Two-time Points Research Articles

An exploration of progress made in the reformulation of food staples in the Republic of Ireland

One hundred and eleven countries currently have national policies, strategies or plans to implement food reformulation, a mechanism to passively improve the diets of consumers. Previous research by our group conducted between 2014 and 2017, showed that salt and sugar in - cereals, breads, spreads and milk had declined by 12% and 7%, respectively. The aim of this study was to explore if there has been further progress in reformulation during the period between 2017 and 2021.We conducted an audit of food staples in the Republic of Ireland. Nutrition labels of food staples were photographed and the extracted data was compared with data previously captured in 2017. We included Supermarkets with the leading market share in the Republic of Ireland at that time including - Dunnes Stores, Supervalu, Tesco, Aldi, Lidl, Marks & Spencer (M&S) and Centra. Two hundred and seventy products were directly compared across the two-time points (2017 & 2021). Overall across all food groups combined, this study shows that salt decreased by 1.9%, sugar levels decreased by 4.9% and saturated fat decreased by 0.1%. Total fat increased by 1.2%, protein increased by 1.1%, energy levels increased by 0.6%, fibre increased by 0.2% and carbohydrates increased by 0.1%. While it is encouraging to see that sugar has declined across all food groups and that salt has declined across most food groups in this study, the magnitude in reduction is lower than during the previous reporting period (2014–2017). Food manufacturers need to double down on their reformulation efforts.

Association of dynamic hepatic metabolism with clinical outcomes in patients with severe Guillain-Barré syndrome: A prospective cohort study from multi-centers in China.

Little is known about the ability of serological biomarkers to monitor clinical outcomes in patients with Guillain-Barré syndrome (GBS). The objective of this study was to determine the associations of liver function, easily available and convenient biomarkers, with the clinical course and outcome of severe GBS in patients. A prospective data collection was conducted in a cohort of 343 GBS patients from multi-centers between September 2019 and December 2023. Serum samples were obtained at four-time points for mechanical ventilation (MV) patients and two-time points for non-MV patients. The primary endpoint was the need for MV during hospitalization, while secondary outcomes included the ability to walk independently and the mortality at 26-week follow-up. (i) A total of 208 patients were eligible, of whom 50 required MV with a median (interquartile range) ventilation duration of 15 (8-27) days. (ii) Hypohepatia, as evidenced by reduced total protein (OR 0.913 [95% CI 0.862-0.967]) and albumin (0.775 [0.679-0.884]) 1 week after treatment, along with raised liver enzymes (2.732 [1.007-7.413]), was associated with the risk of MV after adjusting for confounders. (iii) After 26-week follow-up, patients with hypohepatia were less likely to regain independent walking and exhibited higher mortality in survival analysis (all log-rank p < .05). (iv) In a cross-sectional study spanning up to 4 years of follow-up, patients with prolonged MV (≥15 days) experienced a longer time to regain independent ambulation than those with shorter MV (167 [46-316] vs. 69 [24-106], p = .036). However, no relationships between liver function and prolonged MV were revealed. Dynamically monitoring hepatic metabolism and promptly adjusting, it can aid the improvement of GBS in patients.

