Univariate Associations Research Articles

Genomic Machine Learning Meta-regression: Insights on Associations of Study Features With Reported Model Performance.

Many studies have been conducted with the goal of correctly predicting diagnostic status of a disorder using the combination of genomic data and machine learning. It is often hard to judge which components of a study led to better results and whether better reported results represent a true improvement or an uncorrected bias inflating performance. We extracted information about the methods used and other differentiating features in genomic machine learning models. We used these features in linear regressions predicting model performance. We tested for univariate and multivariate associations as well as interactions between features. Of the models reviewed, 46% used feature selection methods that can lead to data leakage. Across our models, the number of hyperparameter optimizations reported, data leakage due to feature selection, model type, and modeling an autoimmune disorder were significantly associated with an increase in reported model performance. We found a significant, negative interaction between data leakage and training size. Our results suggest that methods susceptible to data leakage are prevalent among genomic machine learning research, resulting in inflated reported performance. Best practice guidelines that promote the avoidance and recognition of data leakage may help the field avoid biased results.

Predictors of outcome in patients with moderate mixed aortic valve disease

ObjectivesGrading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide...

The impact of chronic obstructive pulmonary disease on surgical outcomes after surgery for an acute abdominal diagnosis

PurposeThe current study was undertaken to describe the independent contribution of chronic obstructive pulmonary disease (COPD) to the risk of postoperative morbidity and in-hospital mortality among patients undergoing surgery for an acute abdominal diagnosis.MethodsPatients who underwent emergency abdominal procedures were identified from the electronic database of the Department of Visceral, Transplantation, Thoracic and Vascular Surgery of our institution. To evaluate differences in surgical risk associated with COPD, patients with COPD were matched for age, sex, and type of surgery with an equal number of controls who did not have COPD. Logistic regression was performed to evaluate the univariate and multivariate associations between the independent variables, including COPD and outcome variables.ResultsBetween January 2012 and December 2022, 3519 patients undergoing abdominal emergency surgery were identified in our abdominal surgical department. After removing ineligible cases, 201 COPD cases with an equal number of matched controls remained for analysis. The prevalence of COPD after the exclusion of ineligible cases was 5.7%. There were statistically significant differences in the rate of postoperative pulmonary complications (PPCs [57.7% vs. 35.8%; P < 0.001]), ventilator dependence (VD [63.2% vs. 46.3%; P < 0.001]), thromboembolic events (TEEs [22.9% vs. 12.9%; P = 0.009]), and in-hospital mortality (41.3% vs. 30.8%; P = 029) for patients with and without COPD. Independent of other covariates, the presence of COPD was not associated with a significantly increased risk of in-hospital mortality (OR, 1.16; 95% CI 0.70–1.97; P = 0.591) but was associated with an increased risk of PPCs (OR, 2.49; 95% CI 1.41–4.14; P = 0.002) and VD (OR, 2.26; 95% CI 1.22–4.17; P = 0.009).ConclusionsPreexisting COPD may alter a patient’s risk of PPCs and VD. However, it was not associated with an increased risk of in-hospital mortality.

Oral health behind the bars: oral health seeking behavior among jail prisoners at central jail of Peshawar, Pakistan: a cross-sectional study

BackgroundThe oral health care-seeking behavior among prison inmates is an overlooked area, often leading to deteriorating general health due to the prisoners’ limited awareness of oral hygiene practices. It is crucial to address this issue and understand the factors associated with oral healthcare-seeking behavior in prisons.ObjectiveTo assess the oral healthcare-seeking behavior of prison inmates at Central Prisoner Jail, Peshawar Pakistan and to look the factors associated with their dental care utilization.Material and MethodsThis cross-sectional study was conducted at Central Prisoner Jail, Peshawar Khyber Pakhtunkhwa, Pakistan from November 2021 to April 2022. A consecutive sampling technique was used to collect data from both convicted and under-trial prisoners by using a pre-tested WHO Basic Oral Health Survey 2013 tool. Our outcome variable was “Visit to a dentist in the last 12 months (Never/Once or more than one visit). Chi-square test was used to determine univariate association with other explanatory variables while multivariable logistic regression was performed to adjust for potential confounders.ResultA total of 225 participants were recruited to the study with a mean (SD) age of 32.9(11.4). More than two-thirds of 200(88.9%) of the participants were males. One-third of the sample never visited the dentist75(33.3). Participants who completed college/university education and never visited the dentist in the last 12 months constituted a smaller proportion (17.6%) compared to those who visited the dentist once or more than once n = 28(82.4%, p-value = 0.003). Individuals who were using toothbrushes were most frequently visiting the dentist n = 130(72.6%=p value = 0.001) as compared to never visitors. Multivariate logistic regression analysis revealed that Participants who experienced teeth pain or discomfort had 0.42 times lower odds of visiting the dentist compared to those who did not experience any pain or discomfort [AOR 0.42 (95% CI 0.17–0.80), p = 0.04]. Similarly, Participants who do not use any denture have 4.06 times higher odds[AOR 4.06(95% CI 1.76–9.36), p = 0.001] of visiting the dentist compared to those who use a denture.ConclusionOur result demonstrates that those prisoners who were experiencing tooth pain or discomfort and not using dentures were the strong predictors with lower dental visit frequency to seek oral health care.

