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Factors associated with chronic kidney disease knowledge and preventive practices: An analytical cross-sectional study among patients with hypertension at Amana Regional Referral Hospital in Dar es Salaam, Tanzania
Background Globally, Chronic kidney Disease (CKD) has become a significant public health concern, with sub-Saharan Africa being among the populations experiencing the highest rates. Managing CKD poses a significant challenge due to its health complications and associated high cost of care. Hypertension is one of the leading causes of CKD, responsible for the decline in kidney function in patients. Knowledge and lifestyle modifications are pivotal to the prevention and progression of CKD. In Tanzania, little is known regarding CKD knowledge and preventive practices among patients with hypertension. Therefore, this study aimed to assess context-specific factors associated with CKD knowledge and preventive practices among patients with hypertension at Amana Regional Referral Hospital in Dar es Salaam. Methods An analytical cross-sectional study involving 184 patients was conducted at Amana Regional Referral Hospital. Patient were recruited at the outpatient hypertension clinic using simple random sampling in June and July 2022. Data analysis was conducted using IBM-SPSS Statistics version 25. Bivariate and multiple logistic regression analyses were performed to identify factors associated with knowledge and preventive practices related to CKD, with statistical significance set at a p-value < 0.05. Results The median CKD knowledge score was 13 (IQR: 9–16). Of the 184 respondents, 104 (56.5%) demonstrated high CKD knowledge. None of the sociodemographic factors were significantly associated with CKD knowledge. The median score for CKD preventive practices was 9 (IQR: 8–9), and 111 respondents (60.3%) had good practices. High CKD knowledge was significantly associated with good CKD preventive practices (AOR: 1.98; 95% CI: 1.08, 3.62; p = 0.027). Conclusion A significant proportion of hypertensive patients in this study exhibited both high CKD knowledge and good preventive practices. The positive correlation between CKD knowledge and improved preventive practices highlights the importance of educational interventions to further enhance CKD knowledge among patients with hypertension.
Applying fractional calculus to malware spread: A fractal-based approach to threat analysis
Malware is a common word in modern era. Everyone using computer is aware of it. Some users have to face the problem known as Cyber crimes. Nobody can survive without use of modern technologies based on computer networking. To avoid threat of malware, different companies provide antivirus strategies on a high cost. To prevent the data and keep privacy, companies using computers have to buy these antivirus programs (software). Software varies due to types of malware and is developed on structure of malware with a deep insight on behavior of nodes. We selected a mathematical malware propagation model having variable infection rate. We were interested in examining the impact of memory effects in this dynamical system in the sense of fractal fractional (FF) derivatives. In this paper, theoretical analysis is performed by concepts of fixed point theory. Existence, uniqueness and stability conditions are investigated for FF model. Numerical algorithm based on Lagrange two points interpolation polynomial is formed and simulation is done using Matlab R2016a on the deterministic model. We see the impact of different FF orders using power law kernel. Sensitivity analysis of different parameters such as initial infection rate, variable adjustment to sensitivity of infected nodes, immune rate of antivirus strategies and loss rate of immunity of removed nodes is investigated under FF model and is compared with classical. On investigation, we find that FF model describes the effects of memory on nodes in detail. Antivirus software can be developed considering the effect of FF orders and parameters to reduce persistence and eradication of infection. Small changes cause significant perturbation in infected nodes and malware can be driven into passive mode by understanding its propagation by FF derivatives and may take necessary actions to prevent the disaster caused by cyber crimes.
Does a priming warm-up influence the incidence of V˙O2pl during a ramp test and verification phase?
Objective This study compared the effects of two different warm-up protocols (normal vs. priming) on the oxygen plateau (V˙O2pl) incidence rate during a ramp test. It also compared the cardiopulmonary responses during the ramp test and subsequent verification phase. Methods Eleven recreational cyclists performed two experimental visits. The first visit required a normal warm-up (cycling at 50 W for 10 min) followed by the ramp test (30 W.min-1) and supramaximal verification phase with 30 min rest between tests. The second visit required a priming warm-up (cycling at 50 W for 4 min increasing to 70% difference between the gas exchange threshold [GET] and maximum work rate [WRmax] for 6 min) followed by the same protocol as in the first visit. Physiological responses were collected during the exercise and compared. Oxygen kinetics (V˙O2 Kinetics) and V˙O2pl incidence rate were determined during the ramp tests for both visits. Results As planned, following the warm-up the priming visit experienced greater physiological response. However, the incidence rate of V˙O2pl during the ramp test was the same between visits (73%), and maximal oxygen uptake was not different between visits after the ramp test (normal, 4.0 ± 0.8; primed, 4.0 ± 0.7 L·min−1, p = 0.230) and verification phase (normal, 3.8 ± 0.6; primed, 3.8 ± 0.7 L·min−1, p = 0.924) using a Holm-Bonferroni correction for controlling family-wise error rate. V˙O2 Kinetics were not different between visits during the ramp test (normal, 10.8 ± 1.1; primed, 10.8 ± 1.2 mL·min−1·W-1, p = 0.407). The verification phase confirmed V˙O2max in 100% for both the normal and priming visits. Conclusion Our hypothesis that a priming warm-up facilitates the incidence rate of V˙O2pl during a ramp test is not supported by the results. The verification phase remains a prudent option when determining a ‘true’ V˙O2max is required.
