Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis

BACKGROUND

Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive treatments and risk of drug resistance in post-chemotherapy neutropenic fever (NF) in hematological malignancy (HM) is limited. We aimed to review institutional clinical and microbiological data and explore clinical phenotype pattern groups among data.

METHODS

Available data from 372 NF episodes were included. Demographics, types of malignancies, laboratory data, antimicrobial treatments and febrile-related outcome data such as predominant pathogens and microbiological diagnosed infections (MDIs) were collected. Descriptive statistics, two-step cluster analysis and non-parametric tests were employed.

RESULTS

The occurrences of microbiological diagnosed bacterial infections (MDBIs; 20.2%) and microbiological diagnosed fungal infections (MDFIs; 19.9%) were almost equal. Gram-negative pathogens (11.8%) were comparable with gram-positive pathogens (9.9%), with gram-negative being slightly predominant. Death rate was 7.5%. Two-step cluster analysis yielded four distinct clinical phenotype pattern (cluster) groups: cluster 1 'lymphomas without MDIs', cluster 2 'acute leukemias MDBIs', cluster 3 'acute leukemias MDFIs' and cluster 4 'acute leukemias without MDIs'. Considerable NF events with antibiotic prophylaxis being not identified as MDI might have cases in low-risk with non-infectious reasons causing febrile reactions that might possibly not require prophylaxis.

CONCLUSIONS

Regular institutional surveillance with active parameter assessments to signify risk levels in the post-chemotherapy stage, even prior to the onset of fever, might be an evidence-based strategy in the management of NF in HM.

Clustering of Health and Oral Health-Compromising Behaviours in Army Personnel in Central Peninsular Malaysia

Health- and oral health-compromising behaviours (HOHCBs) impact the health readiness of military personnel, resulting in decreased fitness performance, thus affecting combat readiness. This study aimed to identify the clustering patterns and number of HOHCBs in army personnel in Central Peninsular Malaysia. Thus, a cross-sectional study using a multistage sampling technique and a validated 42-item online questionnaire was conducted to assess ten health (medical screening, physical activity, sedentary lifestyle, smoking status, alcohol consumption, substance abuse, aggressive behaviours, sleep, and road safety habits) and five oral health behaviour domains (tooth brushing, fluoridated toothpaste use, flossing, dental visits, and bruxism). Each HOHCB was dichotomised into healthy and health-compromising behaviour and analysed using hierarchical agglomerative cluster analysis (HACA). With the majority being males (92.5%), of other ranks (96.8%), and healthy (83.9%), 2435 army members of a mean age of 30.3 years (SD = 5.9) participated, with a response rate of 100%. HACA identified two clustering patterns: (i) 'high-risk behaviours' (30 HOHCBs) and (ii) 'most common risk behaviours' (12 HOHCBs) with a mean clustering number of 14.1 (SD = 4.1). In conclusion, army personnel in Central Peninsular Malaysia displayed 2 broad HOHCB clustering patterns, 'high-risk' and 'most common risk', with an average of 14 HOHCB clusters per person.

Probabilistic linguistic fuzzy cognitive maps: applications to the critical factors affecting the health of rural older adults

Background

Achieving healthy ageing has become the only way for China to alleviate the pressure of ageing, especially in rural areas. However, the factors affecting the health of rural older adults are numerous and complex. It is important to identify the critical factors that affecting the health of older adults in rural areas and provide decision-making support for targeted health interventions.

Methods

To overcome some limitations of existing works, an extended probabilistic linguistic fuzzy cognitive map model is proposed in this paper as a useful tool for modeling the cause-effect relationship between factors. The proposed model integrates the advantages of probabilistic linguistic term sets and fuzzy cognitive maps. In the end, to rank and identify the critical factors affecting the health, a novel similarity measure based on Euclidean distance and Z-mapping function is proposed.

