Younger Group Research Articles

Association of age at diagnosis of type 2 diabetes mellitus with the risks of the morbidity of cardiovascular disease, cancer and all-cause mortality: Evidence from a real-world study with a large population-based cohort study.

To investigate the impact of diagnosis age of type 2 diabetes mellitus (T2DM) on subsequent adverse outcomes within the Chinese population. 549,959 eligible T2DM patients were included from Ningbo and Jinhua city in Zhejiang province, China. Standardized ratio was used to evaluate the risks of coronary heart disease (CHD), stroke, cancer and all-cause death in different T2DM diagnosis age groups. For all adverse outcomes, higher excess risks were observed in the youngest age group (30-39) than in the oldest age group (≥80) with T2DM. The standardized incidence ratios (SIR) were 5.93 (95 % CI: 3.46, 10.14) for CHD, 5.45 (95 % CI: 3.72, 7.99) for stroke and 1.85 (95 % CI: 1.38, 2.49) for cancer in the youngest age group, and were 1.32 (95 % CI: 1.08, 1.60) for CHD, 1.25 (95 % CI: 1.08, 1.44) for stroke, and 0.78 (95 % CI: 0.56, 1.09) for cancer, respectively, in the oldest age group. The standardized mortality ratios (SMR) for all-cause death were 3.15 (1.69, 5.84) vs. 1.12 (0.88,1.43). These excess risks decreased with increasing diagnosis age (all P value < 0.001). Consistent results were observed when individuals were stratified by sex or further excluded with the time from T2DM diagnosis to endpoints less than 1 or 2 years. The earlier the diagnosis of T2DM, the higher the risk for subsequent adverse outcomes. It is imperative to enhance the management and monitoring of early-onset patients during follow-up.

Local environment perceived in daily life and urban green and blue space visits: Uncovering key factors for different age groups to access ecosystem services

Inequality in access to green and blue spaces is a major issue in the field of environmental justice. Various factors significantly influence visitations to these spaces, including residential, commuting, and shopping areas. However, studies have mainly focused on residential environments. Analyzing the coupling of environmental and socioeconomic factors, including age, income, and childhood experience, and examining the direct and indirect effects of these factors for different age groups are needed to better understand the detailed context of inequalities in access to ecosystem services. We conducted a questionnaire survey and analysis to address these needs in an urban setting. The results demonstrate that several land use categories (i.e., agricultural lands in residential areas, grasslands near shopping areas, and deciduous forests near commuting destinations) positively correlated with visitation frequency, suggesting the lack thereof may be the cause of access inequalities. In particular, the perimeter per unit area of some land cover types, which shows the complexity of the form of each land cover category, was found to be a significant factor. We identified inequality in nature experience to be the key factor correlated with inequality in nature visits among the young age group. For the middle-aged and old age groups, nature-relatedness was positively correlated with visitation frequency. Proper design of the local environment, such as through land use planning, can be an effective measure for all age groups. For instance, long-bordered green areas in the Monsoon Asian region are an attractive traditional landscape, with high accessibility and a comfortable thermal environment. The key factors for each age group should be considered in spatial design and inclusive information-sharing to reduce inequality in access to ecosystem services.

Gradually increasing context-sensitivity shapes the development of children's verb marking: A corpus study.

There is substantial evidence that children's apparent omission of grammatical morphemes in utterances such as "She play tennis" and "Mummy eating" is in fact errors of commission in which contextually licensed unmarked forms encountered in the input are reproduced in a context-blind fashion. So how do children stop making such errors? In this study, we test the assumption that children's ability to recover from error is related to their developing sensitivity to longer-range dependencies. We use a pre-registered corpus analysis to explore the predictive value of different cues with regards to children's verb-marking errors and observe a developmental pattern consistent with this account. We look at context-independent cues (the identity of the specific verb being used) and at the relative value of context-dependent cues (the identity of the specific subject+verb sequence being used). We find that the only consistent effect across a group of 2- to 3-year-olds and a group of 3- to 4-year-olds is the relative frequency of unmarked forms of specific subject+verb sequences being used. The relative frequency of unmarked forms of the verb alone is predictive only in the younger age group. This is consistent with an account in which children recover from making errors by becoming progressively more sensitive to context, at first the immediately preceding lexical contexts (e.g., the subject that precedes the verb) and eventually more distant grammatical markers (e.g., the fronted auxiliary that precedes the subject in questions). RESEARCH HIGHLIGHTS: We provide a corpus analysis investigating input effects on young children's verb-marking errors (e.g., Mummy go) across development (between 2 and 4 years of age). We find evidence that these apparent errors of omission are in fact input-driven errors of commission that persist into the third year of life. We compare the relative effect on error rates of context-independent (e.g., verb) and context-dependent (e.g., subject+verb sequence) cues across developmental time. Our findings support the proposal that children recover from making verb-marking errors by becoming progressively more sensitive to preceding context.

