Loneliness and associated factors among middle-aged and older adults: cross-sectional and longitudinal survey results from the HAALSI cohort in South Africa.

OBJECTIVES: Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa. METHOD: The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure. RESULTS: The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness. CONCLUSION: One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness.

Tobacco use and heavy episodic drinking among persons aged 18-69 years in Bolivia in 2019.

OBJECTIVES: The aim of this study was to estimate the prevalence and sociodemographic factors associated with tobacco use and heavy episodic drinking (TUHED), current tobacco use only (TU), and current heavy episodic drinking only (HED) among people 18-69 years in Bolivia in 2019. STUDY DESIGN: Cross-sectional study. METHODS: The analysis used cross-sectional data from Bolivia's STEPS 2019 survey; 4472 individuals answered questions about substance use and socio-demographic information. RESULTS: The sample included 50.2% women and 49.8% men, 52.1% had secondary or higher education, 48.6% were Mestizo and 28.0% Quechua. The prevalence of TUHD was 6.0% (10.5% for men, 1.6% for women), TU 12.2% (20.0% for men, 4.4% for women), and HED 11.2% (13.4% for men and 9.1% for women). Male sex increased the risk of TU, HED and TUHED and belonging to the Amara ethnic group decreased the risk of TU and TUHED. Higher education was increased the odds of HED and among women of TUHED. Urban residence increased the risk of TUHED and among women of HED. For women, unemployment was associated with TU and marriage or cohabitation was inversely associated with TU, and for men, belonging to another ethnic group (such as Castellano or Tacana) increased the risk of TU and TUHED. CONCLUSION: More than 10% of the general adult population in Bolivia participated in TU and HED, and among men in TUHED. Various factors associated with the different categories of substance use were identified.

Chronic conditions and incident and persistent depressive symptoms among ageing adults in rural South Africa.

The study aimed to assess associations between chronic diseases and incident and persistent depressive symptoms (DSs) in a cohort study of ageing adults in South Africa. Participants in the baseline survey (in 2014/2015) were 5,059 persons (≥40 years) and at follow-up 4,176 (in 2018/2019). DSs were measured with the Center for Epidemiological Studies Depression scale. Logistic regression was used to estimate the associations between chronic conditions and incident and persistent DS. The prevalence of DS at baseline was 15.5%, incident DS (without DS and/or PTSD at baseline) was 25.1% and persistent DS (DS at both baseline and follow-up) was 4.8%. In unadjusted logistic regression analysis, diabetes had higher odds of incident DS. Participants with baseline heart attack/stroke/angina, dyslipidemia, tuberculosis, chronic bronchitis, kidney disease and three or more chronic conditions had a higher probability of persistent DS. In conclusion, of the eight chronic conditions evaluated, only diabetes (in unadjusted analysis) was associated with incident DS, and five chronic conditions (heart attack/stroke/angina, dyslipidaemia, tuberculosis, chronic bronchitis and kidney disease) and three or more chronic conditions were associated with persistent DS.

Longitudinal Correlates of Grandparenting with Depressive Symptoms and Poor Sleep Quality Among Middle-Aged and Older Women and Men in South Africa.

OBJECTIVES: The study aimed to assess the impact of grandparenting on incident depressive symptoms and incident poor sleep quality among aging women and men in rural South Africa. METHODS: This longitudinal community study enrolled 3,237 adults (≥40 years) from the "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)." MEASUREMENTS: Grandparenting was assessed by self-report at wave 1, and depressive symptoms and poor sleep quality at waves 1 and 2. Outcomes were incident depressive symptoms and incident poor sleep quality at wave 2. Logistic regression was utilized to estimate the associations between grandparenting and incident depressive symptoms and incident poor sleep quality. RESULTS: Almost half of the grandfathers (44.6%) and 68.4% of the grandmothers were parenting 7/days/week. In the final adjusted models, among grandmothers, compared to 0 days/week grandparenting, 7 days/week grandparenting reduced the odds of incident depressive symptoms (AOR: 0.71, 95% CI: 0.55 to 0.91) and reduced the odds of incident poor sleep quality (AOR: 0.58, 95% CI: 0.40 to 0.82). CONCLUSION: Grandparenting significantly reduced poor mental health among grandmothers but not among grandfathers. CLINICAL IMPLICATIONS: Practitioners may encourage grandparent caregiving, among grandmothers, to reduce poor mental health in South Africa.

