Real-life application of a stratification model for HIV care

INTRODUCTION

HIV infection has become a chronic disease with a good long-term prognosis, necessitating a change in the care model. For this study, we applied a proposal for an Optimal Care Model (OCM) for people with HIV (PHIV), which includes tools for assessing patient complexity and their classification into profiles to optimize care provision.

METHODS

Observational, cross-sectional, and retrospective study. Adult PHIV treated at the Tropical Medicine consultations at Ramón y Cajal Hospital from January 1 to June 30, 2023, were included. The complexity calculation and the stratification into profiles for each patient were done according to the OCM.

RESULTS

Ninety-four participants were included, 76.6% cisgender men, with a median age of 41 years (range 23-76). Latin America and Africa were the main regions of origin (72.4%). 98% had an undetectable HIV viral load. The degree of complexity was 78.7% low, 11.7% medium, 1% high, and 8.5% extreme. The predominant profile was blue (64.9%), followed by lilac (11.7%), purple (6.3%), and green (4.3%). 7.4% were unclassifiable, of whom 57.2% had high/extreme complexity. Among the unclassifiable, mental health problems were the most common.

CONCLUSIONS

The OCM tools for People Living with HIV (PLWH) allow for the classification and stratification of most patients in a consultation with a non-standard population. Patients who did not fit into the pre-established profiles presented high complexity. Creating a profile focused on mental health or mixed profiles could facilitate the classification of more patients.

Identifying and understanding cognitive profiles in multiple sclerosis: a role for visuospatial memory functioning

BACKGROUND

The heterogeneous nature of cognitive impairment in people with multiple sclerosis (PwMS) hampers understanding of the underlying mechanisms and developing patient-tailored interventions. We aim to identify and classify cognitive profiles in PwMS, comparing these to cognitive status (preserved versus impaired).

METHODS

We included 1213 PwMS (72% female, age 45.4 ± 10.7 years, 83% relapsing-remitting MS). Cognitive test scores were converted to Z-scores compared to healthy controls for the functions: attention, inhibition, information processing speed (IPS), verbal fluency and verbal/visuospatial memory. Concerning cognitive status, impaired cognition (CI) was defined as performing at Z ≤ - 1.5 SD on ≥ 2 functions. Cognitive profiles were constructed using latent profile analysis on all cognitive functions. Cognitive profiles or status was classified using gradient boosting decision trees, providing the importance of each feature (demographics, clinical, cognitive and psychological functioning) for the overall classification.

RESULTS

Six profiles were identified, showing variations in overall performance and specific deficits (attention, inhibition, IPS, verbal fluency, verbal memory and visuospatial memory). Across the profiles, IPS was the most impaired function (%CI most preserved profile, Profile 1 = 22.4%; %CI most impaired profile, Profile 6 = 76.6%). Cognitive impairment varied from 11.8% in Profile 1 to 95.3% in Profile 6. Of all cognitive functions, visuospatial memory was most important in classifying profiles and IPS the least (area under the curve (AUC) = 0.910). For cognitive status, IPS was the most important classifier (AUC = 0.997).

CONCLUSIONS

This study demonstrated that cognitive heterogeneity in MS reflects a continuum of cognitive severity, distinguishable by distinct cognitive profiles, primarily explained by variations in visuospatial memory functioning.

School Readiness in Preschool-Age Children with Critical Congenital Heart Disease

This study examined the nature, variability, and predictors of school readiness difficulties in young children with critical congenital heart disease (CCHD). We hypothesized that, compared to a community control (CC) group, children with CCHD would score less well on measures of readiness and that readiness would be associated with CCHD-related risk factors. Children (60 CCHD and 60 CC) were 4 to 5 years of age and not yet attending kindergarten. Readiness measures included tests of cognition, executive function, motor ability, and pre-academic skills. Caregivers provided child behavior ratings. Analyses examined group differences in readiness, readiness profiles, and associations of readiness with CCHD-related medical risk factors. The CCHD group had lower scores than the CC group on testing and higher caregiver ratings of problems in social communication, as well as higher rates of deficits on several of the measures. Latent class analysis provided evidence for different readiness profiles, with more children with CCHD displaying profiles characterized by weaknesses in readiness. CCHD-related medical risk factors associated with readiness problems in the CCHD group included a co-morbid genetic disorder, postnatal diagnosis of CCHD, major perioperative complication, and longer periods of hospitalizations, cardiopulmonary bypass, and aortic cross-clamp placements. Findings document multiple problems in school readiness in young children with CCHD. Deficits vary across individuals and are associated with higher medical risk. Results confirm the importance of screening for school readiness in these children and suggest areas to target in designing screening measures and providing early childhood interventions.

Unveiling Chinese senior high school EFL students' burnout and engagement: Profiles and antecedents

Burnout impairs English as a foreign language (EFL) learning, while engagement enhances it. However, most relevant studies have focused on college students, neglecting senior high school students. To address this gap, this mixed-methods study used two scales to assess the levels of burnout and engagement among 1234 Chinese senior high school EFL students. We also applied a person-centered approach with a statistical software (Mplus 8.7) to identify their latent profiles. Then, we conducted semi-structured interviews with 30 students and analyzed the data using thematic analysis with a qualitative software (MAXQDA 2022) to investigate the antecedents of their burnout and engagement. The statistical analysis revealed three profiles: high burnout-low engagement (16.0 %), moderate burnout-moderate engagement (61.8 %), and low burnout-high engagement (22.2 %). The profiles were associated with demographic characteristics such as gender, age, and grade. The thematic analysis identified four major antecedents: high academic stress and low academic support for burnout, and high external support and high internal support for engagement. Each major antecedent consisted of several categories and subcategories. This study could inform the design of effective interventions to reduce Chinese EFL students' burnout and increase their engagement.

