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Background: Atezolizumab, one of the immune checkpoint inhibitors, has been approved as an adjuvant treatment following resection and platinum‐based chemotherapy in patients with stage II–IIIA non‐small cell lung cancer with 1% or more programmed death ligand‐1 (PD‐L1) expression. The Food and Drug Administration (FDA) has approved SP263 as a companion diagnostic assay for adjuvant treatment with atezolizumab; however, in clinical practice, the 22C3 assay is most commonly used for advanced non‐small cell lung cancer. Therefore, our study aimed to compare two PD‐L1 assays, SP263 and 22C3, to evaluate whether 22C3 could replace SP263 when deciding whether to administer adjuvant atezolizumab. Methods: We retrospectively and prospectively analyzed 98 patients who underwent surgical resection at Kanagawa Cancer Center (Japan). An immunohistochemistry assay was performed for all the cases with both SP263 and 22C3. We statistically analyzed the concordance of PD‐L1 expression between SP263 and 22C3 assays. Results: The concordance between the two assays using Cohen's kappa was κ = 0.670 (95% CI: 0.522–0.818) at the 1% cutoff and κ = 0.796 (95% CI: 0.639–0.954) at the 50% cutoff. The Spearman correlation coefficient of 0.874 (p < 0.01) indicated high concordance. PD‐L1 expression with 22C3 resulted slightly higher than that with SP263. Conclusions: This study showed a high concordance of PD‐L1 expression with the SP263 and 22C3 assays. Further studies examining the therapeutic effects of adjuvant atezolizumab are required. [ABSTRACT FROM AUTHOR]

Purpose: To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. Methods: The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. Results: LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. Conclusion: Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF. [ABSTRACT FROM AUTHOR]

Background: Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2; coronavirus 2019 [COVID‐19]), regional and temporal differences in SARS‐CoV‐2 testing in people with HIV across Europe have not been previously described. Methods: We described the proportions of testing, positive test results, and hospitalizations due to COVID‐19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS‐CoV‐2 and with ever testing positive. Results: Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3–26.1) had a SARS‐CoV‐2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central‐Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3, and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9–4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6–0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID‐19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe). Conclusions: We observed large heterogeneity in SARS‐CoV‐2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe. [ABSTRACT FROM AUTHOR]

Introduction: The presence of low‐voltage zones (LVZs) in the left atrium (LA) is associated with the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI). However, there is variability and conflict in the data regarding predictors of LVZs as reported in previous studies. The objective of this study was to identify predictors for the presence of LVZs in a cohort of patients with persistent AF. Methods: The study prospectively enrolled 439 patients with persistent AF who were scheduled for ablation. Voltage map of the LA was collected using a multipolar catheter. An LVZ was defined as an area of ≥3 cm2 exhibiting a peak‐to‐peak bipolar voltage of <0.5 mV. Results: The mean age of the cohort was 65.3 ± 8.6 years and 26.4% were female. Additionally, 25.7% had significant LVZs, most frequently located in the anterior wall of the LA. Multivariable analysis identified the following independent predictors for LVZ: advanced age (OR [odds ratio] = 1.08, 95% CI [confidence interval] = 1.03–1.13, p =.002); female sex (OR = 4.83, 95% CI = 2.66–8.76, p <.001); coronary artery disease (CAD) (OR = 3.20, 95% CI = 1.32–7.77, p =.01) and enlarged LA diameter (OR = 1.10, 95% CI = 1.04–1.17, p =.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the final model was 0.829. Conclusion: Approximately 25% of the patients with persistent AF had LVZs. Advanced age, female sex, CAD, and a larger LA were independent predictors for LVZs with the model demonstrating a very good AUC for the ROC curve. These findings hold the potential to be used to tailor the ablation procedure for the individual patient. [ABSTRACT FROM AUTHOR]

Aim: Efforts to combat frailty and preserve good health in older adults have highlighted oral frailty as an early indicator of overall frailty. Individuals showing oral frailty are at an elevated risk of insufficient nutritional intake compared with those without oral frailty; however, underlying mechanisms remain poorly explored. In this cross‐sectional study, we aimed to examine the link between oral frailty and undernutrition, especially regarding poor appetite and low dietary diversity. Methods: The analysis included 2727 late‐stage older adults (mean age 79.9 ± 4.3 years) who underwent dental checkups in a prefecture in Japan from 2016 to 2020. The examination involved a questionnaire survey (covering basic information, frailty screening index, appetite index: Simplified Nutritional Appetite Questionnaire; and dietary variety: Dietary Variety Score) and a measurement survey (including intraoral confirmation, oral diadochokinesis and masticatory efficiency test). Individuals with three or more indications of poor oral function, identified through oral function assessment, were defined as showing oral frailty. Binomial logistic regression and path analyses examined associations among oral frailty, Simplified Nutritional Appetite Questionnaire and Dietary Variety Score. Results: Among those analyzed, 1208 (44.3%) participants were categorized into the oral frailty group. Binomial logistic regression analysis showed that Simplified Nutritional Appetite Questionnaire (odds ratio for oral frailty per 1‐point increase 0.88, 95% confidence interval 0.84–0.93) and Dietary Variety Score (odds ratio 0.95, 95% confidence interval 0.92–0.98) were significantly associated with oral frailty. The path analysis showed individual associations between each examined factor. Conclusions: Oral frailty was associated with decreased appetite and dietary variety in late‐stage older adults. Geriatr Gerontol Int 2024; 24: 626–633. [ABSTRACT FROM AUTHOR]

Aim: Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection. Methods: In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables. Results: The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable‐adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5–2 versus <0.5 ng/mL: 1.61(1.04–2.49), PCT 2–10 versus <0.5 ng/mL: 1.91(1.15–3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84–4.59), high BNP 1.26 (0.89–1.76) and low Alb 0.68 (0.52–0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased. Conclusions: Concentration‐dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; 24: 571–576. [ABSTRACT FROM AUTHOR]

Aim: We investigated whether the Dementia Assessment Sheet for Community‐based Integrated Care System‐21 Items (DASC‐21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in‐hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. Methods: We retrospectively assessed the DASC‐21 score at the time of admission, in‐hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. Results: The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC‐21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC‐21 score was associated with an increased risk of in‐hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010–1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B‐type natriuretic peptide. Difficulties (3 or 4) with the self‐management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05–10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19–11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00–20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49–25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85–19.35, P = 0.003) were identified as risk factors for in‐hospital death. Patients in the highest tertile of the DASC‐21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). Conclusions: In elderly patients hospitalized for heart failure, higher DASC‐21 scores were associated with an increased risk of in‐hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546–553. [ABSTRACT FROM AUTHOR]

Aim: Advanced glycation end‐products (AGEs) are irreversibly and heterogeneously formed compounds during the non‐enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high‐fat and high‐protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community‐dwelling older adults. Methods: This cross‐sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5‐items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5‐items version ≥6 or not), and investigated the factors associated with fall risk. Results: The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53–0.733; sensitivity 0.415; specificity 0.814; P < 0.05). Conclusion: The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; 24: 517–522. [ABSTRACT FROM AUTHOR]