Computed tomography study of cranial vault thickness in Malaysian subadult population.

Cranial vault thickness (CVT) and its variations provide valuable insights into an individual's biological attributes such as age and sex. This paper aimed to assess the correlations of CVT with age and sex and develop a regression model for age estimation in Malaysian subadults using computed tomography (CT) images. A total of 521 CT images (male/female: 279/242; age range: 0-20 years; Malay/Chinese/Indian: 221/145/155) were included in the study. Correlations of CVT measurements with age and sex, including frontal bone thickness (FBT), occipital bone thickness (OBT), left parietal bone thickness (LPBT), and right parietal bone thickness (RPBT) were assessed and regression formulae were developed for age estimation in subadults. A significant correlation between CVT measurements and age was demonstrated (p < 0.001). Age estimation was most accurate in the younger age group (< 2 years) at frontal and occipital, and accuracy decreases in the older age groups. Additionally, sexual dimorphism was evident in the frontal and parietal bone thickness within the age range of 3-6 years and 16-20 years, respectively. In conclusion, the findings suggested CVT measurements could be used to corroborate other age estimation methods for subadults.

Is Warm-Up Preservation Modulated by Biological Maturation and Sex? Effects on Lower Limbs Performance.

Children and adults may react differently to warm-up preservation due to different physical characteristics. This study aimed to: (i) assess the impact of different rewarm-up routines in swimmers during a transition phase (20-25 min), including passive rest (SWU) or dynamic activities (RWU), on countermovement jump and swimming start performances, and (ii) explore potential RWU adaptations considering maturity offset (peak height velocity-PHV) and sex. Performance was analyzed using mixed effect ANCOVA, considering protocol, maturity offset (pre-PHV, mid-PHV, post-PHV, and adv. post-PHV), and sex. Results favored RWU over SWU with substantial magnitudes for jump height: pre-PHV (min-20, ES = 1.21; min-25, ES = 1.65), mid-PHV (min-20, ES = 1.23; min-25, ES = 1.14), post-PHV (min-20, ES = 1.37; min-25, ES = 0.73), and adv. post-PHV (min-20, ES = 1.03; min-25, ES = 0.65). Significant interactions at 25 min (p = 0.033, 0.047) showed that RWU outperformed SWU, especially in younger groups (pre-PHV, mid-PHV). RWU was superior to SWU for the reactive strength index at 20 min (p = 0.042) and 25 min (p = 0.047), with females having lower RSI than males at 20 min (p = 0.008, p = 0.015) and 25 min (p = 0.049) in later developmental stages. The flight distance (p = 0.009) and horizontal hip velocity (p = 0.014) revealed significant three-way interactions, with the male adv. post-PHV group responding better to RWU. Knee angular velocity was also higher after RWU, with male adv. post-PHV group showing more pronounced improvements (p = 0.016). These results suggest that though RWU had higher influence in male adults, it is a valuable approach for varying ages athletes.

Comparison of Short Fast Fourier Transform and Continuous Wavelet Transform in Study of Stride Interval

Neurodegenerative diseases (NDD) are a heterogeneous group of complex diseases characterized by neuronal loss and progressive degeneration of different areas of the nervous system. Gait analysis presents an early recognition system for NDD which is important to increase the patient’s awareness of their health conditions. However, it is very difficult to identify and formulate suitable digital biomarkers from the data collected from gait experiments such as stride interval and swing. The objective of this paper is to compare the result of Short - Time Fourier Transform (STFT) and Continuous Wavelet Transform (CWT) on the collected stride interval of healthy young people and healthy old people. In this paper, STFT and CWT are performed on the collected stride interval and from the result of the STFT and CWT, further features are extracted like instantaneous RMS and maximum RMS value. STFT is performed on the collected stride interval from a window length of 64 to 512 while CWT is performed on the collected stride interval from the scale of 128 to 2048. The processing time of the STFT and CWT with varied window lengths and scales respectively are collected. Besides, the actual maximum time from the time - frequency plot derived from STFT and CWT is also collected. Both STFT and CWT show that the young group has a higher maximum RMS, an indication of higher stride interval than the old group and higher variance, an indication of higher gait complexity. The suitable window lengths for STFT in analyzing the stride interval are 64 and 128 while the scale for CWT should be set to the lowest scale. Overall, STFT with a window length of 64 and 128 is better in analyzing the stride interval due to low processing time at the expense of slightly less accurate time - frequency representation.

