Pub Date : 2024-06-05DOI: 10.1101/2024.06.05.24308474
A. Andrayas, H. J. Jones, J. Khouja, L. Hines, M. Munafo, J. Heron, H. Sallis
Introduction Smoking contributes a huge burden on public health; thus, identifying risk factors for smoking remains an important area of research. This study adds to the wealth of existing literature by utilising repeated smoking measures collected in a UK sample of young adults to (a) examine differences between longitudinal smoking behaviours, (b) investigate their association with many risk factors, and c) consider how these associations may change over time. Methods This study uses longitudinal latent class analysis and 12 repeated measures to derive patterns of smoking in the Avon Longitudinal Study of Parents and Children. The association of these patterns with 402 risk factor measures collected from 0-28 years is then investigated. The selected risk factors include familial and peer factors, lifestyle and sociodemographic factors, mental health, parenthood, adverse childhood experiences and trauma. Results Five different latent classes of smoking were derived and referred to as non-smoking, short-term smoking, occasional smoking, early-onset smoking, and late-onset smoking. These showed differences in age of onset, frequency, and cessation. Other substance use, and parental and peer substance use, showed the strongest association with smoking patterns. More risk factors were associated with early-onset than late-onset smoking. Many risk factors of regular smoking did not show the same associations with occasional smoking. Fewer measures differentiated late-onset from short-term smoking. Some associations varied depending on the time of measurement or smoking pattern in question. Conclusions Findings from this study may be used to identify groups of people most vulnerable to more harmful smoking patterns despite being exposed to strong tobacco prevention efforts. This could also help better tailor smoking interventions and improve tobacco control policies.
{"title":"Longitudinal patterns of smoking behaviours in adolescence and early adulthood and their association with modifiable and sociodemographic risk factors","authors":"A. Andrayas, H. J. Jones, J. Khouja, L. Hines, M. Munafo, J. Heron, H. Sallis","doi":"10.1101/2024.06.05.24308474","DOIUrl":"https://doi.org/10.1101/2024.06.05.24308474","url":null,"abstract":"Introduction Smoking contributes a huge burden on public health; thus, identifying risk factors for smoking remains an important area of research. This study adds to the wealth of existing literature by utilising repeated smoking measures collected in a UK sample of young adults to (a) examine differences between longitudinal smoking behaviours, (b) investigate their association with many risk factors, and c) consider how these associations may change over time. Methods This study uses longitudinal latent class analysis and 12 repeated measures to derive patterns of smoking in the Avon Longitudinal Study of Parents and Children. The association of these patterns with 402 risk factor measures collected from 0-28 years is then investigated. The selected risk factors include familial and peer factors, lifestyle and sociodemographic factors, mental health, parenthood, adverse childhood experiences and trauma. Results Five different latent classes of smoking were derived and referred to as non-smoking, short-term smoking, occasional smoking, early-onset smoking, and late-onset smoking. These showed differences in age of onset, frequency, and cessation. Other substance use, and parental and peer substance use, showed the strongest association with smoking patterns. More risk factors were associated with early-onset than late-onset smoking. Many risk factors of regular smoking did not show the same associations with occasional smoking. Fewer measures differentiated late-onset from short-term smoking. Some associations varied depending on the time of measurement or smoking pattern in question. Conclusions Findings from this study may be used to identify groups of people most vulnerable to more harmful smoking patterns despite being exposed to strong tobacco prevention efforts. This could also help better tailor smoking interventions and improve tobacco control policies.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.04.24308447
Yimin Li, N. Bollen, S. Hong, Marius Brusselmans, Fabiana G´ambaro, M. Suchard, A. Rambaut, P. Lemey, S. Dellicour, G. Baele
Phylogeographic analyses are able to exploit the location data associated with sampled molecular sequences to reconstruct the spatio-temporal dispersal history of a pathogen. Visualisation software is commonly used to facilitate the interpretation of the accompanying estimation results, as these are not always easily interpretable. spread.gl is a powerful, open-source and feature-rich browser application that enables smooth, intuitive and user-friendly visualisation of both discrete and continuous phylogeographic inference results, enabling the animation of pathogen geographic dispersal through time. spread.gl can render and combine the visualisation of several data layers, including a geographic layer (e.g., a world map), multiple layers that contain information extracted from the input phylogeny, and different types of layers that represent environmental data. As such, users can explore which environmental data may have shaped pathogen dispersal patterns, that can subsequently be formally tested through more principled statistical analyses. We showcase the visualisation features of spread.gl on several representative pathogen dispersal examples, including the smooth animation of a phylogeny encompassing over 17,000 genomic sequences resulting from a large-scale SARS-CoV-2 analysis.