Results

The proposed model can effectively deal with the uncertainty of experts and reflect different opinions of groups well. In terms of representing uncertainty and ambiguity, the proposed method outperforms other models in modeling complex systems. In the real-world case analysis, we find that education is the most important factor affecting the health of rural older adults, followed by previous occupational experiences, psychology, and physical exercise, among other things. Intergenerational relationship has become another important factor affecting the health of rural older adults in China as the development of Chinese society.

Conclusions

From a macro perspective, social economic status, living environment, lifestyle, and health management, are the variables that have the greatest impact on the health of rural older adults. As a result, providing more precise health interventions with the characteristics of factors influencing health is a crucial guarantee for preserving and improving the health of rural older adults in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-02028-9.

Sociodemographic moderation of the association between depression and stroke incidence in a retrospective cohort of 0.4 million primary care recipients with hypertension

BACKGROUND

Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension.

METHODS

We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007-December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011-2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430-437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified.

RESULTS

In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03-1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00-1.67).

CONCLUSION

Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.

Breakfast Consumption and Academic Achievement Among Chinese Adolescents: A Moderated Mediation Model

The studies have shown that a healthy lifestyle has a significant impact on the academic achievement of adolescents. Behavior of breakfast eating is considered a hallmark of dietary patterns and an important component of a healthy lifestyle. The prior study explained that students had a lower level of achievement motivation at school because they were exposed to some militating factors in their families such as absenteeism, ill health, malnutrition, and hunger. This study examined the mediating role of achievement motivation and moderating role of socioeconomic status (SES) in the association between breakfast consumption and academic achievement. This study used a sample of 15-year-old Chinese students who participated in Program for International Student Assessment (PISA) 2015. In terms of gender, female students accounted for 47.2% and male students accounted for 52.8%. The results showed that (1) breakfast consumption had a positive predictive effect on academic achievement; (2) achievement motivation played a partial mediating role in the relationship between breakfast consumption and academic achievement; and (3) the direct and indirect effects were moderated by the SES of students, which meant that the effect of breakfast consumption on achievement motivation can differ depending on the SES of students. Besides, both the effects were stronger for individuals with higher SES. The conclusion of this study has an important theoretical value and reference value to guide the Chinese parents and Chinese adolescents to pay more attention to breakfast consumption and healthy lifestyles.

Mental Health of Chinese Online Networkers under COVID-19: A Sociological Analysis of Survey Data

This paper reports the results of a recent survey of Chinese WeChat networkers (n = 2015, August 2020) about China’s mental health conditions under COVID-19. The purpose of the survey was to measure symptoms of depression, anxiety, and somatization by using a standard 18-item battery and assess how the results were related to an individual’s socioeconomic status, lifestyle, and social capital under an ongoing pandemic. The survey reveals that the pandemic has had a significant impact, as the respondents had more serious mental symptoms when their residential communities exhibited a greater exposure to the spread of the virus. The socioeconomic status of the respondents was negatively associated with the mental symptoms. It modified the impact of COVID-19, and its effect was substantially mediated by measures of lifestyle and social capital.

Physical Activity Clusters and Income Inequality in Brazilian Adults

Background: Income is an important determinant of physical activity (PA) when analyzed in its different domains. Sociodemographic characteristics such as sex, age, education, and marital status reveal distinct population profiles when PA domains are analyzed in isolation. This study aimed to describe clusters of PA in domains within income inequalities and to investigate the associated sociodemographic characteristics of Brazilian adults. Methods: A secondary analysis of the National Health Survey was performed (N = 50,176). PA, sociodemographic characteristics, and family income were investigated. Low- (n = 9504) and high-income adults (n = 6330) were analyzed. Two-step cluster and Rao–Scott chi-square tests were employed. Results: High-income adults accumulated 1.06 times more PA in leisure time compared with low-income adults. Of the 3 clusters observed, the inactive cluster was more prevalent (low-income group: 65.9%; 95% confidence interval [CI], 64.1–67.5; high-income group: 84.5%; 95% CI, 82.9–86.0). Work/leisure activities (21.2%; 95% CI, 19.8–22.8) and commuting/household activities (12.9%; 95% CI, 11.8–14.1) characterized low-income adults. Work/household activities (10.9%; 95% CI, 9.6–12.3) and commuting/leisure activities (4.6%, 95% CI, 3.9–5.4) characterized high-income adults. Sex (P < .001), age (P < .001), and marital status (P = .0023) were associated with low-income clusters. Conclusion: PA clustering differs within income inequalities. PA in leisure differentiates the opportunities in low- and high-income groups, but it is representative of a very small portion of the wealth.

