End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia.

OBJECTIVES: To determine, among neonates at-risk for hyperbilirubinemia, whether measuring end-tidal carbon monoxide concentration (ETCOc) twice before 48 hours could identify those who would develop hyperbilirubinemia and differentiate hemolytic vs. non-hemolytic causes. METHODS: Prospective study on neonates meeting criteria "at-risk for hyperbilirubinemia." Routine bilirubin measurements and 10-day follow-up were used to categorize neonates as; (1) normal (no hyperbilirubinemia, all bilirubins <95th percentile of Bhutani nomogram), (2) having hemolytic hyperbilirubinemia (bilirubin ≥95th percentile, DAT+, elevated retic, or G6PD+), or (3) having non-hemolytic hyperbilirubinemia. RESULTS: 386 neonates were enrolled. 321 (83%) did not develop hyperbilirubinemia and 65 (17%) did, of which 29 were judged hemolytic and 36 non-hemolytic. High ETCOc differentiated the hemolytic group (p < 0.001). First-day ETCOc correlated with bilirubin and with reticulocyte count (r = 0.896 and 0.878) and sensitivity and specificity for predicting hyperbilirubinemia were excellent (83% and 95%). CONCLUSIONS: ETCO measurement in the first 48 hours after birth predicts hemolytic hyperbilirubinemia.

Lung ultrasound score as a tool to predict severity of bronchopulmonary dysplasia in neonates born ≤25 weeks of gestational age.

OBJECTIVE: The primary aim was to evaluate whether the addition of the posterior lung aided in diagnostic accuracy of predicting bronchopulmonary dysplasia (BPD) vs moderate-severe BPD (msBPD); the secondary aim was to explore the diagnostic accuracy of two protocols for BPD vs msBPD. STUDY DESIGN: This was a single-center prospective observational study. Preterm infants with a gestational age ≤ 25 weeks were included. Two LUS score protocols were evaluated on the 14th day of life (DOL): (A) evaluating the anterolateral (LUS score-al) lung and (B) the anterolateral combined with posterior (LUS score-alp) lung. The LUS score range for the two protocols was 0-32 and 0-48, respectively. RESULTS: A total of eighty-nine infants were enrolled. Both the LUS score-al and LUS score-alp were higher in neonates developing BPD and msBPD than in the rest of the cohort (LUS score-al 24 (23,26) vs 22 (20,23); LUS score-alp 36 (34,39) vs 28 (25,32)) (LUS score-al 25 (24,26) vs 23 (21,24); LUS score-alp 40 (39,40) vs 34 (28,36)). The LUS score-al on the 14th DOL showed a moderate diagnostic accuracy to predict BPD and msBPD (AUC 95% CI: 0.797 [0.697-0.896]; 0.811[0.713-0.909]), while the LUS score-alp significantly improved diagnostic accuracy of BPD and msBPD (AUC 95% CI: 0.902 [0.834-0.970]; 0.922 [0.848-0.996]). A cutoff of 25 points in the LUS score-al provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 76.9%, 79.4%, 3.7, and 0.3 respectively to predict msBPD. Meanwhile, that of 39 points in the LUS score-alp provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 81%, 98.4%, 50.5 and 0.19 to predict msBPD, respectively. CONCLUSIONS: The LUS score on the 14th DOL can predict BPD and msBPD with moderate diagnostic accuracy. Apart from that, scanning posterior enhanced diagnostic accuracy.

Spousal Synchrony in Allostatic Load Among Older Couples in the Health and Retirement Study.

OBJECTIVE: Using national data from the Health and Retirement Study, this study examined interpartner associations of allostatic load (AL) among 2338 different-sex couples ( N = 4676 individuals) over a 4-year period among older American couples from a dyadic approach. METHODS: AL was indexed by immune (C-reactive protein), metabolic (high-density lipoprotein cholesterol, total cholesterol, and glycosylated hemoglobin), renal (cystatin C), cardiovascular (systolic and diastolic blood pressures, pulse rate), and anthropometric (waist and body mass index) parameters using the traditional count-based formulation. Actor-partner interdependence models were used to assess interpartner concordance in AL. RESULTS: Higher partners' baseline AL was significantly associated with higher own AL both at baseline and 4 years later. In addition, partners' baseline AL was significantly associated with own AL 4 years later only in women but not men. Lastly, we did not observe any significant moderating effect of relationship quality on interpartner AL concordance. CONCLUSIONS: The findings suggest that older couples' physiological responses to environmental stress are not only linked concurrently, but the associations persist after 4 years, alluding to long-term impacts of couples' psychosocial context and physiology on each other.

