Search

Background: The built environments in which we work, live, and play can influence physical activity behaviors, and perceptions of these environments are associated with walking behavior. This study's objective is to compare national-level data on perceptions of the near-home walking environment from the 2015 and 2020 National Health Interview Survey. Methods: Adults in 2015 (n = 30,811) and 2020 (n = 29,636) reported perceptions of walkable supports (roads, sidewalks, paths, or trails; sidewalks on most streets), destinations (shops, stores, or markets; bus or transit stops; movies, libraries, or churches; places that help you relax, clear your mind, and reduce stress), and barriers to walking (traffic; crime; animals). Age-adjusted prevalence estimates, prevalence differences, and 95% confidence intervals were calculated overall and by demographic characteristics. Results: The reported prevalence of roads, sidewalks, paths, or trails for walking increased overall (85.3% in 2015 to 88.0% in 2020) and for many subgroups. Perceived places to walk to for relaxation, to clear your mind, and to reduce stress increased overall (72.1% in 2015 to 77.1% in 2020) and for all subgroups. Perceptions of crime as a barrier to walking decreased overall (12.5% in 2015 to 11.2% in 2020) and for some subgroups. From 2015 to 2020, the proportion of adults perceiving roads, sidewalks, paths, or trails; places to relax; and crime as a barrier to walking improved. Conclusions: Continuing to monitor perceptions of the walking environment could contribute to progress toward national walking and walkability goals in the United States. [ABSTRACT FROM AUTHOR]

Background: Calls to action addressing the interconnections between physical (in)activity and the climate crisis are increasing. The current study aimed to investigate public support for policy actions that potentially have co-benefits for physical activity promotion and climate change mitigation. Methods: In 2023, a survey through the Angus Reid Forum was completed by 2507 adults living in Canada. Binary logistic regressions were conducted. Separate models were created to reflect support or opposition to the 8 included policy items. Several covariates were included in the models including age, gender, political orientation, physical activity levels, income, urbanicity climate anxiety, and attitudes surrounding physical activity and climate change. The data were weighted to reflect the gender, age, and regional composition of the country. Results: Most individuals living in Canada strongly or moderately supported all actions (ranging from 71% to 85%). Meeting the physical activity guidelines, higher self-reported income, and scoring high on personal experience of climate change were associated with higher odds of supporting the policy actions related to climate actions. Conclusions: Most adults living in Canada support policies that align with the recommended policy actions related to physical activity and climate change. National campaigns enhancing awareness and understanding of the bidirectional relationship between physical activity and climate change are warranted, and these should consider the consistent demographic differences (eg, gender, age, and political orientation) seen in public support for physical activity-related policies. [ABSTRACT FROM AUTHOR]

The authors conducted a survey containing the Copenhagen Burnout Inventory to explore the degree and type of burnout experienced by academic librarians in the spring of 2023. The average burnout score of the respondents (N = 267) was found to be middling (M = 45.68142). When subtypes of burnout were explored, academic librarians showed the most personal burnout, followed closely by work-related burnout. Client-related burnout was low. Analyses were conducted to explore differences due to demographic or workplace characteristics; however, the only significant relationship observed was between the duration of a librarian's career and their degree of client-related burnout. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between socioeconomic inequalities and oral health among adults in the Guangxi province of China. Materials and Methods: The present work was designed as a cross-sectional study, and comprises a secondary analysis of the Fourth National Oral Health Survey from 2015–2016. A multistage cluster sampling method was adopted for this survey, conducted in three urban and three rural districts Guangxi province. Dental examinations were conducted to determine oral health indicators: decayed teeth (DT), clinical attachment loss (CAL) and missing teeth (MT). The outcome measures were DT, CAL and MT. A structured questionnaire was used to collect data on demographic characteristics and socioeconomic status (SES). Multiple logistic regression models were used to analyse the relationship between SES and oral health by adjusting covariates. Results: The sample consisted of 651 participants aged 35–74 years. Logisitic analysis showed a statistically significant association between SES and oral health indicators. In the fully adjusted model, participants with primary education were more likely to suffer more DT (OR = 2.67, 95% CI: 1.17–6.10), teeth with CAL ≥ 4 mm (OR = 2.15, 95% CI: 1.25–3.67) and MT (OR = 3.04, 95% CI: 1.65–5.60) compared to the higher education group. Participants with secondary education exhibited a higher likelihood of experiencing increased MT compared to those in the higher education group in the fully adjusted model (OR = 3.21, 95% CI: 1.78–5.76). Household income was associated with DT and MT in the unadjusted model only. Conclusions: There was strong relationship between SES and oral health of adults. The survey suggested a relationship between low educational attainment and oral health. [ABSTRACT FROM AUTHOR]

Children's loneliness has become an increasingly pervasive issue of public health due to the vulnerability of school-aged children. This study aims to identify latent classes of school-age children based on their exhibited symptoms of loneliness and explore the influencing factors. A cross-sectional study was conducted from March to June 2023 in Shantou, China. Demographic characteristics, Abbreviated Symptom Questionnaire (ASQ), Children's Loneliness Scale (CLS), Perceived social support Scale (PSSS), and Children's Hope Scale (CHS) were collected by questionnaires. Latent class analysis (LCA) was performed based on loneliness symptoms among school-age children, with class characteristics and influencing factors explored through chi-square tests, analysis of variance, lasso regression, and multinomial logistic regression analyses. A total of 2514 school-age children were enrolled. Four diverse latent classes were identified, namely, the low loneliness group, the borderline loneliness group, the moderate loneliness group, and the high loneliness group, with 37.0 %, 40.4 %, 10.3 % and 12.3 % in each class, respectively. Compared with the low loneliness group, the factors influencing loneliness symptoms in other groups were grade, academic performance, father's education level, experience of being bullied, experience of being physical attacked, homework help from parents, one-child status, number of friends, relationship with friends, feeling respect from parents, perceived social support, as well as hope (all P < 0.05). The study's cross-sectional design, limited sample and area, and self-reporting method may affect the findings' reliability and generalizability. LCA can categorize different school-age children according to their loneliness symptoms, offering a new perspective of addressing loneliness issues. • First study to identify diverse loneliness latent classes in children • Children's loneliness categorized into low, borderline, moderate and high groups • Distinct characteristics in each loneliness class, influenced by various factors • Borderline loneliness group shows unique traits, with being an only child as a protector • Personalized interventions and loneliness education for children, teachers, and families [ABSTRACT FROM AUTHOR]

Background: Multifaceted factors play a crucial role in the prevention and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to utilize multifaceted indicators to construct MASLD risk prediction machine learning models and explore the core factors within these models. Methods: MASLD risk prediction models were constructed based on seven machine learning algorithms using all variables, insulin-related variables, demographic characteristics variables, and other indicators, respectively. Subsequently, the partial dependence plot(PDP) method and SHapley Additive exPlanations (SHAP) were utilized to explain the roles of important variables in the model to filter out the optimal indicators for constructing the MASLD risk model. Results: Ranking the feature importance of the Random Forest (RF) model and eXtreme Gradient Boosting (XGBoost) model constructed using all variables found that both homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose-waist circumference (TyG-WC) were the first and second most important variables. The MASLD risk prediction model constructed using the variables with top 10 importance was superior to the previous model. The PDP and SHAP methods were further utilized to screen the best indicators (including HOMA-IR, TyG-WC, age, aspartate aminotransferase (AST), and ethnicity) for constructing the model, and the mean area under the curve value of the models was 0.960. Conclusions: HOMA-IR and TyG-WC are core factors in predicting MASLD risk. Ultimately, our study constructed the optimal MASLD risk prediction model using HOMA-IR, TyG-WC, age, AST, and ethnicity. [ABSTRACT FROM AUTHOR]

