Association of METS-IR index with depressive symptoms in US adults: A cross-sectional study

BACKGROUND

An association between insulin resistance (IR) and depression has been identified in recent years. The purpose of this study was to examine the relationship between IR and depression in the general population.

METHODS

The population for this cross-sectional study consisted of adults participating in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Insulin sensitivity was assessed using the Metabolic Score for IR (METS-IR) index, while depression was evaluated using the Patient Health Questionnaire (PHQ)-9. Logistic regression analyses, subgroup analyses, and dose-response curves were conducted to assess the association between the METS-IR index and depression.

RESULTS

A total of 13,157 adults aged over 20 years were included in this study. After adjusting for potential confounders, it was observed that each unit increase in the METS-IR index was associated with a 1.1 percentage point increase in the prevalence of depression (OR = 1.011; 95 % CI: 1.008, 1.014). Patients in the 4th quartile of the METS-IR index had a higher likelihood of depression compared to those in the 1st quartile (OR = 1.386, 95 % CI: 1.239, 1.549). Stratified analyses demonstrated consistent results in all subgroups, except for men, patients under 40 years of age, and those with a history of cancer. Dose-response curves indicated a nonlinear relationship between the METS-IR index and the risk of depression, with an inflection point value of 32.443 according to threshold effect analysis.

CONCLUSIONS

Our findings suggest that higher METS-IR scores are associated with an increased likelihood of experiencing depressive symptoms among U.S. adults.

Relationship between anemia and its correlates and cognitive function in Chinese patients with chronic schizophrenia: A large cross-sectional study

Background

Although both anemia and schizophrenia (SCZ) can cause cognitive decline, it is unclear whether anemia worsens cognitive decline in patients with SCZ. The primary objective of this study was to investigate the prevalence of anemia and the relationship between anemia, SCZ symptom severity, and cognitive function in patients with SCZ.

Methods

We obtained demographic and clinical data from 1690 inpatients with SCZ. All psychiatric symptoms and cognitive functioning were assessed by the Positive and Negative Syndrome Scale (PANSS), the Mini-Mental State Examination (MMSE), and the Repeated Battery for the Assessment of Neuropsychological Status (RBANS). Hemoglobin (HGB) values as well as red blood cell (RBC) counts were collected by routine blood tests.

Results

The proportion of anemia in patients with SCZ was 26.36 % (383/1453). Compared to SCZ patients without anemia, SCZ patients with anemia were older, had a lower bodyweight, a smaller waist circumference and lower apolipoprotein B levels, but longer QT intervals. Further logistic regression analysis revealed that anemia was associated with age, gender, and weight. In addition, there was no difference in cognitive function between SCZ patients with and without anemia.

Conclusion

Our findings suggest a high proportion of anemia in patients with chronic SCZ in the Han Chinese population. Several demographic and clinical variables are associated with anemia in SCZ patients.

The association of sleep duration and leukocyte telomere length in middle-aged and young-old adults: A cross-sectional study of UK Biobank

BACKGROUND

The relationships between sleep duration and aging-associated diseases are intricate. Leukocyte telomere length (LTL) is a biomarker of aging, while the association of sleep duration and LTL is unclear.

METHODS

The 310,091 study participants from UK Biobank were enrolled in this cross-sectional study. Restricted cubic splines (RCS) analysis was firstly performed to assess the nonlinear relationship between sleep duration and LTL. Sleep duration was then categorized into three groups: <7 h (short sleep duration), 7-8 h (reference group), and >8 h (long sleep duration) and multiple linear regression was applied to analyze the association of short sleep and long sleep duration with LTL. We further performed subgroup analyses stratified by sex, age, chronotype and snoring.

RESULTS

RCS showed an inverted J-shaped relationship between sleep duration and LTL. Compared with the reference group, the inverse association of long sleep duration and LTL was statistically significant in fully-adjusted model (P = 0.001). Subgroup analyses showed that this association was more apparent in people over 50 years (51-60 y: P = 0.002; >60 y: P = 0.005), in men (P = 0.022), and in people preferred evening chronotype (P = 0.001).

CONCLUSION

Compared with participants sleeping 7-8 h, those sleep longer than 8 h had shorter LTL in middle-aged and young-old adults. The negative association between long sleep duration and LTL was more apparent in older people, in men, and in people preferred evening chronotype.

Dietary antioxidant intake is associated with heart failure: Results from the NHANES 2003-2019

BACKGROUND

Growing evidence has shown that antioxidant diets protect against heart failure (HF). However, the association between the composite dietary antioxidant index (CDAI), an important measure of overall antioxidants in the diet, and HF has received little attention.

OBJECTIVE

The purpose of this study was to examine the relationship between the CDAI and HF.

METHODS

A secondary cross-sectional analysis of the 2003 to 2019 National Health and Nutrition Examination Survey (NHANES) was performed. Weighted multivariable logistic regression was used to test the association between the CDAI and HF in four different models, with subgroup analysis and an interaction test subsequently performed.

RESULTS

A total of 37,390 participants were included. The HF groups had lower CDAI levels than those in the non-HF group (0.29 ± 0.04 vs. -0.74 ± 0.16, p < 0.0001). After adjusting for demographic characteristics, lifestyle factors, and disease history, a negative association was found between the CDAI and HF (OR: 0.97, 95 % CI: 0.94, 1.00). There was an inverse trend whereby increasing the CDAI was associated with decreasing the odds of HF (p for trend < 0.001). The subgroup analysis and interaction test showed no significant dependence on demographic characteristics, lifestyle factors, and disease history with regard to this association (all p for interaction > 0.05).

CONCLUSION

The CDAI was inversely associated with HF in US adults, with higher CDAI levels possibly being associated with a lower incidence of HF, suggesting that dietary antioxidants may help prevent HF.

Arsenic exposure and pulmonary function decline: Potential mediating role of TRAIL in chronic obstructive pulmonary disease patients

BACKGROUND

Environmental arsenic (As) exposure is strongly related to the progression of chronic obstructive pulmonary disease (COPD). Pulmonary epithelial cells apoptosis is implicated in the pathophysiological mechanisms of COPD. However, the role of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), one biomarker of apoptosis, remains unclear in As-mediated pulmonary function alternations in COPD patients.

METHODS

This study included 239 COPD patients. The serum level of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) was measured by enzyme-linked immunosorbent assay (ELISA). The blood As level was determined through inductively coupled plasma mass spectrometry (ICP-MS).

RESULTS

Blood As levels exhibited a negative and dose-dependent correlation with pulmonary function. Per unit elevation of blood arsenic concentrations was related to reductions of 0.339 L in FEV1, 0.311 L in FVC, 1.171% in FEV1/FVC%, and 7.999% in FEV1% in COPD subjects. Additionally, a positive dose-response correlation of blood As with serum TRAIL was found in COPD subjects. Additionally, the level of serum TRAIL was negatively linked to lung function. Elevated TRAIL significantly mediated As-induced decreases of 11.05%, 13.35%, and 31.78% in FVC, FEV1, and FEV1%, respectively among the COPD patients.

CONCLUSION

Blood As level is positively correlated with pulmonary function decline and serum TRAIL increase in individuals with COPD. Our findings suggest that elevated TRAIL levels may serve as a mediating mechanism through which As contributes to declining lung function in COPD patients.

Association between thiamine intake and depression: A national cross-sectional study

BACKGROUND

Recent years have seen increasing attention to improving depressive symptoms through dietary intakes, yet the association between thiamine intake and depression remains unclear. The present study aimed to explore this association using data from an American cross-sectional study.

METHODS

We explored the association of covariates, exposure, and outcome with logistic regression equations. Multivariable regression models were performed to further exclude confounding factors. To investigate nonlinear relationships, we employed restricted cubic splines. Recursive algorithms were utilized to identify inflection points. Additionally, we conducted stratified analyses by age and sex to uncover differences among subgroups.

RESULTS

When all covariates were adjusted, the association between thiamine intake and depression was not statistically significant [0.93 (0.82, 1.07)]. In the linear trend test using Q1 as the reference, the ORs (95%CI) for Q2, Q3, and Q4 were 0.87 (0.73, 1.04), 0.83 (0.68, 1.00), and 0.92 (0.73, 1.16), which suggested that the association might be nonlinear. We then confirmed this nonlinear relationship with a restricted cubic spline, and the inflection point of 1.35 mg/day was calculated. Before the inflection point, the effect value of the relationship was 0.68 (0.53, 0.89). After the inflection point, no significant association was found [1.10 (0.92, 1.31)]. Stratified analyses revealed that this nonlinear relationship was consistent among women and individuals aged <60 years.

DISCUSSION

In this cross-sectional study among American general adults, we found a nonlinear association between thiamine intake and depression and further observed differences by age and sex.

Short or long sleep duration was associated with chronic kidney disease in a Chinese nationwide cohort study

OBJECTIVE

Sleep duration is an important factor influencing health outcomes. The association between sleep duration and kidney function remains elusive. This study aimed to explore the association between sleep duration and chronic kidney disease (CKD) amongst Chinese adults.

METHODS

We conducted a cross-sectional study based on the China Health and Nutrition Survey (CHNS) in the wave of 2009. Participants were divided into three groups: ≤ 6 h/day (short sleepers), 7-8 h/day (regular sleepers) and ≥ 9 h/day (long sleepers) according to self-reported sleep duration. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2.

