Background: In the United States, transgender, nonbinary, and gender diverse (TGD) young adults experience a higher risk of depression compared to their cisgender peers. Understanding factors associated with increased risk of depression within the TGD young adult population is important to guide clinical care as well as inform the development of interventions to reduce mental health disparities.
Objective: This exploratory study investigated the prevalence and correlates of positive screening for depressive symptoms among TGD young adults to inform the design, development, and implementation of national interventions aimed at improving mental health in this at-risk population.
Methods: In August 2022, a cross-sectional, nationwide online survey was conducted among TGD young adults aged 18-25 (N=104) in the United States. Measures included sociodemographic variables, family characteristics, mental health care utilization, and the two-item Patient Health Questionnaire-2 (PHQ-2) screener for depression. Poisson regression models with robust variance estimation were fitted to estimate adjusted prevalence ratios (aPR) and 95% CI for correlates of PHQ-2 depression (score ≥3).
Results: The study sample had a mean age of 22 (SD 2) years; 48/104 (46%) individuals identified as Black, Indigenous, or other People of Color, and 69/104 (66%) were nonbinary. Overall, 44 (42%) individuals screened positive for depression using PHQ-2. In a multivariable model adjusted for age, race and ethnicity, US census region, and health insurance status, factors associated with increased depression prevalence using PHQ-2 included low versus high family support (aPR 1.54, 95% CI 1.05-2.27) and identifying with a nonChristian religion versus being unaffiliated (aPR 1.66, 95% CI 1.04-2.63). Factors associated with reduced depression prevalence included living in a rural versus suburban area (aPR 0.48, 95% CI 0.26-0.92) and receiving mental health therapy versus not (aPR 0.71, 95% CI 0.53-0.97).
Conclusions: The high prevalence of depressive symptoms among TGD young adults in this study sample highlights the need for comprehensive mental health evaluation and support in this population. Depression risk is increased among certain subgroups, such as those with low family support. These findings are valuable in informing the development of interventions that aim to improve mental health outcomes among TGD young people.
Background: The generalizability of clinical research hinges on robust study designs, which include the recruitment and maintenance of a representative study population. This study examines the evolution of the demographic characteristics of 329,038 participants who enrolled and participated in The All of Us Research Program (AoURP), a decentralized study aimed at representing the diversity of the United States.
Objective: The primary objectives of this study were to assess alterations in the demographic composition of the cohort at different protocol stages within AoURP, while analyzing completion rates and timeframes for survey and substudy completion. Additionally, we examined how participant interactions with the program impacted engagement and survey responses.
Methods: We conducted a longitudinal analysis of the AoURP data, tracking changes in demographic composition, completion rates, and completion times for surveys and substudies. Comparative analyses were performed to assess differences in engagement and survey completion based on sociodemographic characteristics of participants involved in postenrollment study components.
Results: The sociodemographic composition of the cohort that participated in the postenrollment study (eg, optional components) differed significantly from that of the recruited population. The proportion of self-identified White participants increased by 21.2%, whereas the proportion of Black or African American participants decreased by 12.18% (P=.02). Participants who identified as White (n=93,614, 52.7%) and NonHispanic (n=109,279, 42.21%) were more engaged compared to those identifying as Black or African American (n=10,887, 15.76%), Asian (n=4274, 38.72%), or Hispanic (n=12,530, 20.7%; P=.006). Participants' response times to study surveys and completeness varied across all demographic groups (P<.001). Furthermore, those identifying as White skipped fewer survey questions (1.19) compared to those identifying as Black or African American (1.40) or other racial and ethnic identities (P<.001).
Conclusions: The AoURP dataset serves as an exceptional resource for investigating diverse public health concerns. However, the longitudinal analysis of participant-level data underscores a significant skew in population diversity, suggesting the need for targeted strategies to enhance engagement and retention across all groups. Ensuring diversity in the cohort is essential for maintaining the study's representativeness and the broad applicability of its findings.
Internet-based research has exploded in popularity in recent years, enabling researchers to offer both investigations and interventions to broader participant populations than ever before. However, challenges associated with internet-based research have also increased-notably, difficulties verifying participant data and deliberate data manipulation by bot and spam responses. This study presents a viewpoint based on 2 case studies where internet-based research was affected by bot and spam attacks. We aim to share the learnings from these experiences with recommendations for future research practice that may reduce the likelihood or impact of future attacks. The screening and verification processes used are presented and discussed, including the limitations of these. Based on our experience, security and screening within internet-based research platforms are partly effective, but no solution is available to protect researchers completely against bot attacks. Implications for future research and advice for health researchers are discussed.
Background: China has the largest elderly population globally; the growth rate of the aged tendency of the population was higher than that of Western countries. Given the distinctions in historical, ethnic, and economic status as well as socio-cultural background, Chinese adults had different sleep patterns compared with adults in other countries. Considering the heavy disease burden caused by activities of daily living (ADL) disability, we conducted a cross-sectional analysis using data from the China Health and Retirement Longitudinal Study (CHARLS) to test the hypothesis that individuals with short and longer sleep duration are more likely to have ADL disability.
Objective: ADL disability is a common condition affecting the quality of life among older people. This study aimed to explore the associations between sleep duration and ADL disability among middle-aged and older adults in China.
