable disease status is effective in preventing child morbidity. This study aims to evaluate the infectious disease status of children aged 0-14 in Türkiye. The research is a cross-sectional study conducted using the microdataset of the "Türkiye Health Survey 2022" obtained from the Turkish Statistical Institute. Seven thousand nineteen individuals aged 0-14 were included in the analysis. Data on communicable diseases of children aged 0-14 years in the 6-month period before the survey date was obtained by asking the household head. In our research, the data of 7019 individuals aged 0-14 was evaluated. It was determined that 2.2% of children had a vaccine-preventable infectious disease in the last 6 months. It was observed that the frequency of upper respiratory tract infection, lower respiratory tract infection, urinary tract infection, and diarrhea in children was higher in the 0-6 age group than in the 7-14 age group. Urinary tract infections were more common in girls, whereas respiratory tract infections, communicable diseases, and diarrhea were more common in boys. It was determined that diarrhea and upper respiratory tract infections occur in approximately one out of every three children in the 0-6 age group.

Investigating the Role of Cover-Crop Spectra for Vineyard Monitoring from Airborne and Spaceborne Remote Sensing

The monitoring of grape quality parameters within viticulture using airborne remote sensing is an increasingly important aspect of precision viticulture. Airborne remote sensing allows high volumes of spatial consistent data to be collected with improved efficiency over ground-based surveys. Spectral data can be used to understand the characteristics of vineyards, including the characteristics and health of the vines. Within viticultural remote sensing, the use of cover-crop spectra for monitoring is often overlooked due to the perceived noise it generates within imagery. However, within viticulture, the cover crop is a widely used and important management tool. This study uses multispectral data acquired by a high-resolution uncrewed aerial vehicle (UAV) and Sentinel-2 MSI to explore the benefit that cover-crop pixels could have for grape yield and quality monitoring. This study was undertaken across three growing seasons in the southeast of England, at a large commercial wine producer. The site was split into a number of vineyards, with sub-blocks for different vine varieties and rootstocks. Pre-harvest multispectral UAV imagery was collected across three vineyard parcels. UAV imagery was radiometrically corrected and stitched to create orthomosaics (red, green, and near-infrared) for each vineyard and survey date. Orthomosaics were segmented into pure cover-cropuav and pure vineuav pixels, removing the impact that mixed pixels could have upon analysis, with three vegetation indices (VIs) constructed from the segmented imagery. Sentinel-2 Level 2a bottom of atmosphere scenes were also acquired as close to UAV surveys as possible. In parallel, the yield and quality surveys were undertaken one to two weeks prior to harvest. Laboratory refractometry was performed to determine the grape total acid, total soluble solids, alpha amino acids, and berry weight. Extreme gradient boosting (XGBoost v2.1.1) was used to determine the ability of remote sensing data to predict the grape yield and quality parameters. Results suggested that pure cover-cropuav was a successful predictor of grape yield and quality parameters (range of R2 = 0.37–0.45), with model evaluation results comparable to pure vineuav and Sentinel-2 models. The analysis also showed that, whilst the structural similarity between the both UAV and Sentinel-2 data was high, the cover crop is the most influential spectral component within the Sentinel-2 data. This research presents novel evidence for the ability of cover-cropuav to predict grape yield and quality. Moreover, this finding then provides a mechanism which explains the success of the Sentinel-2 modelling of grape yield and quality. For growers and wine producers, creating grape yield and quality prediction models through moderate-resolution satellite imagery would be a significant innovation. Proving more cost-effective than UAV monitoring for large vineyards, such methodologies could also act to bring substantial cost savings to vineyard management.

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study.

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

Association between exposure to ambient particulate matter and high sensitivity C-reactive protein: A nationwide study in South Korea, 2015–2018

