Evaluation of the prevalence and risk factors of burnout syndrome among healthcare workers:A cross-sectional study

BACKGROUND Burnout syndrome is a significant issue among healthcare professionals worldwide,marked by depersonalization,emotional exhaustion,and a reduced sense of personal achievement.This psychological and physical burden profoundly affects healthcare professionals'quality of care and overall well-being.In Somalia,where the healthcare system faces numerous challenges,the escalating demand for medical services and inadequate resources,coupled with overwhelming workloads,long hours,and high-stress levels,make healthcare providers particularly vulnerable to burnout syndrome.This,in turn,affects both the mental health of healthcare personnel and the quality of care they provide.AIM To examine the prevalence and determinants of burnout syndrome among healthcare practitioners in Mogadishu,Somalia.METHODS This cross-sectional prospective study was performed among 246 healthcare providers employed at a tertiary care hospital in Mogadishu,Somalia,who were recruited via random sampling.Data were collected using questionnaires that covered sociodemographic,psychological,work-related characteristics,and burnout syndrome.Bivariate and multivariate logistic regression analyses were performed to identify the variables that correlated with burnout syndrome.The results were presented using adjusted odds ratios(AORs),95%CIs,and P values,with a cutoff of 0.05 for identifying significant associations.RESULTS Among the participants,24%(95%CI:18.8%–29.8%)exhibited symptoms of burnout syndrome.Factors associated with burnout included female gender(AOR=6.60;95%CI:2.29-19.04),being married(AOR=3.07;95%CI:1.14-8.28),being divorced or widowed(AOR=5.84;95%CI:1.35-25.35),working more than 7 night shifts(AOR=3.19;95%CI:1.30–7.82),having less than 5 years of job experience(AOR=5.28;95%CI:1.29-21.65),experiencing poor sleep quality(AOR=5.29;95%CI:1.88-14.89),and exhibiting depressive(AOR=4.46;95%CI:1.59-12.53)and anxiety symptoms(AOR=7.34;95%CI:2.49-21.60).CONCLUSION This study found that nearly one in four healthcare professionals suffers from burnout syndrome.Improving sleep quality,monitoring,and providing mental health support could enhance their well-being and patient care.

ICU-acquired weakness in critically ill patients at risk of malnutrition: risk factors, biomarkers, and early enteral nutrition impact

BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.

Risk factors for congenital nasolacrimal duct obstruction in children under two years of age

·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.

Association between autoimmune gastritis and gastric polyps:Clinical characteristics and risk factors

BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.

Risk factors,monitoring,and treatment strategies for early recurrence after rectal cancer surgery

Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.

Prognosis in stage II colon cancer:Expanding the horizons of risk factors

we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cancer progression have recently been described in extensive clinical research,and should be included in this analysis to achieve a more accurate prognosis.These factors include inflammation,gut microbiota composition,immune status and nutritional balance,as they influence the post-surgical survival profile of patients with stage II colorectal cancer.We also address the clinical implementation and limitations of these analyses.Evaluation of the patient´s entire context is essential for selection of the most appropriate therapy.

Classification and identification of risk factors for type 2 diabetes

The risk factors for type 2 diabetes mellitus(T2DM)have been increasingly researched,but the lack of systematic identification and categorization makes it difficult for clinicians to quickly and accurately access and understand all the risk factors,which are categorized in this paper into five categories:Social determinants,lifestyle,checkable/testable risk factors,history of illness and medication,and other factors,which are discussed in a narrative review.Meanwhile,this paper points out the problems of the current research,helps to improve the systematic categorisation and practicality of T2DM risk factors,and provides a professional research basis for clinical practice and industry decision-making.

Evaluating risk factors for surgical site infections and the effectiveness of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy

BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.