{"title":"spread.gl: visualising pathogen dispersal in a high-performance browser application","authors":"Yimin Li, N. Bollen, S. Hong, Marius Brusselmans, Fabiana G´ambaro, M. Suchard, A. Rambaut, P. Lemey, S. Dellicour, G. Baele","doi":"10.1101/2024.06.04.24308447","DOIUrl":"https://doi.org/10.1101/2024.06.04.24308447","url":null,"abstract":"Phylogeographic analyses are able to exploit the location data associated with sampled molecular sequences to reconstruct the spatio-temporal dispersal history of a pathogen. Visualisation software is commonly used to facilitate the interpretation of the accompanying estimation results, as these are not always easily interpretable. spread.gl is a powerful, open-source and feature-rich browser application that enables smooth, intuitive and user-friendly visualisation of both discrete and continuous phylogeographic inference results, enabling the animation of pathogen geographic dispersal through time. spread.gl can render and combine the visualisation of several data layers, including a geographic layer (e.g., a world map), multiple layers that contain information extracted from the input phylogeny, and different types of layers that represent environmental data. As such, users can explore which environmental data may have shaped pathogen dispersal patterns, that can subsequently be formally tested through more principled statistical analyses. We showcase the visualisation features of spread.gl on several representative pathogen dispersal examples, including the smooth animation of a phylogeny encompassing over 17,000 genomic sequences resulting from a large-scale SARS-CoV-2 analysis.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.05.24308046
Leening P. Liu, Pouyan Pasyar, Fang Liu, Ph.D Quy Cao, Olivia F Sandvold, Ph.D Pooyan Sahbaee, Ph.D Russell T. Shinohara, M. Harold I. Litt, M. Peter B. Noël
Background: Among the advancements in computed tomography (CT) technology, photon-counting computed tomography (PCCT) stands out as a significant innovation, providing superior spectral imaging capabilities while simultaneously reducing radiation exposure. Its long-term stability is important for clinical care, especially longitudinal studies, but is currently unknown. Purpose: This study sets out to comprehensively analyze the long-term stability of a first-generation clinical PCCT scanner. Materials and Methods: Over a two-year period, from November 2021 to November 2023, we conducted weekly identical experiments utilizing the same multi-energy CT protocol. These experiments included various tissue-mimicking inserts to rigorously assess the stability of Hounsfield Units (HU) and image noise in Virtual Monochromatic Images (VMIs) and iodine density maps. Throughout this period, notable software and hardware modifications were meticulously recorded. Each week, VMIs and iodine density maps were reconstructed and analyzed to evaluate quantitative stability over time. Results: Spectral results consistently demonstrated the quantitative stability of PCCT. VMIs exhibited stable HU values, such as variation in relative error for VMI 70 keV measuring 0.11% and 0.30% for single-source and dual-source modes, respectively. Similarly, noise levels remained stable with slight fluctuations linked to software changes for VMI 40 and 70 keV that corresponded to changes of 8 and 1 HU, respectively. Furthermore, iodine density quantification maintained stability and showed significant improvement with software and hardware changes, especially in dual-source mode with nominal errors decreasing from 1.44 to 0.03 mg/mL. Conclusion: This study provides the first long-term reproducibility assessment of quantitative PCCT imaging, highlighting its potential for the clinical arena. This study indicates its long-term utility in diagnostic radiology, especially for longitudinal studies.