Existing evidence suggests that exposure to ambient particulate matter (PM) causes various adverse health outcomes through systemic inflammation. We explored the association between PM exposure and high-sensitivity C-reactive protein (hs-CRP) levels in a Korean population. This cross-sectional study included a representative sample of 21,154 Korean individuals, linked to modeled air quality data from 2015 to 2018. Concentrations of PM10 and PM2.5 were estimated for 1-week (short-term), 2-month, 4-month, 6-month (medium-term), and 1-year (long-term) moving averages before the survey date for each participant. The association between log-transformed hs-CRP levels and PM exposure was assessed using linear regression. The effect sizes were expressed as percent changes with 95% confidence intervals (CIs). The percent change (95% CI) in hs-CRP levels per a 10-μm/m3 increase in PM10, according to moving averages, was 0.47 (−1.13, 2.10) for 1-week, 4.87 (2.50, 7.29) for 2-month, 8.21 (4.89, 11.64) for 4-month, 11.26 (6.81, 15.89) for 6-month, and 7.15 (2.54, 11.98) for 1-year. The percent change (95% CI) in hs-CRP levels per a 10-μm/m3 increase in PM2.5, according to moving averages, was 0.66 (−2.38, 3.79) for 1-week, 7.51 (2.86, 12.36) for 2-month, 14.26 (8.23, 20.62) for 4-month, 20.29 (12.42, 28.70) for 6-month, and 17.76 (8.51, 27.79) for 1-year. The relationship between PM exposure and hs-CRP levels remained independent even after adjusting for sociodemographic characteristics and other co-pollutants. Exposure to PM10 and PM2.5, particularly over longer periods, showed positive association with hs-CRP levels in Korean adults. These findings highlight the necessity for policy efforts aimed at enhancing air quality and mitigating the health impacts of PM exposure.

Treatment patterns and patient journey in progressive pulmonary fibrosis: a cross-sectional survey

BackgroundFor patients with interstitial lung diseases (ILDs) presenting with a progressive pulmonary fibrosis (PPF) phenotype, current knowledge of disease characteristics at diagnosis, patient journey, and treatment is limited. This study aimed to describe demographics and clinical experiences of patients presenting with PPF in a European real-world setting.MethodsData were analysed from the Adelphi Real World PPF-ILD Disease Specific Programme™, a cross-sectional survey of pulmonologists and rheumatologists in five European countries (France, Germany, Italy, Spain, United Kingdom) and internal medicine specialists (France) from April to October 2022. Physicians provided data for up to 12 consecutive patients with physician-confirmed ILD with a progressive phenotype other than idiopathic pulmonary fibrosis. Analyses were descriptive.ResultsOverall, 265 physicians reported on 1,335 patients. Mean (standard deviation) age at survey date was 60.4 (11.6) years, 91.2% were white, 58.1% female, 44.0% non-smokers. Most patients (63.3%) first consulted a primary care physician. There was a mean delay of 7.8 (22.7) months between first ILD symptom and healthcare professional visit, and another 7.7 (12.8) months to ILD diagnosis. At survey date, 47.7% of patients had physician-reported moderate ILD, 42.3% had mild ILD and 10.0% had severe ILD. Disease progression was reported in the 12 months prior to the survey for 19.5% of patients; of these, progression was based on worsening symptom in 27.3% and lung function decline in 25.8%. For patients experiencing symptoms prior to ILD diagnosis (72.8%), the most common symptoms were dyspnoea on exertion (80.5%) and cough (57.8%). Overall, 17.4% of patients were misdiagnosed prior to ILD diagnosis, with chronic obstructive pulmonary disease suspected in 39.2% of them. The most frequent comorbidities were anxiety (16.9%) and gastroesophageal reflux (15.5%). Although 77.8% of patients were receiving treatment for ILD at survey date, 15.6% of patients had never been prescribed treatment for ILD.ConclusionsThis real-world study expands our understanding of patients, diagnostic delays and treatment gaps experienced by patients diagnosed with PPF in Europe. There was a mean delay of 15.5 months between first ILD symptoms and ILD diagnosis. Given the progressive nature of PPF, diagnostic delay may lead to poor outcomes, including shorter survival.Trial registrationN/a.

The relationships between unmet social needs, oral health measures, and dental service utilization in a pediatric population.

Social Determinants of Health (SDoH) have been linked to health, including oral health and oral health behaviors. Objectives of this retrospective records review were to evaluate the relationships between self-reported unmet social needs and (1) oral health measures and (2) dental service utilization in a pediatric population at a hospital-based dental clinic. Children 2-5 years of age whose families had completed a SDoH survey and who had an encounter with one United States (U.S.) urban children's hospital dental clinic within 6 months (± 3 months) of the survey date were included. A chart review was performed, and information was collected about the child's (1) oral health (e.g., plaque level, presence of caries) and (2) dental service utilization (e.g., no-show rates, number of dental surgeries). The data of patients with one or more parental/caretaker-reported unmet social needs were compared with that of patients with no unmet social needs. Inclusion criteria were met by 2646 children. Those with unmet social needs had significantly higher no-show rates at scheduled appointments than those without unmet social needs (p-value <0.001). Patients who identified as African/Black were more likely to report unmet social needs. There was no statistically significant difference in oral health measures of patients with or without unmet social needs. Children in this population demonstrated varying associations between unmet social needs, health measures, and health behaviors, suggesting a likely complicated association between unmet social needs and health.