Longitudinal Associations Between Food Insecurity and Mental Health in Aging Adults in South Africa.

OBJECTIVES: The aim of this study was to assess the longitudinal unidirectional and bidirectional associations between food insecurity and mental health among aging adults in South Africa. METHODS: The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa (HAALSI) study. RESULTS: The proportion of food insecurity was 20.2% in 2015, 24.1% in 2019 and 18.4% in 2021/2022. Food insecurity was positively associated depressive symptoms, poor life satisfaction, poor sleep quality, PTSD, loneliness, impaired cognition, and current tobacco use. Compared to without food insecurity in all three study waves, having food insecurity in one wave and/or two to three waves was positively associated with incident depressive symptoms, incident poor life satisfaction, incident poor sleep quality, incident PTSD, incident loneliness, incident current tobacco use, and incident current heavy alcohol use. PTSD, impaired cognition, current tobacco use and current heavy alcohol use were positively associated with incident food insecurity. CONCLUSION: We found that food insecurity was unidirectionally associated with depressive symptoms, poor life satisfaction, poor sleep quality and loneliness, and bidirectionally associated with PTSD, impaired cognition, current tobacco use and current heavy alcohol use. CLINICAL IMPLICATIONS: Enhanced screening and management of food insecurity may reduce mental ill-health in South Africa.

Ten-year retrospect of the investigation of proximal limbs metastasis in cancer: a multi-center study on survival outcome, limb function status and surgical procedures analysis.

BACKGROUND: The aim of study was to evaluate survival outcome and limb function in cancer patients with proximal limbs metastasis. Associated factors on survival outcome and limb function were identified. The comparative analysis between intramedullary nailing and prosthesis surgery in cancer patients with proximal limb metastasis was performed. METHODS: In this five-center retrospective study, patients diagnosed with limbs metastasis were collected. Descriptive statistics was used and log-rank test was performed to analyze the survival in subgroups. The Cox proportional hazards regression analysis was performed to identify the independent prognostic factors. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate limb function after surgery, and t test or analysis of variance (ANOVA) was utilized in subgroup analysis. RESULTS: A total of 316 patients with limb metastasis were included with mean age at 61.0 years. The most common primary tumor was breast, followed by renal cancer and lung cancer. The median overall survival was 24.0 months and the 1-, 3- and 5-year survival rates were 86.9%, 34.7% and 6.8%, respectively. Primary tumor type, visceral metastasis and chemotherapy were proved to be the independent prognostic factors. The mean Musculoskeletal Tumor Society (MSTS) score was 20.5, significant difference was observed in subgroup of solitary/multiple bone metastasis, with/without pathological fracture, and type of surgery. CONCLUSION: The present study concluded that primary tumor type, visceral metastasis and chemotherapy were three factors affecting the survival of patients. Compared with intramedullary nailing, the patients underwent prosthesis surgery showed better limb function, this procedure should be encouraged in patients with indication.

Clinicomics-guided distant metastasis prediction in breast cancer via artificial intelligence.

BACKGROUND: Breast cancer has become the most common malignant tumour worldwide. Distant metastasis is one of the leading causes of breast cancer-related death. To verify the performance of clinicomics-guided distant metastasis risk prediction for breast cancer via artificial intelligence and to investigate the accuracy of the created prediction models for metachronous distant metastasis, bone metastasis and visceral metastasis. METHODS: We retrospectively enrolled 6703 breast cancer patients from 2011 to 2016 in our hospital. The figures of magnetic resonance imaging scanning and ultrasound were collected, and the figures features of distant metastasis in breast cancer were detected. Clinicomics-guided nomogram was proven to be with significant better ability on distant metastasis prediction than the nomogram constructed by only clinical or radiographic data. RESULTS: Three clinicomics-guided prediction nomograms on distant metastasis, bone metastasis and visceral metastasis were created and validated. These models can potentially guide metachronous distant metastasis screening and lead to the implementation of individualized prophylactic therapy for breast cancer patients. CONCLUSION: Our study is the first study to make cliniomics a reality. Such cliniomics strategy possesses the development potential in artificial intelligence medicine.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand.

