Worse Health Status Research Articles

Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.

Validation analysis of Polish version of Neuropathic Pain Questionnaire - Short Form (NPQ-SF-PL) and assessment of quality of life in patients with chronic neuropathic pain.

The aims of this study were to translate and culturally adapt the Polish version (PL) of the Neuropathic Pain Questionnaire-Short Form (NPQ-SF), as well as to compare this questionnaire to other diagnostic tools in terms of reliability and psychometric validity. Neuropathic pain (NP) affects up to 10% of the general population. Despite a large number of studies, almost 50% of patients have a poor therapeutic outcome. Diagnostic tools are intended to distinguish between NP and non-NP (NoP) and to guide the examiner to perform further diagnostics in accordance with the guidelines. A total of 140 patients with chronic pain (ChP), 90 with NP and 50 with NoP, were enrolled into this study. NPQ-SF-PL has been developed following the guidelines for translation and cultural adaptation. Reliability of the translated version was examined using internal consistency, predictive validity, and intraclass correlation coefficient (ICC). In the study, women predominated over men, and the average age was 53.22. Cronbach's α value for the entire scale was 0.76 and ICC for test-retest reliability was 0.631. Receiver-operating characteristic curve analysis gave a sensitivity of 90.0% and a specificity of 88.0%. Area under the curve was 0.94. NPQ-SF-PL was moderately associated with self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and weakly associated with the Numerical Rating Scale (NRS). The NP group obtained statistically significantly lower scores than the NoP group in all domains of the 36-Item Short Form Health Survey (SF-36), thus indicating worse health status. Patients aged over 41 years presented a worse quality of life compared to younger ones. Also, more than half of the patients with NP of both genders experienced symptoms of mild or more severe depression. NPQ-SF-PL is a valid screening tool for assessing NP in Polish chronic pain patients. The obtained results showed very good psychometric properties and adequate internal consistency. The repeatability of the questionnaire indicated moderate reliability. Clinical implications/future directions. We believe this study will provide physicians with a new instrument for the evaluation of NP for clinical and research purposes.

Sex-related differences in health-related quality-of-life measured using the EuroQol 5-Dimension questionnaire across the LVEF spectrum in DAPA-HF and DELIVER

Abstract Background Although sex-related differences in response to disease-specific health-related quality-of-life (HRQL) instruments such as the KCCQ have been investigated in patients with heart failure (HF), this is not the case for generic HRQL instruments. Purpose To assess the sex-specific differences in health status measured using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) in patients with HF with reduced and mildly reduced or preserved ejection fraction (HFrEF and HFmrEF/HFpEF), and to assess the effect of dapagliflozin on EQ-5D-5L index scores. Methods Using patient-level data from the DAPA-HF and DELIVER trials comparing dapagliflozin to placebo, we analysed patient-reported outcomes for each dimension of the EQ-5D index scores between men and women. The 5 dimensions of the descriptive section of the EQ-5D-5L include mobility ("walking around"), self-care ("washing or dressing self"), usual activities ("e.g., work, study, housework, family or leisure activities"), pain/discomfort ("pain or discomfort"), and anxiety/depression ("anxious or depressed"). Each dimension is divided into 5 levels (1-5) i.e., no problem, slight problem, moderate problem, severe problem, and extreme problem (cannot do activity/extreme symptom). Results Of 4744 patients with HFrEF, 4390 completed the EQ-5D-5L index scores (3408 men and 982 women, 77.6% vs. 22.4%). The correresponding numbes in 6263 patients with HFmrEF/HFpEF were 5745 overall and 3320 men vs. 2425 women (57.8% vs. 42.2%). Regardless of HF phenotype, women had significantly worse (lower) baseline index scores overall compared to men (0.849 vs. 0.899 in HFrEF and 0.844 vs. 0.884 in HFmrEF/HFpEF, both p<0.001). Although scores varied markedly by question, women generally had worse health status in all the dimensions as compared with men in patients with HFrEF (39% vs. 29% reporting a moderate or greater problem for mobility, 17% vs. 9% for self-care, 36% vs. 25% for usual activities, 29% vs. 19% for pain/discomfort, and 21% vs. 13% for anxiety/depression, all p<0.001) (Figure, top panel). A broadly similar pattern was observed in HFmrEF/HFpEF (Figure, bottom panel). In all patients, across the range of LVEF, there dapagliflozin led to a significant placebo corrected increase (improvement) in index score (0.008, 95% CI 0.002 to 0.014), with no interaction between sex and the effect of dapagliflozin (p for interaction with sex = 0.50). Conclusions Women reported significantly poorer health status in both HFrEF and HFmrEF/HFpEF compared to men. Dapagliflozin treatment improved EQ-5D index scores irrespective of sex across the range of ejection fraction. Figure Sex differences in the distribution of responses to EQ-5D-5L questionnaire. EQ-5D-5L, EuroQol 5-Dimension 5-Level questionnaire; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