Anti-nucleocapsid SARS-CoV-2 antibody seroprevalence in previously infected persons with immunocompromising conditions—United States, 2020–2022
People with immunocompromising conditions (IC) are at increased risk of severe COVID-19 and death. These individuals show weaker immunogenicity following vaccination than individuals without IC, yet immunogenicity after SARS-CoV-2 infection is poorly understood. To address this gap, the presence of infection-induced antibodies in sera following a positive COVID-19 test result was compared between patients with and without IC. A commercial laboratory provided patient data gathered during July 2020–February 2022 on COVID-19 viral test results and antibody assay results, which included infection-induced (anti-N) antibody presence. Participants were categorized into having or not having IC based on if there was an indicative diagnostic code on their health record for a five-year period prior to the study period. Anti-N presence in sera from people with a positive COVID-19 test result was compared by IC status for four post-infection periods: 14–90, 91–180, 181–365, and 365+ days. A longitudinal, logistic regression produced adjusted odds ratios comparing anti-N prevalence among specimens with and without associated IC, adjusted for age, sex, residence in a metro area, and social vulnerability index (SVI) tertile. Data included 17,025 anti-N test results from 14,690 patients, 1,424 (9.7%) of which had at least one IC on record. In an adjusted comparison to patients without IC, patients with any IC were 0.61 times as likely to have infection-induced antibodies (99% CI: 0.40–0.93), during the 14–90 days following infection. Similar patterns were found when comparing people with two specific types of IC to people without any IC: (1) solid malignancies and (2) other intrinsic immune conditions. These findings stress the importance of prevention measures for people with IC, such as additional vaccination doses and consistent mask use before and after a documented infection.
Comparative evaluation of high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) in infants after non-cardiac surgery: Study protocol of a randomized controlled trial
Background Literature regarding the advantages of HFNC in infants for ensuring oxygen supply after non-cardiac surgery is insufficient. The purpose of our study is to compare COT vs. HFNC on postoperative outcomes in infants undergoing non-cardiac surgery. We hypothesize that prophylactic use of HFNC after non-cardiac surgery in infants would reduce the incidence of post-anesthesia hypoxemia and could also be adapted as first-line oxygen therapy after non-cardiac surgery. Methods This is a superior, single-blind, randomized controlled study. A total of 394 infants undergoing general anesthesia will be randomly assigned to accept COT or HFNC in a 1:1 ratio. The primary outcome is the rate of desaturation post-extubation. Secondary outcomes include the rate of mild upper airway obstruction, the rate of severe respiratory depression, the rate of transfer to PICU, duration of oxygen therapy, length of PACU stay, the time to reach full enteral feeding, and postoperative adverse events, including nasal injury, agitation, vomiting, and unplanned secondary surgery related to the initial surgery. Discussion This is the first randomized controlled trial to explore the advantages of HFNC in infants to ensure oxygen supply after non-cardiac surgery. If favorable evidence is obtained, HFNC could be adopted as first-line oxygen therapy for infants following non-cardiac surgery. Trial registration The trial was registered at https://www.chictr.org.cn (Registration number: ChiCTR2400081600, Date: March 6, 2024).
