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Objectives: This study examines how current marital status is associated with epigenetic aging. Methods: Data from the 2016 Health and Retirement Study were used to examine marital status differences in the four epigenetic clocks, that is, GrimAge, DunedinPoAm, PhenoAge, and Zhang (N = 3765). Weighted ordinary least square regression models were estimated separately for men and women. Results: Remarried, cohabiting, divorced/separated and widowed older adults showed greater epigenetic aging than the continuously married similarly among men and women. Distinct sex difference was observed among the never married. While never-married women exhibited greater epigenetic aging than their continuously married counterparts, older men in lifelong singlehood showed comparable epigenetic aging to their continuously married peers. Discussion: The findings speak to the importance of marital context for epigenetic aging in later life and the biological risk associated with lifelong singlehood for older women in the US. [ABSTRACT FROM AUTHOR]

Background: Diet, as a modifiable factor, plays an important role in cognitive function. However, the association between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), measured by Healthy Eating Index (HEI)-2015, and cognitive function remains unclear. This study aims to explore whether HEI-2015 is associated with various cognitive domains and whether such association is modified by age, gender, or ethnicity in the US adults aged 60 years or older using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014.Methods: HEI-2015 scores were calculated from 24-h dietary recall interviews. Cognitive function was evaluated by Digit Symbol Substitution Test (DSST, a measure of processing speed), Animal Fluency Test (AFT, a measure of executive function), a subtest from Consortium to Establish a Registry for Alzheimer's disease (CERAD, a measure of memory), and a composite-z score calculated by summing z scores of individual tests. The associations between HEI-2015 scores and cognitive performance were explored using multiple linear regression models.Results: A total of 2450 participants aged 60 years or older were included. Participants with higher HEI-2015 scores were more likely to have higher DSST, AFT as well as composite-z scores (P<0.05). Significant interaction effects were identified between HEI-2015 and ethnicity in specific cognitive domains (Pinteraction<0.05). Among HEI-2015 components, higher intakes of whole fruits and seafood and plant protein were associated with better cognitive performance (P<0.05).Conclusion: Higher adherence to DGA is associated with better cognitive performance, especially regarding processing speed and executive function among the US adults aged 60 years or older. [ABSTRACT FROM AUTHOR]

Objective: The link between marital quality and cellular aging remains underexplored. This study examined how both positive and negative marital quality were associated with salivary telomere length among partnered adults in the United States over the age of 50°years. Methods: Data were from the 2008 Health and Retirement Study (N = 3203). Ordinary least squares regression was used to estimate the link between marital quality and telomere length. Results: While neither positive nor negative marital quality was significantly associated with telomere length among older women, positive and negative marital quality had an interacting effect on telomere length among men. Specifically, when negative marital quality was low, higher positive marital quality was associated with shorter telomere length, whereas when negative marital quality was high, higher positive marital quality was associated with longer telomere length. Discussion: The findings speak to the complex nature of intimate partnerships and the implications of these partnerships for cellular aging processes. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is still spreading rapidly around the world. In this context, how to accurately predict the turning point, duration and final scale of the epidemic in different countries, regions or cities is key to enabling decision makers and public health departments to formulate intervention measures and deploy resources.Methods: Based on COVID-19 surveillance data and human mobility data, this study predicts the epidemic trends of national and state regional administrative units in the United States from July 27, 2020, to January 22, 2021, by constructing a SIRD model considering the factors of "lockdown" and "riot".Results: (1) The spread of the epidemic in the USA has the characteristics of geographical proximity. (2) During the lockdown period, there was a strong correlation between the number of COVID-19 infected cases and residents' activities in recreational areas such as parks. (3) The turning point (the point of time in which active infected cases peak) of the early epidemic in the USA was predicted to occur in September. (4) Among the 10 states experiencing the most severe epidemic, New York, New Jersey, Massachusetts, Texas, Illinois, Pennsylvania and California are all predicted to meet the turning point in a concentrated period from July to September, while the turning point in Georgia is forecast to occur in December. No turning points in Florida and Arizona were foreseen for the forecast period, with the number of infected cases still set to be growing rapidly.Conclusions: The model was found accurately to predict the future trend of the epidemic and can be applied to other countries. It is worth noting that in the early stage there is no vaccine or approved pharmaceutical intervention for this disease, making the fight against the pandemic reliant on non-pharmaceutical interventions. Therefore, reducing mobility, focusing on personal protection and increasing social distance remain still the most effective measures to date. [ABSTRACT FROM AUTHOR]

