PREDICTION OF MORTALITY USING CLUSTERS BASED ON CLINICAL AND LAB PARAMETERS: DATA FROM 2072 PATIENTS FROM INSPIRE COHORT

BackgroundLupus is a heterogenous diseases which results in significant premature mortality. Most studies have evaluated risk factors for lupus mortality using regression models which considers the phenotype in isolation. Identifying clusters of patients on the other hand may help overcome the limitations of such analyses.ObjectivesThe objectives of this study were to describe the causes of mortality and to analyze survival across clusters based on clinical phenotype and autoantibodies in patients of the Indian SLE Inception cohort for Research (INSPIRE)MethodsOut of all patients, enrolled in the INSPIRE database till March 3st 2022, those who had <10% missing variables in the clustering variables were included in the study. The cause of mortality and duration between the recruitment into the cohort and mortality was calculated. Agglomerative unsupervised hierarchical cluster analysis was performed using 25 variables that define SLE phenotype in clinical practice. The number of clusters were fixed using the elbow and silhouette methods. Survival rates were examined using Cox proportional hazards models: unadjusted, adjusted for age at disease onset, socio-economic status, steroid pulse, CYC, MMF usage and cluster of the patients.ResultsIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting.Out of 2211 patients in the cohort, 2072 were included into the analysis. The median (IQR) age of the patients was 26 (20-33) years and 91.7% were females. There were 288 (13.1%) patients with juvenile onset lupus. The median (range) duration of follow up of the patients was 37 (6-42) months. There were 170 deaths, with only 77 deaths occurring in a health care setting. Death within 6 months of enrollment occured in in 80 (47.1%) patients. Majority (n=87) succumbed to disease activity, 23 to infections, 24 to coexisting disease activity and infection and 21 to other causes. Pneumonia was the leading cause of death (n=24). Pneumococcal infection led to death in 11 patients and SARS-COV2 infection in 7 patients. The hierarchical clustering resulted in 4 clusters and the characteristics of these clusters are represented in a heatmap (Figure-1A,B). The mean (95% confidence interval [95% CI] survival was 39.17 (38.45-39.90), 39.52 (38.71-40.34), 37.73 (36.77-38.70) and 35.80 (34.10-37.49) months (p<0.001) in clusters 1, 2, 3 and 4, respectively with an HR (95% CI) of 2.34 (1.56, 3.49) for cluster 4 with cluster 1 as reference(Figure 1C). The adjusted model showed an HR (95%CI) for cluster 4 of 2.22 (1.48, 3.22) with an HR(95%CI) of 1.78 (1.29, 2.45) for low socioeconomic status as opposed to a high socioeconomic status (Table 1).ConclusionIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting. Disease activity as determined by the traditional activity measures may not be sufficient to understand the true magnitude of organ involvement resulting in mortality. Clinically relevant clusters can help clinicians identify those at high risk for mortality with greater accuracy.Table 1.Univariate and multivariate Cox regression models predicting mortalityUnivariateMultivariateVariablesHazard ratio (95% Confidence interval)P valueHazard ratio (95% Confidence interval)P valueCluster1Reference-Reference-20.87 (0.57, 1.34)0.5320.89 (0.57, 1.38)0.59831.22 (0.81, 1.84)0.3371.15 (0.76, 1.73)0.51342.34 (1.56, 3.49)<0.0012.22(1.48, 3.22)<0.001Socioeconomic statusLower1.78 (1.29, 2.45)<0.001Pulse steroidYes1.6 (0.99, 2.58)0.051MMFYes0.71 (0.48, 1.05)0.083CYCYes1.42 (0.99, 2.02)0.052Proliferative LNYes0.99 (0.62, 1.56)0.952Date of birth age0.99 (0.98, 1.01)0.657CYC- cyclophosphamide, MMF- Mycophenolate mofetilFigure 1.A. Agglomerative clustering dendrogram depicting the formation of four clusters. B.Heatmap depicting distribution of variables used in clustering C. Kaplan-Meier curve showing the survival function across the 4 clusters[Figure omitted. See PDF]REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone eclared.