Characterization of biosecurity practices among cattle transport drivers in Spain

Transmission of pathogens between farms via animal transport vehicles is a potential concern; however, the available information on driver routines and biosecurity measures implemented during transport is limited. Given the above, the aim of this study was to describe and characterize the prevailing practices and biosecurity measures adopted by cattle transport drivers in Spain. Eighty-two drivers were surveyed via face-to-face or remotely. The survey included questions on general characteristics of the drivers (type of journeys and vehicles) together with biosecurity practices implemented during cattle transport and vehicle hygiene practices. Results showed that several risky practices are performed quite frequently such as visiting different premises with different levels of risk (e.g., breeder and fattening farms); entering the farm premises to load/unload animals, passing by several farms to load and unload animals, or not always cleaning and disinfecting the vehicle between travels, among others. To explore similarities among the drivers and identify groups sharing specific practices, hierarchical clustering on principal components (HCPC) was computed on the results of multiple correspondence analysis (MCA). The first three MCA dimensions (out of 13) were retained in the agglomerative clustering and four different clusters were identified. Clusters 1 and Cluster 4 accounted for 39.5% and 29.6% of respondents, respectively. The clusters were mainly differentiated by practices in the loading/unloading of cattle, such as the frequency of contact with animals remaining on the farm, and the frequency of the vehicle's disinfection between farms. Cluster 2 and Cluster 3 were of similar size, about 15% of respondents each. Cluster 2 consisted of drivers who mainly made journeys to slaughterhouse, while drivers in Cluster 3 were characterised by the use of working clothes and boots. Based on these findings, it is advisable to increase awareness on the role that animal transport can have in the spread of pathogens between cattle farms and the importance of biosecurity in preventing such transmission. There is also a need to support animal transport professionals in such task, not only through the development of initiatives to increase awareness, but also through the investment in improving cleaning and disinfection facilities and to consider the economic cost associated with some practices to not compromise the economic viability of the sector.

Profiles of Loneliness and Ostracism During Adolescence: Consequences, Antecedents, and Protective Factors

This longitudinal study (N = 1078, 46% boys; 54% girls) examined profiles of loneliness and ostracism during adolescence and their consequences and antecedents. Longitudinal latent profiles analyses identified four distinct profiles: (1) High emotional loneliness (25%), High and increasing social loneliness (15%), High peer exclusion and high social impact (9%) and No peer problems (51%). Subsequent internalizing problems were typical for the High and increasing social loneliness profile and externalizing problems for the High emotional loneliness and High peer exclusion and high social impact profiles. Furthermore, effortful control, prosocial skills, and relationship quality with parents and teachers were highest in the No peer problems profile, whereas the High and increasing social loneliness profile had the lowest self-esteem and was characterized by low surgency/extraversion, high affiliativeness, and high negative affectivity.

Social Interaction Profiles Among Youth with Intellectual Disabilities: Associations with Indicators of Psychosocial Adjustment

This study investigates the nature of the social interaction profiles observed among youth with intellectual disabilities (ID), defined while considering their relationships with their parents, peers, and teachers, as well as the implication of these profiles for self-esteem, aggressive behaviors, and prosocial behaviors. A sample of 393 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged between 11 and 22 (M = 15.70), was recruited in Canada (n = 141) and Australia (n = 253). Our results revealed four profiles, corresponding to Socially Isolated (23.24%), Socially Integrated (39.83%), Socially Rejected (28.37%) and Socially Connected (8.57%) youth with ID. The socially integrated and connected profiles both presented higher self-esteem, more prosocial behaviors, and less aggressive behaviors than the socially isolated and rejected profiles.

Unsupervised identification of cardiometabolic profiles among adolescents: findings from the PARIS birth cohort study

Metabolic syndrome (MetS) is known as a risk factor in cardiometabolic morbidity but there is no consensus on its definition for teenagers. We aimed to identify cardiometabolic health profiles and which parameters best discriminate them. K-means partitioning identified cardiometabolic profiles by sex using data on health measurements of 530 adolescents from the PARIS birth cohort. A discriminant analysis was performed. Cardiometabolic risk score and handgrip strength were also measured. Depending on definitions, MetS prevalence ranged from 0.2% to 1.3%. Two profiles were identified for the entire group and by sex: "healthy" and "at cardiometabolic risk." Weight and waist-to-height ratio or waist circumference explained more than 87% of the variance in the profile differentiation. The "at cardiometabolic risk" profiles included adolescents with overweight, a waist-to-height ratio over 0.5, and prehypertension. They had higher cardiometabolic risk scores and parents who were more likely to be overweight and have cardiometabolic diseases themselves. They also had higher birthweights, earlier adiposity-rebound and puberty ages, and lower relative handgrip strength.  Conclusion: The two profiles identified, based on cardiometabolic health, were associated with early indicators and handgrip strength. Results suggest that the waist-to-height ratio is a useful clinical tool for screening individuals at cardiometabolic risk and who therefore require clinical follow-up. What is Known: • Although there is a need for tools to assess cardiometabolic health during adolescence, there is no consensus on the definition of metabolic syndrome for this age group. What is Knew: • The findings suggest that waist-to-height ratio can serve as a simple and valuable clinical tool for screening individuals at cardiometabolic risk who may require clinical monitoring for early prevention of cardiovascular diseases.

