Comparison of postoperative ascites replacement strategies on time to first flatus after living donor liver transplantation: Albumin vs. lactated Ringer's solution.

INTRODUCTION: There is insufficient evidence regarding the optimal regimen for ascites replacement after living donor liver transplantation (LT) and its effectiveness. The aim of this study is to evaluate the impact of replacing postoperative ascites after LT with albumin on time to first flatus during recovery with early ambulation and incidence of acute kidney injury (AKI). METHODS: Adult patients who underwent elective living donor LT at Seoul National University Hospital from 2019 to 2021 were randomly assigned to either the albumin group or lactated Ringer's group, based on the ascites replacement regimen. Replacement of postoperative ascites was performed for all patients every 4 h after LT until the patient was transferred to the general ward. Seventy percent of ascites drained during the previous 4 h was replaced over the next 4 h with continuous infusion of fluids with a prescribed regimen according to the assigned group. In the albumin group, 30% of a total of 70% of drained ascites was replaced with 5% albumin solution, and remnant 40% was replaced with lactated Ringer's solution. In the lactated Ringer's group, 70% of drained ascites was replaced with only lactated Ringer's solution. The primary outcome was the time to first flatus from the end of the LT and the secondary outcome was the incidence of AKI for up to postoperative day 7. RESULTS: Among the 157 patients who were screened for eligibility, 72 patients were enrolled. The mean age was 63 ± 8.2 years, and 73.0 % (46/63) were male. Time to first flatus was similar between the two groups (66.7 ± 24.1 h vs. 68.5 ± 25.6 h, p = .778). The albumin group showed a higher glomerular filtration rate and lower incidence of AKI until postoperative day 7, compared to the lactated Ringer's group. CONCLUSIONS: Using lactated Ringer's solution alone for replacement of ascites after living donor LT did not reduce the time to first flatus and was associated with an increased risk of AKI. Further research on the optimal ascites replacement regimen and the target serum albumin level which should be corrected after LT is required.

Associations between Gendered Family Structures and Adolescent Stress, Loneliness, and Sadness in South Korea.

While a large literature connects family environments characterized by access to two married biological parents to better child mental health outcomes, we know less about the mechanisms linking family structure to mental health outcomes for children living in other family structures. While essentialist theory suggests that access to both male and female parents will be an important determinant of child mental health, some research directly comparing single-mother and single-father families found no difference in child outcomes by parent gender, suggesting evidence for more structural theories of gender. However, most of this research uses data from Western countries and seldom extends to examining mental health outcomes. In this paper, we used data from a large, generalizable survey of Korean adolescents (the 2021 Korea Youth Risk Behavior Survey) to compare the mental health of children living in families with two married biological parents, single mothers, and single fathers. Our findings underscore the importance of examining family environments in different contexts.

Work and Family Pathways and Their Associations with Health for Young Women in Korea.

The aim of this study is two-fold: to discern patterns in pathways of work and family transitions among young women (aged 24-39 years) whose decisions and behaviors toward labor force participation, marriage, and parenthood are considerably shaped by social constraints and gender norms; and to examine whether and to what extent work and family pathways are associated with later health. Using data from a longitudinal survey based on a large sample of adult women in Korea (N = 2418), we identified eight dominant pathways of employment, marriage, and parenthood among young women and found that educational attainment and family values are strong predictors of these work-family pathways. We also found that the timing and sequencing of work-family pathways appears to be associated with later health outcomes. In particular, unemployed women who are not married and do not have children seem to be vulnerable to health problems, compared to those with other pathways. We discuss the implications of our findings regarding the occurrence of work and/or family transitions, as well as their timing and sequencing for women's health in later life.

Matching methods to quantify wildfire effects on forest carbon mass in the U.S. Pacific Northwest.

