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BACKGROUND: Numerous studies have linked fine particulate matter (PM2.5) to increased cardiovascular mortality. Less is known how the PM2.5-cardiovascular mortality association varies by use of cardiovascular medications. This study sought to quantify effect modification by statin use status on the associations between long-term exposure to PM2.5 and mortality from any cardiovascular cause, coronary heart disease (CHD), and stroke. METHODS: In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI). RESULTS: Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032-1.053) vs OR = 1.009 (95% CI, 0.996-1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019-1.047), RERI = 0.039 (95% CI, 0.025-0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users. CONCLUSIONS: The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users.

Background: Corticosteroids remain the cornerstone in the management of myasthenia gravis (MG). Initiation of corticosteroid treatment at a high dose and subsequently decreasing the dose or gradual escalation from a low dose is recommended. We aimed to investigate the association between the initial corticosteroid regimen and treatment response. Methods: A retrospective study was conducted on 234 acetylcholine receptor (AChR) antibody (Ab)–positive MG patients who visited our institution between January 2010 and February 2023. Patients were grouped based on prednisolone dosages received: initial high (IH, ≥50 mg/day) or initial low (IL, ≤20 mg/day). Time to initial improvement and the achievement of minimal manifestation (MM) status were the main outcomes. Results: Of the 234 patients, 135 were classified as IH and 99 as IL group. The IH group demonstrated a faster onset of improvement compared with the IL group (20.0 [16.0–29.0] vs. 40.0 [27.0–84.0] days), with the IH group being a significant prognostic factor for initial improvement (HR, 2.44; 95% CI, 1.76–3.39). However, the IH group had a higher incidence of steroid‐induced exacerbation (51.9% vs. 2.0%, p < 0.001). No significant difference between the IH and IL groups was found in terms of the proportion of patients achieving MM or the time to achieve MM within the first year after treatment initiation. Conclusion: While an initial high dose of corticosteroid treatment accelerated the onset of therapeutic responses in patients with AChR Ab–positive MG, it was associated with a higher cumulative steroid dose and an increased risk of steroid‐induced exacerbations. [ABSTRACT FROM AUTHOR]

Background Numerous studies have linked fine particulate matter (PM2.5) to increased cardiovascular mortality. Less is known how the PM2.5-cardiovascular mortality association varies by use of cardiovascular medications. This study sought to quantify effect modification by statin use status on the associations between long-term exposure to PM2.5 and mortality from any cardiovascular cause, coronary heart disease (CHD), and stroke. Methods In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI). Results Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032–1.053) vs OR = 1.009 (95% CI, 0.996–1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019–1.047), RERI = 0.039 (95% CI, 0.025–0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users. Conclusions The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users. [ABSTRACT FROM AUTHOR]

A name is the starting point to acknowledge the existence of ourselves and others in our lives. However, we live in a society where name-based biases and discrimination have permeated. As transnational parent researchers, we examined our children's names and naming practices through the practice of Suda [수다], which is an open-ended nonhierarchical conversational environment and deep/emotional storytelling, drawing on our own onto-epistemological stances. We intend to uncover implicit and hidden racial discourses against Asian/Asian American children's names and naming practices through our children's names and naming practices. The data reveal that our children's names embrace our cultural beliefs, faiths, the wishes of parents, and family histories while being entangled with discrimination and racial discourses. Our children were also actively negotiating and (re)constructing their self-representation by having more than one name. This study provides implications regarding racially minoritized children's names and naming practices in school and future research. [ABSTRACT FROM AUTHOR]