Test-Retest Reliability of the STRAQ-1: A Registered Report

This Registered Report provides the first test of measurement invariance across time points and estimates of test-retest reliability for the Social Thermoregulation, Risk Avoidance Questionnaire (STRAQ-1, Vergara et al., 2019). The scale was developed and validated to understand the physiological drives underlying interpersonal bonding, measured by four constructs: the desire to socially regulate one’s temperature, the desire to solitary regulate one’s temperature, the sensitivity to higher temperatures, and the desire to avoid risk. Previous studies with large samples across 12 countries showed that the STRAQ-1 has a stable factorial structure, satisfying internal consistencies for the temperature subscales, and expected correlations in its nomological network. However, to date, this instrument has no estimates of test-retest reliability. Throughout four academic years (from 2018 to 2022), N = 183 French student participants took the STRAQ-1 at least two times. Out of the four STRAQ-1 subscales, only two were longitudinally invariant across two-time points. Thus, half of the STRAQ-1 constructs and latent scores were dissimilar and incomparable across time. We then conducted test-retest reliability using Intra Class Correlation coefficient (ICC) for the Social Thermoregulation, Solitary Thermoregulation, High-Temperature Sensitivity, and Risk Avoidance subscales. ICCs estimates were respectively for agreement and consistency: .70, .70 overall moderate to good, .62, .62 overall moderate, .67, .67 overall moderate, and .53, .53 overall poor to moderate, respectively. Our study suggests that test-retest reliability was insufficient for psychological diagnosis, and that future studies should address the problem of low generalizability of the constructs.

Comparative Effectiveness of Acupuncture Versus Non-surgical Modalities for Treating Plantar Fasciitis: A Network Meta-Analysis.

Plantar fasciitis, or plantar heel pain, causes inflammation of the plantar fascia due to various causes, with no clear consensus on the treatment protocol. Standard first-line treatment includes non-steroidal anti-inflammatory drugs and physiotherapy. Second-line treatment prior to surgery includes extracorporeal shockwave therapy (ESWT), ultrasound-guided (USG) therapy, corticosteroid injection (CSI), and platelet-rich plasma (PRP) injection. Recently, the use of acupuncture treatment has been gaining popularity, with increasing published evidence showing its effectiveness in treating plantar fasciitis. The objective of this study was to determine whether acupuncture intervention was a viable alternative treatment method for managing plantar fasciitis when compared to ESWT, USG therapy, CSI, and PRP injection. Data sources from PubMed, Google Scholar, Scopus, Science Direct, and China National Knowledge Infrastructure were reviewed. Clinical trials were searched from their inception over the period of January 2000 to October 2020. A total of 32 relevant papers were included for analysis, totaling 2390 samples. Visual Analog Scale (VAS) scores measuring pain were analyzed in terms of outcome after one and three months of treatment. Each time point was analyzed separately through a network meta-analysis using the frequentist approach. VAS scores for each intervention at baseline and the two-time points (i.e., one and three months) were included in the comprehensive meta-analysis. Then, differences in VAS scores were calculated in R studio (V4.1.2; RStudio: Integrated Development for R,RStudio, Inc., Boston, USA) using the netmeta package. The netmeta package was also used to perform the network meta-analysis and generate corresponding figures. Direct and indirect effects were assessed and visualized through a direct evidence plot and a node-splitting forest plot. Randomized controlled trials (RCTs) and non-RCTs involving treatments of acupuncture, ESWT, USG therapy, CSI, or PRP injection, either in comparison with each other or with a placebo, were included in our review. Our meta-analysis showed that at one month, VAS scores for acupuncture treatment had the highest mean difference (MD) of -1.33 (95% confidence interval (95% CI) = -2.19 to -0.46) compared to placebo, indicating thatacupuncture treatment was more effective than other treatment arms when compared to placebo. Analysis at threemonths showed that the highest-ranked treatment was PRP injection, with an MD of -2.67 (95% CI = -6.23 to 0.89). However, the CI for the net effect of all treatments crossed the null effect on the forest plot, indicating no statistically significant difference between the treatment and placebo. Acupuncture treatment should be considered as a second-line treatment for treatment of plantar fasciitis together with other common treatment options such as ESWT, PRP injection, CSI, and USG therapy. Further long-term studies measuring acupuncture treatment outcomes would be beneficial in the future.