Substantial research shows that cardiovascular disease is a major cause of disability in the United States of America (USA) and worldwide. Despite the well-documented significance of intimate partnerships for cardiovascular health and disease management, how relationship quality contributes to the functional health of older adults diagnosed with cardiovascular disease is much less understood than mental health and mortality risk. Informed by the disablement process model and the lifecourse perspective, this study examines the association between relationship quality and functional limitations among partnered older adults aged 50 years and older diagnosed with cardiovascular disease in the USA. Data are from the Health and Retirement Study, 2006–2012 (N = 1,355). Multi-level linear regression analyses show that baseline negative relationship quality is significantly associated with increased functional limitations over the two- and four-year follow-ups. Additionally, the link between negative relationship quality and functional limitations is stronger among older adults with lower household income over a two-year span, compared to their higher-income counterparts, suggesting that these older adults are doubly disadvantaged by higher relationship strains and limited economic resources. Our findings demonstrate the significance of relationship quality for the functional health of older adults with cardiovascular disease and shed light on the importance of marriage/partnerships as an important social context for a critical stage in the disablement process (i.e. functional limitations). [ABSTRACT FROM AUTHOR]

This paper introduces the metric ‘mean duration of obesity’ to measure the average number of years lived with obesity in a population. A procedure was developed to estimate duration from periodic cross-sectional surveys. For annual cohorts born in the United States between 1925 and 1989, I estimated a logit model to derive age-cohort-specific probabilities of overweight and obesity (body mass index 25 to <30 and 30, respectively), and applied life table techniques to convert these into person-years. Duration of obesity by age 50 increased fourfold from 3.58 to 14.35 years. The rate of increase was stronger across the 1945-79 and 1980-89 cohorts than the 1925-44 cohorts. The trend was driven by increased risks of obesity among children: age groups under 20 were responsible for 31 per cent of the duration increase between the 1930 and 1960 cohorts, but 72 per cent between the 1960 and 1985 cohorts. [ABSTRACT FROM AUTHOR]

This study examines the self-reported health of 180,291 married non-Hispanic blacks and whites in interracial versus endogamous marriages. Data are from the National Health Interview Survey pooled over the period 1997-2013. The results from ordinal logistic regressions show that non-Hispanic whites intermarried with non-Hispanic blacks, non-Hispanic whites intermarried with non-Hispanic other races, and non-Hispanic white women with Hispanic husbands report significantly poorer health than their endogamous counterparts. Furthermore, non-Hispanic whites with non-Hispanic black spouses also fare worse than their interracially married peers with Hispanic spouses. In contrast, the self-reported health of married non-Hispanic blacks shows no significant difference between the interracially and the endogamously married. Our findings highlight the theoretical significance of spousal characteristics and couple-level contexts in the household production of health. [ABSTRACT FROM AUTHOR]

Both obesity (body mass index ≥ 30) and educational attainment have increased dramatically in the United States since the 1970s. This study analyzed the influences of educational inequalities in obesity and population improvements in education on national obesity trends between 1970 and 2010. For non-Hispanic white and black males and females aged 25–74 years, educational differences in the probability of being obese were estimated from the 1971–2012 National Health and Nutrition Examination Surveys, and population distributions of age and educational groups, from the 1970 Census and 2010 American Community Survey. In the total population, obesity increased from 15.7% to 38.8%, and there were increases in the greater obese probabilities of non-college graduates relative to four-year college graduates. The increase in obesity would have been lower by 10% (2.2 percentage points) if educational inequalities in obesity had stayed at their 1970 values and lower by one third (7.9 points) if obesity inequalities had been eliminated. Obesity inequalities were larger for females than males and for whites than blacks, and obesity did not differ by education among black males. As a result, the impact of obesity inequalities on the obesity trend was largest among white females (a 47% reduction in the obesity increase if obesity inequalities had been eliminated), and virtually zero among black males. On the other hand, without educational improvements, the obesity increase would have been 9% more in the total population, 23% more among white females and not different in the other three subpopulations. Results indicate that obesity inequalities made sizable contributions to the obesity trends, and the obesity reductions associated with educational improvements were more limited. [ABSTRACT FROM AUTHOR]

Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998-2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors. [ABSTRACT FROM AUTHOR]

The association between body mass index (BMI) categories and mortality remains uncertain. Using three National Health and Nutrition Examination Surveys covering the 1971–2006 period for cohorts born between 1896 and 1968, this study estimates separately for men and women models for year-of-birth (cohort) and year-of-observation (period) trends in how age-specific mortality rates differ across BMI categories. Among women, relative to the normal weight (BMI 18.5–24.9 kg/m2), there are increasing trends in mortality rates for the overweight (BMI 25–29.9) or obese (BMI ≥ 30). Among men, mortality rates relative to the normal weight decrease for the overweight, do not change for the moderately obese (BMI 30–34.9), and increase for the severely obese (BMI ≥ 35). Period and cohort trends are similar, but the cohort trends are more consistent. In the latest cohorts, compared with the normal weight, mortality rates are 50 percent lower for overweight men, not different for moderately obese men, and 100–200 percent higher for severely obese men and for overweight or obese women. For U.S. cohorts born after the 1920s, a lower overweight than normal weight mortality is confined to men. I speculate on possible reasons why the mortality association with overweight and obesity varies by sex and cohort. [ABSTRACT FROM AUTHOR]

Background: Preventive counselling is an effective approach to reducing the prevalence of non-communicable diseases. Studies have shown that there is a positive association between healthy behaviors of Colombian medical students and favorable attitudes towards preventive counselling. However, there is limited research that explores this relationship in different countries. The current study aimed to determine how the health behaviors of medical students from China, U.S., and Australia, are associated with attitudes towards preventive counseling.Methods: Students from five Chinese medical schools, Duke University in the U.S., and the University of Queensland in Australia, completed a 32-item, self-reported online survey. The survey was used to examine the prevalence of healthy behaviors and their association with attitudes towards preventive counseling. The target sample size was 150 students from each grade, or 450 students in total from different medical universities. Logistic regression analyses were used to assess the association between health behaviors and attitudes towards preventive counseling, stratified by grade and adjusted by gender.Results: A positive association was found between healthy behaviors and attitudes towards preventive counseling for all medical students. There are significant differences among medical students' self-reported health behaviors and their attitudes towards preventive counselling from three different countries (P < 0.05). Chinese medical students were more positive in stress control (OR > 1) and more passive in limiting their smoking and alcohol behaviors compared to medical students in Duke University. However, compared to medical students in University of Queensland, five Chinese medical students were more passive in stress control (OR < 1).Conclusion: Based on the finding that healthy behaviors are positively related to favorable attitudes towards preventative counselling, medical students should adopt targeted courses and training in preventive counseling and develop healthy lifestyles. [ABSTRACT FROM AUTHOR]

From in-depth interviews with Chinese immigrant wives in the United States and the Chinese couples in urban China in 2004, researcher found a surprising result in terms of their interpretations of the impact of the male-breadwinner ideal upon perceived marital stability. Over half of the sampled Chinese immigrant wives in the United States reported that they became stay-at-home mothers after their immigration, and most believed that becoming a stay-at-home mother had stabilized their marriage. The traditionally defined gender role for women was actually not as much condemned by the Chinese immigrant wives as it would be if they were in China. When asked whether or not the Chinese urban wives would like to follow the male-breadwinner ideal, a common response was 'No way!' Among urban Chinese couples, wives as well as husbands strongly believed that the male-breadwinner ideal would destabilize rather than stabilize their marriage. In this paper, researcher has put forth a hypothesis that the existing familial, economic, and cultural conditions in the United States and urban China play a role in shaping the Chinese couples' perceptions of the traditional family model and their decision to either adapt or reject it in association with their perceived marital stability. [ABSTRACT FROM AUTHOR]

