Association between serum copper and blood glucose: a mediation analysis of inflammation indicators in the NHANES (2011-2016).

Background: The rising prevalence of diabetes underscores the need for identifying effective prevention strategies. Recent research suggests environmental factors, particularly heavy metals like copper, significantly influence health outcomes, including diabetes, through mechanisms involving inflammation and oxidative stress. This study aims to explore how serum copper levels affect blood glucose, employing NHANES data from 2011 to 2016, to provide insights into environmental health's role in diabetes prevention and management. Methods: The study analyzed data from 2,318 NHANES participants across three cycles (2011-2016), focusing on those with available data on serum copper, inflammatory markers, and blood glucose levels. We utilized principal component analysis for selecting inflammatory markers, mediation analysis to examine direct and indirect effects, multiple linear regression for assessing relationships between markers and glucose levels, and weighted quantile sum regression for evaluating individual and collective marker effects, adjusting for demographic variables and serum copper. Results: Participants averaged 42.70 years of age, with a near-even split between genders. Average serum copper was 119.50 µg/dL, white blood cell count 6.82 × 109/L, and fasting blood glucose 107.10 mg/dL. Analyses identified significant mediation by inflammatory markers (especially white blood cells: 39.78%) in the copper-blood glucose relationship. Regression analyses highlighted a positive correlation between white blood cells (estimate: 1.077, 95% CI: 0.432 to 2.490, p = 0.013) and copper levels and a negative correlation for monocyte percentage (estimate: -1.573, 95% CI: 0.520 to -3.025, p = 0.003). Neutrophil percentage was notably influential in glucose levels. Sensitive analyses confirmed the study's findings. Conclusion: Serum copper levels significantly impact blood glucose through inflammatory marker mediation, highlighting the importance of considering environmental factors in diabetes management and prevention. These findings advocate for public health interventions and policies targeting environmental monitoring and heavy metal exposure reduction, emphasizing the potential of environmental health measures in combating diabetes incidence.

Amorphous ZnSnOx Hollow Spheres Enable Highly Efficient CO2 Reduction.

Carbon dioxide (CO2) adsorption and electron transport play an important role in CO2 reduction reaction (CO2RR). Herein, we have demonstrated a new class of diverse hollow ZnSnOx (ZSO) through the amorphization of hydroxides to enhance CO2 adsorption and accelerate electron transport. The amorphization is occurred by calcination process, as indicated by Fourier transform infrared spectroscopy and Raman spectra. In particular, the ZnSnOx hollow spheres (ZSO HSs) achieve a high Faradaic efficiency (FE) of HCOOH up to 92.7 % at best, outperforming the commercial ZSO (Comm. ZSO, 85.7 %). ZSO HSs also exhibit durable stability with negligible activity decay after 10 h of successive electrolysis. In-situ attenuated total reflectance infrared absorption spectroscopy further reveals strong adsorption of CO2 and rapid intermediate configuration transformation in amorphous ZSO HSs. This work demonstrates the practical application of ZSO for CO2RR and provides a new insight to create efficient CO2RR electrocatalysts.

Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports.

OBJECTIVE: To examine the relationship between the level of state funding for Home- and Community-Based Services (HCBS) and state overall and dimension-specific performances in Long-Term Services and Supports (LTSS). DATA SOURCES AND STUDY SETTING: We employed state-level secondary data from the Medicaid LTSS Annual Expenditures Reports, the American Association of Retired Persons (AARP) State Scorecards, the U.S. Census, and Federal Reserve Economic data, spanning the timeframe of 2010-2020. STUDY DESIGN: Overall state LTSS rankings, along with dimension-specific rankings, were modeled separately against state Medicaid spending on HCBS relative to total Medicaid spending on LTSS. All models were adjusted for state covariates, secular trend, and state fixed effects. DATA COLLECTION/EXTRACTION METHODS: The study sample included all 50 states and the District of Columbia. However, California, Delaware, Illinois, and Virginia were excluded from FY2019 due to missing data on Medicaid HCBS expenditures. PRINCIPAL FINDINGS: Every 10 percentage-point increase in the proportion of Medicaid LTSS spending to HCBS demonstrated 2.05 points improvement (95% confidence interval [CI]: -3.88 to 0.22, p = 0.03) in rankings for state overall LTSS system performance, 2.92 points improvement (95% CI: -4.87 to 0.98, p < 0.01) in rankings for the Choice of Setting and Provider dimension, as well as 1.73 points (95% CI: -3.14 to 0.32, p = 0.02) ranking improvement in the dimension of Effective Transitions. CONCLUSIONS: Our study suggested promising effects of increased state funding for HCBS on LTSS performance.