A retrospective single-center pilot study of the genetic background of the transplanted kidney
Introduction Renal cell carcinoma (RCC) is one of the most prevalent cancers in kidney transplant recipients (KTR). The hereditary background of RCC in native kidneys has been determined, implicating its clinical importance. Materials and methods This retrospective single-center pilot study aimed to identify a potential genetic predisposition to RCC of the transplanted kidney and outcome in KTR who underwent single kidney transplantation between January 2000 and December 2020 and manifested RCC of the transplanted kidney. Next-generation sequencing (NGS) based germline genetic analysis from peripheral blood-derived genomic DNA (gDNA) was performed in both the recipient and donor using a gene panel targeting 226 cancer predisposition genes. Results The calculated incidence of RCC of the transplanted kidney among 4146 KTR was 0.43%. In fifteen KTR and donors, NGS was performed. The mean KTR age at transplantation and the diagnosis of RCC was 50.3 years (median 54; 5–67 years) and 66 years (median 66; 24–79 years), respectively. The mean donor age at transplantation and graft age at RCC diagnosis was 39.7 years (median 42; 7–68 years) and 50.2 years (median 46; 20–83 years), respectively. The mean follow-up after RCC diagnosis was 47 months (median 39.1; 0–112 months). Papillary RCC was the most prevalent (n = 8), followed by clear cell RCC (n = 6) and unspecified RCC (n = 1). Thirteen RCCs were low-stage (pT1a/b) diseases, one was pT3, and one was of unknown stage. Most RCC was higher graded. No germline pathogenic cancer-predisposition variant was found in either KTR or donors except for several variants of uncertain significance. Conclusion RCC of the transplanted kidney is very rare. Germline cancer-predisposition testing has identified several variants of uncertain significance, but no germline genetic predisposition to graft RCC in KTR. Further research is needed to assess the clinical relevance of genetic testing for cancer risk in KTR.
Decreased risk-proneness with increasing age in equally raised and kept wolves and dogs
A basic mechanism of domestication is the selection for fearlessness and acceptance of humans as social partners, which may affect risk-taking behavior and the ability to use humans as social support, both at the behavioural and physiological levels. We combined behavioural observations with heart rate parameters (i.e., HR and heart rate variability, HRV) in equally raised and housed wolves and dogs to assess the responses to food offered in the vicinity of a potential stressor (an unknown spinning object) with and without social support from a familiar human. Based on previous studies on neophobia in wolves and dogs, we expected dogs to be less scared of the object, approach more quickly, show less ambivalent behaviour, lower HR, and higher HRV, than wolves, especially at the presence of a human partner. However, we found that mainly age and the presence of a familiar human affected the behaviour of our subjects: older wolves and dogs were generally bolder and faster to approach the food and the familiar human’s presence increased the likelihood of taking it. HR rate parameters were affected by age and the stage of the test. Wolves and dogs showed particularly high HRs at the beginning and end of the test sessions. We conclude that in our paradigm, wolves’ and dogs’ risk-proneness varied with age, rather than species. Additionally, the presence of a familiar human increased the motivation of both, dogs and wolves to take the food.
Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in treatment-naïve and treatment-experienced people with HIV: 12-month virologic effectiveness and safety outcomes in the BICSTaR Japan cohort
BICSTaR (BICtegravir Single Tablet Regimen) is an ongoing, observational cohort study assessing the virologic effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in treatment-experienced (TE) and treatment-naïve (TN) people with HIV across 14 countries over 24 months. We present 12-month outcomes from participants in the BICSTaR Japan cohort. Retrospective and prospective data were pooled from people with HIV aged ≥20 years receiving B/F/TAF within routine clinical care in Japan. Outcomes included virologic effectiveness (primary endpoint; HIV-1 RNA <50 copies/mL), CD4 count, CD4/CD8 ratio, drug-related adverse events (DRAEs), persistence, and patient-reported outcomes (prospective TN cohort only). Overall, 200 participants were enrolled and included in the 12-month analysis population (150 retrospective, 50 prospective; 116 TN and 84 TE). Most participants were male at birth (99%); median age was 34 years in TN and 45 years in TE participants. At 12 months, virologic effectiveness was high: 92% (90/98) of TN and 95% (72/76) of TE participants had HIV-1 RNA <50 copies/mL (missing = excluded analysis). Median (quartile [Q]1, Q3) CD4 cell count increased by +202.0 (126.0, 311.0) cells/μL in TN (p<0.001) and +11.0 (−60.0, 87.0) cells/μL in TE (p = 0.380) participants. Through 12 months, DRAEs were reported by 13% (25/200) of all participants (16% [18/116] TN, 8% [7/84] TE); diarrhea, weight gain, and headache were the most common. Most DRAEs were mild in severity and no severe DRAEs were reported. One TN participant (<1%; 1/116) and two TE participants (2%; 2/84) discontinued B/F/TAF due to DRAEs (macrocytic anemia, vertigo, diarrhea, and headache). Treatment persistence at 12 months exceeded 98% in both TN and TE participants. In prospective TN participants, improvements in bothersome symptom count and quality-of-life measures were observed. B/F/TAF demonstrated high levels of virologic effectiveness and tolerability in people with HIV treated as part of routine clinical care in Japan.