Relationship between NT-proBNP, echocardiographic abnormalities and functional status in patients with subclinical diabetic cardiomyopathy

Abstract Background Persons with diabetes are at risk for developing a cardiomyopathy through several pathophysiological mechanisms independent of traditional risk factors for heart failure. Among those with so-called diabetic cardiomyopathy (DbCM), the relationship between natriuretic peptides, cardiac structural abnormalities and functional capacity is largely unknown. Purpose This study aimed to evaluate associations between NT-proBNP concentrations, clinical characteristics, echocardiographic findings, health status and activity, and outcomes from cardiopulmonary exercise testing Methods The Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure Trial (ARISE-HF) trial is evaluating the effects of AT-001, a novel aldose-reductase inhibitor in participants with DbCM without a prior history of heart failure (1). Participants were included if they had a known diagnosis of type 2 diabetes and age ≥60 (or ≥45 with a duration of diabetes of ≥10 years or estimated glomerular filtration rate ≤60 mL/min/1.73m2). Participants were required to have evidence of one of: structural cardiac abnormality, elevated cardiac biomarkers, or impaired exercise tolerance, defined as a peak oxygen uptake (VO2) ≤75% of predicted. In this prespecified subgroup analysis of the ARISE-HF trial, 685 participants with baseline echocardiography data, laboratory investigations, and functional assessment were included. Participants were stratified by N-terminal pro-B type natriuretic peptide (NT-proBNP) quartiles, and correlation with echocardiographic and functional parameters were assessed using Spearman correlation test. Results The mean age of participants was 67.4 years and 50% were female. The mean duration of type 2 diabetes was 14.5 years with a mean hemoglobin A1c of 6.98. The median NT-proBNP was 71 (Q1, Q3: 33, 135) ng/L. No association was observed between NT-proBNP concentrations and echocardiographic parameters of either diastolic or systolic dysfunction including global longitudinal strain, left ventricular ejection fraction, left ventricular mass index, left atrial volume index, E/e’, or right ventricular systolic pressure (Figure 1). In contrast, NT-proBNP was significantly correlated with components of the Kansas City Cardiomyopathy Questionnaire (P<0.001), the Physical Activity Scale in the Elderly (P=0.004), duration of cardiopulmonary exercise testing (P<0.001), peak VO 2 (P<0.001), and ratio of minute ventilation/carbon dioxide production (P=0.002; Figure 2). Conclusion Among highly selected patients with subclinical DbCM, elevated NT-proBNP concentrations are associated with worse health status, lower activity levels, and reduced functional capacity, but not with cardiac structural abnormalities. These findings suggest that regardless of cardiac structural abnormalities, biomarker concentrations reflect important deterioration in functional capacity in affected individuals.

Obesity and renal impairment in patients with heart failure and reduced ejection fraction: another obesity paradox?