Objectives. I examined age patterns of mortality differentials associated with body mass because the declining age effect observed in previous comparisons of cross-sectional age groups is susceptible to cohort and period distortions and because previous studies used time since baseline as time at risk, making the evaluation of age-specific mortality impossible. Methods. I conducted a parametric survival analysis of data from the 1988- 1994 National Health and Nutrition Examination Survey for 3 cohorts of American men and women born from 1901 through 1957 and observed from 1988 through 2006 under an age-period-cohort framework. Results. Mortality differentials strengthened across cohorts but did not decline with age or change over the study period. Because excess overweight and obesity mortality increased from earlier cohorts to more recent ones, ignoring cohort differences led to a declining age pattern of excess mortality. Conclusions. Cross-sectional age patterns of mortality differentials appear to be distorted by cohort differences. Age should be used as risk time to study age variations in associations between risk factors and time to event. [ABSTRACT FROM AUTHOR]

Both body weight and educational attainment have risen in the United States. Empirical evidence regarding educational differences in obesity (BMI ≥30) is inconsistent. According to some widely cited claims, these differences have declined since the 1970s, and the most educated have experienced the greatest gain in obesity. Prior research was limited in grouping college graduates with nongraduates, combining men and women in the same analysis, and using self-reported rather than measured anthropometric information. Using the National Health and Nutrition Examination Surveys (NHANES), we address these issues and examine changing educational differences in obesity from 1971-1980 to 1999-2006 for non-Hispanic whites and blacks in two separate age groups (25-44 vs. 45-64 years). We find that (i) obesity differentials by education have remained largely stable, (ii) compared with college graduates, less educated whites and younger black women continue to be more likely to be obese, (iii) but the differentials are larger for women than men, and weak or nonexistent among black men and older black women. There are exceptions to the overall trend. The obesity gap has widened between the two groups of college-educated younger women, but disappeared between the least and most educated younger white men. Thus, the increase in obesity was similar for most educational groups, but significantly greater for younger women with some college and smaller for younger white men without a high-school degree. Lumping together the two distinct college groups has biased previous estimates of educational differences in obesity. [ABSTRACT FROM AUTHOR]

Background: The multiple-indicator, multiple-cause model (MIMIC) incorporates covariates of interest in the factor analysis. It is a special case of structural equation modeling (SEM), which is modeled under latent variable framework. The MIMIC model provides rigorous results and becomes broadly available in multiple statistical software. The current study introduces the MIMIC model and how it can be implemented using statistical software packages SAS CALIS procedure, R lavaan package, and Mplus version 8.0.Methods: In this paper, we first discussed the formulation of the MIMIC model with regard to model specification and identification. We then demonstrated the empirical application of the MIMIC model with the Midlife in the United States II (MIDUS II) Study (N = 4109) using SAS CALIS procedure, R lavaan package and Mplus version 8.0 to examine gender disparities in cognitive functioning. The input, output, and diagram syntaxes of the three statistical software packages were also presented.Results: In terms of data structure, all three statistical programs can be conducted using both raw data and empirical covariance matrix. SAS and R are comprehensive statistical analytic packages and encompass numerous data manipulation capacities. Mplus is designed primarily for latent variable modeling and has far more modeling flexibility compared to SAS and R, but limited in data manipulation. Differences in model results from the three statistical programs are trivial. Overall, the results show that while men show better performance in executive function than women, women demonstrate better episodic memory than men.Conclusions: Our study demonstrates the utility of the MIMIC model in its empirical application, fitted with three popular statistical software packages. Results from our models align with empirical findings from previous research. We provide coding procedures and examples with detailed explanations in the hopes of providing a concise tutorial for researchers and methodologists interested in incorporating latent constructs with multiple indicators and multiple covariates in their research projects. Future researchers are encouraged to adopt this flexible and rigorous modeling approach. [ABSTRACT FROM AUTHOR]

Phthalates might trigger immune dysregulation. The relationship between a phthalate mixture exposure and eczema remains unclear. To address this research gap, four statistical models were used to investigate the individual, combined, and interaction relationships between monoesters of phthalates (MPAEs) and eczema, including the logistic regression, weighted quantile sum regression (WQS), quantile g computation (qg-computation), and bayesian kernel machine regression (BKMR). Moreover, subgroup analyses were performed by sex and age. After adjusting for all covariates, the logistic regression model suggested a positive correlation between mono-(3-carboxypropyl) phthalate (MCPP) and eczema. Subgroup analysis suggested that the effect of the MPAEs on eczema was predominantly present in men and children. In the WQS model, the joint effect of 11 MPAEs on eczema was marginally significant [odds ratio = 1.36, 95% confidence interval: 0.97–1.90]. Moreover, a positive association was observed between the combined exposure to 11 MPAEs and eczema in the BKMR model. MCPP and mono-(carboxynonyl) phthalate were the most substantial risk factors based on the results of WQS and qg-computation models. The exposure to a mixture of MPAEs may lead to an elevated prevalence of eczema in the United States population, with men and children being particularly vulnerable to their effects. [Display omitted] • Four statistical methods were used jointly to yield a conclusion. • Phthalates mixture may be a risk factor for eczema. • Men and children may be more vulnerable to phthalate mixtures. [ABSTRACT FROM AUTHOR]

