Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis

BACKGROUND

The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences.

OBJECTIVE

This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences.

METHODS

The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the "less unhealthy" group and the "more unhealthy" group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the "more unhealthy" group.

RESULTS

The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the "more unhealthy" group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the "more unhealthy" group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the "more unhealthy" group.

CONCLUSIONS

The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post-COVID-19 health and well-being.

Digital Healthy Diet Literacy and Fear of COVID-19 as Associated with Treatment Adherence and Its Subscales among Hemodialysis Patients: A Multi-Hospital Study

Treatment adherence (TA) is a critical issue and is under-investigated in hemodialysis patients. A multi-center study was conducted from July 2020 to March 2021 on 972 hemodialysis patients in eight hospitals in Vietnam to explore the factors associated with TA during the COVID-19 pandemic. Data were collected, including socio-demographics, an End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), 12-item short-form health literacy questionnaire (HLS-SF12), 4-item digital healthy diet literacy scale (DDL), 10-item hemodialysis dietary knowledge scale (HDK), 7-item fear of COVID-19 scale (FCoV-19S), and suspected COVID-19 symptoms (S-COVID19-S). Bivariate and multivariate linear regression models were used to explore the associations. Higher DDL scores were associated with higher TA scores (regression coefficient, B, 1.35; 95% confidence interval, 95%CI, 0.59, 2.12; p = 0.001). Higher FCoV-19S scores were associated with lower TA scores (B, -1.78; 95%CI, -3.33, -0.24; p = 0.023). In addition, patients aged 60-85 (B, 24.85; 95%CI, 6.61, 43.11; p = 0.008) with "very or fairly easy" medication payment ability (B, 27.92; 95%CI, 5.89, 44.95; p = 0.013) had higher TA scores. Patients who underwent hemodialysis for ≥5 years had a lower TA score than those who received <5 years of hemodialysis (B, -52.87; 95%CI, -70.46, -35.28; p < 0.001). These findings suggested that DDL and FCoV-19S, among other factors, should be considered in future interventions to improve TA in hemodialysis patients.

Keratinocytes: innate immune cells in atopic dermatitis

The skin is a unique immune organ that constitutes a complex network of physical, chemical and microbiological barriers against external insults. Keratinocytes are the most abundant cell type in the epidermis. These cells form the physical skin barrier and represent the first line of the host defense system by sensing pathogens via innate immune receptors, initiating anti-microbial responses and producing various cytokines, chemokines and anti-microbial peptides, which are important events in immunity. A damaged epidermal barrier in atopic dermatitis allows the penetration of potential allergens and pathogens to activate keratinocytes. Among the dysregulation of immune responses in atopic dermatitis, activated keratinocytes play a role in several biological processes that contribute to the pathogenesis of atopic dermatitis. In this review, we summarize the current understanding of the innate immune functions of keratinocytes in the pathogenesis of atopic dermatitis, with a special emphasis on skin-derived anti-microbial peptides and atopic dermatitis-related cytokines and chemokines in keratinocytes. An improved understanding of the innate immunity mediated by keratinocytes can provide helpful insight into the pathophysiological processes of atopic dermatitis and support new therapeutic efforts.

Whole sediment toxicity tests for metal risk assessments: on the importance of equilibration and test design to increase ecological relevance

Current laboratory-based approaches for predicting metal toxicity in sediments exhibit a number of limitations. The most important are (1) a lack of sufficient equilibration resulting in unrealistically low pH values or unnaturally high porewater metal concentrations and (2) an inadequate test design regarding the metal concentrations selected for spiking. The present study illustrates that by explicitly accounting for these limitations, one obtains reliable and environmentally realistic toxicity data, thus advancing the metal risk assessments of sediments. To this end, a toxicity test design with natural sediments was developed in which the administered metal concentrations were selected to comprise a range of the difference between the molar concentration of simultaneously extracted metals and acid volatile sulfides (SEM-AVS) closely surrounding zero. In addition, the test design presented includes a 35- or 40-d equilibration period with overlying water renewal during which conductivity, pH, and metal concentrations in the overlying water are monitored. This allows toxicity testing to start after equilibrium for these parameters has been reached. This test design was applied to Ephoron virgo (Olivier, 1791), Gammarus pulex (Linnaeus, 1758), and Lumbriculus variegatus (Mueller, 1774) exposed to Zn and Pb. These tests indicated that the general concept of absence of toxicity when SEM-AVS<0 could not be rejected. However, the onset of Zn toxicity occurred at lower concentrations than generally assumed.