RESULTS

A total of 8096 Chinese adults (45.9% men) with a mean age of 50.6 years were included in the study. Compared with regular sleepers, both short and long regular sleepers had a higher prevalence of CKD. A U-shaped relationship between sleep duration and CKD was displayed by restricted cubic spline curve (P-overall < 0.001, P-nonlinear < 0.001). Multivariate logistic regression models revealed that both short and long sleep duration were clinically associated with higher odds of CKD, after adjustments for covariates [adjusted odds ratio (OR) 1.25 and 1.30; 95% confidence interval (CI) 1.00-1.56 and 1.08-1.54, for short and long sleep duration, respectively]. In subgroup analyses, we found the association was still observed in participants without hypertension or diabetes mellitus.

CONCLUSION

Short or long sleep duration was associated with CKD in the general population.

Current situation and barriers to women's leadership in health care education in Saudi Arabia: A cross-sectional study

Background

The aims of the current study were to explore the true representation of female academic staff who have advanced to leadership positions in Saudi health academic institutions and to determine the possible barriers to women's advancement to leadership positions in academia.

Methodology

This was a cross-sectional study conducted between August 2022 and August 2023 using an adapted self-reported online questionnaire via Google form. Data was analyzed descriptively and comparatively by presenting frequencies with percentages besides means with standard deviations across various background categories and comparing them using student t test.

Results

A total of 115 educators in health care professions participated in the study, three fifths of them were Saudi and female, with the majority being married and employed by government organizations. The most impactful structural challenges for female leadership included the centralization of decision-making within the institution, unclear organizational bylaws for leadership qualifications and appointment processes, and the existence of a wide range of administrative units. The prevailing belief that men possess superior capacity and management skills compared to women in leadership roles and the reluctance to accept women's authority by their subordinates were identified as the most influential culture challenges for female leadership. Most influential personality-related challenges included difficulty of balancing professional responsibilities with family obligations, stress and tension arising from reconciling the needs of subordinates with organizational goals and the complexity of traveling for work.

Conclusions

The study identified the most influential structural, culture, and personality-related barriers and other potential perceived challenges faced by female leadership. A collective effort involving academic institutions, leadership, and relevant stakeholders is critical to address these barriers. Academic institutions must eliminate these challenges to utilize female leaders' talent fully, as they contribute unique perspectives and skills to their institutions.

Factors associated with voluntary HIV counseling and testing among young students engaging in casual sexual activity: a cross-sectional study from Eastern China

OBJECTIVES

To investigate the factors associated with voluntary HIV counseling and testing (VCT) among young students engaging in casual sexual activity and to establish a scientific rationale for developing targeted intervention strategies for preventing HIV/AIDS in this population.

METHODS

Stratified cluster sampling was used to conduct a survey using questionnaires to collect demographic and behavioral information for statistical analysis.

RESULTS

Data from 611 young students, who reported engaging in casual sexual activity, were included in the statistical analysis. Among these, 68 (11.13%) students underwent the VCT. Among young students who engaged in casual sexual activity, those who were non-Zhejiang residents (adjusted odds ratio [aOR]: 2.11; 95% Confidence Interval [CI]: 1.17-3.80), those who had received AIDS-themed lectures or health education courses from the school in the past year (aOR = 3.96, 95% CI = 1.49-10.50), those who had received HIV risk self-assessment conducted by the school in the past year (aOR = 2.31, 95% CI = 1.17-4.59), and those who had engaged in commercial sex activity in the past year (aOR = 1.98, 95% CI = 1.07-3.66) were more inclined to have undergone VCT. Male students (aOR = 0.37, 95% CI = 0.18-0.77) and those who used condoms consistently during casual sexual activity (aOR = 0.45, 95% CI = 0.21-0.97) were less likely to undergo VCT.

CONCLUSION

Casual sexual activity was relatively prevalent among young students, posing a potential risk for HIV transmission. These findings will be instrumental in the development more effective HIV prevention and control strategies for young students. Additionally, it highlights the necessity of promoting and popularizing VCT among young students without Zhejiang province residency, who are involved in commercial sexual activity, and/or those who lacking HIV education. Moreover, additional research and implementation of refined HIV behavioral interventions specifically tailored to young students are necessary to enhance their awareness and knowledge of HIV prevention.

Coma Prevalence in Critical Care Units in Chile: Results of a Cross-Sectional Survey on World Coma Day

BACKGROUND

The purpose of this study was to assess the prevalence of coma among patients in critical care units in Chile. We also aimed to provide insight into the demographic characteristics, etiologies, and complications associated with coma.

METHODS

A single day cross-sectional study was conducted through a national survey of public and private hospitals with critical and intensive cardiac care units across Chile. Data were collected using an online questionnaire that contained questions regarding critically ill patients' information, demographic characteristics, etiology and duration of coma, medical complications, and support requirements.

RESULTS

A total of 84% of all health facilities answered, accounting for a total of 2,708 patients. The overall coma prevalence was 2.9%. The median age of the comatose patients was 61 years (interquartile range 50-72) and 66.2% were male. The median coma duration was five days (interquartile range 2-9). Cerebral hemorrhage was the most common etiology, followed by severe hypoxic-ischemic encephalopathy, acute ischemic stroke, and traumatic brain injury. A total of 48.1% of coma patients experienced acute and ongoing treatment complications, with pneumonia being the most common complication, and 97.4% required support during comatose management.

CONCLUSIONS

This study provides an overview of the prevalence of coma in Chilean critical and cardiac care units. Coma is a common condition. Comatose patients frequently experience medical complications during their hospitalization.

Association between body roundness index and prevalence of kidney stone in the U.S: a study based on the NHANES database

OBJECTIVE

This study aimed to evaluate the potential association between the body roundness index (BRI) and kidney stone prevalence in adults in the United States.

METHODS

A cohort of participants from the National Health and Nutrition Examination Survey (NHANES) database spanning 2007-2018 were gathered for analysis. Logistic regression analyses, subgroup assessments, and calculations were employed to examine the potential link between BRI and kidney stone prevalence.

RESULTS

The study included 30,990 participants aged > 20 years, of which 2,891 declared a kidney stone history. After modulating all relevant confounding factors, each unit increase in the BRI was linked to a 65% increase in kidney stone prevalence (OR = 1.65, 95% CI: 1.47, 1.85). Sensitivity analyses conducted by categorizing the BRI into three groups revealed a 59% increase in kidney stone prevalence in the highest tertile BRI group compared to the lowest one (OR = 1.59, 95% CI: 1.42, 1.79). Furthermore, dose-response curves depicted a positive near-linear correlation between the BRI and the risk of kidney stone prevalence.

CONCLUSION

These findings suggest a clinically noteworthy positive correlation between higher BRI values and kidney stone prevalence among the studied US adult population. However, it is essential to acknowledge that the observed relationship does not establish a causal link.

Knowledge, attitude, and practice towards enhanced recovery after surgery among colorectal cancer patients

To explore the knowledge, attitude, and practice (KAP) towards enhanced recovery after surgery (ERAS) among colorectal cancer (CRC) patients. This cross-sectional study included CRC patients who underwent selective operation at the author's Hospital, between April 2021 and April 2023. Their demographic characteristics and KAP towards ERAS were collected using a self-designed questionnaire. A total of 652 valid questionnaires were collected, with knowledge, attitude, and practice scores of 37.29 ± 11.35 (possible range: 11-55), 39.51 ± 6.40 (possible range: 11-55), and 6.53 ± 2.21 (possible range: 0-8), respectively. A positive correlation was found between knowledge and attitude (r = 0.291, P < 0.001), knowledge and practice (r = 0.292, P < 0.001), and attitude and practice (r = 0.363, P < 0.001). Structural equation model (SEM) analysis showed that knowledge had a significant direct effect on attitude (β = 0.164, P < 0.001) and attitude had direct effect on practice (β = 0.099, P < 0.001), indicating an indirect effect of knowledge on practice. Attitude also had a direct effect on practice (β = 0.038, P < 0.001). CRC patients showed moderate knowledge and attitude, and proactive practice towards ERAS. Further improvement of knowledge may improve their attitude and practice, leading to better outcomes and quality of care among CRC patients.

Mental health difficulties and related factors in Chinese children and adolescents during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

To examine the mental health status and related factors in children and adolescents, and to assess age groups and sexes differences in factors influencing mental health.

METHODS

This cross-sectional study was performed on Chinese children aged 6-18 years from November 2021 to January 2022. Mental health difficulties were accessed by the Strengths and Difficulties Questionnaire. Multivariate logistic regression was used to analyze factors associated with mental health status. Multiple linear regression was used to evaluate factors associated with the scores of the Strengths and Difficulties Questionnaire.