Fatigue and depression at 8 weeks and 1 year after bacterial brain abscess and their relationship with cognitive status

ABSTRACT A bacterial brain abscess (BA) is a focal brain infection with largely unknown long-term implications. This prospective study assessed the frequency of fatigue and symptoms of depression at 8 weeks and 1 year after BA and examined the relationship between fatigue, depressive symptoms, and cognitive status. Twenty BA-patients (age 17–73; 45% female) were assessed for fatigue, depression, memory, and executive functions. Fatigue rates were 40-65% at 8 weeks and 25-33% at 1 year on various fatigue questionnaires. Patient Health Questionnaire indicated symptoms of depression in 10% at the 8-week follow-up only. Relevant comorbidities and vocational outcomes were not associated with fatigue or symptoms of depression. Mean fatigue scores improved significantly between the two-time points. Greater fatigue was related to subjective problems with working memory, inhibition, self-monitoring, and emotional control and worse objective verbal memory performance. Symptoms of depression were associated with one out of two fatigue measures. We conclude that fatigue is common in the first year after BA, and higher levels of fatigue are related to more cognitive problems. Symptoms of clinical depression were rare. These findings underscore fatigue as an important consequence of BA and emphasize the necessity for targeted rehabilitation interventions.

Changes in the attractiveness of medical careers and career determinants during the bachelor’s program at Zurich medical schools

BackgroundMonitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor’s studies.MethodsThe design was cross-sectional, recruiting all medical students who started a bachelor’s program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students’ perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.ResultsWe surveyed 354 medical students at the beginning and 433 at the end of the bachelor’s program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.ConclusionsDuring the bachelor’s program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.Trial registrationNot applicable.

Analgesic Potential Comparison Between Piperine-Combined Curcumin Patch and Non-Piperine Curcumin Patch: A Pragmatic Trial on Post-Cleft Lip/Palate Surgery Pediatric Patients.

Despite its well-acknowledged analgesic potential, curcumin's low bioavailability has been recognized. Piperine, a substance naturally contained in pepper, has been known for its effect on increasing curcumin bioavailability. To investigate the analgesic potential of curcumin and piperine addition to curcumin patch used as adjuvant therapy in the management of acute postoperative orofacial pain. This pragmatic trial recruited 75 patients that underwent oromaxillofacial surgery at Unpad Dental Hospital, Bandung, Indonesia. Research participants were randomly assigned to three different groups: the first group that did not receive any intervention other than the post-operative standard treatment (POST), the second group that received POST and non-piperine curcumin patch, and the third group that received POST and piperine-combined curcumin patch. Participants' pain intensity was evaluated by using the face, leg, activity, cry, and consolability (FLACC) pain scale and salivary prostaglandin-E2 (PGE2) level for two-time points, which were eight hours apart. All data were gathered and analyzed to compare the within and between-group differences. Within groups comparison of the FLACC scores for two evaluation points showed significant differences for all groups (p < 0.01). For salivary PGE2 analysis, a comparison of the non-piperine group to the piperine group also showed significant results. Yet, when all three groups were compared, regardless of the differences, the results were not statistically significant. Despite of the proven efficacy of curcumin patch, the addition of piperine to the curcumin patch in the current study did not provide any significant effects. Further investigation is of importance.

Leadership empowerment behavior and employee referrals: chain mediation of perceived challenge stress and employee experience

Purpose Internal employees of firms are a reliable source of information for potential job seekers. However, few studies have focused on why internal employees actively recommend their firms. Based on the social exchange theory, this study aims to construct a chain mediation model using perceived challenge stress and employee experience as mediators to explore how leadership empowerment behavior affects employee referrals. Design/methodology/approach Bootstrap repeated sampling analysis was conducted on a sample of 307 employees collected through two-time points. Findings Leadership empowerment behavior is positively related to employee referrals; perceived challenge stress and employee experience mediate the effect of leadership empowerment behavior on employee referrals, respectively; in addition, perceived challenge stress and employee experience play a chain mediating role between leadership empowerment behavior and employee referrals. Originality/value The findings can help provide insight into the drivers of employee referrals and can effectively guide organization reputation management.