A gap in emission inventories of urban volatile organic compound (VOC) sources, which contribute to regional ozone and aerosol burdens, has increased as transportation emissions in the United States and Europe have declined rapidly. A detailed mass balance demonstrates that the use of volatile chemical products (VCPs)—including pesticides, coatings, printing inks, adhesives, cleaning agents, and personal care products—now constitutes half of fossil fuel VOC emissions in industrialized cities. The high fraction of VCP emissions is consistent with observed urban outdoor and indoor air measurements. We show that human exposure to carbonaceous aerosols of fossil origin is transitioning away from transportation-related sources and toward VCPs. Existing U.S. regulations on VCPs emphasize mitigating ozone and air toxics, but they currently exempt many chemicals that lead to secondary organic aerosols. [ABSTRACT FROM AUTHOR]

While cultural competence has been proposed as an important framework for enhancing health care equity, how members of different racial/ethnic groups consider the importance of cultural competence and their access to culturally competent health care are insufficiently understood. Despite continuously increasing immigrants into the US, it is unclear how immigration status intersects with race/ethnicity to shape individuals' perception of and access to culturally competent care in the US health care system. To fill this research gap, this study examined how the intersection of race/ethnicity and immigration status is associated with people's perception of and access to culturally competent health care and among immigrants, whether their length of stay matters, using data from the 2017 National Health Interview Survey. The results show that while racial and ethnic minority members reported greater importance of culturally competent care than non-Hispanic whites, Asian, black and other-race immigrants reported even greater importance than their US-born counterparts. Additionally, although racial/ethnic minorities reported greater limited access to culturally competent care than their white peers, this gap in access was observed primarily among US-born racial/ethnic minorities. Shorter length of residence (fewer than 15 years) was associated with greater perceived importance than residence of at least 15 years among immigrants, but access to culturally competent care did not differ by length of residence. The findings speak to racial/ethnic minorities' greater desire for culturally competent care and their unmet needs., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: China faces various public health emergencies, and emergency responders at the Centers for Disease Control and Prevention (CDC emergency responders) are a mainstay in responding to public health emergencies. Career resilience can help CDC emergency responders to effectively respond to and recover from public health emergencies, but there is no specific measurement instrument available. In this study, we aimed to develop and conduct an initial validation of the career resilience instrument for CDC emergency responders in China within the context of public health emergencies from a process perspective., Methods: Based on a survey conducted in Shanghai, interpretive phenomenological analysis (IPA), which is a qualitative research approach to describing and analyzing individual experiences, was used to analyze the interview texts to develop the initial career resilience instrument for CDC emergency responders. The initial career resilience instrument was revised through two rounds of expert consultation. Cronbach's α coefficient and exploratory factor analysis were used to test the reliability and validity of the revised career resilience instrument., Results: The initial career resilience instrument for CDC emergency responders contained three first-level measurement dimensions, 9 second-level measurement dimensions, and 52 measurement items. After expert consultation, the first-level and second-level measurement dimensions were not revised, 13 measurement items were deleted or revised, and six measurement items were added, resulting in 48 measurement items. The revised career resilience instrument was tested for good reliability and validity., Conclusion: Career resilience for CDC emergency responders can be regarded as a set of protective factors and dynamic processes that can be cultivated and intervened in cognitive, affective, and behavioral dimensions to improve their ability to respond to and recover from public health emergencies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Cheng, Fu, Luo, Li, Wang and Jin.)