RESULTS

The prevalence of mental health difficulties was 12.98% (n =1348). Age (OR, 0.909, [95%CI, 0.830-0.996]), sex (OR, 1.424, [95%CI, 1.033-1.963]) and screen time on weekdays ("≥2" h/d vs "< 1" h/d: OR, 2.001, [95%CI, 1.300-3.080]) were related factors for mental health difficulties. For children (year ≤ 12), the strongest related factor for mental health difficulties was screen time on weekdays ("≥ 2" h/d vs "< 1" h/d: OR, 1.821 [95%CI, 1.203-2.755]). The risk of mental health difficulties in females with ≥ 2 h/d screen time on weekends was 3.420 times higher than those with < 1 h/d (OR, 3.420, [95%CI, 1.923-6.081]).

CONCLUSION

The prevalence of mental health difficulties among children and adolescents was relatively high. The lower age, female sex and excessive screen time were associated with a higher risk of mental health difficulties. The factors influencing mental health varied by different age groups and sexes. Thus, specific measures for different age groups and sexes should be adopted to mitigate the impact.

Association between Sense of Coherence and Caries Activity and Caries Experience among Male Adolescents from Southern Brazil: A Cross-Sectional Study

INTRODUCTION

This cross-sectional study assessed the association between sense of coherence (SoC) and caries activity (number of active caries lesions) and caries experience (DMFT index) among 18-19-year-old male adolescents who joined the Brazilian Army as draftees for mandatory military service (n = 507).

METHODS

Data collection included a questionnaire (level of education, family income, and tooth brushing frequency), the Brazilian short version of the SoC scale (SOC-13), and clinical caries examination (noncavitated/cavitated, inactive/active). The main predictor variable was SoC, categorized as low, moderate, or high. Poisson regression models were used for statistical analysis.

RESULTS

A high SoC was significantly associated with a lower number of active lesions (adjusted rate ratio = 0.85; 95% CI = 0.74-0.98). No association between SoC and DMFT was detected.

CONCLUSION

A high SoC was found to be a protective factor to caries activity in this population.

Problematic usage of the internet among Hungarian elementary school children: a cross-sectional study

INTRODUCTION

Problematic usage of the internet (PUI) is perhaps one of the most frequently studied phenomena of the 21st century receiving increasing attention in both scientific literature and the media. Despite intensive research there have been relatively few meaningful studies among elementary school students in Hungary and worldwide, who may be considered as a high-risk population with regard to problematic internet use. The aim of our study was to carry out a complex research focusing on the prevalence and risk factors of PUI among elementary school children aged 10-15 years (Grade 5-8).

METHODS

Demographics included were gender, age, place of stay, type of residence, family type, parental education, start of internet use, used devices, daily internet use, purpose of internet use, internet accounts, ways of keeping in touch with friends and sporting activities. PUI was evaluated using the paper-based version of the Potentially Problematic Use of the Internet Questionnaire.

RESULTS

Overall, 2000 paper-based questionnaires were successfully delivered and the final analysis included 1168 responses (overall response rate 58.4%). Mean age was 12.55 ± 1.24 years. Female gender (OR = 2.760, p = 0,006, CI 95% 0.065 to 0.384), younger age (11-12 years) (OR = 3.812, p < 0.001, 95% CI: 1.747-4.731), early exposure to the internet (OR = 3.466, p = 0.001, 95% CI 1.535-5.446), living in a small village (OR = 1.081, p = 0.002, 95% CI 1.041-1.186) urgency to answer online (OR = 4.677, p < 0.001, 95% CI: 2.714-6.639), decreased frequency of personal contact with friends (OR = 2.897, p = 0.004, 95% CI: 1.037-1.681), spending more than 6 h online (OR = 12.913, p < 0.001, 95% CI: 10.798-14.892), morning and nighttime internet use (OR = 3.846, p < 0.001, CI 95% 1.886-5.810) and never doing any sports (OR = 2.016, p = 0.044, 95% CI: 1.050-3.354) were independently associated with problematic internet use.

CONCLUSIONS

Based on the results of our questionnaire survey more than 10% seemed to be problematic users in our study population, which is a relatively high rate. Early exposure to the internet as well as younger age were strongly related to this phenomenon. Duration of being online as well as daily time interval of internet use are important predisposing factors. Scarcely studied social factors such as being online at the expense of personal relationships and the lack of physical activity should be payed more attention to prevent the development of PUI.

Mean platelet volume is associated with periodontitis: a cross-sectional study

BACKGROUND

It is uncertain if mean platelet volume and periodontitis are related. The objective of this study was to examine the association between levels of mean platelet volume and moderate/severe periodontitis in adult persons who inhabit the U.S.

METHODS

We screened 6,809 people from the National Health and Nutrition Examination Survey (NHANES 2009-2012). Mean platelet volume was measured in the Mobile Examination Centers (MECs) using the Beckman Coulter analyzer. The category of periodontitis was defined by the CDC/AAP using clinical periodontal parameters. Multiple logistic regression models were employed to examine the distribution for covariate differences across the various independent groups. Four models were employed to examine the relationship between mean platelet volume level and periodontitis. Smoothed curve fitting was utilized to confirm the linearity of the relationships. To determine the impact of factors on the connection between MPV and periodontitis, subgroup analysis and interaction testing were utilized.

RESULTS

Results from the multiple logistic regression analysis indicate a significant association between moderate/severe periodontitis and the mean platelet level, even after considering any potential confounding variables (OR = 1.090, 95% CI: 1.019-1.166, P-value = 0.01211). Additionally, those in the upper tertile of mean platelet volume levels had a 21.6% higher probability of developing periodontitis when compared with those in the least tertile of mean platelet levels (OR = 1.216, 95% CI:1.052-1.406, P-value = 0.00816). Moreover, it showed a positive correlation between mean platelet volume (MPV) and moderate/severe periodontitis. Subgroup analyses indicated a positive association between the level of mean platelet volume and moderate/severe periodontitis among individuals who were under 60 years of age, had low income, were obese, never smoked, were heavy drinkers, had hypertension, and had no cardiovascular disease (p < 0.05). However, none of the subgroups exhibited significant interactions (p for interaction > 0.05).

CONCLUSION

A correlation has been found between mean platelet volume levels and periodontal disease in individuals residing in the United States.

The association of long working hours and short sleep duration on mental health among Japanese physicians

This cross-sectional study investigate the association between long working hours, short sleep duration, and mental health among Japanese physicians. We enrolled 232 Japanese physicians. We used the Brief Job Stress Questionnaire to assess high-stress status, and the Japanese version of the Center for Epidemiologic Studies Depression scale to assess depressive status. Daily sleep duration (DSD) and weekly working hours (WWHs) were collected using a self-administered questionnaire. Multivariable-adjusted logistic regression analysis was performed to examine the association of the combined categories of DSD and WWHs with high-stress and depressive status. Compared to physicians with WWHs <80 h and DSD ≥6 h, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of high-stress status for those with WWHs ≥80 and DSD ≥6, WWHs <80 and DSD <6, and WWHs ≥80 and DSD <6 were 2.76 (0.97-7.87), 3.36 (1.53-7.40), and 3.92 (1.52-10.14), respectively. The respective ORs (CIs) of depressive status were 1.82 (0.42-7.81), 4.03 (1.41-11.53), and 4.69 (1.33-16.62). The results showed that regardless of working long hours or not, physicians with DSD <6 h had significantly higher stress and depressive status, suggesting that not only regulating long working hours but also ensuring adequate sleep duration is important for preventing physicians' mental health.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and kidney stones: a cross-sectional study

BACKGROUND

The relationship between the NHHR and kidney stone risk remains unknown. The purpose of this study was to evaluate the association between adult NHHR and kidney stone occurrence in USA.

METHODS

This study used a variety of statistical techniques such as threshold effects, subgroup analysis, smooth curve fitting, multivariate logistic regression, and data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014. We aimed to clarify the relationship between the NHHR and kidney stone risk.

RESULTS

The average age of the 21,058 individuals in this research was 49.70 ± 17.64 years. The mean NHHR was 3.00 ± 1.47, and the overall prevalence of kidney stone occurrence was 9.05%. The prevalence within the quartile ranges (Q1-Q4) was 7.01%, 8.71%, 9.98%, and 10.49%, respectively. The overall average recurrence rate of kidney stones was 3.05%, demonstrating a significant increase with increasing NHHR (Q1: 1.92%, Q2: 2.92%, Q3: 3.35%, Q4: 4.00%, P < 0.01). The occurrence of kidney stones increased by 4% (95% CI: 1.00-1.08, P = 0.0373) and the chance of recurrence increased by 9% (95% CI: 1.03-1.14, P < 0.01) with each unit increase in NHHR. The interaction analysis results demonstrated that the relationship between the NHHR and the risk of kidney stones was not significantly impacted by the following factors: sex, body mass index, poverty income ratio, diabetes, or hypertension. Curve fitting and threshold effect analysis also demonstrated a non-linear association, with a breakpoint found at 3.17, between the NHHR and the risk of kidney stones.

CONCLUSIONS

In adults in the USA, there is a substantial correlation between elevated NHHR levels and a higher probability of kidney stones developing and recurring. Timely intervention and management of NHHR may effectively mitigate the occurrence and recurrence of kidney stones.