{"title":"Assessing the Stability of Photon-Counting CT: Insights from a Two-Year Longitudinal Study","authors":"Leening P. Liu, Pouyan Pasyar, Fang Liu, Ph.D Quy Cao, Olivia F Sandvold, Ph.D Pooyan Sahbaee, Ph.D Russell T. Shinohara, M. Harold I. Litt, M. Peter B. Noël","doi":"10.1101/2024.06.05.24308046","DOIUrl":"https://doi.org/10.1101/2024.06.05.24308046","url":null,"abstract":"Background: Among the advancements in computed tomography (CT) technology, photon-counting computed tomography (PCCT) stands out as a significant innovation, providing superior spectral imaging capabilities while simultaneously reducing radiation exposure. Its long-term stability is important for clinical care, especially longitudinal studies, but is currently unknown. Purpose: This study sets out to comprehensively analyze the long-term stability of a first-generation clinical PCCT scanner. Materials and Methods: Over a two-year period, from November 2021 to November 2023, we conducted weekly identical experiments utilizing the same multi-energy CT protocol. These experiments included various tissue-mimicking inserts to rigorously assess the stability of Hounsfield Units (HU) and image noise in Virtual Monochromatic Images (VMIs) and iodine density maps. Throughout this period, notable software and hardware modifications were meticulously recorded. Each week, VMIs and iodine density maps were reconstructed and analyzed to evaluate quantitative stability over time. Results: Spectral results consistently demonstrated the quantitative stability of PCCT. VMIs exhibited stable HU values, such as variation in relative error for VMI 70 keV measuring 0.11% and 0.30% for single-source and dual-source modes, respectively. Similarly, noise levels remained stable with slight fluctuations linked to software changes for VMI 40 and 70 keV that corresponded to changes of 8 and 1 HU, respectively. Furthermore, iodine density quantification maintained stability and showed significant improvement with software and hardware changes, especially in dual-source mode with nominal errors decreasing from 1.44 to 0.03 mg/mL. Conclusion: This study provides the first long-term reproducibility assessment of quantitative PCCT imaging, highlighting its potential for the clinical arena. This study indicates its long-term utility in diagnostic radiology, especially for longitudinal studies.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.04.24308466
L. Fry, A. Brake, C. Heskett, F. De Stefano, A. Williams, N. Majo, C. Lei, A. Alkiswani, K. Le, A. G. Rouse, J. Peterson, K. Ebersole
Background: Previous studies have reported a positive relationship between higher hospital endovascular thrombectomy (EVT) volume and shorter procedures, higher revascularization rates, and improved functional outcomes. We investigated the association between hospital EVT volume and clinical outcomes using the National Inpatient Sample (NIS) database from 2016-2020. Methods: A cross-sectional analysis of the NIS examining the relationship of hospital EVT volume and outcomes was performed. All relevant clinical and demographic information was collected. The outcomes were favorable functional outcome (home without assistance), inpatient mortality, and intracerebral hemorrhage (ICH). Centers were classified as high-volume if they were in the top quintile of annual EVT volume. We performed univariate, multivariate, nearest neighbor matched analysis, and an exploratory annual case volume cutoff analysis. Results: There were 114,640 patients who underwent EVT included in the sample. Of these, 24,415 (21.3%) were in the high-volume group. High-volume centers had higher rates of favorable functional outcome in univariate (OR 1.20, p < 0.001), multivariate (aOR 1.19, p = 0.003), and matched analysis (OR 1.14, p = 0.028). Prior to matching, lower rates of inpatient mortality (OR 0.83, p < 0.001). However, in univariate and matched analysis there were no differences between high and low-volume centers. There were no differences in ICH across all analyses. Functional benefit was first noted at [≥] 50 EVTs, but centers performing [≥] 175 EVTs had substantially higher functional benefit (aOR 1.42, p = 0.002). Conclusions: Our analysis demonstrates increased hospital case volume is associated with a modest improvement in favorable functional outcomes in patients undergoing EVT for AIS. Attempts to identify procedural cut off values reveal likely improved functional outcomes beginning at 50 EVT per year, while this benefit seems to increase with increasing case volumes. These higher levels of case volumes do not lead to higher rates of inpatient mortality or ICH. ?
{"title":"Association of Endovascular Thrombectomy Volume and Outcomes in Acute Ischemic Stroke: A National Inpatient Sample Study","authors":"L. Fry, A. Brake, C. Heskett, F. De Stefano, A. Williams, N. Majo, C. Lei, A. Alkiswani, K. Le, A. G. Rouse, J. Peterson, K. Ebersole","doi":"10.1101/2024.06.04.24308466","DOIUrl":"https://doi.org/10.1101/2024.06.04.24308466","url":null,"abstract":"Background: Previous studies have reported a positive relationship between higher hospital endovascular thrombectomy (EVT) volume and shorter procedures, higher revascularization rates, and improved functional outcomes. We investigated the association between hospital EVT volume and clinical outcomes using the National Inpatient Sample (NIS) database from 2016-2020. Methods: A cross-sectional analysis of the NIS examining the relationship of hospital EVT volume and outcomes was performed. All relevant clinical and demographic information was collected. The outcomes were favorable functional outcome (home without assistance), inpatient mortality, and intracerebral hemorrhage (ICH). Centers were classified as high-volume if they were in the top quintile of annual EVT volume. We performed univariate, multivariate, nearest neighbor matched analysis, and an exploratory annual case volume cutoff analysis. Results: There were 114,640 patients who underwent EVT included in the sample. Of these, 24,415 (21.3%) were in the high-volume group. High-volume centers had higher rates of favorable functional outcome in univariate (OR 1.20, p < 0.001), multivariate (aOR 1.19, p = 0.003), and matched analysis (OR 1.14, p = 0.028). Prior to matching, lower rates of inpatient mortality (OR 0.83, p < 0.001). However, in univariate and matched analysis there were no differences between high and low-volume centers. There were no differences in ICH across all analyses. Functional benefit was first noted at [≥] 50 EVTs, but centers performing [≥] 175 EVTs had substantially higher functional benefit (aOR 1.42, p = 0.002). Conclusions: Our analysis demonstrates increased hospital case volume is associated with a modest improvement in favorable functional outcomes in patients undergoing EVT for AIS. Attempts to identify procedural cut off values reveal likely improved functional outcomes beginning at 50 EVT per year, while this benefit seems to increase with increasing case volumes. These higher levels of case volumes do not lead to higher rates of inpatient mortality or ICH. ?","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.05.24308489
T. Iwata, T. Yanagisawa, R. Fukuma, Y. Ikegaya, S. Oshino, N. Tani, H. M. Khoo, H. Sugano, Y. Iimura, H. Suzuki, H. Kishima
Objective: Hippocampal ripples are biomarkers of epileptogenicity in patients with epilepsy, and physiological features characterize memory function in healthy individuals. Discriminating between pathological and physiological ripples is important for identifying the epileptogenic (EP) zone; however, distinguishing them from waveforms is difficult. This study hypothesized that the nocturnal synchronization of hippocampal ripples and cortical delta power classifies EP and physiological hippocampi. Methods: We enrolled 38 patients with electrodes implanted in the hippocampus or the parahippocampal gyrus between April 2014 and March 2023 at our institution. We classified 11 patients (11 hippocampi) into the EP group, who were pathologically diagnosed with hippocampal sclerosis, and five patients (six hippocampi) into the non-epileptogenic (NE) group, whose hippocampi had no epileptogenicity. Hippocampal ripples were detected using intracranial electroencephalography of the hippocampal or parahippocampal electrodes and presented as ripple rates per second. Cortical delta power (0.5-4 Hz) was assessed using cortical electrodes. The Pearson correlation coefficient between the ripple rates and the cortical delta power (CRD) was calculated for the intracranial electroencephalographic signals obtained every night during the recordings. Results: Hippocampal ripples detected from continuous recording for approximately 10 days demonstrated similar frequency characteristics between the EP and NE groups. However, CRDs in the EP group (mean [standard deviation]: 0.20 [0.049]) were significantly lower than those in the NE group (0.67 [0.070], F (1,124) = 29.6, p < 0.0001 (group), F (9,124) = 1.0, p = 0.43 (day); two-way analysis of variance). Based on the minimum CRDs during the 10-day recordings, the two groups were classified with 94.1% accuracy. Conclusion: CRD is a biomarker of hippocampal epileptogenicity.
目的：海马波纹是癫痫患者致痫性的生物标志物，而生理特征则是健康人记忆功能的特征。区分病理性波纹和生理性波纹对于识别致痫区非常重要，但将它们与波形区分开来却很困难。本研究假设，海马波纹和皮层德尔塔功率的夜间同步性可对 EP 和生理性海马进行分类。研究方法2014年4月至2023年3月期间，我们在本机构招募了38名在海马或海马旁回植入电极的患者。我们将11名患者（11个海马）分为EP组，他们被病理诊断为海马硬化；将5名患者（6个海马）分为非致痫组（NE），他们的海马没有致痫性。海马波纹是通过海马或海马旁电极的颅内脑电图检测到的，并以每秒波纹率表示。皮质德尔塔功率（0.5-4 赫兹）通过皮质电极进行评估。对每晚记录的颅内脑电信号，计算波纹率与皮层德尔塔功率（CRD）之间的皮尔逊相关系数。结果连续记录约 10 天检测到的海马波纹在 EP 组和 NE 组之间表现出相似的频率特性。然而，EP 组的 CRDs（平均值[标准差]：0.20 [0.049]）明显低于 NE 组（0.67 [0.070]，F (1,124) = 29.6，p < 0.0001（组），F (9,124) = 1.0，p = 0.43（天）；双向方差分析）。根据 10 天记录中的最小 CRD，两组的分类准确率为 94.1%。结论CRD是海马致痫性的生物标志物。
{"title":"Nocturnal synchronization between hippocampal ripples and cortical delta power is a biomarker of hippocampal epileptogenicity","authors":"T. Iwata, T. Yanagisawa, R. Fukuma, Y. Ikegaya, S. Oshino, N. Tani, H. M. Khoo, H. Sugano, Y. Iimura, H. Suzuki, H. Kishima","doi":"10.1101/2024.06.05.24308489","DOIUrl":"https://doi.org/10.1101/2024.06.05.24308489","url":null,"abstract":"Objective: Hippocampal ripples are biomarkers of epileptogenicity in patients with epilepsy, and physiological features characterize memory function in healthy individuals. Discriminating between pathological and physiological ripples is important for identifying the epileptogenic (EP) zone; however, distinguishing them from waveforms is difficult. This study hypothesized that the nocturnal synchronization of hippocampal ripples and cortical delta power classifies EP and physiological hippocampi. Methods: We enrolled 38 patients with electrodes implanted in the hippocampus or the parahippocampal gyrus between April 2014 and March 2023 at our institution. We classified 11 patients (11 hippocampi) into the EP group, who were pathologically diagnosed with hippocampal sclerosis, and five patients (six hippocampi) into the non-epileptogenic (NE) group, whose hippocampi had no epileptogenicity. Hippocampal ripples were detected using intracranial electroencephalography of the hippocampal or parahippocampal electrodes and presented as ripple rates per second. Cortical delta power (0.5-4 Hz) was assessed using cortical electrodes. The Pearson correlation coefficient between the ripple rates and the cortical delta power (CRD) was calculated for the intracranial electroencephalographic signals obtained every night during the recordings. Results: Hippocampal ripples detected from continuous recording for approximately 10 days demonstrated similar frequency characteristics between the EP and NE groups. However, CRDs in the EP group (mean [standard deviation]: 0.20 [0.049]) were significantly lower than those in the NE group (0.67 [0.070], F (1,124) = 29.6, p < 0.0001 (group), F (9,124) = 1.0, p = 0.43 (day); two-way analysis of variance). Based on the minimum CRDs during the 10-day recordings, the two groups were classified with 94.1% accuracy. Conclusion: CRD is a biomarker of hippocampal epileptogenicity.