Ferroptosis is a non-apoptotic form of regulated cell death. Glutathione (GSH) peroxidase 4 (GPX4) and GSH-independent ferroptosis suppressor protein 1 (FSP1) have been identified as major defenses. Here, we uncover a protective mechanism mediated by GSH S-transferase P1 (GSTP1) by monitoring proteinomic dynamics during ferroptosis. Dramatic downregulation of GSTP1 is caused by SMURF2-mediated GSTP1 ubiquitination and degradation at early stages of ferroptosis. Intriguingly, GSTP1 acts in GPX4- and FSP1-independent manners by catalyzing GSH conjugation of 4-hydroxynonenal and detoxifying lipid hydroperoxides via selenium-independent GSH peroxidase activity. Genetic modulation of the SMURF2/GSTP1 axis or the pharmacological inhibition of GSTP1's catalytic activity sensitized tumor responses to Food and Drug Administration (FDA)-approved ferroptosis-inducing drugs both in vitro and in vivo. GSTP1 expression also confers resistance to immune checkpoint inhibitors by blunting ferroptosis. Collectively, these findings demonstrate a GPX4/FSP1-independent cellular defense mechanism against ferroptosis and suggest that targeting SMURF2/GSTP1 to sensitize cancer cells to ferroptosis has potential as an anticancer therapy., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Using national data from the Health and Retirement Study, this study examined interpartner associations of allostatic load (AL) among 2338 different-sex couples ( N = 4676 individuals) over a 4-year period among older American couples from a dyadic approach., Methods: AL was indexed by immune (C-reactive protein), metabolic (high-density lipoprotein cholesterol, total cholesterol, and glycosylated hemoglobin), renal (cystatin C), cardiovascular (systolic and diastolic blood pressures, pulse rate), and anthropometric (waist and body mass index) parameters using the traditional count-based formulation. Actor-partner interdependence models were used to assess interpartner concordance in AL., Results: Higher partners' baseline AL was significantly associated with higher own AL both at baseline and 4 years later. In addition, partners' baseline AL was significantly associated with own AL 4 years later only in women but not men. Lastly, we did not observe any significant moderating effect of relationship quality on interpartner AL concordance., Conclusions: The findings suggest that older couples' physiological responses to environmental stress are not only linked concurrently, but the associations persist after 4 years, alluding to long-term impacts of couples' psychosocial context and physiology on each other., (Copyright © 2023 by the American Psychosomatic Society.)

Aim/objectives/background: The American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for the performance of low-dose-rate (LDR) brachytherapy. LDR brachytherapy is the application of radioactive sources in or on tumors in a clinical setting with therapeutic intent. The advantages of LDR brachytherapy include improving therapeutic ratios with lower doses to nontarget organs-at-risk and higher doses to a specific target., Methods: This practice parameter was developed according to the process described under the heading. The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the Commission on Radiation Oncology, in collaboration with ABS and ASTRO., Results: This practice parameter was developed to serve as a tool in the appropriate application of this evolving technology in the care of cancer patients or other patients with conditions where radiation therapy is indicated. It addresses clinical implementation of LDR brachytherapy including personnel qualifications, quality assurance standards, indications, and suggested documentation. This includes a contemporary literature search., Conclusions: This practice parameter is a tool to guide the use of LDR brachytherapy and does not assess relative clinical indication for LDR brachytherapy when compared with other forms of brachytherapy or external beam therapy, but to focus on the best practices required to deliver LDR brachytherapy safely and effectively, when clinically indicated. Comparative costs of versus other modalities therapy may also need to be considered., Competing Interests: L.L.L. reports grants from National Cancer Institute, other from Astrazeneca, other from Pfizer, outside the submitted work. P.O. reports personal fees from Palette Life Sciences, outside the submitted work. D.S. reports grants from the National Cancer Institute, outside the submitted work. W.S. reports personal fees from Carl Zeiss Meditech, personal fees from Merck, personal fees from Varian, grants from University of Utah, other from NRG Oncology, outside the submitted work. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Diet plays an important role in the development of age-related chronic diseases. However, the association between diet quality assessed by Healthy Eating Index (HEI)-2015, the latest version of HEI, and physical frailty among the general United States (US) elderly adults remains unclear., Aims: The present study aims to explore the association between HEI-2015 and physical frailty in elderly adults using data from National Health and Nutrition Examination Survey (NHANES) 2011-2014., Methods: HEI-2015 scores were calculated from 2 days 24-h recall interviews. Physical frailty status was assessed by four criteria developed by Fried et al.: exhaustion, weakness, low body mass, and low physical activity, and then categorized into robust (0 criteria), pre-frail (1-2 criteria), or frail (3-4 criteria). The binary and multinomial logistic regressions were used to examine the odds of frailty status., Results: A total of 2345 participants aged 60 years or older were included. According to the 4-items frailty criteria, 51.1% participants were robust, 42.1% were pre-frail, and 6.8% were frail. Compared to the lowest HEI-2015 quartile, the elderly adults in the higher quartile had a lower odds of physical frailty (P < 0.05). Regarding the frailty criterion separately, higher HEI-2015 was associated with lower odds of exhaustion, weakness, low physical activity and unintentional weight loss, respectively (P < 0.05). Among 13 HEI-2015 components, adherence to the recommended intake of whole fruits and total vegetables components were less likely to be physically frail (P < 0.05)., Conclusion: Higher HEI-2015 was inversely associated with lower odds of physical frailty in the US elderly adults., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions., (Copyright: © Singapore Medical Association.)