Abstract Background Obesity is associated with poor cardiovascular outcomes in patients with HF and reduced ejection fraction (HFrEF). However, whether obesity is associated with worse kidney outcomes in HFrEF has not been evaluated. Purpose To estimate the association between obesity and change in estimated glomerular filtration rate (eGFR) over time in patients with HFrEF. Methods In this post hoc analysis of the PARADIGM-HF trial, body mass index (BMI) and eGFR was collected in 8,389 patients. Change in eGFR over time was assessed according to baseline BMI (normal weight: BMI <25.0, overweight: BMI 25-29.9, and obesity: BMI ≥30). Results The number of patients in each BMI category was: 2,421 (BMI <25.0), 3,249 (BMI 25-29.9), and 2,719 (BMI ≥30), respectively. Patients with obesity were younger but had worse health status (worse NYHA class and KCCQ scores) and had more comorbidities including diabetes mellitus and hypertension. At baseline, eGFR was lower in patients who were overweight (BMI 25-29.9) and obese (BMI ≥30), compared to those with normal weight. Urine albumin-creatinine ratio (UACR) and kidney injury molecule-1 (KIM-1) were also higher in patients with obesity. However, the rate of change in eGFR per year (eGFR "slope") in the overall cohort did not differ according to BMI: change in eGFR per year was -1.8 [-2.1, -1.6] mL/min/1.73m2 for the normal weight category, -1.6 [-1.8, -1.3] mL/min/1.73m2 for those who were overweight, and -1.5 [-1.8, -1.3] mL/min/1.73m2 for those with obesity; P=0.21) (Figure 1). Among those without diabetes at baseline, those who were obese had a significantly less steep eGFR slope compared to patients in the other BMI categories. In those with diabetes at baseline, the eGFR slope was steeper than in patients without diabetes but was similar across all three BMI categories (Figure 2). Conclusions Although baseline kidney function was more impaired in HFrEF patients with obesity, high BMI was not associated with a more rapid subsequent rate of decline in eGFR. Figure 1. eGFR slope over time according to BMI at baseline in patients with HFrEF in PARADIGM-HF Figure 2. eGFR slope over time according to BMI at baseline in patients with HFrEF in PARADIGM-HF with and without diabetes at baselineFigure 1Figure 2-A and 2-B

Long COVID in the UAE: symptomatology, gender gaps, and health implications among COVID-19 survivors

Abstract Background A growing number of COVID-19 survivors are experiencing symptoms post-SARS-CoV-2 infection, known as long COVID. It is a new multisystem condition and understanding its associated factors and its impact on individuals is crucial. This study aims to characterize long COVID in previously hospitalized patients in the UAE, identifying associated factors and assessing its impact on patients’ daily lives. Methods A multicenter retrospective cohort study was conducted in hospitals in Dubai and Sharjah from January 29, 2020 to October 14, 2021, involving RT-PCR confirmed cases. Clinical, epidemiologic, and long COVID data were collected via hospital records and phone interviews. Results Long COVID affected 48.7% of 533 patients, with 46.6% prevalence persisting over a year. A total of 43 symptoms across 11 organ systems were reported. Females had 1.83 times higher odds of long COVID (95% CI [1.22, 2.74], p = 0.003). Each additional initial symptom (AOR = 1.22, 95% CI [1.05, 1.40], p = 0.008), ICU admission (AOR = 1.77, 95% CI [1.06, 2.98], p = 0.030), and ≥ 2 comorbidities (AOR = 2.19, 95% CI [1.09, 4.40], p = 0.027) increased the odds of long COVID. Long COVID significantly impacted daily life, with poorer health ratings (AOR = 5.576, 95% CI [3.029, 10.265], p < .001), worse health status (AOR = 7.842, 95% CI [4.954, 12.415], p < .001), and work limitations due to physical (AOR = 4.808, 95% CI [3.229, 7.158], p < .001) and emotional issues (AOR = 3.149, 95% CI [2.01, 4.933], p < .001). This impact persisted beyond 12 months post-infection. Conclusions Long COVID presents prolonged multisystem involvement and substantial disability among survivors, necessitating further research to understand its lasting effects and intervention development to mitigate its impact Key messages • Long COVID poses a substantial challenge to public health in the UAE, affecting almost half of hospitalized survivors and extending its impact beyond 12 months post-infection. • Risk factors like gender initial symptoms, ICU stay, and comorbidities increase the risk of long COVID, warranting the need for tailored interventions and support strategies for vulnerable populations.

11.K. Scientific session: Roots of public health: school health literacy to enhance population health outcomes in Europe