Exploring the Relationship between Anemia and Postpartum Depression: Evidence from Malawi.

PURPOSE: Study findings suggest association between anemia and postpartum depression, but available evidence is scant and inconsistent. We investigate whether anemia is related to postpartum depression among women who have recently given birth in Malawi, where anemia prevalence is high. METHODS: We use cross-sectional data from 829 women who were 18-36 years old, married, lived in Lilongwe, Malawi, and gave birth between August 2017 and February 2019. The primary outcome is postpartum depression in the year after birth, defined by the Patient Health Questionnaire-9 (PHQ-9). Anemia status was assessed using hemoglobin levels that were measured at the time of the interview. Multivariate logistic regression analyses were used to investigate the relationship between postpartum depression and anemia status. RESULTS: Our analysis sample consists of 565 women who completed the PHQ-9, tested for anemia, and had no missing values for covariates. Of these women, 37.5% had anemia (hemoglobin levels ≤ 110 g/L), and 2.7% were classified as showing symptoms of a major depressive disorder (MDD). After adjusting for potential confounders, anemia was significantly associated with increased risk of MDD (OR: 3.48, 95% CI: 1.15-10.57, p-value: 0.03). No significant associations were found between other covariates and postpartum depression. CONCLUSIONS: Our findings suggest a potential association between anemia and postpartum depression among women in Malawi. Policies that aim to improve nutrition and health outcomes for pregnant and postpartum women could generate a "double benefit" by both preventing anemia and reducing the risk of postpartum depression.

Racial and ethnic and income disparities in COVID-19 vaccination among Medicare beneficiaries.

BACKGROUND: Older adults have been disproportionately affected by the COVID-19 pandemic. Despite the widespread availability and proved effectiveness of COVID-19 vaccines, the issue of inequity in vaccine uptake in the United States is a potential concern among different populations. This study examined racial and ethnic and income disparities in COVID-19 vaccination rate among Medicare beneficiaries. METHODS: Data from the Medicare Current Beneficiary Survey (MCBS) COVID-19 Winter 2021 Community Supplement were employed (n = 9606 Medicare beneficiaries, weighted N = 50,512,963). We fitted a logistic regression model to determine the association of vaccination status with beneficiary race and ethnicity and income, after controlled for a set of beneficiary characteristics. RESULTS: Compared with non-Hispanic White respondents, Hispanic respondents (OR = 0.72, 95% CI: 0.54-0.96, p = 0.02) and Black respondents (OR = 0.84, 95% CI: 0.67-1.04, p = 0.11) were less likely to receive COVID-19 vaccine. In addition, the likelihood of COVID-19 vaccine uptake for beneficiaries who earn less than $25,000 per year was more than 50% lower than that for those whose annual income was $25,000 or more (OR = 0.44, 95% CI: 0.37-0.53, p < 0.0001). CONCLUSIONS: Racial and ethnic and income disparities exist in COVID-19 vaccination rate among Medicare beneficiaries nationally. Community-based strategies to boost vaccine uptake may target racial and ethnic minorities and socioeconomically disadvantaged groups to reduce such disparities.

Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic.

OBJECTIVES: To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance. RESULTS: The rate of care delay or avoidance since March of 2020 was 29.1% among all respondents (n = 1997), and 10.1% higher for lonely (n = 1,150%, 57.6%) versus non-lonely respondents (33.5% vs. 23.4%; odds ratio = 1.59, p = 0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn't afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor's visit as the two most common care delayed or avoided. CONCLUSIONS: Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.

State social distancing restrictions and nursing home outcomes.