Dementia awareness, motivation and modifiable risk factors amongst older Australians in regional communities

AbstractBackgroundDementia is the second leading cause of death in regional Australia. A large body of research into modifiable dementia risk factors and awareness levels has been gathered with metropolitan communities, yet this remains unexplored within regional areas. Therefore, this study aims to 1) identify awareness of modifiable dementia risk factors; 2) identify the presence/absence of modifiable dementia risk factors; and 3) explore sociodemographic and motivation characteristics associated with modifiable dementia risk in regional areas of AustraliaMethodCross‐sectional data of dementia awareness and risk levels in 180 adults &gt;65 living in rural and remote regions within New South Wales, were collected using an online survey. Data included demographics, awareness of dementia risk factors (British Social Attitudes survey), presence/absence of modifiable dementia risk factors (LIBRA), motivation to reduce dementia risk (MCLHB‐DRR) and social connections (LSNS‐6). Descriptive analyses was used to identify awareness as well as presence/absence of risk factors and univariate associations were used to explore demographic factors and motivation characteristics, associated with dementia awareness and dementia risk.ResultParticipants had a mean age of 72.2 (SD = 5.5) years, majority were female (70%), and had less than 10 years of education (41.1%). 41.7% were from a low socio‐economic background and 97.2% were born in an English‐speaking country. A substantial proportion of participants agreed that dementia risk is modifiable (73.3%) and identified an average of 5.7 (SD = 3.1, out of 12) dementia risk factors correctly. The motivation domain of perceived susceptibility towards dementia was low (11.3 out of 20; SD = 3.4; [4‐20]), and few social connections were reported (8.2; SD = 9.3; [0‐30]).ConclusionRural and remote Australian older adults having a basic understanding that dementia is not inevitable, however, they remain unaware of more than half of the risk and protective factors for dementia. Given the consistencies in dementia risk and the inconsequential association between sociodemographic variables in regional areas, future interventions should adopt a population health approach to improve awareness and create opportunities for communities to target health risk factors contributing to dementia.

Incidence and risk factors for inferior vena cava filter thrombosis detected at time of filter retrieval in patients with lower extremity deep vein thrombosis: a multicenter retrospective cohort study.

Inferior vena cava filter (IVCF) thrombosis is an uncommon complication of IVCF utilization. The aims of this study were to investigate inferior vena cava (IVC) venography before filter retrieval to determine the incidence relative to filter dwell time and risk factors of IVCF thrombosis based on the clinical data and imaging findings in patients with lower extremity deep vein thrombosis (LEDVT). The clinical data from a multicenter randomized trial conducted between October 2017 and March 2019 were reviewed to determine the incidence of IVCF thrombosis in preretrieval venography and the associated risk factors. The correlation between filter dwell times (within 90 days) and incidence was assessed. Baseline demographics, LEDVT presentation, laboratory examination, thrombus characteristics, concurrent pulmonary embolism (PE), comorbidities and risk factors for LEDVT, and IVCF-relevant information were analyzed using the independent samples t-test, chi-squared test, Fisher exact test, and regression analysis to determine the univariable and multivariable associations in assessing the risk factors of IVCF thrombosis. A total of 178 eligible patients were included, of whom 58 were in the IVCF thrombosis group and 120 were in the IVCF nonthrombosis group, and the mean filter dwell time was 22.07±27.91 days (range, 4-190 days). The overall incidence of IVCF thrombosis in patients with LEDVT who received IVCFs was 32.58% (58/178). The incidence of IVCF thrombosis was 35.25% (49/139) in the first 30 days after the IVCF placement and decreased to 22.73% (5/22) between 30 to 60 days of dwell time and to 18.18% (2/11) between 60 and 90 days of dwell time, indicating a decreasing trend within the first 90 days. The risk factors for the occurrence of IVCF thrombosis were concurrent PE [odds ratio (OR) =2.59; 95% confidence interval (CI): 1.27-5.28; P=0.01], rheumatic diseases of the immune system (OR =14.42; 95% CI: 1.52-136.41; P=0.02), IVC:filter radial ratio >0.587 (OR =0.25; 95% CI: 0.10-0.65; P<0.01), and percutaneous angioplasty (PTA) (OR =2.50; 95% CI: 1.09-5.70; P=0.03). The incidence of IVCF thrombosis at the time of filter retrieval appears to decrease with dwell time within 90 days. Concurrent PE, rheumatic diseases of the immune system, and PTA were taken into account as risk factors. An IVC:filter radial ratio of 0.587 was a protective factor against developing IVCF thrombosis. These findings require further validation in a well-designed study since the present study lacked a close follow-up.

Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study.

Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults. The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2). Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively). Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.