Elucidating the changes in the heterogeneity and function of radiation-induced cardiac macrophages using single-cell RNA sequencing.

A mouse model of irradiation (IR)-induced heart injury was established to investigate the early changes in cardiac function after radiation and the role of cardiac macrophages in this process. Cardiac function was evaluated by heart-to-tibia ratio, lung-to-heart ratio and echocardiography. Immunofluorescence staining and flow cytometry analysis were used to evaluate the changes of macrophages in the heart. Immune cells from heart tissues were sorted by magnetic beads for single-cell RNA sequencing, and the subsets of macrophages were identified and analyzed. Trajectory analysis was used to explore the differentiation relationship of each macrophage subset. The differentially expressed genes (DEGs) were compared, and the related enriched pathways were identified. Single-cell regulatory network inference and clustering (SCENIC) analysis was performed to identify the potential transcription factors (TFs) which participated in this process. Cardiac function temporarily decreased on Day 7 and returned to normal level on Day 35, accompanied by macrophages decreased and increased respectively. Then, we identified 7 clusters of macrophages by single-cell RNA sequencing and found two kinds of stage specific macrophages: senescence-associated macrophage (Cdkn1ahighC5ar1high) on Day 7 and interferon-associated macrophage (Ccr2highIsg15high) on Day 35. Moreover, we observed cardiac macrophages polarized over these two-time points based on M1/M2 and CCR2/major histocompatibility complex II (MHCII) expression. Finally, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses suggested that macrophages on Day 7 were characterized by an inflammatory senescent phenotype with enhanced chemotaxis and inflammatory factors, while macrophages on Day 35 showed enhanced phagocytosis with reduced inflammation, which was associated with interferon-related pathways. SCENIC analysis showed AP-1 family members were associated with IR-induced macrophages changes. We are the first study to characterize the diversity, features, and evolution of macrophages during the early stages in an IR-induced cardiac injury animal model.

Development and validation of a brain fog scale for coeliac disease.

Brain fog is a subjective cognitive impairment commonly reported in coeliac disease. A standardised tool to define and assess it is an important unmet need. To develop a patient-informed tool to assess brain fog in coeliac disease to support clinical care, research and drug development. A pilot online study defined patient descriptors of brain fog. A second study evaluated the factor structure and performance of the scale across two-time points ('Now' and in the 'Past week'). One month later, participants were invited to repeat the study with two online cognitive processing tests, the Stroop task and the trail making test. Among adults with treated coeliac disease, 37 (91.9% F) participated in the pilot study and 510 (88.8% F) in the second study of whom 99 repeated the study 1 month later with 51 completing cognitive testing. The most common brain fog descriptors were 'difficulty focusing', 'difficulty thinking' and 'difficulty finding the right words and communicating'. The 12-item scale reflects 'cognitive impairment' and 'somatic and affective experience' and demonstrates strong psychometric properties. It tracked with patients report of brain fog being present or absent across two-time points. It did not significantly correlate with the cognitive tests. The brain fog assessment and severity scale is the first patient-informed clinical outcomes assessment tool measuring brain fog in coeliac disease. It is brief and validated for two time-based formats. Further research coupling it with biomarker discovery is needed to confirm its validity as a predictor of cognitive performance.

External validation of the five domains of negative symptoms: Focus on cognition, functional capacity, and real-world functioning.