The Predictive Value of Lung Ultrasound Score on Hemodynamically Significant Patent Ductus Arteriosus among Neonates ≤25 Weeks.

Lung ultrasound (LU) is increasingly used to diagnose and monitor neonatal pulmonary disorders; however, its role in hemodynamically significant patent ductus arteriosus (hsPDA) has not been elucidated. This prospective study investigated the predictive value of the LU score (LUS) for hsPDA in preterm infants with gestational age (GA) ≤ 25 weeks. Preterm infants with GA ≤ 25 weeks were enrolled in this study. LU was conducted on the fourth day of life (DOL). Six lung regions in every lung were scanned, with each region rated as 0-4 points. The performance of the LUS in predicting hsPDA among infants aged ≤25 weeks was analyzed by plotting the receiver operating characteristic (ROC) curve. A total of 81 infants were included in this study. GA, birth weight (BW), gender, Apgar score, delivery mode, antenatal steroids, meconium-stained amniotic fluid, premature rapture of membrane, and early-onset sepsis were not significantly different, but infants in the hsPDA group had increased LUS (38.2 ± 2.8 vs. 30.3 ± 4.3, p < 0.001) compared with non-hsPDA group. The area under the ROC curve (AUC) value of the LUS on the fourth DOL was 0.94 (95% CI: 0.93-0.99) in predicting hsPDA. The LUS threshold at 33 achieved 89% sensitivity and 83% specificity, with the positive and negative predictive values (PPV and NPV) being 87 and 86%, respectively. The LUS can predict hsPDA in extremely preterm infants at an early stage.

Lung ultrasound score predicts patent ductus arteriosus ligation among neonates ≤25 weeks.

BACKGROUND: This prospective study aimed to investigate whether lung ultrasound score (LUSs) can predict the patent ductus arteriosus (PDA) ligation. METHODS: Preterm infants ≤25 weeks of gestational age (GA) were enrolled. A lung ultrasound was performed on the 14th day of life. Each lung zone was given a score between 0 and 4. A receiver-operating characteristic (ROC) curve was constructed to evaluate the ability of the LUSs for predicting ligation. RESULTS: A total of 81 infants were eligible with a median GA and birth weight (BW) of 25 weeks (24.1-25.2) and 710 g (645-770), respectively. The median time from birth to ligation was 35 days (32-51). Those who underwent ligation had a longer time of mechanical ventilation (34 [26-39] vs. 19 [12-30], p < 0.001), shorter time of noninvasive respiratory support (39 [32-51] vs. 50 [41.5-57], p < 0.01), higher incidence of the bronchopulmonary dysplasia (BPD) (p < 0.01), and severe BPD (p < 0.001). The LUSs had an area under the ROC of 0.96 (95% confidence interval: 0.93-0.99) for the prediction of ligation. A LUSs cutoff of 36 has a sensitivity and specificity of 96% and 86% and positive and negative predictive values of 82% and 98%, respectively. CONCLUSIONS: LUSs at an early stage of life can predict PDA ligation in extremely preterm infants. It would be helpful to reduce morbidity by reducing the duration and magnitude of respiratory support.

Disparities by Race/Ethnicity and Immigration Status in Perceived Importance of and Access to Culturally Competent Health Care in the United States.

While cultural competence has been proposed as an important framework for enhancing health care equity, how members of different racial/ethnic groups consider the importance of cultural competence and their access to culturally competent health care are insufficiently understood. Despite continuously increasing immigrants into the US, it is unclear how immigration status intersects with race/ethnicity to shape individuals' perception of and access to culturally competent care in the US health care system. To fill this research gap, this study examined how the intersection of race/ethnicity and immigration status is associated with people's perception of and access to culturally competent health care and among immigrants, whether their length of stay matters, using data from the 2017 National Health Interview Survey. The results show that while racial and ethnic minority members reported greater importance of culturally competent care than non-Hispanic whites, Asian, black and other-race immigrants reported even greater importance than their US-born counterparts. Additionally, although racial/ethnic minorities reported greater limited access to culturally competent care than their white peers, this gap in access was observed primarily among US-born racial/ethnic minorities. Shorter length of residence (fewer than 15 years) was associated with greater perceived importance than residence of at least 15 years among immigrants, but access to culturally competent care did not differ by length of residence. The findings speak to racial/ethnic minorities' greater desire for culturally competent care and their unmet needs.

