Tag: pubmed

Exp Aging Res. 2023 Oct 13:1-11. doi: 10.1080/0361073X.2023.2269803. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to assess the association between serum 25-hydroxyvitamin D [25(OH)D] levels and depressive symptoms in Mexican older adults 70 years and older.

METHODS: A total of 326 adults aged 70 or older from Coyoacán Cohort Study were included in this study. The depressive symptoms were assessing by Center for Epidemiologic Studies Depression Scale (CES-D) and serum 25-hydroxyvitamin D [25(OH)D] levels were measured by commercially available enzyme-linked immunosorbent assay (ELISA).

RESULTS: Overall, the prevalence of depressive symptoms was 36.5%. The mean age was 79 years, and 53.4% were women. The total serum 25-hydroxyvitamin D [25(OH)D] levels were lower in older adults with depressive symptoms when compared with older adults without depressive symptoms (p = .006). Logistic regression models showed a significant association between low serum 25(OH)D levels and depressive symptoms even after adjusting for potential confounders (OR = 2.453; 95% CI:1.218-4.939; p = .012). In addition, linear regression model to predict the effect of 25-hydroxyvitamin D [25(OH)D] levels on the CES-D score as a continuous variable, was statistically significant [F_(1,324) = 8.54, p = .004], and the R-squared value was .026, indicating that this regression model explains 2.6% of the change in the CES-D score.

CONCLUSION: These results suggest that older Mexican adults with lower serum 25-hydroxyvitamin D [25(OH)D] levels are at higher risk of presenting depressive symptoms.

PMID:37830306 | DOI:10.1080/0361073X.2023.2269803

Hum Reprod. 2023 Oct 12:dead208. doi: 10.1093/humrep/dead208. Online ahead of print.

ABSTRACT

STUDY QUESTION: Do women with multi-partner fertility or multi-partner behavior conceive more often than women with a single partner?

SUMMARY ANSWER: Women with multi-partner behavior conceived more frequently and had more children than non-multi-partner women and multi-partner fertility women.

WHAT IS KNOWN ALREADY: Some women experience having biological children with more than one partner: those women are considered as multi-partner fertility. Women with multi-partner fertility have more children and are substantially less likely to have planned their first birth. Individuals with multi-partner fertility become parents at a younger age, largely with unintended first births, and often do so outside of marriage, compared to parents with two or more children from only one partner. Unmarried women, particularly, are at greater risk of having unintended births. Studies are still scarce and there is a need to assess the contribution of women’s multi-partners fertility and multi-partner behavior to family composition, particularly in low- and middle-income countries.

STUDY DESIGN, SIZE, DURATION: This longitudinal birth cohort study evaluated 1215 mothers whose children belonging to the 2004 Pelotas Birth Cohort were their first pregnancy, and who attended the perinatal, 48-month, 6-year, and 11-year follow-ups. Information was obtained from responses to a questionnaire. The number of years at risk of having children was treated as the exposure, and woman’s multi-partner behavior and multi-partner fertility, dichotomized as ‘Yes’ or ‘No’, were considered endogenous treatment variables.

PARTICIPANTS/MATERIALS, SETTING, METHODS: Data from mothers with a first pregnancy, and with information available from the perinatal, 48-month, 6-year, and 11-year follow-ups, were evaluated. The exposures studied were women’s multi-partner behavior and multi-partner fertility (i.e. conceiving/giving birth), and the outcomes evaluated were the number of pregnancies, the number of children currently alive, and experience of unintended pregnancies from the birth of the child belonging to the 2004 birth cohort until 11 years later. Crude and adjusted risk ratios (RRs) were estimated through Poisson regression with endogenous treatment effects, robust standard errors, and their respective 95% CI.