Abstract This workshop will present empirical results from three representative studies on health literacy and digital health literacy conducted in primary and secondary schools in Wales and Germany: (1) Digital Health Literacy in Schools, (2), HLCA HL-Kids, (3) WHO HBSC Wales. While research on child and adolescent health literacy has gained traction in the past decade, only a few studies focus on health literacy in schools. While the European Commission and WHO, as well as most European governments, highlight the importance of schools to support children’s health literacy, schools remain neglected as a research context. With only little evidence available, it is difficult to derive strategies and programs to promote health literacy in schools. We aim to provide practical novel knowledge and contribute to closing the school health literacy gap that is prevalent in Europe. In turn, this will also contribute to European public health development and population health outcomes. Levels of health literacy in child and adolescent populations across European countries and age groups are alarmingly low, making low health literacy a severe risk factor for health outcomes. Low health literacy is associated with worse health conditions and unhealthy behaviours, and in turn, impacts school attainment and educational outcomes. Evidence suggests that health literacy acts as a determinant of health and itself is influenced by other social determinants of health, such as education, intertwining health and education. All studies conducted so far provide evidence that low health literacy follows a social gradient, with children from less affluent families being more likely to have lower health literacy, widening preexisting health inequities observed in almost all health domains within Europe. While effective interventions on the individual and system levels are needed to enhance health literacy, implementation and evaluation research concerning children’s health literacy is rare. Workshop objectives The aim of this workshop is to present findings from three representative studies on health literacy and digital health literacy in primary and secondary schools: (i) The 1st speaker will introduce a study on health literacy and health behaviours of children aged 8-11 (ii) The 2nd speaker will discuss the influence of living environments on health literacy in 4th-grader school kids (iii) The 3rd presentation will have its focus on navigating the infodemic through digital health literacy in adolescent students (iv) The 4th speaker will show links between digital health literacy and health behaviour in adolescent students The format of this workshop will be 4x10-minute presentations followed by a 20-minute panel discussion with the audience, reflecting the relevance of the results to public health research, practice, and policy. The chairs will provide a brief introduction to the concept and moderate the presentations and panel discussion. Key messages • Our results show that health literacy should be addressed as early as in primary schools and that the places, households, and environments children grow up are critical social determinants of health. • Digital health literacy has proven to be a valid learning topic in secondary schools and is linked to digital and media literacy, allowing us to define it as a targeted curriculum item.

Measurability of overall health in patients with chronic gastrointestinal disorders

Abstract Background Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) patients experience problems in all life areas. The Positive health (PH) concept, based on six different dimensions of health, may hold the answers for a broader understanding of the patients’ well-being. Aim To measure the overall health status of GI-HPB patients, according to the PH concept. Methods In 2019-2021, patients with GI-HPB attending the outpatient clinic of the Maastricht University Medical Center filled in questionnaires before consultation. The six dimensions of PH (bodily functions, mental well-being, meaningfulness, quality of life, participation, daily functioning) were measured by validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L). Results were compared to control groups and assessed with McDonald’s Omega, Zero-order Pearson correlations, and t-tests. Results The 235 participating patients scored lower on quality of life, participation, and daily functioning than healthy controls (p ≤ 0.001) but similar to those with other chronic conditions. Malnutrition (moderate-severe 45.6%) and depressive/anxious symptoms (35%/21.6%) were higher in the GI-HPB group compared to those with other chronic conditions. Conclusions Validated questionnaires addressing the six dimensions of PH showed a significant worse health status compared to controls, and malnutrition and depressive symptoms were higher compared to other patient groups. Key messages • GI-HPB patients have a lower quality of life, participate less, and have less daily functioning than healthy controls and higher malnutrition and depression than those with other chronic diseases. • By using validated questionnaires, an impression of the overall health status of patients can be obtained through the concept of Positive Health.

Impact of Multiple Sclerosis on different life dimensions among working women in Sweden

Abstract Introduction Multiple sclerosis (MS), like many other chronic diseases, may impact the whole life situation. MS is more common among women than men, in addition, women tend to report worse health status. We aimed to explore the self-reported impact of MS on different dimensions of life such as work, family, leisure activities and, contact with friends and acquaintances. Methods All individuals 20-50 years of age listed in the Swedish MS Registry were invited to answer a survey in 2021. Responses from 2659 working women regarding impact of MS in different dimensions (1, not at all; 2-3, occasionally; 4-5, frequently; 6-7 to a high extend) were explored with descriptive statistics. Results Reported impact of MS varied across the different life dimensions. Working women reported that MS had a greater impact on their leisure activities (20.7% - responding to ‘to a high extent’), followed by contact with friends and acquaintances (15.8%), work (15.5%) and family (11.7%). This despite the fact that 77.1% had mild levels of disability. Further, the MS diagnosis was reported to have contributed to reduced working time (31.4%), refrained from changing job (28.8%), changed jobs (20.5%) or changed career track (20.4%). When questioned about positive life-changing experiences due to MS diagnosis, a majority of the women stated that it had contributed to learning how to adapt to things one cannot change (59.2%) and being grateful for everyday (51.7%). Conclusions An MS diagnosis can significantly impact various aspects of life. While work is notably affected, leisure activities also undergo substantial changes after MS diagnosis. However, acceptance, adaptability and finding meaning, among other, can be important parts of the journey. Key messages • At early stages of MS, the disease tend to affect leisure activities more than other dimensions of life. • Finding coping mechanisms to handle MS may contribute to compensate the impact of MS.