INFLUENCE OF AGE, PERIOD, AND BIRTH COHORT EFFECTS ON SECULAR TREND IN GOUT INCIDENCE IN THE UNITED KINGDOM

BackgroundThe risk of incident gout in the United Kingdom (UK) appears to have declined since 2013.[1] However, whether this is temporary or likely to continue is unclear.ObjectivesTo examine the influence of age, calendar year, and year of birth on recent gout incidence in the UK.MethodsUsing data from IQVIA Medical Research Database in the UK, we identified incident gout by READ codes from 1999 to 2019. We grouped age, calendar year, and year of birth into 3-year categories. We assessed the effect of age, calendar year, and birth cohort categories on the incidence rate of gout using the age-period-cohort model among all participants and in men and women separately.ResultsOver the 21 years, there were 164,588 incident gout cases. The incidence rate of gout increased with age until age 80, then leveled off (P for trend <0.001) (Figure 1A). The gout incidence increased from 1999 to 2013, then declined (Figure 1B). The incidence rate of gout was higher in the late birth cohorts than in the early birth cohorts from the Year 1999 to the Year 2013 (Figure 1C);however, such a trend was reversed after the Year 2013, with the incidence rate of gout being higher in the early birth cohorts than that in the late birth cohorts (Figure 1D). Similar patterns were observed in men and women.ConclusionUsing the age-period-cohort model, we found that the risk of gout in the UK increased from 1999 to 2013 and then declined afterward. These findings suggest that some environmental factors occurring after 2013 may play role. Such a downward trend of the risk of gout may continue if these environmental factors are still present.Reference[1]Abhishek A, Tata LJ, Mamas M, et al. Has the gout epidemic peaked in the UK? A nationwide cohort study using data from the Clinical Practice Research Datalink, from 1997 to across the COVID-19 pandemic in 2021. Ann Rheum Dis 2022 Jan 27.Figure 1.(A) Age rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each age category compared with the reference age category (57-59) was adjusted for the calendar year and birth cohort. (B) Calendar year rate ratios and 95% confidence intervals of gout incidence. The relative risk of each calendar year compared with the reference calendar year (2008-2010) was adjusted for age and birth cohort. (C) Cohort rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each birth cohort (1911-1982) compared with the reference birth cohort (1950-1952) was adjusted for age and calendar year. (D) Cohort rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each birth cohort (1923-1988) compared with the reference birth cohort (1950-1952) was adjusted for age and calendar year.[Figure omitted. See PDF]AcknowledgementsThis work was supported by the National Natural Science Foundation of China (81930071, 82072502, U21A20352), Project Program of National Clinical Research Center for Geriatric Disorders (2021LNJJ06, 2022LNJJ07), the Natural Science Foundation of Hunan Province (2022JJ20100), and the Science and Technology Innovation Program of Hunan Province (2022RC3075, 2022RC1009).Disclosure of InterestsNone Declared.

The impact of transgender minority stress and emotion regulation on suicidality and self-harm

Transgender and gender diverse (TGD) individuals experience high levels of minority stress, as well as a high prevalence of suicidality and self-harm. The current study investigates if emotion regulation mediates the relationships of minority stressors with self-harm and suicidality. TGD adult primary care patients (N = 115) completed a survey including measures of minority stressors, emotion dysregulation, self-harm, and suicidality. Emotion regulation mediated the relationship between victimisation and suicidality. Emotion regulation did not mediate the relationship between victimisation and self-harm. TGD individuals' suicide risk may be increased when they experience victimisation through increased emotion dysregulation.

Age- and ethnicity-related reference intervals for serum vitamin B12.