Forest wildfires consume and redistribute carbon within forest carbon pools. Because the incidence of wildfires is unpredictable, quantifying wildfire effects is challenging due to the lack of prefire data or controls from experiments over a large landscape. We explored a quasi-experimental method, propensity score matching, to estimate wildfire effects on aboveground forest woody carbon mass in Washington and Oregon, United States. Observational data, including national forest inventory plot measurements and satellite imagery metrics, were utilized to obtain a control set of unburned plots that are comparable to burned plots in terms of environmental conditions as well as spatial locations. Three matching methods were implemented: propensity score matching (PSM), spatial matching (SM), and distance-adjusted propensity score matching (DAPSM). We investigated if propensity score matching with and without spatial adjustment led to different outcomes in terms of (1) balance in covariate distributions between burned and control plots, (2) mean carbon mass obtained from the selected control plots compared to burned and all unburned plots, and (3) estimates of wildfire effects by burn severity. We found that PSM and SM, which use only the environmental covariate set or the spatial distance for estimating propensity scores, respectively, did not appear to produce a comparable set of control plots in terms of the estimated propensity scores and the outcomes of mean carbon mass. DAPSM was the preferred method both in balancing the observed covariates and in dealing with unobservable confounding variables through spatial adjustment. The average wildfire effects estimated by DAPSM showed clear evidence of redistribution of carbon among aboveground woody pools, from live to dead trees, but the consumption of total woody carbon by wildfire was not substantial. Only moderate burn severity led to significant reduction of total woody carbon mass across Washington and Oregon forests (64% of control plots remained on average). This study provides an applied example of a quasi-experimental approach to quantify the effects of a natural disturbance for which experimental settings are unavailable. The study results suggest that incorporating spatial information in addition to environmental covariates would yield a comparable set of control plots for wildfire effects quantification.

Low income dynamics and depression over the life course in South Korea.

OBJECTIVES: We examined how experiencing low income multiple times is associated with depressive symptoms over the life course to better understand the influence of low income experience on psychological well-being. METHODS: We employed fixed effects models to estimate the association between low income experience and depressive symptoms using data from a longitudinal survey of a representative sample of adults in Korea (N=6,930). We also considered age variations given different perspectives and social circumstances related to different ages and family stages over the life course that potentially modify the association. RESULTS: Our results revealed that the detrimental influence of low income experience on depressive symptoms slowly declines with additional increments in the number of the exposures. Additionally, although older adults have a higher risk of experiencing low income more than once, the detrimental influence appears more salient among younger adults compared to older individuals. DISCUSSION: We offered some explanations for the diminishing effects of additional experiences of low income on depressive symptoms, and the age group variations in the association in Korea. We also discussued policy implications of our findings.

Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies.

BACKGROUND: Despite the critical role that Emergency Medical Services (EMS) provides in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined. OBJECTIVE: To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS. RESEARCH DESIGN: A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury. RESULTS: Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%-30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%-43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%-42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%-32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%-41%; P<0.05) when compared with white patients. CONCLUSIONS: Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.

The Impact of Communication Impairments on the Social Relationships of Older Adults: Pathways to Psychological Well-Being.

Purpose Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment was associated with a range of social measures and to examine the association between these characteristics and psychological well-being. Method Community-dwelling older adults ranging in age from 65 to 94 were recruited for the study of Communication, Health, Aging, Relationship Types and Support. The sample included 240 participants with communication disorders arising from a variety of etiologies including hearing impairment, voice disorders, head and neck cancer, and neurologic disease, as well as older adults without a communication disorder. Results Communication impairment was a significant independent predictor for key characteristics of social relationships, including the number of friends in the social network, two types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was also a significant predictor for higher levels of loneliness and depression. In addition, two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Conclusions Even after controlling for age, gender, health, and disability, communication impairment is a significant independent predictor for key aspects of the social function of older adults and demonstrates two distinct pathways to loneliness and depression. Supplemental Material https://doi.org/10.23641/asha.7250282.

Military Factors Associated with Smoking in Veterans.

Introduction: Given the high prevalence of smoking among Veterans and the economic, social, and clinical implications, it is important to understand the factors that contribute to smoking in order to focus efforts to mitigate these factors and improve smoking cessation efforts among Veterans. The availability of research on smoking in Veterans compared with civilians is limited given the military-specific differences in their life course. We aimed to identify military-specific factors combined with sociodemographic factors for ever smoking and current smoking among Veterans to inform future interventions. Materials and Methods: We used data from the 2010 National Survey of Veterans, the most current, to analyze the association of sociodemographic and military-specific factors with ever versus never smoking, and current versus past smoking using multiple variable logistic regression models (IRB#4125). Results: Among 8,618 respondents, the proportions of current, past, and never smokers were 17%, 48%, and 34%, respectively. Sociodemographic factors associated with ever smoking were female gender, educational attainment of less than a bachelor's degree, and being divorced/separated/widowed. Military-specific factors associated with ever smoking were exposure to dead/dying/wounded soldiers during service, and past, current, and unsure enrollment in Veterans Affairs healthcare. Never smoking was associated with Hispanic ethnicity, income over $75,000, and reporting fair or poor health. Military factors associated with never smoking were presence of a service-connected disability and military service July 1964 or earlier (i.e., pre-Vietnam). Among 5,652 ever smokers, sociodemographic factors associated with current smoking were age less than 65, being non-Hispanic black, educational attainment of less than a bachelor's degree, being divorced/separated/widowed, never married, and having no insurance. Factors associated with reduced likelihood of current smoking compared with past smoking included income >$41,000 and reporting fair or poor health. Military-specific variables associated with reduced likelihood of current smoking were service era of May 1975 or later (i.e., post-Vietnam) and 5 or more years of service. Conclusion: Military-specific variables are associated with smoking behaviors among Veterans. Findings from this study that exposure to dead/dying/wounded soldiers, service era, duration of service, service-connected disability status, and enrollment in VA care all influence smoking in Veterans, can inform prevention and cessation efforts in part by encouraging alternative healthy habits or cessation techniques in subgroups of Veterans with particular military backgrounds. By assessing risk factors in this unique population future research can leverage these findings to determine mechanisms that help explain these associations. Identifying factors associated with smoking offers insights for smoking cessation and prevention interventions given the military experiences and increased smoking incidence among Veterans.