Sub-Optimal Disease Control and Low Blood Eosinophil Testing Frequency in Chinese Adult Patients with Asthma Receiving GINA Step 4/5 Treatment: A Real-World Study.

To inform effective management strategies for severe asthma in China, this study aimed to comprehensively characterize clinical characteristics, treatment patterns, disease control status, and healthcare resource utilization among patients on GINA Step 4/5 therapies by analyzing data from the Adelphi Asthma Disease Specific Program conducted in China. All information was retrieved from medical records or collected from physicians and patients on the survey date (August-December 2018); no follow-up was conducted. Results were summarized descriptively for patients on GINA Step 4/5 therapies, who were pooled from a consecutive sample (comprising three or more consecutive patients with physician-diagnosed asthma from each participating physician) and an oversample (comprising the next two patients with physician-perceived severe asthma from each participating physician). Of the included patients (n=754), 51.5% had ever had a blood eosinophil measurement taken, 22.1% had available records for their most recent blood eosinophil measurements (68.9% of them had an elevated level ≥150 cells/µL), 39.9% had ever been tested for specific immunoglobulin E or radioallergosorbent, and 8.0% were prescribed maintenance oral corticosteroids. Asthma was not well controlled in 69.2% of patients. In the prior year, 27.1% experienced at least one severe exacerbation and 22.8% experienced at least one hospitalization (emergency visit or overnight stay) due to asthma. In Chinese patients with asthma on GINA Step 4/5 therapies, biomarker testing was underutilized, asthma was not well controlled, and severe exacerbations were not infrequent. These findings highlight the urgent need for optimized asthma management for patients on GINA Step 4/5 therapies in China.

Disease Burden, Treatment Patterns and Asthma Control in Adult Patients with Asthma in China: A Real-World Study.

To inform better asthma management in China, this study aimed to comprehensively investigate clinical characteristics, treatment patterns, asthma control status, exacerbations, and humanistic burden among adult patients seeking hospital-based asthma care by analyzing data from Adelphi Asthma Disease Specific Program conducted in China. All information was collected on survey date (August-December 2018) from medical records, physicians, or patients, without follow-up being conducted. Results are summarized descriptively for the overall population as well as subgroups defined by GINA 2018 treatment step. Of the included 765 patients, 46.0%, 40.4%, and 29.2% had undergone lung function, blood eosinophil count, and specific immunoglobulin E/radioallergosorbent testing, and 17.2%, 24.1%, and 58.7% were managed at GINA Steps 1-2, 3, and 4-5, respectively. Asthma was not well controlled in 57.3% of patients based on definitions adapted from the ERS/ATS and 10.7% of patients had experienced ≥1 severe exacerbation in the preceding year. According to patient self-reporting (n=603), the mean (SD) was 0.9 (0.1) for utility on EQ-5D-3L and was 7.8% (10.4%), 36.9% (20.0%), 40.8% (22.2%), and 37.9% (22.3%) for absenteeism, presenteeism, work productivity loss, and activity impairment, respectively, on WPAI. Both asthma control and humanistic burden worsened with progressive GINA treatment steps. In patients seeking hospital-based asthma care in China, lung function and biomarker tests were underutilized, impairment in productivity and quality of life was observed, and more than half did not achieve well-controlled asthma despite approximately 60% being managed at GINA treatment Steps 4-5. These findings highlight the urgent need for optimizing asthma management in China.

Prevalence of continuous positive airway pressure-related aerophagia in obstructive sleep apnea: an observational study of 753 cases undergoing CPAP/BiPAP treatment in a sleep clinic - part one of a two-part series.

