-
Current Problems in Cardiology Jun 2024This study evaluated the relationship between controlling multiple risk factors and diabetes-related heart failure and all-cause mortality, and the extent to which the... (Review)
Review
BACKGROUND
This study evaluated the relationship between controlling multiple risk factors and diabetes-related heart failure and all-cause mortality, and the extent to which the excess risk can be reduced.
METHODS
17,676 patients with diabetes and 69,493 matched non-diabetic control subjects were included in the Kailuan study, with a median follow-up of 11.19 years. The risk factor control was defined by the attainment of target values for systolic blood pressure, body mass index, low-density lipoprotein cholesterol, fasting blood glucose, high-sensitive C-reactive protein and smoking. Fine-Gray and Cox models were used to estimate associations between the degree of risk factor control and risk of heart failure and all-cause mortality respectively.
RESULTS
Among diabetes patients, there was a gradual reduction in the risk of outcomes as the degree of risk factor control increased. For each additional risk factor that was controlled, there was an associated 16% decrease in heart failure risk and a 10% decrease in all-cause mortality risk. Among diabetes patients with ≥5 well-controlled risk factors, the adjusted hazard ratio compared to controls for heart failure and all-cause mortality was 1.25 (95%CI: 0.99-1.56) and 1.17(95%CI: 1.05-1.31) respectively. The protective effect of comprehensive risk factor control on the risk of heart failure was more pronounced in men and those using antihypertensive medications.
CONCLUSIONS
Control for multiple risk factors is associated with reduced heart failure and all-cause mortality risks in a cumulative and sex-specific manner. However, despite optimization of risk factor control, diabetes patients still face increased risks compared to the general population.
PubMed: 38944222
DOI: 10.1016/j.cpcardiol.2024.102737 -
Pathology, Research and Practice Jun 2024Usual Interstitial Pneumonia (UIP) a fibrosing pneumonia is associated with idiopathic pulmonary fibrosis, chronic autoimmune disease (AID), or hypersensitivity...
BACKGROUND
Usual Interstitial Pneumonia (UIP) a fibrosing pneumonia is associated with idiopathic pulmonary fibrosis, chronic autoimmune disease (AID), or hypersensitivity pneumonia. Oxygen radicals, due to tobacco smoke, can damage DNA and might upregulate PARP1. Cytosolic DNA from dying pneumocytes activate cytosolic GMP-AMP-synthase-stimulator of interferon genes (cGAS-STING) pathway and TREX1. Prolonged inflammation induces senescence, which might be inhibited by phagocytosis, eliminating nuclear debris. We aimed to evaluate activation of cGAS-STING-TREX1 pathway in UIP, and if phagocytosis and anti-phagocytosis might counteract inflammation.
METHODS
44 cases of UIP with IPF or AID were studied for the expression of cGAS, pSTING, TREX1 and PARP1. LAMP1 and Rab7 expression served as phagocytosis markers. CD47 protecting phagocytosis and p16 to identify senescent cells were also studied.
RESULTS
Epithelial cells in remodeled areas and macrophages expressed cGAS-pSTING, TREX1; epithelia but not macrophages stained for PARP1. Myofibroblasts, endothelia, and bronchial/bronchiolar epithelial cells were all negative except early myofibroblastic foci expressing cGAS. Type II pneumocytes expressed cGAS and PARP1, but less pSTING. TREX1 although expressed was not activated. Macrophages and many regenerating epithelial cells expressed LAMP1 and Rab7. CD47, the 'don't-eat-me-signal', was expressed by macrophages and epithelial cells including senescence cells within the remodeled areas.
CONCLUSIONS
The cGAS-STING pathway is activated in macrophages and epithelial cells within remodeled areas. LikelyTREX1 because not activated cannot sufficiently degrade DNA fragments. PARP1 activation points to smoking-induced oxygen radical release, prolonging inflammation and leading to fibrosis. By expressing CD47 epithelial cells within remodeled areas protect themselves from being eliminated by phagocytosis.
PubMed: 38944022
DOI: 10.1016/j.prp.2024.155432 -
Addictive Behaviors Jun 2024A subpopulation of adults who smoke cigarettes use electronic nicotine device systems (ENDS) for cigarette cessation. This study examined the relationship between ENDS...
