Gender differences in cardiac rehabilitation participation and outcomes: an 18-year retrospective study in Iran.

BACKGROUND: Cardiac rehabilitation (CR) is crucial for addressing cardiovascular diseases globally, with a specific emphasis on gender differences. Despite its demonstrated benefits for women, there's limited acceptance globally, especially in low- and middle-income countries. The program aims to optimize risk factors and improve overall patient well-being. METHODS: A cohort study was performed on those who were candidates for CR programs during 2001-2019. Assessments were performed within one week before and one week after the 8-week CR program. Age, sex, smoking status, clinical data, resting systolic and diastolic blood pressure (SBP and DBP, respectively), echocardiography and laboratory data were obtained. Functional capacity was evaluated using the international physical activity questionnaire, and a treadmill exercise test. Anxiety, depression, general quality of life (QoL), and health-related QoL were selected for psychological status. Then statistical analysis was performed on data. RESULT: In this study, the number of male patients was 1526 (73.69%). The average age of patients in the female group was higher than that of males (58.66 ± 9.08 vs. 56.18 ± 9.94), according to the crude model results, the changes in emotional, social and physical scores were significant (P-value:0.028, 0.018, 0.030), as well as the differences in Mets and smoking were significant (P-value for both < 0.001) in the adjusted model, the emotional variables and Mets changes were significant in two groups, so that the emotional score in the female group was higher than that of the male group, and the female Mets score was significantly lower than that of the male group. CONCLUSION: The CR program can improve cardiovascular outcomes, but the greatest impact was on the quality of life, patient METs and smoking behavers. Also the number of female participants in the CR program was less than the number of males.

Eligibility for marine omega-3 fatty acid supplementation after acute coronary syndromes.

Background and aims: The 2019 European Society of Cardiology guidelines for the management of dyslipidemia consider the use of high-dose marine omega-3 fatty acid (FA) eicosapentaenoic acid (EPA) supplementation (icosapent ethyl 2 × 2g/day) to lower residual cardiovascular risk in high-risk patients with hypertriglyceridemia. This study aimed to assess the eligibility for omega-3 FA-EPA supplementation in patients with acute coronary syndromes (ACS). Methods: In a prospective Swiss cohort of patients hospitalized for ACS, eligibility for marine omega-3 FA-EPA, defined as plasma triglyceride levels ranging from 1.5 to 5.6 mmol/l, was assessed at baseline and one-year follow-up and compared across subgroups. Lipid-lowering therapy intensification with statin and ezetimibe was modelled to simulate a hypothetical systematic treatment and its effect on omega-3 FA-EPA supplementation eligibility. Results: Of 2643 patients, 98 % were prescribed statin therapy at discharge, including 62 % at a high-intensity regimen; 93 % maintained it after one year, including 53 % at a high-intensity regimen. The use of ezetimibe was 3 % at discharge and 7 % at one year. Eligibility was observed in 32 % (32 % men, 29 % women) one year post-ACS. After modelling systematic treatment with statins, ezetimibe, and both, eligibility decreased to 31 %, 25 % and 24 %, respectively. Eligibility was higher in individuals aged <70 (34 vs 25 %), smokers (38 vs 28 %), diabetics (46 vs 29 %), hypertensive (35 vs 29 %), and obese patients (46 vs 22 % for normal weight), all with p-values <0.001. Conclusion: In a contemporary Swiss cohort of patients with ACS, up to 32 % would be eligible for omega-3 FA-EPA supplementation one year after ACS, highlighting an opportunity to mitigate residual cardiovascular risk in patients with ACS and hypertriglyceridemia.

Effect of smoking on the risk of gastrointestinal cancer after cholecystectomy: A national population-based cohort study.

BACKGROUND: The role of smoking in the incidence of colorectal cancer (CRC) or gastric cancer (GC) in populations undergoing cholecystectomy has not been investigated. AIM: To evaluate the effect of smoking on CRC or GC development in cholecystectomy patients. METHODS: A total of 174874 patients who underwent cholecystectomy between January 1, 2010 and December 31, 2017 were identified using the Korean National Health Insurance Service claims database. These patients were matched 1:1 with members of a healthy population according to age and sex. CRC or GC risk after cholecystectomy and the association between smoking and CRC or GC risk in cholecystectomy patients were evaluated using adjusted hazard ratios (HRs) and 95%CIs. RESULTS: The risks of CRC (adjusted HR: 1.15; 95%CI: 1.06-1.25; P = 0.0013) and GC (adjusted HR: 1.11; 95%CI: 1.01-1.22; P = 0.0027) were significantly higher in cholecystectomy patients. In the population who underwent cholecystectomy, both CRC and GC risk were higher in those who had smoked compared to those who had never smoked. For both cancers, the risk tended to increase in the order of non-smokers, ex-smokers, and current smokers. In addition, a positive correlation was observed between the amount of smoking and the risks of both CRC and GC. CONCLUSION: Careful follow-up and screening should be performed, focusing on the increased risk of gastrointestinal cancer in the cholecystectomy group, particularly considering the individual smoking habits.