Abstract A082: Factors associated with willingness to participate in future clinical trials

Abstract Background: Biannually, Sidney Kimmel Cancer Center at Jefferson in Philadelphia, PA their catchment area to identify and describe the population. Since less than 6.3% of cancer patients nationally are involved in clinical trials, the most recent survey included questions related to willingness to participate in clinical trials (CTs) and reasons for or against participation. Methods: A cross-sectional study was conducted among adult residents in Philadelphia, Delaware, Bucks, and Montgomery Counties in Pennsylvania as well as Camden, Burlington, and Gloucester Counties in New Jersey from July to August 2022 and included 2,744 respondents. Survey questions included reasons for or against willingness to participate in CTs, lifestyle behaviors, cancer screening frequencies, cancer attitudes or beliefs, health literacy, and numeracy. Frequency counts were weighted against population totals from the American Community Survey. The survey was fielded in English, Spanish, and Chinese. The univariate associations of covariates with the outcome were evaluated with a ꭓ2 test. Logistic regression using weighted survey procedures were used to calculate the odds ratios (ORs), 95% confidence intervals (CIs), and p-values of trial participation controlling for covariates. Results: The weighted sample represented the 3,889,048 residents of the catchment area. Survey respondents completed the survey in English (80.1%), Spanish (13.2%), and Chinese (6.7%) and self-identified as Hispanic (9.3%), non-Hispanic (NH) White (57.8%), NH Black (19.0%), and NH Other (14.0%). The catchment population was willing to participate in CTs (69.8%). Respondents answering in Chinese were 40% less likely than those answering in English to indicate future CT participation (OR 0.60, p=0.04). Both Hispanic and NH Black respondents were over 30% less likely to participate compared to NH Whites (OR 0.67, p=0.03 and 0.68 p=0.02, respectively). While some respondents view CTs as “experiments” (17.0%), the most common reason given not to participate in a CT was side effects (25.6%). Respondents reporting a high level of discrimination were 48% more likely to participate in a CT than low discrimination respondents (p=0.02). The population reporting the highest level of discrimination also reported wanting to participate to “learn more about their health and medical condition” (66.3%) and a desire to “help my community” (54.5%). Conclusions: Clinical trials offer a segment of the population access to care not normally available and a way to serve their community. However, fear of experimentation remains a strong reason not to participate. The findings highlight the importance of catchment assessment when designing recruitment methods and future endeavors involving education on the trial safety of trials may improve participation. While education may assuage fears, it will not dispel mistrust. Proactively engaging the community in study design may help repair the relationship between science and the people it serves. Citation Format: Amy L. Shaver, Nikita Nikita, Joshua Banks, Christiane El Khoury, Rebecca J. Melillo, Yawei Song, Grace Lu-Yao, Amy E. Leader. Factors associated with willingness to participate in future clinical trials [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A082.

Derivation of a clinical decision rule to exclude cerebral venous sinus thrombosis in emergency department patients: A retrospective cohort study.

To derive a clinical decision rule to exclude cerebral venous sinus thrombosis (CVST) in the ED. A secondary aim was to derive a rule that incorporated clinical parameters and the non-contrast CT brain. Single-centre, retrospective cohort study. Patients suspected of CVST were identified from the radiology database for CT/MR venograms. Clinical features included in the rule were determined by literature review. The presence of these features in participants was determined by chart review. Variables were tested for univariate association with CVST using logistic regression. Variable selection was accomplished using a forward-stepwise process, calculating the sensitivity/specificity of a rule containing the variable of most significance, then repeating the process after adding the next most significant variable. Forty-five out of 912 participants had confirmed CVST. The primary clinical rule was answering 'no' to all the following: any prothrombotic risk factor, age ≥54 years, confusion: sensitivity 95.6% (95% confidence interval [CI] 84.9-99.5%), specificity 40.9% (95% CI 37.6-44.2%), negative predictive value 99.4% (95% CI 97.9-99.9%) and positive predictive value 7.7% (95% CI 7.1-8.3%). The rule classified 39.5% of participants as CVST ruled out. The rule incorporating the non-contrast CT brain was answering 'no' to all the following: abnormal non-contrast CT brain, any prothrombotic risk-factor, age ≥54 years, confusion: sensitivity 100.0% (95% CI 91.6-100.0%), specificity 42.0% (95% CI 38.7-45.4%), negative predictive value 100.0% (95% CI not calculated) and positive predictive value 7.8% (95% CI 7.4-8.2%). The rule classified 40.0% of participants as CVST ruled out. A clinical decision rule was derived to rule out CVST. These results require validation before adoption into clinical practice.