BACKGROUND: Age and ethnicity are known to influence serum vitamin B12 (B12) concentration, yet universal reference intervals (RIs) are typically applied by laboratories. Both lower and upper RI limits for B12 are clinically relevant. Low values suggest deficiency leading to anemia and/or neurological impairment, while high values are not always an innocuous consequence of high B12 intake but are associated with some cancers, autoimmune, liver, and renal diseases. This work aimed to establish age- and ethnicity-related RIs for B12 using a modified indirect method based on Hoffmann's approach. METHODS: A total of 72,091 anonymized B12 results (Jan 2018-Nov 2019) were analyzed from an ethnically-diverse South-East London general practice patient population. Patients belonged to five ethnic groups: Asian, Black, White, Mixed, or Other. Multiple records for the same patient and results with missing ethnicity were excluded from the analysis of adult RIs. B12 analyses were performed using ARCHITECT® (Abbott Diagnostics). RESULTS: B12 was significantly higher in Black compared with Asian and White adults. There were no differences in B12 between Asian and White adults. Children (all ethnicities) between 2 and 5 years old had the highest B12. Because of the small number of children (up to the age of 13) in each ethnic-related age category, all ethnic groups were combined to obtain age-related RIs. The children's RIs ranged from 159 to 1025 pmol/L for 0-1-year-olds to 276-1102 pmol/L for 2-5-year-olds. The RIs for Black and White/Asian people >13 years of age were 166-805 pmol/L and 134-511 pmol/L respectively. CONCLUSIONS: The application of age- and ethnicity-appropriate RIs into diagnostic practice will provide a more accurate evaluation of B12 status when using the B12 test alone or in combination with other markers.

Fixed-length interval estimation of population sizes: sequential adaptive Monte Carlo mark–recapture–mark sampling

Mark–recapture sampling schemes are conventional approaches for population size (N) estimation. In this paper, we mainly focus on providing fixed-length confidence interval estimation methodologies for N under a mark–recapture–mark sampling scheme, where, during the resampling phase, non-marked items are marked before they are released back in the population. Using a Monte Carlo method, the interval estimates for N are obtained through a purely sequential procedure with an adaptive stopping rule. Such an adaptive decision criterion enables the user to "learn” with the subsequent marked and newly tagged items. The method is then compared with a recently developed accelerated sequential procedure in terms of coverage probability and expected number of captured items during the resampling stage. To illustrate, we explain how the proposed procedure could be applied to estimate the number of infected COVID-19 individuals in a near-closed population. In addition, we present a numeric application inspired on the problem of estimating the population size of endangered monkeys of the Atlantic forest in Brazil.

Dietary supplements' knowledge, attitude and consumption pattern among United Arab Emirates population

PurposeTo study the consumption pattern, attitude and knowledge of the general population about dietary supplements (DS) in the United Arab Emirates (UAE).Design/methodology/approachA community-based cross-sectional study was conducted to collect data on knowledge, attitude and consumption pattern related to the use of DS. Participants aged = 18 years were asked to complete a self-administered online questionnaire that included demographic characteristics, health and lifestyle information, consumption patterns, attitudes and knowledge levels regarding the use of DS.FindingsA total of 207 individuals participated in the study, and 117 (56.5%) participants reported using DS products as influenced by the pandemic of coronavirus disease 2019 (COVID-19), of which 63 (53.8%) participants had been using DS for more than one month but less than one year. The majority of the participants was females (64.7%), non-UAE nationals (60.9%) and employed (51.7%). Multivitamins (77.8%) were the most commonly used DS. Use of DS was more prevalent among older participants (n = 78 (61.9%), p = 0.006), non-UAE nationals (n = 79 (62.7%), p = 0.025) and employed (n = 69 (64.5%), p = 0.023). Improving general health (76.1%) and immune booster (47%) were the most frequently identified reasons for using DS, which is relatable to the COVID-19 pandemic. The majority of study participants (72.12%) reported knowing relatively little about the use of DS. About 154 participants (74.4%) did not know that DS products do not treat diseases.Research limitations/implicationsFurther studies with a larger sample size need to be conducted to examine the association between gender or chronic disease and the consumption and type of DS products used to fill the gap in the literature and overcome the limitations identified in this study.Originality/valueThis study highlights the need for community education programs and strategies that can raise awareness of the health benefits and risks of using DS. Further studies with a larger sample size need to be conducted to examine the association between gender or chronic disease and the consumption and type of DS products used to fill the gap in the literature and overcome the limitations identified in this study.

