Search Results (345)

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that substantially impairs health-related quality of life (HRQoL). Comorbid mental health conditions, particularly depression and anxiety, may further exacerbate this burden, yet evidence from large, population-based studies remains limited. Therefore, this study examined the association between comorbid depression and anxiety and HRQoL among adults with RA using nationally representative data from the United States. Methods: Data were drawn from the 2017–2022 Medical Expenditure Panel Survey. Adults aged ≥18 years with self-reported RA were included. HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12) physical (PCS) and mental (MCS) component summary scores. Multiple linear regression models were used to evaluate associations between depression, anxiety, and HRQoL, adjusting for sociodemographic, behavioral, and health-related covariates. Results: Comorbid depression and anxiety were significantly associated with lower HRQoL scores compared with RA alone. Participants with both conditions exhibited the poorest PCS and MCS scores, indicating a disease burden. Lower income, unemployment, and limited physical activity were also linked to poorer HRQoL, whereas better self-rated health and physical activity were positive predictors. Conclusions: Depression and anxiety independently and jointly contribute to poorer HRQoL among adults with RA, even after controlling for key confounders. These findings highlight the importance of integrated care models that address both psychological and physical health, alongside interventions promoting physical activity to enhance overall well-being. Full article

Background: Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is becoming a leading indication for liver transplantation in the United States. In this growing recipient population, the combined effects of underlying liver disease etiology and associated comorbidities on the evaluation pathway to transplantation warrant closer examination of patient outcomes. Methods: We analyzed adult liver transplant referrals (n = 9981) from the California Liver Network, a multi-center retrospective cohort spanning six high-volume California transplant centers between 2018 and 2020. A total of 6709 patients who underwent formal evaluation were included. Patients were stratified by MASLD vs. non-MASLD etiology and compared for demographics, comorbidities, transplant evaluation timelines, listing rates, and outcomes. Results: MASLD patients (n = 1477) were older, had higher BMI, and had greater prevalence of metabolic comorbidities than non-MASLD patients (n = 5232; p < 0.001 for all). Compared to non-MASLD candidates, MASLD patients were more likely to be waitlisted (OR 1.52, 95% CI 1.33–1.74; p < 0.001). However, MASLD and non-MASLD patients had no statistically significant difference in the rate of transplant (p = 0.182), with clinically similar but statistically inferior post-transplant survival outcomes at 5 years post-transplant (88% vs. 83%; p = 0.014). Competing-risk analysis showed that MASLD candidates had higher cumulative incidence of death on the waitlist (p < 0.001), although MASLD was not independently associated with waitlist mortality when adjusting for covariates (p = 0.300). MASLD patients demonstrated increased mortality following waitlist removal (HR 1.64, 95% CI 1.14–2.35; p = 0.008), primarily among those removed for clinical deterioration (HR 1.50, 95% CI 1.01–2.23; p = 0.044). Conclusions: MASLD patients face unique challenges in liver transplant evaluation. MASLD patients are associated with higher comorbidities, increased incidence of waitlist mortality, and significantly higher mortality rate following waitlist removal. However, transplantation provides significant survival benefit with comparable outcomes to non-MASLD recipients; thus, early access to transplant may optimize outcomes for MASLD liver transplant candidates. Full article