Methods: This cross-sectional study used data from 17,607 participants from the 2018 CHARLS (from 2018 to 2020), an ongoing representative survey of adults aged 45 years or older and their spouses. Self-reported sleep duration per night was obtained from face-to-face interviews. The ADL was measured using a 6-item summary assessed with an ADL scale that included eating, dressing, getting into or out of bed, bathing, using the toilet, and continence. Multiple generalized linear regression models-adjusted for age, sex, education, marital status, tobacco and alcohol use, depression, place of residence, sensory impairment, self-reported health status, life satisfaction, daytime napping, chronic disease condition, and sample weights-were used.
Results: Data were analyzed from 17,607 participants, of whom 8375 (47.6%) were men. The mean (SD) age was 62.7 (10.0) years. Individuals with 4 hours or less (odds ratio [OR] 1.91, 95% CI 1.60-2.27; P<.001), 5 hours (OR 1.33, 95% CI 1.09-1.62; P=.006), 9 hours (OR 1.48, 95% CI 1.13-1.93; P<.001), and 10 hours or more (OR 1.88, 95% CI 1.47-2.14; P<.001) of sleep per night had a higher risk of ADL disability than those in the reference group (7 hours per night) after adjusting for several covariates. Restricted cubic splines analysis suggested a U-shaped association between sleep duration and ADL disability. When sleep duration fell below 7 hours, an increased sleep duration was associated with a significantly low risk of ADL disability, which was negatively correlated with sleep duration until it fell below 7 hours (OR 0.83, 95% CI 0.79-0.87; P<.001). When sleep duration exceeded 7 hours, the risk of ADL disability would increase facing prolonged sleep duration (OR 1.19, 95% CI 1.12-1.27; P<.001). ADL disability should be monitored in individuals with insufficient (≤4 or 5 hours per night) or excessive (9 or ≥10 hours per night) sleep duration.
Unlabelled: In this study, a U-shaped association between sleep duratio
Background: Sepsis is a globally recognized health issue that continues to contribute significantly to mortality and morbidity in intensive care units (ICUs). The association between mean arterial pressure (MAP) and prognosis among patients with patients is yet to be demonstrated.
Objective: The aim of this study was to explore the association between MAP and 28-day mortality in ICU patients with sepsis using data from a large, multicenter database.
Methods: This is a retrospective cohort study. We extracted data of 35,010 patients with sepsis from the MIMIC-IV (Medical Information Mart for Intensive Care) database between 2008 and 2019, according to the Sepsis 3.0 diagnostic criteria. The MAP was calculated as the average of the highest and lowest readings within the first 24 hours of ICU admission, and patients were divided into 4 groups based on the mean MAP, using the quadruple classification approach. Other worst-case indications from the first 24 hours of ICU admission, such as vital signs, severity of illness scores, laboratory indicators, and therapies, were also gathered as baseline data. The independent effects of MAP on 28-day mortality were explored using binary logistic regression and a two-piecewise linear model, with MAP as the exposure and 28-day mortality as the outcome variables, respectively. To address the nonlinearity relationship, curve fitting and a threshold effect analysis were performed.
Results: A total of 34,981 patients with sepsis were included in the final analysis, the mean age was 66.67 (SD 16.01) years, and the 28-day mortality rate was 16.27% (5691/34,981). The generalized additive model and smoothed curve fitting found a U-shaped relationship between MAP and 28-day mortality in these patients. The recursive algorithm determined the low and high inflection points as 70 mm and 82 mm Hg, respectively. Our data demonstrated that MAP was negatively associated with 28-day mortality in the range of 34.05 mm Hg-69.34 mm Hg (odds ratio [OR] 0.93, 95% CI 0.92-0.94; P<.001); however, once the MAP exceeded 82 mm Hg, a positive association existed between MAP and 28-day mortality of patients with sepsis (OR 1.01; 95% CI 1.01-1.02, P=.002).
Conclusions: There is a U-shaped association between MAP and the probability of 28-day mortality in patients with sepsis. Both the lower and higher MAP were related with a higher risk of mortality in patients with sepsis. These patients have a decreased risk of mortality when their MAP remains between 70 and 82 mm Hg.
Unlabelled: Case report forms (CRFs) are the instruments used by research organizations worldwide to collect information about patients and study participants with the purpose of answering specific questions, assessing the efficacy and safety of medical products, and in general improving prevention and treatment in health care. To obtain significant research results out of the collected data, CRFs should be designed following the recommendations issued by regulatory authorities. However, we believe that semantic interoperability in CRFs has not yet been properly addressed. Within an international consortium comprising several COVID-19 cohorts, we scrutinized the questions included in the different CRFs with the purpose of establishing semantic interoperability across the different study data elements so that data could be merged and jointly analyzed. We realized that similar concepts were structured very differently across the different CRFs, making it hard to find and match the information. Based on the experience acquired, we developed 5 guiding principles on how to design CRFs to support semantic interoperability and increase data quality while also facilitating the sharing of data. Our aim in this viewpoint is to provide general suggestions that, in our opinion, should support researchers in designing CRFs. We conclude by urging authorities to establish an international coordination board for standards and interoperable clinical study data with competence in clinical data, interoperability standards, and data protection as part of a preparedness plan for future pandemics or other health threats.
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