A promising use of functional traits is in the prediction of plant species coexistence. Two ideas underly this effort: species coexist when their use of the environment differs enough to overcome competitive disparities, and functional traits provide a proxy for species' use of the environment. Despite successes in using plant functional traits to understand ecosystem function and responses to environmental change, ecologists have struggled to predict species coexistence with functional traits. Mechanistic models of resource competition, which explicitly connect coexistence outcomes to species traits, the environment, and resource dynamics, reveal that coexistence rarely depends on simple differentiation in functional traits, potentially explaining the challenge of connecting individual traits to coexistence. The rationale behind trait-based ecology is that shifting focus from species' taxonomic names to their measurable characteristics ('functional traits') leads to greater generality and predictive power. This idea has been applied to one of ecology's most intractable problems: the coexistence of competing species. But after 20 years, we lack clear evidence that functional traits effectively predict coexistence. Here, we present a theory-based argument for why this might be the case. Specifically, we argue that coexistence often depends on special quantities called 'process-informed metrics' (PIMs), which combine multiple traits and demographic characteristics in non-intuitive ways, obscuring any direct ties between individual traits and coexistence. We then lay a path forward for trait-based coexistence research that builds on mechanistic models of competition. [ABSTRACT FROM AUTHOR]

We did a systematic review and meta-analysis of trials of treatment for rifampicin-susceptible tuberculosis to evaluate the representativeness of participants compared with characteristics of the global population of people with tuberculosis, and the adequacy of adverse event reporting. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from Jan 1, 2000, to Dec 10, 2023, for trials that had greater than or equal to 50 participants per arm and had follow-up to at least treatment completion. Studies were excluded if they compared different formulations of standard drugs (eg, fixed-dose combination tablets); aimed to primarily enrol participants with isoniazid-resistant or rifampicin-resistant tuberculosis; evaluated treatment to prevent tuberculosis infection; tested dietary or vitamin supplementation; tested vaccines or other immune-based interventions; tested adherence support or system-related mechanisms; or enrolled participants with tuberculosis, but tuberculosis treatment itself was not randomised (ie, trials of the timing of antiretroviral therapy initiation). Trial protocols and trials not available in English were also excluded. The outcomes were inclusion and exclusion criteria, characteristics of participants, and adverse event reporting. This systematic review was prospectively registered (PROSPERO ID CRD42022373954). We identified 7328 articles, of which 40 were eligible for analysis. Demographic characteristics, including sex, were reported for 20 420 participants, of which 6663 (33%) were female and 13 757 (67%) were male. We found that people who were greatly affected by the global tuberculosis pandemic were frequently excluded from participation: of the 40 trials, 25 (62·5%) excluded people younger than 18 years, 12 (30·0%) excluded people aged 65 years or older, 34 (85·0%) excluded pregnant or lactating people, 12 (30·0%) excluded people with diabetes, and 11 (27·5%) excluded people with excessive alcohol use, drug use, or both. In the nine trials that reported enrolment of people with diabetes, the pooled proportion of participants with diabetes (9%) was lower than global estimates for the proportion of people with tuberculosis who have diabetes (16%). There were important gaps in adverse event ascertainment, analysis, and interpretation. Of the 40 trials, a minority reported measures of regimen acceptability: 14 (35·0%) reported study withdrawal, eight (20·0%) reported temporary and 16 (40·0%) reported permanent discontinuation of assigned therapy, and 11 (27·5%) reported adherence. Participants in trials were not representative of the global tuberculosis pandemic in demographic and clinical characteristics, restricting the generalisability of trial outcomes. Adverse event reporting could be improved through the use of patient-reported outcomes, standardised definitions of key outcomes, and uniform reporting of measures of regimen acceptability. There was no funding for this systematic review. [ABSTRACT FROM AUTHOR]

At a global level, regional variation in the management of ST-elevation myocardial infarction (STEMI) is influenced by patient demographics and geography. Rural patients with STEMI are disadvantaged in reaching timely care owing to distance and limited ambulance and healthcare resources. Optimising models of STEMI care is key to overcoming the excess rural vs metropolitan cardiovascular morbidity and mortality. In this descriptive study, we compare patient characteristics and STEMI management in three Local Health Districts (LHDs) across NSW: a rural LHD (Western NSW [WNSWLHD]), a regional LHD (Hunter New England), and a metropolitan site (Sydney LHD). Data were collected from file audits conducted from 2019 to 2020 in a rural LHD with a single rural 24/7 cardiac catheter laboratory (WNSWLHD), a regional LHD with a part-time rural cardiac catheter laboratory, and a large regional 24/7 cardiac centre (Hunter New England LHD), and a metropolitan site (Sydney LHD), with two 24/7 cardiac centres. Patients with STEMI presenting in the three geographic regions were compared on demographics, differences in presentation, time to reperfusion treatment, time to percutaneous coronary intervention (PCI) centre, distances travelled, proportion of angiograms within 24 hours, and in-hospital mortality. During 2020, there were 675 recorded STEMI across the three regions. The rural site in WNSWLHD had the highest rate of STEMI per capita, with patients more likely to identify as Indigenous, less likely to call an ambulance, and more likely to present to a non–PCI hospital and to receive thrombolysis. Only 14% of these rural patients received primary PCI (PPCI), with patients presenting a median of 153 km from the PCI centre, vs 69% PPCI in the regional and 89% in metropolitan LHD. Thrombolysis was the main reperfusion treatment in WNSWLHD (76%), and the proportion of patients receiving no treatment was the same in all LHDs at 10%. The percentage of patients receiving angiography within 24 hours in the rural site was 84%. There was no substantial difference in in-hospital mortality among the three LHDs. We document large differences in the demographic profiles, use of ambulance, and access to PPCI in patients with STEMI across the three NSW centres. Current NSW health and ambulance protocols in a large, sparsely populated rural NSW LHD were able to deliver thrombolysis at the point of contact and facilitate "hot" transfer of patients with STEMI to a PCI centre. Long distances and transfer times mean that PPCI is a limited option in rural NSW, with scope for further improvement in models of care. [ABSTRACT FROM AUTHOR]

Background: Over the past several years, the liver transplant community has embraced the concept of fast-tracking patients to facilitate earlier postoperative recovery. Aim: Derive and validate a novel "fast-track" risk score that captures the demographic and clinical characteristics of DDLT patients to predict the likelihood of early extubation after surgery. Design: Adult patients who underwent non-fulminant DDLT between January 2014 and July 2019 were included. The cohort was divided in 2 groups: patients extubated within 4 hours of surgery vs extubated after 4 h. Logistic regression was performed to identify the independent predictors of early extubation. The area under the curve (AUC) was calculated to measure the ability of the risk score to predict early extubation. The score was validated by applying coefficients of the regression model to the validation cohort and calculating the AUC. Results: A total of 290 DDLT patients were included, of which 175 (60%) were in the "delayed extubation" group and 115 (40%) were in the "fast-track" group. Patients with a MELD <29, transfused <4 units of pRBCs, and transfused <5 units of FFP during surgery were 2.30 times, 5.74 times, and 3.09 times more likely to be extubated early, respectively. A risk score with an integer point scale was derived and exhibited an AUC of.80. The proportion of patients who were extubated early increased from 2.78% at a score of 0 to 66.67% at a score of 4. Conclusions: The proposed score provides a fast and easy method to help identify DDLT patients suitable for early extubation. [ABSTRACT FROM AUTHOR]

