RESUMEN
OBJECTIVES: Left atrial (LA) myopathy, characterized by LA enlargement and mechanical dysfunction, is associated with worse prognosis in hypertrophic cardiomyopathy (HCM) while the impact of sarcomere mutation on LA myopathy remains unclear. We aimed to assess the association between LA myopathy and sarcomere mutation and to explore the incremental utility of LA strain in mutation prediction. METHODS: A total of 105 consecutive HCM patients (mean age 47.8 ± 11.9 years, 71% male) who underwent HCM-related gene screening and cardiac MRI were retrospectively enrolled. LA volume, ejection fraction and strain indices in reservoir, conduit, and booster-pump phases were investigated respectively. RESULTS: Fifty mutation-positive patients showed higher LA maximal volume index (59.4 ± 28.2 vs 43.8 ± 18.1 mL/m2, p = 0.001), lower reservoir (21.3 ± 7.9 vs 26.2 ± 6.6%, p < 0.001), and booster-pump strain (12.1 ± 5.4 vs 17.1 ± 5.0%, p < 0.001) but similar conduit strain (9.2 ± 4.5 vs 9.1 ± 4.5%, p = 0.909) compared with mutation-negative patients. In multivariate logistic regression, LA booster-pump strain was associated with sarcomere mutation (odds ratio = 0.86, 95% confidence interval: 0.77-0.96, p = 0.010) independent of maximal wall thickness, late gadolinium enhancement, and LA volume. Furthermore, LA booster-pump strain showed incremental value for mutation prediction added to Mayo II score (AUC 0.798 vs 0.709, p = 0.024). CONCLUSIONS: In HCM, mutation-positive patients suffered worse LA enlargement and worse reservoir and booster-pump functions. LA booster-pump strain was a strong factor for sarcomere mutation prediction added to Mayo II score. CLINICAL RELEVANCE STATEMENT: The independent association between sarcomere mutation and left atrial mechanical dysfunction provide new insights into the pathogenesis of atrial myopathy and is helpful to understand the adverse prognosis regarding atrial fibrillation and stroke in mutation-positive patients. KEY POINTS: ⢠In patients with hypertrophic cardiomyopathy, left atrial (LA) reservoir and booster-pump function, but not conduit function, were significantly impaired in mutation-positive patients compared with mutation-negative patients. ⢠LA booster-pump strain measured by MRI-derived feature tracking is feasible to predict sarcomere mutation with high incremental value added to Mayo II score.
Asunto(s)
Cardiomiopatía Hipertrófica , Enfermedades Musculares , Humanos , Masculino , Adulto , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Sarcómeros/genética , Sarcómeros/patología , Medios de Contraste , Gadolinio , Atrios Cardíacos , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/genética , Cardiomiopatía Hipertrófica/complicaciones , Imagen por Resonancia Magnética , Enfermedades Musculares/complicaciones , Enfermedades Musculares/patología , MutaciónRESUMEN
INTRODUCTION: Mental health symptoms and cognitive impairment are highly prevalent and intertwined among aging people living with HIV (PLWH). This study aimed to assess the interrelationships and strength of connections between individual mental health symptoms and cognitive impairment. We sought to identify specific symptoms linking mental health and cognitive impairment in aging PLWH. METHODS: Participants in the Sichuan Older People with HIV Infections Cohort Study (SOHICS) were recruited between November 2018 and April 2021 in China. Mental health symptoms, including depression and anxiety, were assessed by the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder-7 (GAD-7), respectively. Cognitive impairment was assessed by the Montreal Cognitive Assessment-Basic (MoCA-B). Partial correlation networks were used to depict the interrelationships between mental health symptoms and cognitive impairment, and bridge strength was used to identify specific symptoms linking mental health and cognitive impairment. RESULTS: Of the 1,587 recruited participants with a mean age of 63.0 years old, 47.0% had mild or severe cognitive impairment. Network analysis revealed that cognitive function, visual perception, and problem-solving task of the MoCA-B were negatively correlated with appetite, energy, and motor of the PHQ-9, respectively. Based on their interrelationships, problem-solving task and motor acted as bridge symptoms. CONCLUSION: Problem-solving task and motor may be potential intervention targets to reduce the overall risk of mental health symptoms and cognitive impairment. Future research could assess the feasibility and effectiveness of specific interventions designed for the two symptoms of aging PLWH.