Burden of chronic obstructive pulmonary disease in adults aged 70 years and older, 1990–2021: Findings from the Global Burden of Disease Study 2021
Background Life expectancy at age 70 has continued to rise globally over the past 30 years. However, a comprehensive assessment of the burden of COPD in older adults is lacking. We aimed to estimate the burden of COPD and its attributable risk factors among adults aged ≥70 years. Methods Data on the prevalence, incidence, deaths, disability-adjusted life years (DALYs), and risk factors of COPD among adults aged ≥70 years from 1990 to 2021 across 204 countries and territories, were sourced from the Global Burden of Disease Study 2021. Estimated annual percentage change (EAPC) was used to illustrate temporal trends at global and regional levels from 1990 to 2021. Results In 2021, the global numbers of prevalent and incident COPD cases among older adults were 99.7 and 7.4 million, increasing by 162.2% and 157.4% from 1990. The prevalence and incidence rates increased from 18823.5 (95% uncertainty interval (UI) 16324.4–21208.4) to 20165.6 (17703.8–22549.4) and 1429.0 (1224.2–1613.0) to 1502.7 (1309.0–1677.9) per 100,000 population (EAPC 0.31, 95% CI 0.28–0.33; 0.17, 95% CI 0.16–0.19). The global numbers of COPD-associated deaths and DALYs in 2021 reached 2.9 and 45.4 million, increasing by 70.7% and 70.0% from 2019, while the corresponding rates declined (both EAPC <0). The highest prevalence and the largest increase in incidence rate occurred in high sociodemographic index (SDI) regions, while the largest increase in death and DALY rates occurred in the low SDI regions. The United States had the highest prevalence rates in 2021, while Iran had the largest increase. From 1990 to 2021, the death rates attributable to ambient ozone pollution-related COPD in older adults have risen, particularly in low and low-middle SDI regions. Conclusion COPD in older adults has progressively become a global health challenge with rising prevalence and incidence rates. Although the death and DALY rates attributed to COPD have globally decreased in older adults, the absolute counts are rapidly increasing. The inequalities across different regions and countries underscore a multi-faceted approach to COPD management in older adults.
Spatial variation and determinant factors of alcohol consumption in Ethiopia: Spatial and multilevel analysis of Ethiopian demographic and health survey
Background Alcohol consumption continues to be a public health problem in Ethiopia. Previous investigations have been conducted on alcohol consumption in Ethiopia; however, these investigations were limited to specific localities, which could not represent the existing alcohol consumption in different parts of Ethiopia. Besides, the spatial variation of alcohol consumption was not well investigated in the previous studies, which could hinder the implementation of effective intervention towards alcohol consumption. Hence, this study aimed to determine the spatial distribution and determinant factors of alcohol consumption in Ethiopia. Methods Secondary data from the 2016 Ethiopian demographic health survey was used in this study. A total of 44,023 weight samples were included using a stratified two-stage cluster sampling technique. The spatial variation of alcohol consumption was analyzed using ArcGIS version 10.7.1. The statistical significance of alcohol consumption clusters were identified using Kuldorff’s SaTScan version 10.2. A multi-level analysis was also conducted to identify factors associated with alcohol consumption using STATA version 14. Results In this study, 33.15% (95%CI: 32.5–33.8) of the study participants consumed alcohol with statistically significant spatial variation across regions of the country. Traditional religion (AOR = 13.7; 95%CI: 2.68–70.3), Regional variations (Amhara region—AOR = 3.56; 95%CI: 1.85–6.8, living in a low proportion of community literacy (AOR = 1.84; 95%CI: 1.1–3.18), cigarette smoking habit (AOR = 15.82; 95%CI: 4.31–58.1), and chewing Khat (AOR = 2.98; 95%CI: 1.22–7.27) were positively linked with alcohol consumption. Hot spot areas of alcohol consumption were found in Tigray, Amhara, and some parts of Oromia regions. The statistical significance of the primary clusters was also observed in Tigray and Amhara regions. Conclusions We found that one-third of Ethiopia’s population is consuming alcohol. Having a cigarette smoking habit, chewing khat, high proportion of community literacy, and traditional religion were associated factors for alcohol consumption. Therefore, the federal government of Ethiopia, and ministry of health, and other concerned bodies should work in collaboration to decrease the proportion of people consuming alcohol.