MAIN RESULTS AND THE ROLE OF CHANCE: Multi-partner behavior women had 16% (RR 1.16; 95% CI: 1.08-1.25) and 11% (RR 1.11; 95% CI 1.03-1.19) greater risk of having a new pregnancy and having more children alive, respectively, than those with non-multi-partner behavior. Women with multi-partner fertility had a 23% (RR 1.23; 95% CI: 1.11-1.37) and 20% (RR 1.20; 95% CI: 1.08-1.33) higher risk of having a new pregnancy and having more children alive, respectively, than single-partner fertility mothers. Women who had multiple partners (i.e. behavior), as well as those with multi-partner fertility, showed a lesser proportion of unintended pregnancies when compared to the non-multi-partner ones (34.08%; 95% CI: 28.12-40.60 vs 36.17%; 95% CI: 31.93-40.63), compared to their counterparts’ single partners fertility (33.16%; 95% CI: 26.83-40.17 vs 36.26%; 95% CI: 31.85-40.92), although these findings were not statistically significant.

LIMITATIONS, REASONS FOR CAUTION: The mothers who were not included in the study owing to missing data for some of the follow-up had 5-11 years of education, a low socio-economic level, and were younger, thus the number of pregnancies may be underestimated because these groups presented a high number of pregnancies and children alive. We did not have information about the complete woman’s conjugal history. Therefore, misclassification error of the exposure may be present and, consequently, the measures of association may be underestimated. Furthermore, this study was not truly representative of the Pelotas study female population.

WIDER IMPLICATIONS OF THE FINDINGS: In this study of multi-partner behavior and fertility, women who have multiple partners may be less likely to get married and have a stable partner. Compared to single-partner women, multi-partner fertility and multi-partner behavior women may predominantly become pregnant for the purpose of having children, rather than accidentally.

STUDY FUNDING/COMPETING INTEREST(S): This article is based on data from the study ‘Pelotas Birth Cohort, 2004’ conducted by the Postgraduate Program in Epidemiology at the Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). From 2009 to 2013, the Wellcome Trust supported the 2004 birth cohort study. The World Health Organization, National Support Program for Centers of Excellence (PRONEX), Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children’s Pastorate supported previous phases of the study, and also was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)-Finance Code 001. The authors declare that the supported agencies have no role in any step of performing this study. No conflicts of interest exist.

TRIAL REGISTRATION NUMBER: N/A.

PMID:37830301 | DOI:10.1093/humrep/dead208

Neurourol Urodyn. 2023 Oct 13. doi: 10.1002/nau.25286. Online ahead of print.

ABSTRACT

OBJECTIVE: Success following urological procedures is traditionally defined through objective endpoints. This approach may not capture the impact on patient satisfaction. There is a paucity of literature evaluating patient-centered metrics such as satisfaction and decisional regret in the field of urology. This study investigates long-term satisfaction and decisional regret amongst patients who underwent sacral neuromodulation (SNM) for the treatment of refractory overactive bladder (OAB).

MATERIALS AND METHODS: This study retrospectively reviewed patients who underwent SNM for refractory OAB from 2015 to 2022 at a single institution serving an ethnically diverse and underrepresented community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret was measured with the validated modified SDS-DRS scale (satisfaction with decision scale-decision regret scale). Descriptive statistics, Wilcoxan rank sum, and median regression analyses were performed using STATA 15.0 with p < 0.05 as significant.

RESULTS: Out of 191 patients who underwent SNM, 63 were unreachable (wrong number in chart, number not in service, patient did not answer, deceased). Eighty-nine out of 128 patients reached agreed to participate (70% response rate). The mean time since surgery was 37.3 ±25.2 months. The median satisfaction with decision score was 4.0 (IQR: 3.7-4.7) with a score of 1 correlating with low satisfaction and a score of 5 correlating with high satisfaction. The median decisional regret score was 2.0 (IQR: 1.2-2.9) with a score of 1 correlating with low decisional regret and a score of 5 correlating with strong decisional regret. Ten patients reported complications after surgery, which was significantly associated with lower SDS and higher DRS scores (p < 0.01), and persisted after adjusting for age, body mass index, sex, and comorbidities (SDS β coef: -0.84, 95% CI: -1.5 to 0.15, p = 0.02; DRS β coef: 1.48, 95% CI: 0.55-2.41, p < 0.01).

