Integrating genomic profiling to clinical data: assessing the impact of CD147 expression on plaque stability.

Background: Acute Coronary Syndrome (ACS) continues to be a leading cause of death and illness worldwide. Differentiating stable from unstable coronary plaques is essential for enhancing patient outcomes. This research investigates the role of CD147 as a biomarker for plaque stability among coronary artery disease patients. Methods: The study began with high-throughput sequencing of blood samples from six patients, divided equally between those with Stable Angina (SA) and Unstable Angina (UA), followed by bioinformatics analysis. Expanding upon these findings, the study included 31 SA patients and 30 patients with ACS, using flow cytometry to examine CD147 expression on platelets and monocytes. Additionally, logistic regression was utilized to integrate traditional risk factors and evaluate the predictive value of CD147 expression for plaque stability. Results: Initial sequencing displayed a notable difference in CD147 expression between SA and UA groups, with a significant increase in UA patients. Further analysis confirmed that elevated platelet CD147 expression was strongly associated with unstable plaques (OR = 277.81, P < .001), after adjusting for conventional risk factors, whereas monocyte CD147 levels did not show a significant difference. Conclusion: Elevated CD147 expression on platelets is a crucial biomarker for identifying unstable coronary artery plaques, offering insights into patient risk stratification and the development of targeted treatment strategies. This underscores the pivotal role of molecular research in understanding and managing coronary artery disease, paving the way for improved clinical outcomes.

Association of diastolic and systolic blood pressure with depression: a cross-sectional study from NHANES 2005-2018.

Background: Many studies worldwide have reported the association between mental health and blood pressure, but the results are mixed, and even contradictory. We aim to investigate the relationship between systolic and diastolic blood pressure and depression in the entire US population. Methods: This study analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. All adults completed 3-4 blood pressure measurements after sitting quietly for 5 minutes. Depression was diagnosed based on the Patient Health Questionnaire (PHQ-9), with a score ≥10 defined as depression. Weighted logistic regression and restricted cubic splines (RCS) were used to assess the relationship between blood pressure and depression. Two-piecewise linear regression was used to determine the inflection point. Additionally, subgroup analyses and interaction tests were conducted to identify potential subgroups. Finally, two sensitivity analyses were conducted. Results: A total of 26,581 American adults were included, with a mean age of 47.2 years, of whom 13,354 (49.54%) were male; 2,261 individuals were defined as depressed, with a weighted prevalence of 7.41%. All participants' mean systolic blood pressure (SBP) was 121.7 mmHg, and the mean diastolic blood pressure (DBP) was 70.9 mmHg. RCS showed a nonlinear association between SBP and depression, while DBP showed a positive linear association with depression. Two-piecewise linear regression showed that the inflection point of the association between SBP and depression was 129.7 mmHg. Weighted logistic regression showed that after fully adjusting for depression-related risk factors, there was a significant positive correlation between per 10 mmHg increase in DBP and depression (OR: 1.06, 95% CI: 1.00-1.12, P=0.04); however, only on the left side of the inflection point, SBP tended to decrease the odds of depression (P =0.09). Furthermore, interaction analysis showed that the association between DBP and depression was significantly stronger in cancer patients (P for interaction=0.02); on the left side of the inflection point (<129.7 mmHg), current smokers also significantly interacted with SBP (P for interaction=0.018). Finally, two sensitivity analyses also supported our findings. Conclusion: In the adult population of the United States, there is a positive linear association between DBP and depression, while the association between SBP and depression exhibits a significant threshold effect, maintaining SBP at 129.7 mmHg is associated with the lowest prevalence of depression.

Association of healthy eating index-2015 and overactive bladder: a cross-sectional study.

Objective: The aim of this cross-sectional study was to investigate the association of HEI-2015 and overactive bladder (OAB) in a large population. Methods: Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 datasets. Univariate and multivariate logistic regression were performed to evaluate the association between HEI-2015 and OAB. The restricted cubic spline (RCS) model was conducted to investigate the dose-response relationship. Results: Totally, this study included 29,206 participants with 6,184 OAB patients among them. The higher continuous HEI-2015 value was independently associated with lower OAB incidence (OR: 0.87; 95%CI: 0.78, 0.98). Similarly, the highest quartile categorical HEI-2015 was significantly associated with a lower OAB odds (OR: 0.72; 95%CI: 0.52, 0.99) when compared with the lowest quartile. The RCS curve also showed a favorable non-linear dose-response relationship between HEI-2015 and OAB. Conclusion: A higher HEI-2015 had a favorable association with OAB and there was a non-linear dose-response relationship between them. We suggest adherence to the United States diet recommendation as a potential behavioral prevention of OAB. Large-scale long term prospective cohort studies across various regions are needed to verify the findings of this paper.