Age-dependent changes in cardiac output following balloon pulmonary angioplasty: Implications for combination therapy in chronic thromboembolic pulmonary hypertension

Abstract Background Balloon pulmonary angioplasty (BPA) is an accepted treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients still have exercise intolerance even after normalizing mean pulmonary arterial pressure with BPA. Although medical therapy may be a potential option for such patients, it cannot be necessary for all patients. Low cardiac output (CO) after BPA is associated with exercise intolerance. However, the change in CO with BPA could be affected by the patient’s age and pulmonary hypertension (PH) medication status. The specific patients’ characteristics that require medical therapy following BPA remain unknown. Methods This single-centre, retrospective observational study included 286 patients with CTEPH who underwent BPA and right heart catheterization one year BPA at our hospital. The patients were classified into three age groups (younger: age &amp;lt; 60 years, n=91; middle-aged: 60 ≤ age &amp;lt; 70 years, n=91; elderly: 70 years ≤ age, n=104), and also stratified by two groups based on PH medication status (Group 1: patients without PH medications before and after BPA, Group 2: patients who received PH medications before BPA and discontinued them after BPA). CO and its percent change were compared between Groups 1 and 2 in each age group. Results CO increased significantly in the younger group (4.3±0.2 to 4.5±0.1 L/min, p=0.040) and decreased in the elderly group (4.0±0.1 to 3.8±0.1 L/min, p=0.035), resulting in no significant change overall. CO in the younger and middle-aged groups significantly increased after BPA in Group 1, whereas in Group 2, those in the middle-aged and elderly groups significantly decreased after BPA. The percent CO changes declined in an age-dependent manner in both groups. Conclusions Increasing CO with BPA alone may be challenging in elderly patients. Adjuvant medical therapy might be necessary, even after successful BPA, especially in elderly patients.Percent change in CO stratified by age

Prevalence and temporal trends of risk factors among young patients with acute myocardial infarction - a nationwide cohort study

Abstract Background Cardiovascular disease, including acute myocardial infarction (AMI) is the leading cause of death globally.(1) While the risk of AMI is higher with increasing age, the consequences of AMI can be more severe in younger individuals, causing larger loss-of-life-expectancy and imposing burdens for society in terms of healthcare costs and premature retirements. Description of the young AMI cohort is of greatest interest to identify modifiable risk factors and/or other predisposing factors that may be optimized. Aims To describe the prevalence and temporal trend of risk factors among young individuals with AMI. Methods We used data from the SWEDEHEART registry, the National Patient Registry, the Drug Prescription registry and the Swedish Population registry. Adult young patients, defined as 18-59 years, admitted with a first AMI from January 2003 to January 2022 were included. Prevalence of the potentially modifiable risk factors; hypertension, diabetes, hyperlipidemia, smoking and obesity was defined on admission. In the analyses the cohort was further divided into two age groups 18-44 and 45-59 years. Results From January 2003 to January 2022, 249 735 patients were admitted with a first AMI and among these, 50 281 (20.1% of the total AMI cohort) were classified as young and included in the study. 44 243 (88.0%) patients were 45-59 years and 6038 (12%) were 18-44 years. The overall prevalence of risk factors was substantial, with higher rates observed in women compared to men (Table 1a) and in the older age group, except for obesity, which was more common in the younger age group (Table 1b). While the prevalence of diabetes and hyperlipdemia remained unchanged over time, smoking decreased and hypertension slightly increased. Notably, the prevalence of obesity more than doubled (Figure 1). Conclusion Among young AMI patients the prevalence of modifiable risk factors was substantial with an even higher prevalence in women than in men. The increasing prevalence of obesity especially in the younger age group may indicate a potential future rising health care risks.Figure 1

Validating weight optimization’s Impact on participants via Social Impact Bonds

Abstract Background To promote health for everyone, even the health-unconcerned, Okayama City has established the Social Impact Bond (SIB), which funds and executes social programs for defined outcomes, with third-party assessment. This study examined the normalization of participants’ physiques three years later to verify the effectiveness of SIB. Methods We conducted a study of a quasi-experimental design, non-randomized controlled trial. A total of 8,251 eligible people applied for the program. Of these, 1,599 were enrolled in the National Health Insurance System (NIH), and 731 of them were included in the intervention group in 2018. Among 705 non-participating matched members and randomly selected, 170 were used as the control group. Whether or not the standard physique in the endpoint (EP) FY2021, was used as the dependent variable, and the participation as the independent variable. Age, gender, and physique at baseline (BL) were used as covariates for logistic regression analysis. Results A total of 532 patients underwent health checkups for both BL and EP, and the follow-up rate was 60.5% in the intervention group and 52.9% in the control group. Examination of between-group differences in BL revealed that the mean age was 66.7 years significantly higher in the males’ intervention group and 60.6 years in the control group (p &amp;lt; 0.01). The crude odds ratio (OR) of maintaining or achieving standard BMI in the participating group was 0.90, and the adjusted OR was 1.23 and 1.31 after propensity score matching, both were not significant. On the other hand, when restricted to people with thinness, the pre-adjusted OR was 5.00 and the adjusted OR was 12.43. Conclusions Participation in the project contributed about 20% to 30% to weight optimization, and it could not be denied that it was brought about by chance. However, when limited to thin physiques, project participation was about twelve times higher, and the probability of having an appropriate physique was increased. Key messages • SIB might affect the BMI optimization for older people in improving thinness. • Efforts will be needed to encourage participation among younger age groups.