Asunto(s)
Trastornos de Ansiedad , Disfunción Cognitiva , Infecciones por VIH , Humanos , Anciano , Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , Salud Mental , Estudios de Cohortes , Envejecimiento , China/epidemiologíaRESUMEN
Aim: This article aims to identify risk factors for severe radiation-induced oral mucositis (RIOM) in head and neck cancer (HNC) patients. In addition, we intend to establish a predictive model in patients undergoing intensity-modulated radiotherapy. Patients & methods: In this retrospective study, several HNC patients (n = 179) treated at Zhejiang Provincial People's Hospital from January 2019 to June 2023 were considered. The recruited subjects were divided into modeling and validation groups. The experimental data on clinical characteristics and treatment were collected and analyzed to identify predictive factors for severe RIOM based on the logistic regression approach. Results: The results indicated that severe RIOM occurred in 55.3% of patients. Accordingly, significant predictors included smoking history, diabetes, concurrent chemotherapy, cumulative radiation dose and weight loss of ≥5% in relative to admission weight. A nomogram based on these factors was validated, showing excellent predictive accuracy. Conclusion: In summary, the predictive model could effectively identify high-risk patients for severe RIOM, enabling the design of targeted interventions and improving patient management during radiotherapy.
[Box: see text].
RESUMEN
BACKGROUND: Evidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality in older adults in long-term care setting with different levels of disability. METHODS: This prospective cohort study was based on the government-led long-term care programme in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. BP was measured during the baseline survey by trained medical personnel using electronic sphygmomanometers. Disability profile was assessed using the Barthel index. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality. RESULTS: The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135 and 150 mmHg. In severe disability group, SBP < 150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150 and 170 mmHg. The associations were robust in subgroup analyses in terms of age, gender, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk. CONCLUSION: The optimal SBP range was found to be higher in older individuals in long-term care with severe disability (150-170mmHg) compared to those with mild to moderate disability (135-150mmHg). This study provides new evidence that antihypertensive treatment should be administered cautiously in severe disability group in long-term care setting. Additionally, assessment of disability using the Barthel index can serve as a valuable tool in customizing the optimal BP management strategy. TRIAL REGISTRATION: Chinese Clinical Trial Registry (Registration Number: ChiCTR2100049973).
Asunto(s)
Presión Sanguínea , Personas con Discapacidad , Cuidados a Largo Plazo , Humanos , Masculino , Femenino , Anciano , China/epidemiología , Estudios Prospectivos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/tendencias , Presión Sanguínea/fisiología , Persona de Mediana Edad , Anciano de 80 o más Años , Estudios de Cohortes , Hipertensión/mortalidad , Hipertensión/fisiopatología , Hipertensión/epidemiología , Mortalidad/tendencias , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Healthy lifestyles are crucial for preventing chronic diseases. Nonetheless, approximately 90% of Chinese community residents regularly engage in at least one unhealthy lifestyle. Mobile smart devices-based health interventions (mHealth) that incorporate theoretical frameworks regarding behavioral change in interaction with the environment may provide an appealing and cost-effective approach for promoting sustainable adaptations of healthier lifestyles. We designed a randomized controlled trial (RCT) to evaluate the effectiveness of a socioecological model-guided, smart device-based, and self-management-oriented lifestyles (3SLIFE) intervention, to promote healthy lifestyles among Chinese community residents. METHODS: This two-arm, parallel, cluster-RCT with a 6-month intervention and 6-month follow-up period foresees to randomize a total of 20 communities/villages from 4 townships in a 1:1 ratio to either intervention or control. Within these communities, a total of at least 256 community residents will be enrolled. The experimental group will receive a multi-level intervention based on the socioecological model supplemented with a multi-dimensional empowerment approach. The control group will receive information only. The primary outcome is the reduction of modifiable unhealthy lifestyles at six months, including smoking, excess alcohol consumption, physical inactivity, unbalanced diet, and overweight/obesity. A reduction by one unhealthy behavior measured with the Healthy Lifestyle Index Score (HLIS) will be considered favorable. Secondary outcomes include reduction of specific unhealthy lifestyles at 3 months, 9 months, and 12 months, and mental health outcomes such as depression measured with PHQ-9, social outcomes such as social support measured with the modified Multidimensional Scale of Perceived Social Support, clinical outcomes such as obesity, and biomedical outcomes such as the development of gut microbiota. Data will be analyzed with mixed effects generalized linear models with family and link function determined by outcome distribution and accounting for clustering of participants in communities. DISCUSSION: This study will provide evidence concerning the effect of a mHealth intervention that incorporates a behavioral change theoretical framework on cultivating and maintaining healthy lifestyles in community residents. The study will provide insights into research on and application of similar mHealth intervention strategies to promote healthy lifestyles in community populations and settings. TRIAL REGISTRATION NUMBER: ChiCTR2300070575. Date of registration: April 17, 2023. https://www.chictr.org.cn/index.aspx .