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation associated with enhanced chronic airway inflammation. Growth factors implicated in COPD’s inflammatory processes may serve as biomarkers for disease progression and exacerbation risk. This study evaluated the relationship between serum growth factors and COPD exacerbations over one year. Serum levels of eleven growth factors, including brain-derived neurotrophic factor (BDNF), leukemia inhibitory factor (LIF), fibroblast growth factor-2 (FGF-2), vascular endothelial growth factor (VEGF), nerve growth factor (NGF), epidermal growth factor (EGF), and stem cell factor (SCF), were measured in COPD patients at baseline. Participants were followed prospectively for one year, and associations between these biomarkers and acute exacerbations (AE) and frequent acute exacerbations (Frequent AE) were assessed using statistical analyses and receiver operating characteristic (ROC) curves. Among the study population, 42 patients experienced at least one AE within the follow-up period. Lower serum FGF-2 levels were significantly associated with increased AE risk (adjusted odds ratio significant after covariate adjustment). ROC analysis identified FGF-2 ≤ 9.12 pg/mL as a predictor of AE (AUC = 0.614, sensitivity = 64.3%, specificity = 57.1%, p = 0.032). For Frequent AE, eight patients experienced multiple exacerbations and exhibited significantly lower levels of NGF, EGF, FGF-2, and LIF. After adjustment, NGF remained significantly predictive; NGF ≤ 25.23 pg/mL demonstrated strong discriminatory power for Frequent AE (AUC = 0.797, p < 0.001). However, interpretations are limited by the small Frequent AE subgroup. Serum growth factors, particularly FGF-2 and NGF, are associated with COPD exacerbation risk. Lower serum FGF-2 may indicate a higher likelihood of acute exacerbations, while lower NGF strongly predicts frequent exacerbations. Larger studies and longer follow-ups are needed to confirm these biomarkers’ predictive utility. Full article

Background: Oral health is increasingly recognized as a determinant of overall well-being, but its role in mental health remains underexplored. Chewing difficulty and tooth loss can impair nutrition, social interaction, and quality of life, thereby contributing to psychological distress. Objectives: This study examined the association between oral health indicators and anxiety among Korean adults. Methods: Data were obtained from 4746 adults aged ≥19 years who participated in the 2023 Korea National Health and Nutrition Examination Survey (KNHANES). Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7), a validated 7-item self-report questionnaire with responses on a 4-point Likert scale (0 = not at all to 3 = nearly every day). Anxiety severity was categorized into four levels. Severity was categorized into four levels using the GAD-7. Oral health predictors included the number of remaining teeth and self-reported chewing difficulty, along with toothache experience, toothbrushing frequency, and unmet dental care needs. Complex survey-weighted ordinal logistic regression models were applied, adjusting for sociodemographic, behavioral, and clinical covariates. Results: Overall, 15.3% of adults reported mild, 3.1% moderate, and 1.6% severe anxiety. Chewing difficulty, fewer than 20 remaining teeth, overweight status, high stress, depressive symptoms, and unmet dental care needs were significantly associated with greater anxiety severity. Conclusions: The number of remaining teeth retention and chewing function were closely related to anxiety. Preserving functional dentition and ensuring timely access to dental care may be effective public health measures to reduce the psychological burden in the general population. Full article

Background: While experimental models show that leptin and adiponectin have inverse effects on the cardiovascular system, it has been suggested that the leptin-to-adiponectin (L/A) ratio may be an important predictor of cardiovascular disease and death. Higher circulating leptin and adiponectin levels are observed in uremia due to decreased renal degradation and/or clearance and increased production. We sought to examine the association between the L/A ratio and mortality in a prospective hemodialysis cohort. Methods: Among a prospective cohort of 448 hemodialysis patients from the NIH “Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (CKD) (MADRAD) study who underwent leptin and adiponectin measurements, we examined characteristics associated with high leptin and adiponectin (defined as the highest tertile) using logistic regression. We then examined the association of L/A ratio levels (categorized as tertiles) with all-cause mortality using Cox regression. Results: Multivariable logistic regression analyses showed female sex, diabetes, presence of an arteriovenous fistula/graft, and lower serum albumin, IL-6, and adiponectin were associated with high leptin, whereas female sex, longer vintage, Black race, higher IL-6, and lower leptin were associated with high adiponectin. When examining L/A ratios, the highest tertile was associated with lower mortality in case-mix Cox models (ref: lowest tertile): HR (95% CI) 0.14 (0.06–0.35). These associations were robust in analyses that additionally adjusted for laboratory covariates: (HR 95% CI) 0.18 (0.07–0.46). Conclusions: In a prospective cohort of hemodialysis patients, inflammation and malnutrition markers were associated with lower leptin and higher adiponectin levels. Additionally, high L/A ratio levels were associated with lower mortality. Further studies are needed to determine the mechanisms relating adipocytokines, inflammation and nutrition, and survival in this population. Full article