Joint associations of psychological distress and working conditions with sickness absence in Finland

Abstract Background Psychological distress has increased remarkably, especially among younger age groups, during the last years. Both psychological distress and exposure to strenuous working conditions are known risk factors for sickness absence (SA). We examined whether psychological distress and working conditions are jointly associated with SA periods of 1-7 days and 8+ days among young and midlife Finnish employees. Methods We linked survey data from the Helsinki Health Study cohort from 2017 (response rate 51.5%) with the employer’s SA register for the City of Helsinki, Finland (82% consented to the linkage; n = 3949, 80% women, age 19-39 years). Mean follow-up time was 2.1 years. We calculated rate ratios (RR) and 95% confidence intervals (CI) for SA periods of 1-7 days and 8+ days using negative binomial regression models among participants with and without psychological distress, and with and without exposure to strenuous working conditions. Psychological distress was measured with the emotional wellbeing subscale of RAND-36 (cut-off 60 points). Working conditions included physical and mental strenuousness of work and hours per day spent in heavy physical work. Results Participants with psychological distress and exposure to strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of ≥ 8 days (physically strenuous work: RR: 2.38, CI: 1.97-2.88; mentally strenuous work: RR: 2.08, CI: 1.72-2.53; ≥3 h per day spent in physical work: RR: 2.48, CI: 2.01-3.06), the interactions being additive. The associations were weaker for SA periods of 1-7 days. Adjusting for marital and employment status, education, alcohol use, smoking and body mass index only slightly attenuated these associations. Conclusions Psychological distress and exposure to strenuous working conditions were additively associated with SA. Both individual- and workplace-related risk factors for SA are important to be considered when planning preventive actions. Key messages • Young and early midlife Finnish employees with simultaneous psychological distress and exposure to strenuous working conditions had the highest rates of SA periods, the interactions being additive. • Both psychological distress and exposure to strenuous physical and mental working conditions should be considered when planning preventive actions to reduce employees’ SA.

The association between remnant cholesterol and all-cause mortality and cardiovascular mortality was modified by aged in American adults: a retrospective cohort study

Abstract Background Limited evidence exists regarding the association between remnant cholesterol (RC) and both all-cause and cardiovascular mortality. Also, the effect of age on the association between RC and the risk of mortality in general population has not been studied comprehensively. Therefore, the aim of this study is to investigate how age modifies the relationship between RC and the risk of all-cause and cardiovascular mortality. Methods A total of 21722 participants aged over 18 years were obtained from the National Health and Nutrition Examination Survey (1999–2018) , with follow-up mortality outcomes records linked to the National Death Index (NDI) until December 31, 2019 and divided into two groups (&amp;lt;65 years old and ≥65 years old).Weighted multivariable cox proportional hazards models and weighted restricted cubic spline (RCS) were used to estimate the relationship of RC with the risk of all-cause mortality and cardiovascular mortality among American adults. The age interaction between RC and all-cause mortality and cardiovascular mortality was assessed. Restricted cubic spline (RCS) and sensitivity analysis were also used. Results During a median 110-month follow-up, a total of 3176 (10.77%) all-cause deaths and 1002 (3.22%) cardiovascular related deaths were recorded. A significant age interaction between RC and all-cause or cardiovascular mortality was found. After adjusting for multiple potential confounding factors, higher RC was associated with an increased risk of all-cause mortality[RC per unit increase Hazard Ratio (HR) 1.45, 95% Confidence Interval (CI) 1.16–1.81, p=0.001] and cardiovascular mortality (RC per unit increase HR 1.80, 95% CI 1.15–2.84, p=0.010) specifically in the younger age group but not in the older age group. Consistent findings were observed in restricted cubic spline analyses and sensitivity analyses. Conclusion In our study, we observed that the association between serum RC and all-cause mortality and cardiovascular mortality was modified by age. Specifically, higher RC levels were found to be significantly associated with an increased risk of all-cause mortality and cardiovascular mortality exclusively in patients below 65 years old. This novel finding warrants further confirmation through randomized controlled trials to provide robust evidence.