Risk factors, prevention and screening of colorectal cancer: A rising problem

Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Adolescent suicide risk factors and the integration of socialemotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide.Rapid changes in adolescents’physical and mental states,as well as in their lives,significantly and undeniably increase the risk of suicide.Psychological,social,family,individual,and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct,indirect,or combined pathways.Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide.When deliberately cultivated,fostered,and enhanced,selfawareness,self-management,social awareness,interpersonal skills,and responsible decision-making,as the five core competencies of social-emotional learning,can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support.Among numerous suicide intervention methods,school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents.The characteristics of school-based interventions based on social-emotional competence,including their appropriateness,necessity,cost-effectiveness,comprehensiveness,and effectiveness,make these interventions an important means of addressing the crisis of adolescent suicide.To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide,additional financial support should be provided,the combination of socialemotional learning and other suicide prevention programs within schools should be fully leveraged,and cooperation between schools and families,society,and other environments should be maximized.These efforts should be considered future research directions.

Systematic review of risk factors,prognosis,and management of colorectal signet-ring cell carcinoma

BACKGROUND Colorectal signet-ring cell carcinoma(CSRCC)is a rare clinical entity which accounts for approximately 1%of all colorectal cancers.Although multiple studies concerning this specific topic have been published in the past decades,the pathogenesis,associated risk factors,and potential implications on treatment are still poorly understood.Besides the low incidence,historically confusing histological criteria have resulted in confusing data.Nevertheless,the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis,highlight the actual interest to synthesize the known literature regarding CSRCC.AIM To provide an updated overview of risk factors,prognosis,and management of CSRCC.METHODS A literature search in the MEDLINE/PubMed database was conducted with the following search terms used:‘Signet ring cell carcinoma’and‘colorectal’.Studies in English language,published after January 1980,were included.Studies included in the qualitative synthesis were evaluated for content concerning epidemiology,risk factors,and clinical,diagnostic,histological,and molecular features,as well as metastatic pattern and therapeutic management.If possible,presented data was extracted in order to present a more detailed overview of the literature.RESULTS In total,67 articles were included for qualitative analysis,of which 54 were eligible for detailed data extraction.CSRCC has a reported incidence between 0.1%-2.4%and frequently presents with advanced disease stage at the time of diagnosis.CSRCC is associated with an impaired overall survival(5-year OS:0%-46%)and a worse stagecorrected outcome compared to mucinous and not otherwise specified adenocarcinoma.The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised.Surgery is the mainstay of treatment,although the rates of curative resection in CSRCC(21%-82%)are lower compared to those in other histological types.In case of peritoneal metastasis,cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.CONCLUSION CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation.As such,diagnostic modalities and therapeutic approach should be tailored accordingly.

High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.

Risk factors for running-related injuries:An umbrella systematic review

Purpose:This umbrella systematic review(SR) of SRs and meta-analysis seeks to comprehensively synthesize existing literature to identify and consolidate the diverse range of risk factors contributing to running-related injuries(RRIs).Methods:Systematic searches were conducted on June 28,2023,across Web of Science,SPORTDiscus,Scopus,PubMed,and Cochrane Library.We included SRs,whether accompanied by meta-analyses or not,that focused on investigating risk factors for RRIs within observational studies.The methodological quality of the SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews Ⅱ.To assess the extent of overlap across reviews,the corrected covered area metric was calculated.Results:From 1509 records retrieved,13 SRs were included.The degree of overlap between SRs was low(4%),and quality varied from critically low(n=8) to low(n=5).Two hundred seven outcomes assessed in 148 primary studies were identified as being associated with the occurrence of RRIs.The effect sizes of the associations for which risk measures were reported(n=131) were classified as large(n=30,23%),medium(n=38,29%),small(n=48,37%) or no effect(n=15,11%).Running/training characteristics,health and lifestyle factors,along with morphological and biomechanical aspects,exhibit large effect sizes in increasing the risk for RRIs.Conclusion:Drawing from the outcomes of the low-quality SRs and associations with large effect sizes,our findings indicate that running/training characteristics and health and lifestyle factors,as well as morphological and biomechanical aspects,are all implicated in elevating the risk of RRIs,emphasizing the multifactorial basis of injury incidence in running.Given the low quality and heterogeneity of SR,individual findings warrant cautious interpretation.