Clinical profiles of older adults in French Caribbean nursing homes: a descriptive cross-sectional study.

Background: Nursing homes in the Caribbean are scarce and the characteristics of their residents have not been previously documented. This study aimed to describe the clinical profiles of residents living in nursing homes in Guadeloupe and Martinique (French West Indies). Methods: This is a cross-sectional study of the baseline screening data from the KASEHPAD (Karukera Study of Ageing in nursing homes) study. Clinical characteristics and geriatric scale scores, including the Activities of Daily Living (ADL), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment Short-Form (MNA-SF) and Short Physical Performance Battery (SPPB) were collected and analysed. Results: A total of 332 older adults were recruited between September 2020 and November 2022. The mean age of the residents was 81.3 ± 10.1, with a male-female ratio of 1:1. Diabetes was reported in 28.3% of the residents, hypertension in 66.6% and heart disease in 18.4%. Dementia was diagnosed in 52.3% of the residents and 74.9% had a MMSE score ≤18. The prevalence of Parkinson's disease was 9.0%. Additionally, 18.4% were unable to perform any basic activities of daily living (ADL score of 0). The prevalence of physical impairment (SPPB < 8) was 90.0%. One-quarter of the residents were classified as undernourished (MNA-SF score ≤ 7). Conclusion: Residents in Caribbean nursing homes are younger than in metropolitan France, whereas they present quite similar clinical profiles. Notably, a high prevalence of diabetes, cardiovascular diseases and neurodegenerative diseases was observed. This study represents a preliminary effort to address the knowledge gap regarding the aging trajectories of older adults in the Caribbean and could guide the development of future nursing homes in these countries.

Exploring the Sociodemographic Factors and Consequences related to Alcohol Consumption among Older Indigenous Community of a District in Nepal: A Qualitative Study.

INTRODUCTION: Alcoholism is a major global public health concern associated with numerous health conditions. Alcohol use has been a cultural part of several ethnic groups in Nepal. This study aimed to explore the qualitative dimension of alcohol use, its promoting factors, and consequences in Nepalese communities. METHODS: Qualitative study was conducted among 20 older adults belonging to the Magar community of Mathagadhi Rural Municipality, Lumbini Province, Nepal after acquiring ethical approval from Institutional Review Committee of CiST College (Reference number: 179/078/079). The data were analyzed using inductive thematic analysis, and themes were identified based on participants' responses to explore promoting factors for alcohol consumption along with its consequences. RESULTS: Traditional beliefs, cultural practices, and socioeconomic factors were the major contributors to alcohol misuse. Increased alcohol consumption during old age was perceived to be associated with body pain, tension, painful life events, and loneliness. CONCLUSIONS: A conflicting perception was observed, where some of the participants expressed the need to promote alcohol use as a part of their culture while some shared the view that the use of alcohol as a cultural practice should be limited. This study highlights the need for culturally appropriate interventions to address alcohol misuse among indigenous communities. Interventions should focus on addressing traditional beliefs and cultural practices that normalize alcohol consumption and the social and economic problems associated with alcohol misuse.

Congenital Heart Disease among Children Undergoing Echocardiography in the Department of Paediatrics of Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Congenital heart disease in children are a major cause of infant mortality and morbidity. It is important to detect and manage these disorders timely as they are preventable. The objective of this study was to find out proportion of congenital heart disease in children in paediatric department in a tertiary hospital. METHODS: This is a descriptive cross-sectional study carried out in the Department of Paediatric at Nepal Medical College and Teaching Hospital where all children (0-18 years) suspected to have congenital heart disease who underwent echocardiography were studied over a period of 1 year (2020-2021). The presence or absence of congenital heart disease were confirmed by echocardiography performed by paediatric cardiologist. The socioeconomic variables,clinical features and echocardiography findings were noted. RESULTS: Out of total 249 patients,the proportion of patients diagnosed to have cardiac disorders was 73 with male predominance of 165 (66.26%). The most common age group was found to be neonates 111 (44%).The notable clinical features were murmur 47 (18.87%), tachypnoea 27 (10.84%) ,tachycardia 27 (10.84%) and cyanosis 9 (3.61%), clubbing 2 (0.80%), oedema 1 (0.40%), hypertension 9 (3.65%), murmur 47 (18.87%).Out of the total, there were 49 (19.67%) cases of acyanotic congenital heart disease, and 27 (10.84%) cases of cyanotic congenital heart disease. CONCLUSIONS: Our study focuses on early recognition of cardiac diseases which is crucial for preventing morbidity and mortality.