Single versus combined exposure of Hyalella azteca to zinc contaminated sediment and food

The amphipod Hyalella azteca was exposed for 28 d to different combinations of Zn contaminated sediment and food. Sediment exposure (+clean food) resulted in increased Zn body burdens, increased mortality and decreased body mass when the molar concentrations of simultaneously extracted Zn were greater than the molar concentration of Acid Volatile Sulfide (SEM(Zn)-AVS>0), suggesting that dissolved Zn was a dominant route of exposure. No adverse effect was noted in the food exposure (+clean sediment), suggesting selective feeding or regulation. Combined exposure (sediment+food) significantly increased adverse effects in comparison with sediment exposure, indicating contribution of dietary Zn to toxicity and bioaccumulation. The observed enhanced toxicity also supports the assumption on the presence of an avoidance/selective feeding reaction of the amphipods in the single sediment or food exposures. During 14 d post-exposure in clean medium, the organisms from the same combined exposure history received two feeding regimes, i.e. clean food and Zn spiked food. Elevated Zn bioaccumulation and reduced reproduction were noted in amphipods that were offered Zn spiked food compared to the respective organisms that were fed clean food. This was explained by the failure of avoidance/selective feeding behavior in the absence of an alternative food source (sediment), forcing the amphipods to take up Zn while feeding. Increasing Zn body burdens rejected the assumption that Zn uptake from food was regulated by H. azteca. Our results show that the selective feeding behavior should be accounted for when assessing ecological effects of Zn or other contaminants, especially when contaminated food is a potential exposure route.

Field measurement of nickel sediment toxicity: role of acid volatile sulfide

A field experiment was performed in four freshwater systems to assess the effects of Ni on the benthic macroinvertebrate communities. Sediments were collected from the sites (in Belgium, Germany, and Italy), spiked with Ni, and returned to the respective field sites. The colonization process of the benthic communities was monitored during a nine-month period. Nickel effect on the benthos was also assessed in the context of equilibrium partitioning model based on acid volatile sulfides (AVS) and simultaneously extracted metals (SEM). Benthic communities were not affected at (SEM - AVS) ≤ 0.4 µmol/g, (SEM - AVS)/fraction of organic carbon (f(OC)) < 21 µmol/g organic carbon (OC). Sediments with (SEM - AVS) > 2 µmol/g, (SEM - AVS)/f(OC) > 700 µmol/g OC resulted in clear adverse effects. Uncertainty about the presence and absence of Ni toxicity occurred at (SEM - AVS) and (SEM - AVS)/f(OC) between 0.4 to 2 µmol/g and 21 to 700 µmol/g OC, respectively. The results of our study also indicate that when applying the SEM:AVS concept for predicting metal toxicity in the field study, stressors other than sediment characteristics (e.g., sorption capacity), such as environmental disturbances, should be considered, and the results should be carefully interpreted.

Chronic toxicity of copper to five benthic invertebrates in laboratory-formulated sediment: sensitivity comparison and preliminary risk assessment