Background: Achieving low-density lipoprotein cholesterol (LDL-C) goals is essential for secondary prevention after atherosclerotic ischemic stroke or transient ischemic attack (TIA). This study assessed the prevalence of LDL-C goal attainment and identified associated determinants post-ischemic stroke/TIA. Methods: A cohort of Thai patients discharged on statin therapy after admission with acute ischemic stroke or TIA was evaluated for LDL-C goal attainment within 12 months post-discharge. Logistic regression determines factors associated with LDL-C goal attainment, and the generalized linear model confirmed the association between covariates and LDL-C reduction. Results: Among 487 patients (85.8% with ischemic stroke), the prevalence of LDL-C goal attainment differed across LDL-C target levels: 9.9% for <55 mg/dL, 29.0% for <70 mg/dL, 70.4% for <100 mg/dL, and 17.5% for ≥50% reduction from baseline. Logistic regression identified high-intensity statins as a significant predictor of goal attainment at <70 mg/dL (OR 1.91, 95% CI 1.09–3.34), <100 mg/dL (OR 1.64, 95% CI 1.01–2.67), and ≥50% reduction (OR 2.32, 95% CI 1.14–4.73), but not <55 mg/dL (OR 1.65, 95% CI 0.72–3.79). In the generalized linear model, high-intensity statin and baseline LDL-C were significant determinants of LDL-C reduction. Conclusions: LDL-C target attainment after ischemic stroke/TIA is modest overall, and remains low for the more stringent targets (<55 mg/dL). High-intensity statins improve goal attainment and produce greater LDL-C reductions, supporting wider use of more aggressive lipid-lowering strategies in this high-risk population. Full article

Dramatic shifts in state-level cannabis laws (CLs) and federal hemp regulations have resulted in increased availability and use of cannabis and cannabidiol (CBD) products throughout the US, with unknown implications for the youth. Youth with mood disorders represent a vulnerable population that is more likely to use cannabis and CBD and is at elevated risk for experiencing cannabis-related adverse health outcomes. This multisite study characterized attitudes, health perceptions, and behaviors related to cannabis and CBD use among US youth receiving mood disorder treatment and their parents, and assessed whether attitudinal differences varied as a function of respondent group and state-level CL status. Anonymous surveys were completed by 84 youths and 66 parents recruited from six child mood clinics providing care to patients living in eleven US states with variable CLs. Covariate-adjusted regressions were run using respondent group and state-level CL status as between-subject factors. Most youths (76% and 74%) and parents (65% and 68%) endorsed believing that cannabis and CBD, respectively, are safe and effective treatments for mental health conditions, and that regular use of these products reduces depression, anxiety, and suicidal behaviors. Intergenerational differences in cannabis-related attitudes and health perceptions were observed, with some associations varying as a function of state-level CL. Among the youth, male sex and positive cannabis expectancies and attitudes were associated with higher cannabis use intentions. Findings can inform prevention and public health messaging efforts. Full article