Spatial Heterogeneity and Risk Factors of Dental Caries in 12-Year-Old Children in Shanxi Province,China

Objective This study aimed to explore the spatial heterogeneity and risk factors for dental caries in 12-year-old children in Shanxi province,China.Methods The data encompassed 3,721 participants from the two most recent oral health surveys conducted across 16 districts in Shanxi Province in 2015 and 2018.Eighteen specific variables were analyzed to examine the interplay between socioeconomic factors,medical resources and environmental conditions.The Geo-detector model was employed to assess the impacts and interactions of these ecological factors.Results Socioeconomic factors(Q=0.30,P<0.05)exhibited a more substantial impact compared to environmental(Q=0.19,P<0.05)and medical resource factors(Q=0.25,P<0.05).Notably,the urban population percentage(UPP)demonstrated the most significant explanatory power for the spatial heterogeneity in caries prevalence,as denoted by its highest q-value(q=0.51,P<0.05).Additionally,the spatial distribution’s heterogeneity of caries was significantly affected by SO2 concentration(q=0.39,P<0.05)and water fluoride levels(q=0.27,P<0.05)among environmental factors.Conclusion The prevalence of caries exhibited spatial heterogeneity,escalating from North to South in Shanxi Province,China,influenced by socioeconomic factors,medical resources,and environmental conditions to varying extents.

Risk factors,prognostic factors,and nomograms for distant metastasis in patients with diagnosed duodenal cancer:A population-based study

BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tumor areas,no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.AIM To develop and evaluate nomograms for predicting the risk of DM and person-alized prognosis in patients with duodenal cancer.METHODS Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer,and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM.Two novel nomograms were established,and the results were evaluated by receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS A total of 2603 patients with duodenal cancer were included,of whom 457 cases(17.56%)had DM at the time of diagnosis.Logistic analysis revealed independent risk factors for DM in duodenal cancer patients,including gender,grade,tumor size,T stage,and N stage(P<0.05).Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM,including age,histological type,T stage,tumor grade,tumor size,bone metastasis,chemotherapy,and surgery(P<0.05).The accuracy of the nomograms was validated in the training set,validation set,and expanded testing set using ROC curves,calibration curves,and DCA curves.The results of Kaplan-Meier survival curves(P<0.001)indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.CONCLUSION The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM,potentially enhancing clinical decision-making.

Association between Residential Greenness and Cardiometabolic Risk Factors among Adults in Rural Xinjiang Uygur Autonomous Region,China:A Cross-Sectional Study

Objective This study aimed to explore the relationships between residential greenness and cardiometabolic risk factors among rural adults in Xinjiang Uygur Autonomous Region(Xinjiang)and thus provide a theoretical basis and data support for improving the health of residents in this region.Methods We recruited 9,723 adult rural residents from the 51st Regiment of the Third Division of the Xinjiang Production and Construction Corps in September 2016.The normalized difference vegetation index(NDVI)was used to estimate residential greenness.The generalized linear mixed model(GLMM)was used to examine the association between residential greenness and cardiometabolic risk factors.Results Higher residential greenness was associated with lower cardiometabolic risk factor prevalence.After adjustments were made for age,sex,education,and marital status,for each interquartile range(IQR)increase of NDVI500-m,the risk of hypertension was reduced by 10.3%(OR=0.897,95%CI=0.836-0.962),the risk of obesity by 20.5%(OR=0.795,95%CI=0.695-0.910),the risk of type 2 diabetes by 15.1%(OR=0.849,95%CI=0.740-0.974),and the risk of dyslipidemia by 10.5%(OR=0.895,95%CI=0.825-0.971).Risk factor aggregation was reduced by 20.4%(OR=0.796,95%CI=0.716-0.885)for the same.Stratified analysis showed that NDVI500-m was associated more strongly with hypertension,dyslipidemia,and risk factor aggregation among male participants.The association of NDVI500-m with type 2 diabetes was stronger among participants with a higher education level.PM10 and physical activity mediated 1.9%-9.2%of the associations between NDVI500-m and obesity,dyslipidemia,and risk factor aggregation.Conclusion Higher residential greenness has a protective effect against cardiometabolic risk factors among rural residents in Xinjiang.Increasing the area of green space around residences is an effective measure to reduce the burden of cardiometabolic-related diseases among rural residents in Xinjiang.