Burnout profiles among French healthcare professionals caring for young cancer patients

PURPOSE

The aims of this study were to identify specific burnout profiles among healthcare workers caring for young cancer patients and to investigate their specificities in terms of sociodemographic characteristics, stress, coping mechanisms, and perceived rewards.

METHODS

A total of 262 French healthcare professionals working with young cancer patients completed the study protocol (sociodemographic characteristics, Pediatric Caregiver Stress Questionnaire, Work Rewards Scale-Pediatric Oncology, Ways of Coping Checklist - Revised, Maslach Burnout Inventory). A cluster analysis was performed to identify burnout profiles. ANOVAs and chi-tests were performed in order to identify the differences between the clusters.

RESULTS

The cluster analysis performed showed two end-points profiles with three low or high dimensions (Engagement, Burnout) and three intermediate profiles with only one high dimension (Overextended, Disengaged, Ineffective). The Burnout profile was characterized by a high level of stress, particularly related to working conditions, a low level of perceived rewards, and a low use of problem-focused coping. The Overextended profile was characterized by a high level of stress, particularly related to working conditions. The Disengaged profile had a higher level of stress and a lower level of perceived rewards than the Engagement profile. The Ineffective profile was characterized by low levels of perceived rewards, problem-focused coping, and social support seeking.

CONCLUSION

Interventions to improve the health of healthcare professionals caring for young cancer patients should focus primarily on improving working conditions (work overload, work/life balance) and promoting a stable work environment, enabling healthcare workers to develop their resources at work.

Profiles of patients with substance-related disorders who dropped out or not from addiction treatment

This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.

Profiles, Transitions, and Resilience Factors of Suicide Risk in Early Chinese Adolescents

As a severe public health concern directly endangering life safety, adolescent suicide has been extensively investigated in variable-centered studies. However, gaps remain in the knowledge of heterogeneous suicide risk patterns and their developmental nature. Additionally, little is known about protective factors associated with suicide risk patterns and changes. This study applied person-centered approaches to explore suicide risk profiles and transitions over time in early Chinese adolescents, along with their protective factors. A total of 1518 junior high school students (49.6% girls, Mage = 13.57, SD = 0.75) participated in two surveys within a 12-month interval. Latent Profile Analysis and Latent Transition Analysis were used to model the profiles and transitions of suicide risk. Three risk profiles were identified at both time points: low risk profile (73.9, 78.3%), medium risk-high threat profile (16.2, 10.2%), and high risk profile (9.9, 10.2%). Low risk profile was stable, while medium risk-high threat and high risk profiles showed great transitions over 12 months. Sense of control, meaning in life, and regulatory emotional self-efficacy served as protective factors against suicide risk profiles and transitions. Findings underscore the importance of comprehensively illustrating suicide risk states from multiple aspects, as well as understanding the fluid nature of transitions between different risk states. Prevention and intervention strategies aimed at enhancing resilience, such as increasing sense of control, perceived meaningfulness, and belief in emotional regulation, may contribute to reducing the risk of suicide among adolescents.

Profiles of quality of life among patients using emergency departments for mental health reasons

BACKGROUND

This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use.

METHODS

Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them.

RESULTS

Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions.

CONCLUSION

The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

Characterization of the radiation beam of a tomotherapy equipment with MCNP

This work aims to model and characterize the radiation beam of one Accuray tomotherapy equipment using the Monte Carlo Code MCNP5 (Monte Carlo N-Particle). This tomotherapy equipment is used for delivering high doses of radiation in tumor regions to kill cancer cells and shrink the tumor during radiation therapy of cancer patients, however, the radiation can damage surrounding areas and nearby organs at risk (OAR) if the radiation field is not well delimited. In particular, intensity-modulated radiotherapy treatments (IMRT) with tomotherapy equipment offer great benefits to patients allowing treatment of tumor regions without affecting surrounding areas and OAR. Nowadays, it is well known that a correct simulation of transport of radiation in tomotherapy equipment facilitates considerably the estimation of ideal doses in the tumor, surrounding regions, and OAR. For that reason, in this work, we simulated the geometry of the 6 MV ACCURAY Tomotherapy equipment of the CECAN using the MCNP5. The model includes a TomoLINAC consisting of an electron source that emits Gaussian distribution particles with an average energy of 5.7 MeV and width of 0.3 MeV. The emitted particles impact the tungsten target and pass through primary collimators and jaws that define the irradiation field in the isocenter. To validate the geometry and radiation transport in the TomoLINAC the curves of depth dose percentage (PDD) estimated by simulation and the curves measured experimentally were tuned. In the same way, the simulated transverse and longitudinal profiles were compared with the experimental results. In addition, a comparison between the qualities of the radiation beam characterized with MCNP and measured experimentally in CECAN showed a deviation of 1%. For the simulations, cylindrical detectors located inside a water phantom were considered and it was employed the tally *F8. A good agreement was observed between the PDD's curves obtained from the simulation and those measured experimentally for a field of 5 × 10 cm2 in the isocenter and SSD (distance from the source to the surface) of 85 cm. Also, the comparison between the simulated and experimental transverse profiles obtained at 1.5 cm, 10 cm and 15 cm depth with a radiation field of 5 × 40 cm2 showed very good agreement. The longitudinal profiles were estimated with the same depths as the transverse ones, but for each of them, the openings of the jaws were 5.0 cm, 2.5 cm and 1.0 cm in the longitudinal direction, which corresponds to the direction in which the patient's table moves. The comparison between the simulated and experimental longitudinal profiles showed good concordance too. Once the radiation beam of the ACCURAY tomotherapy equipment had been characterized, experimental dose measurements were made using a Cheese phantom and two A1SL ionization chambers. These results obtained experimentally were compared with those estimated with MCNP for a field of 5 × 40 cm2 at the isocenter and SAD of 85 cm and, it was concluded that both results were similar considering the regions of uncertainty. Finally, we must highlight that the modeling and characterization of the radiation beam of CECAN's ACCURAY tomotherapy equipment can be a key tool for dose estimations in different cancer treatment plans and future research.