Time to Treatment for Patients with Suspected Acute Promyelocytic Leukemia (APL)

Introduction: Acute promyelocytic leukemia (APL) is a rare subtype of acute myeloid leukemia characterized by dysplastic promyelocytes which cause aberrations in coagulation, including hemorrhage and disseminated intravascular coagulation (DIC), leading to a rapidly fatal course if treatment is not initiated promptly. Early administration of all-trans retinoic acid (ATRA) in patients suspected of having APL is crucial for reducing morbidity and mortality. However, APL still exhibits a high early death rate in part due to failure to rapidly initiate ATRA. Therefore, we conducted a retrospective study to investigate the time it takes for ATRA to be ordered and administered to patients with suspected APL at our tertiary care University hospital. We also examined demographic and clinical variables to identify any opportunities for quality improvement. Methods: We queried our electronic medical record (EMR) for all adult patients without a prior diagnosis of APL from 2017-2021 who received at least one dose of ATRA at Thomas Jefferson University Hospital. Our analysis included 91 patients. We collected a wide range of demographic and clinical data (Table 1). The time of admission was defined as the time the admission order was placed in the EMR, and the time of administration was defined as the time the nurse marked the medication as administered. A simple general linear model was used to evaluate univariate association between each single covariate and each log transformed outcome. Model selection by Akaike information criterion (AIC) was conducted to identify the best model according to goodness of fit criteria. The smaller the AIC value, the better the model fit. The parsimonious models were obtained using backward elimination of non-significant predictors (p-values &amp;gt; 0.05) from the best models according to goodness of fit criteria (AIC). Results: The mean time for interval A (time from hospital admission to ordering ATRA) was 284 minutes, the mean time for interval B (time from ATRA order being placed to ATRA administration) was 104 minutes, and the mean time for interval C (time from admission to ATRA administration) was 388 minutes. Further analysis of the time intervals is presented in Table 2. The results of the demographic and clinical variables (Table 1) show that the majority of patients were transferred from an outside hospital (89%) and admitted overnight (87%). Consequently, ATRA was most often ordered (76%) and administered (70%) overnight. Only 26 (29%) patients were ultimately confirmed to have APL. During the index admission, patients required a mean of 6 units of packed red blood cells and 9 units of platelets. A quarter of patients were noted to have signs or symptoms of bleeding upon admission. The results of the multiple linear regression analysis are shown in Table 2. Only signs or symptoms of bleeding were associated with a statistically significant decrease in time to ATRA. Patients with signs of symptoms of bleeding experienced, on average, 39% less time from admission to ATRA being ordered (95% CI: 0.396-0.946, p=0.030) and 31% shorter time from admission to ATRA administration compared to those without signs or symptoms of bleeding (95% CI: 0.489-0.967, p=0.034). Conclusions: Our study highlights that, even at a large, resource-rich, academic medical center, the time to ATRA administration in patients with suspected APL is longer than optimal. The presence of bleeding was the only variable that significantly decreased the time to ATRA. Earlier identification of bleeding risk (including evolving DIC or thrombocytopenia), increased recognition of possible acute leukemia, and more rapid hematology/oncology consultation could help to decrease the time to ATRA and to avoid bleeding complications before they start. Additionally, we found that most patients (89%) were transferred from an outside hospital. Although we were not able to quantify the time from outside hospital admission to transfer, we suspect that the time was substantial and that there are even greater opportunities to improve the care of these patients by increasing ATRA availability at community hospitals, enhancing the education of all front-line providers regarding the prompt recognition of coagulopathy in the setting of suspected acute leukemia, and improving transfer center acceptance documentation that emphasizes the concern for APL and appropriate next steps in evaluation and treatment.

A Novel Prediction Model for BK Virus Associated Hemorrhagic Cystitis in Acute Leukemia Patients Following Allogenic Hematopoietic Cell Transplantation: A Retrospective Cohort Study

Introduction BK polyomavirus (BKV) has been associated with hemorrhagic cystitis (HC) after allogeneic hematopoietic cell transplantation (HSCT). BK virus hemorrhagic cystitis (BKHC) is associated with high morbidity and higher mortality. Previous studies have identified several risk factors associated with BKHC (Biol Blood Marrow Transplant, 2022). However, these results are contradictory among studies, and the potential mechanisms of BKHC are still unclear. Therefore, an accurate systematic evaluation method for screening high-risk populations before the onset of BKHC is highly necessary. This study was designed to establish an efficient prediction model for BKHC in acute leukemia patients following HSCT, thereby facilitating identification and early intervention in patients at high risk of BKHC. Methods In our retrospective study, a cohort of 789 acute leukemia patients following allogenic hematopoietic cell transplantation in 2019 was included and further divided into a BKHC group and a non-BKHC group. Among these patients, 80% were assigned to the derivation cohort, and 20% were assigned to the validation cohort. We first calculated the univariate association of each variable with the occurrence of BKHC. Second, the variables with p values less than 0.05 in the univariate analysis were further included as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. The variables that remained in the final model based on the outcomes of the multivariate analysis in the derivation cohort were identified as independent risk factors. The discrimination power of the model was assessed in both derivation and validation cohorts through ROC curve (AUC), calibration curve and decision curve analyses. Results Among 789 acute leukemia patients following allogenic hematopoietic cell transplantation, 171 patients were diagnosed with BKHC 14 days post transplantation according to the European Conference on Infections in Leukemia (ECIL) definition of BKHC. Patients with early-onset HC occurring within 14 days post transplantation were excluded from the BKHC group. The incidence rate of developing BKHC after allo-HSCT was 21.7%. The median time from transplantation to BKHC development was 30 days. Using multivariable logistic regression methods with stepwise variable selection, four highly significant independent risk factors for developing BKHC were identified: use of ATG during the transplantation regimen (p=0.048; odds ratio [OR], 2.32; 95% confidence interval [CI], 0.025-1.71), use of bone marrow blood and peripheral blood as sources of stem cells (p&amp;lt;0.001; odds ratio [OR], 0.25; 95% confidence interval [CI], 0.025-1.71), age less than 30 years old (p=0.02; odds ratio [OR], 1.74; 95% confidence interval [CI], 0.089-1.021) and absolute lymphocyte count at 14 days post-transplantation less than 0.035×10 9/L (p=0.02; odds ratio [OR], 2.59; 95% confidence interval [CI], 0.31-1.62). The area under the ROC curve (AUC) was 0.741 (95% confidence interval [CI], 0.694-0.789). According to the calibration plots, the model-predicted probabilities showed a good correlation with actual observed frequencies in both the derivation and validation cohorts. Decision curve analysis indicated that the clinical implementation of this model could benefit BKHC patients. A BKV-associated HC Risk Index (BHRI) was constructed according to the regression coefficients. The patient cohort was divided into a high-risk group and a low-risk group according to risk scores. Kaplan‒Meier estimations of the probabilities of BKHC were significantly different between the two risk groups. Conclusions Patients with BKHC after allo-HSCT usually have high morbidity and higher mortality. A novel prediction model, BHRI, was developed and validated, and this is the first straightforward scoring system designed to evaluate the probability of patients developing BKHC after receiving allo-HSCT to treat hematological malignancies. This model can be effectively utilized to help improve the prognosis of BKHC patients by accelerating the early identification of patients at a high risk of developing BKHC and contributing to the appropriate implementation of timely medical support.