The conceptualization of negative symptoms (NS) in schizophrenia is still controversial. Recent confirmatory factor-analytic studies suggested that the bi-dimensional model (motivational deficit [MAP] and expressive deficit [EXP]) may not capture the complexity of NS structure, which could be better defined by a five-factor (five NS domains) or a hierarchical model (five NS domains as first-order factors, and MAP and EXP, as second-order factors). A validation of these models is needed to define the structure of NS. To evaluate the validity and temporal stability of the five-factor or the hierarchical structure of the brief negative symptom scale (BNSS) in individuals with schizophrenia (SCZ), exploring associations between these models with cognition, social cognition, functional capacity, and functioning at baseline and at 4 years follow-up. Clinical variables were assessed using state-of-the-art tools in 612 SCZ at two-time points. The validity of the five-factor and the hierarchical models was analyzed through structural equation models. The two models had both a good fit and showed a similar pattern of associations with external validators at the two-time points, with minor variations. The five-factor solution had a slightly better fit. The associations with external validators favored the five-factor structure. Our findings suggest that both five-factor and hierarchical models provide a valid conceptualization of NS in relation to external variables and that five-factor solution provides the best balance between parsimony and granularity to summarize the BNSS structure. This finding has important implications for the study of pathophysiological mechanisms and the development of new treatments.

The moderating role of circadian gene polymorphisms in the relationship between sleep disturbance and circulating lymphocyte subsets in colorectal cancer patients

AimWe investigated the impact of sleep disturbance on immune status in colorectal cancer (CRC) patients with consideration of the moderating role of circadian clock gene polymorphisms. MethodsA prospective longitudinal study design was used to collect information regarding sleep disturbance. Blood samples for immunologic assays were obtained the day before the first (baseline) and last cycles of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy. Clinical sleep disturbance was compared between the two-time points using the Pittsburgh Sleep Quality Index (PSQI) global score. We analysed single-nucleotide polymorphisms in rs2278749, rs3749474, rs2291738, rs17031614, and rs2287161. The dependent variables included changes in the percentages of CD4+, CD8+, CD19+, and CD16/56+ lymphocytes between the two-time points. The results were analysed using moderated regression analysis; the p-values were adjusted using the false discovery rate. ResultsAmong the 104 patients, no significant dyadic associations were observed between changes in lymphocyte percentages and the PSQI global score. However, the moderated regression analysis revealed five significant associations (rs2287161 with CD8+, rs2278749 and rs2291738 with CD19+, and rs17031614 with CD4+ and CD16/56+ lymphocytes). The inclusion of each interaction resulted in a significant increase (5.7–10.7%) in the variance explained by changes in lymphocyte percentage. ConclusionPatients with specific circadian gene allele types may be more susceptible to immune dysregulation when experiencing sleep disturbances. Considering that sleep disturbance is a modifiable factor that can impact immune regulation, it is essential to prioritise the management of sleep disturbances in CRC patients receiving FOLFOX chemotherapy.

Different cutoff value of motor evoked potentials for the postoperative outcome in the ossification of the posterior longitudinal ligament surgery in the cervical and thoracic spine