Schizophrenia more employable than depression? Language-based artificial intelligence model ratings for employability of psychiatric diagnoses and somatic and healthy controls
Artificial Intelligence (AI) assists recruiting and job searching. Such systems can be biased against certain characteristics. This results in potential misrepresentations and consequent inequalities related to people with mental health disorders. Hence occupational and mental health bias in existing Natural Language Processing (NLP) models used in recruiting and job hunting must be assessed. We examined occupational bias against mental health disorders in NLP models through relationships between occupations, employability, and psychiatric diagnoses. We investigated Word2Vec and GloVe embedding algorithms through analogy questions and graphical representation of cosine similarities. Word2Vec embeddings exhibit minor bias against mental health disorders when asked analogies regarding employability attributes and no evidence of bias when asked analogies regarding high earning jobs. GloVe embeddings view common mental health disorders such as depression less healthy and less employable than severe mental health disorders and most physical health conditions. Overall, physical, and psychiatric disorders are seen as similarly healthy and employable. Both algorithms appear to be safe for use in downstream task without major repercussions. Further research is needed to confirm this. This project was funded by the London Interdisciplinary Social Science Doctoral Training Programme (LISS-DTP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Association between normal weight obesity and comorbidities and events of cardiovascular diseases among adults in South China
Background The increased risks for cardiovascular comorbidities and cardiovascular diseases (CVD) in populations with normal weight obesity (NWO) have not been well-identified. We aimed to study their associations in an adult population in South China. Methods Based on the CVD prevalence of 4% in Shenzhen and a calculated sample size of 6,000, a cross-sectional study with a multi-stage stratified cluster sampling method was conducted in Shenzhen City. The cardiovascular comorbidities being studied were abdominal obesity (AO), diabetes, hypertension, dyslipidemia, metabolic syndrome, and chronic kidney disease, while the CVD events were occurrences of myocardial infarction and strokes. Questionnaire surveys, physical examinations, and laboratory tests were performed. NWO was defined as a condition with the highest tertile of body fat percentage (BF%) among the normal body mass index (BMI) range (18.5–23.9 kg/m2). Continuous data were reported as mean [standard deviation (SD)] and categorical data as percentages (%). CVD comorbidities and CVD events and their detection rates in different groups were compared using ANONA analysis and Chi-squared test. Spearman’s correlation coefficients between BF% and cardiometabolic abnormalities were calculated by partial correlation analysis. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for BF%, CVD comorbidities, and CVD events, adjusted for multiple confounders. Results Among the total 6,240 subjects who completed the study and had BMI and BF% data available, 3,086 had normal BMI. The prevalence of NWO was 16.36%, with 13.15% for men and 19.54% for women. With confounders adjusted, the risks of AO (OR = 6.05, 95%CI = 3.40–10.75), essential hypertension (OR = 1.56, 95%CI = 1.09–2.22), dyslipidemia (OR = 1.85, 95%CI = 1.49–2.29), and metabolic syndrome (OR = 4.61, 95%CI = 2.32–9.18) were significantly increased in the populations with NWO compared with the population without NWO (P < 0.05). BF% was not significantly associated with the risk of CVD events in the total (OR = 1.56, 95%CI = 0.83–2.93), male (OR = 1.00, 95%CI = 0.44–2.30), and female populations (OR = 2.53, 95%CI = 0.91–7.06). Conclusion NWO was found to be positively associated with CVD comorbidities but not with CVD events. The current study provides a ground to conduct further studies on whether body fat affects the risk of occurrence of CVD events and the underlying mechanisms in the future.
Predicting fiber content in herbivore fecal samples using a multispecies NIRS model
Fiber is essential for rumen health, microbial fermentation, and the energy supply of herbivores. Even though the study of fecal fiber contents (neutral detergent fiber NDF, acid detergent fiber ADF, and acid detergent lignin ADL) using near-infrared reflectance spectroscopy (NIRS) has allowed investigating nutritional ecology of different herbivore species, NIRS calibrations are species-specific and require a large number of samples for predictions. A multispecies calibration would be an advantage since samples from different herbivores could be used to calibrate a model capable of predicting the fecal fiber content of other herbivores. To date, however, multispecies models have not been developed to predict fiber contents in the feces of herbivores. Here, we fill this gap by calibrating three fiber multispecies models (NDF, ADF and ADL) using fecal samples from domestic and wild herbivore species. We also evaluated the effect of incorporating sodium sulfite in fiber determination protocol. The initial dataset consisting of 445 samples of six herbivore species was used to calibrate (80% of the samples) and validate (20% of the samples) the models. Subsequently, 63 samples of five herbivores not included in the calibration set were used for the external validation of the model. Since sodium sulfite did not significantly improve fecal fiber prediction, our model was developed without this compound. The multispecies models obtained were highly accurate determining NDF, ADF and ADL (R2CAL, coefficient of determination in calibration, ≥ 0.93, R2VAL, coefficient of determination in validation, ≥ 0.91) and independent of external confounders. For external validation, the accuracy in predicting fecal samples in other herbivore species was also satisfactory, with consistently better values for NDF (R2VAL, 0.86–0.94) and ADF (R2VAL, 0.80–0.95) than for ADL (R2VAL, 0.66–0.89). We show that multispecies NIRS calibrations can be used with high accuracy to assess fecal fiber contents across diverse herbivore species. This finding represents a significant advance in the study of the nutritional ecology of herbivores with contrasting foraging patterns. In the future, widening the data range (e.g., species and locations) of the initial dataset could further improve the accuracy of these models.