Purpose: Following esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients. Methods: A national survey describing a post-esophagectomy patient was emailed to 23,524 attending anesthesiologists who were members of the American Society of Anesthesiologists. The survey included 3 demographic and 12 anesthetic management questions. Responses were further stratified by gender, years in practice and frequency of exposure to the patient population of interest. Results: A total of 744 (3.2%) respondents completed the survey. The respondent demographic characteristics closely reflected recent US anesthesiology workforce analyses. Endotracheal tube was the preferred method of airway management for 648 (87.1%), 419 (64.7%) used a rapid sequence induction, and 504 (67.7%) elected a reverse Trendelenburg position, with the latter two choices being favored among anesthesiologists with routine (vs. rarely/never) exposure to post-esophagectomy patients (76.6% vs. 58.4%; p < 0.001; and 73.6% vs. 63.9%; p = 0.021, respectively). Across survey participants, induction of GA was highly variable with differential effects of gender, years in practice and exposure frequency to post-esophagectomy patients. Conclusions: US attending anesthesiologists' approach to induction of GA in a patient with a history of successful esophagectomy was not uniform. The majority of responses reflected a concern for aspiration in such a patient. Considering surgical and non-surgical upper gastrointestinal changes, establishment of practice guidance to optimize perioperative care is an unmet need. [ABSTRACT FROM AUTHOR]

How does politics affect, and possibly distort, how resources are allocated? I show that where the federal government provides public goods and financial assistance depends not only on who has power within Congress but also on the characteristics of their constituents. In a federal system like the United States, the central government provides resources by allocating grants to subnational governments based on demographic characteristics. Thus, to maximize funding for their states, members of Congress must also distribute funding to states with similar characteristics. Using panel data on education spending and a difference-in-differences design, I demonstrate that grants disproportionately benefit states represented by Senate committee chairs, but this benefit spills over to similar states. However, I find no evidence of committee influence over grants in the House. These findings contribute to our understanding of distributive politics and shed light on the consequences of allocating resources within a federal system. [ABSTRACT FROM AUTHOR]

This study sought to compare frequency of paid work by autistic adolescents to paid work by adolescents with other neurodevelopmental disorders and typically developing adolescents, and to examine whether demographic and clinical characteristics were associated with autistic adolescent employment with data from 2016–2019 National Survey of Children's Health. Rate of paid work was significantly lower in the autistic group (22.01%) than typically developing (49.38%) and other neurodevelopmental disorders (44.27%) groups. Younger age, lower household income, co-occurring intellectual disability, and more severe autism were associated with lower odds of an autistic adolescent having worked. This study indicates that work disparities impacting autistic individuals begin in youth and highlights the need for improved vocational support to address employment barriers for autistic youth. [ABSTRACT FROM AUTHOR]

In high tuberculosis (TB) burden countries such as Bangladesh, research and policy tend to focus on rifampicin (RIF)-resistant TB patients, leaving RIF-sensitive but isoniazid (INH)-resistant (Hr-TB) patients undiagnosed. Our study aims to determine the prevalence of INH resistance among pulmonary TB patients in selected health care facilities in Bangladesh. This study was conducted across nine TB Screening and Treatment Centres situated in Bangladesh. Sputum samples from 1084 Xpert-positive pulmonary TB patients were collected between April 2021 and December 2022 and cultured for drug susceptibility testing. Demographic and clinical characteristics of Hr-TB and drug-susceptible TB patients were compared. Among available drug susceptibility testing results of 998 culture-positive isolates, the resistance rate of any INH regardless of RIF susceptibility was 6.4% (64/998, 95% CI: 4.9–8.2). The rate was significantly higher in previously treated (21.1%, 16/76, 95% CI: 12.0–34.2) compared with newly diagnosed TB patients (5.2%, 48/922, 95% CI: 3.8–6.9) (p < 0.001). The rate of Hr-TB was 4.5% (45/998, 95% CI: 3.3–6.0), which was also higher among previously treated patients (6.6%, 5/76, 95% CI: 1.4–13.5) compared with newly diagnosed TB patients (4.3%; 40/922, 95% CI: 3.1–5.9) (p 0.350). Most importantly, the rate of Hr-TB was more than double compared with MDR-TB (4.5%, 45/998, vs. 1.9%, 19/998) found in the current study. This study reveals a high prevalence of Hr-TB, surpassing even that of the multi-drug-resistant TB in Bangladesh. This emphasizes the urgent need to adopt WHO-recommended molecular tools at the national level for rapid detection of INH resistance so that patients receive timely and appropriate treatment. [ABSTRACT FROM AUTHOR]

Quantify cognitive deficits in patients with postacute sequelae of COVID-19 (PASC) and identify key variables related to cognitive impairment in PASC. Patients with polymerase chain reaction-confirmed COVID-19 underwent a comprehensive neuropsychological evaluation. The comparison group included patients without neurological disorders determined by the neuropsychologist to be cognitively intact. Cognitive impairment was defined as impairment (Composite T ≤35) in 1 of 6 cognitive domains. The PASC group was split into impaired or intact based on the above criteria. Multivariable logistic regression models assessed predictors including demographics, COVID-19 severity, clinical characteristics, and mood. There were 210 patients with PASC, predominantly female (73.3%, P <.001), without other demographic differences when compared with 369 normal controls. Patients with PASC were more likely to have cognitive impairment (odds ratio 3.61; 95% confidence interval, 2.36-5.54; P <.001) compared with controls, with significantly lower scores in domains of memory, language, processing speed, visuospatial function, executive function (P <.001), and higher depressive (P =.004) and anxiety symptoms (P =.003). Patients with PASC who demonstrated cognitive impairment (n = 93) had higher body mass index compared with those with PASC without cognitive impairment (n = 117), without differences in other predictors. Patients with PASC are almost 4 times more likely to evidence cognitive dysfunction compared with normal controls. Forty-four percent of patients with PASC demonstrated cognitive deficits about 7 months from infection. Estimated premorbid intelligence significantly correlated with impairment. Higher body mass index was the only metric shown to differentiate those with PASC and cognitive impairment from those with PASC who were cognitively intact. [ABSTRACT FROM AUTHOR]

Background: The rate of disease progression, measured by the decline of ALS Functional Rating Scale-Revised (ALSFRS-R) from symptom onset to diagnosis (ΔFS) is a well-established prognostic biomarker for predicting survival. Objectives: This study aims to categorize a large patient cohort based on the initial ΔFS and subsequently investigate survival deviations from the expected prognosis defined by ΔFS. Methods: 1056 ALS patients were stratified into three progression categories based on their ΔFS: slow progressors (below 25th percentile), intermediate progressors (between 25th and 75th percentiles), and fast progressors (above 75th percentile). Survival outcomes were classified as short survivors (<2 years), average survivors (2–5 years), and long survivors (>5 years). Clinical and demographic characteristics within each subgroup were then analyzed. Results: ΔFS stratification yielded cutoff values of <0.29, 0.29–1.03, and >1.03 points/month. Long survivors comprised 26% and 21% were short survivors. Six percent of the fast progressors had a life expectancy of more than 5 years, and none of the clinical and demographic characteristics analyzed could fully explain this discrepancy. Conversely, 13% of intermediate progressors lived less than 2 years, according to a short-diagnostic delay in these patients. Discussion: Our study reaffirms ΔFS as a prognostic biomarker for ALS. We disclosed outliers defying anticipated patterns. The observed shift in progression categories underscores the non-linear nature of disease progression. Genetic and unknown biological reasons may explain these deviations. Further research is needed to fully understand modulation of ALS survival. [ABSTRACT FROM AUTHOR]

Most older adults aspire to age in their homes and communities; they often face challenges due to functional limitations. The demand for home and community-based services (HCBS) has steadily increased to address these challenges. This scoping review explores the relationship between HCBS and the health outcomes of older adults. A total of 11,317 peer-reviewed articles published between January 1, 2005, and August 1, 2023, were identified from major electronic databases, with 12 articles selected for the final sample. The findings indicate that HCBS are consistently associated with better health outcomes, including improvements in physical and mental health and reduced hospitalizations. However, Black and Asian older adults reported lower accessibility to HCBS and poorer self-rated health compared to their White counterparts. Additionally, low density and lack of HCBS in neighborhoods were linked to poorer health outcomes among older adults. Policymakers should prioritize improving HCBS accessibility in neighborhoods, consider the demographic characteristics of older adults, and address their diverse needs to tailor HCBS effectively. [ABSTRACT FROM AUTHOR]