The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is a lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social distancing restrictions from June to August of 2020, and their associations with the weekly numbers of new COVID-19 cases, new COVID-19 deaths, and new non-COVID-19 deaths in nursing homes of the US. We found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, and somewhat increased non-COVID-19 death rate, although the estimates for non-COVID-19 deaths were sensitive to alternative model specifications.

Pain and the Alzheimer's Disease and Related Dementia Spectrum in Community-Dwelling Older Americans: A Nationally Representative Study.

CONTEXT: Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD). OBJECTIVES: Examine the association between cognitive impairment across the ADRD spectrum and pain assessment and treatment in community-dwelling older Americans. METHODS: This cross-sectional, population-based study included 16,836 community-dwelling participants ≥ 50 years in the 2018 Health and Retirement Study. ADRD, assessed by validated cognitive measures, was categorized into "dementia," "cognitive impairment, no dementia (CIND)" and "intact cognition." Pain assessment included pain presence (often being troubled with pain), pain severity (degree of pain most of the time [mild/moderate/severe]), and pain interference (pain making it difficult to do usual activities). Pain treatment included recent use of over-the-counter pain medications and opioids (past 3 months), and regular intake of prescriptions for pain. RESULTS: Dementia were associated with lower likelihood of reporting pain presence (Odds Ratio [OR]= 0.61, P = 0.01), pain interference (OR = 0.46, P < 0.001), reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.38, P < 0.001), and lower likelihood of receiving pain treatment, that is, recent use of over-the-counter pain medications (OR = 0.60, P = 0.02) and opioids (OR = 0.33, P < 0.001), and regular intake of prescriptions for pain (OR = 0.461, P = 0.002). CIND was associated with reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.75, P = 0.021), lower likelihood of reporting pain interference (OR = 0.79, P = 0.045) and recent over-the-counter pain medication use (OR = 0.74, P = 0.026). CONCLUSION: CIND and dementia increased the risk of under-report and under-treatment of pain. Systematic efforts are needed to improve pain recognition and treatment among older adults with cognitive impairment, regardless of dementia diagnosis.

Trends in racial and ethnic disparities in coronavirus disease 2019 (COVID-19) outcomes among nursing home residents.

OBJECTIVES: To evaluate trends in racial and ethnic disparities in weekly cumulative rates of coronavirus disease 2019 (COVID-19) cases and deaths in Connecticut nursing homes. DESIGN: Longitudinal analysis of nursing-home COVID-19 reports and other databases. Multivariable negative binomial models were used to estimate disparities in COVID-19 incidence and fatality rates across nursing-home groups with varying proportions of racial and ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups. Trends in such disparities were estimated from week 1 (April 13) to week 10 (ending on June 19, 2020). SETTING: The study was conducted across 211 nursing homes. RESULTS: The average number of cases ranged from 6.1 cases per facility for the low-proportion group to 11.7 cases per facility for the high-proportion group in week 1, and from 26.7 to 58.5 cases per facility in week 10. Compared to the low-proportion group, the adjusted incidence rate ratios (IRRs) for the high-proportion group were 1.18 (95% confidence interval [CI], 0.77-1.80; P > .10) in week 1 and 1.54 (95% CI, 1.05-2.25; P < .05) in week 10, showing a 30% (95% CI, 5%-62%) relative increase (P < .05). The average weekly number of COVID-19-related deaths ranged from 0 to 0.3 deaths per facility for different groups in week 1, and from 7.6 to 13.3 deaths per facility in week 10. Adjusted disparities in fatalities similarly increased over time. CONCLUSIONS: Connecticut nursing homes caring for predominately racial and ethnic minority residents tended to have higher COVID-19 incidence and fatality rates. These across-facility disparities increased during the early periods of the pandemic.

Association of state social distancing restrictions with nursing home COVID-19 and non-COVID-19 outcomes.

The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social distancing restrictions from June to August of 2020, and their associations with the weekly numbers of new COVID-19 cases, new COVID-19 deaths, and new non-COVID-19 deaths in nursing homes of the US. We found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, but more deaths due to non-COVID-19 reasons among nursing home residents.