Background: Women living with HIV (WLHIV) in low-income urban settings face multiple intersecting nutritional risks from food insecurity, poor dietary quality, and mental health problems. We evaluated the prevalence of household food insecurity and inadequate dietary diversity, examining their associations with depressive symptoms, antiretroviral therapy (ART)-related factors, and body mass index (BMI) among WLHIV attending routine ART clinics in Kinshasa, The Democratic Republic of Congo. This study addresses critical gaps in understanding the interplay between mental health and nutrition in the context of HIV care, with significant implications for improving health outcomes among vulnerable populations. Methods: In this clinic-based cross-sectional study (February–April 2024), we enrolled 571 women on ART in Masina 2, Kinshasa. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS), dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD_W; inadequate ≤ 5 food groups in 24 h), and probable depression was assessed using the Hopkins Symptom Checklist-10 (HSCL-10), which is a validated screening tool. We obtained baseline BMIs from clinic records at ART induction, which we measured again upon survey completion. We used analysis of covariance (ANCOVA) to model follow-up BMI, adjusting for baseline values, age, ART duration, self-reported adherence, household food insecurity, dietary diversity, and probable depression. Sensitivity analyses included change-score and mixed-effects models. Results: The prevalence of any household food insecurity was high (75%; 95% CI:71.5–78.6), with 57.6% (95% CI:53.5–61.6) of the participants experiencing inadequate dietary diversity (MDD_W < 5). Furthermore, forty-two per cent (95% CI:38.4–46.5) experienced depressive symptoms and sixty-eight percent (95% CI: 64.4–72.0) adhered to antiretroviral therapy (ART). The mean MDD_W was 4.3, with a low consumption rate of animal-source foods. Baseline BMI was associated with follow-up values (adjusted β_{unstandardized}, 0.48 kg/m² per 1 kg/m² baseline, 95% CI 0.38–0.59; p < 0.001). Probable depression was independently associated with a lower follow-up BMI (adjusted β_{unstandardized}, −0.99 kg/m²; 95% CI −1.72 to −0.26; p = 0.008). Time since ART initiation showed a slight positive association with BMI (adjusted β_{unstandardized}, 0.10 kg/m² per year). Self-reported ART adherence, household food insecurity, and dietary diversity were not independently associated with follow-up BMI in fully adjusted models. The interaction between age and probable depression did not suggest heterogeneity between age groups (p = 0.503). Conclusions: In our cohort, food insecurity and poor dietary diversity were widespread but did not significantly correlate with BMI, while probable depression, a potentially modifiable factor, was independently associated with lower BMI after accounting for baseline nutritional status. These findings highlight the need for HIV care programs integrating mental health screening and services with nutrition-sensitive interventions to support recovery and long-term health among WLHIV. Full article

Background/Objectives: Growing evidence supports the use of a single trough concentration, rather than both a peak and trough, to estimate the 24 h area under the curve (AUC₂₄) of vancomycin using Bayesian software (InsightRx^® Ver.1.71). However, patients with body mass index (BMI) ≥ 40 kg/m² are underrepresented in validation studies. Studies in patients with obesity have produced mixed results, potentially because of different population models used. Methods: This single-center, retrospective study evaluated adult inpatients with BMI ≥ 40 kg/m². Steady-state AUC₂₄ estimates generated by Bayesian software using both two-concentration and one-concentration inputs were compared. Agreement was defined as a percent difference within ±20%. Subgroup analyses were conducted for patients with defined peak and trough concentrations and for comparisons between two Bayesian population models (Carreno vs. Hughes). Linear regression assessed covariates associated with percent difference. Results: Among 82 encounters, 97.5% of one-concentration estimates based on the smaller concentration were within ±20% of the two-concentration AUC_24,SS (mean difference: 2.9%, 95% CI: 0.14 to 3.8%). Similar agreement was observed using the larger concentration (97.5%, mean difference: −3.1%, 95% CI: −4.7 to −0.1.5%). Subgroup analysis for encounters with true peak/trough levels (n = 22) also showed 100% agreement within ±20%. The percent difference did not correlate with BMI or other covariates. Comparison of Hughes vs. Carreno models showed larger variability (only 59.1% within ±20%). Conclusions: In patients with BMI ≥ 40 kg/m², Bayesian AUC_24,SS estimation using a single vancomycin concentration is feasible. Greater caution is warranted in the setting of acute kidney injury, poor model fit, or targeting AUC at the extremes of the therapeutic range. The population model used to generate the Bayesian AUC estimate has a much greater influence than the number of concentrations analyzed. Furthermore, measuring two concentrations does not ensure concordance between models. Full article