Asunto(s)
Automanejo , Humanos , Ejercicio Físico , Estilo de Vida , Obesidad , Estilo de Vida Saludable , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Lactobacillus delbrueckii ssp. bulgaricus M58 (M58) and Streptococcus thermophilus S10 (S10) are 2 dairy starter strains known for their favorable fermentation characteristics. Therefore, this research aimed to study the effects of 1-d low-temperature ripening on the physicochemical properties and metabolomics of fermented milk. Initially, the performance of single (M58 or S10) and dual (M58+S10) strain fermentation was assessed, revealing that the M58+S10 combination resulted in a shortened fermentation time, a stable gel structure, and desirable viscosity, suggesting positive strain interactions. Subsequently, non-targeted metabolomics analyses using LC-MS and GC-MS were performed to comparatively analyze M58+S10 fermented milk samples collected at the end of fermentation and after 1-d low-temperature ripening. The results showed a significant increase in almost all small peptides and dodecanedioic acid in the samples after one day of ripening, while there was a substantial decrease in indole and amino acid metabolites. Moreover, notable increases were observed in high-quality flavor compounds, such as geraniol, delta-nonalactone, 1-hexanol,2-ethyl-, methyl jasmonate, and undecanal. This study provides valuable insights into the fermentation characteristics of the dual bacterial starter consisting of M58 and S10 strains and highlights the specific contribution of the low-temperature ripening step to the overall quality of fermented milk.
RESUMEN
BACKGROUND AND AIMS: Identifying patients with hypertrophic cardiomyopathy (HCM) who are candidates for implantable cardioverter defibrillator (ICD) implantation in primary prevention for sudden cardiac death (SCD) is crucial. The aim of this study was to externally validate the 2022 European Society of Cardiology (ESC) model and other guideline-based ICD class of recommendation (ICD-COR) models and explore the utility of late gadolinium enhancement (LGE) in further risk stratification. METHODS: Seven hundred and seventy-four consecutive patients who underwent cardiac magnetic resonance imaging were retrospectively enrolled. RESULTS: Forty-six (5.9%) patients reached the SCD-related endpoint during 7.4 ± 2.5 years of follow-up. Patients suffering from SCD had higher ESC Risk-SCD score (4.3 ± 2.4% vs. 2.8 ± 2.1%, P < .001) and LGE extent (13.7 ± 9.4% vs. 4.9 ± 6.6%, P < .001). Compared with the 2014 ESC model, the 2022 ESC model showed increased area under the curve (.76 vs. .63), sensitivity (76.1% vs. 43.5%), positive predictive value (16.8% vs. 13.6%), and negative predictive value (98.1% vs. 95.9%). The C-statistics for SCD prediction of 2011 American College of Cardiology (ACC)/American Heart Association (AHA), 2014 ESC, 2020 AHA/ACC, and 2022 ESC models were .68, .64, .76 and .78, respectively. Furthermore, in patients without extensive LGE, LGE ≥5% was responsible for seven-fold SCD risk after multivariable adjustment. Whether in ICD-COR II or ICD-COR III, patients with LGE ≥5% and <15% showed significantly worse prognosis than those with LGE <5% (all P < .001). CONCLUSIONS: The 2022 ESC model performed better than the 2014 ESC model with especially improved sensitivity. LGE enabled further risk stratification based on current guidelines.
Asunto(s)
Cardiomiopatía Hipertrófica , Desfibriladores Implantables , Humanos , Medios de Contraste , Gadolinio , Medición de Riesgo/métodos , Estudios Retrospectivos , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/terapia , Factores de Riesgo , Muerte Súbita Cardíaca/prevención & controlRESUMEN
Public health surveillance is defined as the ongoing, systematic collection, analysis, and interpretation of health data and is closely integrated with the timely dissemination of information that the public needs to know and upon which the public should act. Public health surveillance is central to modern public health practice by contributing data and information usually through a national notifiable disease reporting system (NNDRS). Although early identification and prediction of future disease trends may be technically feasible, more work is needed to improve accuracy so that policy makers can use these predictions to guide prevention and control efforts. In this article, we review the advantages and limitations of the current NNDRS in most countries, discuss some lessons learned about prevention and control from the first wave of COVID-19, and describe some technological innovations in public health surveillance, including geographic information systems (GIS), spatial modeling, artificial intelligence, information technology, data science, and the digital twin method. We conclude that the technology-driven innovative public health surveillance systems are expected to further improve the timeliness, completeness, and accuracy of case reporting during outbreaks and also enhance feedback and transparency, whereby all stakeholders should receive actionable information on control and be able to limit disease risk earlier than ever before.