To curb the spread of the novel coronavirus, most cities and states implemented COVID-19 public health restrictions that became enforceable offenses. Unfortunately, concerns about unequitable enforcement arose among minority and impoverished communities. The current study uses official data from San Antonio, Texas to investigate the relationship between zip code racial and ethnic composition and income on the enforcement of COVID-19 public health violations. Over 28,000 enforcement activities from March 2020 to March 2021 were analyzed using random effects logistic regression. Results indicate that enforcement activities in zip codes with above average percent Black and above average percent Hispanic were more likely to receive citations, even though citations were issued in less than one percent of all enforcement activities. [ABSTRACT FROM AUTHOR]

Rationale: Serum IgG deficiency is associated with morbidity in chronic obstructive pulmonary disease (COPD), but it is unclear whether concentrations in the lower end of the normal range still confer risk. Objectives: To determine if levels above traditional cutoffs for serum IgG deficiency are associated with exacerbations among current and former smokers with or at risk for COPD. Methods: Former and current smokers in SPIROMICS (the Subpopulations and Intermediate Outcome Measures of COPD study) (n = 1,497) were studied: 1,026 with COPD and 471 at risk for COPD. In a subset (n = 1,031), IgG subclasses were measured. Associations between total IgG or subclasses and prospective exacerbations were evaluated with multivariable models adjusting for demographic characteristics, current smoking, smoking history, FEV1 percent predicted, inhaled corticosteroids, and serum IgA. Measurements and Main Results: The 35th percentile (1,225 mg/dl in this cohort) of IgG was the best cutoff by Akaike information criterion. Below this, there was increased exacerbation risk (incidence rate ratio [IRR], 1.28; 95% confidence interval [CI], 1.08–1.51). Among subclasses, IgG1 and IgG2 below the 35th percentile (354 and 105 mg/dl, respectively) were associated with increased risks of severe exacerbation (IgG1, IRR, 1.39; 95% CI, 1.06–1.84; IgG2, IRR, 1.50; 95% CI, 1.14–1.1.97). These associations remained significant when additionally adjusting for a history of exacerbations. Conclusions: Lower serum IgG is prospectively associated with exacerbations in individuals with or at risk for COPD. Among subclasses, lower IgG1 and IgG2 are prospectively associated with severe exacerbations. The optimal IgG cutoff was substantially higher than traditional cutoffs for deficiency, suggesting that subtle impairment of humoral immunity may be associated with exacerbations. [ABSTRACT FROM AUTHOR]

The large literature on the correlates of entrepreneurship pays little attention to America's military Veterans. We leverage two national surveys with rich demographic and behavioural data to estimate how military experience relates to entrepreneurship and financial success. After accounting for demographic differences, Veterans are less likely to become entrepreneurs than their peers. Veteran entrepreneurs also earn less and have lower financial satisfaction. These results contradict the common narrative and theoretical expectation that average military experience imparts human capital that prepares Veterans for entrepreneurship. We also find that female, Black and more educated Veterans are relatively more likely to pursue entrepreneurship. [ABSTRACT FROM AUTHOR]

Cyber-ostracism threatens adolescents' socialization and the reverse may also matter. However, little attention has been paid to the bidirectional relationship between cyber-ostracism and prosocial behaviors in adolescents, along with the underlying mechanisms. Therefore, this study examined the longitudinal association between cyber-ostracism and prosocial behaviors, as well as the role of rumination. A total of 716 Chinese adolescents completed the questionnaires at three time points during six months. Adolescents reported on cyber-ostracism, prosocial behaviors, rumination and demographic characteristics at each time point. The random-intercept cross-lagged panel model (RI-CLPM) was carried out. Results from RI-CLPM analysis suggested that cyber-ostracism predicted adolescents' prosocial behaviors negatively across time at the within-person level. Moreover, the RI-CLPM analysis further suggested that rumination mediated the longitudinal association between cyber-ostracism and prosocial behaviors at the within-person level. Specifically, the findings suggest that cyber-ostracism contributes to increased rumination among adolescents, subsequently leading to reduced engagement in prosocial behaviors. Our findings uncover the effect of cyber-ostracism on adolescents' prosocial behaviors and the mediating role of rumination at the within-person level. IMPACT SUMMARY: Prior State of Knowledge: It has been documented that cyber-ostracism is harmful to adolescents' socialization and the reverse may also matter. However, little attention has been paid to the bidirectional relationship between cyber-ostracism and prosocial behaviors in adolescents, along with the underlying mechanisms. Novel Contributions: We aimed to examine the longitudinal association between cyber-ostracism and prosocial behaviors, as well as the role of rumination. Importantly, we adopted the random-intercept cross-lagged panel model (RI-CLPM) to reveal the associations across time at the within-person level. Practical Implications: Findings have potential implications for parents to timely know whether adolescents encounter adverse events online. Once adolescents encounter negative events online, parents should help find positive cognitive strategies together, which is crucial for the development of adolescents' prosocial behaviors. [ABSTRACT FROM AUTHOR]

Despite the growth in self-service technology (SST) usage in service settings, SST-centric service is difficult for some customers. Thus, this paper addresses how voluntary use of SST influences customers' SST behavior based on a cognitive-affective-conative framework. Questionnaire data were collected from customers with difficulties using SST in the United States. Hypotheses were tested using partial least squares structural equation modeling with SmartPLS. The model sample comprised 218 retail service customers. Results showed that voluntary use positively impacts customer attitudes toward both SST and the service provider, which directly affects recommendation and repurchase intentions. Also, customer demographic characteristics were examined and indicated that the impact of voluntary use of SST on customer attitude is stronger among male, young, and low-income customers. This study highlights the importance of not forcing customers to use SST, especially when they have difficulties. [ABSTRACT FROM AUTHOR]

Background: The population figures in Germany are obtained by updating the results of the latest census with information from the statistics on birth, deaths and migration statistics. The Census 2011 in Germany corrected population figures, which have only been updated over a long period of time. The aim of this work is to show the effect of the census-based correction of the population figures on the magnitude of mortality rates in Germany 2011–2013. Methods: We compared mortality rates (total, cancer, and cardiovascular disease) for the period 2011–2013 based on the uncorrected and Census 2011 corrected population figures. We also compared the effect of the choice of different standard populations in the age standardization of rates on the difference in uncorrected and corrected mortality rates. Results: There is a clear decline in age-specific cancer mortality among men aged 90 and over when using the uncorrected population figures, which is reversed as soon as the corrected population figures are used. Among women, there is hardly any difference between the uncorrected and corrected mortality rates. The correction of the population figures does not lead to a qualitatively different pattern in the mortality rates for cardiovascular diseases and myocardial infarction, but it increases the magnitude of the rates, particularly for elderly men. Standard populations with higher weights at older ages produced larger corrections in mortality rates. Conclusions: Even though the Census 2011 corrected nationwide mortality rates without age stratification differed only slightly from the uncorrected rates, there were noticeable increases in mortality, particularly in the city states of Hamburg and Berlin and in old age. Due to the particularly large error in the population figures in the older age range, an age standard that assigns lower weights at older ages should be used for age standardization of rates wherever possible. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a primary cause of chronic liver disease, with potential progression to cirrhosis and hepatocellular carcinoma (HCC). Although systemic inflammatory biomarkers are associated with liver diseases, their specific role in MASLD remains unclear. This study examines the association between systemic inflammatory biomarkers and MASLD. Methods: This cross-sectional study enrolled 6613 adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) spanning from 2017 to March 2020. Among these participants,, 34.67% were aged 40–59 years, 50.85% were female, and 63.26% were Non-Hispanic White. We investigated 10 inflammatory biomarkers: ALI, SIRI, SII, SIPS, IBI, NLR, PLR, CAR, LMR, and PNI. Logistic regression models were performed to assess the linear association between systemic inflammatory biomarkers and MASLD. Restricted cubic spline (RCS) regression was employed to explore potential nonlinear relationships between biomarkers and MASLD risk. Additionally, subgroup analyses were conducted to examine the influence of various demographic and clinical characteristics on the observed associations. Results: After adjusting for key confounders, NLR and PLR exhibited negative association with MASLD risk, while ALI, CAR, and PNI exhibited the opposite association (P < 0.05). Most biomarkers, including ALI, SIRI, IBI, CAR, LMR, and PNI, exhibited significant non-linear correlations with MASLD (P < 0.05). Subgroup analyses revealed substantial age-related differences in the association between ALI and MASLD risk, as well as varying relationships between PNI and MASLD risk across various cardiovascular outcomes (P < 0.05). Conclusion: Systemic inflammatory biomarkers are significantly associated with MASLD risk. Large-scale prospective studies are warranted to confirm these findings and elucidate the underlying mechanisms. [ABSTRACT FROM AUTHOR]