Model to explain dental visit for children aged 0 to 5: Scoping review of birth cohorts
Introduction Health services accessibility is a multidimensional concept. An early-life dental visit could improve child dental health. Through birth cohorts, it is possible to identify health conditions and pathways of exposure that occur earlier in life. The aim of this study is to propose a theorical model to explain the use of dental care for children with primary teeth, based on results from birth cohorts. Method 3 databases were queried: PubMed, Embase and Dentistry & Oral Sciences Source. Eligible articles presented data on children’s dental visits, with at least one follow-up visit between birth and the child’s 6th birthday and based on birth cohorts. Results We identified 649 articles in biomedical literature databases. After exclusions, we read 136 abstracts, and finally 36 articles in their full length. A total of 22 articles were included in the analysis, from 15 countries on 5 continents. The mains proximal factors for access to dental care for preschool children are related to caregivers’ perception of children’s oral health and its impacts on quality of life. These perceptions are influenced by the child’s oral health, the child’s and mother’s use of healthcare, and the healthcare organization. Dental fear seems to be another proximal factor. However, family social background seems to be an enabling moderator for dental visits. Conclusion The scoping review allowed us to develop a model that explains dental visits for children aged 0–5 years as a multifactorial process influenced by caregivers’ perceptions of the child’s oral health, the family’s quality of life, and the child’s dental anxiety.
Use of virtual care near the end of life before and during the COVID-19 pandemic: A population-based cohort study
Background and aims The expanded use of virtual care may worsen pre-existing disparities in use and delivery of end-of-life care among certain groups of people. We measured the use of virtual care in the last three months of life before and after the introduction of virtual care fee codes that funded care delivery at the start of COVID-19 on March 14, 2020, and identified changes in the characteristics of people using it. Methods We used linked clinical and administrative datasets to study use of virtual care in the last three months of life among 411,564 adults who died between January 25, 2018, and November 30, 2022. Modified Poisson regression was used to measure the association of the use of virtual care in the last three months of life with the pandemic study period and its association with each person- and physician-level factor. Results 14,261 people (8%) used virtual care in the last three months of life before the pandemic, and 161,000 people (69%) used it during the pandemic (relative risk [RR] 8.76; 95% CI 8.48–9.05). Several individual patient characteristics were associated with statistically significant increases in the use of virtual care after March 14, 2020 (following the introduction of virtual care fee codes), compared to before such as among older adults, ethnic minorities, multiple chronic comorbid health conditions and higher frailty groups. Conclusions The introduction of new fee codes broadening technology and funding for end-of-life care at the start of pandemic combined with pandemic-related effects was associated with a substantial increase in the use of virtual care near the end of life among certain groups and a general leveling of pre-existing disparities in its use. Virtual end-of-life care delivery may strengthen person-centredness for individuals with limited ability to attend in-person appointments and by providers who may not have previously engaged in such care.
Assessing the effects of drought stress on photosynthetic performance and physiological resistance in camphor seedling leaves
The impact of seasonal short-term drought on plant physiology and resilience is crucial for conservation and management strategies. This study investigated drought stress effects on growth, photosynthetic capacity, and physiological responses of Camphor (Cinnamomum camphora) seedlings in Guangxi province, China. Fertilized potted plants underwent continuous drought treatments to assess varying water supply effects. Treatments included normal water supply (CK), light drought (D1), moderate drought (D2), and severe drought (D3). Physiological indicators including net photosynthetic rate (Pn), stomatal conductance (Gs), transpiration rate (Tr), and intercellular CO2 concentration (Ci) were measured. Additionally, the stomatal limitation value (Ls) was calculated using the formula Ls = 1-Ci/Ca, and water use efficiency (WUE) was computed as Pn/Tr. Furthermore, parameters such as PIABS (Performance Index based on absorbed light energy), WK (the ratio of variable fluorescence FK at the K point to the amplitude FO-FJ), VJ (the ratio of variable fluorescence FJ at the J point to the amplitude FO-FP), ΔI/I0 (the relative amplitude of the 820 nm light absorption curve), superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and malondialdehyde (MDA) were measured to evaluate the impact of drought stress on various physiological processes and antioxidant enzyme activities. Results showed significant decreases in base diameter growth (GD) and seedling height growth (GH) with increasing drought stress. Notably, moderate (D2) and severe (D3) drought treatments led to negative GD values. GD decreased by 23.79%, 114.85%, and 175.50% for D1, D2, and D3 treatments, respectively, while reductions of 40.00%, 73.33%, and 90.00% in GD were observed compared to the control (CK). Pn decreased significantly across treatments, with D1<CK<D2<D3 in Ci. Stomatal limit value (Ls) and water use efficiency (WUE) followed the order: D1>CK>D2>D3. Light energy transmission to PSI by the unit reaction center (REo/RC) initially increased then decreased, significantly smaller in D3 compared to D1. Conversely, heat dissipation absorbed by the unit reaction center (DIo/RC) increased notably in D3 compared to D1 and CK. PIABS, WK, VJ, and ΔI/I0 decreased over time, while Rubisco enzyme activity decreased, while proline (Pro) levels increased. Superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and malondialdehyde (MDA) levels significantly increased during D1 treatment but decreased with D2 and D3 treatments. Overall, drought severity had varying impacts on Cinnamomum camphora growth and photosynthetic structure, with D1 treatment maintaining normal growth and metabolic activities, while D2 and D3 treatments resulted in severe membrane damage, rendering seedlings essentially unable to survive. These findings provide a theoretical basis for implementing water management practices and conservation strategies for camphor seedlings.