Aim: Despite limited evidence regarding the impact of sleep quality on sarcopenia, it is widely recognized as being associated with various diseases. This study aimed to explore the causal relationship between sleep traits and sarcopenia‐related traits. Methods: This study utilized a two‐sample bidirectional Mendelian randomization analysis. Genetic genome‐wide summary data of sleep quality indicators, including chronotype, morning wake‐up time, sleep duration, daytime napping, insomnia and daytime dozing, were used. Data on sarcopenia‐related traits, such as appendicular lean mass, grip strength of both hands, walking pace and waist circumference, were collected from a large cohort study. The primary method used was the inverse‐variance weighted analysis. Results: A causal association was found between chronotype and appendicular lean mass (odds ratio [OR] 1.019, 95% confidence interval [CI] 1.016–1.211, P = 0.021). Napping during the day was connected with walking pace (OR 0.879, 95% CI 0.834–0.928, P = 2.289 × 10−6) and waist circumference (OR 1.234, 95% CI 1.081–1.408, P = 0.002). Insomnia was related to lower grip strength of the right hand (OR 0.844, 95% CI 0.747–0.954, P = 0.007), left hand (OR 0.836, 95% CI 0.742–0.943, P = 0.003), as well as walking pace (OR 0.871, 95% CI 0.798–0.951, P = 0.002). Furthermore, the reverse Mendelian randomization analysis showed associations between certain sarcopenia‐related traits and poor sleep quality. Conclusions: Some sleep traits were associated with the occurrence of sarcopenia. These findings emphasized the significance of prioritizing sleep quality as a preventive measure against sarcopenia. Geriatr Gerontol Int 2024; 24: 537–545. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults. Methods: This cross‐sectional study enrolled 29 039 community‐dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster‐related damage (by complete or not complete housing damage) and psychological damage (by post‐traumatic stress reaction [PTSR]) after the GEJE using a self‐report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster‐related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables. Results: Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19–0.27) and PTSR (β = 0.60; 95% CI: 0.53–0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR. Conclusions: Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; 24: 509–516. [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity is prevalent among children and adults. Yet, understanding the relationship between parent and child weight trajectories is limited. Objective: (1) Examine the association between parent/child undesirable body mass index (BMI) category change. (2) Assess whether parental BMI category predicts child modified BMI z‐score (mBMIz) annual change. Methods: We conducted a cross‐sectional study of weight trajectories of 3821 parent–child dyads between March 2020 and December 2021 within the NYC Health + Hospitals system. Undesirability of child and parental BMI category change and the magnitude of mBMIz change by parental BMI are analysed. Results: Of 3821 children (mean [SD] baseline age, 9.84 [3.51]), 1889 were female. Of the 3220 parents (mean [SD] baseline age, 39.9 [8.51]), 2988 were female. Most children (53.52%) and parents (81.94%) presented with overweight and obesity. Undesirable BMI change in children was associated with concordant change in parents (adjusted OR: 1.7, 95% CI [1.45, 2.01], adjusted p < 0.001). Children of parents with obesity (adjusted coef: 0.076, 95% CI [0.004, 0.147], p < 0.038) and severe obesity (adjusted coef: 0.1317, 95% CI [0.024, 0.239], adjusted p < 0.016) demonstrated greater change in mBMIz than those of parents with normal weight or underweight. Conclusion: Parents and children have concordant weight trajectories, and public health interventions targeting both populations are essential. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common chronic liver disease among US children. Studies have associated food insecurity with MASLD in adults, but there are few studies of pediatric MASLD, particularly in high‐risk populations. We assessed the impact of household food insecurity at 4 years of age on MASLD in Latinx children. Methods: Using a prospective cohort design, Latina mothers were recruited during pregnancy and followed with their children until early to mid‐childhood. Our primary exposure was household food insecurity at 4 years of age measured using the validated US Household Food Security Food Module. Our primary outcome, MASLD, was defined as alanine transaminase (ALT) ≥95th% for age/gender plus body mass index (BMI) ≥85% at time of ALT measurement (assessed between ages 5–12). We used multivariable logistic regression models to test for independent associations between household food insecurity and pediatric MASLD. Results: Among 136 children, 28.7% reported household food insecurity at 4 years of age and 27.2% had MASLD in early to middle childhood. Approximately 49% of children with MASLD and 21% of children without MASLD were food insecure (p < 0.01). Exposure to household food insecurity at age 4 was independently associated with a 3.7‐fold higher odds of MASLD later in childhood (95% CI: 1.5–9.0, p < 0.01). Conclusions: Exposure to household food insecurity at 4 years of age was associated with increased risk for MASLD later in childhood. Further studies are needed to explore mechanism(s) and impact of reducing food insecurity on risk for MASLD. [ABSTRACT FROM AUTHOR]

Objectives: To investigate gender‐specific factors associated with case complexity in a population‐based sample of middle‐aged and older adults using a holistic approach to complexity. Methods: Data were derived from the 8‐year follow‐up home visits of the ESTHER study—a German population‐based study in middle‐aged and older adults. Cross‐sectional analyses were conducted for 2932 persons (aged 57–84). Complexity was assessed by the well‐established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio‐psycho‐social variables and case complexity was analyzed using gender‐specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). Results: Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05–3.30; OR men: 3.19, 1.25–8.12), higher total somatic morbidity (women: 1.08, 1.04–1.12; men: 1.06, 1.02–1.11), higher depression severity (women: 1.34, 1.28–1.40; men: 1.35, 1.27–1.44), and higher loneliness scores (women: 1.19, 1.05–1.36; men: 1.23, 1.03–1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11–2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09–3.74) higher odds for complexity only in men. Conclusions: This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle‐aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle‐aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies. Key points: Prevalence of complexity was found to be 8.3% with significantly higher prevalence in women (10.6%) compared to men (5.8%) (p < 0.001).Being divorced, higher total somatic morbidity, higher depression severity, and higher loneliness scores were associated with higher odds for complexity in both genders.Obesity was linked to higher odds for complexity only in women, while high oxidative stress was linked to complexity only in men.This study expands the holistic understanding of complexity by identifying novel variables associated with complexity in middle‐aged and older adults, including loneliness for both genders and high oxidative stress for men. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship between precarious employment (PE) and mental well‐being, focusing on age‐specific interactions. Methods: Nationally representative Korean workers (N = 29,961) were surveyed between 2020 and 2021 to collect data on multidimensional PE (categorized as low, moderate, or high) and the WHO‐5 well‐being index. Workers' ages were classified as young (<35 years), middle‐aged (35–54 years), and older (≥55 years). Logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). The interaction between PE and age on well‐being was examined by including interaction terms in the regression models. Results: The prevalence of poor well‐being was 25%, 29%, and 39% for low, moderate, and high precariousness, respectively, whereas it was 26%, 30%, and 39% for young, middle‐aged, and older workers, respectively. In the overall sample, the OR (95% CI) of the association between PE and poor well‐being was 1.24 (1.17–1.32) for moderate and 1.54 (1.43–1.65) for high precariousness, compared with low precariousness. There was a significant interaction between old age and PE on the odds of poor well‐being. Compared with young workers with low PE, middle‐aged workers with high PE (OR: 1.85, 95% CI: 1.62–2.10) and older workers with high PE (OR: 2.10, 95% CI: 1.83–2.40) exhibited increased odds of having poor mental well‐being. Conclusion: PE serves as a social determinant of older workers' psychological well‐being. Policy interventions are required to protect older workers' psychological well‐being. Key points: We explored how precarious employment (PE) interacts with workers' age to affect the mental well‐being of employees.The odds of experiencing poor mental well‐being was greater for older workers with higher PE compared with those with lower PE.We observed a supra‐multiplicative interaction between workers' age and PE on the odds of experiencing poor mental well‐being.Policy interventions are required to protect the mental health of precarious older workers. [ABSTRACT FROM AUTHOR]

Background and aims: Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use. Design: Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states. Setting and participants: Adolescent‐parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5). Measurements Alcohol, tobacco, cannabis and 3,4‐methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3–7. Potential confounders were collected at Waves 1–6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status. Findings Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5–7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07–1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07–1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43–8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59–20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95–8.81) were associated with transitioning to polysubstance use. Conclusions: Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets. [ABSTRACT FROM AUTHOR]

