Compliance in the public versus the private realm: Economic preferences, institutional trust and COVID-19 health behaviors

To what extent do economic preferences and institutional trust predict compliance with physical distancing rules during the COVID-19 pandemic? We reexamine this question by introducing the theoretical and empirical distinction between individual health behaviors in the public and in the private domain (e.g., keeping a distance from strangers vs. abstaining from private gatherings with friends). Using structural equation modeling to analyze survey data from Germany's second wave of the pandemic (N = 3350), we reveal the following major differences between compliance in both domains: Social preferences, especially (positive) reciprocity, play an essential role in predicting compliance in the public domain but are barely relevant in the private domain. Conversely, individuals' degree of trust in the national government matters predominantly for increasing compliance in the private domain. The clearly strongest predictor in this domain is the perception pandemic-related threats. Our findings encourage tailoring communication strategies to either domain-specific circumstances or factors common across domains. Tailored communication may also help promote compliance with other health-related regulatory policies beyond COVID-19.

Predictors of controlled attenuation parameter in metabolic dysfunction

BACKGROUND & AIMS

Hepatic fat content can be non-invasively estimated by controlled attenuation parameter (CAP) during transient elastography. The aim of this study was to examine the determinants and predictors of CAP values in individuals with metabolic dysfunction.

METHODS

We enrolled 1230 consecutive apparently healthy individuals (Liver-Bible-2022 cohort) with ≥3 metabolic dysfunction features. CAP was measured by Fibroscan. CAP determinants and predictors were identified using backward stepwise analysis and introduced in generalized linear models.

RESULTS

Participants were predominantly males (82.9%), mean age was 53.8 ± 6.4 years, 600 (48.8%) had steatosis (CAP ≥ 275 dB/m), and 27 had liver stiffness measurement (LSM) ≥ 8 kPa. CAP values correlated with LSM (p < 10-22). In multivariable analysis, fasting insulin and abdominal circumference (AC) were the main determinants of CAP (p < 10-6), together with body mass index (BMI; p < 10-4), age, diabetes, triglycerides, ferritin, and lower HDL and thyroid stimulating hormone (TSH; p < 0.05 for all). In a subset of 592 participants with thyroid hormone measurement, we found an association between higher free triiodothyronine levels, correlating with lower TSH, and CAP values, independent of TSH and of levothyroxine treatment (p = 0.0025). A clinical CAP score based on age, BMI, AC, HbA1c, ALT, and HDL predicted CAP ≥ 275 dB/m with moderate accuracy (AUROC = 0.73), which was better than that of the Fatty Liver Index and of ALT (AUROC = 0.70/0.61, respectively) and validated it in multiple cohorts.

CONCLUSION

Abdominal adiposity and insulin resistance severity were the main determinants of CAP in individuals with metabolic dysfunction and may improve steatotic liver disease risk stratification. CAP values were modulated by the hypophysis-thyroid axis.

The kinetics of Torque Teno virus plasma load following calcineurin inhibitor dose change in kidney transplant recipients

Torque Teno virus (TTV) is nonpathogenic, highly prevalent, and reflects the immune status of its host. Thus, TTV plasma load was suggested for the guidance of immunosuppression post solid organ transplantation. The present study was designed to determine the kinetics of TTV following changes in calcineurin inhibitor (CNI) dose. A total of 48 adult recipients of a kidney graft transplanted at the Medical University of Vienna between 2018 and 2019 with isolated changes in CNI dose were selected from the prospective TTV-POET trial. TTV plasma load was quantified by in-house PCR. At Day 30 following CNI dose adaptation (median 33% of daily dose) no changes in TTV load were noted. However, at Day 60, following CNI dose reduction a lower TTV load of 6.4 log10 c/mL (median; interquartile range [IQR] 4.9-8.1) compared with the baseline of 7.1 log10 c/mL (IQR 5.3-8.9) was noted (p = 0.001); there was also a trend toward a higher TTV load following CNI increase (6.6 log10 c/mL, IQR 4.1-9.7 vs. 5.2 log10 c/mL, IQR 4.5-6.8; p = 0.09). The data suggested that TTV load changes become noticeable only 2 months after CNI dose adaptation, which might be the ideal time point for TTV load monitoring.

Clinical performance of additively manufactured subperiosteal implants: a systematic review

PURPOSE

The aim of this study was to assess implant survival and complications rate of modern subperiosteal implants (CAD designed and additively manufactured).

METHODS

A systematic review was conducted using three electronic databases; Medline (Pubmed), Cochrane library, and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: "In patients with bone atrophy (P), do additively manufactured subperiosteal implants (I), compared to subperiosteal implants manufactured following traditional approaches (c), present satisfactory implant survival and complication rates (O)? The study was pre-registered in PROSPERO (CRD42023424211). Included articles quality was assessed using the "NIH quality assessment tools".