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.04.24308459
R. Lamichhane, V. Bharti, A. R. Lamichhane, K. Zaheer
Metabolic dysfunction of metabolic syndromes (MetS) has been widely reported to be a significant risk factor for heart failure (HF). While this interaction is well studied, what combinations of MetS factors pose the greatest risk for HF are not well defined. We hypothesize that some components of MetS are of higher risk of HF compared to others. We explored the relationship between the independent components of MetS and their combinatory effect on the risk of HF. All metabolic syndrome components except hypertriglyceridemia were significant individually (P-value<0.001), while hypertension (HTN) and diabetes or insulin resistance (IR) had the higher risk of developing heart failure when taken collectively. The odds of heart failure among the individuals who had HTN and IR was 7.7 times those who didn't have any MetS components. We observed the additive effect of number of metabolic components on HF, for the individuals who had only one MetS symptom, the odds of HF was 5.4 time compared to those who didn't have any of MetS symptoms. Similarly, these odds of HF were 6.4 and 7.4 times for those who had at least 2 or at least 3 symptoms respectively. Even though obesity is a significant risk factor for cardiovascular diseases, we found the protective effect of obesity on heart failure, which is an interesting result and needs further investigation. Keywords: Retrospective case-control study, metabolic syndrome, heart failure, obesity, hypertension, insulin resistance, risk analysis
{"title":"Risk of Heart Failure among Individuals with Metabolic Syndrome Components","authors":"R. Lamichhane, V. Bharti, A. R. Lamichhane, K. Zaheer","doi":"10.1101/2024.06.04.24308459","DOIUrl":"https://doi.org/10.1101/2024.06.04.24308459","url":null,"abstract":"Metabolic dysfunction of metabolic syndromes (MetS) has been widely reported to be a significant risk factor for heart failure (HF). While this interaction is well studied, what combinations of MetS factors pose the greatest risk for HF are not well defined. We hypothesize that some components of MetS are of higher risk of HF compared to others. We explored the relationship between the independent components of MetS and their combinatory effect on the risk of HF. All metabolic syndrome components except hypertriglyceridemia were significant individually (P-value<0.001), while hypertension (HTN) and diabetes or insulin resistance (IR) had the higher risk of developing heart failure when taken collectively. The odds of heart failure among the individuals who had HTN and IR was 7.7 times those who didn't have any MetS components. We observed the additive effect of number of metabolic components on HF, for the individuals who had only one MetS symptom, the odds of HF was 5.4 time compared to those who didn't have any of MetS symptoms. Similarly, these odds of HF were 6.4 and 7.4 times for those who had at least 2 or at least 3 symptoms respectively. Even though obesity is a significant risk factor for cardiovascular diseases, we found the protective effect of obesity on heart failure, which is an interesting result and needs further investigation. Keywords: Retrospective case-control study, metabolic syndrome, heart failure, obesity, hypertension, insulin resistance, risk analysis","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.05.24308495
M. Perini, T. K. Yamana, M. Galanti, J. Suh, R. F. Kaondera-Shava, J. Shaman
Background: Metapopulation models provide platforms for understanding infectious disease dynamics and predicting clinical outcomes across interconnected populations, particularly for large epidemics and pandemics like COVID-19. Methods: We developed a novel metapopulation model for simulating respiratory virus transmission in the North America region, specifically for the 96 states, provinces, and territories of Canada, Mexico and the United States. The model is informed by COVID-19 case data, which are assimilated using the Ensemble Adjustment Kalman filter (EAKF), a Bayesian inference algorithm, and commuting and mobility data, which are used to build and adjust the network and movement across locations on a daily basis. Findings: This model-inference system provides estimates of transmission dynamics, infection rates, and ascertainment rates for each of the 96 locations from January 2020 to March 2021. The results highlight differences in disease dynamics and ascertainment among the three countries. Interpretation: The metapopulation structure enables rapid simulation at large scale, and the data assimilation method makes the system responsive to changes in system dynamics. This model can serve as a versatile platform for modeling other infectious diseases across the North American region.