Chagas disease stroke and associated risk factors: A case-control study

Introduction: The intricate relationship between Chagas disease and ischemic stroke remains unclear. Limited evidence exists concerning secondary prophylaxis, etiological diagnosis, and stroke-related determinants. This study aims to discern factors linked to stroke in Chagas disease by contrasting patients with and without a history of ischemic stroke. Methods: Retrospective data from all outpatient Chagas disease patients from two Brazilian hospitals – one Chagas center and one stroke clinic – were examined. Descriptive analyses were conducted to identify stroke-associated factors. Variables were compared between patients with and without ischemic stroke history. Results: Among 678 subjects, 72 had experienced stroke. Univariate associations with stroke included male gender, heart failure, prior or ongoing alcoholism, electrocardiographic features (non-sinus rhythm, left bundle branch, right bundle branch block, left anterosuperior fascicular block, atrial fibrillation), as well as echocardiographic findings indicative of reduced left ventricular ejection fraction and segmental abnormalities. After logistic regression (multivariate analysis), congestive heart failure, right bundle branch block, left anterosuperior divisional block, and atrial fibrillation retained independent associations. Conclusion: In this study, cardiac involvement emerged as the predominant factor correlated with stroke in Chagas disease. While atherosclerosis-related risk factors were prevalent, their influence on ischemic stroke in Chagas disease appeared limited.

Trust in provider and stigma during second-trimester abortion

ObjectiveTo determine whether trust in the provider and sociodemographics are associated with individual-level abortion stigma. MethodsWe performed a cross sectional and exploratory study design using secondary analysis of a randomized trial that enrolled participants undergoing second trimester abortion. We collected baseline survey data from 70 trial participants to assess stigma (Individual Level of Abortion Stigma scale, ILAS; range 0–4), trust in provider (Trust in Physician scale; range 1–5), anxiety, depression, and sociodemographics. We performed multiple linear regression, for which ILAS score was the outcome of interest. Univariate associations were used to inform the regression model. ResultsThe mean abortion stigma score was at the low end of the ILAS at 1.21 (range 0.2–2.8, SD 0.66). Age, race, income, BMI, parity, gestational age at time of abortion, and reasons for ending the pregnancy were not significantly associated with the ILAS score. Higher trust in provider scores were (m 4.0, SD 0.49) and inversely related to the ILAS score, even after adjustment for confounders (β −0.02, CI −0.03 to −0.004, p = 0.013). Screening positive for anxiety or depression was associated with a higher ILAS score ((β 0.48, CI 0.10, 0.90, p = 0.015); (β = 0.27 CI −0.097, 0.643)), while cohabitation was associated with lower ILAS score (β −0.44, CI −0.82 to −0.57, p = 0.025). ConclusionsTrust in an abortion provider, anxiety, depression, and cohabitation are associated with abortion stigma among people seeking second trimester abortion care. Interventions that improve trust in a provider may be an area of focus for addressing abortion stigma. Future research should confirm these findings in larger populations and across diverse locations and demographics and to conduct qualitative research to understand what patients perceive as trust-promoting behaviors and words during abortion encounters.

Associations Between HIV and Severe Mpox in an Atlanta Cohort.