Five benthic organisms commonly used for sediment toxicity testing were chronically (28 to 35 days) exposed to copper in standard laboratory-formulated sediment (following Organization for Economic Cooperation and Development guidelines) and lethal and sub-lethal toxicities were evaluated. Sub-lethal endpoints considered were reproduction and biomass production for Lumbriculus variegatus, growth and reproduction for Tubifex tubifex, growth and emergence for Chironomus riparius, and growth for Gammarus pulex and Hyalella azteca. Expressed on whole-sediment basis the observed lethal sensitivity ranking (from most to least sensitive) was: G. pulex>L. variegatus>H. azteca=C. riparius=T. tubifex, with median chronic lethal concentrations (LC50) between 151 and 327 mg/kg dry wt. The sub-lethal sensitivity ranking (from most to least sensitive, with the most sensitive endpoint between parentheses): C. riparius (emergence)>T. tubifex (reproduction)=L. variegatus (reproduction)>G. pulex (growth)>H. azteca (growth), with median effective concentrations (EC50) between 59.2 and 194 mg/kg dry wt. No observed effect concentrations (NOEC) or 10% effective concentrations (EC10) for the five benthic invertebrates were used to perform a preliminary risk assessment for copper in freshwater sediment by means of (a) the "assessment factor approach" or (b) the statistical extrapolation approach (species sensitivity distribution). Depending on the data (NOEC or EC10) and the methodology used, we calculated a Predicted No Effect Concentration (PNEC) for sediment between 3.3 and 47.1 mg Cu/dry wt. This range is similar to the range of natural (geochemical) background concentrations of copper in sediments in Europe, i.e. 90% of sediments have a concentration between 5 and 49 mg Cu/kg dry wt. A detailed analysis of the outcome of this preliminary exercise highlighted that multiple issues need to be explored for achieving a scientifically more sound risk assessment and for the development of robust sediment quality criteria for copper, including (i) the use of the assessment factor approach vs. the statistical extrapolation approach, (ii) the importance of bioavailability modifying factors (e.g., organic carbon, acid volatile sulfide), and (iii) the influence of prevailing geochemical (bioavailable) background concentrations on the copper sensitivity of local benthic biota.

Toxicological availability of nickel to the benthic oligochaete Lumbriculus variegatus

It is generally accepted that the bioavailability of metals in sediments is influenced by the presence of acid volatile sulfides (AVS). The pore water hypothesis predicts that, if the molar concentration of simultaneously extracted metals (SEM) in a sediment is smaller than the molar concentration of AVS, the free metal ion activity in the pore water is very small and that consequently no metal toxicity in short-term toxicity tests is observed. In this study we examined (1) if this concept can be extended to predict the absence of chronic Ni toxicity to the oligochaete deposit-feeding worm Lumbriculus variegatus and (2) if the organic carbon normalized excess SEM; i.e. [SEM-AVS]/f(OC) predicts the magnitude of Ni toxicity to L. variegatus. A 28-day toxicity experiment was performed in which biomass production of L. variegatus was determined in two natural sediments with different [AVS] and f(OC), spiked at different Ni concentrations. The absence of toxicity is predicted correctly by the [SEM-AVS]<0 criterion when only the 0-1 cm surface layer of the sediment is considered, but not when the whole bulk sediment is considered (0-3 cm). In both sediments, the same [SEM-AVS]/f(OC) at the surface corresponds with a similar decrease in L. variegatus biomass. Thus, [SEM-AVS]/f(OC) in the surface layer accurately predicts the magnitude of toxicity. This measure is therefore a good estimator of toxicologically available Ni. On the other hand, the free Ni(2+) ion activity in the overlying water appeared to be an equally good predictor of the magnitude of toxicity. Consequently, it was not possible to determine the relative importance of the overlying water and pore water exposure route with the semi-static laboratory experiments.