Background: Depression is a significant public health concern, with working mothers at greater risk due to combined biological and psychosocial stressors. Recent evidence suggests that inner strength may play a mediating role in the link between biological risks and depression. Objectives: The primary objective was to determine whether inner strength mediates the relationship between biological risk factors (hormonal fluctuations, smoking, alcohol use, family psychiatric history, and physical diseases) and depressive symptoms among Chinese working mothers. A secondary objective was to assess the prevalence of depressive symptoms in this population, measured with the OI-Depression subscale (Outcome Inventory-21). Methods: A cross-sectional online survey was conducted with 330 Chinese working mothers aged 30–45 years, using validated instruments to measure depression, inner strength, and parental stress. Mediation analysis evaluated the indirect effect of inner strength, while covariate-adjusted regression analyses explored associated factors. Results: Biological risk factors showed a significant direct effect (β = 0.584, p < 0.001) and an indirect effect through inner strength (indirect effect = 0.623, 95% CI [0.294, 0.962]. The Sobel test indicated that the indirect effect of biological risk factors on depressive symptoms through inner strength was statistically significant (z = 3.67, p < 0.001). The prevalence of clinically significant depressive symptoms was 38.2%. Conclusions: Biological factors significantly contribute to depressive symptoms, but inner strength partially mediates this relationship, suggesting that interventions to enhance inner strength may help reduce depression risk in working mothers. Further research should investigate strategies to build inner resilience in this population. Full article

Background/Objectives: Psoriasis is a chronic immune-mediated disorder that may share pathogenic pathways with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Although Western studies suggest a possible link between psoriasis and increased IBD risk, large-scale evidence from Asian populations remains limited and inconsistent. Using nationwide Korean cohort data, we aimed to investigate this association. Methods: In this retrospective, nested case–control study using the Korean National Health Insurance Service–National Sample Cohort (2002–2019), incident IBD cases were matched 1:4 to controls by age, sex, income, region, and index date. Psoriasis history prior to the IBD index date was identified using diagnostic codes. Overlap propensity score weighting balanced covariates, and weighted multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Among 10,966 IBD patients and 43,864 controls, psoriasis was associated with higher IBD risk (aOR 1.63; 95% CI, 1.38–1.93). The association was stronger for UC (aOR 1.77; 95% CI, 1.44–2.18) than for CD (aOR 1.37; 95% CI, 1.01–1.84). UC risk was elevated across most subgroups, whereas CD risk reached significance only in individuals < 45 years. Conclusions: In this large, nationally representative Korean cohort, psoriasis was linked to an increased risk of subsequent IBD, particularly UC. Although causality cannot be inferred, these findings may underscore the importance of considering possible gastrointestinal comorbidity in patients with psoriasis. Full article

Colorectal cancer (CRC) has a complex etiology involving genetic, lifestyle, and environmental factors. This study investigates the association between exposure to water contaminants and the risk of developing CRC in Lebanon. Population Attributable Fraction (PAF) was calculated using exposure prevalence from environmental reports and water quality assessments. Relative risks (RR) were obtained from multiple meta-analyses and epidemiological studies to quantify the contribution of five water contaminants to CRC incidence: nitrates, mercury, arsenic, trihalomethanes (THMs), and microbial pollutants (E. coli). A synthetic cohort was simulated using national exposure data and probabilistic techniques, employing multivariate logistic regression models to ensure precise CRC risk and controlling for lifestyle covariates. Adjusted PAF values were calculated using regression data to determine the proportion of CRC cases attributable to each water contaminant. THMs and E. coli showed the strongest association with CRC, with adjusted PAF values of 25.76% and 23.65%, respectively. Exposure to nitrates, arsenic, and mercury contributed less to CRC risk (1.02%, 0.52% and 2.20%, respectively). Multivariate regression confirmed that THMs and E. coli remained the strongest independent predictors of CRC risk (OR = 1.37, p = 0.001) and (OR = 1.79, p < 0.0001) among water contaminants, respectively. Our model-based approach carries limitations due to reliance on indirect exposure and risk estimates, which may introduce uncertainty stemming from data gaps and underlying assumptions. This study highlights the importance of water quality management in CRC prevention as exposure to drinking water contaminants contributes meaningfully to disease burden. Full article