Objective: The present study aims to explore the association between ideal diet behaviours recommended by the American Heart Association (AHA) and hypertension in the United States (US) adults using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014., Methods: Whole grains, fruits and vegetables, fish, sodium and sugar-sweetened beverages at an ideal level were defined as the AHA's recommendation. Associations between number of ideal diet behaviours and hypertension were assessed through multivariate logistic regression models., Results: A total of 4462 US adult participants (2110 men and 2352 women) were included in the analysis, of whom 1516 (34.0%) were diagnosed with hypertension. The multivariate adjusted odds ratios and 95% confidence intervals (95% CIs) for hypertension in the groups with one, two and at least three ideal diet behaviours were 0.88 (0.71-1.10), 0.89 (0.70-1.12) and 0.67 (0.49-0.91), when the group with 0 ideal diet behaviour was used as the reference. Results also showed that women with three or more ideal diet behaviours had 43% (95% CI: 10-64%) lower odds of hypertension., Conclusion: The number of diet behaviours at the ideal level recommended by the AHA was inversely associated with hypertension in US adults.

Exposure to per- and polyfluoroalkyl substances (PFASs) is a major concern due to their widespread occurrence and adverse health outcomes. The possible binding of PFASs to peroxisome proliferator-activated receptors (PPARs) and nuclear receptors raises concerns that PFASs may impact cholesterol levels in human. In this study, the U.S. National Health and Nutrition Examination Survey (NHANES) data were employed to address the temporal trend for PFAS concentrations in biomonitoring and associations between cholesterol levels and PFAS exposure. Compared to the PFAS levels in 2003-2004, the median perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) levels in human serum in 2013-2014 decreased from 3.7 to 1.8 ng/mL, 19.2-4.7 ng/mL, 1.7 ng/mL to 1.3 ng/mL and 0.8 ng/mL to 0.6 ng/mL, respectively. Also, an estimate of 1.5 ± 0.7 mg/dL (95% confidence interval: 0.2 - 2.8) and 0.4 ± 0.2 mg/dL (95% confidence interval: 0.1 - 0.6) total cholesterol increases for unit PFOA and PFOS increase (ng/mL), respectively. By using hybrid approach, RfDs were estimated to be 2.0 ng PFOS/kg per day and 0.8 ng PFOA/kg per day. However, it should be cautious when using proposed RfDs based on data obtained from cross-sectional datasets, especially evidence based on data originating from experimental or animal studies is still controversial., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: To develop and validate a nomogram based on log of odds between the number of positive lymph node and the number of negative lymph node (LODDS) in predicting the overall survival (OS) and cancer specific survival (CSS) for epithelial ovarian cancer (EOC) patients., Materials and Methods: A total of 10,692 post-operative EOC patients diagnosed between 2004 and 2013 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training (n = 7,021) and validation (n = 3,671) cohorts. Multiple clinical pathological parameters were assessed and compared with outcomes. Parameters significantly correlating with outcomes were used to build a nomogram. Bootstrap validation was subsequently used to assess the predictive value of the model., Results: In the training set, age at diagnosis, race, marital status, tumor location, stage, grade and LODDS were correlated significantly with outcome in both the univariate and multivariate analyses and were used to develop a nomogram. The nomogram demonstrated good accuracy in predicting OS and CSS, with a bootstrap-corrected concordance index of 0.757 (95% CI, 0.746-0.768) for OS and 0.770 (95% CI, 0.759-0.782) for CSS. Notably, in this population our model performed favorably compared to the currently utilized Federation of Gynecology and Obstetrics (FIGO) model, with concordance indices of 0.699 (95% CI, 0.688-0.710, P < 0.05) and 0.719 (95% CI, 0.709- 0.730, P < 0.05) for OS and CSS, respectively. Using our nomogram in the validation cohort, the C-indices were 0.757 (95% CI, 0.741-0.773, P < 0.05, compared to FIGO) for OS and 0.762 (95% CI, 0.746-0.779, P < 0.05, compared to FIGO) for CSS., Conclusions: LODDS works as an independent prognostic factor for predicting survival in patients with EOC regardless of the tumor stage. By incorporating LODDS, our nomogram may be superior to the currently utilized FIGO staging system in predicting OS and CSS among post-operative EOC patients.