During the first year of the COVID-19 pandemic, the Republic of Korea (ROK) experienced three epidemic waves in February, August, and November 2020. These waves, combined with the overarching pandemic, significantly influenced trends in spinal surgery. This study aimed to investigate the trends in degenerative lumbar spinal surgery in ROK during the early COVID-19 pandemic, especially in relation to specific epidemic waves. Using the National Health Information Database in ROK, we identified all patients who underwent surgery for degenerative lumbar spinal diseases between January 1, 2019 and December 31, 2020. A joinpoint regression was used to assess temporal trends in spinal surgeries over the first year of the COVID-19 pandemic. The number of surgeries decreased following the first and second epidemic waves (p<0.01 and p = 0.34, respectively), but these were offset by compensatory increases later on (p<0.01 and p = 0.05, respectively). However, the third epidemic wave did not lead to a decrease in surgical volume, and the total number of surgeries remained comparable to the period before the pandemic. When compared to the pre-COVID-19 period, average LOH was reduced by 1 day during the COVID-19 period (p<0.01), while mean hospital costs increased significantly from 3,511 to 4,061 USD (p<0.01). Additionally, the transfer rate and the 30-day readmission rate significantly decreased (both p<0.01), while the reoperation rate remained stable (p = 0.36). Despite the impact of epidemic waves on monthly surgery numbers, a subsequent compensatory increase was observed, indicating that surgical care has adapted to the challenges of the pandemic. This adaptability, along with the stable total number of operations, highlights the potential for healthcare systems to continue elective spine surgery during public health crises with strategic resource allocation and patient triage. Policies should ensure that surgeries for degenerative spinal diseases, particularly those not requiring urgent care but crucial for patient quality of life, are not unnecessarily halted. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the mediating effects of health literacy on the relationship between frailty and health-related quality of life (HRQOL) among community-dwelling older adults. Methods: This study used the Korean Frailty and Aging Cohort Database (KFACD) for secondary data analysis. We selected data from 1,631 people without missing main variable values for analysis. Frailty was determined based on the modified Fried's phenotype [MFP], and HRQOL was measured using the Korean version of the 5-level EuroQol questionnaire (EQ-5D-5L). Health literacy was assessed using the questions on the Behavioral Risk Factor Surveillance System (BRFSS) used by the U.S. Center for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and HRQOL, Baron & Kenny's three-step mediating effect verification method was utilized. Results: The participants had a mean frailty score of 1.37±1.02, health literacy score of 8.56±2.59, and HRQOL score of 0.84±0.10. Frailty was negatively correlated with health literacy (r = -0.27, p <.001) and HRQOL (r = -0.32, p <.001), while health literacy was positively correlated with HRQOL (r = 0.34, p <.001). We observed that health literacy played a partial mediating role in the relationship between frailty and HRQOL. Conclusion: To increase older adults' HRQOL, measures that directly prevent and manage frailty as well as interventions that target the enhancement of health literacy are needed. [ABSTRACT FROM AUTHOR]

Korea operates exclusive bus lanes (XBLs) on many of its expressways. As XBLs convert one lane of regular-use traffic into bus-only traffic, they have a large impact on traffic flow, so careful judgment is required to determine if the operation is effective. However, XBLs have been operated based on only political judgment due to the lack of standards for the operation of expressway XBLs. Therefore, we sought to establish standards for the operation of expressway XBLs using the micro-traffic simulation program VISSIM and the multi-criteria value function methodology. Various scenarios were established based on traffic volume changes of passenger vehicles and bus traffic of four- and five-lane expressway networks. Through an expert survey, the average speed and speed-deviation values, which are the criteria for evaluating operational efficiency and safety, were determined. Also, value points were converted using average speed and speed deviation extracted from the simulation. In addition, quantitative operation standards were established using the converted value scores. Using the results of this study, we established standards for the operation of the XBLs and presented guidelines for related agencies such as police, bus groups, and corporations. The National Police have prepared guidelines for the operation of the XBLs. Citing the results of this study, the new guidelines were implemented in February 2021, and sections of some XBLs have been abolished. Through this study, quantitative standards for the operation of XBLs, one of the management lane techniques necessary for sustainable highway operation, were prepared and applied to actual highways. By properly applying the newly applied guidelines according to quantitative standards, there will be effects of reducing traffic congestion, improving travel time, and enhancing environmental characteristics such as exhaust gas emission. It is also expected to have a positive effect on safety. [ABSTRACT FROM AUTHOR]