BACKGROUND
A subpopulation of adults who smoke cigarettes use electronic nicotine device systems (ENDS) for cigarette cessation. This study examined the relationship between ENDS flavors, device types, and nicotine concentration with past month cigarette abstinence among adults using ENDS for cigarette cessation.
METHODS
We used the Population Assessment of Tobacco and Health (PATH) Study (waves 5 and 6) to identify adults who self-reported using ENDS to quit cigarettes at baseline (wave 5) and investigated their cigarette abstinence at follow-up (wave 6) [n = 1252]. Measures assessed include ENDS features (flavors, device types, nicotine concentration) at baseline and past-month abstinence from cigarette smoking at follow-up. Weighted descriptive analysis was used, and multivariable logistic regression models examined ENDS features associated with past-month cigarette abstinence, adjusting for demographic factors and tobacco dependence at baseline.
RESULTS
Most participants used disposable devices (37.2 %; 95 % CI:33.2-41.5), followed by refillable tanks (30.2 %; 95 % CI:26.2-34.5). Additionally, fruit (41.3 %; 95 % CI:37.3-45.5), followed by menthol (19.1 %; 95 % CI:16.2-22.4), and tobacco (18.5 %; 95 % CI:15.5-22.1) were the most common flavors. The most common nicotine concentration used was 1-6 mg/ml (38.8 %; 95 % CI:34.6-43.2). Furthermore, in the adjusted model, daily ENDS users at baseline had 86 % (95 % CI:1.08-3.18) higher odds of past month cigarette abstinence at follow-up, than individuals who indicated 'not at all' to the current use of ENDS at baseline. There were no significant differences by preferred flavors, device type and nicotine concentrations (p-values > 0.05).
CONCLUSIONS
Daily ENDS users had higher odds of quitting cigarettes compared to those who stopped using ENDS. However, the type of device, flavoring, and nicotine concentration used by ENDS users were not associated with past-month cigarette abstinence at follow-up two years later.
PubMed: 38943930
DOI: 10.1016/j.addbeh.2024.108097 -
Public Health Jun 2024This study aimed to explore the intricate relationship between the health literacy and the awareness of risks and prevention awareness of infection disease among...
OBJECTIVE
This study aimed to explore the intricate relationship between the health literacy and the awareness of risks and prevention awareness of infection disease among prisoners.
STUDY DESIGN
A cross-sectional descriptive study was conducted among 1350 prisoners at an L Type Closed Penal Execution Institution in Turkey, using comprehensive criteria to ensure the inclusion of a diverse participant pool.
METHOD
Data was collected via face-to-face interviews using the "personal information form," "health literacy scale (HLS)," and "communicable diseases risk awareness and protection Scale (CDRAPS)." Both scales exhibited high reliability. Statistical analyses, including Pearson correlation and linear regression, were conducted to evaluate the relationships between the dimensions of these scales.
RESULTS
The study was completed with 1031 prisoners. The participants' mean age was 38.65 with a majority being single (69.2%) and high school graduates (46.3%). A weak positive correlation (r = 0.448, P = 0.000) was observed between the CDRAPS (mean score 135.98 ± 24.00) and the HLS (mean score 89.85 ± 22.30), indicating health literacy explained a 20% variance in communicable diseases risk awareness and prevention. Furthermore, a significant relationship was established considering multiple variables including age, marital and educational status, family health personnel presence, smoking and alcohol use, and comorbidities, showing a combined effect on disease risk awareness and prevention (R = 0.203, β = 0.458, P = 0.000).
CONCLUSION
These findings highlight the importance for governments and policy makers to implement preventive and educational programs that are focused on public health, aiming to increase prisoners' health literacy and awareness of infectious diseases.