Current Marital Status and Epigenetic Clocks Among Older Adults in the United States: Evidence From the Health and Retirement Study.

Objectives: This study examines how current marital status is associated with epigenetic aging. Methods: Data from the 2016 Health and Retirement Study were used to examine marital status differences in the four epigenetic clocks, that is, GrimAge, DunedinPoAm, PhenoAge, and Zhang (N = 3765). Weighted ordinary least square regression models were estimated separately for men and women. Results: Remarried, cohabiting, divorced/separated and widowed older adults showed greater epigenetic aging than the continuously married similarly among men and women. Distinct sex difference was observed among the never married. While never-married women exhibited greater epigenetic aging than their continuously married counterparts, older men in lifelong singlehood showed comparable epigenetic aging to their continuously married peers. Discussion: The findings speak to the importance of marital context for epigenetic aging in later life and the biological risk associated with lifelong singlehood for older women in the US.

Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus.

Background: Platelet-rich thrombosis leads to the occlusion of arteries. Whether the association between platelet count and closure of hemodynamically significant patent ductus arteriosus (hsPDA) exists remains inconclusive. Given that neonatal platelet count is significantly affected by infection, this study aims to evaluate the association of platelet parameters before ibuprofen treatment with the closure of hsPDA in very low birth weight (VLBW) infants without concurrent infection. Methods: A retrospective study was conducted at the NICU of Shenzhen Maternity and Child Healthcare Hospital from January 2016 to August 2020. VLBW infants diagnosed with hsPDA, treated with oral ibuprofen and without concurrent infection were included in this study. The platelet parameters were retrieved from the whole-blood test routinely performed within 24 h before starting treatment of oral ibuprofen. A multiple regression model was built to evaluate the association between platelet parameters before ibuprofen treatment and successful closure of hsPDA. Results: A total of 129 premature infants with hsPDA were analyzed in this study. After oral ibuprofen treatment, successful closure of hsPDA was achieved in 70 (54.3%) infants. The gestational age at birth and birth weight in infants with successful or failed closure of hsPDA after ibuprofen treatment were 28.3 vs. 27.6 weeks (p = 0.016) and 1,120 vs. 960 g (p = 0.043), respectively. The rate of mechanical ventilation in infants with successful closure of hsPDA was significantly lower compared to those with failed closure of hsPDA, 31.4 vs. 54.2%, p = 0.014. The platelet count in infants with successful closure of hsPDA after ibuprofen treatment was significantly higher compared to those with failed closure of hsPDA, 212 vs. 183 (in a unit of 109/L), respectively (p = 0.024). Multivariate logistic regression analysis showed that a higher platelet count (≥181 × 109/L) before ibuprofen treatment was independently associated with successful closure of hsPDA [odds ratio 2.556, 95% confidence interval (1.101-5.932), p = 0.029]. Conclusion: The findings in this study suggest that a higher platelet count before oral ibuprofen treatment may predict the probability of successful closure of hsPDA in VLBW infants.

The correlation between workers' working pressure and physical and mental health analyzed by the job demand-resource stress model.

BACKGROUND: Under the background of the information society, teachers' pressure from work and life is increasing. Meanwhile, the working pressure has a potential inevitable connection with the physical and mental health of teachers. OBJECTIVE: To analyze the correlation between working pressure of workers and mental health status, expand the application of the job demand-resource stress (JD-RS) model in the adjustment of working characteristic pressure, and achieve the coordinated development between working pressure and mental health. METHODS: The occupation of the teacher is taken as the research object. First, the pressure source questionnaire and Symptom Check List 90 (SCL-90) are chosen to measure the working pressure and mental health. Also, the reliability and validity of the pressure source questionnaire are tested. Second, the gender, duty, teaching age, and workload of teachers are chosen as the foundation for comparing and analyzing the impact of various dimensions and project factors on teachers' working pressure and mental health. Finally, based on the method of univariate linear regression analysis, the correlation between teachers' working pressure and mental health is analyzed and characterized. RESULTS: The measurement tool based on the pressure source questionnaire has good performance reliability and validity. The five dimensions of Cronbach's coefficients are all greater than 0.8, and the indicators of fitting all meet psychometrics requirements. Significance analysis shows that different genders, duties, teaching ages, and workloads have different levels of significant influence on teachers' working pressure and mental health. Linear regression analysis shows that teachers' working pressure has a significant impact on their physical and mental health, which has a predictive effect. Teachers who bear high-intensity pressure have psychological problems. CONCLUSIONS: The research based on the JD-RS model has a positive role in promoting the balanced and coordinated development of working pressure and the physical and mental health of employed workers.