In the Southeastern United States, the 2022 mpox outbreak disproportionately impacted people who are black and people with HIV (PWH). We analyzed a cohort of 395 individuals diagnosed with mpox across 3 health care systems in Atlanta, Georgia between 1 June 2022 and 7 October 2022. We present demographic and clinical characteristics and use multivariable logistic regression analyses to evaluate the association between HIV status and severe mpox (per the US Centers for Disease Control and Prevention definition) and, among PWH, the associations between CD4+ T-cell count and HIV load with severe mpox. Of 395 people diagnosed with mpox, 384 (97.2%) were cisgender men, 335 (84.8%) identified as black, and 324 (82.0%) were PWH. Of 257 PWH with a known HIV load, 90 (35.0%) had > 200 copies/mL. Severe mpox occurred in 77 (19.5%) individuals and there was 1 (0.3%) death. Tecovirimat was prescribed to 112 (28.4%) people, including 56 (72.7%) people with severe mpox. In the multivariable analysis of the total population, PWH had 2.52 times higher odds of severe mpox (95% confidence interval [CI], 1.01-6.27) compared with people without HIV. In the multivariable analysis of PWH, individuals with HIV load > 200 copies/mL had 2.10 (95% CI, 1.00-4.39) times higher odds of severe mpox than PWH who were virologically suppressed. Lower CD4+ T-cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis. PWH with nonsuppressed HIV loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with nonsuppressed HIV loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment.

Impact of neurofibromatosis type 1 with plexiform neurofibromas on the health-related quality of life and work productivity of adult patients and caregivers in the UK: a cross-sectional survey

BackgroundPlexiform neurofibromas (PN) are complex, benign nerve-sheath tumours that occur in 30–50% of patients with neurofibromatosis type 1 (NF1), a rare, genetic disorder. PN are associated with substantial, heterogeneous morbidities that impact health-related quality of life (HRQoL), including affecting motor function and causing pain, though HRQoL and work productivity data are scarce. This UK cross-sectional study explored HRQoL and work productivity in adult patients with NF1 PN and caregivers of paediatric patients.MethodsAdult patients and caregivers of paediatric patients self-enrolled in an online survey (March–April 2021). Outcomes included EQ-5D-5L, PROMIS® GH and INF1-QOL (adult patients only), and EQ-5D-5L, CarerQol and WPAI (caregivers only). Utilities were estimated from EQ-5D-5L responses using the UK crosswalk value set. Linear regression models explored univariable associations between adult patient characteristics and HRQoL.ResultsMean (± standard deviation) EQ-5D utility in adult patients with NF1 PN was 0.65 (± 0.29; n = 35; age-/sex-matched norm: 0.89 [± 0.04]). Moderate–extreme pain/discomfort and anxiety/depression were reported by 14/35 (40.0%) and 18/35 (51.4%) patients, respectively. Mean PROMIS® GH physical and mental health scores were 43.6 (± 9.19) and 41.7 (± 11.5; n = 35; matched norm: 50.0 [± 10.0]). Mean INF1-QOL score was 11.03 (± 6.02; n = 33). Chronic itching, at least one symptom, at least one comorbidity, PN location at extremities (arms/legs) and pain were associated with worse HRQoL scores.Mean caregiver EQ-5D utility was 0.72 (± 0.24; n = 8; age-/sex-matched norm: 0.88 [± 0.03]). Moderate pain/discomfort and moderate–severe anxiety/depression were reported by 4/8 (50.0%) and 2/8 (25.0%) caregivers, respectively. Mean CarerQol score was 69.3 (± 13.9; n = 8). Mean WPAI regular activity productivity loss was 36.3% (± 31.6%; n = 8).ConclusionsNF1 PN worsens adult patient and caregiver HRQoL compared to the general population, notably affecting pain and discomfort, anxiety and depression and caregiver productivity.

Treatment and Prognosis of Newly Diagnosed Advanced-Stage Extranodal Natural Killer/T-Cell Lymphoma: A Single-Center Real-World Study across Two Decades

Introduction: Although there is now a consensus on asparaginase-based chemotherapy regimens in the treatment of advanced-stage extranodal natural killer/T-cell lymphomas (ENKTCLs), patient survival in the real-world setting is still not optimistic according to previous literature reports, and the optimal chemotherapeutic regimens and integration of different therapeutic methods under the concept of combined-modality treatment still need to be further explored and verified. Methods: Newly diagnosed stage Ⅲ/Ⅳ ENKTCL patients from Chinese National Cancer Center in the last two decades were retrospectively collected and analyzed. Overall survival (OS) and progression-free survival (PFS) were determined as primary endpoints. Log-rank tests and Cox proportional hazard models were performed to test for survival differences between subgroups and examine the univariable and multivariable associations. Results: The study included 83 newly diagnosed stage Ⅲ/Ⅳ ENKTCL patients and reported a median OS of 26.07 months and an estimated 5-year OS of 41.3% with a median follow-up of 82.13 months. First-line asparaginase-based regimens compared to non-asparaginase-based regimens significantly prolonged PFS (p = 0.007; HR = 0.48, p = 0.020) and showed a tendency to improve OS (p = 0.064; HR = 0.74, p = 0.359). Gemcitabine-based regimens also exhibited a trend toward improved PFS (p = 0.048; HR = 0.59, p = 0.164) and OS (p = 0.008; HR = 0.67, p = 0.282) compared to non-gemcitabine-based ones. The asparaginase and gemcitabine combinations yielded a 5-year OS of 55.0% and led to significantly superior PFS (p = 0.020; HR = 0.40, p = 0.022) and slightly better OS (p = 0.054; HR = 0.79, p = 0.495) compared to the remaining regimens. First-line combined-modality treatment integrating chemotherapy and radiotherapy improved PFS (p = 0.051) and OS (p = 0.036) compared to chemotherapy alone. Four autologous hematopoietic stem cell transplantation recipients reached a median OS of 58.34 months. Conclusion: Asparaginase and gemcitabine alone brought a favorable impact on PFS and OS; and the asparaginase and gemcitabine combination chemotherapy yielded the optimal efficacy, response duration, and survival outcomes. Combined-modality treatment including potent chemotherapy supplemented by radiotherapy and/or consolidative transplantation could improve prognosis in newly diagnosed advanced-stage ENKTCLs.