Are novel ASCVD risk factors more prevalent in young middle eastern women who have classical risk factors

Abstract Introduction Urbanization is an important contributor to atherosclerotic cardiovascular disease (ASCVD) in the Middle East, especially in the younger age groups. There is a scarcity of data on clinical profiles and cardiovascular risk factors (RFs) in urban young women compared with those who reside in rural areas in this region. Purpose To study the demographic and clinical profiles and prevalence of traditional and novel CV RFs in a cohort study of young urban Middle Eastern women compared with those in rural areas. Methods The prevalence of 19 traditional and novel cardiovascular RFs were compared in urban vs. rural young women residents (18-50 years of age), who were enrolled in 12 centers (August 2020 to October 2023). Results Of 627 young women enrolled (mean age 44.2 ± 5.1 years old), 463 (74%) were urban residents and 164 (26%) were rural residents. ASCVD was diagnosed in 32% of urban and 37.3% of rural young women. Table shows the prevalence of traditional and novel, sex-specific RFs with significant differences in the 2 groups. Other RFs with no significant differences included hypertension, diabetes and gestational diabetes, preterm delivery, persistent weight gain after delivery, radiation for breast cancer, and polycystic ovary syndrome. Conclusion In this cohort of Middle Eastern young women, despite heterogeneity, those who were urban residents had worse clinical profiles with higher prevalence of certain classical and sex-specific risk factors.

Diabetes among people with intellectual disabilities vs the general population: a register study

Abstract People with intellectual disabilities have an increased risk of diabetes mellitus (DM). They tend to develop it at earlier ages than the general population, resulting in even higher risks in younger people. However, few studies have separated Type 1 and Type 2 DM. The aim of this study was to assess prevalence of different types of DM in different age groups in relation to the general population. We categorized all people in Skåne, Sweden, as ID (service and support for people with ID and/or autism, or a diagnosis of ID or Down syndrome; n = 14 716) or general population (gPop; excluding family members of people in ID; n = 1 226 955). Data regarding diagnoses of Type 1 (E10 in ICD-10) and Type 2 (E11) DM were collected for 2014-2021. Age at inclusion (i.e., 2014) was considered as children (0-12 years), adolescents (13-18), young adults (19-24), adults (25-44), lower middle-age (45-54), upper middle-age (55-64), older people (65+). The overall prevalence of Type 1 DM was 2.3% in ID and 1.6% in gPop (relative risk [RR] 2.14, 95% confidence interval 1.93-2.38). In ID, the prevalence was below 2% in the youngest age groups, and then increased with age until upper middle-age, where it reached 6.0%. The risk of Type 1 DM among people with ID compared to gPop was relatively stable, with the RR ranging between 1.16 (older people) to 2.83 (adults). For Type 2 DM, the overall prevalence was 7.2% in ID and 7.8% in gPop (RR 2.00, 1.89-2.13). There was a consistent age-related increase in prevalence in ID, from 0.3% among children to 27.4% among older people. The opposite pattern was found for the risk compared to gPop, with the higher risks (RR 3.63-6.98) in the younger age groups and lower risks (RR 1.27-4.41) in the older age groups. Both types of DM were more prevalent among people with intellectual disabilities than in the general population. However, the patterns of prevalence and risk compared to the general population differed for the two types. Key messages • People with intellectual disabilities have increased risk of both Type 1 and Type 2 diabetes mellitus. • Type 1 and Type 2 diabetes mellitus displays different age patterns among people with intellectual disabilities.

Social patterning of health misinformation in two Eastern Mediterranean populations

Abstract Background Health misinformation, the spread of false or misleading information relevant to health, has been proposed as a major global public health thread by the WHO. We aimed to identify the major social determinants of health misinformation in the general Greek and Cypriot populations. Methods Following proportional quota sampling we recruited a nationwide sample of 585 adults from Greece and Cyprus between January 2022 and May 2023. A newly developed, culturally adopted questionnaire comprising 48 items, was used to assess misinformation on COVID-19 vaccines and the pandemic. Sociodemographic determinants of interest included gender, age, marital status, area of residence, educational attainment, and income. Multiple linear regression was used to determine associations between the aforementioned social factors and the two dimensions of health misinformation, applying mutual adjustment. Results Misinformation about both vaccination and the pandemic was higher in younger age groups (p-trend 0.026 and 0.007, respectively), among those separated, divorced, or widowed (mean difference, 95% CI compared to those single: 9.73, 0.45, 19.01), and among those living in semi-urban compared to urban areas (11.14, 1.32; 20.97 and 9.44, 1.96; 16.92, respectively). We also detected strong inverse socioeconomic gradients in health misinformation based on educational attainment and income (p-trend &amp;lt;0.001, for both). Conclusions Younger individuals, those living alone, those residing in semi-urban areas, and those with lower educational attainment and income are particularly prone to health misinformation. Our adjusted models show that this social phenomenon is not simply explained by differences in education, hence more complex, cultural, political, perceptual, and psychosocial dynamics might be in place. Addressing the social patterning of health misinformation would help manage the issue more effectively and also reduce health inequalities. Key messages • Health misinformation is strongly socially patterned in two Eastern Mediterranean European populations. • Targeting efforts to tackle health misinformation to those more vulnerable, would render such programmes more effective, also helping reduce social inequalities in health.