PurposeMaterials and methodsResultsDiscussionConclusionThe self-assessment is a component of the National Training and Development Curriculum (NTDC) used by resource (i.e. foster, adoptive, and kinship) parents to understand strengths and areas of potential growth associated with successful parenting. This outcome evaluation assesses changes in caregiver self-assessment results after receiving the NTDC classroom-based training.Resource parents from six U.S. states completed the self-assessment at baseline before the NTDC classroom-based training and 90 days after completing the training. Regression analyses were conducted for 20 training competencies and 14 parenting characteristics, controlling for demographic and caregiver characteristics and using propensity-score weights to account for potential bias from attrition between completion of the self-assessment at baseline and follow-up. The number of participant responses in the analytic sample varied across the training competencies and parenting characteristics, with an average of n = 321 responses per construct.All training competencies and parenting characteristics observed statistically significant improvements in participant scores from baseline to follow-up, with average training competency scores improving by 11% and parenting characteristic scores by 5%.These results suggest that the NTDC classroom-based curriculum may help caregivers to develop knowledge and skills in content areas related to effective parenting.The NTDC self-assessment seems to function as intended for participants to understand areas of strength and potential growth in a variety of training competencies and parenting characteristics associated with effective parenting. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionTo examine the relationship between body mass index (BMI), newly developed sleep disorders and functional outcome after moderate-to-severe traumatic brain injury (msTBI).Retrospective data from the TBI Model Systems National Database was analyzed, focusing on the independent association between BMI, sleep disorder diagnosis, and functional outcome as measured by the Extended Glasgow Outcome Scale (GOSE) at 1-year post-injury. Linear and logistic regression were used.Out of 2,142 participants, 84% reported no sleep disorder (NSD), 9% reported a sleep disorder before TBI (PreSD), and 7% developed a sleep disorder after TBI (PostSD). Over 50% of participants were overweight or obese. After adjusting for demographic and clinical characteristics, a one-unit increase of BMI at the time of rehabilitation admission was associated with 3.7% higher odds of PostSD (OR [95%CI]: 1.037 [1.007, 1.068], p = 0.015). PostSD was associated with a 53.6% higher chance of unfavorable GOSE compared to NSD (OR [95%CI]: 1.536 [1.069–2.207], p = 0.02) and an 81.7% higher chance compared to PreSD (OR [95% CI]: 1.817 [1.137–2.905], p = 0.01).Being overweight/obese and developing a sleep disorder had adverse effects on functional outcome, emphasizing the importance of addressing sleep and lifestyle factors in post-msTBI rehabilitation. [ABSTRACT FROM AUTHOR]

Background: To explore the knowledge, attitudes, and practice (KAP) toward sarcopenia among maintenance dialysis (MHD) patients in Anhui. Methods: This multicenter cross-sectional study was conducted in November 2022 among MHD patients in the Anhui Province, China. A self-administered questionnaire was used to collect their demographic characteristics and KAP toward sarcopenia. Results: A total of 1548 questionnaires were collected, with 909 (58.72%) being valid. The average knowledge, attitude, and practice scores were 4.45 ± 4.21 (possible range: 0–12), 28.21 ± 3.71 (possible range: 8–40), and 18.04 ± 4.28 (possible range: 7–35) points, respectively. The multivariable logistic regression showed that 5.1–10 years of dialysis (OR = 0.38, 95% CI: [0.15, 0.97]) and attitude scores (OR = 1.36, 95% CI: [1.25, 1.48]) were independently associated with practice. The structural equation model showed that knowledge had a direct effect on attitudes (β = 0.38, 95% CI: [0.33, 0.44]) and practice (β = 0.18, 95% CI: [0.11, 0.24]) and had an indirect effect on practice though attitudes (β = 0.42, 95% CI: [0.35, 0.50]). Conclusion: The MHD patients in Anhui showed insufficient knowledge and moderate attitudes and practices toward sarcopenia. Proactive practice might be facilitated and achieved by improving knowledge and attitudes. [ABSTRACT FROM AUTHOR]

Aims: This study aims to assess the serum levels of pepsinogen (PG)I, PG II, and gastrin (G17) in patients with gastric intestinal metaplasia (GIM) and evaluate their correlation with demographic characteristics. Methods: A total of 247 normal controls (NC) and 240 patients diagnosed with GIM were enrolled in this study. All participants underwent a gastroscopy procedure followed by pathological examination for diagnosis confirmation. The expression level of PGI, PG II, and G 17 was detected by fluorescence immunochromatography and Hp infection was detected by 13-carbon breath test. The demographic characteristics of the subjects were obtained through questionnaires. Results: Compared to the NC group, the GIM group showed a reduction in PG II expression level [10.71(6.40,16.89) VS 9.21(6.14,14.55), p = 0.010]. GIM patients had a higher prevalence of previous Hp eradication history (14.98% VS 23.75%, p = 0.014). The low PG II group exhibited a higher incidence rate of GIM compared to the high PG II group (54.10% VS 44.44%, p = 0 0.020). In the Hp-negative(Hp-) group, there was a decrease in both PGI and PG II expression levels when compared to the Hp-positive(Hp+) group [146.73 ± 78.53 VS 125.61 ± 68.75 and 10.19(7.27, 16.58) VS 7.36(5.62,12.53), p = 0.036 and p < 0.001]. Among patients without Hp eradication history, those with low PG II levels had a higher proportion of individuals with a history of Hp eradication than those with high PG II levels (29.31% VS 3.13%, p = 0.003). Additionally, within the subgroup that underwent Hp eradication, there was a decrease in PG II expression level compared to the subgroup without Hp eradication (6.16(5.13, 7.52) VS 8.73(5.67, 13.35), p = 0.041). Conclusion: The prevalence of GIM was significantly associated with low levels of PG II. There was a significant association between HP eradication history and the prevalence of GIM. Hp eradication history resulted in reduced expression levels of PG II in Hp- GIM patients. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) stigma remains a significant barrier to TB control efforts globally, especially in countries with a high TB burden. Studies about TB stigma done in Uganda so far have been limited in scope and focused on data collected health facilities. In this study we report TB related stigma at community level for the period 2021/2022. We used the 2021/22 Lot Quality Assurance Sampling (LQAS) data from a sample of 33,349 participants across 77 districts, to measure TB stigma determine factors associated. We included demographic characteristics, knowledge and participant perspectives as our study variables. Univariable and multivariate logistic regression analyses were performed to identify factors associated with TB stigma. TB stigma was assessed as a categorical variable (below or above the median) due to the skewness of the data when fitting the scores. The data set had equal proportions of males and females. The largest age group was 20–29 years old (38.47%). Most participants were married (62.94%) and had primary level education (65.80%). The TB stigma scores were assigned on a scale from 0 to 30, with an average score of 21.67 (±8.22) and a median score of 24 (19–28). Overall, 45.48% of participants had TB stigma scores above the median. Variations in TB stigma levels were observed across different districts. Factors associated with higher TB stigma included older age, higher education levels, urban residence, and TB knowledge. To reduce TB stigma and misinformation that can make an impact on TB response, community interventions should balance increasing awareness with minimizing fear. These interventions should be well-rounded and context-specific to address disparities within communities and bolster TB control efforts in the country. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsThis study aimed to identify psychological factors and characteristics associated with fear of falling (FOF) and fear of falling avoidance behavior (FFAB) among older adults.This cross-sectional study used data from the National Health and Aging Trends Study (Wave 9, n = 4,977).We found that increased fall history, more frequent depression and anxiety, and poorer perceived overall health were significantly higher among older adults with FFAB compared to FOF (ps < .001). Perceived overall health, depression, and anxiety explained a significant amount of variance in FOF and FFAB. Lastly, demographic characteristics differ between older adults reporting no FOF/FFAB, FOF, and FFAB.FOF and FFAB are prevalent among older adults. Older adults experiencing FFAB had poorer health perceptions, more falls, and more frequent depression and anxiety than those experiencing FOF. The association of psychological factors and demographic characteristics with FOF and FFAB may indicate potential treatment targets. Clinical Implications: Addressing psychological variables, such as health perception, anxiety, and depression among older adults, may mitigate the impact of FOF and the development of FFAB; however, further research is needed. [ABSTRACT FROM AUTHOR]