Psychological effects of mould and damp in the home: scoping review

People spend a substantial amount of time at home, so it is important that homes are safe, healthy environments. Damp and mould represent common housing problems but little is known about their potential psychological effects. This scoping review explores existing literature on the relationship between household damp/mould and psychological wellbeing. Systematic searches of six databases were conducted, supplemented by hand-searches. Thirty studies were included; 21/24 (87.5%) found significant univariate associations between damp/mould and psychological outcomes and 13/17 (76.5%) found that damp/mould remained significant independent predictors in multivariate analyses. Qualitative data from six studies revealed that participants feared potential physical health consequences of damp/mould and felt self-conscious about clothes/homes smelling damp. Our findings suggest that exposure to damp and mould accounts for a significant amount of variance in psychological outcomes. Improving housing quality, ensuring healthcare professionals are aware of the psychological health effects of damp/mould and campaigns to educate the public about how to remove damp and mould may be useful.

Predictors of disease burden in patients with untreated transthyretin amyloid cardiomyopathy: post hoc analysis of an international survey study

Abstract Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition that can cause debilitating symptoms.[1] The burden of untreated ATTR-CM was recently evaluated in an international, multicentre, real-world survey study.[2] Identifying predictors of ATTR-CM burden can help improve patients’ therapeutic journey. Purpose To identify predictors of disease burden on patients with ATTR-CM treated with symptomatic but not disease-modifying therapy using data from the recent international real-world survey study. Methods The original study surveyed 208 patients with untreated ATTR-CM recruited from international amyloidosis centres of excellence in 7 countries between July 2021 and August 2022. This post hoc analysis used univariate and multivariate models to evaluate selected survey variables as predictors of patient burden. Variables and outcomes included in the models are described in the figure. Univariate associations were confirmed with a t-test and Pearson correlation coefficient. The full multivariate models included all variables and were then optimised using forward selection and CV Press criteria with 8-fold cross-validation to identify the best predictors. Results The patient population in the original study were generally male (86%) and elderly (median 81 [range: 46 – 90] years), with wild-type ATTR-CM (91% of 155 with genetic testing; median time since diagnosis: 6 months). Of the 199 patients with a recorded NYHA classification, 60% were class II, 22% were class III, 18% were class I, and none were class IV. The investigator reported each neurologic symptom variable (Figure) as a current symptom in 25–41 patients, and gastrointestinal or urinary problems in 36 patients. Out-of-pocket expenses in the prior 3 months were reported by 78 patients. Respective median (IQR) KCCQ-OS, -CS and -TS scores were 67.7 (46.4–84.4; n = 183), 69.0 (49.5–87.5; n = 202), and 75.0 (52.1–91.7; n = 208); HADS-A and HADS-D scores were 5.0 (3.0–8.0; n = 205), and 6.0 (3.0–10.0; n = 204); SF-12 PCS and MCS scores were 36.3 (27.5–43.5; n = 206) and 46.8 (39.4–54.4; n = 206); and PROMIS Fatigue T-score was 50.8 (45.8–57.8; n = 203). In the unadjusted univariate models, NYHA class and the neurologic symptom variable of weakness, especially in the legs, were independently associated with all outcome measures of burden. Closely reflecting the statistically significant predictors in the full multivariate models, older age (continuous or age over 80 years), symptomatic heart failure (NYHA class II or III), female sex, and having weakness, especially in the legs, were among the best predictors of a higher burden in several optimized models (Table). Conclusions In this study of patients with ATTR-CM receiving symptomatic but not disease-modifying therapy, our analysis suggests that older age, female sex, and cardiac or neurologic symptoms are often predictors of higher disease burden.Figure:Variables and outcome measuresTable:Optimised models

Impact on clinical outcome of ventricular arrhythmias in patients undergoing transcatheter aortic valve implantation (TAVI)