Association between cardiometabolic Index (CMI) and endometriosis: a cross-sectional study on NHANES.

BACKGROUND: Endometriosis is intricately linked to metabolic health. The Cardiometabolic Index (CMI), a novel and readily accessible indicator, is utilized to evaluate metabolic status. This study seeks to investigate the potential correlation between CMI and endometriosis. METHODS: Data from four consecutive survey cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2006 were utilized. This included adult females with self-reported diagnoses of endometriosis and complete information required for calculating the CMI. The calculation formula for CMI is Triglycerides(TG) / High-density lipoprotein cholesterol (HDL-C) × WHtR (WHtR = waist circumference / height). A multivariable logistic regression model was employed to investigate the linear association between CMI and endometriosis. Subgroup analyses were performed to explore potential influencing factors. Additionally, the linear relationship was validated using restricted cubic spline (RCS) curve plotting and threshold effect analysis. RESULTS: This study, based on the National Health and Nutrition Examination Survey (NHANES), included a cohort of 2,224 adult women. The multivariable logistic regression analysis demonstrated that in the fully adjusted model, individuals with the highest CMI exhibited a 78% elevated likelihood of endometriosis compared to those with the lowest CMI (OR = 1.78; 95% CI, 1.02-3.11, P < 0.05). The subgroup analysis indicated that there were no significant interactions between CMI and specific subgroups (all interaction P > 0.05), except for the subgroup stratified by stroke status (P < 0.05). Additionally, the association between CMI and endometriosis was linear, with a 20% increase in the association for each unit increase in CMI when CMI > 0.67 (OR = 1.20; 95% CI, 1.05-1.37, P < 0.01). CONCLUSION: The study found that CMI levels are closely correlated with endometriosis, with this correlation increasing when the CMI exceeds 0.67. This finding implies that by regularly monitoring CMI levels, physicians may be able to screen women at risk for endometriosis at an earlier stage, thereby enabling the implementation of early interventions to slow the progression of the disease. To further validate these findings, larger-scale cohort studies are required to support the results of this research.

Association between systemic immune-inflammation index and cataract among outpatient US adults.

Background: While several studies have noted a higher SII correlates with multiple diseases, research on the association between SII and cataract remains limited. Our cross-sectional study seeks to examine the association between SII and cataract among outpatient US adults. Methods: This compensatory cross-sectional study utilized NHANES data from 1999 to 2008 cycles, conducting sample-weighted multivariate logistic regression and stratified analysis of subgroups. Results: Among 11,205 adults included in this study (5,571 [46.2%] male; 5,634 [53.8%] female), 2,131 (15.2%) had cataract and 9,074 (84.8%) did not have cataract. A fully adjusted model showed that SII higher than 500 × 109/L was positively correlated with an increased risk of cataracts among women (OR, 1.27; 95% CI, 1.02-1.59) (p = 0.036). However, no difference was found in the men subgroup, and there was no significant interaction between SII and sex. Conclusion: Our results indicated that a SII higher than 500 × 109/L was positively correlated with an increased risk of cataracts in women. This study is the first to specifically investigate the impact of a high SII on cataract risk in outpatient adults in the United States. By effectively addressing inflammation, it is possible to mitigate cataract progression and significantly enhance patient outcomes.

Cardiometabolic index is associated with increased bone mineral density: a population-based cross-sectional study.

Background: Osteoporosis is a multifactorial bone disease in which lipid metabolism plays an important role. Bone Mineral Density (BMD) measured by Dual-energy X-ray Absorptiometry (DXA) is a critical indicator for diagnosing osteoporosis. The cardiometabolic index (CMI) is a novel metric that combines two quantitative indicators of blood lipids-triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). This study explores the association between CMI and BMD and seeks to elucidate the role of lipid metabolism in the context of bone health. Methods: Based on the data of the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020-pre-pandemic, weighted multiple linear regression and smooth curve fitting were used to study the relationship between CMI and femoral BMD. Stratified analyses were also conducted for age, gender, BMI, ethnicity, diabetes and hypertension status. And, the saturation threshold effect of CMI was further analyzed using a two-stage linear regression model. Result: This study enrolled a total of 1,650 participants (48.7% males), with an average age of 63.0 ± 8.6 years. After adjusting for multiple confounding factors, CMI was positively correlated with total femur BMD, trochanter BMD, and intertrochanter BMD, while the correlation with femur neck BMD was not statistically significant. In the fully adjusted model, each unit increase in CMI was associated with a 0.026 (g/cm2) increase in total femur BMD, a 0.022 (g/cm2) increase in trochanter BMD, and a 0.034 (g/cm2) increase in intertrochanter BMD. Subjects in the highest quartile of CMI had a 0.034 (g/cm2) increase in total femur BMD, a 0.035 (g/cm2) increase in trochanter BMD, and a 0.039 (g/cm2) increase in intertrochanter BMD in the fully-adjusted model compared to those in the lowest quartile. In addition, saturation was observed between CMI and total femur BMD, trochanter BMD and intertrochanter BMD, with saturation thresholds of 1.073, 1.431 and 1.073, respectively. Conclusion: CMI is strongly associated with BMD, indicating its potential relevance in bone metabolism. However, the role of CMI in the context of bone health, especially regarding osteoporosis risk, requires further investigation in large-scale prospective studies.