{"title":"Modelling COVID-19 in the North American region with a metapopulation network and Kalman filter","authors":"M. Perini, T. K. Yamana, M. Galanti, J. Suh, R. F. Kaondera-Shava, J. Shaman","doi":"10.1101/2024.06.05.24308495","DOIUrl":"https://doi.org/10.1101/2024.06.05.24308495","url":null,"abstract":"Background: Metapopulation models provide platforms for understanding infectious disease dynamics and predicting clinical outcomes across interconnected populations, particularly for large epidemics and pandemics like COVID-19. Methods: We developed a novel metapopulation model for simulating respiratory virus transmission in the North America region, specifically for the 96 states, provinces, and territories of Canada, Mexico and the United States. The model is informed by COVID-19 case data, which are assimilated using the Ensemble Adjustment Kalman filter (EAKF), a Bayesian inference algorithm, and commuting and mobility data, which are used to build and adjust the network and movement across locations on a daily basis. Findings: This model-inference system provides estimates of transmission dynamics, infection rates, and ascertainment rates for each of the 96 locations from January 2020 to March 2021. The results highlight differences in disease dynamics and ascertainment among the three countries. Interpretation: The metapopulation structure enables rapid simulation at large scale, and the data assimilation method makes the system responsive to changes in system dynamics. This model can serve as a versatile platform for modeling other infectious diseases across the North American region.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To date, survival data on risk factors for COVID-19 mortality in south-Ethiopia is limited, and none of the published survival studies have used a competing risk approach. This study aims to identify risk factors for in-hospital mortality in COVID-19 patients hospitalized at one of the six hospitals in southeast-Ethiopia, considering recovery as a competing risk. Methods: This observational multisite study included a medical record of 827 confirmed SARS-CoV-2 cases hospitalized at one of the six hospitals in southeast-Ethiopia from October 1, 2022 to May 31, 2023. We compiled data on the patients' socio-demographic characteristics, clinical manifestation, comorbidity, treatment status, treatment outcomes, and length of stay. We performed a Cox regression analysis for competing risks, presenting cause-specific hazard ratios (HRcs) for the effect of preselected factors on the absolute risk of death and recovery. Results: 827 patients were included (51.9% male; median age 50 years, IQR: 38-65). Patients were hospitalized for a median duration of 5 days (IQR: 1-7); 139 (17%) of them died, while 516 (62%) were recovered and discharged alive, the rest 172 (21%) were censored. Patients with higher age (HRcs 2.62, 95% CI 1.29-5.29), immune-compromised state (HRcs 1.46, 95% CI 1.08-1.98) had increased risk of death, whereas male sex paradoxically (HRcs 0.45, 95% CI 0.22-0.91) associated with decreased risk of death. We found no increased mortality risk in diabetes patients. Conclusion: This competing risk survival analysis allows us to corroborate specific pattern of risk factors about COVID-19 mortality and its progression among different groups of individuals (differentiated by age and immune-compromised state). 62% presenting cases recovered within a median duration of 5 days; where as 17% die within the first 72 hours, most with immune-compromised conditions. This should be considered while planning and allocating the distribution of care services for effective health service delivery.