OBJECTIVES: The aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand. METHODS: We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE). RESULTS: The proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight). CONCLUSION: We found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.

Self-rated physical and mental health among older adults 80 years and older: cross-sectional results from a National community sample in Thailand.

BACKGROUND: The aim of this study was to assess the self-reported physical health (SRPH) and self-reported mental health (SRMH) of older adults 80 years and older in Thailand. METHODS: We analyze national cross-sectional data from the Health, Aging and Retirement in Thailand (HART) in 2015. Physical and mental health status was assessed by self-report. RESULTS: The sample included 927 participants (excluding 101 proxy interviews), 80-117 years, median age 84 years [interquartile range (IQR) 81-86 years]. The median SRPH was 70.0 (IQR = 50.0-80.0), and median SRMH was 80.0 (IQR = 70.0 to 90.0). The prevalence of (good) SRPH was 53.3%, and the prevalence of (good) SRMH was 59.9%. In the final adjusted model, low or no income, living in the Northeastern, Northern and Southern region, daily activity limitations, moderate/severe pain, having one or two or more physical conditions, and low cognitive functioning were negatively associated, and higher physical activity was positively associated with good SRPH. No or low income, residing in the northern region of the country, daily activity limitations, low cognitive functioning, and probable depression were negatively associated with good SRMH, and physical activity was positively associated with good SRMH. CONCLUSION: SRPH and SRMH was relatively high rated among the oldest old in Thailand, and influenced by various social, economic, and health-related factors. Special attention should be given to those with no or low income, those living in the non-central regions and those having no or low formal social engagement. Health care and other services should improve physical activity, financial support, and physical and mental care management to promote physical and mental well-being of older adults 80 years and older in Thailand.

Prevalence and correlates of major depressive disorder among a national sample of middle-aged and older adults in India.

Objectives: This study aimed to assess the prevalence and correlates of major depressive disorder (MDD) among middle-age and older adults in India.Methods: The cross-sectional sample consisted of 72,262 persons (45 years and older) from the 2017 to 2018 Longitudinal Ageing Study in India (LASI) Wave 1. MDD is defined using DSM-5 criteria and measured with the CIDI-SF. Logistic regression was used to evaluate the associations with MDD.Results: The prevalence of past 12-month MDD was 7.6%, 8.1% among women and 7.0% among men, and 8.2% in persons 60 years and older. In the final adjusted model, food insecurity, having 3-6 discrimination experiences, ill-treatment, victim of violent crime, disaster exposure, unsafe home/neighbourhood, poor childhood health, hypertension, stroke, tobacco use, and physical pain were positively associated with MDD. Being male, married, high socioeconomic status, living in urban areas, high spirituality/religiosity, health insurance and medium social network were negatively associated with MDD.Conclusion: Almost one in ten middle-aged and older adults in India had MDD and several associated factors were identified.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries.

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Combined victimization of face-to-face and cyberbullying and adverse health outcomes among school-age adolescents in Argentina.

Face-to-face bullying victimization (FBV) and cyber bullying victimization (CBV) are of global concern, including in Latin America. The aim of this study was to evaluate the associations between combined FBV and CBV relative to single victimization (FBV or CBV) and no victimization with a wide range of adverse health outcomes among school-aged adolescents from Argentina. National cross-sectional school data from 56,981 adolescents that responded to questions on FBV, CBV, and adverse health outcomes were analyzed. The results showed a prevalence of 18.7% FBV alone, 8.1% CBV alone and 13.6% combined FBV and CBV. Combined FBV and CBV had higher odds than single victimization (FBV or CBV) in 18 negative health outcomes, including anxiety, suicidal ideation, loneliness, suicide plan and attempt, smoking, smokeless tobacco use, history of intoxication, alcohol-related problems, current cannabis use, ever use of amphetamine, school truancy, participation in physical fighting, physically attacked, injury, ever sex, multiple sexual partners and sedentary behaviour. In conclusion, combined FBV and CBV had higher odds than single BV or no BV in most adverse health outcomes.