Asunto(s)
COVID-19 , Vigilancia en Salud Pública , Humanos , Vigilancia en Salud Pública/métodos , Inteligencia Artificial , COVID-19/epidemiología , COVID-19/prevención & control , Sistemas de Información Geográfica , Medición de Riesgo , Vigilancia de la Población/métodos , Salud PúblicaRESUMEN
Fermentation is one of the most effective methods of food preservation. Since ancient times, food has been fermented using lactic acid bacteria (LAB). Fermented milk is a very intricate fermentation ecosystem, and the microbial metabolism of fermented milk largely determines its metabolic properties. The two most frequently used dairy starter strains are Streptococcus thermophilus (S. thermophilus) and Lactobacillus delbrueckii subsp. bulgaricus (L. bulgaricus). To enhance both the culture growth rate and the flavor and quality of the fermented milk, it has long been customary to combine S. thermophilus and L. bulgaricus in milk fermentation due to their mutually beneficial and symbiotic relationship. On the one hand, the symbiotic relationship is reflected by the nutrient co-dependence of the two microbes at the metabolic level. On the other hand, more complex interaction mechanisms, such as quorum sensing between cells, are involved. This review summarizes the application of LAB in fermented dairy products and discusses the symbiotic mechanisms and interactions of milk LAB starter strains from the perspective of nutrient supply and intra- and interspecific quorum sensing. This review provides updated information and knowledge on microbial interactions in a fermented milk ecosystem.
The symbiotic relationship between Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus is reviewed.Their nutrient co-dependence is discussed.The role of quorum sensing in their interaction is discussed for the first time.This review is of interest to colleagues interested in exploiting LAB starter cultures.
RESUMEN
OBJECTIVES: We aimed to evaluate immediate and midterm cardiac remodeling after surgery by cardiac magnetic resonance (CMR) in Ebstein's anomaly (EA), and also to investigate preoperative predictors of right ventricular (RV) normalization. METHODS: We retrospectively analyzed CMR parameters of the whole heart in adult patients with EA before surgery, at discharge and follow-up. RESULTS: A total of 26 patients were included and performed CMR at 7 days (interquartile range, 3-13 days) before surgery. Immediate postoperative CMR was finished at discharge (median: 8 [7-9] days; n = 18) and follow-up CMR at 187 days (interquartile range, 167-356 days; n = 17). RV and right atrial (RA) volumes promptly decreased immediately after surgery and at follow-up (all p < 0.05). RV ejection fraction decreased significantly at discharge (p < 0.05) but recovered at follow-up (p = 0.18). However, RV global longitudinal strain and RA reservoir strain were significantly impaired immediately and midterm after surgery (all p < 0.05). Indexed left ventricular (LV) end-diastolic volume, stroke volume, as well as global longitudinal strain increased from preoperative to follow-up (all p < 0.05). Patients who achieved normalization of RV volumes after surgery had smaller severity index and RV and RA volumes and higher LV ejection fraction and RA reservoir strain at baseline than patients without RV normalization (all p < 0.05). CONCLUSIONS: Reverse biventricular remodeling took place in EA after tricuspid valve surgery. Tricuspid valve reconstruction should be performed before deterioration of RV volume overload and LV function to achieve reverse RV remodeling. Key Points ⢠After removing the volume load of tricuspid regurgitation in Ebstein's anomaly, reverse remodeling was detected by CMR in both left and right heart at midterm follow-up. ⢠Tricuspid valve reconstruction should be performed before deterioration of RV volume overload and LV function to achieve reverse RV remodeling.