Establishment of reference intervals for complete blood count in times of COVID-19 and vaccination.

Introduction: COVID-19 and vaccination may affect some parameters of the complete blood count (CBC). The aim of this study was to determine reference intervals (RI) of CBC in healthy population with different COVID-19 and vaccination backgrounds and compare them with those established previously. Materials and methods: A cross-sectional study was conducted in donors who attended the Traumatology Hospital "Dr. Victorio de la Fuente Narváez" (HTVFN) from June to September 2021. Reference intervals were established using the non-parametric method on Sysmex XN-1000. For differences between groups with different COVID-19 and vaccination backgrounds, non-parametric tests were used. Results: The RI were established in 156 men and 128 women. Haemoglobin (Hb), haematocrit (Hct), red blood cells (RBC), platelets (Plt), mean platelets volume (MPV), monocytes and relative neutrophils were higher in men than women (P < 0.001). The percentiles of Hb, Hct, RBC, MPV and relative monocytes showed higher values; Plt, white blood cells (WBC), lymphocytes, monocytes, neutrophils, eosinophils and absolute basophils, the 2.5th was higher and the 97.5th was lower; for lymphocytes and relative neutrophils, both percentiles had a trend toward lower values, compared to previous RI. Differences between groups with different COVID-19 and vaccination backgrounds, in lymphocytes (P = 0.038), neutrophils (P = 0.017) and eosinophils (P = 0.018) in men; Hct (P = 0.014), RDW (P = 0.023) in women and MPV (P = 0.001) in both, were not considered pathological. Conclusions: The RI for the CBC were established in a Mestizo-Mexican population with different COVID-19 and vaccination backgrounds, so should be updated and validated in different hospitals close to the HTVFN that use the same analyser.

A comparative analysis of instructional delivery methods in a higher education institution in the United Arab Emirates

This comparative quantitative study aims at investigating whether instructional delivery methods, such as online, hybrid, blended learning and face-to-face delivery methods, had an effect on students' grades when teaching mathematics to English language learners in a higher education Institution in the United Arab Emirates. Final course grades, in GPA format, of 574 students were collected over the course of three academic years. Assumptions of analysis of variance (ANOVA), post hoc tests, effect sizes Cohen's d were examined. The statistically significant difference across four different instructional delivery methods showed effect sizes that grew from medium to large to very large when increasing the amount of online instruction. These findings surpass other studies and suggest a high practical significance. The consequences of COVID19 on instructional delivery methods had a favourable effect on students' grades. Higher education institutions in the UAE may use these findings for future planning, even beyond the pandemic. Recommendations are made for further research to include more variables and other disciplines.

Vaccination against infectious agents and allergen-specific immunotherapy: A critical analysis.

Allergen immunotherapy (AIT) and vaccination against infectious agents (VIA) are treatments actively interfering with the immune system. This raises the question of whether these therapies influence each other positively and/or negatively if applied simultaneously. For AIT, it should be taken into account that the mechanisms of subcutaneous and sublingual allergen application are in principle similar, but must be assessed in respect to vaccination differently due to their different routes of allergen administration. Here, the immunological mechanisms of both AIT application forms in respect to VIA are discussed in more detail followed by a critical discussion based on the literature and considering current practice.