Cigarette smoke induces an inflammatory response in the lungs by recruiting inflammatory cells, leading to lung diseases such as lung cancer, chronic obstructive pulmonary disease, and pulmonary fibrosis. Existing inhalation exposure methods for assessing the adverse effects of cigarette smoke require expensive equipment and are labor‐intensive. Therefore, we attempted to develop a novel method to assess these adverse effects using intratracheal instillation (ITI) of whole cigarette smoke condensate (WCSC). The WCSC (0, 5, 10, or 20 mg/mL) was administered by ITI once daily for 6 or 12 days using an automatic video instillator. Repeated WCSC ITI increased the lung weight, and monocyte chemoattractant protein‐1 (MCP‐1), neutrophil, and lymphocyte levels within bronchoalveolar lavage fluid compared to the control. In the histopathological analysis of the lung tissue, a mild inflammatory response was observed in the 6 and 12 days 20 mg/mL WCSC exposure groups. The genome‐wide RNA‐seq expression patterns revealed that inflammatory and immune response‐related genes, such as the chemokine signaling pathway, Th1/Th2 cell differentiation, and cytokine‐cytokine receptor interaction, were employed following WCSC exposure. In addition, MCP‐1 was time‐dependent and increased in the 10 mg/mL exposure group compared to the control group. These results suggested that the WCSC might induce the potential pulmonary inflammatory response. Furthermore, we proposed that ITI may be a rapid and effective method of evaluating the adverse effects of WCSC within a short exposure period (less than 2 weeks), and it can be used to evaluate cigarette inhalation toxicity studies as an alternative method. [ABSTRACT FROM AUTHOR]

Ogura male sterile cytoplasm is widely used for radish breeding. In this study, high-resolution melting (HRM) markers associated with Rft and Rfo, major restorer-of-fertility genes in Ogura cytoplasmic male sterility (CMS) in radish, were developed. Genetic mapping was carried out using F2 populations derived from crosses between male-sterile Ogura CMS lines and male-fertile lines. Identification of the Rft and Rfo loci was achieved through SNP-based genotyping and linkage grouping. HRM markers were subsequently developed based on flanking sequences of SNPs linked to these loci. For the Rft gene, a set of 117 SNPs was selected within a candidate region on chromosome 5, and 14 HRM markers were successfully developed. Genotyping of F2 showed high correlation between three markers and the phenotype. Regarding the Rfo gene, a set of 27 HRM markers was designed based on flanking sequences of SNPs located on chromosomes 9 and 0. Genotyping in the Rfo segregating population identified a single marker, RSRF27, that accurately distinguished the male sterility phenotype. Validation of the developed markers was performed in populations containing both Rft and Rfo genes, confirming their utility for genotyping and demonstrating that these two genes independently contribute to male sterility recovery. Overall, this study provides HRM markers that can be used for genotyping Rft and Rfo and contributes to a deeper understanding of male sterility restoration mechanisms in Ogura CMS. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that they do not have any conflicts of interest.

Background: This study aimed to develop an instrument for assessing physical functioning among adults aged 50 years or older living in the community., Methods: Based on a review of various national health surveys and cohort studies, a 144-item bank was constructed for assessing physical functioning. Focus group interviews were conducted among adults aged 50 years or older to investigate their level of understanding of 60 selected items, followed by a pretest of the items on a nationally representative sample (n = 508). The final 25-item questionnaire was tested on an independent sample (n = 259) for validity and reliability based on classical test and item response theories. Predictive validity at the 6-month follow-up was tested in a separate sample (n = 263)., Results: The newly developed Life Functioning (LF) scale assessed the dimensions of functional limitations, disabilities, and social activities. The scale satisfied a one-dimensionality assumption with good item fit and demonstrated criterion validity, construct validity, high internal consistency (Cronbach's alpha = 0.93), and test-retest reliability (intra-class correlation coefficient = 0.84; 95% CI, 0.76-0.89). The LF scale comprised 25 items with a total score ranging from 0 to 100. Higher scores indicated higher levels of functioning. The LF score was significantly associated with the physical functioning score at 6 months., Conclusion: The LF scale was developed to assess the physical functioning of people in their late midlife or older. Future studies should test the instrument on a national sample and evaluate its application in diverse population subgroups.