Background and aims: E‐cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state‐level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state‐level ENDS and tobacco policies, as well as the youth's cigarette smoking status. Design: Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state‐year database on tobacco and ENDS policies. Multivariable discrete‐time event history models of ENDS initiation were estimated. Setting: United States. Participants: Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations). Measurement We examined comprehensive indoor vaping bans (i.e. 100% vape‐free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22. Findings Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio‐demographic background and state‐level covariates. Conclusions: In the United States, state‐level vaping bans (i.e. 100% vape‐free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use. [ABSTRACT FROM AUTHOR]

Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) post-stroke is often problematic, despite potential benefits. This study aimed to evaluate CPAP adherence in patients with OSA post-stroke based on the Andersen behavioral model of health services utilization. A total of 227 eligible participants were recruited from a Chinese hospital. After baseline assessment, participants were followed for 6 months to determine short-term CPAP adherence. Those with good short-term adherence were followed for an additional 6 months to explore long-term adherence and influencing factors. Short-term CPAP adherence rate was 33%. Being married or living with a partner, having an associate degree or baccalaureate degree or higher, and stronger health beliefs independently predicted short-term CPAP adherence. Only 25% of participants from the adherent group showed good long-term adherence. The factor associated with long-term CPAP adherence was participants not using alcohol. Adherence to CPAP is suboptimal among patients having OSA post-stroke. Addressing unfavorable predisposing factors and modifying health beliefs are suggested. [ABSTRACT FROM AUTHOR]

Background: Rough sex refers to consensual sexual activities that incorporate playful aggression, such as hair pulling, spanking, or choking. It is relevant in the context of sexual health as it can enhance sexual arousal, pleasure, and intimacy among consenting partners. However, it can also be associated with consent violations, discomfort, and injuries ranging from mild to severe or even fatal. The prevalence of rough sex in Germany is widely unknown. Our study aims to establish, for the first time, the overall age‐related and gender‐related prevalence rates of active and passive rough sex involvement among adults in Germany. Methods: A national online sample of 1101 adults from Germany, aged 18–69 years (50% men, 49% women, 1% gender‐diverse individuals) gave informed consent and reported on their lifetime engagement in rough sex in active and passive roles. We recruited participants through a professional panel provider for a multi‐themed sexual health survey. Data analysis was conducted using R, with 95% confidence intervals of prevalence rates computed to answer the research questions. Results: Lifetime prevalence of rough sex involvement was 29%. Adults below the age of 40 reported higher rates of involvement (up to 43%) than people over 40 (up to 26%). Men reported predominantly active role involvement and women reported primarily passive role involvement. Discussion: Results show that rough sex is common. Sexual health professionals, educators, and researchers should be prepared to guide current and aspiring practitioners of rough sex, helping them understand potential benefits, risks, and age‐ and gender‐related differences. [ABSTRACT FROM AUTHOR]

Context: In the United States (US) men who undergo vasectomy and/or vasectomy reversal (vasovasotomy) are likely to pay out‐of‐pocket for these procedures. We characterized the publicly disclosed pricing of both procedures with a focus on variability in self‐pay prices. Methods: We queried all US hospitals for publicly disclosed prices of vasectomy and vasovasotomy. We assessed interhospital variability in self‐pay pricing and compared hospitals charging high (≥75th percentile) and low (≤25th percentile) self‐pay prices for either procedure. We also examined trends in pricing after the 2022 US Supreme Court decision that allowed individual states to ban abortion. Results: Of 6692 hospitals, 1375 (20.5%) and 281 (4.2%) disclosed self‐pay prices for vasectomy and vasovasotomy, respectively. There was a 17‐fold difference between the 10th and 90th percentile self‐pay prices for vasectomy ($421–$7147) and a 39‐fold difference for vasovasotomy ($446–$17,249). Compared with hospitals charging low (≤25th percentile) self‐pay prices for vasectomy or vasovasotomy, hospitals charging high (≥75th percentile) prices were larger (median 150 vs. 59 beds, p < 0.001) and more likely to be for‐profit (31.2% vs. 7.8%, p < 0.001), academic‐affiliated (52.7% vs. 23.1%, p < 0.001), and located in an urban zip code (70.1% vs. 41.3%, p < 0.001). From October 2022 to April 2023, the median self‐pay price of vasectomy increased by 10% (from $1667 to $1832) while the median self‐pay price of vasovasotomy decreased by 16% (from $3309 to $2786). Conclusion: We found large variability in self‐pay pricing for vasectomy and vasectomy reversal, which may serve as a barrier to the accessibility of male reproductive care. [ABSTRACT FROM AUTHOR]

Background: Dietitians are central members of the multidisciplinary long‐term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end‐of‐life care via referrals. Methods: Retrospective chart reviews for 164 deceased residents (mean age = 88.3 ± 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2‐week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time‐varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life. Results: Nearly three‐quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort‐focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04). Conclusions: Our findings suggest that dietitians are involved in end‐of‐life and comfort‐focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team. Key points: Dietitian referrals increased in prevalence in the last 2 weeks of life for residents living in Ontario long‐term care homes.Residents experienced a variety of complex eating challenges that required additional support from a dietitian.Dietitian referrals were associated with the initiation of comfort‐focused nutrition care orders.With earlier engagement, dietitians would be well positioned to champion and manage a palliative approach to care among multidisciplinary long‐term care teams. [ABSTRACT FROM AUTHOR]

Background: Studies on the association between vegetarian diets and nonalcoholic fatty liver disease (NAFLD) are limited and have inconsistent results. This study aims to explore the association between vegetarian diets and NAFLD and compare the stage of fibrosis between vegetarians and nonvegetarians in a US representative sample. Methods: Cross‐sectional data from 23,130 participants aged ≥20 years were obtained from the National Health and Nutrition Examination Survey, 2005–2018. Vegetarian status was classified based on two 24‐h dietary recalls. We examined the association between vegetarian diets and the risk of NAFLD using the propensity score weighting method. Results: Vegetarian diets were significantly associated with decreases in hepatic steatosis index (HSI), US fatty liver index and nonalcoholic fatty liver disease fibrosis score with mean differences of −2.70 (95% confidence interval [CI]: −3.69, −1.70), −3.03 (95% CI: −7.15, −0.91) and −0.12 (95% CI: −0.26, −0.01), respectively. While modelling the risk of NAFLD, we estimated that vegetarians were 53% less likely to have NAFLD assessed by HSI (odds ratios [OR]: 0.47; 95% CI: 0.34, 0.65). The effect of vegetarian diets was higher among individuals with lower waist circumferences (OR: 0.20) than among those with higher waist circumferences (OR: 0.53, pinteraction ${p}_{\text{interaction}}\,$= 0.004). However, the association was largely attenuated after adjusting for body mass index and diabetes status. No significant association was identified between vegetarian diets and advanced fibrosis. Conclusions: Vegetarian diets were associated with a lower prevalence of NAFLD among US adults, and the association appeared to be stronger in people with lower waist circumferences. Further studies are warranted to replicate our findings. Key points: Vegetarians had low risks of nonalcoholic fatty liver disease (NAFLD) development.A stronger association was observed among people with lower waist circumferences.Vegetarians were observed to have lower degrees of fibrosis among people with NAFLD.Future nutritional interventions may prioritise a low‐inflammatory dietary plan. [ABSTRACT FROM AUTHOR]

Background: An increasing number of care‐dependent older people living at home need external support to receive regular dental care. Objectives: To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self‐care and nutrition. Materials and Methods: This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population‐based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6‐month follow‐up. Results: At baseline, 43% of participants reported visits to oral health care within the previous year. At 6‐month follow‐up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6‐month follow‐up (OR = 1.1, 95% CI = 1.0–1.2; OR = 3.4, 95% CI = 1.5–7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1–0.4). Belonging to the intervention group was not associated with increased use. Conclusions: In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services. [ABSTRACT FROM AUTHOR]