Aerophagia occurring during continuous positive airway pressure (C-aerophagia in CPAP) in patients with obstructive sleep apnea (OSA) disturbs CPAP therapy. However, the diagnostic criteria and exact prevalence of C-aerophagia are not well documented; therefore, this study aimed to evaluate them. Newly developed criteria (flatulence, eructation, and abdominal bloating, with quantitative evaluation of these symptoms and a clear timing of onset) were used to diagnose C-aerophagia. The study included 753 adults with OSA who underwent follow-up visits for positive airway pressure treatment (including CPAP and bilevel positive airway pressure). The observation period ranged from 6 months to 3 years past the survey date (between May 1 and July 31, 2023). Medical records of patients were retrospectively analyzed. Discomfort associated with C-aerophagia was examined using a visual analog scale (VAS); a score ≥ 7 was associated with definite discomfort. Association of patient demographics and CPAP parameters with occurrence of C-aerophagia was analyzed using multivariate analysis. The prevalence of C-aerophagia was 7.2%. Although more than half of these patients reported discomfort associated with aerophagia, only 44.4% reported to their physician. The multivariate analysis showed that increased CPAP pressure level (odds ratio [OR] = 1.24) and comorbid gastroesophageal reflux disease (GERD; OR = 2.52) promote C-aerophagia, while increased age (OR = 0.76) and body mass index (BMI; OR = 0.88) inhibit it. The prevalence of C-aerophagia was 7.2%. Most patients with C-aerophagia experience discomfort, but may not report these symptoms. High CPAP pressure and GERD promoted C-aerophagia, while aging and increased BMI prevented it.

Serum 25-hydroxyvitamin D levels and risk of all-cause and cause-specific mortality: A 14-year prospective cohort study

Background & AimsThe circulating vitamin D level that is optimal for health is unknown. This study aimed to examine the association between circulating vitamin D level and risk of all-cause and cause-specific mortality. MethodsThis prospective cohort study included 18,797 Korean adults aged 40 years or older, living in rural areas, with no history of cancer or cardiovascular disease (CVD) at baseline. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured at baseline. Participants were followed-up from the survey date (2005–2012) until December 31, 2021. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality by baseline vitamin D level. Restricted cubic splines were used to explore the nonlinearity. ResultsThe median (interquartile range) of 25(OH)D level was 55.8 (40.8–71.8) nmol/L. During a median follow-up of 14.3 years, 2,250 deaths were recorded. Compared with participants with a 25(OH)D level < 30 nmol/L, higher vitamin D levels (30 to < 50, 50 to < 75, and ≥ 75 nmol/L) were associated with a lower risk of all-cause mortality: HR (95% CI) of 0.82 (0.69–0.98), 0.74 (0.62–0.88), and 0.69 (0.57–0.84), respectively. A nonlinear relationship between vitamin D level and all-cause mortality was observed, with the risk plateauing between 50 and 60 nmol/L (p for nonlinearity = 0.009). The association was more pronounced for cancer-related mortality. HR 0.55 (95% CI: 0.39–0.77) for a 25(OH)D level ≥ 75 nmol/L compared with < 30.0 nmol/L. Low vitamin D levels were associated with increased CVD mortality in men. ConclusionsVitamin D level was inversely associated with all-cause and cause-specific mortality in middle-aged and older adults. Maintaining a serum 25(OH)D level of approximately 50–60 nmol/L may contribute to longevity and warrants further investigation.

Associations of mothers’ decisional conflicts and satisfaction with governmental health promotion materials with their daughters’ HPV vaccination uptake in China: A cross-sectional survey