Health-Related Quality of Life (HRQoL) in COVID-19 Patients After Recovering from the Acute Infection

Background: Nearly four years after the COVID-19 outbreak, its burden persists, with long-term physical and mental impacts still being discovered. Objectives: Given that these effects may vary across different periods post-infection and in diverse cultural, medical, and economic settings, we aimed to evaluate the health-related quality of life (HRQoL) in Iranian patients six months after acute infection. Methods: A total of 194 infected patients were enrolled and re-evaluated six months after the onset of acute infection. Health-related quality of life was assessed using the validated EQ-5D-3L questionnaire. Results: The mean age of patients was 50.1 ± 15.8 years, with a female-to-male ratio of 1.04. Diabetes mellitus and hypertension were the most common comorbidities. Significant impairment was observed in all categories of HRQoL after recovery from acute COVID-19 infection (P-value < 0.05). Female gender, older age, and intensive care unit admissions were independent factors associated with worsened health status post-recovery. The overall reduction in post-COVID-19 infection quality of life (QoL) score was 25%. Conclusions: The mental and physical burden of COVID-19 in our study population was considerable. Comorbid conditions and a lack of supportive measures post-infection, especially in a low-income country, may contribute to the long-term effects of COVID-19.

Health status of individuals with polyhandicap across a 5-year follow-up period

The present longitudinal study examined a large sample of individuals with PIMD/Polyhandicap to: (i) describe the evolution over time of the health status in terms of severity, (ii) identify the potential predictors of health status change. This study used the data of the French national EVAL-PLH cohort. Inclusion criteria were: individuals with PIMD/Polyhandicap; age > 3 years at the time of inclusion; age at onset of cerebral lesion younger than 3 years old. The definition of the change in health status over the 5-year period was derived from the Polyhandicap Severity Scale. Among the 875 individuals included in 2015–2016, 492 (56.2%) individuals were assessed in 2020–2021. According to the definition, 68.8% (n = 309), 64.7% (n = 310), and 80.2% (n = 368) of the individuals presented with a worsened or stable severity status based on the global score, the abilities score, and the comorbidities score, respectively. Compared with the individuals with a non-worsened health status (global score), the individuals with a stable or worsened health status were more likely to receive care in specialized rehabilitation centres, more likely to have an antenatal or progressive aetiology, and more likely to have a higher dependency level. The current study provides a robust perspective of the worsened health among persons with PIMD/Polyhandicap over time.

Self-Monitoring Practices and Use of Self-Monitoring Technologies by People with Rheumatic and Musculoskeletal Diseases: An International Survey Study

Background/Objectives: Digital health applications (DHAs) promise to improve disease self-management, but adherence remains suboptimal. We aimed to explore self-monitoring practices of rheumatic and musculoskeletal diseases (RMD) patients. A web-survey was conducted over 7 months including RMD patients to study their self-monitoring practices and the potential of DHAs. Methods: Health, sociodemographic, and technology adherence indicators were retrieved for comparison. Regression analyses and unsupervised profiling were performed to investigate multiple patient profiles. Results: From 228 responses gathered, most reported willingness to use DHAs to monitor their condition (78% agreement), although the majority rarely/never tracked symptoms (64%), often due to stable condition or no perceived value (62%). Of those tracking regularly, 52% used non-digital means. Participants with regular self-monitoring practices were more open to use a self-monitoring app (OR = 0.8 [0.6, 0.9]; p = 0.008) and be embedded in multidisciplinary care (OR = 1.4 [1.1, 1.6]; p < 0.001), but showed worse health status (g = 0.4; p = 0.006). Cluster analyses revealed three distinct groups of reasons for not tracking regularly (χ2 = 174.4; p < 0.001), two characterised by perceived low disease activity. Conclusions: Effective use of DHAs remains limited and non-digital means prevail in symptom monitoring. Findings suggest that better patient engagement strategies and passive monitoring should be adopted in early development stages of DHAs for better long-term disease self-care.