Risk factors for hepatocellular carcinoma in cirrhosis:A comprehensive analysis from a decade-long study

BACKGROUND Cirrhosis is a significant risk factor for the development of hepatocellular carcinoma(HCC).Variability in HCC risk among patients with cirrhosis is notable,particularly when considering the diverse etiologies of cirrhosis.AIM To identify specific risk factors contributing to HCC development in patients with cirrhosis.METHODS This retrospective study analyzed data from cirrhotic patients at Beijing Youan Hospital from January 1,2012 to September 30,2022 with at least 6 mo of followup.Patient demographics,medical histories,etiologies,and clinical characteristics were examined.Cox regression analysis was used to analyze correlations of the above parameters with hepatocarcinogenesis,while competing risk regression was used to estimate their adjusted hazard ratios accounting for death.The cumulative incidence was plotted over time.RESULTS Overall,5417 patients with cirrhosis(median age:54 years;65.8%males)were analyzed.Hepatitis B virus(HBV)was the most common etiology(23.3%),with 25%(n=1352)developing HCC over a 2.9-year follow-up period.Patients with multiple etiologies had the HCC highest incidence(30.3%),followed by those with HBV-related cirrhosis(29.5%).Significant risk factors included male sex,advanced age,hepatitis C virus(HCV)infection,elevated blood ammonia,and low platelet count.Men had a higher 5-year HCC risk than women(37.0%vs 31.5%).HBV,HCV,and HBV/HCV co-infected patients had 5-year risks of HCC of 45.8%,42.9%,and 48.1%,respectively,compared to 29.5%in nonviral hepatitis cases,highlighting the significant HCC risk from viral hepatitis,especially HBV,and underscores the importance of monitoring these high-risk groups.CONCLUSION In conclusion,HBV-related cirrhosis strongly correlates with HCC,with male sex,older age,viral hepatitis,elevated blood ammonia,and lower albumin and platelet levels increasing the risk of HCC.

Risk Factors of Depression Screened by Two-Sample Mendelian Randomization Analysis:A Systematic Review

Objective This study explored the potentially modifiable factors for depression and major depressive disorder(MDD)from the MR-Base database and further evaluated the associations between drug targets with MDD.Methods We analyzed two-sample of Mendelian randomization(2SMR)using genetic variant depression(n=113,154)and MDD(n=208,811)from Genome-Wide Association Studies(GWAS).Separate calculations were performed with modifiable risk factors from MR-Base for 1,001 genomes.The MR analysis was performed by screening drug targets with MDD in the DrugBank database to explore the therapeutic targets for MDD.Inverse variance weighted(IVW),fixed-effect inverse variance weighted(FE-IVW),MR-Egger,weighted median,and weighted mode were used for complementary calculation.Results The potential causal relationship between modifiable risk factors and depression contained 459 results for depression and 424 for MDD.Also,the associations between drug targets and MDD showed that SLC6A4,GRIN2A,GRIN2C,SCN10A,and IL1B expression are associated with an increased risk of depression.In contrast,ADRB1,CHRNA3,HTR3A,GSTP1,and GABRG2 genes are candidate protective factors against depression.Conclusion This study identified the risk factors causally associated with depression and MDD,and estimated 10 drug targets with significant impact on MDD,providing essential information for formulating strategies to prevent and treat depression.