Background: Intracerebral amyloid β (Aβ) accumulation is considered the initial observable event in the pathological process of Alzheimer's disease (AD). Efficient screening for amyloid pathology is critical for identifying patients for early treatment. This study developed machine learning models to classify positron emission tomography (PET) Aβ-positivity in participants with preclinical and prodromal AD using data accessible to primary care physicians. Methods: This retrospective observational study assessed the classification performance of combinations of demographic characteristics, routine blood test results, and cognitive test scores to classify PET Aβ-positivity using machine learning. Participants with mild cognitive impairment (MCI) or normal cognitive function who visited Oita University Hospital or had participated in the USUKI study and met the study eligibility criteria were included. The primary endpoint was assessment of the classification performance of the presence or absence of intracerebral Aβ accumulation using five machine learning models (i.e., five combinations of variables), each constructed with three classification algorithms, resulting in a total of 15 patterns. L2-regularized logistic regression, and kernel Support Vector Machine (SVM) and Elastic Net algorithms were used to construct the classification models using 34 pre-selected variables (12 demographic characteristics, 11 blood test results, 11 cognitive test results). Results: Data from 262 records (260 unique participants) were analyzed. The mean (standard deviation [SD]) participant age was 73.8 (7.8) years. Using L2-regularized logistic regression, the mean receiver operating characteristic (ROC) area under the curve (AUC) (SD) in Model 0 (basic demographic characteristics) was 0.67 (0.01). Classification performance was similar in Model 1 (basic demographic characteristics and Mini Mental State Examination [MMSE] subscores) and Model 2 (demographic characteristics and blood test results) with a cross-validated mean ROC AUC (SD) of 0.70 (0.01) for both. Model 3 (demographic characteristics, blood test results, MMSE subscores) and Model 4 (Model 3 and ApoE4 phenotype) showed improved performance with a mean ROC AUC (SD) of 0.73 (0.01) and 0.76 (0.01), respectively. In models using blood test results, thyroid-stimulating hormone and mean corpuscular volume tended to be the largest contributors to classification. Classification performances were similar using the SVM and Elastic Net algorithms. Conclusions: The machine learning models used in this study were useful for classifying PET Aβ-positivity using data from routine physician visits. Trial registration: UMIN Clinical Trials Registry (UMIN000051776, registered on 31/08/2023). [ABSTRACT FROM AUTHOR]

Objective: Guided by Self-System Processes Theory, Social Support Theory, and Stress and Coping Theory, this study investigates how perceived school climate influences adolescents' negative emotions through the chain mediation of school belonging and social avoidance and distress. It also examines demographic differences across gender and grade and tests the structural invariance of the proposed model. Method: A cross-sectional survey of 1,507 Chinese adolescents in grades 5–9 was conducted using validated scales. Independent samples t-tests and one-way ANOVA were used to examine gender and grade differences in the key variables. Structural equation modeling (SEM) tested the hypothesized mediation model, while multigroup SEM assessed structural invariance across subgroups. Results: Perceived school climate reduced negative emotions both directly and indirectly, with school belonging and social avoidance and distress as key mediators. Peer support demonstrated the strongest indirect effect, while teacher support and autonomy opportunities influenced negative emotions through both direct and indirect pathways. A chain mediation pathway was identified, and structural invariance testing confirmed consistent relationships across gender and grade groups. Conclusion: This study reveals a complex chain mediation mechanism and highlights the stability of structural relationships across demographic groups. The findings provide valuable theoretical and practical insights for fostering supportive school environments to promote adolescent emotional well-being. [ABSTRACT FROM AUTHOR]

AbstractObjective: Prior research demonstrated that military/veteran students report lower belongingness than civilian students, but the reasons why remain unclear. We investigated the impact of demographic characteristics, state and local politics, and school-specific veteran resources on reported belongingness. Participants: Participants included 104,162 students (2,814 military/veteran) who completed a survey for the Healthy Minds Study between 2014 and 2018. Methods: A combined mixed effect model and models stratified by military status to determine differences in belongingness between military/veteran students and civilian students. Results: Unadjusted models indicated military/veteran students reported lower belongingness than civilian students (b = −0.10, p < . 001). However, adjusting for demographic characteristics and state and school attributes reduced this effect (b = −0.04, p = .001). Conclusion: We were able to demonstrate that military/veteran students’ reduced belongingness is largely due to the demographic differences among military/veteran students rather than aspects of the school or political leanings. [ABSTRACT FROM AUTHOR]

This study examines whether the detrimental effects of the COVID-19 pandemic on the affectivity of the population extend one year after the outbreak. In an online-mobile session, participants completed surveys (i.e., demographic characteristics, positive-negative affectivity, interoceptive awareness) and a similarity judgment task of triplets of emotional concepts, from which we derived 2D maps of their affective knowledge representation. Compared with pre-pandemic data derived from a comparable population, we report three main findings. First, we observed enhanced negative affectivity during the pandemic, but no changes in positive affectivity levels. Second, increased self-reported interoceptive awareness compared to pre-pandemic data, with greater attention to bodily sensations and adaptive aspects of interoceptive sensitivity. Furthermore, female participants reported higher scores than males on the questionnaire subscales of Emotional Awareness and Attention Regulation. Third, the effect of pandemic-related conditions is also apparent in the mental organization of emotional concepts, especially for female participants (i.e., reduced coherence in the organization of the concepts along the arousal dimension and more misclassification of concepts based on arousal) and participants who did not perform physical activity (a collapse of the arousal dimension). Some of the effects of the pandemic, thus, persist about a year after the outbreak. These results advise providing programs of psychological and emotional assistance throughout the pandemic beyond the outbreak, and that age-dependent gender differences should be accounted for to define tailored interventions. Physical activity might relieve pandemic-related stressors, so it should be promoted during particularly stressful periods for the population. [ABSTRACT FROM AUTHOR]

The goal of this study was to assess the outcomes of a grant-funded intervention designed to provide comprehensive training and support for holistic admissions in 26 STEM PhD programs at five California research universities. This pilot intervention combined a flexible, research-based model of holistic review, training for faculty involved with admissions, and informal coaching in how to critically analyze and redesign their admissions processes. Using a theoretical framework centered on organizational learning as a mechanism of equity-minded change, we assessed evidence of learning in two ways: 1) adoption of admissions practices that align with a new paradigm, and 2) changes in the racial and gender composition of applicants, admits, and enrollees. Drawing on administrative and survey data from participating programs, we find evidence suggestive of positive, sustained changes in both adoption of new admissions practices and racial diversity. This indicates that systemic, scaffolded approaches may promote more equitable processes and outcomes in the graduate and professional education context. [ABSTRACT FROM AUTHOR]