Impact of VR Application in an Academic Context

Traditional learning has faced major changes due to the COVID-19 pandemic, highlighting the necessity for innovative education methods. Virtual reality (VR) technology has the potential to change teaching and learning paradigms by providing a gamified, immersive, and engaging education. The purpose of this study is to evaluate the impact of virtual reality in academic context by using a VR software instrument (called EduAssistant). The system's features such as virtual amphitheater, search by voice recognition, whiteboard, and a video conference system have fostered a sense of connection and community interaction. The study involved 117 students for VR experience, out of which 97 watched a pre-recorded video and 20 students used the VR headset, and an additional 20 students for traditional learning. The students who used the VR headset achieved a significantly higher mean quiz score of 8.31 compared to 7.55 for the traditional learning group with a two-tailed p-value of 0.0468. Over 80% of the total number of participants were satisfied (4 or 5 out of 5) with the experience and the confidence level when searching through voice recognition was over 90%. The study demonstrates that virtual reality is an excellent approach for changing conventional education. The research results, based on samples, simulations, and surveys, revealed a positive impact of VR and its gamification methods on the students' cognitive performance, engagement, and learning experience. Immersion provided by a virtual assistant tool helped to promote active and deep learning. Experiments based on EduAssistant features suggest that virtual reality is also an effective strategy for future research related to students with disabilities.

Identifying, exploring, and interpreting time series shapes in multivariate time intervals

We introduce a concept of episode referring to a time interval in the development of a dynamic phenomenon that is characterized by multiple time-variant attributes. A data structure representing a single episode is a multivariate time series. To analyse collections of episodes, we propose an approach that is based on recognition of particular patterns in the temporal variation of the variables within episodes. Each episode is thus represented by a combination of patterns. Using this representation, we apply visual analytics techniques to fulfil a set of analysis tasks, such as investigation of the temporal distribution of the patterns, frequencies of transitions between the patterns in episode sequences, and co-occurrences of patterns of different variables within same episodes. We demonstrate our approach on two examples using real-world data, namely, dynamics of human mobility indicators during the COVID-19 pandemic and characteristics of football team movements during episodes of ball turnover. © 2023 The Author(s)

How Resilience and Wellness Behaviors Affected Burnout and Academic Performance of First-Year Pharmacy Students During COVID-19

Objective. To determine whether students' levels of resilience and self-reported wellness behaviors predicted burnout and grade point average at the end of the first fall semester of the COVID-19 pandemic. Methods. We measured first-year students' resilience, burnout (exhaustion and disengagement), and self-reported wellness behaviors (sleep, nutrition, social time, and self-care activities) at the beginning and end of the fall 2020 semester of pharmacy school. We also collected students' demographic information and end-of-semester grade point average from their academic records. Using multivariable regression, we assessed whether students' resilience and wellness behaviors predicted burnout and grade point average at the end of the semester. We also assessed for changes in burnout and wellness behaviors over time. Results. Resilience was positively associated with older age and was lower among students of color. Exhaustion and disengagement were high at baseline and continued to worsen over time. Students' selfreported wellness behaviors also decreased over time, except for ratings of sleep adequacy. Resilience predicted lower levels of disengagement at the end of the semester, but its relationship with exhaustion was inconsistent. The only wellness behaviors associated with lower burnout were nutrition and sleep adequacy. Students' end-of-semester grade point average was also related to nutrition and sleep adequacy but not resilience or burnout. Conclusion. Resilience offered some protection from burnout, but its relationship to immutable factors suggests that individual-focused interventions to improve student well-being (eg, wellness behaviors such as mindfulness meditation) should be complemented by organizational support, especially for younger students and students of color.

Facilitated virtual learning for advanced geriatric education among nursing students during the COVID pandemic in Taiwan

PurposeThis study explored the students' perception of their adoption and acceptance of virtual learning (VL), the factors affecting the adoption of educational technologies and the correlation between their intention, perceived behavioral control and care competence in caring for older adults.Design/methodology/approachA cross-sectional survey was conducted. Surveys were administered to evaluate the participants who were involved in VL on geriatric care during coronavirus disease 2019 (COVID-19) pandemic. A total of 315 nursing students participated in the survey, and 287 valid questionnaires were collected (response rate: 91.11%).FindingsA total of 287 participants (mean age 21.09, SD 1.44 years;242/287, 84.3% female) were included in the study. The variables of intention to use technologies were positively correlated with care competence (r = 0.59, p < 0.001). The results revealed that the major predictors were perceived ease-of-use (PEOU) (β = 0.28, 95% confidence interval (CI) 0.16–0.40) and perceived usefulness (PU) (β = 0.22, CI 0.09–0.35) which were significantly positive predictors of competence in geriatric care.Research limitations/implicationsNursing students lack in clinical knowledge and situational experience in geriatric care;therefore, their perceptiveness, expressions and reflection on the process of providing care to hospitalized older patients should be increased. These results indicated that students improved in geriatric healthcare after/during the VL program during COVID-19 pandemic.Originality/valueIt is hoped that the present study would make an invaluable contribution to existing research on education in general and on the quality of care in geriatric nursing as limited studies have been published so far.