Background and Objectives: Prior research has shown that temporary deferrals negatively influence donor return rates, but it remains unknown the extent to which these effects vary across reasons for deferral. We investigate whether deferrals differ in their degree of perceived stigmatization and, if so, how being deferred for stigmatizing (vs. non‐stigmatizing) reasons affects subsequent donation behaviour. Materials and Methods: We examined whether reasons for deferral vary on their perceived level of stigmatization through an online survey (n = 400). Furthermore, we used a dataset encompassing 25 years of donation records from the state‐run blood collection agency (BCA) from Rio de Janeiro, Brazil, to investigate how stigmatizing (vs. non‐stigmatizing) reasons for deferral affected return rates of 82,648 donors over a 60‐month follow‐up period. Results: Being deferred for sex‐ and drug‐related reasons was perceived as much more stigmatizing than other reasons for deferral (odds ratio = 3.14, 95% confidence interval [CI]: 2.33–4.25). Controlling for multiple observables, prospective donors were less likely to return to the BCA when deferred for stigmatizing (vs. non‐stigmatizing) reasons (adjusted hazard ratio = 0.87, 95% CI: 0.83–0.93). Conclusion: Donors perceive deferrals motivated by sex‐ and drug‐related reasons as particularly stigmatizing, which is negatively associated with donor return rates. BCAs may want to pay special attention when communicating stigmatizing reasons for deferral to prospective donors. [ABSTRACT FROM AUTHOR]

Objective: To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early‐career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. Methods: A cross‐sectional study. Design: A questionnaire‐based study. Setting: Australian general practice. Participants: Early‐career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. Main Outcome Measures: Current provision of NHV and HV. Results: NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major‐city practice, was strongly associated with performing NHV as an early‐career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early‐career specialist GP. On multivariable analyses, these were no longer statistically significant. Conclusion: Early‐career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV. [ABSTRACT FROM AUTHOR]

Background and Aim: This study systematically reviewed and meta‐analyzed the performance of the Asia–Pacific Colorectal Screening (APCS) score and its incorporation with the fecal immunochemical test (FIT) in stratifying the risk of advanced colorectal neoplasia (ACN). Methods: We systematically searched for relevant articles in 12 electronic databases and registers on October 20, 2021, and updated the search to September 1, 2023. Random‐effect models were used to obtain the pooled performance statistics of the APCS score for ACN risk. Results: From the 101 records screened, 13 eligible studies in the Asia–Pacific region involving 69 762 subjects who had undergone colonoscopy were enrolled. The pooled prevalences of ACN in the average‐risk (AR) tier (APCS 0–1), moderate‐risk (MR) tier (APCS 2–3), and high‐risk (HR) tier (APCS ≥ 4) groups were 0.9%, 3.1%, and 8.1%, respectively. Compared with the combined AR–MR group, the HR group was significantly associated with a higher ACN risk (pooled diagnostic odds ratio: 2.84, 95% confidence interval [CI]: 2.35–3.45, P < 0.001). The APCS score showed a sensitivity of 0.42 (95% CI: 0.40–0.44) and a specificity of 0.86 (95% CI: 0.85–0.86) for predicting the ACN risk, with a weighted area under the curve of 0.642 (95% CI: 0.610–0.657). The combination of the APCS score and FIT substantially improved ACN risk identification, demonstrating pooled diagnostic odds ratios of 4.02 (95% CI: 2.50–6.49) in the AR–MR groups and 5.44 (95% CI: 1.89–15.63) in the MR–HR groups. Conclusions: The APCS score could effectively stratify the ACN risk in the Asia–Pacific population. Incorporating FIT further improves its performance in identifying high‐risk subjects who should be prioritized for colonoscopy screenings. [ABSTRACT FROM AUTHOR]

Aim: Investigating the association between sugar‐sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. Materials and Methods: Cross‐sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30–50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC‐AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self‐reported diabetes. Results: Among 4473 cases analysed, 198 self‐reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30–2.06), ≥7 (OR 1.92; 95% CI = 1.50–2.46) and ≥14 (OR 2.19; 95% CI = 1.50–3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self‐reported diabetes had less impact than the cumulative effect. Conclusions: SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes. [ABSTRACT FROM AUTHOR]

Aim: To evaluate site‐related changes in periodontal pocket depth (PPD) after non‐surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis. Materials and Methods: PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow‐ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi‐level logistic regression analysis was performed to identify factors influencing PPD changes during SPC. Results: This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (−1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p <.001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118–0.540), residual pockets (p <.001, OR: 0.503, 95% CI: 0.429–0.590) and TM Degrees I–III (Degree I: p =.002, OR: 0.765, 95% CI: 0.646–0.905; Degree II: p =.006, OR: 0.658, 95% CI: 0.489–0.886; Degree III: p =.023, OR: 0.398, 95% CI: 0.180–0.879) correlated significantly with increasing PPD. Conclusions: Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I–III and residual pockets after APT lead to worsening of periodontal pockets. [ABSTRACT FROM AUTHOR]

Background: Point‐of‐care ultrasound is an invaluable bedside tool for anesthesiologists and has been integrated into anesthesiology residency training and board certification in the United States. Little is known about point‐of‐care ultrasound training practices in pediatric anesthesia fellowship programs. Aims: To describe the current state of point‐of‐care ultrasound education in pediatric anesthesia fellowship programs in the United States. Methods: We conducted a cross‐sectional survey study distributed to 60 American Accreditation Council for Graduate Medical Education‐accredited pediatric anesthesia fellowship programs. Two programs were in their initial accreditation period and were excluded due to lack of historical data. Program directors or associate program directors were invited to complete this 23‐item survey. Results: Thirty‐three of fifty‐eight programs (57%) completed the survey. Of those, 15 programs (45%) reported having a point‐of‐care ultrasound curriculum. Programs with ≤3 fellows per year were less likely to have an ultrasound curriculum compared to programs with ≥4 fellows per year (30% programs 0–3 fellows/year vs. 69% programs ≥4 fellows/year, odds ratio 0.19 [95% confidence intervals 0.04–0.87]; p =.03). Program directors and associate program directors rated point‐of‐care ultrasound training as highly valuable to fellows' education. Barriers to use most commonly included lack of experience (64%), lack of oversight/interpretive guidance (58%), and lack of time (45%). Programs without point‐of‐care ultrasound training had significantly higher odds of listing lack of ultrasound access as a primary barrier (50% programs without vs. 13% programs with, odds ratio 6.5, [95% confidence intervals 1.3–50]; p =.04). Conclusions: This observational survey‐based study suggests that fewer than half of pediatric anesthesia training programs in the United States offer point‐of‐care ultrasound education. Additional research is needed to optimize this education and training in pediatric anesthesia fellowship programs. [ABSTRACT FROM AUTHOR]