Health risk behaviour and persistent and incident depression among middle-aged and older adults in South Africa.

The aim of this study was to assess the association between five health risk behaviours and persistent and incident depressive symptoms in a longitudinal study in South Africa. The sample included 5059 men and women (≥40 years) in 2014/2015, and 4176 in 2018/2019 of the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa'. Depressive symptoms were assessed with the Centre for Epidemiologic Studies Depression scale. Multivariable logistic regression analysis was conducted to assess the associations between five health risk behaviours and persistent and incident depressive symptoms. Results indicate that 5.0% of participants had depressive symptoms at both wave 1 and 2 (persistent depressive symptoms), and 27.9% had incident depressive symptoms in wave 2. Higher education and moderate baseline physical activity were negatively associated and those with cardiovascular disease were positively associated with persistent depressive symptoms. Middle wealth index was negative, and being HIV positive and baseline tobacco use were positively associated with incident depressive symptoms. In conclusion, of five health risk behaviours assessed (inadequate fruit/vegetable intake, alcohol dependence, tobacco use, physical activity, and sedentary behaviour), only moderate physical activity was protective against persistent depressive symptoms, and tobacco use was associated with incident depressive symptoms.

Religiosity and Depression Among Community-Dwelling Older Adults in India: Results of a National Survey in 2017-2018.

This study aimed to investigate the association between religiousness (affiliation, nonorganizational, organizational, and intrinsic religiosity) and major depressive disorder (MDD) and depressive symptoms among older adults in a national population survey in India. In total, 72,262 people (≥ 45 years) from the cross-sectional longitudinal aging study in India 2017-2018 responded to questions on religiosity, MDD, and depressive symptoms. Results indicate that 57.0% of participants were engaged in high nonorganizational (daily prayer) religiosity, 14.0% engaged in high (> 1/week or every day) organizational religiosity (attending religious services) and 34.9% had high intrinsic religiosity. In the adjusted logistic regression analysis, high nonorganizational religiosity (daily prayer), and high intrinsic religiosity were inversely associated with MDD. Similarly, high nonorganizational religiosity and high intrinsic religiosity were inversely associated with depressive symptoms. Organizational religiosity was not significantly associated with MDD or depressive symptoms. Compared to Hindus, Christians had lower odds of MDD and Sikhs had lower odds of depressive symptoms. High religiosity was observed among older adults in India. Nonorganizational and intrinsic religiosity were inversely associated with MDD and depressive symptoms.

Blood Pressure, Depression, and Suicidal Ideation Among Pregnant Women with HIV.

Although prior research has examined associations between blood pressure (BP), depression, and suicidal ideation, few studies have examined this in high-risk populations such as pregnant women with HIV (WHIV). The current study examined the association of BP with depression and suicidal ideation among pregnant WHIV (n = 217) in rural South Africa. BP data (measured ≤ 1 month before the study visit) was extracted from medical records. Depressive symptomatology and suicidal ideation were assessed using the Edinburgh Postnatal Depression Scale. Diastolic BP was positively associated with both suicidal ideation and depressive symptomatology, even after controlling for demographic variables, gestational age, and intimate partner violence. These findings suggest that WHIV with elevated BP may be at greater risk for antenatal depression and suicidal ideation. Future research should utilize longitudinal designs to examine potential mechanisms and the directionality of the relationship, as well as other contributing factors.

RESUMEN: Aunque investigaciones anteriores han examinado las asociaciones entre la presión arterial (PA), depresión e ideación suicida, pocos estudios han examinado esto en poblaciones de alto riesgo, como las mujeres embarazadas con VIH. El estudio actual examinó la asociación de la PA con la depresión y la ideación suicida entre mujeres embarazadas con VIH (n = 217) en zonas rurales de Sudáfrica. Los datos de PA (medidos ≤ 1 mes antes de la visita del estudio) se extrajeron de los registros médicos. La sintomatología depresiva y la ideación suicida se evaluaron mediante la Escala de depresión posnatal de Edimburgo. La PA diastólica se asoció positivamente tanto con la ideación suicida como con la sintomatología depresiva, incluso después de controlar variables demográficas, edad gestacional y violencia de la pareja íntima. Estos hallazgos sugieren que mujeres embarazadas con VIH con PA elevada puede tener un mayor riesgo de depresión prenatal e ideación suicida. Las investigaciones futuras deberían aprovechar diseños longitudinales para examinar los posibles mecanismos y la direccionalidad de la relación, así como otros factores contribuyentes.