In this paper, we examine whether mayors' partisan affiliations lead to differences in crime and policing. We use a large new dataset on mayoral elections and three different modern causal inference research designs (a regression discontinuity design centered around close elections and two robust difference-in-differences methods) to determine the causal effect of mayoral partisanship on crime, arrests, and racial differences in arrest patterns in medium and large US cities. We find no evidence that mayoral partisanship affects police employment or expenditures, police force or leadership demographics, overall crime rates, or numbers of arrests. At the same time, we find some suggestive evidence that mayoral partisanship may modestly affect the racial composition of arrests. Overall, the results from our multimethod analyses indicate that local partisan politics has little causal impact on crime and policing. [ABSTRACT FROM AUTHOR]

Purpose: To compare between the dartos and tunica vaginalis flaps as covering layers in denovo distal or mid-shaft penile hypospadias underwent tubularized incised plate (TIP) repair. Methods: This is a single-center, randomized trial was for denovo distal or mid-shaft penile hypospadias. Children with history of orchiectomy, orchiopexy and inguinal hernia repair were excluded. Eighty-eight patients were divided into two groups: the first used dartos flap (DF), while the second used tunica vaginalis flap (TVF). The primary outcome was to assess the incidence of urethrocutaneous fistula. The secondary outcome was to assess cosmetic outcome using paediatric penile perception score (PPPS) and hypospadias objective scoring evaluation (HOSE). Results: Baseline demographic and clinical characteristics showed no statistically significant. Median operative time (IQR) was 100 (90, 120) and 145 (140, 150) minutes in in DF and TVF Groups, respectively (p < 0.001). Urethrocutaneous Fistula was detected in 9 (20.9%) in DF group and 2 (4.9%) in TVF group (p 0.029). Meatal stenosis occurred in 3 (7%) in DF group and 2 (4.9%) in TVF group. Penile torque was diagnosed in one (2.4%) in TVF group. There was no significant difference in total PPPS score (p = 0.076), however, there was a significant difference in total HOSE score in the favour to TVF group (p = 0.024). At 12 months, testicular ascent occurred in 0% and 3 (7.3%) in DF and TVF groups, respectively (p = 0.071). Conclusion: Compared to dartos flap, tunica vaginalis flap significantly helps in reduction of fistula rate. However, it has significant more operative time. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the prevalence of smartphone addiction, physical activity levels, and depressive symptoms among secondary school students, and to analyze the combined impact of smartphone addiction and physical activity on depressive symptoms. Methods: A cluster sampling method was employed in two secondary schools in the Jing'an District of Shanghai, China. Univariate analysis was used to compare the prevalence of depressive symptoms across different demographic characteristics. Logistic regression was utilized to examine the associations between smartphone addiction, physical activity, and their combined effect on depressive symptoms. Results: A total of 1,316 respondents participated in the study, with reported prevalence rates of depressive symptoms (36.2%), smartphone addiction (19.2%), and insufficient physical activity (23.3%). Risk factors for depressive symptoms included being a non-only child (OR=1.421, 95% CI: 1.090-1.853, P=0.009), inadequate sleep duration (OR=2.722, 95% CI: 2.070-3.578, P<0.001) and smartphone addiction (OR=2.173, 95% CI: 1.621-2.913, P < 0.001). Adolescents with smartphone addiction were significantly more likely to report depressive symptoms compared to those without (OR=2.173, 95% CI: 1.621-2.913, P < 0.001). Joint analysis indicated that combined smartphone addiction and insufficient physical activity significantly increased the risk of depressive symptoms (OR=2.781, 95% CI: 1.627-4.753, P < 0.001). Conclusion: The study identified a high prevalence of severe smartphone addiction, insufficient physical activity, and elevated rates of depressive symptoms among secondary school students. Smartphone addiction and inadequate physical activity were associated with increased likelihood of depressive symptoms. Moreover, higher levels of physical activity appeared to mitigate the adverse impact of smartphone addiction on depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Abdominal aortic calcification (AAC) is a prevalent form of vascular calcification associated with adverse cardiovascular outcomes. While previous studies on AAC and cardiovascular risk exist, many have limitations such as small sample sizes and limited clinical significance outcomes. This study aims to prospectively investigate the association between AAC and all-cause and cardiovascular disease (CVD)-specific mortality rates in a nationally representative sample of adults in the United States, using data from the National Health and Nutrition Examination Survey (NHANES). Methods: The study, conducted on NHANES participants aged 40 years or older during the 2013–2014 cycle, assessed AAC using the Kauppila scoring system. Demographic characteristics, mortality data, and comorbid factors such as age, gender, diabetes, and hypertension were considered. Statistical analyses, including weighted percentages, Kaplan-Meier survival curves, and multivariable Cox proportional hazards regression models, were employed to evaluate the associations between AAC and mortality risks. Results: After analyzing a final sample of 2717 participants, the study found a significant association between severe AAC (SAAC) and higher all-cause mortality risk (HR 1.70, 95% CI 1.17–2.48). The dose-response relationship indicated an increased risk with higher AAC scores. However, no independent association was observed between AAC and cardiovascular mortality. Stratified analysis revealed variations in the AAC-all-cause mortality association based on gender and hypertension. Conclusion: This population-based study provides valuable insights into the prospective association between AAC and all-cause mortality, emphasizing the potential role of AAC assessment in identifying individuals at higher risk. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led to major changes in everyone's lives, including adolescents. Given that adolescence is a crucial developmental stage, designing strategies to alleviate the impact of the COVID-19 on adolescents is critical. Furthermore, there is a growing literature on the relationship between how adolescents spend their time and impact upon health, nutrition, educational attainment and overall well-being outcomes, and the existence of a socioeconomic gradient with how time is allocated. Therefore, this study explored changes in adolescents' time use during the first COVID-19 lockdown in the UK and the relationship between these changes and individual-level socioeconomic indicators including family affluence, free school meal eligibility, and food insecurity. Methods: The data were collected from 11-15-year-olds using an online survey, which contained questions on demographic characteristics, socioeconomic indicators, and time use across a range of activities before and during the first COVID-19 lockdown. Changes in time use in relation to socioeconomic indicators were explored using descriptive and regression analysis. Results: 687 adolescents completed the survey. There was an overall decrease in the amount of time spent on school work, an increase in screen time, and an increase in sleep duration during the week. Descriptive analysis showed evidence of inequalities with changes in time use. In adjusted regression analyses, family affluence was associated with a greater increase in time spent on socialising with household members and a decrease in time spent on exercise. Free school meal eligibility and experience of food insecurity were associated with an increase in sleep duration. Discussion: This study contributes to the body of evidence on the impact of the COVID-19 pandemic on young people and suggests that some of the pre-lockdown inequalities in time allocation were attenuated as a result of the lockdown. Furthermore, the results underscore the need for longer term surveillance to monitor changes in time use in adolescents to mitigate the impact on outcomes over the life course. [ABSTRACT FROM AUTHOR]