Aim: Optimising preconception health increases the likelihood of conception, positively influences short‐ and long‐term pregnancy outcomes and reduces intergenerational chronic disease risk. Our aim was to synthesise study characteristics and maternal outcomes of digital or blended (combining face to face and digital modalities) interventions in the preconception period. Methods: We searched six databases (PubMed, Cochrane, Embase, Web of Science, CINHAL and PsycINFO) from 1990 to November 2022 according to the PRISMA guidelines for randomised control trials, quasi‐experimental trials, observation studies with historical control group. Studies were included if they targeted women of childbearing age, older than 18 years, who were not currently pregnant and were between pregnancies or/and actively trying to conceive. Interventions had to be delivered digitally or via digital health in combination with face‐to‐face delivery and aimed to improve modifiable behaviours, including dietary intake, physical activity, weight and supplementation. Studies that included women diagnosed with type 1 or 2 diabetes were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality criteria checklist. Study characteristics, intervention characteristics and outcome data were extracted. Results: Ten studies (total participants n=4,461) were included, consisting of nine randomised control trials and one pre–post cohort study. Seven studies received a low risk of bias and two received a neutral risk of bias. Four were digitally delivered and six were delivered using blended modalities. A wide range of digital delivery modalities were employed, with the most common being email and text messaging. Other digital delivery methods included web‐based educational materials, social media, phone applications, online forums and online conversational agents. Studies with longer engagement that utilised blended delivery showed greater weight loss. Conclusion: More effective interventions appear to combine both traditional and digital delivery methods. More research is needed to adequately test effective delivery modalities across a diverse range of digital delivery methods, as high heterogeneity was observed across the small number of included studies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)‐guided suction curettage alone for cesarean scar pregnancy (CSP). Methods: Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS‐guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS‐guided suction curettage alone were analyzed. Results: Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100–14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148–12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617–50.881) were independent predictors of failure in TAUS‐guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. Conclusion: The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS‐guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose. [ABSTRACT FROM AUTHOR]

We investigated the associations of low handgrip strength (HGS, i.e., a marker of muscular fitness) with liver fat content (LFC) and serum liver enzymes in a population‐based setting. We used data from 2700 participants (51.7% women), aged 21–90 years, from two independent cohorts of the population‐based Study of Health in Pomerania (SHIP‐START‐2 and SHIP‐TREND‐0). Cross‐sectional, multivariable adjusted regression models were performed to examine the associations of HGS with LFC, measured by magnetic resonance imaging and serum liver enzymes. We found significant inverse associations of HGS with both LFC and serum liver enzymes. Specifically, a 10‐kg lower HGS was associated with a 0.59% (95% confidence interval [CI]: 0.24–0.94; p = 0.001) higher LFC, a 0.051 µkatal/L (95% CI: 0.005–0.097; p = 0.031) higher gamma‐glutamyltransferase (GGT) concentration and a 0.010 µkatal/L (95% CI: 0.001–0.020; p = 0.023) higher aspartate aminotransferase (AST) concentration. The adjusted odds‐ratio for prevalent hepatic steatosis (defined by a MRI‐PDFF ≥5.1%) per 10‐kg lower HGS was 1.21 (95% CI: 1.04–1.40; p = 0.014). When considering only obese individuals, those with low HGS had a 1.58% (95% CI: 0.18–2.98; p = 0.027) higher mean LFC and higher chance of prevalent hepatic steatosis (adjusted OR 1.74, 95% CI: 1.15–2.62; p = 0.009) compared to individuals with high HGS. We found similar associations in individuals with overweight, but not in those with normal weight. Lower HGS was strongly associated with both higher LFC and higher serum GGT and AST concentrations. Future studies might clarify whether these findings reflect adverse effects of a sedentary lifestyle or aging on the liver. Highlights: We used magnetic resonance imaging, the most accurate and sensitive noninvasive diagnostic tool for determination of hepatic steatosisLower handgrip strength was strongly associated with both higher liver fat content and higher serum GGT and AST concentrationsEspecially overweight and obese individuals with low handgrip strength had a significant higher risk of prevalent hepatic steatosis [ABSTRACT FROM AUTHOR]

We aimed to assess the effects of muscle disuse on muscle strength (MS), muscle mass (MM) and cardiovascular fitness. Databases were scrutinized to identify human studies assessing the effects of muscle disuse on both (1) MM and (2) maximal oxygen uptake (VO2max) and/or MS. Random‐effects meta‐analysis and meta‐regression with initial physical fitness and length of the protocol as a priori determined moderators were performed. We quantitatively analyzed 51 different studies, and the level of significance was set at p < 0.05. Data from the participants in 14 studies showed a decline in both VO2max (SMD: −0.93; 95% CI: −1.27 to −0.58) and MM (SMD: −0.34; 95% CI: −0.57 to −0.10). Data from 47 studies showed a decline in strength (−0.88; 95% CI: −1.04 to −0.73) and mass (SMD: −0.47; 95% CI: −0.58 to −0.36). MS loss was twice as high as MM loss, but differences existed between anatomical regions. Notably, meta‐regression analysis revealed that initial MS was inversely associated with MS decline. VO2max and MS decline to a higher extent than MM during muscle disuse. We reported a more profound strength loss in subjects with high muscular strength. This is physiologically relevant for athletes because their required muscular strength can profoundly decline during a period of muscle disuse. It should however be noted that a period of muscle disuse can have devastating consequences in old subjects with low muscular strength. Highlights: Disuse induces a greater decline in muscular and cardiovascular fitness than in muscle mass (MM).Initial fitness level is inversely associated with fitness decline but not with MM loss.Muscle strength loss is likely due to neural rather than muscular factors.The role of muscular factor on strength loss can change depending on the anatomical region. [ABSTRACT FROM AUTHOR]

Background: Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery. Methods: This is a single‐center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020–2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini‐Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's‐Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3‐Minute Diagnostic Confusion Assessment Method (3D‐CAM) test administered by the geriatric team, and identification through the medical records using the Chart‐based Delirium Identification Instrument (CHART‐DEL). We used multivariable regression to assess the risk factors for postoperative delirium. Results: Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0–1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1–4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use. Conclusions: HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity and functional limitation are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on health‐related quality of life in patients with HF is not well understood. Methods: Patients aged ≥30 years with two or more HF diagnostic codes and one or more HF‐related prescription drugs from four U.S. institutions were mailed a survey to measure patient‐centric factors including functional status (activities of daily living [ADLs]) and health‐related quality of life (PROMIS‐29 Health Profile). Patients with HF from January 1, 2013 to February 1, 2018 were included. Multimorbidity was defined as ≥2 non‐cardiovascular comorbidities; functional limitation as any limitation in at least one of eight ADLs. Patients were categorized into four groups by multimorbidity (Yes/No) and functional limitation (Yes/No). We dichotomized the PROMIS‐29 sub‐scale scores at the median and calculated odd ratios for the four multimorbidity/functional limitation groups. Results: A total of 3330 patients with HF returned the survey (response rate 31%); 3020 completed the questions of interest and were retained. Among these patients (45% female; mean age 73 [standard deviation: 12] years), 29% had neither multimorbidity nor functional limitation, 24% had multimorbidity only, 22% had functional limitation only, and 25% had both. After adjustment, having functional limitation only was associated with higher anxiety (odds ratio [OR]: 3.44, 95% confidence interval [CI]: 2.66–4.45), depression (OR: 3.11, 95% CI: 2.39–4.06), and fatigue (OR: 4.19, 95% CI: 3.25–5.40); worse sleep (OR: 2.14, 95% CI: 1.69–2.72) and pain (OR: 6.73, 95% CI: 5.15–8.78); and greater difficulty with social activities (OR: 9.40, 95% CI: 7.19–12.28) compared with having neither. Results were similar for having both multimorbidity and functional limitation. Conclusion: Patients with only functional limitation have similar poor health‐related quality of life scores as those with both multimorbidity and functional limitation, underscoring the important role that physical functioning plays in the well‐being of patients with HF. [ABSTRACT FROM AUTHOR]

Background: Little is known about the trend of informal care (unpaid care provided by family or other caregivers) provided to nursing home residents before or during the COVID‐19 pandemic. This study assessed this trend during 2010–2021, for all and Medicaid versus non‐Medicaid residents. Methods: Using data from the RAND Health and Retirement Study longitudinal file, our study sample included a total of 2025 resident‐years (860 for Medicaid and 1165 for non‐Medicaid residents). We fit two‐part regression models to determine adjusted trends in average amount of informal care over time, and difference by resident Medicaid status. Results: Informal care received by residents reduced substantially over time, from an average of 39.2 h in the past month of interview in 2010–11 to 23.2 h in 2018–19, and then to 11.2 h in the COVID‐19 pandemic (2020–21). The reduced hours were due to both reduced percentages of nursing home residents who received any informal care and reduced hours of care among those who did receive it over time. Multivariable analyses confirmed this trend and similar downward trends for Medicaid versus non‐Medicaid residents. Medicaid residents on average received 10.02 fewer hours of informal care per month (95% confidence interval −17.16, −2.87; p = 0.006) than non‐Medicaid residents after adjustment for resident characteristics and time trends. Conclusion: Informal care provided to nursing home residents during 2010–2021 reduced over time, especially during the COVID‐19 pandemic (2020–21). Medicaid residents tended to receive less informal care than non‐Medicaid residents. [ABSTRACT FROM AUTHOR]

The article presents a study on trends in estrogen therapy (ET) use from a sample of ambulatory care visits to evaluate co-prescription of ET and sedating potentially inappropriate medications (PIMS) and assess whether ET was a marker for polypharmacy in women aged 65 and older. Topics include demographic and clinical characteristics of 2006-2016 ambulatory visits, prevalence of estrogen prescribing in ambulatory visits, and association between ET and polypharmacy.