Patient profiles in heart failure with reduced ejection fraction: Prevalence, characteristics, treatments and outcomes in a real-world heart failure population

AIMS

The Heart Failure Association of the European Society of Cardiology has recently proposed to optimize guideline-directed medical treatments according to patient's profiles. The aim of this analysis was to investigate prevalence/characteristics/treatments/outcomes for individual profiles.

METHODS AND RESULTS

Patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry (SwedeHF) between 2013 and 2021 were considered. Among 108 profiles generated by combining different strata of renal function (by estimated glomerular filtration rate [eGFR]), systolic blood pressure (sBP), heart rate, atrial fibrillation (AF) status and presence of hyperkalaemia, 93 were identified in our cohort. Event rates for a composite of cardiovascular (CV) mortality or first HF hospitalization were calculated for each profile. The nine most frequent profiles accounting for 70.5% of the population had eGFR 30-60 or ≥60 ml/min/1.73 m2 , sBP 90-140 mmHg and no hyperkalaemia. Heart rate and AF were evenly distributed. The highest risk of CV mortality/first HF hospitalization was observed in those with concomitant eGFR 30-60 ml/min/1.73 m2 and AF. We also identified nine profiles with the highest event rates, representing only 5% of the study population, characterized by no hyperkalaemia, even distribution among the sBP strata, predominance of eGFR <30 ml/min/1.73 m2 and AF. The three profiles with eGFR 30-60 ml/min/1.73 m2 also showed sBP <90 mmHg.

CONCLUSIONS

In a real-world cohort, most patients fit in a few easily identifiable profiles; the nine profiles at highest risk of mortality/morbidity accounted for only 5% of the population. Our data might contribute to identifying profile-tailored approaches to guide drug implementation and follow-up.

Perfluoroalkyl substances (PFASs) in aquatic products from the Yellow-Bohai Sea coasts, China: Concentrations and profiles across species and regions

Perfluoroalkyl substances (PFASs) are emerging contaminants capable of harming human health, primarily via ingesting aquatic products. The current study monitored a survey of 23 PFASs in 1049 aquatic products from the coasts of the Yellow-Bohai Sea in China to comprehensively investigate the concentrations and distributions of PFASs. PFOA, PFOS, PFNA, PFOSA, and PFUdA were more predominantly and frequently detected than other PFASs in all samples, dominating PFAS patterns in aquatic products. The mean levels of ∑PFASs in different species followed the order: marine shellfish > marine crustaceans > fish > cephalopods > sea cucumber. Profiles of PFASs differ between species, suggesting species-specific accumulation plays a role. Various aquatic species are potential environmental bioindicators that signal individual PFAS contamination. For instance, clams can act as a potential PFOA bioindicator. High ∑PFAS levels in some sites (such as Binzhou, Dongying, Cangzhou, and Weifang) could be attributed to industrial activities involving fluoropolymer manufacture. The differences between PFAS concentrations and profiles in aquatic products across the study regions have been proposed as PFAS fingerprints of the Yellow-Bohai Sea coasts. Analyses of principal components and Spearman correlations indicated that the precursor biodegradation possibly contribute to C₈-C₁₀ PFCAs in the study samples. This study reported a wide presence of PFASs in different species of aquatic products across the Yellow-Bohai Sea coasts. The potential health risks that PFASs pose in certain species (such as marine shellfish and marine crustaceans) should not be neglected.

Profiles, correlates, and risk of death among patients with mental disorders hospitalized for psychiatric reasons

This study identified profiles of hospitalized patients with mental disorders (MD) based on their 3-year hospitalization patterns and clinical characteristics and compared sociodemographic profiles and other service use correlates as well as risk of death within 12 months after hospitalization. Quebec (Canada) medical administrative databases were used to investigate a 5-year cohort of 4,400 patients hospitalized for psychiatric reasons. Latent class analysis, chi-square tests and survival analysis were produced. Three profiles of hospitalized patients were identified based on hospitalization patterns and other patient characteristics. Profile 3 patients had multiple hospitalizations and early readmissions, worst health and social conditions, and used the most outpatient services. Profiles 2 and 1 patients had only one hospitalization, of brief duration in the case of Profile 2 patients, who had mainly common MD and made least use of psychiatric care. All Profile 1 patients were hospitalized for serious MD but received least continuity of physician care and fewest biopsychosocial interventions. Risk of death was higher for Profiles 3 and 2 versus Profile 1 patients. Interventions like early follow-up care after hospitalization for Profile 3, collaborative care between general practitioners and psychiatrists for Profile 2, and continuous biopsychosocial care for Profile 1 could be greatly improved.