Functioning of post-COVID-19 patients: a cross-sectional study at the outpatient clinic for long-term effects.

BACKGROUND: After COVID-19 infection, long-term impacts on functioning may occur. We studied the functioning of patients with post-COVID-19 condition (PCC) and compared them to controls without PCC. METHODS: This cross-sectional study consisted of 442 patients with PCC referred to rehabilitation at the Helsinki University Hospital (HUS) Outpatient Clinic for the Long-Term Effects of COVID-19, and 198 controls without PCC. Functioning was assessed with a questionnaire including WHODAS 2.0. Patients underwent physical testing including a hand grip strength test (HGST) and a 6-minute walking test (6MWT). Lifestyle was assessed by questionnaire and comorbidities were collected as ICD-10 codes from the HUS Data Lake on the HUS Acamedic platform. RESULTS: The WHODAS 2.0 average total score was 34 (SD 18) (moderate functional limitation) for patients with PCC and 6 (SD 8) (normal or mild limitation) for the controls. The disability was higher in all aspects of WHODAS 2.0 in patients with PCC. Bivariate binomial and multivariable regression analyses showed that the presence of comorbidities, anxiety, depression, and smoking predicted a WHODAS 2.0 score of 24 (moderate functional limitation) or above in the PCC group. The average 6MWT distance was 435 m (SD 98 m) in patients with PCC and 627 m (SD 70 m) in controls. HGST measurements showed no significant differences from controls. CONCLUSIONS: In conclusion, patients with PCC had significantly reduced functioning based on WHODAS 2.0 scores and the 6MWT results. Comorbidities, anxiety, depression, and smoking were associated with moderate or severe limitations in functioning. Findings support that PCC is multifactorial and requires a holistic approach to rehabilitation.

The post-COVID-19 condition (PCC) has been shown to negatively impact functioning, quality of life, and mental health, with cognitive and physical impairments being prevalent.This study found that patients with PCC had significantly reduced functioning compared to controls.Key factors predicting severe disability included comorbidities, smoking, and mental health issues like anxiety and depression.The reduced functioning in patients with PCC appears to be multifactorial and not only related to COVID-19 infection.

Nutritional status and its associated factors among infants and young children aged 6-23 months in Addis Ababa, Central Ethiopia, 2021: a cross-sectional study.

The aim of this study is to assess nutritional status and associated factors among infants and young children aged 6-23 months in Yeka sub-city, Ethiopia, 2021. An institution-based cross-sectional study was conducted in selected health centres found in the Yeka sub-city from May 2021 to July 2021. In total, 396 systematically selected infants and young children aged 6-23 months attended the selected health centres were included in the study. Data were collected by using a structured questionnaire and anthropometric measurements. A multinomial logistic regression model was used. The overall magnitude of undernutrition and overnutrition among infants and young children were 24.7% and 5.5%, respectively. Dietary diversity score (DDS) ((adjusted odd ratio (AOR) = 5.65; 95% CI = 2.301, 10.87; P value = 0.003), minimum meal frequency (MMF) (AOR = 5.435; 95% CI = 2.097, 11.09; P value = 0.0052), and diarrhoea (AOR = 2.52; 95% CI = 1.007, 6.310; P value = 0.002) were statistically significantly associated factors for nutritional status among infants and young children. Malnutrition (undernutrition and overnutrition) is a public health problem among infants and young children in Yeka sub-city, Ethiopia. DDS, MMF, and diarrhoeal disease were associated with higher odds of undernutrition.

Single Institutional Cross-Sectional Phone Survey Study: Evaluation of Causes for Loss to Follow-up After Spinal Cord Stimulator Implantation.