Asunto(s)
Anomalía de Ebstein , Insuficiencia Cardíaca , Adulto , Humanos , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Válvula Tricúspide/patología , Anomalía de Ebstein/diagnóstico por imagen , Anomalía de Ebstein/cirugía , Anomalía de Ebstein/patología , Estudios Retrospectivos , Remodelación Ventricular , Función Ventricular Derecha , Espectroscopía de Resonancia MagnéticaRESUMEN
Inconsistent correlations of screen use with physical activity (PA) and social capital (SC) in youths have been observed in existing cross-sectional studies. This study aimed to elucidate associations among variables in screen use, PA, and SC domains during COVID-19, to improve the prediction and prevention of suboptimal health status in youths. An online survey based on the nationwide COVID-19 Impact on Lifestyle Change Survey (COINLICS) was conducted in China, and 10,082 youths reported their screen use, PA, and SC in the months immediately before, during, and after the COVID-19 lockdown. Cross-sectional and longitudinal network models were used to identify associations of variables in domains of screen use with PA and SC. Effect modifications of bridges and predictors in the associations were examined. The network models suggested that individual SC was a bridge that strongly connected other types of SC, and domains of screen use and PA before lockdown, while phone use became such a bridge during and after lockdown. More PC/TV use before lockdown predicted less household-related PA during lockdown (ß = -0.142); more phone use during lockdown was a predictor for higher levels of household-related PA (ß = 0.106), active transport (ß = 0.096), and individual SC (ß = 0.072) after lockdown. Phone use was negatively associated with PA through PC/TV use in the more phone use subgroup. Relationships among screen use, PA, and SC dynamically changed during COVID-19, and phone use that was identified as a bridge and a predictor may be the potential action point for health intervention in youths during lockdown.
Asunto(s)
COVID-19 , Capital Social , Humanos , Adolescente , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles , Estudios Transversales , Pandemias/prevención & control , China/epidemiología , Ejercicio FísicoRESUMEN
BACKGROUND: Assessing the structure and function of left atrium (LA) is crucial in hypertrophic obstructive cardiomyopathy (HOCM) because LA remodeling correlates with atrial fibrillation. However, few studies have investigated the potential effect of myomectomy on LA phasic remodeling in HOCM after myectomy using cardiovascular magnetic resonance (CMR) feature tracking (FT). This study aims to evaluate the LA structural and functional remodeling with HOCM after myectomy by CMR-FT and to further investigate the determinants of LA reverse remodeling. METHODS: In this single-center study, we retrospectively studied 88 patients with HOCM who received CMR before and after myectomy between January 2011 and June 2021. Preoperative and postoperative LA parameters derived from CMR-FT were compared, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster function (booster EF, active strain [εa], late peak negative strain rate [SRa]). Eighty-six healthy participants were collected for comparison. Univariate and multivariate linear regression identified variables associated with the rate of change of εa. RESULTS: Compared with preoperative parameters, LA reservoir function (total EF, εs, SRs), booster function (booster EF, εa, SRa), and SRe were significantly improved after myectomy (all P < 0.05), while no significant differences were observed in passive EF and εe. Postoperative patients with HOCM still had larger LA and worse LA function than healthy controls (all P < 0.05). After analyzing the rates of change in LA parameters, LA boost function, especially εa, showed the most dramatic improvement beyond the improvements in reservoir function, conduit function, and volume. In multivariable regression analysis, minimum LA volume index (adjusted ß = - 0.39, P < 0.001) and Δleft ventricular outflow tract (LVOT) pressure gradient (adjusted ß = - 0.29, P = 0.003) were significantly related to the rate of change of εa. CONCLUSIONS: Patients with HOCM after septal myectomy showed LA reverse remodeling with a reduction in LA size and restoration in LA reservoir and booster function but unchanged LA conduit function. Among volumetric and functional changes, booster function had the greatest improvement postoperatively. Besides, preoperative LAVmin index and ΔLVOT might be potential factors associated with the degree of improvement in εa.