Prevalence, Risk Factors and Pain Subtypes of Post-COVID Pain in Nonhospitalized Older Adults: A Cross-Sectional Study.

BACKGROUND: Post-COVID pain (PCP) is a condition that ensues from an infection of coronavirus disease 2019 (COVID-19). Some researchers have explored the prevalence of PCP and its characteristics in the individuals who experience it. However, most individuals involved in the previous studies were middle-aged, and those studies focused mainly on hospital patients and musculoskeletal PCP. Existing data on PCP and its subtypes among older adults and outpatients are scanty. OBJECTIVE: Our study aims to identify PCP's prevalence and associated risk factors and to compare the quality of life (QoL), sleep quality, and anxiety and depression levels in nonhospitalized elderly COVID-19 survivors with different PCP subtypes. STUDY DESIGN: A cross-sectional study. SETTING: The study was conducted from April 2023 to June 2023 after the first outbreak of the Omicron variant of SARS-CoV-2 in the Taikang Yanyuan Continuing Care Retirement Community (CCRC) in China. METHODS: Eligible participants were surveyed using the Numeric Rating Scale (NRS), Douleur Neuropathique-4 questionnaire (DN4), EuroQol 5D-5L questionnaire (EQ-5D-5L), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale. COVID-19 symptoms and laboratory parameters were obtained through an electronic healthcare system. Descriptive analysis was performed based on the presence of PCP and PCP subtypes. Multivariable logistic regression analysis and multiple linear regression were used for risk-factor analysis and adjustment of confounding factors. RESULTS: A total of 668 individuals (female: 59.3%, median age: 84 years) who had been infected with COVID-19 for a median duration of 145 (126-168) days were enrolled in our study. PCP was observed in 9.4% (63/668) of elderly COVID-19 survivors. Number of COVID-19 symptoms (aOR 1.31, 95%CI 1.05-1.64, P = 0.018) and previous chronic pain (aOR 4.24, 95%CI 1.59-11.27, P = 0.004) were risk factors associated with PCP. Individuals with neuropathic PCP exhibited higher NRS scores (5 [5-6] vs. 3 [3-4], P < 0.001) and more use of analgesic drugs (70.0%, 7/10 vs. 20.8%, 11/53, P = 0.005) for pain management. Neuropathic PCP was associated with lower scores on the EQ-5D index (B = -0.210, 95% CI -0.369 to -0.051, P = 0.011) and EQ-VAS (B = -10.808, 95% CI -21.149 to -0.468, P = 0.041) and higher PHQ-9 scores (B = 3.154, 95% CI 0.674-5.634, P = 0.014). LIMITATIONS: It is difficult to establish a strong causality between PCP and SARS-CoV-2 infection due to the study's cross-sectional nature. Selection bias could not be eliminated, since our study relied on volunteer participation. Due to neuropathic PCP's lower prevalence than nonneuropathic PCP, larger sample sizes and multicenter studies are crucial for a comprehensive understanding of the neuropathic PCP condition. CONCLUSION: Our study found a PCP prevalence of 9.4% in nonhospitalized older adults who had survived COVID-19. Number of COVID-19 symptoms and history of previous chronic pain seemed to be potential risk factors for PCP. Neuropathic PCP was associated with lower QoL and a more severe depression level.

Addressing Information Biases Within Electronic Health Record Data to Improve the Examination of Epidemiologic Associations With Diabetes Prevalence Among Young Adults: Cross-Sectional Study.

Background: Electronic health records (EHRs) are increasingly used for epidemiologic research to advance public health practice. However, key variables are susceptible to missing data or misclassification within EHRs, including demographic information or disease status, which could affect the estimation of disease prevalence or risk factor associations. Objective: In this paper, we applied methods from the literature on missing data and causal inference to assess whether we could mitigate information biases when estimating measures of association between potential risk factors and diabetes among a patient population of New York City young adults. Methods: We estimated the odds ratio (OR) for diabetes by race or ethnicity and asthma status using EHR data from NYU Langone Health. Methods from the missing data and causal inference literature were then applied to assess the ability to control for misclassification of health outcomes in the EHR data. We compared EHR-based associations with associations observed from 2 national health surveys, the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey, representing traditional public health surveillance systems. Results: Observed EHR-based associations between race or ethnicity and diabetes were comparable to health survey-based estimates, but the association between asthma and diabetes was significantly overestimated (OREHR 3.01, 95% CI 2.86-3.18 vs ORBRFSS 1.23, 95% CI 1.09-1.40). Missing data and causal inference methods reduced information biases in these estimates, yielding relative differences from traditional estimates below 50% (ORMissingData 1.79, 95% CI 1.67-1.92 and ORCausal 1.42, 95% CI 1.34-1.51). Conclusions: Findings suggest that without bias adjustment, EHR analyses may yield biased measures of association, driven in part by subgroup differences in health care use. However, applying missing data or causal inference frameworks can help control for and, importantly, characterize residual information biases in these estimates.