Indication of frailty transitions on 2-year adverse health outcomes among older Chinese inpatients: Insight from a multicenter prospective cohort study
Introduction Frailty is thought to be associated with an increased risk of adverse health outcomes such as death and falls, but comparatively little is known about the impact of frailty transitions on the adverse health outcomes. Moreover, owing to insufficient sample size or a single-center study design, previous studies have not been sufficiently representative of elderly inpatients in China. This study aimed to provide estimates at the population level of the association between frailty transitions and adverse outcomes among elderly inpatients following discharge. Methods This was a large-scale multicenter cohort study conducted from October 2018 to February 2021. The FRAIL scale was used to estimate frailty status. Frailty transitions were derived by considering frailty status at baseline and the 3-month follow-up, which encompassed five patterns: persistent non-frailty, persistent pre-frailty, persistent frailty, improvement in frailty, and worsening of frailty. The outcome variables included mortality, falls, hospital readmissions, and Health-Related Quality of Life (HRQoL). Cox proportional hazard regression, generalized linear models and linear regression was used to examine the association between frailty transitions and adverse health outcomes. Results A total of 8,256 patients were included in the study, 40.70% of study participants were non-frail, 43.04% were pre-frail, and 16.27% were frail. Compared with patients who persistently non-frail patients, those who frailty improvement, persistent pre-frailty, worsening frailty, and persistent frailty showcased escalated risks of mortality within 2 years after enrollment [HR (95% CI): 1.32 (1.06–1.64)], 1.71 (1.37–2.13), 2.43 (1.95–3.02), and 2.44 (1.81–3.29), respectively. These groups also faced elevated hazards of 2-year falls [OR(95% CI): 1.586(1.13–2.23), 2.21(1.55–3.15), 1.94(1.33–2.82), 2.71(1.59–4.62)] and re-hospitalization risk within 2 years[OR(95% CI): 1.33(1.13–1.56), 1.56(1.32–1.86), 1.53(1.28–1.83), 2.29(1.74–3.01). The number of falls increased by 0.76 over 2 years in frailty-worsened patients and 0.81 in persistently pre-frail patients. The total days of rehospitalization increased by 0.35 over 2 years in frailty-improved patients, by 0.61 in frailty-worsened patients, by 0.66 in elderly in persistently pre-frail patients and by 0.80 in persistently frail patients. Moreover, patients exhibiting frailty-improved [-1.23 (95% CI: -2.12 to -0.35)], persistently pre-frail[-4.95 (95% CI: -5.96 to -3.94)], frailty-worsened [-3.67 (95% CI: -4.71 to -2.62)], and persistently frail [-9.76 (95% CI: -11.60 to -7.93)] displayed inverse correlations with the regression coefficients of HRQoL. Discussion Frailty-improved, worsened, persistently pre-frail, and frail inpatients face higher risks of mortality, falls, rehospitalization, reduced HRQoL than consistently non-frail inpatients. Screening for frailty among elderly inpatients can identify individuals at increased risk of adverse health outcomes.