CONCLUSIONS: Patients who underwent SNM for refractory OAB overall had low regret and high satisfaction with their decision at an average 3 years of follow-up. As expected, those who developed postoperative complications had worse scores. The inclusion of patient-centric outcomes is imperative when determining the success of a surgical procedure and is useful for shared decision-making when advancing to third-line therapy for OAB. Longer-term follow-up is necessary to assess durability of high satisfaction and low regret over time.

PMID:37830272 | DOI:10.1002/nau.25286

J Magn Reson Imaging. 2023 Oct 13. doi: 10.1002/jmri.28998. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of left ventricular mechanical dyssynchrony (LVMD) on the long-term prognosis of ST-segment elevation myocardial infarction (STEMI) is unclear.

HYPOTHESIS: MR uniformity ratio estimates (URE) can detect LVMD and assess STEMI prognosis.

STUDY TYPE: Retrospective analysis of a prospective multicenter registry (EARLY-MYO trial, NCT03768453).

POPULATION: Overall, 450 patients (50 females) with first-time STEMI were analyzed, as well as 40 participants without cardiovascular disease as controls.

FIELD STRENGTH/SEQUENCE: 3.0-T, balanced steady-state free precession cine and late gadolinium enhancement imaging.

ASSESSMENT: MRI data were acquired within 1 week of symptom onset. Major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal re-infarction, hospitalization for heart failure, and stroke, were the primary clinical outcomes. LVMD was represented by circumferential URE (CURE) and radial URE (RURE) calculated using strain measurements. The patients were grouped according to clinical outcomes or URE values. Patients’ clinical characteristics and MR indicators were compared.

STATISTICAL TESTS: The Student’s t-test, Mann-Whitney U test, chi-square test, Fisher’s exact test, receiver operating characteristic curve analysis with area under the curve, Kaplan-Meier analysis, Cox regression, logistic regression, intraclass correlation coefficient, c-index, and integrated discrimination improvement were used. P < 0.05 was considered statistically significant.

RESULTS: CURE and RURE were significantly lower in patients with STEMI than in controls. The median follow-up was 60.5 months. Patients with both lower CURE and RURE values experienced a significantly higher incidence of MACEs by 3.525-fold. Both CURE and RURE were independent risk factors for MACEs. The addition of UREs improved diagnostic efficacy and risk stratification based on infarct size and left ventricular ejection fraction (LVEF). The indicators associated with LVMD included male sex, serum biomarkers (peak creatine phosphokinase and cardiac troponin I), infarct size, and LVEF.

DATA CONCLUSION: CURE and RURE may be useful to evaluate long-term prognosis after STEMI.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

PMID:37830268 | DOI:10.1002/jmri.28998

Brain Behav. 2023 Oct 13:e3281. doi: 10.1002/brb3.3281. Online ahead of print.

ABSTRACT

OBJECTIVES: In this study, the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and Alzheimer-related biomarkers in cerebrospinal fluid (CSF) was investigated to determine whether high NLR is a potential risk factor for postoperative delirium (POD) and to evaluate its predictive efficacy.

METHODS: We selected 1000 patients from the perioperative neurocognitive disorder risk factor and prognosis (PNDRFAP) database and 999 patients from the perioperative neurocognitive disorder and biomarker lifestyle (PNDABLE) database. Patients in the PNDABLE database have been measured for Alzheimer-related biomarkers in CSF (Aβ₄₀ , Aβ₄₂ , P-tau, and tau protein). Mini-mental state examination was used to assess the preoperative mental status of patients. POD was diagnosed using the confusion assessment method and assessed for severity using the memorial delirium assessment scale. Logistic regression analysis was utilized to explore the association of preoperative NLR with POD. What’s more, we also performed sensitivity analysis by adding corrected confounders, and the results were almost unchanged. Spearman’s rank correlation was used to determine the associations between NLR and Alzheimer-related biomarkers. Mediation analyses with 10,000 bootstrapped iterations were used to explore the mediation effects. Finally, we use decision curves and the nomogram model to evaluate the efficacy of preoperative NLR in predicting POD; we also performed external validation using data from Qilu Hospital.