Obesity paradox exists in super elderly patients with heart failure

Abstract Background Aging and obesity are two global concerns in public health. As obesity is associated with several metabolic disorders, it is a well-known risk factor of heart failure (HF). However, several studies have suggested that obesity may have paradoxical survival benefits in patients with HF. Therefore, the aim of this study was to investigate whether the obesity paradox exists in super elderly patients with HF in Japan. Methods A total of 4,292 patients from our hospital HF registry were divided into four age subgroups: (A) less than 65, (B) elderly 65-74, (C) high elderly 75-84, (D) super elderly ≥85. The primary endpoint was the all-cause death within 1-year after discharge. Results At baseline, the proportion of men in each group was 42-76%, the mean left ventricular ejection fraction was 49-61%, the average of N-terminal pro-B-type natriuretic peptide was 1972-2944 pg/ml, and the mean body mass index (BMI) ranged 21-25 kg/m2. Patients with higher BMI were more common in the younger age group, while those with lower BMI were more common in the older age group. Cubic spline curves of Cox proportional hazard regression models demonstrated an inverse relationship between BMI and mortality (Fig. 1). Lower BMI was associated with higher all-cause mortality in all ages, although this association was attenuated at the young age, and pre-obesity (25–29.9 kg/m2) was associated with the greatest survival benefit. Meanwhile, the impact of underweight (&amp;lt;18.5 kg/m2) was stronger super elderly subjects, a one-unit increase in BMI was associated with a 10.3% decrease in the hazard ratio of death (P=0.021). Kaplan-Meier curves for all-cause mortality also showed that lower BMI was associated with higher all-cause mortality in all groups, and the differences were statistically significant in Groups B, C, and D (Fig. 2). Conclusion Our study suggested the existence of the obesity paradox among HF patients in super elderly. Mildly overweight may be beneficial at old age with HF.

Barriers to adopting a plant-based diet in various Finnish sociodemographic groups

Abstract Background According to nutrition recommendations, plant-based diets are favorable for both climate and health. However, the adoption of such diets varies between sociodemographic groups. Aims of this study are to examine how large proportions of the population have shifted towards plant-based diets to combat climate change, and to identify perceived barriers to dietary changes by gender, age, urbanization level, education, and household income. Methods The study is based on the Healthy Finland Survey conducted in 2022-2023, including 5390 participants (56% women) aged 20-74 years. Questions related to plant-based diet had pre-defined response options. Results Women reported that they had changed their diets to be more plant-based more often than men (46% vs. 31%). Women and men living in urban areas, having high education, or belonging to the highest income quartile had made changes more often than those in other sociodemographic groups. Women and men reported barriers in shifting to more plant-based diets, such as uncertainty about nutritional value (20% and 24%) and lacking skills to prepare tasty vegetarian food (30% and 28%). Disliking vegetarian foods (23%) or not being interested in the topic (28%) were also frequent issues in men, while women commonly cited the preferences of their close ones as preventing them from making vegetarian food (17%). These perceived barriers also differed between sociodemographic groups. For example, while uncertainty about nutritiousness of plant-based diets was most common in the oldest age group (29%), lack of skills to prepare tasty vegetarian food was most common in the youngest age group (35%). One third of men living in remote rural areas or with basic education reported not being interested in the topic. Conclusions Understanding barriers that prevent people in different sociodemographic groups from changing their diets to more plant-based is critical in tailoring more targeted and effective health promotion and policy. Key messages • Moving towards more plant-based diets to combat climate change and perceived barriers to dietary changes vary by gender, age, urbanization level, education, and household income. • Understanding barriers preventing people in different sociodemographic groups from changing their diets to more plant-based is critical in tailoring targeted and effective health promotion and policy.