BACKGROUND: Spinal cord stimulation (SCS) is often an option of last resort for patients with post-laminectomy syndrome or an alternative option for patients with complex regional pain syndrome, chronic nonsurgical low back pain, or painful diabetic peripheral neuropathy when conservative management has failed. Although SCS is a helpful option, it is not without complications that can frequently lead to explantation of the SCS device and dissatisfaction with the treatment. Furthermore, as with any technology, SCS has potential issues that may lead to patient frustration and ultimately result in patient noncompliance and lack of follow-up visits. OBJECTIVES: The goals of this study are to explore the magnitude of and reasons for patient loss to follow-up after SCS device implantation. STUDY DESIGN: A cross-sectional phone survey. SETTING: A tertiary-care academic hospital. METHODS: A cross-sectional phone survey was performed on 49 patients who were deemed lost to follow-up when they did not return to the clinic one month after being implanted with permanent SCS devices at Beth Israel Deaconess Medical Center. Patients were administered an institutional review board-approved questionnaire exploring their reasons for not returning to the clinic. RESULTS: Over a 5-year period, 257 patients underwent full implantation of an SCS device. Of the 49 patients lost to follow-up, 24 were able to be contacted, and they completed the questionnaire. Twenty of the patients continued to use the SCS device but were lost to follow-up for the following reasons: 58% (14/24) due to improvement of pain, 13% (3/24) due to minimal improvement in pain control, 4% (1/24) due to other urgent health conditions, and 8% (2/24) due to patient noncompliance and missing follow-up appointments (4/24). Four patients discontinued using the SCS device after an average of 1.5 years +/- one year, 12% (3/24) due to inadequate pain control and 4% (1/24) due to inability to recharge the device (1/24). Of these patients, 2 of the 4 contacted their SCS representatives for help with troubleshooting prior to discontinuation. None of the patients was explanted. LIMITATIONS: The main limitation of this study was the incompletion rate, which was 51.0% (25 out of 49 patients). CONCLUSIONS: This paper, the first cross-sectional study of loss to follow-up among patients who are implanted with SCS devices, identifies that up to 19% of patients are quickly lost to follow-up after implantation. Only half of the patients in this study could be reached, with most successfully using their device for meaningful pain control, but a substantial number of patients likely required additional device optimization for pain relief.

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

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

Prevalence of problem drinking in the Swedish workforce: differences between labour market industries based on gender composition and main job activity.

BACKGROUND: Identifying problem drinking patterns across industries is essential for addressing drinking problems in the workforce. Still, it is not well understood how problem drinking differs across industries and whether it is associated with industry gender composition. This study aimed to measure the prevalence of problem drinking (PPD) across Swedish industries and investigate possible associations between gender-typed industries and problem drinking. METHODS: 9,155 current workers were selected from the Swedish Longitudinal Occupational Survey of Health (SLOSH) data collected in 2020. Participants' work industries were identified through the Swedish Standard Industrial Classification (SNI) codes. Seven gender-typed industry categories were created based on gender composition and main job activity in each industry. Self-reported problem drinking was measured using a slightly modified Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire and a cut-off score 2 was used to determine problem drinking. Poisson regression with robust standard errors was used to investigate the association between gender-typed industries and problem drinking. RESULTS: PPD in the workforce was 6.6%. Men (8.5%) had a higher prevalence than women (5.3%). Across industries, PPD varied from 2.3% in Water supply and waste management to 15.4% in Mining and quarrying. The highest prevalence for men was in Mining and quarrying (18.2%), whereas for women it was in Construction (11.1%). Within gender-typed industries, the highest PPD was in male-dominated Goods and Energy Production (7.7%), and the lowest was in female-dominated Health and Social Care (4.7%). In the regression analysis, both Education (aPR: 1.39, p = 0.03) and Labour-intensive Services (aPR: 1.39, p = 0.02) had higher adjusted prevalence ratios (aPR) compared with Health and Social Care. However, there was no significant difference in aPR among gender-typed industries when considering the gender composition of industries only. CONCLUSIONS: PPD in the Swedish workforce varied significantly across industries, with differences observed between men and women. Problem drinking differed between industries when categorized by gender composition and main job activity, but not when categorized by gender composition only. Future research should investigate how industry-specific psychosocial factors influence individual alcohol consumption.