Asunto(s)
Cardiomiopatía Hipertrófica , Atrios Cardíacos , Humanos , Estudios Retrospectivos , Valor Predictivo de las Pruebas , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/cirugía , Cardiomiopatía Hipertrófica/complicaciones , Espectroscopía de Resonancia MagnéticaRESUMEN
BACKGROUND: Despite the use of cardiovascular magnetic resonance (CMR) feature tracking (FT) imaging to detect myocardial deformation, the optimal strain index in dilated cardiomyopathy (DCM) is unclear. This study aimed to determine whether atrial and biventricular strains can provide the greatest or joint incremental prognostic value in patients with DCM over a long follow-up period. METHODS: Four hundred-twelve DCM patients were included retrospectively. Comprehensive clinical evaluation and imaging investigations were obtained, including measurements of CMR-FT derived left atrial (LA) reservoir, conduit, booster strain (εs, εe, εa); left ventricular (LV) and right ventricular (RV) global longitudinal, radial, circumferential strain (GLS, GRS, GCS). All patients were followed up for major adverse cardiac events (MACE) including all-cause mortality, heart transplantation, and implantable cardioverter defibrillator discharge. The predictors of MACE were examined with univariable and multivariable Cox regression analysis. Subsequently, nested Cox regression models were built to evaluate the incremental prognostic value of strain parameters. The incremental predictive power of strain parameters was assessed by Omnibus tests, and the model performance and discrimination were evaluated by Harrell C-index and integrated discrimination improvement (IDI) analysis. Patient survival was illustrated by Kaplan-Meier curves and differences were evaluated by log-rank test. RESULTS: During a median follow-up of 5.0 years, MACE were identified in 149 (36%) patients. LAεe, LVGLS, and RVGLS were the most predictive strain parameters for MACE (AUC: 0.854, 0.733, 0.733, respectively). Cox regression models showed that the predictive value of LAεe was independent from and incremental to LVGLS, RVGLS, and baseline variables (HR 0.74, 95% CI 0.68-0.81, P < 0.001). In reclassification analysis, the addition of LAεe provided the best discrimination of the model (χ2 223.34, P < 0.001; C-index 0.833; IDI 0.090, P < 0.001) compared with LVGLS and RVGLS models. Moreover, LAεe with a cutoff of 5.3% further discriminated the survival probability in subgroups of patients with positive LGE or reduced LVEF (all log-rank P < 0.001). CONCLUSION: LAεe provided the best prognostic value over biventricular strains and added incremental value to conventional clinical predictors for patients with DCM.
Asunto(s)
Cardiomiopatía Dilatada , Humanos , Pronóstico , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/terapia , Estudios Retrospectivos , Imagen por Resonancia Cinemagnética/métodos , Valor Predictivo de las Pruebas , Función Ventricular Izquierda , Volumen SistólicoRESUMEN
Men who have sex with men (MSM) are at disproportionate risk for developing sexually transmitted infections (STIs) such as HIV. Understanding the relationships among factors related to risky sexual behaviors, such as internalized homophobia, sexual sensation seeking, and individual and community norms, among MSM with different sexual partner types may contribute to designing targeted interventions for reducing risky sexual behaviors and STI transmission. We conducted a cross-sectional study recruiting 781 MSM in Sichuan Province, China. All participants were divided into groups with and without sexual partners, groups with regular and casual sexual partners, and groups with only male and both male and female partners in the past 6 months. Network analysis was used to analyze the relationships among dimensions of self-reported sexual sensation seeking, internalized homophobia, and social norms in different groups. Of 781 MSM, 606 (77.6%) had sexual partners in the past 6 months, and among these participants, 429 (70.8%) had casual sexual partners, and 103 (17.0%) had both male and female sexual partners. The complex and intensive relationships between dimensions were mainly observed in networks of MSM with any type of sexual partners, with individual norms (dimension of social norms) presenting strongly negative relationships with fresh feeling (dimension of sexual sensation seeking) and homosexuality morality (dimension of internalized homophobia). One dimension of sexual sensation seeking (i.e., fresh feeling) and two dimensions of internalized homophobia (i.e., homosexuality morality and self-identification) were relatively central variables in most groups, especially for those with casual sexual partners. Our study highlights the role of individual norms in restraining sensation seeking, internalized homophobia, especially among MSM with sexual partners. Intervention targeting these central variables may contribute to reduced risky sexual behaviors and further slow the spread of STIs in MSM.
RESUMEN
BACKGROUND: Inequality in health is a prevalent and growing concern among countries where people with disabilities are disproportionately affected. Unmet healthcare needs explain a large part of the observed inequalities between and within countries; however, there are other causes, many non-modifiable, that also play a role. AIM: This article explores the difference in health across income levels in populations with spinal cord injury (SCI). SCI is of special interest in the study of health systems, as it is an irreversible, long-term health condition that combines a high level of impairment with subsequent comorbidities. METHODS: We estimated the importance of modifiable and non-modifiable factors that explain health inequalities through a direct regression approach. We used two health outcomes: years living with the injury and a comorbidity index. Data come from the International Spinal Cord Injury Survey (InSCI), which has individual data on people with SCI in 22 countries around the world. Due to the heterogeneity of the data, the results were estimated country by country. RESULTS: On average, the results exhibit a prevalence of pro-rich inequalities, i.e., better health outcomes are more likely observed among high-income groups. For the years living with the injury, the inequality is mostly explained by non-modifiable factors, like the age at the time of the injury. In contrast, for the comorbidity index, inequality is mostly explained by unmet healthcare needs and the cause of the injury, which are modifiable factors. CONCLUSIONS: A significant portion of health inequalities is explained by modifiable factors like unmet healthcare needs or the type of accident. This result is prevalent in low, middle, and high-income countries, with pervasive effects for vulnerable populations like people with SCI, who, at the same time are highly dependent on the health system. To reduce inequity, it is important not only to address problems from public health but from inequalities of opportunities, risks, and income in the population. HIGHLIGHTS: ⢠Better health status is evident among high-income groups, which is reflected in pro-rich inequalities. ⢠Age at the time of the injury is the most important factor to explain inequalities in years living with the injury. ⢠Unmet health care needs are the most important factor to explain inequalities in comorbidities. ⢠The inequality in health varies by country dependent upon socioeconomic factors.