Marital Quality and Salivary Telomere Length Among Older Men and Women in the United States.

Objective: The link between marital quality and cellular aging remains underexplored. This study examined how both positive and negative marital quality were associated with salivary telomere length among partnered adults in the United States over the age of 50°years. Methods: Data were from the 2008 Health and Retirement Study (N = 3203). Ordinary least squares regression was used to estimate the link between marital quality and telomere length. Results: While neither positive nor negative marital quality was significantly associated with telomere length among older women, positive and negative marital quality had an interacting effect on telomere length among men. Specifically, when negative marital quality was low, higher positive marital quality was associated with shorter telomere length, whereas when negative marital quality was high, higher positive marital quality was associated with longer telomere length. Discussion: The findings speak to the complex nature of intimate partnerships and the implications of these partnerships for cellular aging processes.

Comparing multiple statistical software for multiple-indicator, multiple-cause modeling: an application of gender disparity in adult cognitive functioning using MIDUS II dataset.

BACKGROUND: The multiple-indicator, multiple-cause model (MIMIC) incorporates covariates of interest in the factor analysis. It is a special case of structural equation modeling (SEM), which is modeled under latent variable framework. The MIMIC model provides rigorous results and becomes broadly available in multiple statistical software. The current study introduces the MIMIC model and how it can be implemented using statistical software packages SAS CALIS procedure, R lavaan package, and Mplus version 8.0. METHODS: In this paper, we first discussed the formulation of the MIMIC model with regard to model specification and identification. We then demonstrated the empirical application of the MIMIC model with the Midlife in the United States II (MIDUS II) Study (N = 4109) using SAS CALIS procedure, R lavaan package and Mplus version 8.0 to examine gender disparities in cognitive functioning. The input, output, and diagram syntaxes of the three statistical software packages were also presented. RESULTS: In terms of data structure, all three statistical programs can be conducted using both raw data and empirical covariance matrix. SAS and R are comprehensive statistical analytic packages and encompass numerous data manipulation capacities. Mplus is designed primarily for latent variable modeling and has far more modeling flexibility compared to SAS and R, but limited in data manipulation. Differences in model results from the three statistical programs are trivial. Overall, the results show that while men show better performance in executive function than women, women demonstrate better episodic memory than men. CONCLUSIONS: Our study demonstrates the utility of the MIMIC model in its empirical application, fitted with three popular statistical software packages. Results from our models align with empirical findings from previous research. We provide coding procedures and examples with detailed explanations in the hopes of providing a concise tutorial for researchers and methodologists interested in incorporating latent constructs with multiple indicators and multiple covariates in their research projects. Future researchers are encouraged to adopt this flexible and rigorous modeling approach.

Novel information processing at work across time is associated with cognitive change in later life: A 14-year longitudinal study.

This study examined whether the degree of novel information processing at work (NPW) attenuates cognitive aging across 14 years for adults 50+ in the United States and how NPW links with job complexity. To answer these questions, we used data (N = 4,252) from the Health and Retirement Study. Detailed information on occupational characteristics from O*Net between 2000 and 2014 was used to assess NPW and matched with participants' occupational codes across time. Multilevel transition models were employed to estimate the relationship between NPW and cognitive functioning across time and to explore the moderating effect of cognitive level. Our results showed that exposure to more NPW across time attenuates cognitive decline as indicated by immediate word recall and serial 7s performance, while adjusting for baseline age, leisure, volunteering activities, cognition at previous wave, and other covariates. This buffering effect of NPW is reduced but sustained when controlling for change in job complexity, indicating that, as expected, NPW and job complexity are linked. We also found that particularly for workers with lower levels of cognitive performance, exposure to NPW across 14 years was linked with less decline in serial 7s performance (controlling for job complexity). This, however, was not the case for immediate word recall performance, which asks for further study. Overall, our findings suggest that mental stimulation through NPW is one mechanism (in the work context) that buffers cognitive decline. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

[Fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth].