The increased tendency for anemia in traditional Chinese medicine deficient body constitution is associated with the gut microbiome.

Constitution is a valuable part of traditional Chinese medicine theory; it is defined as the internal foundation for the occurrence, development, transformation and outcome of diseases, and has its characteristic gut microbiota. Previous study showed that deficiency constitution was related to lower Hb counts. However, no research has examined how alterations in the gut microbiome induced by deficiency constitution may increase the tendency for anemia. We used a multiomics strategy to identify and quantify taxonomies and compounds found under deficient constitution individuals and further explore the possible pathological factors that affect red blood cell indices. ① People with deficient constitution showed lower hemoglobin (Hb), more Firmicutes, less Bacteroidetes, and higher α diversity. ② We identified Escherichia coli, Clostridium bolteae, Ruminococcus gnavus, Streptococcus parasanguinis and Flavonifractor plautii as potential biomarkers of deficient constitution. ③ Slackia piriformis, Clostridium_sp_L2_50 and Bacteroides plebeius were enriched in balanced-constitution individuals, and Parabacteroides goldsteinii was the key bacterial marker of balanced constitution. ④ Flavonifractor plautii may be a protective factor against the tendency for anemia among deficient individuals. ⑤ Ruminococcus gnavus may be the shared microbe base of deficiency constitution-related the tendency for anemia. ⑥ The microorganism abundance of the anaerobic phenotype was lower in deficient constitution group. ⑦ Alterations in the microbiome of deficient-constitution individuals were associated with worse health status and a greater risk of anemia, involving intestinal barrier function, metabolism and immune responses, regulated by short-chain fatty acids and bile acid production. The composition of the gut microbiome was altered in people with deficient constitution, which may explain their poor health status and tendency toward anemia.

Tendência da taxa de mortalidade por sepse em Minas Gerais entre 2010 e 2023: um estudo ecológico

Sepsis is a critical condition with high mortality, responsible for approximately 11 million deaths annually worldwide and 20% of deaths in Brazil. Between 2010 and 2019, Brazil recorded over 1 million cases and around 463,000 deaths due to sepsis, with the highest mortality in the Southeast region. This ecological study analyzed the age-standardized mortality rate for sepsis in Minas Gerais from 2010 to 2023, using data from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE). Prais-Winsten linear regression was applied to identify trends, and the correlation between the age-standardized mortality rate for sepsis (TPMS) and the Social Development Index (SDI) was investigated. Results showed a significant increase in sepsis mortality, with the rate rising from 9.16 in 2010 to 17.98 in 2023, reflecting an Annual Percentage Variation (APV) of 12.86%. The analysis revealed a growing trend with an R² of 0.9600. The positive correlation between TPMS and SDI indicates that regions with higher social development may have higher mortality rates due to better diagnostic capabilities, rather than worse health conditions. The study highlights the urgent need for targeted interventions, such as awareness programs and improvements in sepsis management. Public health strategies focused on prevention, early diagnosis, and effective treatment are essential to mitigate the impact of sepsis and improve clinical outcomes in the region.

Chinese utility weights for the EORTC cancer-specific utility instrument QLU-C10D.

The aim of this study is to provide Chinese utility weights for the European Organization for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions (EORTC QLU-C10D) which is a preference-based cancer-specific utility instrument derived from the EORTC QLQ-C30. We conducted an online survey of the general population in China, with quota sampling for age and gender. Each respondent was asked to complete a discrete choice experimental survey consisting of 16 randomly selected choice sets. The conditional logit model and mixed logit model were used to analyze respondents' preferences, and the goodness of fit of the model was tested. A total of 2003 respondents were included in the analysis. Utility decrements within dimensions were typically monotonic. Monotonic inconsistency issues in the Fatigue, Sleep, and Nausea dimensions were normalized by monotonicity correction. Physical functioning, Pain, and Role functioning were associated with the greatest utility weights, with the smallest decrements being in Bowel problems and Emotional functioning. The utility value for the worst health state was 0.083, i.e. slightly higher than being dead. This study provides the first China-specific set of value for the QLU-C10D based on societal preferences of the Chinese adult general population. The value set can be used as a cancer-specific scoring system for economic evaluations of new oncology therapies and technologies in China.