Attachment Style, Affective Temperament, and Psychological Distress among Mental Health Nurses during the COVID-19 Pandemic

The nursing staff is more likely to experience drastic stress, which can compromise their physical and mental health and affect the quality of their work. This study aimed to assess the attachment type and affective temperament in connection to the psychological effects of the COVID-19 pandemic on psychiatric hospital nurses. We conducted a cross-sectional online survey utilizing a convenience sample population of 100 nurses who served on the front lines during the COVID-19 outbreak. The key findings showed that most nurses reported moderate attachment anxiety, moderate affective temperament, and mild psychological distress. It is crucial to offer nurses psychological support during COVID-19 through various channels.

COVID-19 Vaccine Effectiveness Against Omicron Infection and Hospitalization

OBJECTIVES: This study aimed to provide real-world evidence on coronavirus disease 2019 vaccine effectiveness (VE) against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years. METHODS: We used the test-negative study design and linked provincial databases to estimate BNT162b2 vaccine effectiveness against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years between January 2 and August 27, 2022 in Ontario. We used multivariable logistic regression to estimate VE by time since the latest dose, compared with unvaccinated children, and we evaluated VE by dosing interval. RESULTS: We included 6284 test-positive cases and 8389 test-negative controls. VE against symptomatic infection declined from 24% (95% confidence interval [CI], 8% to 36%) 14 to 29 days after a first dose and 66% (95% CI, 60% to 71%) 7 to 29 days after 2 doses. VE was higher for children with dosing intervals of ≥56 days (57% [95% CI, 51% to 62%]) than 15 to 27 days (12% [95% CI, - 11% to 30%]) and 28 to 41 days (38% [95% CI, 28% to 47%]), but appeared to wane over time for all dosing interval groups. VE against severe outcomes was 94% (95% CI, 57% to 99%) 7 to 29 days after 2 doses and declined to 57% (95%CI, -20% to 85%) after ≥120 days. CONCLUSIONS: In children aged 5 to 11 years, 2 doses of BNT162b2 provide moderate protection against symptomatic Omicron infection within 4 months of vaccination and good protection against severe outcomes. Protection wanes more rapidly for infection than severe outcomes. Overall, longer dosing intervals confer higher protection against symptomatic infection, however protection decreases and becomes similar to shorter dosing interval starting 90 days after vaccination.

Changes in Going Out after Lifting a Stay-At-Home Order and Decreases of Higher-Level Functional Capacities

To clarify associations between changes in going out after lifting a stay-at-home order and decrease in higher-level functional capacities among older adults with impairments. This study was conducted using questionnaires completed by people registered in two day-service facilities and a nursing station. A baseline survey was conducted during Japan's declaration of emergency for the coronavirus disease 2019, and follow-up surveys were conducted in 4, 8, and 12 months after the declaration was lifted. We performed binary logistic regression analyses to clarify the above associations There were significant associations between Δ sum of purposes of going out and the decrease in higher-level functional capacities in 4 months (OR 0.57) and in 8 months (OR 0.47). Increasing the sum of purposes of going out after lifting a stay-at-home order was associated with lower odds for a decrease in higher-level functional capacities in 4 and 8 months.