PubMed: 38943834
DOI: 10.1016/j.puhe.2024.05.028 -
Maturitas Jun 2024A helpful method to understand cognitive decline in older people is to consider this entity as increasing cognitive frailty caused by a number of interacting... (Review)
Review
A helpful method to understand cognitive decline in older people is to consider this entity as increasing cognitive frailty caused by a number of interacting pathological processes. Over the last 20 years, multiple lifestyle, environmental and constitutional factors have been linked to the development of cognitive decline. For two interventions based on these factors, increasing physical activity and the control of hypertension, there is class 1 evidence for benefit. Other interventions based on these factors do not have the support of high-level evidence for the alteration of cognitive decline, but their other benefits would argue for their implementation. These interventions include increasing education, smoking cessation, avoiding head injuries, decreasing exposure to air pollution and increased social connections. As cognitive decline is experienced almost universally with ageing, and serious cognitive decline is experienced by substantial numbers of low-risk individuals, whole-of-population intervention strategies are the most effective and efficient. For other interventions to help prevent cognitive decline there is not sufficient evidence for their implementation to be recommended. These include alteration of alcohol ingestion, correction of hearing loss, treatment of depression, dietary interventions, menopausal hormone treatment and monoclonal antibodies directed against amyloid-β.
PubMed: 38943792
DOI: 10.1016/j.maturitas.2024.108062 -
Nigerian Journal of Clinical Practice Jun 2024Unexplained infertility is defined as the absence of any pathology in the basic evaluation performed in couples who cannot achieve pregnancy after 1 year of unprotected...
BACKGROUND
Unexplained infertility is defined as the absence of any pathology in the basic evaluation performed in couples who cannot achieve pregnancy after 1 year of unprotected sexual intercourse. The results of tests examining the causes of infertility show no identifiable cause in almost 15% of couples.
AIM
The aim of this study was to investigate the effects of reactive oxygen species (ROS) on pregnancy and embryos.
METHODS
This study included 200 patients, aged between 20-44 years, with unexplained infertility, who had recurrent intrauterine inseminations failures and hence started in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment. Some amounts of waste follicular fluid samples were collected by embryologists from the oocytes of these patients during the ovum pick-up procedure. Next, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were calculated in the biochemistry laboratory.
RESULTS
In terms of pregnancy status, both follicular TOS and OSI values were not significantly different in patients with biochemical and clinical pregnancy, whereas TAS values were significantly higher in patients with pregnancy (P < 0.05). In terms of embryo quality, no significant difference was observed in TAS, TOS, and OSI values between grade 1 and 2 embryos, whereas pregnancy rates were significantly higher in patients who received grade 1 embryo transfer (P < 0.05). However, the follicular fluid TAS levels were significantly lower in smoking patients than in those who did not smoke; TOS and OSI levels were significantly higher.
CONCLUSION
This study showed that exposure to oxidative stress might be a causative factor for infertility. In addition, ROS decreased the level of TAS by increasing OSI in the follicular fluid; thus, antioxidant supplementation might be a necessity.
Topics: Humans; Follicular Fluid; Female; Adult; Antioxidants; Pregnancy; Oxidants; Oxidative Stress; Fertilization in Vitro; Reactive Oxygen Species; Young Adult; Pregnancy Rate; Infertility, Female; Sperm Injections, Intracytoplasmic; Infertility
PubMed: 38943298
DOI: 10.4103/njcp.njcp_836_23 -
Particle and Fibre Toxicology Jun 2024Today, nanomaterials are broadly used in a wide range of industrial applications. Such large utilization and the limited knowledge on to the possible health effects have...
BACKGROUND
Today, nanomaterials are broadly used in a wide range of industrial applications. Such large utilization and the limited knowledge on to the possible health effects have raised concerns about potential consequences on human health and safety, beyond the environmental burden. Given that inhalation is the main exposure route, workers exposed to nanomaterials might be at risk of occurrence of respiratory morbidity and/or reduced pulmonary function. However, epidemiological evidence regarding the association between cumulative exposure to nanomaterials and respiratory health is still scarce. This study focused on the association between cumulative exposure to nanomaterials and pulmonary function among 136 workers enrolled in the framework of the European multicentric NanoExplore project.
RESULTS
Our findings suggest that, independently of lifelong tobacco smoking, ethnicity, age, sex, body mass index and physical activity habits, 10-year cumulative exposure to nanomaterials is associated to worse FEV and FEF, which might be consistent with the involvement of both large and small airway components and early signs of airflow obstruction. We further explored the hypothesis of a mediating effect via airway inflammation, assessed by interleukin (IL-)10, IL-1β and Tumor Necrosis Factor alpha (TNF-α), all quantified in the Exhaled Breath Condensate of workers. The mediation analysis results suggest that IL-10, TNF-α and their ratio (i.e., anti-pro inflammatory ratio) may fully mediate the negative association between cumulative exposure to nanomaterials and the FEV/FVC ratio. This pattern was not observed for other pulmonary function parameters.