Asunto(s)
Renta , Traumatismos de la Médula Espinal , Humanos , Factores Socioeconómicos , Encuestas y Cuestionarios , Disparidades en el Estado de Salud , Atención a la Salud , Traumatismos de la Médula Espinal/epidemiologíaRESUMEN
OBJECTIVES: Through a cross-sectional study, we explored the association between sensory impairment and cognitive function in Chinese older adults, and tested the mediating roles of anxiety and depressive symptoms between this relationship. METHODS: Based on the 2018 Chinese Longitudinal Healthy Longevity Survey, a total of 10,895 older adults aged 65 and above were selected as samples for research. Anxiety, depressive symptoms and cognitive function were evaluated by the Generalized Anxiety Disorder, the Center for Epidemiologic Studies Depression (CES-D10) and the Chinese version of modified Mini-Mental State Examination scales, respectively. Sensory impairment was assessed from self-reported vision and hearing functions. Multiple linear regression and SPSS Macro PROCESS were used for statistical analysis. RESULTS: Compared with no sensory impairment, vision impairment (B = -1.012, 95%CI: -1.206, -0.818), hearing impairment (B = -2.683, 95%CI: -2.980, -2.386) and dual sensory impairment (B = -6.302, 95%CI: -6.585, -6.020) have a significant association with cognitive function in older adults, respectively. Anxiety and depressive symptoms not only acted as independent mediators, but also played sequential mediating effects on the relationship between sensory impairment and cognitive function. CONCLUSIONS: Greater attention should be paid to anxiety and depressive symptoms of older adults with sensory impairment, which might be beneficial to maintain cognitive function.
Asunto(s)
Disfunción Cognitiva , Depresión , Humanos , Anciano , Depresión/epidemiología , Estudios Transversales , Ansiedad/epidemiología , Trastornos de Ansiedad , Cognición , China/epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicologíaRESUMEN
The coronavirus disease 2019 (COVID-19) pandemic poses wide-ranging impacts on the physical and mental health of people around the world, increasing attention from both researchers and practitioners on the topic of resilience. In this article, we review previous research on resilience from the past several decades, focusing on how to cultivate resilience during emerging situations such as the COVID-19 pandemic at the individual, organizational, community, and national levels from a socioecological perspective. Although previous research has greatly enriched our understanding of the conceptualization, predicting factors, processes, and consequences of resilience from a variety of disciplines and levels, future research is needed to gain a deeper and comprehensive understanding of resilience, including developing an integrative and interdisciplinary framework for cultivating resilience, developing an understanding of resilience from a life span perspective, and developing scalable and cost-effective interventions for enhancing resilience and improving pandemic preparedness.
Asunto(s)
COVID-19 , Resiliencia Psicológica , Humanos , Salud Mental , Pandemias/prevención & control , SARS-CoV-2RESUMEN
BACKGROUND: Evidence on associations of residential greenness with dyslipidemia is limited, particularly regarding dose-response relations and mediation. OBJECTIVES: To investigate associations between greenness and dyslipidemia, non-linear dose-response relationships and mediators. METHODS: This cross-sectional study draws on the 2018 Fujian Behavior and Disease Surveillance (FBDS) cohort that used multi-stage stratified random sampling from the general population of Fujian Province, China. Participants with one or more abnormities in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C) were classified as having dyslipidemia. Residential greenness was operationalized as 3-year average of the normalized difference vegetation index (NDVI500m) and enhanced vegetation index (EVI500m). A doubly robust approach was used for effect quantification. Dose-response relations were studied with natural cubic splines. Mediation via physical activity (PA), body mass index (BMI), PM2.5, PM10, SO2, and NO2 was also examined. RESULTS: Data from 43,183 participants were analyzed. Increases in NDVI500m and EVI500m residential greenness were associated with decreased dyslipidemia risk and improved blood lipids. Non-linear dose response relationships were discovered. Significant reduction of dyslipidemia risk was observed at levels of EVI500m > 0.48 and NDVI500m > 0.65. Joint mediation effects of PA, BMI, PM2.5, PM10, NO2, and SO2 on the associations of NDVI500m and EVI500m with dyslipidemia risk were 49.74% and 44.64%, respectively. CONCLUSIONS: Increased residential exposure to greenness was associated with decreased risk of dyslipidemia. A non-linear dose-response relationship between greenness and dyslipidemia suggests that specific thresholds of greenness need to be reached in order to achieve effects. BMI, PM2.5, and PM10 partially mediated the association.