BACKGROUND CONTEXTTranscranial muscle motor evoked potentials (Tc-mMEPs), a key component of intraoperative neurophysiologic monitoring (IONM), effectively reflect the changes in corticospinal tract integrity and are closely related to the occurrence of the postoperative motor deficit (PMD). Most institutions have applied a specified (fixed) alarm criterion for the heterogeneous groups in terms of etiologies or lesion location. However, given the high risk of PMD in ossification of the posterior longitudinal ligament (OPLL) surgery, it is essential to determine a tailored cutoff value for IONM. PURPOSEWe aimed to establish the intraoperative cutoff value of Tc-mMEPs reduction for predicting PMD in OPLL according to lesion levels. DESIGNRetrospective analysis using a review of electrical medical records. PATIENT SAMPLEIn this study, we included 126 patients diagnosed with OPLL, who underwent surgery and IONM. OUTCOME MEASURESThe occurrence of PMD immediately and 1 year after operation, as well as the decrement of intraoperative Tc-mMEPs amplitude. METHODSWe analyzed OPLL surgery outcomes using Tc-mMEPs monitoring. Limbs with acceptable baseline Tc-mMEPs in the tibialis anterior or abductor hallucis were included in the final set. PMD was defined as a ≥1 decrease in Medical Research Council score in the legs, and it was evaluated immediately and 1year after operation. The reduction ratios of Tc-mMEPs amplitude compared with baseline value were calculated at the two time points: the maximal decrement during surgery and at the end of surgery. Receiver operating characteristic curve analysis was used to determine the cutoff value of Tc-mMEPs amplitude decrement for predicting PMDs. RESULTSIn total, 203 limbs from 102 patients with cervical OPLL and 42 limbs from 24 patients with thoracic OPLL were included. PMD developed more frequently in thoracic lesions than in cervical lesions (immediate, 9.52% vs 2.46%; 1 year, 4.76% vs 0.99%). The Tc-mMEPs amplitude cutoff point at the end of surgery for PMD (both immediate and 1-year) was a decrease of 93% in cervical and 50% in thoracic OPLL surgeries. Similarly, the Tc-mMEPs amplitude cutoff point at the maximal decrement during surgery for PMD (both immediate and 1 year) was a reduction of 97% in cervical and 85% in thoracic OPLL surgeries. CONCLUSIONSThe thoracic lesion exhibited a lower cutoff value than the cervical lesion for both immediate and long-term persistent PMD in OPLL surgery (Tc-mMEPs at the end of surgery measuring 93% vs 50%; and Tc-mMEPs at the maximal decrement measuring 97% vs 85% for cervical and thoracic lesions, respectively). To enhance the reliability of monitoring, considering the application of tailored alarm criteria for Tc-mMEPs changes based on lesion location in OPLL could be beneficial.

Cell-type proteomic and metabolomic resolution of early and late grain filling stages of wheat endosperm.

The nutritional value of wheat grains, particularly their protein and metabolite composition, is a result of the grain-filling process, especially in the endosperm. Here, we employ laser microdissection (LMD) combined with shotgun proteomics and metabolomics to generate a cell type-specific proteome and metabolome inventory of developing wheat endosperm at the early (15 DAA) and late (26 DAA) grain-filling stages. We identified 1803 proteins and 41 metabolites from four different cell types (aleurone (AL), sub-aleurone (SA), starchy endosperm (SE) and endosperm transfer cells (ETCs). Differentially expressed proteins were detected, 67 in the AL, 31 in the SA, 27 in the SE and 50 in the ETCs between these two-time points. Cell-type accumulation of specific SUT and GLUT transporters, sucrose converting and starch biosynthesis enzymes correlate well with the respective sugar metabolites, suggesting sugar upload and starch accumulation via nucellar projection and ETC at 15 DAA in contrast to the later stage at 26 DAA. Changes in various protein levels between AL, SA and ETC support this metabolic switch from 15 to 26 DAA. The distinct spatial and temporal abundances of proteins and metabolites revealed a contrasting activity of nitrogen assimilation pathways, e.g. for GOGAT, GDH and glutamic acid, in the different cell types from 15 to 26 DAA, which can be correlated with specific protein accumulation in the endosperm. The integration of cell-type specific proteome and metabolome data revealed a complex metabolic interplay of the different cell types and a functional switch during grain development and grain-filling processes.

Measuring SETPOINT vocational interest dimensions: The development and validation of three short scales

Vocational interest research has seen a resurgence in the applied psychology literature, given evidence showing its predictive validity for key work outcomes. There is a need for integrative, reliable, and valid measures to advance research in this space. While the RIASEC model of vocational interests (Holland, 1997) has been the most widely used and studied typology for the assessment of six broad interest types, more recent work with the SETPOINT model (Su et al., 2019) suggests that eight interest dimensions provide better fit to interest data and demonstrates stronger criterion-related validity evidence. However, to date, no short scales are available for measuring the broad SETPOINT dimensions. We developed three short scales with 8, 24, and 41 items, respectively, that capture the eight dimensions of the SETPOINT model in an integrative manner. Using a sample of 972 full-time working adults assessed across two-time points over five weeks, we validated these three short scales following robust psychometric analyses. These scales are shown to have good psychometric properties. The development and validation of the three short scales help close the operational gap for the SETPOINT model and further facilitate the study of interests and use of interest measures in academic and applied settings.