The Effect of the COVID-19 Pandemic on Use of Select Child Health Services in Kenyan Hospitals

Introduction. Kenya reported its first case of coronavirus disease (COVID-19) in March 2020. Pandemics may disrupt provision of essential health services. This study sought to find out if the COVID-19 outbreak had any effect on reported paediatric workload in Kenya. Methods. Aggregate workload data for 12 months before COVID-19 outbreak and 12 months of the COVID-19 outbreak were extracted from the Kenya Health Information System and negative binomial regression conducted. Results. A significant decline was observed across all indicators. Paediatric clinics attendance declined by 36%, paediatric admissions by 31.4%, outpatient attendance by 28.7%, and child wellness clinics attendance by 10.3%. In outpatient attendance, the five conditions with the highest attendance reported a decline ranging from 17.3% to 33.8%. Conclusion. COVID-19 partially disrupted essential health services among children in Kenya. Children in need of specialized treatment were more disadvantaged.

Post-COVID-19 pulmonary fibrosis and its predictive factors: a prospective study

BackgroundWe aimed to prospectively assess the lung fibrotic-like changes, as well as to explore their predictive factors, in the patients who survived Coronavirus Disease 2019 (COVID-19) infection. In this prospective cross-sectional study, we recruited patients who had been treated for moderate or severe COVID-19 pneumonia as inpatients and discharged from Rohani hospital in Babol, northern Iran, during March 2020. The clinical severity of COVID-19 pneumonia was classified as per the definition by World Health Organization. We also calculated the CT severity score (CSS) for all patients at admission. Within the 3 months of follow-up, the next chest CT scan was performed. As the secondary outcome, the patients with fibrotic abnormalities in their second CT scan were followed up in the next 3 months.ResultsTotally, 173 COVID-19 patients were finally included in the study, of whom 57 (32.9%) were male and others were female. The mean age was 53.62 ± 13.67 years old. At 3-month CT follow-up, evidence of pulmonary fibrosis was observed in 90 patients (52.0%). Consolidation (odds ratio [OR] = 2.84), severe disease (OR 2.40), and a higher CSS (OR 1.10) at admission were associated with increased risk of fibrotic abnormalities found at 3-month CT follow-up. Of 62 patients who underwent chest CT scan again at 6 months of follow-up, 41 patients (66.1%) showed no considerable changes in the fibrotic findings, while the rest of 21 patients (33.9%) showed relatively diminished lung fibrosis.ConclusionPost-COVID-19 lung fibrosis was observed in about half of the survivors. Also, patients with severe COVID-19 pneumonia were at a higher risk of pulmonary fibrosis. Moreover, consolidation, as well as a higher CSS, in the initial chest CT scan, was associated with increased risk of post-COVID-19 lung fibrosis. In addition, some patients experienced diminished fibrotic abnormalities in their chest CT on 6-month follow-up, while some others did not.

Sleep Deficit as a Risk Factor for Hypertension in Korean Adults

This study aims to evaluate the association between sleep duration and hypertension in Korean adults aged 30 and older. This is a population-based cross-sectional study using the 2020 Korean National Health and Nutritional Examination Survey data. Study subjects numbered 3984 after excluding people with missing data for key exposures and outcome variables. Of the study subjects, 18.8% (n = 748) sleep for less than 6 h a day. Increased risk for hypertension was associated with being male, of old age, unemployed, of low educational achievement, and overweight, as well as drinking, smoking, stress, and short sleep duration. The prevalence of sleep deficit was associated with sex, age, education level, income, and health insurance type. Logistic regression analyses were performed to identify whether sleep duration affects the risk of hypertension. In the unadjusted model, the odds ratio (OR) of having hypertension was lower among people sleeping for 7.0–7.9 h (OR = 0.52, 95% confidence interval (95% CI) = 0.42–0.64) than those sleeping for fewer than 6 h per day. After adjusting for sociodemographic factors (sex, age, education level, occupation, and health insurance), the OR for 7.0–7.9 h remained significant (OR = 0.74, 95% CI = 0.59–0.92). This association was not significant when the model was further adjusted for health-related factors (smoking, drinking, physical activity, BMI level, and stress). Measures to promote adequate sleep duration should be included in programs to prevent and manage hypertension.