Methodological Aspects of the Study on Food Commercialization in Brazilian Schools (Caeb) / Aspectos Metodológicos del Estudio sobre la Comercialización de Alimentos en Escuelas Brasileñas (Caeb) / Aspectos metodológicos do estudo Comercialização de Alimentos em Escolas Brasileiras (Caeb)

It presents the methodological aspects of the design and organization of the study Food Commercialization in Brazilian Schools, which aimed to evaluate aspects related to the commercialization of food and beverages in private schools, based on information collected from school cafeteria managers and street vendors located in the immediate surroundings of the schools. A cross-sectional study was conducted in private elementary and high schools that had cafeterias, in the 26 Brazilian state capitals and the Federal District. Simple random sampling with inverse replacement was used, and in the end, 2,241 cafeterias and 700 street vendors were evaluated. The proportion of sample loss was 21.2%. The questionnaire was developed and reviewed by specialists, covering questions about: food and nutritional information, infrastructure for meals, convenience, price, availability, variety, and promotion. The logistics included a coordinating team that conducted training, managed and controlled data quality, local researchers, and a company that assisted with fieldwork. The data collection took place between 2022 and 2024. The main implementation challenges were its overlap with the 2022 election period, episodes of violence in schools, internal school policies, and the complexity of Brazil's cultural diversity and vast territorial extension. The study's strengths include the novelty of the data collected in terms of depth and representativeness, the use of the generated evidence to propose public policies for regulating the school food environment, and the support in building a network of researchers on the topic.

Se presentan los aspectos metodológicos de la concepción y organización del estudio Comercialización de Alimentos en Escuelas Brasileñas, cuyo objetivo fue evaluar aspectos relacionados con la comercialización de alimentos y bebidas en escuelas privadas, a partir de información recopilada de los gestores de cantinas escolares y vendedores ambulantes presentes en el entorno inmediato de las escuelas. Se realizó un estudio transversal en escuelas privadas de enseñanza primaria y secundaria que contaban con cantinas, en las 26 capitales brasileñas y en el Distrito Federal. Se empleó un muestreo aleatorio simple con reposición inversa, y al final se evaluaron 2.241 cantinas y 700 vendedores ambulantes. La proporción de pérdidas muestrales fue del 21,2%. El cuestionario fue desarrollado y evaluado por especialistas, abarcando cuestiones sobre: información alimentaria y nutricional, infraestructura para la alimentación, conveniencia, precio, disponibilidad, variedad y promoción. La logística contó con un equipo coordinador que llevó a cabo las capacitaciones, gestionó y controló la calidad de los datos, investigadores locales y una empresa que asistieron en el trabajo de campo. Las recolecciones de datos se llevaron a cabo entre 2022 y 2024. Las principales dificultades de implementación fueron su coincidencia con el período electoral de 2022, episodios de violencia en las escuelas, políticas internas de las escuelas y la complejidad de la diversidad cultural y la vasta extensión territorial brasileña. Como puntos fuertes se destacan la novedad de los datos recogidos en términos de profundidad y representatividad, el uso de la evidencia generada para proponer políticas públicas de regulación del entorno alimentario escolar y el apoyo en la construcción de una red de investigadores en la temática.

Apresenta os aspectos metodológicos da concepção e organização do estudo Comercialização de Alimentos em Escolas Brasileiras, que teve como objetivo avaliar aspectos relacionados à comercialização de alimentos e bebidas em escolas privadas, a partir de informações coletadas com gestores de cantinas escolares e ambulantes presentes no entorno imediato das escolas. Realizou-se um estudo transversal em escolas privadas, de ensino fundamental e médio que possuíam cantinas, nas 26 capitais brasileiras e no Distrito Federal. Foi empregada aleatória simples com reposição inversa, ao final, foram avaliadas 2.241 cantinas e 700 ambulantes. A proporção de perdas amostrais foi de 21,2%. O questionário foi desenvolvido e avaliado por especialistas contemplando questões sobre: informação alimentar e nutricional, infraestrutura para alimentação, conveniência, preço, disponibilidade, variedade e promoção. A logística contou com uma equipe coordenadora que conduziu os treinamentos, realizou a gestão e controle da qualidade dos dados, pesquisadores locais e uma empresa que auxiliaram no trabalho de campo. As coletas ocorreram entre 2022 e 2024. As principais dificuldades de implementação foram sua concomitância com o período eleitoral de 2022, episódios de violência nas  escolas, políticas internas das escolas e a complexidade da diversidade cultural e a vasta extensão territorial brasileira. Como pontos fortes destacam-se o ineditismo dos dados coletados em profundidade e representatividade, o uso das evidências geradas para proposição de políticas públicas de regulação do ambiente alimentar escolar e o apoio na construção de uma rede de pesquisadores na temática.

Association between serum total bilirubin with Parkinson's disease among American adults (NHANES 1999 to 2018).