Fear of detachment from mobile phone: nomophobia and suicidality among Malaysian university students before and during the COVID-19 pandemic

ABSTRACT The attachment to mobile devices during the COVID-19 pandemic has led to the possibility of increased nomophobia, which is the intense fear of losing access to one’s mobile device. Therefore, this study aimed to determine if nomophobia was independently associated with suicidality before and during the COVID-19 pandemic among university students in Malaysia. This cross-sectional study had two-time points in data collection: one year before and one year into the COVID-19 pandemic. N = 806 university students aged ≥ 18 years completed an online questionnaire comprising the Nomophobia Questionnaire, Multidimensional Scale of Perceived Social Support, and the Suicidal Behaviors Questionnaire-Revised. A multiple logistic regression (controlling for gender, age, and social support) was conducted to determine the association between nomophobia and suicidality before and during the COVID-19 pandemic. The prevalence of severe nomophobia before and during the COVID-19 pandemic was 15.7% and 35.6% respectively. The level of nomophobia was significantly higher during the COVID-19 pandemic compared to pre-pandemic. Pre-pandemic, there were no significant associations. During the pandemic, participants with moderate (aOR 3.09, 95% CI [1.14–8.40], p = .027) and severe (aOR 3.57, 95% CI [1.25–10.20], p = .018) nomophobia had higher odds of suicide plan. During the pandemic, moderate and severe nomophobia were independently associated with more than three times higher odds for a lifetime suicide plan. Our study findings carry implications for the well-being of university students.

A Resampling Approach for Causal Inference on Novel Two-Point Time-Series with Application to Identify Risk Factors for Type-2 Diabetes and Cardiovascular Disease

AbstractTwo-point time-series data, characterized by baseline and follow-up observations, are frequently encountered in health research. We study a novel two-point time-series structure without a control group, which is driven by an observational routine clinical dataset collected to monitor key risk markers of type-2 diabetes (T2D) and cardiovascular disease (CVD). We propose a resampling approach called “I-Rand” for independently sampling one of the two-time points for each individual and making inferences on the estimated causal effects based on matching methods. The proposed method is illustrated with data from a service-based dietary intervention to promote a low-carbohydrate diet (LCD), designed to impact risk of T2D and CVD. Baseline data contain a pre-intervention health record of study participants, and health data after LCD intervention are recorded at the follow-up visit, providing a two-point time-series pattern without a parallel control group. Using this approach we find that obesity is a significant risk factor of T2D and CVD, and an LCD approach can significantly mitigate the risks of T2D and CVD. We provide code that implements our method.

Assessing Frequency and Appropriateness of Proton Pump Inhibitor Deprescription in Patients Requiring Endoscopic Therapy for Esophageal Strictures.

There have been concerns about the widespread usage of proton pump inhibitors (PPIs), leading to recommendations to deprescribe PPIs in certain patients. This study aims to determine if PPI deprescription in patients with symptomatic esophageal strictures was consistent with published guidelines and to compare the rate of PPI deprescription between two-time points. All patients from two gastroenterology practices who received endoscopic dilation to treat symptomatic strictures between the years of 2015-2017 and 2019-2021 were identified using physician billing codes. We defined inappropriate PPI deprescription as: a patient who was deprescribed their PPI with a past medical history of esophageal stricture, Barrett's esophagus, grade C/D esophagitis, or who had experienced symptom recurrence after PPI deprescription. Furthermore, we analyzed the rate of PPI deprescription between two time periods 2015-2017 (group 1) and 2019-2021 (group 2). Two hundred twenty-three esophageal dilations were analyzed. Twenty-six patients in the sample were deprescribed their PPI, with the majority (57 percent) meeting the criteria for inappropriate PPI deprescription. There was a trend towards more inappropriate deprescription in the second time period. (71 percent vs. 33 percent; P = 0.06). Patients in group 2 had a higher rate of PPI deprescription (23.9 percent) than group 1 (6.0 percent; P < 0.001). PPI deprescription in patients treated for symptomatic esophageal strictures appears to be more common in the second time period. Most patients were defined as inappropriate deprescription. Physicians must apply guidelines carefully when considering deprescribing PPIs.