Introduction: Undiagnosed chronic disease has serious health consequences, and variation in rates of underdiagnosis between populations can contribute to health inequalities. We aimed to estimate the level of undiagnosed disease of 11 common conditions and its variation across sociodemographic characteristics and regions in England. Methods: We used linked primary care, hospital and mortality data on approximately 1.3 million patients registered at a GP practice for more than one year from 01/04/2008–31/03/2020 from Clinical Practice Research Datalink. We created a dynamic state model with six states based on the diagnosis and mortality of 11 conditions: coronary heart disease (CHD), stroke, hypertension, chronic obstructive pulmonary disease, type 2 diabetes, dementia, breast cancer, prostate cancer, lung cancer, colorectal cancer, and depression/anxiety. Undiagnosed disease was conceptualised as those who died with a condition but were not previously diagnosed. This was combined with observed data on the incidence of diagnosis, the case fatality rate in the diagnosed, and an assumption about how that rate varies with diagnosis to estimate the number of undiagnosed disease cases over the total number of disease cases (underdiagnosis) in each population group. We estimated underdiagnosis by year, sex, 10-year age group, relative deprivation, and administrative region. We then applied small-area estimation techniques to derive underdiagnosis estimates for health planning areas (CCGs). Results: Levels of underdiagnosis varied between 16% for stroke and 69% for prostate cancer in 2018. For all diseases, the level of underdiagnosis declined over time. Underdiagnosis was not consistently concentrated in areas with high deprivation. For depression/anxiety and stroke, underdiagnosis was estimated to be higher in less deprived CCGs, whilst for CHD and T2DM, it was estimated to be higher in more deprived CCGs, with no apparent relationships for other conditions. We found no uniform spatial patterns of underdiagnosis across all diseases, and the relationship between age, deprivation and the probability of being undiagnosed varied greatly between diseases. Discussion: Our findings suggest that underdiagnosis is not consistently concentrated in areas with high deprivation, nor is there a uniform spatial underdiagnosis pattern across diseases. This novel method for estimating the burden of underdiagnosis within England depends on the quality of routinely collected data, but it suggests that more research is needed to understand the key drivers of underdiagnosis. [ABSTRACT FROM AUTHOR]

Background: Canadian Veterans experiencing chronic pain report concerns about accessing accurate information on the risks associated with medical cannabis (MC) use. The Lower Risk Cannabis Use Guidelines (LRCUG) were developed to equip individuals who use cannabis recreationally with safer-use strategies. Many of the harm reduction recommendations for recreational cannabis use are relevant and important considerations for MC use. The primary objective of our study was to assess Canadian Veterans' awareness of and interest in the LRCUG, and engagement in potential higher-risk MC use behaviours. Methods: Canadian Armed Forces Veterans living with chronic pain (N = 582) were recruited online and through the Chronic Pain Centre of Excellence for Canadian Veterans. Participants completed measures on: cannabis use (never, past, current use), sources of cannabis knowledge, mental health, and awareness of and interest in receiving the LRCUG. Chi-Square and post-hoc analyses characterized the sample and assessed for demographic differences based on cannabis use status and awareness of the LRCUG. Engagement in higher-risk MC use behaviours were aligned to LRCUG recommendations, and detailed descriptively. Results: Veterans who currently use cannabis were more likely to be unemployed (z = 3.62, p <.01), released as a Non-Commissioned Officer (z = -3.83, p <.01), and unable to work due a disability (z = -3.43, p <.01) than Veterans who do not currently use. Less than 30% of Veterans were aware of the LRCUG, with greater awareness among individuals who currently use cannabis (n = 356). Engagement in higher-risk MC use behaviours that contradicted LRCUG recommendations ranged from ~ 9% to ~ 85%. Approximately 9% of Veterans experienced co-morbid mental health concerns, yet their MC use was not for mental health purposes (LRCUG recommendation #7). Additionally, almost 85% of Veterans engaged in daily MC use (LRCUG recommendation #5). The majority of Veterans who currently use cannabis engaged in two or more higher-risk MC use behaviours (60.2%; LRCUG recommendation #12). Almost half of all Veterans received their cannabis information from a healthcare provider or the internet. Conclusions: Our study suggests the importance of safer use guidelines tailored for MC use. Development of lower-risk MC use guidelines can support prescribing practitioners and Veterans with information needed for safer and better-informed MC use decisions, tailored to patients' needs and circumstances. [ABSTRACT FROM AUTHOR]

The purpose of this study was to look into the prevalence and associations of meeting adherence to 5-2-1-0 health guidelines (5 or more servings of fruits and vegetables/day (FV), ≤2 hours of recreational screen time/day (ST), at least 1 hour of moderate and/or vigorous physical activity (PA), and 0 sugar-sweetened beverages/day) among school adolescents in the Philippines. The 2011, 2015 and 2019 Philippines Global School-based Student Health Survey, a nationally representative survey of teenagers aged 11 to 18 provided the study’s data. Measures included self-reported demographics, peer and parental support, body mass index, six externalized and four internalized behaviours, and four hygiene behaviours, and 5-2-1-0 health guidelines. The relationship between behavioural outcomes and meeting the 5-2-1-0 health guidelines number was investigated using logistic regression models. The percentages of participants who adhered to none, one, and two, 5-2-1-0 health guidelines were 11.6%, 38.9%, and 41.8%, respectively, whereas 7.7% of participants met three (7.2%) or four (0.5%) guidelines. Compared to participants from study wave 2011, participants from study waves 2015 and 2019, and having obesity were negatively associated with adhering to 3 or 4 5-2-1-0 health guidelines, while school attendance, peer and higher parental support were positively associated with adhering to 3 or 4 5-2-1-0 health guidelines. Compared with meeting none of the 5-2-1-0 health guidelines, participants who met a higher number of recommendations were less likely to report externalizing behaviours (current alcohol use, history of intoxication, participation in physical fighting, sustained a physical injury, were physically attacked and had been bullied), internalizing behaviours (suicidal ideation, plan and attempt and psychological distress) and hygiene behaviours (inadequate tooth brushing, not always hang hygiene before meals, after toilet and with soap). Future behavioural and mental health interventions for adolescents should focus on improving their overall 5-2-1-0 behaviours while taking demographic differences into account. [ABSTRACT FROM AUTHOR]

Background: Clinically, the ability to distinguish which Crohn's disease patients can benefit from Adalimumab is limited. Aims: This study aimed to develop a model for predicting clinical remission probability for Crohn's disease patients with Adalimumab at 12 weeks. The model assists clinicians in identifying which Crohn's disease patients are likely to benefit from Adalimumab treatment before starting therapy, thus optimizing individualized treatment strategies. Methods: Demographic and clinical characteristics of Crohn's disease patients were utilized to develop a model for clinical remission probability. LASSO regression was used to select predictive factors, and predictions were made using a logistic regression model. The model was internally validated using the bootstrap method (resampling 1000 times). Results: 68 patients with Crohn's disease were enrolled in this study. Clinical remission was observed in 55.9% at 12 weeks. Three variables were selected through the least absolute shrinkage and selection operator regression method, including Adalimumab-positive cell count, disease duration, and neutrophil count of Crohn's disease patients. A predictive model was constructed by multivariate logistic regression (Adalimumab-positive cell count (OR, 1.143; 95%CI, 1.056–1.261), disease duration (OR, 0.967; 95%CI, 0.937–0.986), and neutrophil count (×109/L) (OR, 1.274; 95%CI,1.014–1.734)). The predictive model yielded an area under the curve of 0.866 (95%CI, 0.776–0.956), and in the internal validation, the area under the curve was 0.870 (95%CI, 0.770–0.940). Conclusions: This model provides a convenient tool to assess the likelihood of patient remission prior to Adalimumab treatment, thereby supporting the development of personalized treatment plans. [ABSTRACT FROM AUTHOR]

In recent decades there has been significant interest among policy makers in supporting entrepreneurship among university students, with the goal to improve labor market outcomes and contribute to the economy through venture creation. Drawing from the 2018 National Graduate Survey in Canada, our study examines who engages in entrepreneurial activity after graduation, investigating differences among demographic groups and between those who participated in entrepreneurship education on campus and those who did not participate. We find that those graduates who participated in entrepreneurship education are more likely to be self-employed and own their own business three years after graduating than the general population of university graduates. We also find differences according to gender, citizenship, and socio-economic status in entrepreneurial activity. Our results are consistent with previous studies documenting demographic disparities in entrepreneurship and provide more generalizable evidence about the relationship between entrepreneurship education and subsequent entrepreneurship. [ABSTRACT FROM AUTHOR]