Understanding educational attainment disparities in Northern Ireland: the impact of pupils’ demographic characteristics and health status on post-primary outcomes.

Across the UK, attainment disparities remain at the forefront of education and policy debates. This is particularly evident in Northern Ireland (NI), which although is a jurisdiction of the UK, reflects a different context due to its transition to a post-conflict society and its dually selective education system (academically and religiously). In NI, post-primary attainment disparities have been reported according to pupil characteristics such as gender and socio-economic background. However, due to the lack of available data, there is limited evidence examining the influence of the health status of pupils on their educational outcomes. This study examines the influence of a pupil’s socio-demographic profile, health status, and school-level factors on post-primary attainment, using a linked administrative dataset that combined the household Census (2011), School Census (2010-2014) and School Leavers Survey (2010-2014) for the first time. Multilevel modelling and interactions terms were conducted to consider the relative effects of physical health and mental health on attainment. In addition, the study presents a holistic approach to understanding the association between health status and education outcomes by considering self-reported health status, the presence of an illness that limits daily activities, and the presence of a physical and mental health condition. The findings highlight that poor physical and mental health have negative associations with post-primary attainment in NI. More specifically, pupils reporting bad health, a physical or mental health condition and a limiting illness that affects their daily activities have lower educational attainment outcomes than those with no markers of ill-health (physically or mentally).

Comparative analysis of household deprivation among Jewish and other religious groups in England and Wales

Abstract The health and well-being of some residents in the United Kingdom are quite challenged, as access to some required treatments and support is limited due to some level of deprivation. This study compared the Jewish and other religious groups in England and Wales, to determine households’ deprivation in the health and disability, housing, education, and employment dimensions. This study further investigated the number of households with disabled residents, people living with non-limiting long-term physical or mental health conditions, and unpaid carers. The analysis was based on secondary data (UK 2021 Census data) from the Office for National Statistics. The findings of the study revealed that more households are deprived in the health and disability dimension. This suggests that apart from households that have at least a disabled resident, a few households have residents who are not disabled but their day-to-day activities are limited due to ill-health (bad or very bad health conditions). A high level of deprivation was also observed in the education dimension. Based on the high level of deprivation in the education dimension and the high proportion of households deprived in the health and disability dimension, the UK government needs to look into the health and well-being of these households. In addition, while focusing on larger local authorities (LAs) like Barnet (with a large number of households across LAs), targeted government interventions are needed to improve health and well-being of Jewish households in LAs such as Swansea, Southend-on-Sea, Hackney, Oxford, and Gateshead that have a higher proportion (within the LA) of deprivation in any of the tested dimensions or affected in terms of disability, non-limiting long-term health conditions, or the proportion of unpaid carers.

Assessing the prevalence and impact of preserved ratio impaired spirometry in low-income and middle-income countries: a post-hoc cross-sectional analysis

More than 90% of the morbidity and mortality from chronic respiratory disease occurs in low-income and middle-income countries (LMICs), with substantial economic impact. Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with increased mortality in high-income countries. We aimed to conduct a post-hoc analysis of a cross-sectional study to assess the prevalence of, the risk factors for, and the impact of PRISm in three diverse LMIC settings. We recruited a random, age-stratified and sex-stratified sample of the population in semi-urban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda. Quality-assured post-bronchodilator spirometry was performed to American Thoracic Society standards and PRISm was defined as a forced expiratory volume in one second (FEV1) of less than 80% predicted with a FEV1/forced vital capacity ratio of 0·70 or more. We used t tests and χ2 analyses to assess the relationships between demographic, biometric, and comorbidity variables with PRISm. Multivariable logistic models with random intercept by site were used to estimate odds ratios (ORs) with 95% CIs. 10 664 participants were included in the analysis, with a mean (SD) age of 56·3 (11·7) years and an equal distribution by sex. The prevalence of PRISm was 2·5% in Peru, 9·1% in Nepal, and 16·0% in Uganda. In multivariable analysis, younger age (OR for each decile of age 0·87, 95% CI 0·82-0·92) and being female (1·37, 1·18-1·58) were associated with increased odds of having PRISm. Biomass exposure was not consistently associated with PRISm across sites. Individuals with PRISm had impairment in respiratory-related quality of life as measured by the St George's Respiratory Questionnaire (OR by decile 1·18, 95% CI 1·10-1·25). The prevalence of PRISm is heterogeneous across LMIC settings and associated with age, female sex, and biomass exposure, a common exposure in LMICs. A diagnosis of PRISm was associated with worse health status when compared with those with normal lung function. Health systems in LMICs should focus on all spirometric abnormalities as opposed to obstruction alone, given the disease burden, reduced quality of life, and size of the undiagnosed population at risk. Medical Research Council.