A latent class analysis of health lifestyles and health outcomes among Chinese older adults

Prior analyses have repeatedly documented the association between individual health behaviours and health outcomes. Nonetheless, few studies have taken a health lifestyle theory approach to examine how health lifestyle behaviours have shaped Chinese older adults’ health status. Using the most recent 2011–2012 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among Chinese older adults aged 65–105. Four distinct classes representing health lifestyles emerged. Furthermore, the research found the way in which the four classes representing older adults’ health lifestyles can be predicted by the respondent's demographic and socio-economic characteristics. In addition, health lifestyles were found to be strongly associated with Chinese older adults’ health outcomes which were measured by self-rated health, functional independence, cognitive function and chronic diseases, even after controlling for demographic features as well as individual and parental socio-economic disadvantage. Findings supported the cumulative disadvantage theory in health. The research highlighted the importance of promoting health lifestyles to improve older adults’ health outcomes.

Clustering of Physical Activity and Sedentary Behavior Associated to Risk for Metabolic Syndrome in Older Adults

This study aimed to investigate the clustering patterns of physical activity, sedentary time (ST), and breaks in ST, and the association between the identified clusters at risk for metabolic syndrome associated with obesity in older adults. Participants included 212 users of community health centers in Brazil. A questionnaire about sociodemographic characteristics was used to describe the sample, and physical activity, ST, and breaks in ST were evaluated using accelerometers. Waist circumference was measured as an indicator of the risk for metabolic syndrome. A two-step cluster analysis and logistic regression analysis were conducted. The following four clusters were identified: sitters (37.7%), inactive (28.3%), active (25.5%), and all-day sitters/lightly active (8.5%). Participants in the active cluster were 60% less likely to be at risk for metabolic syndrome. This study may contribute to a comprehensive understanding of which older adult groups need more attention in the context of community health centers.

A comparison of health expectancies over 10 years: implications for elderly service needs in Hong Kong

OBJECTIVES

We aimed to estimate health expectancies at age 65 based on physical and cognitive function in 2001-2002 and 2011-2012 and project future needs for carers from 2021 to 2041.

METHODS

Data from the Elderly Health Centres (EHCs) of the Department of Health of the Government of Hong Kong comprising of people aged 65 years or older who enrolled between 2001 and 2002 (EHC 2001-2002) and between 2011 and 2012 (EHC 2011-2012) provided proportion estimates for physical impairment (assessed by independence in activities of daily living) and cognitive impairment (assessed by Abbreviated Mental Test/Mini-Mental Status Examination and self-reported doctor diagnosis of dementia). Health expectancies (years lived with/without physical and/or cognitive impairment) were calculated by Sullivan's method. The proportions of physical and/or cognitive impairment were used to project future needs for carers.

RESULTS

Between 2001-2002 and 2011-2012, years lived without physical/cognitive impairment decreased for men but increased for women, both of which were less than the increases in total life expectancy. Men assessed in 2011-2012 (classified as EHC 2011-2012) lived more years with physical and/or cognitive impairment than those assessed in 2001-2002 (classified as EHC 2001-2002), and women in EHC 2011-2012 lived more years with physical impairment, but fewer years with cognitive impairment than those in EHC 2001-2002, and women enrolled in EHC 2011-2012 lived more years with physical impairment, but fewer years with cognitive impairment than those in EHC 2001-2002. As populations age, the number of carers needed is expected to increase from 344,000 in 2021 to 629,000 by 2041, or an increase of 82.9%. Sensitivity analyses excluding the participants who had been assessed in 2011-2012 from EHC 2001-2002 gave similar estimations.