Looking for COVID side effects in the EU through the analysis of health and behavioural profiles

More than two years after the great outbreak of COVID suffered in almost the whole world, and in particular in Europe, we have gradually learned about the direct effects of this virus on our health and what consequences it can have if we become infected. However, this pandemic also had great economic and social consequences that affected people in an indirect way, which we can call COVID side effects. In this work we carried out an innovative type of analysis based on the concept of archetypoids in order to find extreme observations in a database of mixed-type data and used them to classify individuals yielding to different health and behavioural profiles in coping with the COVID outbreak in the EU. We use data from the first COVID-19 Survey of the SHARE project (Survey on Health, Aging and Retirement in Europe). The resulting profiles are easier to interpret than others based on central observations, and help to understand how the situations of restrictions and lock-downs affected people since the outbreak of the pandemic. Another key point of the work was to analyse how determinant are some aspects such as gender, age group or even geographical location in how each person experienced the pandemic. The method that we propose is wide enough to be used in other health and wellbeing surveys.

Resilient entrepreneurs? - revisiting the relationship between the Big Five and self-employment

The Big Five personality traits and their influence on entrepreneurial action have been repeatedly studied using a trait-based approach. The present paper partly deviates from this perspective by analysing the role of personality prototypes in relation to entrepreneurship. This person-centred approach suggests that combinations of Big Five traits form individual personalities. By using data from the German Socio-Economic Panel (SOEP), we show that at least three prototypes can be identified, one of which - the resilient type - can be hypothesized to significantly increase the likelihood of entrepreneurial action. Our regression results provide evidence of a positive impact of this prototype on the likelihood of and transitioning into self-employment but not the likelihood of exit. We also show that the prototyping approach explains individual self-employment decisions over and above what can already be explained by the profiling approach, another person-centred Big Five approach. The paper concludes with implications for policy and research.

The Profiles of Laryngopharyngeal Reflux in Patients With Different Vocal Fold Lesions

OBJECTIVES

To investigate the profiles of laryngopharyngeal reflux (LPR) and the relationship between hypopharyngeal-proximal reflux episodes (HREs) and the positive rate of salivary pepsin testing in patients with vocal fold lesions (VFLs).

METHODS

The enrolled patients were divided into vocal fold cancer group (VFCG), vocal fold leukoplakia group (VFLG), benign vocal fold lesion group (BVFLG) and control group (CG). Patients benefited from multichannel intraluminal impedance-pH monitoring (MII-pH) and multi-time point salivary pepsin testing (MTPSPT). The LPR profiles of patients with VFLs were studied by analyzing the MII-pH findings. The relationship between HREs and positive rate of MTPSPT was investigated through the nonparametric test.

RESULTS

177 patients were included. According to 24 h MII-pH, the occurrence of HREs tended to increase after meals. 55.75%, 63.98%, 66.82% and 55.77% of the HREs in the VFCG, VFLG, BVFLG and CG occurred within 3 h after meals, respectively. The overall positive rate of MTPSPT was higher in the VFCG than the remaining groups. In the VFCG, there was a significant correlation between overall positive results of MTPSPT and HREs occurring within 3 h after meals.

CONCLUSION

In the Chinese population, the occurrence of HREs tend to more frequently after meals in patients with VFLs, and most HREs occur within 3 h after meals. By analyzing the 24h MII-pH findings, we can develop a more individualized anti-reflux therapeutic strategy for LPR patients.

What differentiates youths who use e-cigarettes from those who smoke traditional tobacco products?

Background

Electronic cigarette (e-cigarette) use has spread among adolescents in many countries, however users’ characteristics are not well known. We aimed to compare characteristics of exclusive e-cigarette users to those of exclusive tobacco users and dual users.

Methods

Data come from a representative sample of 11–19 years old students in Paris, surveyed each year between 2013 and 2017. Current e-cigarette and tobacco use were ascertained in the preceding 30 days. Data were analyzed using random intercept multinomial logistic regression models, exclusive tobacco smokers being the reference group.

Results

Among the 17,435 students included, 2.3% reported exclusive e-cigarette use, 7.9% exclusive tobacco use and 3.2% dual e-cigarette and tobacco use. Compared to exclusive tobacco smokers, e-cigarette users were: a) less likely to use cannabis (adjusted Odds-Ratio (aOR) = 0.15, 95% confidence interval (95% CI) = 0.09–0.25); b) more likely to initiate smoking with an e-cigarette or a hookah rather than traditional cigarettes (aOR = 2.91, 95% CI = 1.74–4.87 and aOR = 15.99, 95% CI = 8.62–29.67, respectively). Additionally, exclusive e-cigarette users are younger with an aOR = 0.29 (95% CI = 0.17–0.49) among 13–15 years and aOR = 0.11 (95% CI = 0.06–0.21) among > 17 years as compared to 11–13 years. The probability of being an exclusive e-cigarette user is lower among participants whose best friend smokes tobacco (aOR = 0.30, 95% CI = 0.20–0.44). Exclusive tobacco users and dual users have similar profiles.

Conclusions

Adolescents who only used e-cigarettes had intermediate levels of risk compared to nonusers and those who used tobacco and/or e-cigarettes, suggesting that e-cigarettes use extends to young people at low-risk of using tobacco products.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13673-0.