Association between heavy metal exposure and bacterial vaginosis: A cross-sectional study
Bacterial vaginosis (BV) is a prevalent cause of vaginal symptoms in women of reproductive age. With the widespread of heavy metal pollutants and their harmful function on women’s immune and hormonal systems, it is necessary to explore the association between heavy metal exposure and BV. This study investigates the potential relationship between serum heavy metals and bacterial vaginosis in a cohort of American women. The present study employed a cross-sectional analysis of 2,493 women participating in the 2001–2004 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were utilized in the study to assess the correlation between these variables. A stratified analysis was performed to investigate the relationship among different population groups further, and smooth curve fittings were conducted to intuitively evaluate the correlation. According to the current cross-sectional study results, a significant correlation was identified between the high levels of lead and cadmium in the serum and the likelihood of developing bacterial vaginosis. We found that serum lead (OR = 1.35, 95% CI: 1.06–1.72, p = 0.016) and serum cadmium (OR = 1.41, 95% CI: 1.01–1.98, p = 0.047) increased the risk of bacterial vaginosis by 35% and 41%, respectively, in the highest level group in comparison to the lowest level group in the fully adjusted model. Furthermore, the research discovered no statistically significant association between the levels of total mercury in the serum and a heightened susceptibility to bacterial vaginosis (OR = 0.96, 95% CI: 0.75–1.23, p = 0.763). Results of our study indicated an inverse association between serum heavy metals and bacterial vaginosis risk, including lead and cadmium. Reducing exposure to heavy metals could be vital to preventing and managing bacterial vaginosis.
Relationship between mental health and substance abuse on COVID-19 vaccine hesitancy in youth: A mixed methods longitudinal cohort study
Background Mental health and substance use challenges are highly correlated in youth and have been speculated to be associated with COVID-19 vaccine hesitancy. Literature has also suggested that mental health challenges in youth have increased during the COVID-19 pandemic. However, the longitudinal relationship between mental health challenges in youth and COVID-19 vaccine hesitancy is not well established. Objective We examined the relationship between mental health, substance use and COVID-19 vaccine hesitancy in youth during the COVID-19 pandemic. Methods Youth ages 14 to 29-years participated in a longitudinal survey study. Participants provided sociodemographic, mental health, and substance use data, as well as qualitative and quantitative information on their vaccine perspectives every two months between February 2021 to August 2021, and on February 2022. Generalized estimating equation logistic regression models were used to analyze the effect of mental health and substance use on vaccine hesitancy over time. Qualitative content area analyses were used to identify trends in vaccine attitudes. Results Mental health challenges and substance use frequency were associated with vaccine hesitancy, and significantly increased the odds of vaccine hesitancy over time. Additionally, mental health challenges were associated with decreases in vaccine hesitancy (OR: 0.80 (95% CI 0.66, 0.97)) when vaccines first began to emerge, but increases in vaccine hesitancy (OR: 1.72 (95% CI 1.32, 2.26)) one year later. Participants reported perceptions regarding vaccine safety and efficacy were the primary determinants influencing hesitant, uncertain, and acceptant vaccine attitudes. Additionally, changes in vaccine attitudes over time for some participants, were associated with changes in mental health. Conclusions Increases in mental health challenges and substance use were associated with increases in COVID-19 vaccine hesitancy in youth over the COVID-19 pandemic. Health policy agencies should be aware of the potential impact of mental health challenges and substance use in youth, when developing vaccine policy and programs.
Comparison of early warning scoring systems for predicting stroke occurrence among hospitalized patients: A study using smart clinical data warehouse
Background This study aimed to evaluate the predictive ability of two widely used early warning scoring systems, the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS), for predicting stroke occurrence in hospitalized patients. Methods The study enrolled 5,474 patients admitted to the intensive care unit from the general ward using data from the Smart Clinical Data Warehouse (CDW). MEWS and NEWS were calculated based on vital signs and clinical parameters within four hours of stroke onset. Stroke occurrence was categorized as ischemic or hemorrhagic. Logistic regression and receiver operating characteristic curve analyses were performed to assess the predictive abilities of the scoring systems. Results Of the enrolled patients, 33.9% (n = 1853) experienced stroke, comprising 783 cases of ischemic stroke and 1,070 cases of hemorrhagic stroke. Both the MEWS and the NEWS were found to significantly predict overall stroke occurrence with a cutoff value of 4 (MEWS>4; OR [95% CI]: 13.90 [11.51–16.79], p<0.001; NEWS>4; OR [95% CI]: 6.71 [5.75–7.83], p<0.001). Parameters, such as prior malignancy, atrial fibrillation, AVPU response, heart rate, respiratory rate, and oxygen saturation, are also associated with stroke occurrence. The predictive ability of MEWS and NEWS was good for overall stroke occurrence. (AUC of MEWS: 0.92, 95% CI [0.91–0.93], p<0.001; AUC of NEWS: 0.85, 95% CI [0.84–0.86], p<0.001). The predictive ability was considered fair for ischemic stroke but good for hemorrhagic stroke. Conclusion MEWS and NEWS demonstrated significant predictive abilities for overall stroke occurrence among hospitalized patients, with MEWS slightly outperforming NEWS.