Psychological and physical intimate partner violence and sexual risk behavior among South African couples: a dyadic analysis.

This study aimed to examine intimate partner violence (IPV) as it relates to both partners' perceptions of IPV and sexual behaviors, considering how their IPV might be interdependent within the relationship dynamics. The sample consisted of 713 female-male dyads in which women were pregnant and living with HIV in rural South Africa. Using an actor-partner interdependence model (APIM), we examined the interdependent influence of psychological and physical IPV on men by their female partners and psychological and physical IPV on women by their male partners on sexual risk behavior. The APIM model found there were no actor (b = -0.06, SE = 0.05, p = .221) or partner (b = -1.2, SE = 0.06, p = .056) effects contributing to protected sex by female IPV victimization. In contrast, significant actor (b = -0.28, SE = 0.06, p < .001) and partner (b = -0.29, SE = 0.06, p < .001) effects for protection were related to male IPV victimization. The model also found that the covariate of female HIV disclosure was associated with both male (b = 0.5, SE = 0.12, p < .001) and female protected sexual intercourse (b = 0.58, SE = 0.1, p < .001). Female HIV disclosure was related to an increased likelihood of protected sex by both male and female partners. As male partners reported more IPV victimization, the likelihood of protected sex between male and female partners decreased.Trial registration: ClinicalTrials.gov identifier: NCT02085356.

Mental distress and incident functional disability among a rural ageing population in South Africa.

OBJECTIVES: The aim of the study was to investigate the association between mental symptoms and incident functional disability among middle-age and older adults in South Africa. METHODS: Longitudinal data from two consecutive population surveys (2014/2015-2018/2019) in Agincourt, South Africa, were analysed. RESULTS: In total, 298 of 3813 participants without functional disability in wave 1 (8.8%) had functional disability in wave 2. The prevalence of baseline functional disability was 9.1%. In the fully adjusted models for people without functional disability at baseline, depressive symptoms (AOR: 1.74, 95% CI: 1.08-2.80) among men and lower life satisfaction among men (AOR: 0.86, 95% CI: 0.80-0.93) and among women (AOR: 0.90, 95% CI: 0.83-0.98) increased the odds of incident functional disability. Posttraumatic stress disorder symptoms, poor sleep quality, restless sleep, and loneliness were not significantly associated with incident functional disability. CONCLUSIONS: Depressive symptoms among men and lower life satisfaction among both sexes were independently associated with incident functional disability in ageing rural South Africans.

Sleep duration and incident and persistent depressive symptoms among a rural ageing population in South Africa.

BACKGROUND: The aim of the study was to assess the relationship between sleep duration and incident depressive symptoms (IDS) and persistent depressive symptoms (PDS) using longitudinal data from South Africa. METHODS: This longitudinal community study enrolled 3891 adults (≥40 years) from the "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)". Sleep duration was assessed by self-report at wave 1, and depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale at wave 1 and 2. Outcomes were incident and persistent depressive symptoms at wave 2. Multivariable logistic regression analysis was conducted to assess the associations between sleep duration at wave 1 and incident, and persistent depressive symptoms. RESULTS: The prevalence of IDS was 25.6% and PDS 30.8%. The prevalence of very short, short, normal, and long sleep duration at baseline was 3.6%, 10.1%, 60.9% and 25.4%, respectively. In the fully adjusted model, long sleep duration was positively associated with IDS among men (AOR: 1.37, 95% CI: 1.02-1.84), but not among women (AOR: 0.91, 95% CI: 0.67-1.23). No models among both men and women showed a significant association between short sleep and IDS. Long sleep duration was associated with PDS (AOR: 2.04, 95% CI: 1.20-3.48) among men but not among women (AOR: 1.26, 95% CI: 0.76-2.11). Short sleep showed among both sexes no significant associations with PDS. CONCLUSION: Long but not short sleep duration was independently associated with IDS and PDS among men but not among women.