Association of dietary intake of B vitamins with glaucoma

This cross-sectional study investigated the association between glaucoma and B vitamin dietary intake. A total of 5025 enrolled individuals participated in self-reported glaucoma questionnaire and 3264 participated in International Society Geographical and Epidemiological Ophthalmology (ISGEO) criteria. In self-reported glaucoma, the risk of having self-reported glaucoma was lower in the third quartile of vitamin B1 intake (odds ratio [odds ratio [OR] 0.63, 95% confidence interval [CI] 0.40-0.97), and P trend (P trend = 0.004) for vitamin B12 was significant; in males, the third quartile of vitamin B1 intake (OR 0.44, 95% CI 0.24-0.83) and the fourth quartile of vitamin B2 intake (OR 0.39, 95% CI 0.17-0.89) were associated with a lower risk. In glaucoma based on ISGEO criteria, the increase of niacin intake (OR 0.94, 95% CI 0.89-0.99) was negatively associated with the odds of self-reported glaucoma. After sex-stratified analysis, the third quartile of vitamin B6 intake (OR 0.21, 95% CI 0.08-0.60) in males were associated with reduced odds of glaucoma. The restricted cubic spline analysis revealed a nonlinear association of vitamin B2 (p for nonlinearity = 0.04) and B9 (p for nonlinearity = 0.024) intake with glaucoma diagnosed by ISGEO criteria in females.

Association between weekend catch-up sleep and depression of the United States population from 2017 to 2018: A cross-sectional study

Insufficient sleep on weekdays has become a societal norm, and studies have shown that sleep deprivation increases the risk of depression. Although individuals often resort to weekend catch-up sleep (CUS) as a compensatory measure, the present evidence supporting its efficacy in mitigating the risk of depression is limited. This article attempts to explore the relationship between CUS and depression. In this study, a total of 5510 participants were included, characterized into two groups: nondepressed (n = 5051) and depressed (n = 459), with data extracted from the National Health and Nutrition Examination Survey (NHANES). Compared with people without CUS, those practicing CUS exhibited a significantly lower risk of depression (OR = 0.81, P = 0.048). In subgroup analysis, this reduction effect was only observed in males (OR = 0.70, 95 % CI 0.05 to 0.99, P = 0.04), middle-aged (>40, ≤60) (OR: 0.57, 95 % CI: 0.40 to 0.81, P = 0.002), married or living with parents (OR: 0.61, 95 % CI: 0.44 to 0.86, P = 0.004), groups with three or more family members (OR: 0.69, 95 % CI: 0.52 to 0.93, P = 0.01), and individuals without alcohol intake (OR: 0.24,95 % CI: 0.09 to 0.67, P = 0.006). Therefore, in the realm of depression treatment, doctors may consider advising patients to get adequate sleep on weekends as part of their overall treatment plan. At the same time, individuals can also choose weekend sleep as a proactive strategy for regulating their psychological status.

Associations between per- and polyfluoroalkyl substances exposure and thyroid hormone levels in the elderly

This study aimed to measure the exposure of the elderly to per- and polyfluoroalkyl substances (PFAS) and explore their effects on thyroid hormone levels. A cross-sectional study of plasma samples from 746 elderly people (aged >60 years) from Taiyuan, China was conducted. Fourteen PFASs were determined using liquid chromatography-tandem mass spectrometry and five thyroid function indicators, thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free T4 (FT4), and free T3 (FT3), using an enzyme-linked immunoassay. Descriptive analysis was used to investigate PFC exposure and the toxic equivalent quantity (TEQ) was used to calculate the transthyretin (TTR)-disrupting toxicity of combined exposure to PFAS. Linear additive and multiple linear regression models were used to explore the relationship between PFAS and hormones, using PFC concentration as quartiles and continuous variables. Among the PFAS identified, 12 PFASs had detection rates >80 %, with perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) having the highest concentrations. Perfluorodecanoic acid (PFDA), PFOS, and perfluorononanoic acid (PFNA) were negatively correlated with TSH levels and each interquartile range (IQR) concentration increase caused a reduction in TSH levels by 2.14 %, 1.78 %, and 3.04 %, respectively. Perfluorotridecanoic acid (PFTrA) and perfluoropentanoic acid (PFPA) were positively correlated with T4 and T3 levels, respectively, and levels increased by 4.52 % (T4) and 1.14 % (T3) with IQR concentration increase. Perfluorobutanoic acid (PFBA) was negatively correlated with FT4 levels, which decreased by 1.89 % with IQR concentration increase. A negative correlation was found between the combined exposure indices of TEQ and TSH levels; IQR increase in TEQ decreased the TSH concentration by 1.91 %. In conclusion, exposure to PFAS was common in the elderly population and was associated with decreased TSH and FT4 levels and increased T4 and T3 levels. These results indicated that PFASs may cause thyroid-disrupting effects in the elderly population.

Association of healthy lifestyle score with control of hypertension among treated and untreated hypertensive patients: a large cross-sectional study

Background

Hypertension stands as the leading single contributor to the worldwide burden of mortality and disability. Limited evidence exists regarding the association between the combined healthy lifestyle score (HLS) and hypertension control in both treated and untreated hypertensive individuals. Therefore, we aimed to investigate the association between HLS and hypertension control among adults with treated and untreated hypertension.

Methods

This cross-sectional study, including 311,994 hypertension patients, was conducted in Guangzhou using data from the National Basic Public Health Services Projects in China. The HLS was defined based on five low-risk lifestyle factors: healthy dietary habits, active physical activity, normal body mass index, never smoking, and no alcohol consumption. Controlled blood pressure was defined as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg. A multivariable logistic regression model was used to assess the association between HLS and hypertension control after adjusting for various confounders.

Results

The HLS demonstrated an inverse association with hypertension control among hypertensive patients. In comparison to the low HLS group (scored 0-2), the adjusted odds ratios (95% confidence intervals) for hypertension were 0.76 (0.74, 0.78), 0.59 (0.57, 0.60), and 0.48 (0.46, 0.49) for the HLS groups scoring 3, 4, and 5, respectively (Ptrend < 0.001). Notably, an interaction was observed between HLS and antihypertensive medication in relation to hypertension control (Pinteraction < 0.001). When comparing the highest HLS (scored 5) with the lowest HLS (scored 0-2), adjusted odds ratios (95% confidence intervals) were 0.50 (0.48, 0.52, Ptrend < 0.001) among individuals who self-reported using antihypertensive medication and 0.41 (0.38, 0.44, Ptrend < 0.001) among those not using such medication. Hypertensive patients adhering to a healthy lifestyle without medication exhibited better blood pressure management than those using medication while following a healthy lifestyle.

Conclusion

HLS was associated with a reduced risk of uncontrolled blood pressure.

Association of endometriosis with asthma: a study of the NHANES database in 1999-2006

OBJECTIVE

Asthma is a chronic inflammatory disease of the airways with a gender differences in the prevalence after puberty. Recent studies have reported a relationship between asthma and endometriosis, possibly related to the immune response mechanisms, but the evidences are limited and inconsistent. Herein, this research aimed to investigate the association of endometriosis with asthma based on the representative population in the United States (U.S.) to provide some reference for further exploration on mechanism of gender difference in asthma.

METHODS

In this cross-sectional study, data of women aged ≥ 20 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) database in 1999-2006. Weighted univariate and multivariate logistic regression analyses were utilized to explore the association of endometriosis with asthma. The multivariate models adjusted for covariates including age, race, education level, marital status, poverty income ratio (PIR), body mass index (BMI), waist circumference, smoking, estrogen and progesterone hormones use, uterine fibroids, at least one ovary removed, and birth control pills intake. The evaluation indexes were odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, race, BMI, and pregnancy history were also performed.

RESULTS

Among 5,556 eligible women, 782 had asthma, and 380 had endometriosis. The average age of participants was 37.19 years old, and more than half of them were non-Hispanic White (68.44%). After adjusting for covariates, endometriosis was associated with higher odds of asthma compared with non-endometriosis [OR = 1.48, 95%CI: (1.10-1.99)]. This relationship was also found in 40-49 years old [OR = 2.26, 95%CI: (1.21-4.23)], BMI of 25-29.9 kg/m2 [OR = 2.87, 95%CI: (1.52-5.44)], and pregnancy history [OR = 1.44, 95%CI: (1.01-2.06)] subgroups.

CONCLUSION

Endometriosis had a positive association with asthma in adult women. Females aged 40-49 years old, with BMI of 25-29.9 kg/m2 and had a history of pregnancy should take care about monitoring endometriosis to reduce the potential risk of asthma. Further studies are still needed to clarify the causal association between endometriosis and asthma.

Association of serum soluble α‑klotho with risk of kidney stone disease: a population-based cross-sectional study

BACKGROUND

The aim of the study was to explore the association of serum soluble klotho with kidney stone disease (KSD) in the general population over the age of 40 years in the United States.

METHODS

We integrated the data in National Health and Nutrition Examination Survey from 2007 to 2016 years. The relationship between serum soluble α‑klotho and prevalence of KSD was analyzed by constructing weighted multivariable logistic regression model, restricted cubic spline (RCS) curve, and subgroup analyses.

RESULTS

In the study, a total of 13,722 individuals were included in our study. A U-shaped association between serum soluble klotho and the risk of KSD was shown by the RCS curve (P value for nonlinear < 0.05). In the full adjusted model, compared with the lowest quartile of serum soluble α‑klotho, the adjusted odd ratios (95% confidence intervals) for KSD across the quartiles were (0.999 (0.859, 1.164), 1.005 (0.858, 1.176), and 1.061 (0.911, 1.235)). Subgroup analyses also showed that the U-shaped association of serum soluble α‑klotho with KSD was found among subjects who were age < 60 years, female or male, with or without hypertension, and BMI ≥ 30 kg/m2.