CONCLUSIONS
Safeguarding the respiratory health of workers exposed to nanomaterials should be of primary importance. The observed association between cumulative exposure to nanomaterials and worse pulmonary function parameters underscores the importance of implementing adequate protective measures in the nanocomposite sector. The mitigation of harmful exposures may ensure that workers can continue to contribute productively to their workplaces while preserving their respiratory health over time.
Topics: Humans; Male; Nanostructures; Female; Occupational Exposure; Adult; Inhalation Exposure; Middle Aged; Lung; Pneumonia; Forced Expiratory Volume; Respiratory Function Tests; Cytokines; Air Pollutants, Occupational; Europe
PubMed: 38943182
DOI: 10.1186/s12989-024-00589-3 -
Trials Jun 2024Social isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U?...
Impact of an intergenerational program to improve loneliness and social isolation in older adults initiated at the time of emergency department discharge: study protocol for a three-arm randomized clinical trial.
BACKGROUND
Social isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U? intervention using peer support from similar-aged volunteers and demonstrated reduced SIL among older adults discharged from the emergency department (ED). Generativity, defined as "the interest in establishing and guiding the next generation," can provide an alternative theoretical basis for reducing SIL via intergenerational programs between members of younger and older generations. The current protocol will examine the impact of younger intergenerational volunteers providing the HOW RU?
METHODS
In this randomized clinical trial, we will compare the following three arms: (1) the standard same-generation peer support HOW R U? intervention, (2) HOW R U? intervention delivered by intergenerational volunteers, and (3) a common wait-list control group. Outcome assessors will be blinded to the intervention. Trained volunteers will deliver 12 weekly telephone support calls. We will recruit participants ≥ 70 years of age with baseline loneliness (six-item De Jong loneliness score of 2 or greater) from two EDs. Research staff will assess SIL, depression, quality of life, functional status, generativity, and perceived benefit at baseline, at 12 weeks, and 24 weeks post-intervention.
DISCUSSION
We hypothesize participants receiving the intergenerational intervention will show improved outcomes compared to the control group and peer support HOW R U?
INTERVENTION
We also hypothesize that participants with higher perceptions of generativity will have greater reductions in SIL than their lower generativity counterparts. Aging is experienced diversely, and social interventions combatting associated SIL should reflect that diversity. As part of a program of research following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, the findings of this RCT will be used to define which intervention characteristics are most effective in reducing SIL.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05998343 Protocol ID:21-0074E. Registered on 24 July 2023.
Topics: Humans; Loneliness; Social Isolation; Aged; Emergency Service, Hospital; Randomized Controlled Trials as Topic; Patient Discharge; Intergenerational Relations; Female; Quality of Life; Male; Peer Group; Social Support; Age Factors; Time Factors; Treatment Outcome; Volunteers
PubMed: 38943176
DOI: 10.1186/s13063-024-08250-2 -
BMC Public Health Jun 2024Coronavirus disease 2019 (COVID-19), a global public health crisis, continues to pose challenges despite preventive measures. The daily rise in COVID-19 cases is...
BACKGROUND
Coronavirus disease 2019 (COVID-19), a global public health crisis, continues to pose challenges despite preventive measures. The daily rise in COVID-19 cases is concerning, and the testing process is both time-consuming and costly. While several models have been created to predict mortality in COVID-19 patients, only a few have shown sufficient accuracy. Machine learning algorithms offer a promising approach to data-driven prediction of clinical outcomes, surpassing traditional statistical modeling. Leveraging machine learning (ML) algorithms could potentially provide a solution for predicting mortality in hospitalized COVID-19 patients in Ethiopia. Therefore, the aim of this study is to develop and validate machine-learning models for accurately predicting mortality in COVID-19 hospitalized patients in Ethiopia.
METHODS
Our study involved analyzing electronic medical records of COVID-19 patients who were admitted to public hospitals in Ethiopia. Specifically, we developed seven different machine learning models to predict COVID-19 patient mortality. These models included J48 decision tree, random forest (RF), k-nearest neighborhood (k-NN), multi-layer perceptron (MLP), Naïve Bayes (NB), eXtreme gradient boosting (XGBoost), and logistic regression (LR). We then compared the performance of these models using data from a cohort of 696 patients through statistical analysis. To evaluate the effectiveness of the models, we utilized metrics derived from the confusion matrix such as sensitivity, specificity, precision, and receiver operating characteristic (ROC).