Characterizing sediment acid volatile sulfide concentrations in European streams

Sediment acid volatile sulfide (AVS) concentrations were measured in wadeable streams of a wide variety of ecoregions of western Europe (84 sites in 10 countries and nine ecoregions) to better understand spatial distribution and ecoregion relationships. Acid volatile sulfide has been shown to be a major factor controlling the bioavailability and toxicity of many common trace metals, such as Cd, Cu, Ni, Pb, and Zn. Sediment characteristics varied widely. The ratio of the sum of the simultaneously extracted metals (SEM) to AVS ranged from 0.03 to 486.59. The sigmaSEM-AVS ranged from -40.02 to 17.71 micromol/g. On a regional scale, sediment characteristics such as dominant parent soil material showed significant trends in AVS distribution and variation by ecoregion. Total Fe and Mn were correlated weakly with SEM concentrations. Three AVS model approaches (i.e., the SEM:AVS ratio, SEM-AVS difference, and carbon normalization) were compared at threshold exceedance levels of SEM/AVS > 9, SEM-AVS > 2, and SEM-AVS/foc > 150 micromol/g organic carbon (OC). Only 4.76% of the sediments exceeded all three AVS thresholds; 22.6% of the sediments exceeded two models; and 13% of the sediments exceeded one model only. Using the SEM:AVS, SEM-AVS, and fraction of organic carbon models, and including site-specific data and regional soil characteristics, ecoregions 1 (Portugal), 3 (Italy), 4 (Switzerland), and 9 (Belgium/Germany) had the highest potential metals toxicity; ecoregions 13 and 8 (Belgium/France) showed the lowest potential toxicity. However, because AVS can vary widely spatially and temporally, these data should not be considered as representative of the sampled ecoregions. The general relationship between AVS levels and sediment characteristics provides some predictive capability for wadeable streams in the European ecoregions.

Field validation of sediment zinc toxicity

A field study was conducted to validate concentrations of zinc in freshwater sediments that are tolerated by benthic macroinvertebrate communities and to determine whether a relationship exists with the acid volatile sulfide (AVS)-simultaneously extracted metal (SEM) model. In both the lake and riverine systems, one sediment type was high in AVS and one low in AVS, which resulted in zinc-spiked sediments that ranged from low to high SEM to AVS ratios. The colonization trays were sampled seasonally, ranging from 6 to 37 weeks of exposure, and were evaluated using several appropriate benthic indices. Results of the field evaluations at the four test sites confirmed the validity of the AVS-SEM model, predicting benthic macroinvertebrate effects correctly 92% of the time. In sediments where the SEM to AVS ratio or the AVS and organic (OC)-normalized fractions exceeded 8 and 583 micromol/g of OC, toxicity was observed from the zinc-spiked sediments. Conversely, when the SEM to AVS ratio or OC-normalized AVS fractions were less than 2 or 100 micromol/g of OC, no toxicity was observed. In the range of 148 to 154 micromol/g of OC, toxicity varied in two treatments. Total zinc concentrations in sediments showed no relationship to benthic effects. The most impaired benthic community occurred in the high-gradient stream sediments, which had low OC and AVS concentrations and SEM to AVS ratios of 33 and 44 in the spiked sediments. Five to six benthic metrics were depressed at SEM to AVS ratios of 8.32 and 9.73. The no-observed-effect level appeared to be near a SEM to AVS ratio of 2, with slight to no effects between ratios of 2.34 and 2.94. No sites with ratios of less than 2 showed any adverse effects.

Embryo-larval toxicity tests with the African catfish (Clarias gariepinus): comparative sensitivity of endpoints

Embryo-larval toxicity tests with the African catfish (Clarias gariepinus) were performed to assess the comparative sensitivity of different endpoints. Measured test responses included embryo and larval survival, hatching, morphological development, and larval growth. Chromium, cadmium, copper, sodium pentachlorphenol (NaPCP), and malathion were used as model toxicants. Hatching was not affected by any of the chemicals tested, and embryo survival was only affected by chromium at > or = 36 mg/L. The growth of larvae was significantly reduced at > or = 11 mg/L Cr, > or = 0.63 mg/L Cu, > or = 0.03 mg/L NaPCP, and > or = 1.25 mg/L malathion. Morphological development of C. gariepinus was affected by all of the toxicants tested. Different types of morphological aberrations were observed, i.e., reduction of pigmentation in fish exposed to cadmium and copper, yolk sac edema in fish exposed to NaPCP and malathion, and deformation of the notochord in fish exposed to chromium and malathion. The sensitivity of the endpoints measured can be summarized as follows: growth > abnormality > larval survival > embryo survival > hatching.