Transmission of multidrug-resistant tuberculosis in Jiangxi, China, and associated risk factors.

In order to effectively combat the urgent threat of multidrug-resistant tuberculosis (MDR-TB), it is imperative to gain a comprehensive understanding of the drug-resistant profiles, transmission dynamics, and associated risk factors. Our study encompassed a population-based retrospective analysis with 130 MDR-TB patients from 2018 to 2021. The research methodology incorporated whole-genome sequencing, drug susceptibility testing , and logistic regression analysis to discern the risk factors of genomic clustering linked to recent transmission. The findings from phenotypic drug resistance assessments revealed notable resistance rates: ethambutol at 62.3% (81/130), streptomycin at 72.3% (94/130), levofloxacin at 51.5% (67/130), and moxifloxacin at 50.0% (65/130). Furthermore, among all patients, 38 individuals (29.23%, 38/130) were found to be part of 17 clusters, indicating instances of recent MDR-TB transmission. The genomic clustering patients were deeply investigated. Lineage 2.2.1 was established as the primary sub-lineage (86.15%, 112/130), followed by lineage 4 (9.23%, 12/130). Moreover, the logistic regression analysis underscored that unemployment, farming occupations, and prior TB treatment were identified as significant risk factors for recent transmission. IMPORTANCE: The high prevalence of multidrug-resistant tuberculosis (MDR-TB) in Jiangxi Province highlights the importance of understanding the genetic background and drug resistance patterns of these strains. This knowledge is crucial for developing effective control methods. Furthermore, in light of the significance of preventing transmission among tuberculosis patients, whole-genome sequencing was utilized to investigate the recent transmission of MDR-TB and identify associated risk factors. The findings revealed that individuals in the farming sector, those who are unemployed, and patients with a history of tuberculosis treatment are at elevated risk. Consequently, targeted public interventions for these at-risk groups are imperative.

Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990-2021.

BACKGROUND: Oral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce. METHODS: This study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031. RESULTS: From 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031. CONCLUSIONS: The study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease's impact.

Interplay of Age and Risk Factor Control Upon Coronary Atheroma Progression.

BACKGROUND & AIM: The extent and composition of coronary plaque, and its progression differ with patients' age. The interplay of patient's age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression. METHOD: We performed a posthoc pooled analysis of data from 10 prospective, randomised trials involving serial coronary intravascular ultrasonography (IVUS) (n=5,823). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. RESULTS: Mean overall age was 58±9 years (28% women). In a fully adjusted multivariable analysis (following adjustment of sex, body mass index, systolic blood pressure [SBP], smoking, high-density lipoprotein and low-density lipoprotein [LDL]-cholesterol, triglyceride levels, peripheral vascular disease, diabetes mellitus, trial, region, and baseline PAV), an increase in age by one standard deviation was linked with PAV progression (ß-estimate 0.097; 95% confidence interval 0.048-0.15; p<0.001). In patients with good risk factor control (LDL-cholesterol <1.8 mmol/L and SBP <130 mmHg), increasing age remained associated with PAV progression (0.123; 0.014-0.23; p=0.027). Lower effect sizes for the association of age with PAV progression were observed for patients with partial control of LDL-cholesterol and SBP and were not significantly associated with PAV progression when both LDL-cholesterol and SBP were not controlled (0.099; 0.032-0.167; p=0.004 and 0.042; -0.056 to 0.14; p=0.40, respectively). CONCLUSIONS: Patient age is directly associated with coronary atheroma progression independently of traditional cardiovascular risk factors. In the setting of poor risk factor control, the influence of age on coronary artery disease progression is attenuated.

Abscesses in different body sites among children: a single-center prospective study.

OBJECTIVES: An abscess is a localized collection of pus contained within a fibrous capsule. In this study, we aimed to determine the demographic pattern, common anatomical sites, risk factors, and the microbial profile of abscesses in different body sites among children. METHODS: We conducted a prospective study in our pediatric surgical department among children with abscesses in different body sites between January 2019 and December 2022. RESULTS: During the study period, 85 children were included. The participant age range was 0 to 14 years old, and 66% of participants were boys. The most common anatomical sites where abscesses formed were the pelvis (n = 29, 34%), abdomen (n = 22, 26%), neck (n = 14, 16%), and extremities (n = 12, 14%). Risk factors of abscesses in different body sites included cannulation, lymphadenitis, mastitis, perforated appendix, and perianal fistula. We observed that 74% of abscesses were of a polymicrobial nature. CONCLUSION: The most common anatomical sites for abscesses in children included the pelvis, abdomen, neck, and extremities. Most abscesses in these sites were polymicrobial in nature.

Factors associated with anxiety in colorectal cancer survivors: a scoping review.

PURPOSE: Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety. METHODS: Using Arksey and O'Malley's (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included. RESULTS: We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used. CONCLUSIONS: This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods. IMPLICATIONS FOR CANCER SURVIVORS: This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.