Background: Prescribing cascades are important contributors to polypharmacy. Little is known about which older adults are at highest risk of experiencing prescribing cascades. We explored which older veterans are at highest risk of the gabapentinoid (including gabapentin and pregabalin)–loop diuretic (LD) cascade, given the dramatic increase in gabapentinoid prescribing in recent years. Methods: Using Veterans Affairs and Medicare claims data (2010–2019), we performed a prescription sequence symmetry analysis (PSSA) to assess loop diuretic initiation before and after gabapentinoid initiation among older veterans (≥66 years). To identify the cascade, we calculated the adjusted sequence ratio (aSR), which assesses the temporality of LD relative to gabapentinoid initiation. To explore high‐risk groups, we used multivariable logistic regression with prescribing order modeled as a binary dependent variable. We calculated adjusted odds ratios (aORs), measuring the extent to which factors are associated with one prescribing order versus another. Results: Of 151,442 veterans who initiated a gabapentinoid, there were 1,981 patients who initiated a LD within 6 months after initiating a gabapentinoid compared to 1,599 patients who initiated a LD within 6 months before initiating a gabapentinoid. In the gabapentinoid–LD group, the mean age was 73 years, 98% were male, 13% were Black, 5% were Hispanic, and 80% were White. Patients in each group were similar across patient and health utilization factors (standardized mean difference <0.10 for all comparisons). The aSR was 1.23 (95% CI: 1.13, 1.34), strongly suggesting the cascade's presence. People age ≥85 years were less likely to have the cascade (compared to 66–74 years; aOR 0.74, 95% CI: 0.56–0.96), and people taking ≥10 medications were more likely to have the cascade (compared to 0–4 drugs; aOR 1.39, 95% CI: 1.07–1.82). Conclusions: Among older adults, those who are younger and taking many medications may be at higher risk of the gabapentinoid–LD cascade, contributing to worsening polypharmacy and potential drug‐related harms. We did not identify strong predictors of this cascade, suggesting that prescribing cascade prevention efforts should be widespread rather than focused on specific subgroups. [ABSTRACT FROM AUTHOR]

Background: The electronic health record (EHR) presents new opportunities for the timely identification of patients at high risk of critical illness and the implementation of preventive strategies. This study aims to externally validate an EHR‐based Elders Risk Assessment (ERA) score to identify older patients at high risk of future critical illness during a primary care visit. Methods: This historical cohort study included patients aged ≥65 years who had primary care visits at Mayo Clinic Rochester, MN, between July 2019 and December 2021. The ERA score at the time of the primary care visit was used to predict critical illness, defined as death or ICU admission within 1 year of the visit. Results: A total of 12,885 patients were included in the analysis. The median age at the time of the primary care visit was 75 years, with 44.6% being male. 93.7% of participants were White, and 64.2% were married. The median (25th, 75th percentile) ERA score was 4 (0, 9). 11.3% of study participants were admitted to the ICU or died within 1 year of the visit. The ERA score predicted critical illness within 1 year of a primary care visit with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.83–0.85), which indicates good discrimination. An ERA score of 9 was identified as optimal for implementing and testing potential preventive strategies, with the odds ratio of having the primary outcome in patients with ERA score ≥9 being 11.33 (95%CI 9.98–12.87). Conclusions: This simple EHR‐based risk assessment model can predict critical illness within 1 year of primary care visits in older patients. The findings of this study can serve as a basis for testing and implementation of preventive strategies to promote the well‐being of older adults at risk of critical illness and its consequences. See related article by Haimovich and Deardorff. [ABSTRACT FROM AUTHOR]

Background: Half of all Medicare beneficiaries are enrolled in Medicare Advantage (MA). Many studies document lower care utilization and mortality in MA than traditional Medicare (TM), but evidence for persons with Alzheimer's disease and related dementias (ADRD) is limited. Methods: We conducted a retrospective cohort study of 2015–2018 Medicare claims and encounter data for community‐dwelling beneficiaries aged 65 and over in TM and MA with an incident ADRD diagnosis in 2017. We compared monthly hospitalization rates and outpatient visits 12 months before and after diagnosis and mortality 1 year from diagnosis. Models adjusted for sociodemographic characteristics and comorbidities. Sensitivity analyses addressed residual confounding using a control group with incident arthritis/glaucoma or excluding MA Special Needs Plans, and potential underreporting by restricting to MA plans with high data completeness. Results: Among 454,508 beneficiaries diagnosed with ADRD in 2017, 250,837 (55%) were in TM and 203,671 (45%) in MA. Four to 12 months before diagnosis, monthly hospitalizations and outpatient visits were similar in TM and MA. In the diagnosis month, 36.5% of beneficiaries in TM had a hospitalization compared with 25.4% in MA, an adjusted difference of 10.7 percentage points [95% CI: 10.3, 11.1]. Beneficiaries in TM averaged 10.5 outpatient visits in the diagnosis month compared with 8.4 in MA, an adjusted difference of 1.59 visits [95% CI: 1.47–1.70]. Utilization differences narrowed but remained higher in TM for many months. One‐year mortality was 27.9% in TM and 22.2% in MA; an adjusted odds ratio of 1.152 [95% CI: 1.135–1.169] for those in TM compared with MA. Controlling for hospitalization in the diagnosis month substantially reduced the mortality difference. Conclusion: Hospitalization rates and outpatient visits increased more after an ADRD diagnosis in TM than MA. One‐year post‐diagnosis, mortality was not higher in MA than TM but comparisons of quality of life and caregiver burden are needed. [ABSTRACT FROM AUTHOR]

Background: Older adults with severe dementia are at increased risk of being physically restrained in nursing homes and acute care settings, but little is known about restraint use among those cared for at home. This study explores caregiver‐reported use of restraints among community‐dwelling older adults with severe dementia. Methods: Using cross‐sectional data from 215 family caregivers, we describe restraint use among older adults with severe dementia living at home. We then use multivariable logistic regression to identify factors associated with restraint use. Results: Nearly half (47%) of caregivers reported on older adults who had been subject to restraints. Most caregivers reporting restraint use suggested safety reasons, such as prevention of falls (68%), wandering (30%), and removal of catheters or feeding tubes (29%); and 44% indicated doctors or other health care providers were involved in the decision to restrain. Feeding tubes (OR = 4.16, 95% CI: 1.27–13.59) and physically aggressive agitation behaviors (OR = 1.93, 95% CI: 1.09–3.40) were associated with higher odds of restraint use among older adults with severe dementia. Caregivers who received strong emotional support from friends (OR = 0.45, 95% CI: 0.21–0.95) were less likely to report restraint use while serving as a caregiver to others (OR = 2.77, 95% CI: 1.36–5.63) increased the odds of restraint use. Conclusions: The pervasiveness of restraint use is concerning and suggests a lack of evidence‐based guidance and support for both caregivers and healthcare providers to prevent restraint use among older adults with severe dementia cared for at home. [ABSTRACT FROM AUTHOR]