CONCLUSIONS

Our findings suggested that serum klotho levels had a U-shaped correlation with risk of KSD. When the Klotho level is at 818.66 pg/mL, prevalence of KSD is lowest. Therefore, maintaining a certain level of serum soluble α‑klotho could prevent the occurrence of KSD.

Unveiling blood donation knowledge, attitude, and practices among 12,606 university students: a cross-sectional study across 16 countries

We assessed university students' knowledge, attitude, and practice toward blood donation and identified the factors that promote or hinder their willingness to donate. We employed a multicenter cross-sectional design, collecting data from August to October 2022 through self-administered questionnaires available in Arabic and English. Both online (Google Forms) and paper surveys were utilized. Data were analyzed using R Statistical Software (v4.1.3; R Core Team 2022). A total of 12,606 university students (7966 females and 4640 males) from 16 countries completed the questionnaire; of them, 28.5% had a good knowledge level regarding blood donation, and 22.7% had donated blood at least once. Students in health science colleges had significantly more awareness of blood donation (p-value < 0.001), but there were no significant differences in practice (p-value = 0.8). Barriers to donation included not being asked (37%), medical ineligibility (33%), fear of pain or infection (18%), concerns about negative health effects (18%), difficulty accessing donation centers (15%), and medical mistrust (14%). Individuals aged > 20 years had significantly higher odds of possessing a high knowledge level (adjusted odds ratio [aOR] 1.77, p < 0.001). Private and international university enrollment was associated with increased knowledge (aOR 1.19, p-value < 0.001 and aOR 1.44, p-value = 0.003), while non-health science college students had lower odds (aOR 0.36, p < 0.001). Regarding blood donation status, participants > 20 years old were more likely to donate (aOR 2.21, p < 0.001). Conversely, being female, having congenital or chronic diseases, and possessing low knowledge levels were associated with decreased odds of blood donation (all p < 0.05). University students show insufficient knowledge about blood donation, with health science students displaying higher awareness levels. Despite their positive attitudes, blood donation rates remain low across all disciplines. It is imperative to enhance education and accessibility to foster a culture of blood donation among students.

Association between oxidative balance score and rheumatoid arthritis in female: a cross-sectional study

OBJECTIVE

Although oxidative stress is a recognized factor of inflammation, the correlation between oxidative balance score (OBS), a biomarker indicating the balance of oxidation and antioxidant, and rheumatoid arthritis (RA), an immune system disease that tends to occur in women, remains unexplored. Hence, the aim of this study was to investigate the potential association between OBS and RA in women.

METHODS

Observational surveys were performed by employing information extracted from the National Health and Nutrition Examination Survey (NHANES) for the period 2007-2018. Various statistical techniques were employed to investigate the association between OBS and RA, encompassing multivariable logistic regression analysis, subgroup analyses, smooth curve fitting, and threshold effect analysis.

RESULTS

The study included 8219 female participants, including 597 patients with RA. The results showed that higher Total OBS (TOBS) significantly correlated with lower RA prevalence in the entirely modified model [odd ratio (OR) = 0.968; 95% confidence interval (CI) = 0.952 to 0.984; P = 0.0001]. Dietary OBS (DOBS) and lifestyle OBS (LOBS) also negatively correlated with RA. This association was remarkably consistent across TOBS subgroups by age, race, education level, family poverty-to-income ratio (PIR), hypertension and diabetes. Smooth curve fitting and threshold effect analysis also revealed the linear relationship between OBS and RA.

CONCLUSIONS

Overall, OBS was negatively associated with RA in female. This study suggested that an antioxidant diet and lifestyle may be promising measures to prevent RA in female.

Food and beverage selection in children's sports arenas in Norway: a cross-sectional study

OBJECTIVE

To assess the selection of foods and beverages in children's sports arenas in Norway.

DESIGN

A cross-sectional study design with a digital questionnaire was used. Descriptive statistics were used to present the results. Moreover, Pearson's χ2 tests examined the factors that could aid in distinguishing clubs with healthy or unhealthy consumables.

SETTING

Children's sports clubs in Norway.

PARTICIPANTS

Representatives from 301 children's sports clubs in Norway answered the questionnaire between September and November 2021.

RESULTS

In total, 89·4% of the participating sports clubs (n 301) offered soda drinks with sugar. Most of the sports clubs (88 %) reported to offer batter-based cakes such as pancakes and waffles and 63·8 % offered cakes. Furthermore, 47·5% sold hot dishes with processed meat, such as hamburgers and hot dogs. More than 80% of the sports clubs offered sweets and snacks, while 44·5% did not offer fruits, vegetables and/or berries. Notably, the important factors that distinguished sports clubs with healthier food selections from those with unhealthier selections were the presence of guidelines for the food offered and purchase agreements with food suppliers.

CONCLUSIONS

Educational, governmental guidelines for the promotion of healthy eating and establishing agreements with suppliers of healthier foods could help to overcome barriers to unhealthy food selection.

Challenges and potential improvements in the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019) derived through meta-evaluation: a cross-sectional study

PURPOSE

This study aimed to identify challenges and potential improvements in Korea's medical education accreditation process according to the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019). Meta-evaluation was conducted to survey the experiences and perceptions of stakeholders, including self-assessment committee members, site visit committee members, administrative staff, and medical professors.

METHODS

A cross-sectional study was conducted using surveys sent to 40 medical schools. The 332 participants included self-assessment committee members, site visit team members, administrative staff, and medical school professors. The t-test, one-way analysis of variance and the chi-square test were used to analyze and compare opinions on medical education accreditation between the categories of participants.

RESULTS

Site visit committee members placed greater importance on the necessity of accreditation than faculty members. A shared positive view on accreditation's role in improving educational quality was seen among self-evaluation committee members and professors. Administrative staff highly regarded the Korean Institute of Medical Education and Evaluation's reliability and objectivity, unlike the self-evaluation committee members. Site visit evaluators positively perceived the clarity of accreditation standards, differing from self-assessment committee members. Administrative staff were most optimistic about implementing standards. However, the accreditation process encountered challenges, especially in duplicating content and preparing self-evaluation reports. Finally, perceptions regarding the accuracy of final site visit reports varied significantly between the self-evaluation committee members and the site visit committee members.

CONCLUSION

This study revealed diverse views on medical education accreditation, highlighting the need for improved communication, expectation alignment, and stakeholder collaboration to refine the accreditation process and quality.

Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study

BACKGROUND

HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi.

METHODS

At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST.

RESULTS

July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p < 0.001), attending an urban facility (43% urban vs. 34.6% rural, p = 0.025) and regular salary-earners (49.5% regular vs. 36.8% non-regular, p = 0.012). After adjustment, only sex was found to be associated with choice of self-test (adjusted OR 0.43 (95%CI: 0.3-0.61); p-value < 0.001). Among 264 reporting blood-based HIVST results, 11 (4.2%) were HIV-positive. Blood-based HIVST had sensitivity of 100% (95% CI: 71.5-100%) and specificity of 99.6% (95% CI: 97.6-100%), with 20 (7.6%) invalid results. Among 416 reporting oral-fluid-based HIVST results 18 (4.3%) were HIV-positive. Oral-fluid-based HIVST had sensitivity of 88.9% (95% CI: 65.3-98.6%) and specificity of 98.7% (95% CI: 97.1-99.6%), with no invalid results.

CONCLUSIONS

Offering both blood-based and oral-fluid-based HIVST resulted in high uptake when compared directly with provider-delivered testing. Both types of self-testing achieved high accuracy among users provided with a pre-test demonstration beforehand. Policymakers and donors need to adequately plan and budget for the sensitisation and support needed to optimise the introduction of new quality-assured blood-based HIVST products.

Multivitamins co-intake can reduce the prevalence of kidney stones: a large-scale cross-sectional study

BACKGROUND

This research aimed to explore the association between changes in the intake of common individual vitamins and combinations of vitamins and the prevalence of kidney calculi.

METHODS

We used data from NHANES to investigate the association between nine common vitamins and kidney stone prevalence. Participants were clustered into several vitamin exposure patterns using an unsupervised K-means clustering method. We used logistic regression models and restrictive cubic spline curves to explore the influence of vitamins.

RESULTS

The regression model exposed that compared to lower intake, high intake of vitamin B6 [Q4: OR (95% CI) = 0.76 (0.62, 0.93)], vitamin C [Q4: OR (95% CI) = 0.73 (0.59, 0.90)] and vitamin D [Q4: OR (95% CI) = 0.77 (0.64, 0.94)] individually exerted protective effects against the prevalence of kidney stones. Furthermore, the restrictive cubic spline analysis showed that the protective effect against the prevalence of kidney stones is enhanced as the take of vitamin B6 and vitamin D increased. Moreover, with the increase in vitamin C intake, its protective effect may turn into a risk factor. Regarding mixed exposure, Cluster 4 exhibited a significant protective effect against kidney stones compared with Cluster 1 [Model 3: OR (95% CI) = 0.79 (0.64, 0.98)].