RESULTS
The study included a total of 696 patients, with a higher number of females (440 patients, accounting for 63.2%) compared to males. The median age of the participants was 35.0 years old, with an interquartile range of 18-79. After conducting different feature selection procedures, 23 features were examined, and identified as predictors of mortality, and it was determined that gender, Intensive care unit (ICU) admission, and alcohol drinking/addiction were the top three predictors of COVID-19 mortality. On the other hand, loss of smell, loss of taste, and hypertension were identified as the three lowest predictors of COVID-19 mortality. The experimental results revealed that the k-nearest neighbor (k-NN) algorithm outperformed than other machine learning algorithms, achieving an accuracy of 95.25%, sensitivity of 95.30%, precision of 92.7%, specificity of 93.30%, F1 score 93.98% and a receiver operating characteristic (ROC) score of 96.90%. These findings highlight the effectiveness of the k-NN algorithm in predicting COVID-19 outcomes based on the selected features.
CONCLUSION
Our study has developed an innovative model that utilizes hospital data to accurately predict the mortality risk of COVID-19 patients. The main objective of this model is to prioritize early treatment for high-risk patients and optimize strained healthcare systems during the ongoing pandemic. By integrating machine learning with comprehensive hospital databases, our model effectively classifies patients' mortality risk, enabling targeted medical interventions and improved resource management. Among the various methods tested, the K-nearest neighbors (KNN) algorithm demonstrated the highest accuracy, allowing for early identification of high-risk patients. Through KNN feature identification, we identified 23 predictors that significantly contribute to predicting COVID-19 mortality. The top five predictors are gender (female), intensive care unit (ICU) admission, alcohol drinking, smoking, and symptoms of headache and chills. This advancement holds great promise in enhancing healthcare outcomes and decision-making during the pandemic. By providing services and prioritizing patients based on the identified predictors, healthcare facilities and providers can improve the chances of survival for individuals. This model provides valuable insights that can guide healthcare professionals in allocating resources and delivering appropriate care to those at highest risk.
Topics: Humans; COVID-19; Machine Learning; Ethiopia; Male; Female; Middle Aged; Adult; Algorithms; Aged; SARS-CoV-2; Hospitalization; Electronic Health Records; Young Adult; Adolescent
PubMed: 38943093
DOI: 10.1186/s12889-024-19196-0 -
British Journal of Cancer Jun 2024Through the use of an innovative method to identify original publications, we conducted a meta-analysis of all epidemiological studies evaluating the association... (Review)
Review
Through the use of an innovative method to identify original publications, we conducted a meta-analysis of all epidemiological studies evaluating the association between second-hand smoke (SHS) exposure and breast cancer risk among female non-smokers published in English up to October 2022. Pooled relative risks (RR) were obtained through the use of random-effects models. Dose-response relationships were derived using log-linear functions. Out of 73 identified eligible studies, 63 original articles were included in the meta-analysis. The pooled RR for breast cancer for overall exposure to SHS was 1.24 (95% confidence interval, CI, 1.15-1.34, number of articles, n = 52). Regarding the setting of exposure, RRs were 1.17 (95% CI 1.08-1.27, n = 37) for SHS exposure at home, 1.03 (95% CI 0.98-1.08, n = 15) at the workplace, 1.24 (95% CI 1.11-1.37, n = 16) at home or workplace, and 1.45 (95% CI 1.16-1.80, n = 13) for non-specified settings. The risk of breast cancer increased linearly with higher duration (RR 1.29; 95% CI 1.04-1.59 for 40 years of SHS exposure, n = 12), intensity (RR 1.38; 95% CI 1.14-1.67 for 20 cigarettes of SHS exposure per day, n = 6), and pack-years (RR 1.50; 95% CI 0.92-2.45 for 40 SHS pack-years, n = 6) of SHS exposure. This meta-analysis shows a statistically significant excess risk of breast cancer in women exposed to SHS.
PubMed: 38942988
DOI: 10.1038/s41416-024-02732-5