Background: Community‐dwelling older adults often serve as caregivers despite having their own health concerns and disabilities, yet little is known about their care needs. Methods: Cross‐sectional analysis including community‐dwelling U.S. adults over age 60 years who self‐identified as caregivers in the National Social Life, Health, and Aging Project in 2015–2016. Caregiving was defined by self‐reported assistance of another adult with day‐to‐day activities due to age or disability; overlapping care‐receiving was defined by simultaneous receipt of help for at least one activity of daily living (ADL) or independent ADL (IADL). Multivariable logistic regression models examined attributes associated with overlapping care‐receiving among older caregivers, adjusted for caregiver characteristics (age, gender, spousal caregiving, self‐reported physical and mental health, cognitive function, and household assets). Results: Among the 444 caregivers, the mean age was 67.8 (SD 0.29) years, 55.8% were women, 78.1% were non‐Hispanic White, 54.7% self‐identified as primary caregivers, and 30.7% were caring for a spouse. Thirty‐two percent of older caregivers were caregiving while themselves receiving assistance with at least one ADL or IADL. Thirty‐four percent of caregivers reported <$50,000 in household assets and 10% did not answer the question. Given prior research that supports that most nonrespondents fall into the low‐income group, subjects were combined. Analyses with and without nonrespondents did not substantially change the results. Compared to caregivers who were not simultaneously receiving care, caregivers reporting overlapping care‐receiving had greater odds of being older (AOR 1.30, 95% confidence interval [CI] [1.14, 1.48] per each 5‐year age increase), caregiving for a spouse (AOR 1.93, 95% CI [1.20, 3.13]), having limited household assets (AOR 2.10, 95% CI [1.17, 3.80], for <$50,000 compared to ≥$50,000), and having poor or fair self‐reported physical health (AOR 2.94, 95% CI [1.43, 6.02]). Conclusions: Over 30% of older adult caregivers report simultaneously receiving care for their own daily activities. Older caregivers who receive care are more likely to be older, spousal caregivers, and have limited assets and worse physical health. Targeted strategies are needed to support older caregivers who are uniquely vulnerable due to their overlapping care needs. [ABSTRACT FROM AUTHOR]

Background: Maternal risk factors for having a child diagnosed on the fetal alcohol spectrum disorders (FASD) continuum are complex and include not only the quantity, frequency, and timing of alcohol use but also a woman's physical stature, socio‐economic status, and pregnancy‐related factors. Exposure to trauma may predispose women to a range of physiological and mental disorders. A woman's mental and physical health may in turn influence her probability of having a child with FASD. This study investigated the role of maternal childhood trauma and lifetime traumatic stress on prenatal alcohol consumption and on the risk of having a child with FASD. Methods: A nested, case‐control study was conducted for maternal risk assessment. Study participants were mothers of first‐grade learners from five rural communities in the Western Cape Province of South Africa who were assessed for FASD. Face‐to‐face surveys were conducted, which included mental health and trauma assessment questionnaires. Results: In logistic regression analyses, higher maternal childhood trauma scores were associated with an increased likelihood of having a child diagnosed with FASD, although the increase in risk was modest (OR = 1.014, p = 0.015). In addition, structural equation modeling investigated relationships between maternal drinking, childhood trauma, traumatic stress, and a child's FASD diagnosis. Traumatic stress and drinking during pregnancy, but not lifetime alcohol use, were associated with maternal childhood trauma. Lifetime alcohol use influenced drinking during pregnancy, which in turn was significantly associated with having a child diagnosed on the continuum of FASD. Conclusion: No direct influence of maternal childhood trauma on FASD diagnosis could be demonstrated. However, maternal trauma may indirectly contribute to the risk of having a child diagnosed with FASD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID‐19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health‐related outcomes within an adolescent cohort followed during the pandemic. METHODS: During 3 semi‐annual follow‐up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self‐efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting. RESULTS: Relative to in‐person instruction, students in remote instruction reported lower academic self‐efficacy (Beta: −0.11; 95% confidence interval [CI]: −0.22, −0.01) and school connectedness (Beta: −0.37; 95% CI: −0.48, −0.25), greater odds of past 30‐day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30‐day e‐cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86). CONCLUSIONS: Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether eligibility for an age‐related universal (pioneer generation [PG]) subsidy incentivises dental attendance by older Singaporeans. Methods: Data were collected between 2018 and 2021 from in‐person interviews of Singaporean adults aged 60–90 years using a questionnaire and a clinical examination. The questionnaire included details of age, gender, ethnicity, education, residential status, socio‐economic status, marital status, eligibility for subsidy (community health assistance/CHAS, PG or both) and frequency of dental attendance. The clinical examination recorded number of teeth (categorized as edentulous, 1–9 teeth;10–19 teeth; ≥20 teeth). To estimate the effect of the PG subsidy on dental attendance pattern, a regression discontinuity (RD) analysis was applied using age as the assignment variable. Results: A total of 1172 participants aged 60–90 years (64.2% female) were recruited, with 498 (43%) being eligible for the PG subsidy. For those eligible for PG subsidy, there was a higher proportion of regular attenders than irregular attenders (53.6% vs. 46.4%). In age adjusted RD analysis, those eligible for the PG subsidy were 1.6 (95% CI: 1.0, 2.7) times more likely to report regular attendance than their PG non‐eligible counterparts. The association remained strong (OR 2.1; 95% CI: 1.1–3.7) even after further controlling for demographics, socioeconomic factors, number of teeth and eligibility for the CHAS subsidy. Conclusions: Being eligible for the PG subsidy substantially increased the odds of regular dental attendance. [ABSTRACT FROM AUTHOR]