Predictive Strength of Self-Rated Health for Mortality Risk Among Older Adults in the United States: Does It Differ by Race and Ethnicity?

Self-rated health (SRH) is widely used to capture racial and ethnic disparities in health. It is therefore critical to understand whether individuals with different racial and ethnic backgrounds assess their SRH differently. Despite the high overall predictive validity of SRH for subsequent mortality, few studies paid attention to potential variations by race and ethnicity. This study examines racial and ethnic differences in the predictive validity of SRH for subsequent mortality risk among older adults (55-84) by estimating Cox Proportional Hazard models using data from the National Health Interview Surveys Linked Mortality Files (1989-2006; N = 289,432). Results indicate that SRH predicts mortality risk less well for non-Hispanic Blacks and Hispanics than non-Hispanic Whites. Three proposed mechanisms-socioeconomic status, immigration status, and cause of death-explain only a modest proportion of the variation. These results suggest that individuals from different racial and ethnic groups may evaluate their heath differently, and thus caution is necessary when using SRH to estimate racial and ethnic health disparities.

Examination of Age Variations in the Predictive Validity of Self-Rated Health.

OBJECTIVES: The high predictive validity of self-rated health (SRH) is a major strength of this widely used population health measure. Recent studies, however, noted that the predictive validity varies across population subgroups. The aim of this study is to examine respondents' age as a moderator of SRH predictive validity with respect to subsequent mortality risk. METHOD: Using data from the National Health Interview Survey-Linked Mortality Files (NHIS-LMF) 1986-2006, we estimate Cox proportional hazard models of all-cause and cause-specific mortality for adults aged 45-84 years as a function of their health ratings (N = 574,008). RESULTS: The data show significant age moderation of the predictive validity of SRH across all levels of ratings: the hazard ratios for mortality decline by about a half between the ages of 50 and 80 years. This attenuation appears primarily among earlier birth cohorts; there is no significant age attenuation in more recent cohorts-however, this may be in part attributed to the earlier ages when the respondents are observed. DISCUSSION: The findings of declining predictive validity of SRH across age imply that individuals may evaluate their health differently as they age. The results also suggest caution in using SRH to capture age-related health changes in the older population.

Stressors, social support, religious practice, and general well-being among Korean adult immigrants.

Through this cross-sectional study the authors explore how stressors, social support, and religious practice are associated with the general well-being of 147 Korean adult immigrants through interviews. Hierarchical regression analysis reveals that low English proficiency and financial hardship are significantly related to low general well-being. However, high social support and religious practice are significantly associated with high general well-being. Social service and health care providers need to carefully assess stressors, social support systems, and spiritual issues for providing appropriate services/programs for English, culture, or social activities as well as spiritual intervention to maximize the strengths of Korean immigrants coping with health issues.

Trends in the Educational Gradient of U.S. Adult Mortality from 1986 to 2006 by Race, Gender, and Age Group.

The educational gradient of U.S. adult mortality became steeper between 1960 and the mid 1980s, but whether it continued to steepen is less clear given a dearth of attention to these trends since that time. This study provides new evidence on trends in the education-mortality gradient from 1986 to 2006 by race, gender, and age among non-Hispanic whites and blacks using data from the 2010 release of the National Health Interview Survey Linked Mortality File. Results show that, for white and black men, the gradient steepened among older ages because declines in mortality risk across education levels were greater among the higher educated. The gradient steepened among white women, and to a much lesser and only marginally significant extent among black women, largely because mortality risk decreased among the college-educated but increased among women with less than a high school degree. Greater returns to higher education and compositional changes within educational strata likely contributed to the trends.