Comparison of bile acids profiles in the enterohepatic circulation system of mice and rats

Bile acids (BAs) were selected as biomarkers for the diagnosis and prevention of multiple liver diseases, and they were also considered as an important signal transductor via "liver-gut" axis. As important factors for maintaining the normal function and tissue morphology, BA homeostasis throughout the enterohepatic circulation system was guaranteed by BA synthases and transporters, nuclear receptors (NRs) and gut microbiota, all of which presented significant species differences. Thus, we simultaneously quantify BA profiles in the enterohepatic circulation of SD rats and C57BL/6 mice to reveal the species differences of BA homeostasis between these two main rodents of preclinical studies. Our results showed that BA profiles of mice plasma, bile and liver were most dissimilar from these of rats. Meanwhile, BAs profiles also presented obvious species differences in the intestine of mice and rats, especially small intestine. Unlike rats, taurine-conjugated bile acids (T-BAs) were predominant in mice small intestine content and tissue, in which taurocholic acid (TCA) was the most prominent BAs. BAs dynamic analysis showed that compared with rats, mice showed stranger taurine and glycine de-conjugations in lager intestine. However, both the ratios of unconjugated bile acids (Un-BAs) to conjugated BAs, and secondary BAs to primary BAs in mice small content and tissue were all much lower than these in rats. Furthermore, ileum BAs profiles also showed significantly separation trend between rats and mice, whether content or tissue. Our data revealed that the patterns of BAs homeostasis in mice enterohepatic circulation system were significantly different from these in rats (especially in intestine), suggesting that more cautious should be paid to the selection of BAs as biomarkers for disease diagnosis or/and drug induced toxicity, and the certain role and mechanism of individual BA in the pathological process of BA-related diseases via "liver-gut" axis should be verified by using of multiple species.

Personality characteristics of empathy profiles - practical implications for education of medicine students

BACKGROUND

Empathy plays the key role in the doctor - patient relationship. The research of empathy determinants plays an important role in formulating practical guidelines for the education of medical students. The aim of this study was to analyse personality characteristics of empathy profiles among students of medicine, with consideration of chief personality factors and their subdimensions according to the FFM model.

METHODS

During workshops in Clinical Psychological Skills, 153 students (M = 57, F = 96; mean age 23 years) analysed their psychological functioning styles by examining their personality profiles and empathy indicators. Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R) were applied for this purpose. The analyses of empathy indicators were presented by means of cluster analysis. Variance analysis with post hoc Tukey-b test was performed for differences between clusters and to differentiate between personality factors and their components in empathy clusters. This study was approved by the Jagiellonian University Bioethics Committee (approval number: 1072.6120.175.2018 date: 28.06.2018).

RESULTS

The first cluster included students who presented high empathetic concern for others, understood their perspective and needs characterised by medium level of Neuroticism, high levels of other dimensions The second group included students who could understand others very well, yet with lower tendency to react emotionally to suffering, characterised by medium level of Neuroticism, Extraversion, Openness, high Conscientiousness and low Agreeableness. The third cluster included students who react strongly to painful and unpleasant reactions of others, characterised by high Neuroticism and Agreeableness, low Extraversion.

CONCLUSIONS

Each empathy profile is manifested in relations with patients in a specific way. Medical education in empathy holds great potential to reduce anxiety, stress, and burnout associated with the medical profession. Discussion of individual results with students, gives an opportunity to talk about how their empathy and personality characteristics may influence their everyday medical practice.

Urinary neonicotinoid insecticides in children from South China: Concentrations, profiles and influencing factors

Neonicotinoid insecticides can selectively interact with the unique nicotinic acetylcholine receptor subtypes in insects and are considered to be low toxic to mammals. However, there is still insufficient knowledge on human exposure to neonicotinoid insecticides, especially for children. This study aimed to investigate urinary concentrations and profiles of neonicotinoid insecticides in South China children and to analyze potential influencing factors. Six neonicotinoid insecticides, including imidacloprid (IMI), thiamethoxam (THM), acetamiprid (ACE), clothianidin (CLO), thiacloprid (THD) and dinotefuran (DIN), exhibited high detection frequencies (>90%) in urine samples collected from 305 children, suggesting broad exposure in South China children. The median concentrations were determined to be 0.13, 0.21, 0.01, 0.19, 0.002 and 1.64 μg/L, respectively. Among the target neonicotinoids, urinary concentrations of CLO and THM exhibited a significant and positive correlation between each other (p < 0.05), suggesting similar sources of these two chemicals.

Males and females with first episode psychosis present distinct profiles of social cognition and metacognition

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Impact of a School-Based Multicomponent Positive Psychology Intervention on Adolescents' Time Attitudes: A Latent Transition Analysis

Time attitudes, which refer to positive and negative feelings towards the past, present, and future, are a salient phenomenon in the developmental stage of adolescence and have been related to better well-being. Positive feelings towards time can be promoted in the school setting through empirically validated positive psychology interventions. However, the extent to which these interventions impact the time attitudes of adolescents remains unknown. The current study investigated the influence of a multicomponent positive psychology intervention on adolescents’ transitions between time attitude profiles and how these transitions are related to their emotional, social, and psychological well-being. Participants consisted of 220 (M = 14.98; 47.3% female) adolescents from two Spanish high schools who participated in the six-week Get to Know Me+ program. Adolescents’ time attitudes and well-being were measured via the Adolescents and Adult Time Inventory–Time Attitudes and the Mental Health Continuum–Short Form, respectively, at pre- and postintervention. Participants were clustered in different profiles through a latent profile analysis, and the transitions were analyzed using a latent transition analysis. Five profiles were identified (negative, present/future negative, past negative, optimistic, and positive), and results indicated that adolescents who participated in the intervention were more likely to transition to positive profiles (optimistic and positive) and generally reported higher well-being, especially those in the negative, present/future negative, and optimistic profiles. Preliminary evidence showed that school-based multicomponent positive psychology interventions can have a positive impact on adolescents’ feelings towards time and well-being.