Abstract Background Transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis has considerably grown in the latest years. There are limited data, however, about predictors of long-term prognosis in this population. Particularly, whether ventricular arrhythmic burden is associated with clinical outcome has poorly been investigated. Purpose The aim of our study was to investigate the association between ventricular arrhythmias and adverse clinical outcomes in patients undergoing TAVI. Methods We performed a 24-hour 3-channel ECG Holter monitoring (HM) in 267 consecutive patients who underwent TAVI for severe aortic stenosis at our Centre within 30 days from a successful procedure (average 10.2 days, range 2-30). For each patient we obtained the number of premature ventricular complexes (PVCs) and the presence of non-sustained ventricular tachycardia (NSVT, &amp;gt;3 PVCs with a rate &amp;gt;100 bpm). Frequent PVCs were defined as the presence of at least 30 PVCs per hour. We also collected clinical and echocardiographic findings for each patient. Assessment of clinical events at follow-up was performed by clinical visits or telephone interviews of patients or relatives (in case of fatal events). The primary endpoint of the study was the occurrence of cardiovascular events (CVE), a composite of cardiovascular death and resuscitation from cardiac arrest. All-cause-mortality was assessed as secondary endpoint. Survival Cox regression was applied to assess the univariate and multivariate association of clinical, echocardiographic and HM variables with endpoints. Results Clinical outcome could be obtained for 228 patients (85%), for an average follow-up of 3.5 years (range 1.0-8.6). Among these patients, frequent PVCs (≥30/hour) and episodes of NSVT at HM were found in 47 (20.6%) and 52 (22.4%) patients, respectively. CVE occurred in 26 patients (11.4%) and 63 patients died (27.6%). Frequent PVCs at HM were detected in 12 patients with (46.2%) and 35 patients without (17.3%) CVE (HR 2.29; 95% CI 1.03-5.09; p=0.04). One or more episodes of NSVT were detected in 9 patients with (34.6%) and 43 patients without (21.3%) CVE (HR 2.29; 95% CI 1.03-5.09; p=0.04), although it was not predictive of all-cause mortality (HR 1.18; 95% CI 0.48-2.77; p=0.52). Both the presence of PVCs&amp;gt;30/hour (HR 1.19; 95% CI 0.69-2.08; p=0.53) and NSVT (HR 0.93; 95% CI 0.52-1.65; p=0.22) were not significantly associated with all-cause mortality. Moreover, no clinical (age, gender, cardiovascular risk factors) and echocardiographic (aortic valve area, trans-aortic mean gradient, left ventricle mass and ejection fraction) variable showed significant association with both the primary and secondary outcome in our patients. Conclusions In our study the detection of frequent PVCs at HM after TAVI was a major predictor of CVE (cardiovascular death/cardiac arrest), suggesting that a 24-hour HM after TAVI can be helpful for risk stratification of these patients.

Relation between non-sustained ventricular tachycardia and major arrhythmic events in patients with dilated cardiomyopathy caused by titin truncating variants

Abstract Background Truncating titin variants (TTNtv) are the most frequent monogenetic cause of dilated cardiomyopathy (DCM). Current data suggest that nonsustained ventricular arrhythmia is common in patients with TTVtv but its relation to the risk of major arrhythmic events (MAE) is uncertain. Purpose To investigated the relationship between NSVT recorded on Holter ECG or implanted device and MAE in patients with DCM. Methods We retrospectively studied consecutively evaluated patients with DCM (left ventricle ejection fraction (LVEF) below 50%) on echocardiography and a pathogenic TTNtv. Patients with obstructive coronary artery disease, valvular disease, ventricular tachycardia ablation during follow-up time and follow-up less than one month were excluded. Survival was modelled from the initial Holter or device implantation. NSVT was defined as ≥3 consecutive ventricular beats at a rate &amp;gt;120 beats per minute, lasting for &amp;lt;30 s. MAE was defined as sustained ventricular tachycardia (VT), ventricular fibrillation (VF), sudden cardiac death, implantable cardioverter defibrillator (ICD) treated ventricular arrhythmias (appropriate shock and ATP). The clinical endpoint was MAE (sustained VT, VF, sudden cardiac death, ICD shocks and ATP) and multivariable analysis was performed using Cox proportional hazards models. Event-free survival probabilities were estimated using the Kaplan-Meier method, and comparisons of Kaplan-Meier curves were made using log-rank tests. Results The cohort comprised 58 men and 30 women [mean age 49 ± 15 years; mean follow-up 3.5 ± 1.8 years]. Symptoms were NYHA class I in 56 patients, class II in 25 patients, class III in 7 patients and class IV in none. Holter ECGs were performed in 77 patients, 41 of whom had NSVT. Twenty five patients had pacemaker/ICD in situ; 14 had NSVT. Six patients had MAE; 4 with NSVT. Univariate analysis association between MAE and LVEF ≤35% (hazard ratio (HR), 9.03; 95% confidence interval (CI), 1.49-54.71; P=0.017), prolonged (&amp;gt;8 beats) NSVT (HR, 6.71; 95% CI, 1.22-36.98; P=0.029) and fast (&amp;gt;200 bpm) NSVT (HR, 5.09; 95% CI, 1.02-25.47; P=0.048). Kaplan-Meier showed similar differences in freedom from MAE (LVEF ≤35%; P=0.004, long NSVT; P=0.025, fast NSVT; P=0.031). Conclusion Fast and prolonged NSVT is associated with a higher risk of MAE in patients with TTNtv.Characteristics at the beginningSurvival probability for freedom