RESULT: Logistic regression results showed that an elevated preoperative NLR was a risk factor for the development of POD in patients (PNDRFAP: OR = 1.067, 95% CI 1.020-1.116; PNDABLE: OR = 1.182, 95% CI 1.048-1.335, p < .05). Spearman’s rank correlation analysis showed a positive but weak correlation between NLR and P-tau/T-tau (R = .065). The mediating effect results indicate that NLR likely mediates the occurrence of POD through elevated tau protein levels (proportion: 47.47%). The results of the box plots showed statistically significant NLR and CSF biomarkers between the POD and non-POD (NPOD) groups (p < .05), with higher NLR, P-tau, and T-tau in the POD group than in the NPOD group. In contrast, the NPOD group had higher Aβ₄₂ levels compared to the POD group. In addition, we used R package to plot the decision curve and nomogram both suggesting a good predictive effect of preoperative NLR on the occurrence of POD.

CONCLUSION: Elevated preoperative NLR levels may be a risk factor for POD and likely mediate the development of POD through elevated P-tau/T-tau levels.

PMID:37830267 | DOI:10.1002/brb3.3281

Ann Surg. 2023 Oct 13. doi: 10.1097/SLA.0000000000006129. Online ahead of print.

ABSTRACT

OBJECTIVE: Defining the role of adjuvant therapy in duodenal adenocarcinoma (DAC) and intestinal subtype ampullary carcinoma (iAC).

SUMMARY BACKGROUND DATA: DAC and iAC share a similar histological differentiation but the benefit of adjuvant therapy remains unclear.

METHODS: Patients undergoing curative-intent surgical resection for DAC and iAC between 2010 and 2021 at five high-volume centers were included. Patient baseline, perioperative and long-term oncological outcomes were evaluated. Statistical testing was performed with SPSS 25 (IBM).

RESULTS: A total of 136 patients with DAC and 171 with iAC were identified. Patients with DAC had more advanced tumors than those with iAC. Median overall survival (OS) in DAC patients was 101 months versus 155 months for iAC patients (P=0.098). DAC had a higher rate of local (14.1% vs. 1.2%, P<0.001) and systemic recurrence (30.4% vs. 3.5%, P<0.001). Adjuvant therapy failed to improve overall survival in all patients with DAC and iAC. For DAC, patients with perineural invasion, but not other negative prognostic factors had improved OS rates with adjuvant therapy (72 m vs. 44 m, P=0.044). IAC patients with N+ (190 m vs. 57 m, P=0.003), T3-4 (177 m vs. 59 m, P=0.050) and perineural invasion (150 m vs. 59 m, P=0.019) had improved OS rates with adjuvant therapy.

CONCLUSION: While adjuvant therapy fails to improve OS in all patients with DAC and iAC in the current study, it improved overall survival in DAC patients with perineural invasion and in iAC patients with T3-4 tumors, positive lymph nodes, and perineural invasion.

PMID:37830246 | DOI:10.1097/SLA.0000000000006129

J Dermatol. 2023 Oct 13. doi: 10.1111/1346-8138.16984. Online ahead of print.

ABSTRACT

Since the COVID-19 outbreak, there have been numerous reports concerning COVID-19 skin manifestations. Debate has ensued as to whether these lesions are unique or represent a form of viral reactivation. The aim of this research was to compare the incidence of herpetic skin lesions between a COVID-19 group, a Sars-CoV-2 mRNA vaccination group, and their respective controls, taking into account their Herpesviridae carrier status. To achieve this goal, the Maccabi Healthcare Services’ database was scanned and cohorts of both verified COVID-19 and mRNA vaccinated patients were extracted and matched to random control groups. Patients with a documented occurrence of any Herpesviridae infection that occurred prior to the studied ‘event’ (i.e., COVID-19 or mRNA vaccination) were regarded as carriers of Herpesviridae. A COVID-19-related or vaccination-related lesion was defined as a clinically diagnosed herpetic lesion appearing 1 month after the index date. In the COVID-19 cohort, there was an insignificant difference in herpetic lesion incidence between the groups. However, logistic regression demonstrated that the interaction of COVID-19 with the Herpesviridae carrier status was statistically significant. For the vaccination cohort, the data showed statistically significant differences between groups in herpetic frequencies, which manifested as an almost 2-fold odds of developing a herpetic lesion. In conclusion, following the analysis of two large cohorts, there is evidence to support the contribution of both COVID-19 and the mRNA vaccine to the reactivation of Herpesviridae. Our results diminish the idea that COVID-19 has unique, herpetic-like lesions.