BackgroundChina started to implement the HPV vaccination program for females in 2016. This study investigated associations between mothers’ decisional conflicts, satisfaction with governmental health promotion materials, and their daughters’ HPV vaccination uptake. MethodsA cross-sectional online survey was conducted between July and October 2023 among mothers of girls aged 9–17 years in Shenzhen, China. Participants were mothers having a daughter aged 9–17 years at the survey date and a smartphone with internet access. About 3 % of all primary and secondary schools in Shenzhen were randomly selected by the research team (11 primary schools and 13 secondary schools). Teachers at the selected schools invited mothers of female students aged 9–17 years to complete an anonymous online questionnaire. Multivariate logistic regression was fitted. ResultsAmong 11,728 mothers who completed the survey, 18.9% of their index daughters received at least one dose of HPV vaccination. In multivariate analysis, less decisional conflict about the choice of HPV vaccines for their daughters (AOR: 1.07, 95%CI: 1.05, 1.10), more satisfaction with the government’s health promotional materials related to HPV vaccines (AOR: 1.15, 95%CI: 1.12, 1.19), receiving more cue to action from significant others (AOR: 1.23, 95%CI: 1.19, 1.27), and perceived higher self-efficacy related to HPV vaccines (AOR: 1.79, 95%CI: 1.67, 1.92) were associated with a higher uptake of HPV vaccines. Perceived susceptibility to HPV (AOR: 0.79, 95%CI: 0.74, 0.85), perceived barriers to having the index daughter receive HPV vaccines (AOR: 0.82, 95%CI: 0.80, 0.84), and mothers who were hesitant to receive HPV vaccination (AOR: 0.75, 95%CI: 0.68, 0.84) were associated with a lower uptake. ConclusionHPV vaccination uptake was low among girls in China. Future health promotion should address mothers’ decisional conflicts about the choice of HPV vaccines for their daughters and improve the health promotional materials. School-based HPV vaccination programs might be useful.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PurposeAs future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.MethodsWe systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg’s and Egger’s tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.ResultsWe identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%–49%) and 48% (95% CI, 43%–52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%–32%) and 30% (95% CI, 26%–35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%–99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.ConclusionsWe demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Vanishing giants: An assessment on the population status of giant clams across Malaysia

The iconic giant clams are known for its multifaceted importance throughout the Indo-Pacific –for functional, ecological, or cultural purposes. In Malaysia, habitat destruction and illegal poaching were main reasons behind the declining populations of giant clams. As previous surveys date back to 1990 s, an update on the status of giant clam populations in Malaysia is overdue. Using the extensive monitoring data from Reef Check Malaysia, we analysed and provided an assessment of population trends of giant clams between 2007 and 2021 in Malaysia. This study showed a decline in giant clam population in the east coast Peninsula and Sabah, while their abundances have always been low in the west coast Peninsula and Sarawak. In the east coast Peninsula, Tridacna maxima and T. crocea were most common (2.7 ± 7.3 and 1.4 ± 7.6 clams per 100 m2, respectively), followed by T. squamosa (0.7 ± 1.4 clams per 100 m2), and Hippopus hippopus (0.3 ± 2.5 clams per 100 m2). The boring species, T. maxima and T. crocea, typically displayed highly aggregated populations, reaching densities of 41.5 and 70 clams per 100 m2, where a reciprocal abundance shift between both species was observed between northern and southern sites of east coast Peninsula. The demography of T. maxima and T. crocea is either positively skewed or normally distributed, indicating abundant recruits that correspond to their higher densities. In contrast, T. squamosa showed a negative skew, suggesting poor recruitment rates. Findings here underscore the need to tailor conservation strategies for respective giant clam species in Malaysia. Proposed initiatives include establishing conservation zones in key areas like Perhentian, Lang Tengah, Redang, and Tioman Islands, which have significant T. maxima and T. crocea recruit populations. Also, targeted restocking efforts are necessary for T. squamosa and H. hippopus to ensure long-term viability of populations.

The effect of coping strategies on health–related quality of life in acromegaly patients

PurposePatients with acromegaly oftentimes exhibit a reduced physical and psychological health-related quality of life (HRQoL). Maladaptive coping styles are associated with poor HRQoL in a number of diseases and patients with pituitary adenomas in general exhibit less effective coping styles than healthy controls. This study aimed to assess coping strategies in acromegaly patients in order to explore leverage points for the improvement of HRQoL.MethodsIn this cross-sectional study, we administered self-report surveys for coping strategies and HRQoL (Short Form SF-36, Freiburg questionnaire on coping with illness, FKV-LIS) in patients with acromegaly. These were set into relation with a variety of health variables.ResultsAbout half of the 106 patients (44.3% female) with a mean age of 56.4 ± 1.3 years showed impaired physical and psychological HRQoL on average 11.2 years after the initial diagnosis. Body mass index, age at survey date and concomitant radiotherapy explained 27.8% of the variance of physical HRQoL, while depressive coping added an additional 9.2%. Depressive coping style and trivialization and wishful thinking were pivotal predictors of an impaired psychological HRQoL with a total explained variance of 51.6%, whereas patient health variables did not affect psychological HRQoL.ConclusionOur results show that maladaptive coping styles have a substantial negative impact on psychological HRQoL in patients with acromegaly, whereas physical HRQoL is influenced to a lesser extent. Specialized training programs aimed at improving coping strategies could reduce long-term disease burden and increase HRQoL in the affected patients.