CONCLUSIONS

Increased life expectancy was not accompanied by an increase in years lived without physical/cognitive impairment. These findings suggest that people will live longer but could be more dependent, which would have considerable implications for elderly service needs in Hong Kong.

Stress, anxiety and depression in clinical nurses in Vietnam: a cross-sectional survey and cluster analysis

Background

Hospital nurses are exposed to various work-related factors that may be associated with increased risk of developing different mental disorders. Empirical evidence on the prevalence and correlates of individual mental health problems such as stress, anxiety and depression is widely reported, while a combined pattern of these conditions is unknown. This study aims to examine the co-occurrence of stress, anxiety and depression among clinical nurses, and to explore socio-demographic characteristics of, and working conditions experienced by, nurses that may be associated with these three mental health conditions.

Methods

A cross-sectional study was implemented in one tertiary hospital in Hanoi city, Vietnam, from May to September 2015. A self-reported questionnaire including a short version of the Depression, Anxiety and Stress scale 21 items and questions on demographic and work-related characteristics was delivered to 787 registered nurses. 600 completed questionnaires was used in the final analysis (76.2% response rate). The two-step clustering analysis was performed to identify sub groups. Chi square test and post hoc ANOVA analysis with Bonferroni correction were used to examine differences in psychological status, demographic characteristics and working conditions among the clusters (two-tailed p < 0.05).

Results

The prevalence of self-reported stress, anxiety and depression were 18.5%, 39.8% and 13.2%, respectively. 45.3% participants reported symptoms of at least one mental disorder, 7.3% had all three. Nurses in the first cluster (high prevalence of mental disorders), had high task demand and conflict at work with low job control and reward. The second cluster nurses (moderate percentage of mental strain) were significantly older and in marital relationship, high task demand and job control, and presence of chronic diseases. The lowest proportion of self-perceived mental disorders were observed in the cluster three who were younger and had fewer years of services, moderate task demand and low job control and better physical health in comparison with those in the other two clusters (p < 0.05).

Conclusions

Stress, anxiety and depression were prevalent among clinical nurses. Heterogeneity in demographic characteristics and working conditions were observed across clusters with different patterns of mental disorders. Institutional effort should be emphasized to support nurses in their career development to reduce psychological strains.

Electronic supplementary material

The online version of this article (10.1186/s13033-018-0257-4) contains supplementary material, which is available to authorized users.

Lifetime socioeconomic status and early life microbial environments predict adult blood telomere length in the Philippines

OBJECTIVES

Psychosocial stress is postulated to hasten senescence in part by accelerating the shortening of telomere length (TL). One pathway through which this may happen is via increasing inflammation and innate immune system activation-a pathway which recent studies suggest acts more strongly for those who grew up in low microbial environments. Thus, we hypothesized that: (1) Psychosocial stress will be inversely associated with TL, (2) early life microbial environments will predict TL, and (3) microbial environments will moderate the association between psychosocial stress and TL.

METHODS

We utilized data from the Cebu Longitudinal Health and Nutrition Survey based in the Philippines (N = 1410). We determined early life microbial environments by season of birth and exposure to animal feces. Psychosocial stress measures included perceived stress in adulthood, lifetime socioeconomic status (SES), and parental instability in childhood. TL was measured in blood from young adults by qPCR.

RESULTS

Contrary to predictions, we found that higher SES was associated with shorter TL and no association of TL with the other stress variables. Individuals born in the higher microbial exposure season had shorter TL, but early life microbial environments did not moderate the association between psychosocial stress and TL.

CONCLUSIONS

The unexpected inverse association between SES and TL suggests that higher SES, while indexing lower psychosocial stress, may impact TL more strongly through nonstress factors in the Philippines, such as unhealthy behavior. The inverse association between microbial environments and TL is consistent with other evidence connecting early life infections to decreased life expectancies.