Longitudinal analyses (2018-2022) of the COVID-19 impact on Swiss pediatric healthcare utilization

Abstract Background The impact of COVID-19 on healthcare utilization in the early pandemic is well documented. However, studies on changes in both primary and tertiary pediatric healthcare utilization that considered data beyond the first pandemic year is lacking. Methods National health insurance data (primary care) and pediatric emergency department data (tertiary care) from Jan. 2018 - June 2022 and on 0-18-year-olds were analyzed with interrupted time series. The first lockdown was used to differentiate between pre-pandemic and pandemic periods. Results Several healthcare services yielded significantly lower average utilization rates during the pandemic vs. the pre-pandemic period, particularly in the youngest age groups. In primary care, the relative utilization, compared to the pre-pandemic mean, dropped in regards to regular (0-5y: 0.760 [0.644-0.896]; 6-10y: 0.850 [0.742-0.974]), well-child (0-5y: 0.871 [0.765-0.992]), and urgent visits (0-5y: 0.638 [0.500-0.813]; 6-10y: 0.810 [0.665-0.985]), and for the vaccination against measles/mumps/rubella (MMR; 0-5y: 0.841 [0.729-0.971]). Similarly, in tertiary care, this pattern emerged for non-urgent (Zurich: 0.55 [0.482-0.627]; Geneva: 0.526 [0.435-0.636]; Ticino: 0.502 [0.436-0.578]) and urgent visits (Zurich: 0.573 [0.498-0.659]; Geneva: 0.487 [0.375-0.632]; Ticino: 0.676 [0.57-0.802]). The utilization rates of most services dropped markedly after the lockdown and recovered to some extent over the pandemic phase. However, no recovery was found for the MMR-vaccination. In primary care, higher average utilization rates during the pandemic were identified for telephone consultations (0-5y: 1.394 [1.218-1.594]; 6-10y: 1.547 [1.387-1.726]; 11-15y: 1.578 [1.430-1.741]; 16-18y: 1.831 [1.614-2.076]). Conclusions The pandemic’s effect on utilization seemed to have occurred temporarily, but it cannot be ruled out that some children have not fully caught up on preventative measures (well-child visits and MMR-vaccinations). Key messages • Pediatric healthcare utilization dropped considerably immediately after the lockdown, with the most pronounced decrease observed in the youngest children. • The heterogenous recovery over the pandemic period points to the necessity to continue to monitor utilization rates, catch-up visits, and vaccination statistics.

Glucose lowering drugs with proven cardiovascular benefit following acute coronary syndrome in type 2 diabetes: treatment gaps and outcomes

Abstract Background and Aims Real-world data on the implementation and prognostic impact of glucose-lowering drugs with proven cardiovascular benefits in patients with type 2 diabetes (T2D) following acute coronary syndromes (ACS) is limited. We investigated the utilization and treatment patterns of sodium-glucose contrasporter-2 inhibitors (SGLT2I) and glucagon-like peptide-1 receptor-agonists (GLP1RA) in T2D patients experiencing ACS, and analyzed their association with mortality and major adverse cardiovascular events (MACE) including recurrent ACS, acute revascularization, heart failure or ischemic stroke. Methods Retrospective analysis of 9,756 patients with T2D from a nationwide healthcare organization hospitalized with ACS between 01/2019 and 01/2022. Drug prescriptions were estimated pre-hospitalization, 90-days and 1-year following hospitalization. The association between SGLT2I and/or GLP1RA treatment with MACE and mortality was investigated using time-dependent Cox regression analysis with multivariable adjustment. Results Prescription rates (prehospitalization, 90-days and 1-year posthospitalization) of GLP1RA were 13%, 13.2%, and 18%, and of SGLT2I were 23.9%, 33.6% and 42.7%, respectively. At 1-year, 13.9% prescribed both therapeutic groups. The use of SGLT2I and/or GLP1RA was higher in younger age-groups, and increased from 2019 to 2021 (38.1% to 59.2%). The adjusted hazard ratio for the association of pre- or post-hospitalization SGLT2I and/or GLP1RA treatment with mortality and MACE was 0.724 (0.654-0.801) and 0.974 (0.909-1.043), respectively. Conclusions In real-world practice of patients with T2D experiencing ACS, implementation of SGLT2I and particularly GLP1RA was suboptimal, both early and 1-year following hospitalization, emphasizing the need to improve medical care. Treatment with SGLT2I and/or GLP1RA was associated with favorable impact on mortality but not MACE.Graphical Abstract

Young patients in the cardiac intensive care unit: insights from the critical care cardiology trials network registry