Subtyping treatment-seeking gaming disorder patients

BACKGROUND AND AIMS

Gaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach.

METHODS

The sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits.

RESULTS

Two GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles.

CONCLUSIONS

GD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients.

Profiles and trajectories of mental health service utilisation during early intervention in psychosis

BACKGROUND

Early intervention in psychosis services (EIS) support individuals experiencing a first episode of psychosis. Support required will vary in response to the remittance and reoccurrence of symptoms, including relapses. Characterising individuals who will need more intensive support can inform care planning. This study explores service utilisation profiles and their trajectories of service use in a sample of individuals referred to EIS.

METHOD

We analysed service utilisation during the 3 years following referral to EIS (n = 2363) in West London between 2011 and 2020. Mental health service utilisation data were submitted to model-based clustering. Latent growth models were then estimated for identified profiles. Profiles were compared regarding clinical and demographic characteristics and onward pathways of care.

RESULTS

Analyses revealed 5 profiles of individuals attending EIS based on their service utilisation over 3 years. 55.5% of the sample were members of a low utilisation and less clinically severe profile. The distinct service use patterns of these profiles were associated with Health of the Nations Outcome Scale scores at treatment initiation (at total, subscale, and individual item level), along with age and gender. These patterns of use were also associated with onward care and ethnicity.

CONCLUSIONS

Profiles and trajectories of service utilisation call for development of integrated care pathways and use of more personalised interventions. Services should consider patient symptoms and characteristics when making clinical decisions informing the provision of care. The profiles represent typical patterns of service use, and identifying factors associated with these subgroups might help optimise EIS support.

What would an 'ideal' glaucoma examination be like? - A conjoint analysis of patients' and physicians' preferences

Purpose

To structurally determine patients’ and physicians’ preferences for glaucoma diagnostic methods in order to improve glaucoma patient care and improve patient compliance with follow-up visits.

Methods

Forty-one patients with glaucoma and 32 ophthalmologists were included in this cross-sectional study. Profiles representing glaucoma examinations were created using conjoint analysis (CA). The following factors of a glaucoma examination method were evaluated: (1) examination comfort, (2) examination frequency, (3) follow-up examination necessary in case of suspicious result, (4) cost for the patient, (5) travel time to examination site, (6) sensitivity and (7) specificity of the examination method.

Results

Preferences were highest in both groups for examination sensitivity, followed by cost and specificity for the patient group. For the physician group, specificity was second most important, followed by cost. Least important was travel time for the patients and follow-up examinations for the physicians.

Conclusions

Participants would rather pay more and travel longer to get a highly sensitive examination. This form of care is present in university eye hospitals. Consequently, it would be advisable to enhance capacities of these centers. Outpatient practices that offer glaucoma service should be fully equipped and should employ a glaucoma specialist.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10792-021-01960-5.

Using chi-squared automatic interaction detection modelling to identify student opinion profiles regarding same-sex couples as a family structure

The aim was to determine the opinions held by a sample of students in relation to homoparenting as a family modality. A cross-sectional study was conducted on a sample of university students specialization: social sciences using the AHFH. It is patent that opinions of students about the three factors (support, rejection and acceptance) that compose the construct of attitudes towards same-sex couples as a family structure, differ greatly depending on the positive or negative nature of these components. In conclusion, in relation to the dimension pertaining to rejection of same-sex couples as a family entity, we derived a configuration determined by 1 of the 4 predictor variables. In this case, gender was the only one of the 4 variables considered to support formation of a profile. This profile was constituted by male students who, independent of their birthplace setting, qualification and whether they personally know any same-sex couples, showed stronger agreement with the dimension describing rejection of same-sex couples as a family structure.

Profiles of bacteria/phage-comediated ARGs in pig farm wastewater treatment plants in China: Association with mobile genetic elements, bacterial communities and environmental factors

In this study, the profiles of bacteria/phage-comediated antibiotic resistance genes (b/pARGs) were monitored in water samples collected from 45 pig farm wastewater treatment plants (WWTPs) in seven different regions of China. We found that 8 major types and 112 subtypes of b/pARGs were detected in all the water samples, and the detected number ranged from 53 to 92. The absolute abundances of bARGs and pARGs in the influent were as high as 10⁹ copies/mL and 10⁶ copies/mL, respectively. Anaerobic anoxic/oxic (AAO) and anaerobic short-cut nitrification/denitrification (ASND) treatment plants can effectively reduce the absolute abundance and amount of b/pARGs. Anaerobic treatment plants cannot reduce the absolute abundance of pARGs, and even increase the amount of pARGs. Mobile genetic elements (MGEs), bacterial communities and environmental factors were important factors impacting the b/pARG profile. Among these factors, the bacterial community was the major driver that impacted the bARG profile, while bacterial community and MGEs were the major codrivers impacting the pARG profile. This study was the first to investigate the profiles of b/pARGs in pig farm WWTPs in China on such a large scale, providing a reference for the prevention and control of ARG pollution in agricultural environments.

Characteristics of exposure to multiple environmental chemicals among pregnant women in Wuhan, China

BACKGROUND

Previous studies on environmental pollutant exposure during pregnancy have mostly focused on individual chemical substances or single urine measurements. Thus, our understanding of the potential cumulative or interactive effects of exposure is limited.