Background: The entry of generic drugs into markets previously monopolized by patented, branded drugs often represents large potential savings for healthcare payers in the USA., Objectives: Our objectives were to describe and explain the trends in drug reimbursement by public Medicaid programmes post-generic entry for as many drug markets and for as long a time period as possible., Methods: The data were the Medicaid State Drug Utilization Data maintained by the Centers for Medicare and Medicaid Services. Quarterly utilization and expenditure data from 1991 to 2008 were extracted for 83 drugs, produced by 229 firms, that experienced initial generic entry between 1992 and 2004. A relative 'price' for a specific drug, firm and quarter was constructed as Medicaid reimbursement per unit (e.g. tablet, capsule or vial) divided by average reimbursement per unit for the branded drug the year before entry. Fixed-effects models controlling for time-, firm- and drug-specific differences were estimated to explain reimbursement., Results: Twelve quarters after generic entry, 18 % of drugs had average per-unit reimbursement less than 50 % of the original branded-drug reimbursement. For each additional firm manufacturing the drug, reimbursement per unit, relative to the pre-generic-entry branded-drug reimbursement, was estimated to fall by 17 (p < 0.01) and 3 (p < 0.01) percentage points for generic and branded-drug companies, respectively. Each additional quarter post-generic entry brought a 2 (p < 0.01) percentage point drop in relative reimbursement., Conclusions: State Medicaid programmes generally have been able to obtain relief from high drug prices following patent expirations for many branded-drug medications by adjusting reimbursement following the expanded competition in the pharmaceutical market.

Background: Medicaid programs' spending on antidepressants increased from $159 million in 1991 to $2 billion in 2005. The National Institute for Health Care Management attributed this expenditure growth to increases in drug utilization, entry of newer higher-priced antidepressants, and greater prescription drug insurance coverage. Rising enrollment in Medicaid has also contributed to this expenditure growth., Objectives: This research examines the impact of specific events, including branded-drug and generic entry, a black box warning, direct-to-consumer advertising (DTCA), and new indication approval, on Medicaid spending on antidepressants., Methods: Using quarterly expenditure data for 1991-2005 from the national Medicaid pharmacy claims database maintained by the Centers for Medicare and Medicaid Services, a time-series autoregressive integrated moving average (ARIMA) intervention analysis was performed on 6 specific antidepressant drugs and on overall antidepressant spending. Twenty-nine potentially relevant interventions and their dates of occurrence were identified from the literature. Each was tested for an impact on the time series. Forecasts from the models were compared with a holdout sample of actual expenditure data., Results: Interventions with significant impacts on Medicaid expenditures included the patent expiration of Prozac® (P<0.01) and the entry of generic paroxetine producers (P=0.04), which reduced expenditures on Prozac® and Paxil®, respectively, and the 1997 increase in DTCA (P=0.05), which increased spending on Wellbutrin®. Except for Paxil®, the ARIMA models had low prediction errors., Conclusions: Generic entry at the aggregate level did not lead to a reduction in overall expenditures (P>0.05), implying that the expanding market for antidepressants overwhelmed the effect of generic competition., (Copyright © 2011 Elsevier Inc. All rights reserved.)