Background: Currently, the existing evidence on the correlation between serum total bilirubin (STB) and Parkinson's disease (PD) is insufficient. The objective of this study was to clarify the relationship between STB levels and PD within the US (United States) population. Methods: A cross-sectional analysis was conducted using data from 25,637 participants in the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Weighted logistic regression, smooth curve fitting, subgroup analysis, and sensitivity analyses were employed to validate the research objectives. Results: Among all eligible subjects, the mean age was 57.11 ± 11.78 years. The prevalence of PD was 1.18 % overall, with 47.86 % in males. After adjusting for multiple variables, the odds ratio [OR] (95 % confidence interval [CI]) for PD associated with STB levels in T2 and T3 were 0.59 (95 % CI = 0.40-0.85, p = 0.006) and 0.67 (95 % CI = 0.45-0.99, p = 0.045), respectively, when compared to STB levels in T1. The analysis using restricted cubic splines (RCS) indicated an L-shaped relationship between STB levels and the prevalence of PD (p for nonlinearity = 0.004), with the lowest risk observed at 10.84 µmol/L. Comparable patterns of association were noted in subgroup analyses. Furthermore, consistent findings were derived from additional sensitivity analyses. Conclusions: Our study findings indicated that the level of STB is significantly negatively correlated with the prevalence of PD. Therefore, more prospective studies need to be designed to prove the causal relationship between them.

The humanistic care ability of nurses in 27 provinces in China: a multi-center cross-sectional study.

Background: Currently, studies found that the humanistic care ability of nurses is at low level in China, resulting in patients' concerns and dissatisfaction regarding the lack of empathy among nurses. We aimed to explore the factors that influence nurses' humanistic care ability, providing a new perspective on improving patient satisfaction and promote high quality medical services. Methods: A multi-center cross-sectional study recruited nurses from tertiary and secondary hospitals in China between July 2022 and August 2022. Data concerning self-developed questions on nurses' socio-demographic data and Caring Ability Inventory (CAI) were collected through the Questionnaire Star Platform, using a multi-stage sampling method. Results: The total score for the level of caring ability among the 15,653 surveyed Chinese nurses was 192.16 ± 24.94. Various factors significantly influence the level of humanistic care ability, including professional title, department, degree of passion for the job, job satisfaction, emphasis on self-care, participation in humanistic care training, support from family for the job, relationships with colleagues, satisfaction with salary, and previous experience working in pilot wards emphasizing humanistic care (p < 0.01). Conclusion: At present, nurses exhibit a comparatively modest proficiency in humanistic care ability. Numerous factors contribute to this situation. Nursing administrators ought to enhance the scope of humanistic care practices, conduct consistent professional training sessions, advocate for the implementation of model wards emphasizing humanistic care, foster a supportive organizational culture conducive to nurses, and underscore the significance of both nurturing nurses and promoting self-care among them.

Psychometric Testing of an Instrument Assessing Family Knowledge, Contemplation, Confidence and Readiness for Engaging in Early Mobilisation of Critically Ill Patients: A Multi-Site Cross-Sectional Design.

BACKGROUND: Early mobilisation is beneficial to support recovery among critically ill patients. The literature highlights the benefits of family engagement in early mobilisation, yet this practice remains underutilised. Effective implementation depends on understanding the key antecedents that influence family engagement in early mobilisation, specifically families' knowledge, contemplation, confidence and readiness. However, no measurement tools currently exist to assess these. Therefore, developing a psychometrically supported instrument is essential to understanding and enhancing families' factors influencing their engagement in early mobilisation. AIM: To develop and evaluate the psychometric properties of an instrument to assess families' knowledge, contemplation, confidence and readiness to engage in early mobilisation. DESIGN: A multi-site cross-sectional survey design. METHODS: Based on established psychological theory (Social Cognitive Theories and Behaviour Change Theories), an item pool was developed to assess families' knowledge, contemplation, confidence and readiness to participate in early mobilisation. To psychometrically evaluate the new tool, a multi-site cross-sectional survey was undertaken from May 2020 to June 2022 across five intensive care units in Australia. Data from 370 families of critically ill patients were used to evaluate the structural, convergent and discriminant validity as well as the reliability of the new instrument. RESULTS: Confirmatory factor analysis indicated good model fit, supporting the proposed structure. All items displayed high standardised factor loadings except one, which improved upon freeing an error covariance. Positive inter-factor correlations were moderate to strong and were substantially lower than the square root of the average variance extracted, supporting both convergent and discriminant validity, respectively. Additionally, all subscales demonstrated well to excellent reliability. CONCLUSION: The findings provide preliminary support for the multiple types of validity evidence and the reliability of the instrument. This new instrument is suitable for use in clinical and research applications to assess families' knowledge, contemplation, confidence and readiness for their engagement in early mobilisation. IMPACT: Family engagement in early mobilisation activities may have multiple benefits but it is not commonly implemented in the ICU. Factors influencing family engagement in early mobilisation are poorly understood. Influential psychological theories highlight the likely importance of knowledge, contemplation, confidence and readiness. A readily available instrument designed to assess these constructs among family members is needed to deepen research understanding and guide clinical practice. The proposed instrument is designed to measure factors influencing family engagement in early mobilisation, which may support healthcare professionals and health services to identify and tailor strategies to support family engagement in early mobilisation. REPORTING METHOD: Recommendations for reporting the results of studies of instrument and scale development and testing was followed to report this study. PATIENT OR PUBLIC CONTRIBUTION: Family members of adult critically ill patients participated in this study, and they provided the data through the survey.