CONCLUSIONS

Our research revealed that high levels of vitamin B6 and vitamin D intake were linked to a lower prevalence of kidney stone. With the gradual increase intake of vitamin C, the prevalence of kidney calculi decreased first and then increased. In addition, the co-exposure of nine vitamins is a protective factor for kidney stone disease.

Dietary isoflavone intake is inversely associated with remnant cholesterol in US adults: A cross-sectional study

BACKGROUND

Several studies have shown that dietary isoflavones are negatively correlated with total cholesterol and low-density lipoprotein cholesterol. However, few studies have investigated the link between dietary isoflavones and remnant cholesterol (RC).

OBJECTIVES

We used the National Health and Nutrition Examination Survey (NHANES) database to explore the association between dietary isoflavone intake and RC.

METHODS

A cross-sectional study was conducted with 4731 participants aged ≥ 20 years from the 2007-2008, 2009-2010, and 2017-2018 NHANES databases. We adopted univariate and multiple linear regression analysis and restricted cubic spline (RCS) to assess the relationship between dietary isoflavone intake and RC. Moreover, we conducted stratified and interaction analyses to ensure the stability of the results and identify specific populations.

RESULTS

The weighted multifactor linear regression model showed a negative correlation between dietary isoflavone intake and remnant cholesterol (Model 2, β = -0.049, 95% CI: (-0.096, -0.002), P = 0.040). The RCS analysis indicated that there was an L-shaped negative correlation between dietary isoflavone intake and RC (P-value for non-linearity was 0.0464). Stratified analyses showed the inverse relationship between dietary isoflavone intake and RC persisted in most subgroups and there was no interaction except for the recreational activity group.

CONCLUSIONS

Our study found a non-linear and negative association between dietary isoflavone intake and RC in US adults, so we hypothesized that consuming an isoflavone-rich diet may help reduce blood RC and further reduce the risk of cardiovascular disease.

Association between short- and medium-term exposure to air pollutants and depressive episode using comprehensive air quality index among the population in South Korea

BACKGROUND

Currently, air pollution is suggested as a risk factor for depressive episodes. Our study aimed to consider multiple air pollutants simultaneously, and continuously evaluate air pollutants using comprehensive air quality index (CAI) with depressive episode risk.

METHODS

Using a nationally representative sample survey from South Korea between 2014 and 2020, 20,796 participants who underwent health examination and Patient Depression Questionnaire-9 were included in the study. Six air pollutants (PM10, PM2.5, O3, CO, SO2, NO2) were measured for the analysis. Every air pollutant was standardized by air quality index (AQI) and CAI was calculated for universal representation. Using logistic regression, short- and medium-term exposure by AQI and CAI with the risk of depressive episode was calculated by odds ratio and 95 % confidence interval (CI). Furthermore, consecutive measurements of CAI over 1-month time intervals were evaluated with the risk of depressive episodes. Every analysis was conducted seasonally.

RESULTS

There were 950 depressive episodes occurred during the survey. An increase in AQI for short-term exposure (0-30 days) showed higher risk of depressive episode in CO, while medium-term exposure (0-120 days) showed higher risk of depressive episode in CO, SO2, PM2.5, and PM10. During the cold season, the exposure to at least one abnormal CAI within 1-month intervals over 120 days was associated with a 68 % (95 % CI 1.11-2.54) increase in the risk of depressive episode.

CONCLUSIONS

Short- and medium-term exposure of air pollution may be associated with an increased risk of depressive episodes, especially for cold season.

[Status of the implementation of simulation-based education in Germany: A cross-sectional study]

Status of the implementation of simulation-based education in Germany: A cross-sectional study Abstract. Background: The importance of simulation-based learning in nursing education is growing. Its success depends on the qualification of facilitators and the use of standards. Up to now, there has been a lack of data on the state of implementation of simulation-based learning in nursing education in Germany. Research question: Which qualification level do simulation facilitators show in nursing education in Germany and which concepts and standards are used? Methods: A cross-sectional survey was conducted among simulation facilitators in three different educational areas. The questionnaire included socio-demographic and professional characteristics as well as qualification measures completed, and concepts and standards applied. Data were analysed descriptively by determining arithmetic means plus standard deviation (SD) or absolute and relative frequencies. Results: A total of 156 simulation facilitators (mean age 41.5 (SD 9.8) years, 74.2% female) participated. 95.4% of participants reported being (very) highly motivated for simulation-based learning. Specific simulation pedagogy training was completed by 16.8% of participants. The application of evidence-based concepts is not occurring across the board. Conclusions: Against the background of international standards, qualification needs for simulation facilitators in Germany become apparent. Increased specific, standardized continuing education and training as well as the establishment of evidence-based concepts are important for high quality in simulation facilitation.

Association between Weight-Adjusted Waist Index and depressive symptoms: A nationally representative cross-sectional study from NHANES 2005 to 2018

BACKGROUND

Depressive symptoms are strongly associated with the development of various diseases and are one of the leading causes of disability in the world. However, the relationship between weight-adjusted waist index (WWI) and depressive symptoms has not been studied. This study aimed to assess the relationship between depressive symptoms and WWI.

METHODS

This study took NHANES data from 2005 to 2018 with 32,374 participants. Depressive symptoms were measured by a questionnaire (PHQ-9).WWI was determined by dividing the square root of waist circumference (cm) by weight (kg). Multivariate logistic regression models, smoothed curve fitting, and weighted generalized additive model (GAM) regression were used to examine the relationship between depressive symptoms and WWI, BMI, and waist circumference. Subgroup analyses and interaction tests were also performed.

RESULTS

In fully adjusted models, the OR (95 % CI) for WWI and depressive symptoms with WWI, BMI, and waist circumference were 1.18 (1.05, 1.34), BMI 1.01 (1.00, 1.02, 1.01 (1.00, 1.01), respectively. Participants in the highest quartile (Q4) had a 49 % higher depressive symptoms compared to those in the lowest quartile (Q1) (OR = 1.49, 95 % CI:1.14-1.96). Subgroup analyses and interaction tests showed a stable relationship between depressive symptoms and WWI.

LIMITATIONS

It is difficult to determine a causal relationship between the two; questionnaire collection may be somewhat biased; CONCLUSIONS: WWI was positively associated with depressive symptoms. This association was stronger than BMI and waist circumference. However, this relationship was stable. This study emphasizes the potential utility of WWI in preventing depressive symptoms and improving prognosis in the population.

Exposure to per- and polyfluoroalkyl substance and metabolic syndrome: A nationally representative cross-sectional study from NHANES, 2003-2018

Per- and polyfluoroalkyl substances(PFAS) are widespread organic pollutants with endocrine-disrupting effects on human health, but the association of PFAS exposure with metabolic syndrome remains conflicting. National Health and Nutrition Examination Survey(NHANES) program was utilized to evaluate the association of individual PFAS exposure and metabolic disorders and further determined the joint effect of PFAS co-exposures. 13921 participants and five PFAS exposures(PFHxS, MPAH, PFDE, PFNA, and PFUA) were included for analysis. The association between individual PFAS and metabolic syndrome varied in the specific PFAS and the specific metabolic disorder examined. PFHxS was negatively associated with obesity(Q4; OR = 0.75; P < 0.001), but positively associated with hyperlipidemia (Q3; OR = 1.2; P = 0.013). PFUA was negatively associated with obesity (Q4; OR = 0.6; P < 0.001), hyperlipidemia (Q3; OR = 0.85; P = 0.03), and non-alcoholic fatty liver disease (NAFLD, Q4; OR = 0.64; P = 0.015), but positively associated with hyperglycemia(Q3; OR = 1.27; P = 0.004). Furthermore, PFAS co-exposures were negatively associated with obesity(OR = 0.63; P < 0.001) and NAFLD(OR = 0.85; P = 0.021), and positively associated with hyperlipidemia(OR = 1.05; P = 0.022), but not significantly associated with hyperglycemia or hypertension. Overall, there was a negative association between PFAS co-exposures and metabolic severity score(β = -0.15; P < 0.001). Subgroup analysis stratified by gender and obesity consistently showed the negative association of PFAS co-exposures with metabolic severity score, and the positive association with hyperlipidemia. However, subgroup analysis showed a negative association with NAFLD in females but not in males, and a negative association with hyperglycemia in the obesity group, but not in the non-obesity group. Collectively, our study showed a negative association of PFAS co-exposures with metabolic syndrome severity score, but did not support a consistent association between PFAS co-exposures and individual components of metabolic syndrome. Additionally, there were gender-specific as well as BMI-specific differences in these associations. Further studies are needed to rule out the reverse causality and clarify the relationship of PFAS co-exposures with the specific metabolic disorder.

Vitamin D deficiency during the coronavirus disease 2019 (COVID-19) pandemic among healthcare workers

BACKGROUND & AIMS

Vitamin D deficiency is a common nutritional problem worldwide that may have worsened during the coronavirus disease 2019 (COVID-19) pandemic. The present study sought to examine the prevalence and correlates of vitamin D deficiency among healthcare workers three years after the start of the COVID-19 pandemic.