{"title":"Competing Risk Survival analysis of time to in-hospital mortality or Recovery among Covid-19 Patients in South-East Ethiopia: a hospital-based multisite study","authors":"Addis Wordofa, Ayalneh Demissie, Abdurehman Kalu, Abdurehman Tune, Mohammed Suleiman, Abay Kibret, Zerihun Abera, Yonas Mulugeta, Details","doi":"10.1101/2024.06.04.24308446","DOIUrl":"https://doi.org/10.1101/2024.06.04.24308446","url":null,"abstract":"Background: To date, survival data on risk factors for COVID-19 mortality in south-Ethiopia is limited, and none of the published survival studies have used a competing risk approach. This study aims to identify risk factors for in-hospital mortality in COVID-19 patients hospitalized at one of the six hospitals in southeast-Ethiopia, considering recovery as a competing risk. Methods: This observational multisite study included a medical record of 827 confirmed SARS-CoV-2 cases hospitalized at one of the six hospitals in southeast-Ethiopia from October 1, 2022 to May 31, 2023. We compiled data on the patients' socio-demographic characteristics, clinical manifestation, comorbidity, treatment status, treatment outcomes, and length of stay. We performed a Cox regression analysis for competing risks, presenting cause-specific hazard ratios (HRcs) for the effect of preselected factors on the absolute risk of death and recovery. Results: 827 patients were included (51.9% male; median age 50 years, IQR: 38-65). Patients were hospitalized for a median duration of 5 days (IQR: 1-7); 139 (17%) of them died, while 516 (62%) were recovered and discharged alive, the rest 172 (21%) were censored. Patients with higher age (HRcs 2.62, 95% CI 1.29-5.29), immune-compromised state (HRcs 1.46, 95% CI 1.08-1.98) had increased risk of death, whereas male sex paradoxically (HRcs 0.45, 95% CI 0.22-0.91) associated with decreased risk of death. We found no increased mortality risk in diabetes patients. Conclusion: This competing risk survival analysis allows us to corroborate specific pattern of risk factors about COVID-19 mortality and its progression among different groups of individuals (differentiated by age and immune-compromised state). 62% presenting cases recovered within a median duration of 5 days; where as 17% die within the first 72 hours, most with immune-compromised conditions. This should be considered while planning and allocating the distribution of care services for effective health service delivery.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.04.24308469
Sarah Polack, Vinicius Delgado Ramos, L. Köptcke, Indyara de, Araújo Morais, Veronika Reichenberger, Nathaniel Scherer, Maria do, Socorro Veloso de Albuquerque, Hannah Kuper, T. Lyra, Christina May Moran de Brito
Background: People with disabilities face more barriers accessing healthcare and, on average, experience worse health outcomes. Strengthening health access for people with disabilities requires coordinated action across the health system. The Missing Billion Inclusive Health System Framework is a new tool to support policy makers assess levels of disability inclusion within health systems. In this study we use the framework within the Unified Health System in Brazil. We consider the relevance and feasibility of the indicators, as part of further testing and refining the framework. Methods: Information sources, used to complete the assessment, included Brazilian laws and policies, publically available data, published literature and interviews with people with disabilities and service providers. A workshop with stakeholders was held to co-develop key recommendations. Findings: Overall, the framework was comprehensive and feasible to complete. It highlighted key strengths in terms of disability inclusion in the Brazilian health system as well as gaps and leverage points for action. Interpretation: The Missing Billions framework can identify progress and opportunities to strengthen disability inclusion in health systems. In Brazil, key promotive factors include supportive policies, leadership and financing structures. There are also opportunities for strengthening data and evidence, healthcare worker training on disability and health service accessibility. Actions must be centered on, and informed by, people with disabilities.
{"title":"Disability inclusion in the Brazilian health system: results of a health system assessment","authors":"Sarah Polack, Vinicius Delgado Ramos, L. Köptcke, Indyara de, Araújo Morais, Veronika Reichenberger, Nathaniel Scherer, Maria do, Socorro Veloso de Albuquerque, Hannah Kuper, T. Lyra, Christina May Moran de Brito","doi":"10.1101/2024.06.04.24308469","DOIUrl":"https://doi.org/10.1101/2024.06.04.24308469","url":null,"abstract":"Background: People with disabilities face more barriers accessing healthcare and, on average, experience worse health outcomes. Strengthening health access for people with disabilities requires coordinated action across the health system. The Missing Billion Inclusive Health System Framework is a new tool to support policy makers assess levels of disability inclusion within health systems. In this study we use the framework within the Unified Health System in Brazil. We consider the relevance and feasibility of the indicators, as part of further testing and refining the framework. Methods: Information sources, used to complete the assessment, included Brazilian laws and policies, publically available data, published literature and interviews with people with disabilities and service providers. A workshop with stakeholders was held to co-develop key recommendations. Findings: Overall, the framework was comprehensive and feasible to complete. It highlighted key strengths in terms of disability inclusion in the Brazilian health system as well as gaps and leverage points for action. Interpretation: The Missing Billions framework can identify progress and opportunities to strengthen disability inclusion in health systems. In Brazil, key promotive factors include supportive policies, leadership and financing structures. There are also opportunities for strengthening data and evidence, healthcare worker training on disability and health service accessibility. Actions must be centered on, and informed by, people with disabilities.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1101/2024.06.05.24308397