Association between anemia and diabetic lower extremity ulcers among US outpatients in the National Health and Nutrition Examination Survey: a retrospective cross-sectional study.

Purpose: The aim of this study was to explore the relationship between hemoglobin levels, anemia and diabetic lower extremity ulcers in adult outpatient clinics in the United States. Methods: A retrospective cross-sectional study was conducted on 1673 participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to evaluate the relationship between anemia and diabetic lower extremity ulcers. Model 1 adjusted for demographic and socioeconomic variables (age, sex, race and ethnicity, educational level, family income, and marital status). Model 2 included additional health-related factors (BMI, cardiovascular disease, stroke, family history of diabetes, hyperlipidemia, alcohol and smoking status). Model 3 further included clinical and laboratory variables (HbA1c, CRP, total cholesterol, and serum ferritin levels). Stratified analyses were also conducted based on age, sex, HbA1c level, body mass index (BMI), and serum ferritin level. Results: The study included 1673 adults aged 40 years and older, with a mean age of 64.7 ± 11.8 years, of whom 52.6% were male. The prevalence of diabetic lower extremity ulcers (DLEU) was 8.0% (136 participants). Anemia was found in 239 participants, accounting for 14% of the study group. Model 1 showed an OR of 2.02 (95% CI=1.28~3.19) for anemia, while Model 2 showed an OR of 1.8 (95% CI=1.13~2.87). In Model 3, the OR for DFU in patients with anemia was 1.79 (95% CI=1.11~2.87). Furthermore, when serum ferritin was converted to a categorical variable, there was evidence of an interaction between DLEU status and serum ferritin in increasing the prevalence of DLEU. Conclusion: After adjusting for confounding variables, higher levels of anemia were proportionally associated with an increased risk of incident DLEU. These results suggest that monitoring T2DM patients during follow-up to prevent the development of DLEU may be important. However, further prospective studies are needed to provide additional evidence.

Association Between Serum Uric Acid Levels and Metabolic-Associated Fatty Liver Disease in Southeast China: A Cross-Sectional Study.

Objective: This study aimed to explore the association between serum uric acid (sUA) levels and metabolic-associated fatty liver disease (MAFLD) in Southeast China. Methods: We performed a cross-sectional study of 2605 subjects who underwent physical examination between 2015 and 2017 in Southeast China. To explore the association between sUA levels and the risk of MAFLD, we employed logistic regression, restricted cubic spline (RCS), subgroups and multiplicative interaction analysis. Results: Logistic regression analysis showed a positive association between sUA and MAFLD [aOR total population (95% CI)= 1.90 (1.49 ~ 2.42)], [aOR male (95% CI)= 2.01 (1.54 ~ 2.62)], [aOR female (95% CI)= 1.15 (0.62 ~ 2.11)], respectively. The RCS plot presented a significant nonlinear dose-response relationship between sUA levels and MAFLD risk, and the risk of MAFLD increased significantly when sUA> 5.56 mg/dL (P nonlinear< 0.001). Subgroups analysis revealed that the positive association between sUA and MAFLD was consistent across strata of gender, age, BMI, drinking status, smoking status and tea drinking status. Significant associations between sUA and MAFLD were not only found in males but also existed in subjects whose age ≤60, BMI ≥24 kg/m2, drinkers, smokers and tea-drinkers. Adjusted ORs were estimated to be 2.01, 1.95, 2.11, 2.29, 2.64 and 2.20, respectively. Multiplicative interactions were not observed between gender, age, drinking status, smoking status, tea drinking status and sUA (all P interaction> 0.05). Conclusion: According to our study, sUA was positively associated with the risk of MAFLD. Additionally, the risk of MAFLD increased significantly when sUA levels exceeded 5.56 mg/dL. Our study may help clarify whether sUA plays a diagnostic role in MAFLD.