Background: Although COVID-19 has disproportionately impacted immigrant agricultural workers, vaccination efforts have been challenging. Barriers to immunization include language, visa status, and access to medical care. Additionally, vaccine hesitancy, mistrust, and misinformation contributed to low uptake. Methods: A community needs assessment was conducted with immigrant agricultural workers ( n   =  9) and community stakeholders ( n   =  15) in rural areas of Maryland and Delaware. In-depth interviews were recorded, transcribed verbatim, and analyzed using template analysis. Results : The participants named trusted and untrusted sources, sources of misinformation, and barriers to accessing information and physical locations to receive the vaccine as reasons for not getting the vaccine. Trusted sources included known community leaders and television programs. Some barriers mentioned were fear of deportation, lack of paid time off, language barriers, and difficulty navigating the U.S. healthcare system. Discussion: There is a need for culturally-tailored programs that address misinformation and barriers and use community-based programming., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determine whether prenatal food insecurity was associated with breastfeeding (versus not) and exclusive breastfeeding duration among Oregon women. Method: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 2008 to 2015 and the Oregon PRAMS-2 follow-up survey were used ( n = 3,624) in this study. Associations with breastfeeding initiation and duration were modeled with multivariable logistic regression and accelerated failure time (AFT), respectively. Models were adjusted for maternal sociodemographic and pre-pregnancy health characteristics. Results: Nearly 10% of women experienced prenatal food insecurity. For breastfeeding initiation, unadjusted models suggested non-significant decreased odds (odds ratio (OR) 0.88 [confidence intervals (CI): 0.39, 1.99]), whereas adjusted models revealed a non-significant increased odds (OR 1.41 [CI: 0.58, 3.47]). Unadjusted AFT models suggested that food-insecure mothers had a non-significant decrease in exclusive breastfeeding duration (OR 0.76 [CI: 0.50, 1.17]), but adjustment for covariates attenuated results (OR 0.89 [CI: 0.57, 1.39]). Conclusions: Findings suggest minimal differences in breastfeeding practices when exploring food security status in the prenatal period, though the persistence of food insecurity may affect exclusive breastfeeding duration. Lower breastfeeding initiation may be due to other explanatory factors correlated with food insecurity and breastfeeding, such as education and marital status.

Study Objectives: Sex differences in the prevalence of restless legs syndrome (RLS) have been reported, with a higher prevalence in women than in men. However, sex differences in clinical presentation remain unclear. We aimed to investigate the phenotypic differences in patients with RLS between sexes by comparing clinical presentations, iron status, polysomnographic parameters, and treatment., Methods: We retrospectively evaluated 614 patients (225 men, 389 women) diagnosed with RLS. To enhance the robustness of the study, an age-matched control group of 179 men and 286 women without sleep disorders was also included. Information on demographics and sleep-related questionnaires were collected. Iron status was evaluated using blood samples, and polysomnography was performed to evaluate periodic leg movements and comorbid sleep disorders., Results: Our analysis revealed no sex difference in the severity of RLS but a difference in the pattern of symptoms. Women had more frequent symptoms of pain and awakening during sleep, while men had more common motor symptoms (both self-reported symptoms and periodic leg movement on polysomnography). Women with RLS also had lower iron parameters and received more frequent iron supplementation therapy than men. In contrast to women with RLS, who presented higher sleep disturbances and depressive mood, men with RLS had a higher risk of comorbidities such as hypertension and cardiovascular disease. These sex differences were notably more pronounced than in the control group., Conclusions: This study suggests that sex differences exist in RLS phenotypes, and clinicians should consider these differences for treatment., Citation: Kim J, Kim JR, Park HR, Joo EY. Sex-specific patterns of discomfort in patients with restless legs syndrome. J Clin Sleep Med . 2024;20(2):253-259., (© 2024 American Academy of Sleep Medicine.)