PMID:37830227 | DOI:10.1111/1346-8138.16984

Prehosp Disaster Med. 2023 Oct 13:1-9. doi: 10.1017/S1049023X23006490. Online ahead of print.

ABSTRACT

BACKGROUND: Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined.

METHODS: This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients’ demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score.

RESULTS: The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant.

CONCLUSION: The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.

PMID:37830209 | DOI:10.1017/S1049023X23006490

Circulation. 2023 Oct 13. doi: 10.1161/CIRCULATIONAHA.123.065472. Online ahead of print.

ABSTRACT

BACKGROUND: Life’s Simple 7 (LS7) is an easily calculated and interpreted metric of cardiovascular health based on 7 domains: smoking, diet, physical activity, body mass index, blood pressure, cholesterol, and fasting glucose. The Life’s Essential 8 (LE8) metric was subsequently introduced, adding sleep metrics and revisions of the previous 7 domains. Although calculating LE8 requires additional information, we hypothesized that it would be a more reliable index of cardiovascular health.

METHODS: Both the LS7 and LE8 metrics yield scores with higher values indicating lower risk. These were calculated among 11 609 Black and White participants free of baseline cardiovascular disease (CVD) in the Reasons for Geographic and Racial Differences in Stroke study, enrolled in 2003 to 2007, and followed for a median of 13 years. Differences in 10-year risk of incident CVD (coronary heart disease or stroke) were calculated as a function LS7, and LE8 scores were calculated using Kaplan-Meier and proportional hazards analyses. Differences in incident CVD discrimination were quantified by difference in the c-statistic.

RESULTS: For both LS7 and LE8, the 10-year risk was approximately 5% for participants around the 99th percentile of scores, and a 4× higher 20% risk for participants around the first percentile. Comparing LS7 to LE8, 10-year risk was nearly identical for individuals at the same relative position in score distribution. For example, the “cluster” of 2013 participants with an LS7 score of 7 was at the 35.8th percentile in distribution of LS7 scores, and had an estimated 10-year CVD risk of 8.4% (95% CI, 7.2%-9.8%). In a similar location in the LE8 distribution, the 1457 participants with an LE8 score of 60±2.5 at the 39.4th percentile of LE8 scores, with a 10-year risk of CVD of 8.5% (95% CI, 7.1%-10.1%), similar to the cluster defined by LS7. The age-race-sex adjusted c-statistic of the LS7 model was 0.691 (95% CI, 0.667-0.705), and 0.695 for LE8 (95% CI, 0.681-0.709) (P for difference, 0.12).

CONCLUSIONS: Both LS7 and LE8 were associated with incident CVD, with discrimination of the 2 indices practically indistinguishable. As a simpler metric, LS7 may be favored for use by the general population and clinicians.

PMID:37830200 | DOI:10.1161/CIRCULATIONAHA.123.065472

Hypertension. 2023 Oct 13. doi: 10.1161/HYPERTENSIONAHA.122.20572. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to develop a risk-scoring model for hypertension among Africans.

METHODS: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 vascular risk factors. We randomly split the data set into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0% to 100% using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating between hypertensives.

RESULTS: Mean age was 59.9±13.3, 56.0% were hypertensives, and 7 factors, including diabetes, age in years, waist circumference, body mass index, highest education completed, family history of cardiovascular diseases, and current alcohol use, were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both data sets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test data set. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing data set.

CONCLUSIONS: The novel risk assessment model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.

PMID:37830199 | DOI:10.1161/HYPERTENSIONAHA.122.20572