M. Kenyon, S. O'Neil, L. English, A. Mallows, M. Lee, C. Stubbs, S. McAuliffe, G. Stephens, Briggs-Price, Kirwan S., P.
Title Clinician examination of Psychological and Psychosocial factors during management of patients with tendinopathy: An International Survey of Practice Background Psychological and psychosocial factors play an important role in the management of patients with musculoskeletal disorders. Currently, there is no information exploring how clinicians current practice is informed by these factors in the people with tendinopathy exists. Objectives To explore healthcare providers knowledge and use of psychological and social screening and interventions in the management of patients with tendinopathy Methods An online survey was developed by a group of tendon experts. The survey was disseminated via special interest groups, social networks and professional organisations internationally. Results The survey had 103 completed responses. The majority of respondents used the subjective, 53% (N=55), subjective and objective, 28%(n=29), or objective 6% (n=6) examination to screen for psychological factors using both verbal and nonverbal methods. Psychosocial factors were screened for during the subjective assessment by 75% (n=77) of respondents. A further 15% (n=15) screened during the subjective and objective combined whilst 5% (n=5) examined this factor in the objective assessment in isolation. Psychological screening tools were used by 25% (n= 26) of respondents and psychosocial factors by 12% (n=12) of respondents. Treatment typically comprised of individualised education, reassurance, addressing mal-adaptive behaviours and behaviour change. Confidence in assessment and treatment was mixed and clinicians identified a desire for more specific training and self-development. Conclusion The proportion of clinicians screening and measuring psychological and psychosocial factors in clinical practice is high, but few use validated tools due to a lack of time and confidence. Implication for clinical practice Clinicians commonly assess psychological and social factors during assessment of individuals with tendinopathy, as part of their subjective and objective assessments. It is unclear how successfully clinicians identify these factors during their assessments, as they rarely use validated screening tools. Key words Tendinopathy, psychological factors, social factors, holistic, biopsychosocial Funding None.
{"title":"Healthcare providers knowledge and use of psychological and psychoSOCIAL screening and interventions in the management of patients with tendinopathy: An International Survey of Practice","authors":"M. Kenyon, S. O'Neil, L. English, A. Mallows, M. Lee, C. Stubbs, S. McAuliffe, G. Stephens, Briggs-Price, Kirwan S., P.","doi":"10.1101/2024.06.05.24308397","DOIUrl":"https://doi.org/10.1101/2024.06.05.24308397","url":null,"abstract":"Title Clinician examination of Psychological and Psychosocial factors during management of patients with tendinopathy: An International Survey of Practice Background Psychological and psychosocial factors play an important role in the management of patients with musculoskeletal disorders. Currently, there is no information exploring how clinicians current practice is informed by these factors in the people with tendinopathy exists. Objectives To explore healthcare providers knowledge and use of psychological and social screening and interventions in the management of patients with tendinopathy Methods An online survey was developed by a group of tendon experts. The survey was disseminated via special interest groups, social networks and professional organisations internationally. Results The survey had 103 completed responses. The majority of respondents used the subjective, 53% (N=55), subjective and objective, 28%(n=29), or objective 6% (n=6) examination to screen for psychological factors using both verbal and nonverbal methods. Psychosocial factors were screened for during the subjective assessment by 75% (n=77) of respondents. A further 15% (n=15) screened during the subjective and objective combined whilst 5% (n=5) examined this factor in the objective assessment in isolation. Psychological screening tools were used by 25% (n= 26) of respondents and psychosocial factors by 12% (n=12) of respondents. Treatment typically comprised of individualised education, reassurance, addressing mal-adaptive behaviours and behaviour change. Confidence in assessment and treatment was mixed and clinicians identified a desire for more specific training and self-development. Conclusion The proportion of clinicians screening and measuring psychological and psychosocial factors in clinical practice is high, but few use validated tools due to a lack of time and confidence. Implication for clinical practice Clinicians commonly assess psychological and social factors during assessment of individuals with tendinopathy, as part of their subjective and objective assessments. It is unclear how successfully clinicians identify these factors during their assessments, as they rarely use validated screening tools. Key words Tendinopathy, psychological factors, social factors, holistic, biopsychosocial Funding None.","PeriodicalId":506788,"journal":{"name":"medRxiv","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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