Asunto(s)
Contaminación del Aire , Dióxido de Nitrógeno , Humanos , Índice de Masa Corporal , Dióxido de Nitrógeno/análisis , Estudios Transversales , Material Particulado/análisis , Contaminación del Aire/análisis , China/epidemiología , ColesterolRESUMEN
BACKGROUND: Healthcare workers suffered with high prevalence of occupational burnout, which might be related with their job satisfaction and well-being. This study aimed to provide evidence of complex interrelations among occupational burnout, flourishing, and job satisfaction, and identify key variables from the perspective of network structure among healthcare workers. METHODS: A cross-sectional study was conducted between July and October 2021, and 907 (the response rate was 98.4%) HIV/AIDS healthcare workers completed their sociodemographic characteristics, occupational burnout, flourishing and job satisfaction. Network analysis was conducted to investigate the interrelations of occupational burnout, flourishing, and job satisfaction communities, and identify central variables and bridges connecting different communities with different bridge strength thresholds in the network structure. The Network Comparison Test (NCT) was conducted to examine the gender differences in networks. RESULTS: In the network, feeling exhausted at work (strength: 1.42) and feeling frustrated at work (1.27) in occupational burnout community, and interested in daily activities (1.32) in flourishing community were central variables. Bridges in the network were job reward satisfaction (bridge strength: 0.31), satisfaction with job itself (0.25), and job environment satisfaction (0.19) in job satisfaction community, as well as interested in daily activities (0.29) and feeling respectable (0.18) in flourishing community, with bridges selected with top 20% bridge strengths. Feeling frustrated at work (0.14) in occupational burnout community and leading a purposeful and meaningful life (0.11) in flourishing community became bridges when using thresholds of top 25% and 30% bridge strengths, respectively. We also observed higher network densities in females (network density: 0.37) than that in males (0.34), and gender differences in the distribution of partial correlation coefficients (M = 0.27, P = 0.017). CONCLUSIONS: In the network structure of occupational burnout-flourishing-job satisfaction, feeling frustrated at work in occupational burnout community and interested in daily activities in flourishing community were both central variables and bridges, which may be targeted variables to intervene to alleviate the overall level of symptoms in the network and therefore prevent poor health outcomes in healthcare workers.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Agotamiento Profesional , Masculino , Femenino , Humanos , Agotamiento Profesional/epidemiología , Satisfacción en el Trabajo , Estudios Transversales , Personal de Salud , China/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Metabolic-associated fatty liver disease (MAFLD) is of concern in employed adults, while the crucial indicators in predicting MAFLD are understudied in this population. We aimed to investigate and compare the prediction performance of a set of indicators for MAFLD in employed adults. METHODS: A cross-sectional study recruiting 7968 employed adults was conducted in southwest China. MAFLD was assessed by abdominal ultrasonography and physical examination. Comprehensive indicators of demographics, anthropometric, lifestyle, psychological, and biochemical indicators were collected by questionnaire or physical examination. All indicators were evaluated for importance in predicting MAFLD by random forest. A prognostic model based on multivariate regression model was constructed to obtain a prognostic index. All indicators and prognostic index were compared to evaluate their prediction performance in predicting MAFLD by the receiver operating characteristic (ROC) curve, calibration plot, and Decision curve analysis (DCA). RESULTS: Triglyceride Glucose-Body Mass Index (TyG-BMI), BMI, TyG, triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C), and TG ranked the top five important indicators, and TyG-BMI performed the most accurate prediction of MAFLD according to the ROC curve, calibration plot and DCA. The area under the ROC curves (AUCs) of the five indicators were all over 0.7, with TyG-BMI (cut-off value: 218.284, sensitivity: 81.7%, specificity: 78.3%) suggesting the most sensitive and specific indicator. All five indicators showed higher prediction performance and net benefit than the prognostic model. CONCLUSION: This epidemiological study firstly compared a set of indicators to evaluate their prediction performance in predicting MAFLD risk among employed adults. Intervention targeting powerful predictors can be helpful to reduce the MAFLD risk among employed adults.