Abstract Background Elderly patients treated in the cardiac intensive care unit (CICU) have engendered much warranted investigation. However, little is known about young patients as another distinct population. Purpose: To describe the demographics, clinical profiles, and outcomes of young CICU patients in order to understand any distinct needs and challenges of this population. Methods: We analyzed consecutive admissions to adult CICUs from 2018 to 2023 in the Critical Care Cardiology Trials Network (CCCTN), a multicenter prospective registry of advanced CICUs in North America coordinated by the TIMI Study Group. Patients aged &amp;lt;40 years were classified as "young patients" and compared to patients ≥ 40 years of age. Results: Among 29,035 CICU admissions during the study period, the median age was 67 years (25th, 75th %iles: 56, 70). Admissions 18 to 40 years of age comprised 6.7% (n=1959) of total admissions. The young cohort was more likely to be female (40.0% vs 36.4%, p=0.0015) and non-Caucasian (55.3% vs. 43.0%, p&amp;lt;0.0001). Traditional cardiovascular risk factors were less common among the young, as were prior cardiovascular diagnoses other than congenital heart disease and pulmonary hypertension. Initial SOFA scores and serum lactate levels were similar in the 2 groups (Table). The most common CICU admission diagnoses in the young were heart failure (HF), arrhythmia, and acute coronary syndrome (ACS) (Panel A). Of these, HF was more common in the young (26.4% vs 19.5%, p&amp;lt;0.0001), while arrhythmia (16.8% vs 18.9%, p=0.03) and ACS (10.9% vs 29.4%, p&amp;lt;0.0001) were less common compared to the older group (Panel B). Tamponade, hypertensive emergency, and congenital disease were more common in the young (Panel B). Respiratory insufficiency was the most common indication for admission to CICU in the young (24.6%) followed by cardiogenic shock (22.4%), unstable arrythmia (15.7%), and cardiac arrest (12.7%, Panel C). Critical care resources, other than coronary angiography/PCI, were utilized significantly more often in the young group (Panel D). Overall utilization of mechanical circulatory support (MCS) was modestly higher among the young cohort (13.1% vs. 11.4%, p=0.03, Panel D); however, among those managed with MCS, the % of MCS that was ECMO was higher among the young (29.3% vs 9.9%, p&amp;lt;0.0001). Young admissions had longer CICU stays (2.7 [1.2-5.9] vs 2.3 [1.2-4.9], p&amp;lt;0.0001). CICU mortality (6.5% vs 10.5%, p&amp;lt;0.0001) and hospital mortality (9.5% vs 14.4%, p&amp;lt;0.0001) were significantly lower in the young. Conclusion: Patients under the age of 40 admitted to CICUs presented with similar disease severity to older patients but more often had shock or cardiac arrest, had longer ICU stays, and more use of advanced ICU therapies but with lower in-hospital mortality. This important patient cohort merits continued clinical and research focus.

Real world evidence of Sacubitril/Valsartan in octogenarian patients with heart failure. Results From the PARACHUTE-HF Study

Abstract Introduction The beneficial effects of Angiotensin Receptor Neprilysin Inhibitors (ARNI) on heart failure (HF) patients, particularly those with reduced left ventricular ejection fraction (LVEF), have been highlighted in several randomized controlled trials. Since 2020, ARNI has been available for HF treatment in Japan, a country known for its aging population. However, the inclusion of octogenarians in previous trials has been limited, leaving a gap in evidence regarding ARNI's effectiveness in the elderly. Objective This study aims to explore the real-world efficacy and safety of ARNI treatment among octogenarian HF patients in Japan, reflecting its status as a leading aging society. Methods The Prospective Area Registry of ARNI for Congestive Heart failUre in Tokyo East (PARACHUTE) trial, a multicenter registry, was conducted. It involved patients newly prescribed ARNI for chronic HF regardless of LVEF between 2020 and 2021. We compared patient backgrounds, changes in NT-proBNP levels at 6 months, and the rate of ARNI discontinuation between groups aged below and above 80 years. Results The study enrolled 105 patients, with an average age of 75 years. Forty-six patients (44%) were over 80 years old, and the majority (72%) were male. Among the younger group, 50% had preserved LVEF, compared to 32% in the octogenarian group (p=0.01). Median NT-proBNP levels across all patients decreased significantly from 2,540 pg/mL at baseline to 998 pg/mL at 6 months. The reduction in NT-proBNP was similar between the two age groups, with no significant interaction (p=0.46). Discontinuation rates due to any cause were not significantly different between younger and older patients (7% vs. 13%, p=0.28). Conclusion ARNI treatment resulted in significant reductions in NT-proBNP levels in HF patients, both under and over 80 years of age, with comparable discontinuation rates. These findings highlight the effectiveness and safety of ARNI in the management of chronic HF in the elderly, offering valuable real-world evidence from Japan's unique demographic context.