Background: Emotional eating (EmE) is a maladaptive eating behavior that has been frequently observed among university students, possibly due to academic stress and lifestyle changes. However, its specific assessment in health science students has been poorly addressed, even though this population faces high levels of academic stress and emotional burden. Objective: This study explores the association between self-perceived health status, life satisfaction, and EmE among university students in the health field on the north coast of Peru. Methods: A cross-sectional study was conducted on a sample of 1213 students. Self-perceived health, life satisfaction, and EmE were assessed using validated instruments. In addition, sociodemographic data were considered as covariates and possible confounding factors. T-tests, chi-square tests, and Poisson regression with robust variance were applied. Results: EmE was more prevalent in women (78.0%) than in men (66.8%; p < 0.001). In addition, an inverse association was observed between self-perceived health and emotional eating: students with average self-perceived health (adjusted OR = 0.88; 95% CI: 0.83–0.94) and those with high self-perceived health (adjusted OR = 0.75; 95% CI: 0.69–0.81) showed a progressively lower prevalence of EmE compared to those with low self-perceived health. Similarly, high life satisfaction was associated with a lower prevalence of EmE (adjusted PR = 0.88; 95% CI: 0.80–0.96). Conclusions: Low self-perceived health and life dissatisfaction were significantly associated with a higher probability of EmE in medical and nursing students. These results highlight the need to strengthen university programs on mental health, emotional regulation, and subjective well-being promotion as strategies to prevent maladaptive eating behaviors in academic settings, considering gender. Full article

Understanding genetic variation in commercially valuable tree species is essential for improving breeding and conservation efforts. This study investigates genetic variation, heritability, and trait relationships in Pterocarpus macrocarpus, a vital hardwood species for Thailand’s reforestation initiatives. We evaluated growth (height and diameter), morphology (biomass dry weight and specific leaf weight), and physiological traits (net photosynthesis [A], transpiration rate [E], and water-use efficiency [WUE]) across 112 open-pollinated families from six natural populations under controlled nursery conditions over 30 weeks. Using a randomised complete block design, variance and covariance analyses were conducted to estimate genetic parameters. Seedling survival reached 95%, confirming favourable conditions for genetic expression. There were significant differences among populations and families within populations in growth and biomass. In contrast, physiological traits showed notable family-level variation (A, E, WUE) and only population effects for WUE. Residual variance was predominant across traits, indicating considerable within-family variation. Growth and biomass exhibited moderate to high heritability (individual: 0.39–1.00; family: 0.61–0.90), while specific leaf weight and shoot-to-root ratio had lower heritability at the individual level. Physiological traits showed low to moderate heritabilities (individual: 0.26–0.43; family: 0.47–0.62), with maternal effects via seed weight significantly influencing early growth. The heritability of height decreased over time, whereas the heritability of diameter remained stable. Strong genetic correlations among growth and biomass suggest the potential for combined selection gains. However, physiological traits show weak or no correlations with growth, highlighting their independent genetic control. Variation at the population level in growth and WUE may reflect adaptive responses to seed-source environments. Our findings support the use of nursery-based screening as a cost-effective method for the early identification of high-quality families. WUE is a promising focus for breeding programs targeting drought-prone regions. This study provides key insights for advancing the genetic improvement and conservation of P. macrocarpus, emphasizing the importance of incorporating physiological traits into breeding and conservation strategies. Full article

Background/Objectives: Multimorbidity, where patients have ≥2 comorbidities, is recognized as a major challenge for health systems worldwide, driving up morbidity and cost. The differences in multimorbidity burden between those with and without type-2 diabetes mellitus (T2DM) in the Veteran population are not well studied. This large retrospective cohort study fills the existing gap. Methods: Using a retrospective cohort of adult Veterans with and without T2DM, we examined 29 comorbidities defined by Elixhauser criteria for 10,499,394 Veterans from 1 January 2008 to 31 December 2009. We then ascertained diabetes status for 10 years of follow-up from 1 January 2010 to 31 December 2019. Multimorbidity status was categorized using the Elixhauser comorbidity index (0, 1, ≥2) and logistic regression was used to estimate the odds ratio (OR) for its association with risk of diabetes, adjusting for covariates. Results: Compared to those with zero comorbidities, the odds of having diabetes were more than doubled (2.53, CI: 2.51–2.54) for those with ≥2 comorbidities. Conclusions: The doubling of the odds of T2DM among those with more than one comorbidity is typical of Veterans with T2DM. In addition, the odds were significantly higher for Hispanics compared to other groups when adjusting for covariates. This calls for more attention to reduce the risk of T2DM through improved management and effective use of treatments informed by disparities that exist in the VHA. Full article