RESULTS

Thirteen articles were finally selected (5 cohort studies and 8 case series), including 227 patients (121 female / 106 male; weighted mean age 62.4 years) and 227 implants. After a weighted mean follow-up time of 21.4 months, 97.8% of implants were in function (5 failures reported), 58 implants (25.6%) presented partial exposure, 12 patients (5.3%) suffered soft tissue or persistent infection. Fracture of the interim prosthesis was reported in 8 of the155 patients (5.2%) in which the use of a provisional prosthesis was reported. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible.

CONCLUSIONS

Within the limitations of this study, modern additively manufactured subperiosteal implants presented a good survival in the short-time, but a noticeable number of soft-tissue related complications were reported. Further studies are needed to assess the clinical behavior in the medium- and long-term.

Going the extra mile? General practitioners' upcoding of fees for home visits

General practitioners' (GPs') income often relies on self-reported activities and performances. They can therefore 'game the system' to maximize their remuneration. We investigate whether Danish GPs game their travel fees for home visits. Combining administrative and geographical data, we measure the difference between GPs' traveled and billed distances. We exploit a rise in the fees for home visits. If there is a link between the rise in fees and upcoding, we interpret this finding as indicative of gaming behavior. We find that upcoding occurs slightly more often than downcoding (16% vs. 13% of visits) for visits that can be both upcoded and downcoded. Using linear probability models with GP fixed effects, we find that the fee rise is associated with a reduction in upcoding of 0.6% of home visits (2.8% for visits where upcoding is feasible) and no change in downcoding. Importantly, we find no statistically significant differences in the reduction in upcoding across distance bands despite large differences in their fee rises. We therefore conclude that there is no causal evidence of GPs gaming their fees.

Potential of the Oxidized Form of the Oleuropein Aglycon to Monitor the Oil Quality Evolution of Commercial Extra-Virgin Olive Oils

The quality of commercially available extra-virgin olive oils (VOOs) of different chemical compositions was evaluated as a function of storage (12 months), simulating market storage conditions, to find reliable and early markers of the virgin olive oil (VOOs) quality status in the market. By applying a D-optimal design using the Most Descriptive Compound (MDC) algorithm, 20 virgin olive oils were selected. The initial concentrations of oleic acid, hydrophilic phenols, and α-tocopherol in the 20 VOOs ranged from 58.2 to 80.5%, 186.7 to 1003.2 mg/kg, and 170.7-300.6 mg/kg, respectively. K270, ∆K, (E, E)-2.4-decadienal and (E)-2-decenal, and the oxidative form of the oleuropein aglycon (3,4-DHPEA-EA-OX) reflected the VOO quality status well, with 3,4-DHPEA-EA-OX being the most relevant and quick index for simple monitoring of the "extra-virgin" commercial shelf-life category. Its HPLC-DAD evaluation is easy because of the different wavelength absorbances of the oxidized and non-oxidized form (3,4-DHPEA-EA), respectively, at 347 and 278 nm.

Obesity Is Associated with Attenuated Tissue Immunity in COVID-19

Rationale: Obesity affects 40% of U.S. adults, is associated with a proinflammatory state, and presents a significant risk factor for the development of severe coronavirus disease (COVID-19). To date, there is limited information on how obesity might affect immune cell responses in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objectives: To determine the impact of obesity on respiratory tract immunity in COVID-19 across the human lifespan. Methods: We analyzed single-cell transcriptomes from BAL in three ventilated adult cohorts with (n = 24) or without (n = 9) COVID-19 from nasal immune cells in children with (n = 14) or without (n = 19) COVID-19, and from peripheral blood mononuclear cells in an independent adult COVID-19 cohort (n = 42), comparing obese and nonobese subjects. Measurements and Main Results: Surprisingly, we found that obese adult subjects had attenuated lung immune or inflammatory responses in SARS-CoV-2 infection, with decreased expression of IFN-α, IFN-γ, and TNF-α (tumor necrosis factor α) response gene signatures in almost all lung epithelial and immune cell subsets, and lower expression of IFNG and TNF in specific lung immune cells. Peripheral blood immune cells in an independent adult cohort showed a similar but less marked reduction in type-I IFN and IFNγ response genes, as well as decreased serum IFNα, in obese patients with SARS-CoV-2. Nasal immune cells from obese children with COVID-19 also showed reduced enrichment of IFN-α and IFN-γ response genes. Conclusions: These findings show blunted tissue immune responses in obese patients with COVID-19, with implications for treatment stratification, supporting the specific application of inhaled recombinant type-I IFNs in this vulnerable subset.