Background: Patients with painful temporomandibular disorders (TMD) more often experience jaw functional limitations. The study of jaw functional limitations should be primarily focused on painful TMD. Objectives: The impact of TMD pain characteristics (source, chronicity and intensity) on jaw functional limitations were evaluated using Jaw Functional Limitation Scale (JFLS). Methods: This cross‐sectional study reviewed the dental records and self‐report questionnaires of patients with painful TMD. The pain source, chronicity and intensity were evaluated to study the TMD pain characteristics. The jaw functional limitations were analysed using the Thai version of the JFLS. Results: A total of 176 patients with painful TMD were included in this study. The jaw functional limitations were affected only by pain intensity. Patients with TMD with severe pain intensity had significantly higher jaw functional limitations than those with mild‐to‐moderate pain intensity (p <.05). A significant association was observed between pain intensity and jaw functional limitations (p <.05). Mastication was highly restricted by pain intensity (odd ratio = 1.39, 95% confidence interval = 1.16–1.67). Conclusion: The present study found a significant effect of TMD pain intensity on jaw functional limitations. Patients with severe TMD pain intensity were more likely to experience jaw functional limitations, particularly mastication limitation. Management focusing on reduction of pain intensity may improve jaw functions in patients with TMD. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress indicators affect chronic orofacial pain (COFP), but how to reduce these effects is uncertain. Objectives: 11 oxidative stress biomarkers were collected as exposures, while four forms of COFP were chosen as outcomes for Mendelian randomization (MR) study. Methods: The effect estimates between oxidative stress and COFP were calculated using inverse variance‐weighted MR (IVW‐MR). Then, functional mapping and annotation (FUMA) was utilized in order to carry out SNP‐based functional enrichment analyses. In addition, the IVW‐MR method was applied to combine effect estimates when using genetic variants associated with oxidative stress biomarkers as an instrument for exploring potential druggable targets. Results: The results indicated that oxidative stress biomarkers (causal OR of uric acid (UA), 0.998 for myofascial pain, 95% CI 0.996–1.000, p <.05; and OR of glutathione transferase (GST), 1.002 for dentoalveolar pain, 95% CI 1.000–1.003, p <.05) were significantly linked with the probability of COFP. Functional analysis also demonstrated that UA and myofascial pain genes were prominent in nitrogen and uracil metabolism, while GST and dentoalveolar pain genes were enriched in glutathione metabolism. Also, the study provided evidence that solute carrier family 2 member 9 (SLC2A9) and glutathione S‐transferase alpha 2 (GSTA2) cause discomfort in the myofascial pain (OR = 1.003, 95% CI 1.000–1.006; p <.05) and dentoalveolar region (OR = 1.001, 95% CI 1.000–1.002; p <.05), respectively. Conclusions: In conclusion, this MR study indicates that genetically predicted myofascial pain was significantly associated with decreased UA and dentoalveolar pain was significantly associated with increased GST level. SLC2A9 inhibitor and GSTA2 inhibitor were novel chronic orofacial pain therapies and biomarkers, but clinical trials are called to examine if these oxidative biomarkers have the protective effect against orofacial pain, and further research are needed to explore the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of food insecurity (FI) among patients in a regional New Zealand ED, factors associated with FI and feasibility of an ED‐based FI screening programme with voluntary social work (SW) follow up. Methods: Cross‐sectional study of patients presenting to the Whangarei Hospital ED, using the validated two‐item Hunger Vital Sign screening tool to assess for FI. Participants were offered SW follow up to discuss community food resources. Results: Of the 300 participants who completed the questionnaire, 111 (37.0%, 95% confidence interval [CI] 32.0–43.0) were food insecure. Factors associated with FI include Māori ethnicity (odds ratio [OR] 2.12 [95% CI 1.19–3.80], P = 0.011), household crowding (OR 1.19 [95% CI 1.02–1.39], P = 0.024) and lower socioeconomic status (OR 1.13 [95% CI 1.00–1.27], P = 0.048). There was no statistically significant association between FI and number of comorbidities or the primary reason for ED attendance. Of participants who were food insecure, only half reported being aware of (n = 56/111, 50.5%) or had used (n = 60/111, 54.1%) food resources. Participants who were food insecure were more likely to have utilised resources, either currently or in the past (OR 8.50 [95% CI 4.46–16.18], P < 0.001). Forty (13.3%) participants requested SW follow up and of those, most (n = 31/40, 77.5%) were successfully contacted. FI was associated with interest in SW follow up (OR 16.95 [95% CI 5.81–49.42], P < 0.001). At follow up, the majority (n = 24/31, 77.4%) of participants requested further information regarding food resources. Conclusion: FI was prevalent among patients in a regional NZ ED. An ED‐based FI screening programme with voluntary SW follow up was feasible and acceptable to ED patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of ketamine alone with those of ketamine‐dexmedetomidine combination for sedation during brain CT in paediatric patients with head injuries. Methods: We retrospectively analysed the data of paediatric patients who underwent sedation for brain CT at the ED. We included patients aged 6 months to 6 years with American Society of Anesthesiologists physical status I or II. The sedative protocol involved the administration of intramuscular (IM) ketamine 3 mg/kg (K), ketamine 2 mg/kg with dexmedetomidine 1.5 μg/kg (KD) or ketamine 1.5 mg/kg with dexmedetomidine 1.5 μg/kg (low‐KD). The primary and secondary outcomes were sedation failure and adverse events, respectively. Results: We included 77 patients; among them, 28, 23 and 26 were in the K, KD and low‐KD groups, respectively. In multivariable analysis, the combination groups (KD and low‐KD groups) were significantly associated with a lower possibility of sedation failure compared to the K group (adjusted odds ratio, 0.12; 95% confidence interval, 0.02–0.56). Moreover, there were no significant differences in adverse events between the groups, and the sedation‐related time variables also did not significantly differ among the three groups. Conclusions: Our findings indicated that a combination of IM ketamine‐dexmedetomidine provides effective sedation for paediatric patients undergoing brain CT without significant adverse events. Further research is needed to investigate the potential benefits of using lower doses of ketamine in combination. [ABSTRACT FROM AUTHOR]

Objective: Low acuity presentations (LAPs) contribute to large numbers of ED presentations and carry numerous consequences. The present study sought to improve the understanding of regional infant LAPs by analysing temporal patterns of presentation, discharge diagnoses and potential predictive factors. Methods: This retrospective observational study examined ED presentations among children less than 12 months old (infants) to the Royal Prince Alfred Hospital between 2017 and 2019. Descriptive statistics were used to identify temporal patterns of presentation and common discharge diagnoses among LAPs. Multivariable logistic regression was used to determine the association between early life, demographic and perinatal factors and low acuity presenters. Results: Of 6881 infant ED presentations, 19.8% were LAPs, occurring disproportionately on weekdays (82.2%) and during hours of 08.00–17.00 (69.9%). Respiratory tract infections and gastrointestinal complaints were most common overall, though non‐allergic rash, feeding difficulties, eczema and developmental concerns contributed substantially among LAPs. Socio‐economic status (SES) (odds ratio [OR] 1.71), overseas maternal nationality (OR 1.25) and Medicare ineligible maternal financial class (OR 0.49) were associated with low acuity presenters. Low appearance, pulse, grimace, activity and respiration score (OR 3.53), low SES (OR 3.26), complicated delivery (OR 1.64), maternal multiparity (OR 0.50), maternal partner presence (OR 0.40) and obstetric complications (OR 0.37) were associated with repeat, multi‐low acuity presenters (multi‐LAPs). Conclusion: A substantial minority of infant ED presentations are LAPs. Targeted interventions may benefit from focusing on families with a background of socioeconomic disadvantage, social isolation, cultural and linguistic diversity and perinatal complications, with a view to strengthening engagement with community‐based services among these groups. [ABSTRACT FROM AUTHOR]

Objective: Despite high in‐hospital mortality, the epidemiology of prehospital suspected sepsis presentations is not well described. This retrospective cohort study aimed to quantify the burden of such presentations, and to determine whether such a diagnosis was independently associated with longer‐term mortality. Methods: Retrospective, observational population‐based cohort study examining all adult prehospital presentations in Victoria, between January 2015 and June 2019, who required subsequent in‐hospital assessment. Linked data were extracted from clinical and administrative datasets. Demographics, illness severity, prehospital treatment and mortality were compared between prehospital suspected sepsis and non‐sepsis patients. Multivariable logistic regression was used to determine the adjusted association between prehospital assessment (suspected sepsis vs non‐sepsis) and 6‐month mortality. Results: A total of 1 218 047 patients were included. The age‐adjusted incidence rate of prehospital suspected sepsis was 65 cases per 100 000 person‐years. Those with prehospital suspected sepsis were older (74 vs 62 years), more frequently male (55% vs 47%), with greater physiological derangement. Intravenous cannulas were more often inserted prehospital (60% vs 29%). Crude in‐hospital mortality was 6.5‐fold higher in the prehospital suspected sepsis group (11.8% vs 1.8%), and by 6 months, 22.6% had died. After adjustment for demographics, illness severity, comorbidity, treatment and hospital location, a diagnosis of prehospital suspected sepsis was associated with a 35% higher likelihood of 6‐month mortality (OR 1.35, 95% CI 1.29–1.41). Conclusions: The burden of prehospital suspected sepsis in the Australian setting is significant, with paramedics identifying patients at high‐risk of poor longer‐term outcomes. This implies the need to consider improved care pathways for this highly vulnerable group. [ABSTRACT FROM AUTHOR]