METHODS

Participants comprised 2543 staff members from a medical research institute, who completed a questionnaire and donated blood samples in June 2023. 25-hydroxyvitamin D (25[OH]D) levels were measured using an electrochemiluminescence immunoassay. Logistic regression was used to calculate the odds ratio and its 95% confidence interval while adjusting for covariates.

RESULTS

The proportions of participants with vitamin D insufficiency (25[OH]D 20-29 ng/mL) and deficiency (25[OH]D < 20 ng/mL) were 44.9% and 45.9%, respectively. In a multivariable-adjusted model, factors associated with a higher prevalence of vitamin D deficiency included younger age, female sex, fewer hours of daytime outdoor physical activity during leisure time (without regular use of sunscreen), lower intake of fatty fish, no use of vitamin D supplements, smoking, and no alcohol consumption. Occupational factors, including shift work, were not independently associated with vitamin D deficiency.

CONCLUSIONS

Our results suggest that vitamin D insufficiency and deficiency are highly prevalent among healthcare workers. Health education regarding lifestyle modifications for this occupational group are warranted to improve their vitamin D status in the COVID-19 era.

Age of hypertension onset and cognitive function in the elderly: an observational study from the NHANES 2011-2014

PURPOSE

This study aims to evaluate the association between age of hypertension onset and cognitive function in a representative sample of US older adults.

METHODS

We assessed 2334 elderly adults (including 1655 hypertensive patients) who participated in the National Health and Nutrition Examination Survey 2011-2014. We used the age when the participants were first informed by the doctor that they had hypertension or were first clinically diagnosed with hypertension as the age of onset of hypertension. The Digit Symbol Substitution test (DSST), the Animal Fluency test, the Consortium to Establish a Registry for Alzheimer's disease (CERAD), and a composite-z score calculated by summing z-scores from these three individual tests, were used to assess cognitive function.

RESULTS

Participants with hypertension onset age < 35 years (early onset hypertension) had the worst performance in almost all cognitive tests, followed by those with onset age ≥ 65 years. Compared with those without hypertension, early onset hypertension was associated with - 4.15 (95% CI - 6.63, - 1.68), - 1.10 (95% CI - 2.08, - 0.12), - 0.75 (95% CI - 1.91, 0.42), and - 0.56 (95% CI - 0.94, - 0.19) scores for DSST, animal fluency test, CERAD, and composite z-score. Participants with early onset hypertension (onset age < 35 years) had higher odds for cognitive decline defined by DSST (OR: 3.28, 95% CI 1.94, 5.54) and composite z-score (OR: 1.77, 95% CI 1.07, 2.92).

CONCLUSIONS

Early onset hypertension was associated with the worst performance in cognitive function and an increased odds of cognitive decline in the elderly.

Dairy products intake and prevalence, incidence, and recovery of non-alcoholic fatty liver disease in Chinese population

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a growing public health concern. Modifiable factors such as diet and lifestyle are of research interest in preventing or reversing the disease. The relationship between dairy products and NAFLD remains unclear.

METHODS

In this cohort study, 36,122 participants aged 20-74 were enrolled by multi-stage, stratified, randomized cluster sampling from 2016 to 2017. A total of 25,085 participants finished at least one follow-up visit from 2019 to 2023. Dairy intake was collected by food frequency questionnaire at baseline. NAFLD was defined as fatty liver diagnosed by ultrasonography with excessive alcohol drink excluded. Logistic regression and Cox proportional hazard models were used to analyze the association between dairy intake and NAFLD.

RESULTS

A total of 34,040 participants were included in the baseline analysis. The prevalence of NAFLD was inversely associated with dairy intake (OR>7vs 0 servings/week = 0.91, 95% CI 0.84-0.98; ORper serving/day increase = 0.95, 95% CI 0.92-0.99). 20,460 participants entered the follow-up analysis. Among 12,204 without NAFLD at baseline, 4,470 developed NAFLD after a median time of 4.3 years. The incidence of NAFLD was inversely associated with dairy intake (HR>7 vs 0 servings/week = 0.89, 95% CI 0.81-0.98; HRper serving/day increase = 0.94, 95% CI 0.89-0.99). Among 8256 with NAFLD at baseline, 3,885 recovered after 4.2-year follow-up. Total dairy intake did not show significant associations with recovery of NAFLD, and the HRs (95% CI) were 0.96 (0.87-1.06) for > 7 servings/week and 0.98 (0.93-1.03) for per serving/day increase.

CONCLUSION

Dairy product intake of more than one serving per day was associated with a lower prevalence and incidence of NAFLD in Chinese population. However, total dairy intake did not show significant association in NAFLD reversal.

Knowledge, attitudes, and practice toward postoperative cognitive dysfunction among anesthesiologists in China: a cross-sectional study

BACKGROUND

To investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China.

METHODS

This cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good.

RESULTS

This study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were "the anesthetic drugs that tend to cause POCD" (23.3%) and "Treatment of POCD" (40.3%). Multivariable analysis showed that ≥ 40 years old, master's degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice.

CONCLUSIONS

These results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education.

TRIAL REGISTRATION

ChiCTR2200066749.

Role of active and environmental tobacco smoke on susceptibility to osteoporosis in women undergoing dual-X-ray absorptiometry

PURPOSE

Current smoking is a risk factor for osteoporosis (Op), but few data are available regarding the passive smoke impact on Op susceptibility. This cross-sectional study aimed to evaluate the association between the smoking habits and Op in community-dwelling women undergoing dual-energy X-ray absorptiometry (DXA).

METHODS

On 01/06/2018, general practitioners from "COMEGEN" Medical Cooperative, Naples, Italy, selected the medical records from the last 10 years of women who had a measurement of bone mineral density performed and simultaneously completed a questionnaire about their smoking behaviour and their cohabiters'. The binary logistic regression analysis was used to estimate the role of passive smoke on the risk of Op, adjusting for age and body mass index (BMI).

RESULTS

Among 10,616 subjects, 3942 were currently smokers [CS; mean age 69.4 ± 10.4 years; BMI 27.0 ± 4.9 kg/m2], 873 were passive smokers (PS; mean age 67.8 ± 11.6 years; BMI 27.0 ± 4.9 kg/m2) and 5781 were never smokers (NS; mean age 67.8 ± 11.6 years; body mass index (BMI) 27.0 ± 4.9 kg/m2). Of all, 8562 women (mean age 70.3 ± 10.2 yrs; BMI 27.0 ± 4.9 kg/m2) received the Op diagnosis. PS showed an increased Op risk compared to NS [odds ratio (OR) 1.38 (1.14-1.67)] and comparable to CS [OR 1.02 (0.84-1.24)].

CONCLUSION

The study results demonstrate an association between passive smoke and Op in community-dwelling women already presenting with susceptibility to Op according to Italian essential assistance levels, suggesting that passive and active smoke are equivalent Op risk factors in women.

Knowledge, attitude, and practice of healthcare providers on chronic refractory cough: A cross-sectional study

Objective

Previous studies from outside China showed that the knowledge, attitudes, and practice (KAP) of chronic refractory cough (CRC) was moderate among physicians. This study examined the KAP toward CRC in Chinese healthcare providers.

Methods

This single-center cross-sectional study was conducted at The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, from July 2022 to January 2023 and enrolled healthcare providers. The demographic characteristics and KAP scores were collected using a questionnaire (Cronbach's α = 0.934) developed based on CRC guidelines.

Results

The study included 539 healthcare providers. The mean knowledge score was 8.27 ± 2.37 (maximum of 14, 59.07%), indicating poor knowledge. The highest rates of inaccuracies pertained to knowledge about the definition of chronic cough, empirical treatment methods, and potential risks of different treatments, suggesting a need for unified training in all aspects of CRC for medical staff. The mean attitude score was 49.74 ± 63.63 (maximum of 60, 82.90%), indicating favorable attitudes. Most healthcare providers believed that CRC affects normal work and life and that it would be necessary to provide more help to patients from the perspectives of drug treatment and psychological counseling. The mean practice score was 23.20 ± 6.28 (maximum of 35, 66.29%), indicating poor practice.

Conclusion

This study suggests that healthcare providers in Yancheng have poor knowledge, favorable attitudes, and poor practice of CRC. This study provides points that should be targeted in future training and continuing education activities.

Association between weight-adjusted waist index and serum total testosterone in males aged 6-19 years in the United States: Data from NHANES 2013-2016

Objective

This study aimed to estimate the association between weight-adjusted waist index and serum total testosterone (sTT) in males aged 6-19 years in the United States.

Methods

A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. sTT was considered as the response variable, and weight-adjusted waist circumference index (WWI) as the independent variable. Multiple linear regression was performed to estimate the association between the two variables, and subgroup analysis was performed to identify sensitive cohorts. Smoothing curve fitting and threshold effects analysis was carried out to assess possible nonlinear relationships between WWI and sTT.