OBJECTIVE: To investigate the fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth. METHODS: A total of 98 preterm infants were enrolled and divided into extremely preterm infant group (n=17), early preterm infant group (n=48), and moderate-to-late preterm infant group (n=33). According to the dose of fat emulsion, they were further divided into low- and high-dose subgroups. The umbilical cord blood and dried blood filter papers within 3 days after birth were collected. Tandem mass spectrometry was used to measure the content of short-, medium-, and long-chain acylcarnitines. RESULTS: The extremely preterm infant and early preterm infant groups had a significantly lower content of long-chain acylcarnitines in the umbilical cord blood and dried blood filter papers within 3 days after birth than the moderate-to-late preterm infant group (P<0.05), and the content was positively correlated with gestational age (P<0.01). On the second day after birth, the low-dose fat emulsion subgroup had a significantly higher content of short-, medium-, and long-chain acylcarnitines than the high-dose fat emulsion subgroup among the extremely preterm infants (P<0.05). In the early preterm infant and moderate-to-late preterm infant groups, there were no significant differences in the content of short-, medium-, and long-chain acylcarnitines between the low- and high-dose fat emulsion subgroups within 3 days after birth. CONCLUSIONS: Compared with moderate-to-late preterm infants, extremely preterm infants and early preterm infants have a lower capacity to metabolize long-chain fatty acids within 3 days after birth. Early preterm infants and moderate-to-late preterm infants may tolerate high-dose fat emulsion in the early stage after birth, but extremely preterm infants may have an insufficient capacity to metabolize high-dose fat emulsion.

Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans.

Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998-2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors.

Fertility Decline and the 1918 Influenza Pandemic in Taiwan.

The impact of the 1918 influenza pandemic on human fertility has been subject to significant scholarly debate. The current study characterizes the inter-temporal association between excess deaths during the pandemic and the subsequent birth deficit by identifying the length of time between these two phenomena using cross-correlations of monthly death and birth data from Taiwan from 1906 to 1943. The analysis demonstrates a strong and negative correlation between deaths (d) at time t and births (b) at time t + 9 (r(db)(9) = -0.68, p < .0001). In other words, a significant drop in births was observed nine months after pandemic mortality peaked. The findings suggest that the 1918 influenza pandemic impacted subsequent births primarily through the mechanism of reduced conceptions and embryonic loss during the first month of pregnancy rather than through late-first-trimester embryonic loss.

[Effect of the proteasome inhibitor MG-132 on hyperoxic lung injury and its mechanism in rats].

OBJECTIVE: To observe the effects of proteasome inhibitor MG-132 on hyperoxic lung injury in rats and explore the mechanism. METHODS: Thirty SD rats were randomly divided into 3 groups, namely the normoxic group, hyperoxic group, and hyperoxic with MG-132 treatment group, and rat models of hyperoxic exposure-induced lung injury were established in the latter two groups. After pathological grading of the lung injury under optical microscope and determination of the wet/dry weight ratio of the lung tissue, the expressions of ubiquitin protein and nuclear factor-kappaB (NF-kappaB) p56 and the activity of proteasome 20S and myeloperoxidase (MPO) were detected. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) expressions in the lung tissue were also detected. RESULTS: The rats with hyperoxic exposure showed obvious pulmonary edema and increased wet/dry weight ratio of the lung tissue (P<0.01), which were significantly alleviated with MG-132 treatment (P<0.01). Compared with the normoxic group, hyperoxic exposure resulted in significant lung pathologies (P<0.01), which was reduced after MG-132 treatment. Immunohistochemistry and Western blotting demonstrated increased expression of ubiquitin protein in the lung tissue after hyperoxic exposure (P<0.01), which was lowered by MG-132 treatment (P<0.01). Proteasome 20S activity was obviously enhanced in the hyperoxic group (P<0.01) but lowered by MG-132 treatment (P<0.01). Hyperoxic exposure also caused obviously enhanced MPO activity and expressions of NF-kappaB, TNF-alpha, and IL-6 (P<0.01), which were all reduced by MG-132 treatment (P<0.05). CONCLUSION: MG-132 alleviates hyperoxic lung injury probably by inhibiting the NF-kappaB/inflammatory factor pathways.