Inflammation in Obesity-Related HFpEF: The STEP-HFpEF Program

BackgroundInflammation is thought to be an important mechanism for the development and progression of obesity-related heart failure with preserved ejection fraction (HFpEF). In the STEP-HFpEF Program, once-weekly 2.4 mg semaglutide improved heart failure–related symptoms, physical limitations, and exercise function, reduced the levels of C-reactive protein (CRP), a biomarker of inflammation, and reduced body weight in participants with obesity-related HFpEF. However, neither the prevalence nor the clinical characteristics of patients who have various magnitudes of inflammation in the context of obesity-related HFpEF have been well described. Furthermore, whether the beneficial effects of semaglutide on the various HF efficacy endpoints in the STEP-HFpEF Program are modified by the baseline levels of inflammation has not been fully established. Finally, the relationship between weight reduction and changes in CRP across the STEP-HFpEF Program have not been fully defined. ObjectivesThis study sought to: 1) evaluate baseline characteristics and clinical features of patients with obesity-related HFpEF that have various levels of inflammation in the STEP-HFpEF Program; 2) determine if the effects of weekly semaglutide 2.4 mg vs placebo across all key outcomes are influenced by baseline levels of inflammation assessed by CRP levels; and 3) determine the relationship between change in CRP and weight loss in the STEP-HFpEF Program. MethodsThis was a secondary analysis of pooled data from 2 international, double-blind, placebo-controlled, randomized trials (STEP-HFpEF and STEP-HFpEF DM). The outcomes were change in the dual primary endpoints (health status [measured by the Kansas City Cardiomyopathy Questionnaire—Clinical Summary Score (KCCQ-CSS)] and body weight) from baseline to 52 weeks according to baseline CRP levels. Additional efficacy endpoints included change in 6-minute walk distance (6MWD), a hierarchical composite endpoint that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6MWD, and levels of CRP in semaglutide- vs placebo-treated patients. Patients were stratified into 3 categories based on baseline CRP levels (<2, ≥2 to <10, and ≥10 mg/L). ResultsIn total, 1,145 patients were randomized, of which 71% of patients had evidence of inflammation (CRP ≥2 mg/L). At baseline, those with higher levels of inflammation were younger, were more likely to be female, and had higher body mass index, worse health status (KCCQ-CSS), and shorter 6MWD. Semaglutide vs placebo led to reductions in HF-related symptoms and physical limitations as well as body weight, and to improvements in 6MWD and the hierarchical composite endpoint that were consistent across baseline CRP categories (all P interaction nonsignificant). Semaglutide also reduced CRP to a greater extent than placebo regardless of baseline CRP levels (P interaction = 0.32). Change in CRP from baseline to 52 weeks was similar regardless of the magnitude of weight loss (P interaction = 0.91). ConclusionsInflammation is highly prevalent in obesity-related HFpEF. Semaglutide consistently improved HF-related symptoms, physical limitations, and exercise function, and reduced body weight across the categories of baseline CRP. Semaglutide also reduced inflammation, regardless of either baseline CRP or magnitude of weight loss during the trials. (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity [STEP-HFpEF; NCT04788511]; Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes [STEP HFpEF DM; NCT04916470])

Scalp Arteriovenous Malformation. Percutaneous Multistage Ligature under Ultrasound Guidance: Palliative Technique to be Considered. Case report.

Background: Scalp arteriovenous malformations (AVMs) are fast-flow malformations characterized by the presence of arteriovenous shunting without an intervening capillary bed within the subcutaneous layer. Aim: To report a case of AVMs managed by percutaneous multistage ligature under ultrasound guidance. Case report: A 68-year-old patient with a AVMs was managed by percutaneous multistage ligature under ultrasound guidance with acceptable cosmetic and functional results. Conclusion: Some patients with bad health conditions and a high risk of anesthesia with comorbidities can benefit from multistage transcutaneous ligation of the principal arterial pedicular under ultrasound guidance. This simple and palliative technique must be considered in some cases.