38 Operational teams leads-stuck in the middle?

Abstract Background Middle managers have a crucial role in implementing integrated care service models, but very little research has been undertaken on their experiences. A key element of the National Clinical Programme for Older People’s support for the implementation of the National Older Person’s Service Model is the establishment of Community Specialist Teams for Older People (CST-OP). These interdisciplinary teams are critical to supporting older people with complex care needs necessitating integrated care. Operational Team Leads (OTLs) are responsible for coordinating the interdisciplinary team effort to meet that aim. This research is focused on capturing OTLs experiences as they commence their roles in supporting inter-professional collaboration to achieve integrated care. Methods We employed a qualitative case study design. The unit of analysis was the process of OTLs establishing their roles over two-time points. A total of 18 OTLs participated in interviews (n = 11), and focus groups (n = 7) documentary summaries were reviewed. Results OTLs are creating networks to share knowledge to advance their work Key factors impacting some OTLs included a lack of induction and preparation for the role. They noted a need for national centralised resources and guidance, national standards development, education and networking and feedback loops. Locally there are some tensions in role clarity and clear reporting lines. Work is required to position the CSTs within community governance structures. Developing a team’s vision, mission and goals, building trust and ensuring psychological safety are necessary. Resources on how to undertake change were stressed. Recognition by OTLs of managing expectations of their role as they focus on shifting from acute to the community with some recruitment challenges, need for a shared ICT system, and enabling collaborative team spaces. Conclusion The role of managers within integrated care systems is evolving. There is an evidence gap in understanding the operations of implementing integrated care for older people. This research responds to these gaps and will be shared across the CSTs network.

Association between red blood cell distribution width and the prognosis of brain death in patients with a Glasgow Coma Scale < 6

Red blood cell distribution width (RDW) has been reported as a meaningful prognostic factor in various diseases. Our study compared patients’ RDW levels and prognosis at admission and discharge time. A total of 128 patients 77 patients who suffered brain death (subject group), and 51 patients who were discharged from the hospital (control group) with GCS ≤ 6 were recruited from 60 hospitals for this study. Demographical data and RDW measurements in these patients at admission time and brain death/discharge time were extracted into two groups. 46 (35.9%) patients were females and 82 patients (64.1%) were males with a median age of 36 years old. A significant difference in baseline characteristics of GCS (P < 0.001), RDW at admission time (P < 0.001), and RDW at discharge or brain death time (P < 0.001) were noted between the two groups. In the overall population, RDW at admission time had a median value of 13.75% and was positively correlated with gender (P < 0.04, rs = 0.582) and age (P < 0.023, rs = − 0.201). Initially, there were no significant differences in RDW upon admission. However, upon discharge, although the RDW in the control group was not significant (P < 0. 1), the RDW level at the time of brain death was notably 0.45 fold higher (P = 0.001) compared to the time of admission. The standardized residuals at the two-time points showed an approximately normal distribution. The most effective RDW cut-off in Brain death was determined as 14.55. Based on the findings, using RDW as a prognostic factor has a sensitivity of 0.468 and a specificity of 0.137 in diagnosing brain death. RDW biomarker is a simple and inexpensive laboratory test that may be seen as a valuable perspective for initial patient evaluation. RDW is a powerful marker for the prognosis of brain death in patients with a GCS ≤ 6 at admission time, in order to identify a subset of patients who may require more aggressive management in the trauma center.