Survival Estimation, Prognostic Factors Evaluation, and Prognostic Prediction Nomogram Construction of Breast Cancer Patients with Bone Metastasis in the Department of Bone and Soft Tissue Tumor: A Single Center Experience of 8 Years in Tianjin, China.

Purpose: Bone metastasis in breast cancer remains globally concerned. Accurate survival estimation would be beneficial for clinical decision-making, especially for the patients with potential indications of surgery. Based on a retrospective cohort from China, the study aimed to construct a prognostic prediction nomogram for breast cancer patients with bone metastasis. Methods: Breast cancer patients with bone metastasis diagnosed between 2009 and 2017 in our department were retrospectively selected. The total cohort was divided into construction and validation cohorts (ratio 7 : 3). A nomogram was constructed to predict the probability of survival, and the performance of model was validated. Results: A total of 343 patients were enrolled with 243 and 100 patients in construction and validation cohorts, respectively. The median overall survival for the total cohort was 63.2 (95% CI: 52.4-74.0) months. Elevated ALP (HR = 1.71, 95% CI: 1.16-2.51; P=0.006), no surgery for breast cancer (HR = 2.19, 95% CI: 1.30-3.70; P=0.003), synchronous bone metastasis (HR = 1.98, 95% CI: 1.22-3.22; P=0.006), and liver metastasis (HR = 1.68, 95% CI: 1.20-2.37; P=0.003) were independent prognostic factors for worse survival. The independent predictors and other five factors (including age at diagnosis, ER status, PR status, Her-2 status, and the performance of bisphosphonate) were incorporated to construct the nomogram. The C-index was 0.714 (95% CI: 0.636-0.792) and 0.705 (95% CI: 0.705) in the construction cohort and validation cohort, respectively. All the calibration curves were close to the 45-degree line, which indicated satisfactory calibration. Conclusion: A retrospective study aiming at prognostic estimation of breast cancer patients with bone metastasis was designed. Four independent prognostic factors were identified and a prognostic nomogram was constructed with satisfactory discrimination and calibration. The model could be used in survival estimation and individualized treatment planning.

Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey.

BACKGROUND: This study aimed to investigate, using Andersen's model of health care utilization, factors associated with COVID-19 testing among adults in nine low- and middle- income countries. METHODS: In between 10 December 2020 and 9 February 2021, an online survey was organized in nine low- and middle-income countries. In total 10,183 adults (median age 45 years, interquartile range 33-57 years, range 18-93 years), including 6470 from Brazil, 1738 Malaysia, 1124 Thailand, 230 Bangladesh, 219 DR Congo, 159 Benin, 107 Uganda, 81 Malawi and 55 from Mali participated in the study. COVID-19 testing/infection status was assessed by self-report. RESULTS: Of the 10,183 participants, 40.3% had ever tested for COVID-19, 7.3% tested positive, and 33.0% tested negative. In an adjusted logistic regression model, predisposing factors (residing in Brazil, postgraduate education), enabling/disabling factors (urban residence, higher perceived economic status, being a student or worker in the health care sector, and moderate or severe psychological distress), and need factors (having at least one chronic condition) increased the odds of COVID-19 testing. Among those who were tested, participants residing in Bangladesh, those who had moderate to severe psychological distress were positively associated with COVID-19 positive diagnosis. Participants who are residing in Malaysia and Thailand, and those who had higher education were negatively associated with a COVID-19 positive diagnosis. Considering all participants, higher perceived economic status, being a student or worker in the health sector, and moderate or severe psychological distress were positively associated with a COVID-19 positive diagnosis, and residing in Malaysia, Thailand or five African countries was negatively associated with a COVID-19 positive diagnosis. CONCLUSION: A high rate of COVID-19 testing among adults was reported in nine low-and middle-income countries. However, access to testing needs to be increased in Africa. Moreover, COVID-19 testing programmes need to target persons of lower economic status and education level who are less tested but most at risk for COVID-19 infection.