Results

The study included 4207 participants. The mean value of sTT (117.93 ng/dl) was used as the grouping basis, with 1066 participants having serum total testosterone levels above the mean. A negative association was observed between WWI and sTT [beta coefficient (β) = -72.50, 95% confidence interval (CI): -79.45, -65.55], which decreased as WWI increased (P for trend<0.05). Subgroup analysis indicated a stronger negative correlation in late adolescent (16-19 years) males (β = -128.94, 95% CI: -146.75, -111.13). The smoothing curve fit analysis revealed a U-shaped curve relationship for the negative correlation between WWI and sTT. Threshold effect analysis suggested a significant change when WWI exceeded 10.09 (β = -15.82, 95% CI: -24.11, -7.54), and stepwise threshold effect analysis indicated that this negative correlation became less stable when WWI exceeded 11.45 (β = -0.80, 95% CI: -9.15, 7.56).

Conclusions

Participants with higher WWI exhibited lower total testosterone levels, and a negative association was found between WWI and total testosterone, particularly in late adolescent males aged 16-19 years. Among males aged 6-19 years, caution should be exercised regarding the risk of lower testosterone levels associated with elevated WWI, particularly when WWI is below 10.09.

Polypharmacy, drug-drug interactions, anticholinergic burden and cognitive outcomes: a snapshot from a community-dwelling sample of older men and women in northern Italy

Polypharmacy (PP) use is very common in older people and may lead to drug-drug interactions (DDIs) and anticholinergic burden (ACB) that may affect cognitive function. We aimed to determine the occurrence of PP, potential DDIs and ACB and their role in cognitive outcomes in an older population. Cross-sectional data from 636 community-dwelling adults (73.2 ± 6.0 SD, 58.6% women) participating in the NutBrain study (2019-2023) were analyzed. Participants were asked about their medication use, and data on potential DDIs and ACB were extracted. The associations of PP (≥ 5 drugs/day), potential DDIs, and ACB with mild cognitive impairment (MCI) and specific cognitive domains were assessed using logistic regression adjusted for confounders. Sex-stratified analysis was performed. Overall, 27.2% of the participants were exposed to PP, 42.3% to potential DDIs and 19% to cumulative ACB. Women were less exposed to PP and more exposed to ACB than men. In multivariate analysis, the odds of having MCI (24%) were three times higher in those with severe ACB (≥ 3) (OR 3.34, 95%CI 1.35-8.25). ACB was positively associated with poor executive function (OR 4.45, 95%CI 1.72-11.49) and specifically with the Frontal Assessment Battery and neuropsychological tests of phonological and semantic fluency. In sex-stratified analysis, ACB was statistically significantly associated with MCI and executive function in women and with memory in men. PP, potential DDIs and anticholinergics use are very common in community-dwelling older people. ACB exposure is associated with MCI, particularly with poor executive function. Clinicians are encouraged to be vigilant when prescribing anticholinergics.Trial registration: Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).

Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study

BACKGROUND

Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP.

METHODS

Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models.

RESULTS

Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96-15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28-0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09-0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08-0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP.

CONCLUSIONS

Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.

Knowledge, attitude, and practice toward weight management among diabetic patients in Qidong City, Jiangsu Province

BACKGROUND

Weight management is an effective prevention and treatment strategy for diabetes mellitus. This study aimed to assess the knowledge, attitude, and practice (KAP) of diabetic patients towards weight management.

METHODS

Diabetic patients treated at Qidong City, Jiangsu Province, between January 2023 and June 2023 were included in this cross-sectional study. A self-designed questionnaire was used to collect their demographic characteristics and KAP toward weight management. Structural equation modeling (SEM) was employed to examine the inter-relationships among KAP scores.

RESULTS

Among a total of 503 valid questionnaires that were collected, 55.07% were filled out by men and 54.67% by those aged < 60 years. The mean scores for knowledge, attitude, and practice were 8.03 ± 3.525 (possible range: 0-13), 31.88 ± 3.524 (possible range: 10-50), and 22.24 ± 3.318 (possible range: 9-45), respectively. Pearson's correlation analysis revealed the knowledge was positively associated with attitude (r = 0.295, P < 0.001) and practice (r = 0.131, P < 0.001), and attitude was positively associated with practice (r = 0.140, P = 0.002). SEM demonstrated positive associations between knowledge and attitude (β = 0.28, P < 0.001), and attitude and practice (β = 0.09, P = 0.019). Moreover, older age was negatively associated with knowledge (β=-0.04, P = 0.001), while higher education (β = 1.220, P < 0.001), increased monthly income (β = 0.779, P < 0.001), diagnosis of fatty liver (β = 1.03, P = 0.002), and screening for excess visceral fat (β = 1.11, P = 0.002) were positively associated with knowledge.

CONCLUSION

Diabetic patients showed moderate knowledge, neutral attitudes, and inappropriate practices toward weight management. Knowledge was positively associated with attitude and practice. These findings provided valuable directions for healthcare interventions targeting improved KAP status of weight management among diabetic patients.

Association between alcohol intake and bone mineral density: results from the NHANES 2005-2020 and two-sample Mendelian randomization

We used the data from the NHANES cross-sectional study among 14,113 participants and indicated a positive correlation between alcohol intake frequency and bone mineral density in different body sites. Mendelian randomization was conducted, and no causal relationship is significant between these two variables. The study can provide some suggestions on the daily consumption of alcohol for osteoporosis patients.

PURPOSE

The effect of alcohol intake on bone mineral density (BMD) remains unclear. This study explored the association and causality between alcohol intake and BMD.

METHODS

Based on the 2005-2020 National Health and Nutrition Examination Survey including 14,113 participants, we conducted co-variate-adjusted multilinear regression analyses to explore the association between alcohol intake levels and spine or femur BMD. To evaluate the causal association between alcohol intake frequency and bone mineral density, the inverse variance weighted approach of two-sample Mendelian randomization (MR) was used with genetic data from the Medical Research Council Integrative Epidemiology Unit (462,346 cases) for alcohol intake frequency and the Genetic Factors for Osteoporosis Consortium (28,496 cases) for lumbar spine and femur neck BMD (32,735 cases).

RESULTS

Compared with non-drinkers, total femur BMDs but not total spine BMD increased with daily alcohol intake in males (β = 3.63*10-2 for mild drinkers, β = 4.21*10-2 for moderate drinkers, and β = 4.26*10-2 for heavy drinkers). By contrast, the higher total spine BMD in females was related to higher alcohol intake levels (β = 2.15*10-2 for mild drinkers, β = 2.59*10-2 for moderate drinkers, and β = 3.88*10-2 for heavy drinkers). Regarding the two-sample MR results, no causal relationship was observed between alcohol intake frequency and lumbar spine BMD (odds ratio [OR] = 1.016, P = 0.789) or femur neck BMD (OR = 1.048, P = 0.333).

CONCLUSION

This study suggests a positive association between alcohol intake frequency and BMD, although the causal relationship was not significant.

Subfoveal choroidal thickness in a general elderly population; Tehran geriatric eye study

PURPOSE

To determine the distribution of subfoveal choroidal thickness (SFCT) and its associated demographic, ocular, and systemic factors in an elderly population.

METHODS

This report is part of the Tehran Geriatric Eye Study (TGES); a population-based cross-sectional study that was conducted on the urban elderly population of Tehran, aged 60 years and above using multi-stage stratified random cluster sampling. Choroidal imaging was performed using Spectralis SD-OCT with enhanced depth imaging mode.

RESULTS

The average SFCT was 265.3 ± 25.9 μm (95% CI: 262.8-267.7) in the whole sample. According to the multiple generalized estimating equation (GEE) model, pseudophakia had a statistically significant direct relationship with SFCT (coefficient = 5.69), and history of cerebrovascular accident (CVA) was significantly inversely related to SFCT (coefficient=-4.77). Moreover, there was a significant interaction between age and sex in the average SFCT so that with increasing age, the SFCT increased in men and decreased in women.

CONCLUSION

The normal values of SFCT in the present study can be used as a reference database for clinical and research purposes. Age-sex interaction, pseudophakia, and history of CVA were significantly associated with SFCT in the elderly population. It is recommended that these factors be taken into account when interpreting SFCT data.

Association between multipollutant exposure and thyroid hormones in elderly people: A cross-sectional study in China

Environmental chemicals have been indicated to cause disruption of thyroid homeostasis in human populations. However, previous studies mostly focused on single group of chemicals. Herein, we investigate the independent and combined effects of multiple pollutants on thyroid homeostasis, including thyroid-stimulating hormone (TSH), total and free thyroxine (tT4 and fT4) and total and free triiodothyronine (tT3 and fT3) in elderly people. These environmental pollutants (n = 144) are from ten categories, including phenols, parabens, perfluoroalkyl substances (PFASs), polychlorinated biphenyls (PCBs), phthalate esters (PAEs), polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), organophosphate pesticides (OPPs), synthetic pyrethroids (SPs), herbicides, and metals. Few studies have evaluated the health risks of these 144 chemicals, especially their joint effects. In single-pollutant evaluations, multiple linear regression (MLR) models were used to estimate the independent associations between multiple exposures and thyroid biomarkers. In multi-pollutant evaluations, elastic net regression and Bayesian kernel machine regression (BKMR) models were used to estimate the combined associations. The MLR models showed that 41 chemicals were significantly related to THs levels. BKMR models revealed the most important chemical groups: metals for TSH, PAHs, SPs and PCBs for tT4, herbicides and SPs for tT3. This study will contribute to the understanding of multipollutant exposure and help prioritize specific chemical groups related to thyroid hormone disruption.