OBJECTIVE

We aimed to ascertain the characteristics and predictors of exposure to environmental chemicals over three trimesters among pregnant women.

METHODS

We measured the concentrations of 34 chemicals in spot urine samples provided by 745 participants in their early, middle, and late pregnancy. We calculated Spearman correlation coefficients (SCC) between exposure levels of multiple chemicals in each trimester. K-means clustering and principal components analysis (PCA) were applied to classify the populations and reduce data dimensionality. We used generalized linear models (GLM) to confirm predictors of each cluster and principal component.

RESULTS

SCC showed that the correlations of chemical concentrations from the same classes were higher than those among concentrations of different classes. Cluster analysis categorized participants into three clusters, and each cluster represented different chemical concentrations. We restricted the principal components to six, which explained more than 50% of the data variations. Several physiological, socio-demographic factors, and behavior patterns were related to different clusters and principal components.

CONCLUSION

Distinct exposure patterns and dominant exposure components of multiple environmental chemicals among pregnant women might help research the potential health effects of exposure to chemical mixtures and develop relevant public health interventions.

A pilot study of organophosphate esters in surface soils collected from Jinan City, China: implications for risk assessments

Data monitoring is a prerequisite for the occurrence of organophosphate esters (OPEs) in the soil environment in light of their potential toxicity, bioaccumulation, and environmental persistence. In this study, we determined the concentrations and profiles of OPEs in surface soils collected from Jinan City, East China. The soil concentrations of ΣOPE (sum of all OPEs) were in the range of 2.55-581 ng/g dry weight (dw), with an average value of 106 ng/g dw. Industrial soils (mean: 433 ng/g dw) had significantly higher levels of ΣOPE compared with those in urban (42.1 ng/g dw) and farmland soils (7.89 ng/g dw) (p < 0.01), suggesting that industrial activity is an important source of OPEs to ambient soil environment. Tris(1-chloro-2-propyl) phosphate (TCIPP), triphenyl phosphate (TPHP), and tris(2-butoxyethyl) phosphate (TBOEP) were the most abundant OPEs in industrial soils, contributing 30%, 25%, and 20% of ΣOPE, respectively. Principal component analysis revealed that TCIPP, TPHP, and TBOEP in soils derived from respective industrial activities. As compared with other cities within China, the surface soil of Jinan City was mildly contaminated by OPEs, and its human exposure and eco-toxicological risks were found to be negligible. Our study provides current contamination status of OPEs in soils across the multiple functional regions of Jinan, which could be used to support the authorities to make relevant regulations.

Awareness of users and motivational factors for using new psychoactive substances in Belgium

BACKGROUND

Few data on motivations for using new psychoactive substances (NPS) are available. However, the cost, the legal status, and their accessibility through channels like internet contributed to the popularity of NPS. The objective of this article are first to gain a deeper understanding of the culture surrounding NPS in Belgium and second to define the awareness of the users concerning the content of the NPS they are consuming.

METHODS

Snowball sampling and partners in the drug demand reduction field were used as a gateway in order to reach a heterogeneous study population. In total, 45 users were recruited and in-depth interviews were conducted. The personal experiences of NPS users and their needs for support along the continuum of care were explored through an interview guideline, while subjects were given the opportunity to deposit a NPS sample for forensic analysis in a recognized laboratory.

RESULTS

A diversity of profiles was found among NPS users but also a wide diversity in the motives to consume NPS: personal reasons such as pleasure, mind exploration, being connected to others, or out of curiosity, but also external reasons such as price, accessibility or the specific effects procured by certain NPS. The results showed as well that a majority of NPS users seem to be aware of the substances they are using.

CONCLUSION

Understanding the motivations of use is of importance to determine which type of NPS targeted interventions are adapted to different profiles of users.

Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms

The objective of this study was to determine whether: (a) cancer-related coping profiles change across time; (b) coping profile transition types predict changes in depressive and physical symptoms. Latent transition analysis was conducted with repeated measures of seven cancer-related coping processes from 460 women recently diagnosed with breast cancer. In multilevel models, coping profile transition groups were entered as predictors of symptoms across 12 months. Three coping profiles emerged at study entry, with two profiles at later assessments. Forty-eight percent of women maintained high-moderate approach-oriented coping over time. Specific factors (e.g., age, acceptance of emotions) differentiated the transition groups. Women who increased and then maintained high-moderate approach-oriented coping had relatively high initial depressive symptoms that declined steeply. When cancer-related acceptance predominated, women experienced increasing physical symptoms. Distinct cancer-related coping patterns are related to the level of and change in depressive and physical symptoms longitudinally. Early intervention to increase approach-oriented coping strategies could yield favorable outcomes.

Sexual self-concept among men and women child sexual abuse survivors: Emergence of differentiated profiles

BACKGROUND

Child sexual abuse (CSA) can impact survivor's sexuality, notably regarding sexual self-concept, a key component of sexual well-being. Yet, sexual self-concept has been understudied among CSA survivors and gender differences have been sparsely investigated.

OBJECTIVE

The current study aimed to identify CSA survivors' distinct profiles according to their sexual self-concept, and compare these profiles based on factors such as CSA characteristics, gender, current age, sexual functioning and adult sexual assault (ASA).

PARTICIPANTS AND SETTING

A total of 176 CSA survivors (60 % women, 40 % men), recruited through community organizations for CSA victims and social media publications, completed an online survey.

METHODS

Hierarchical cluster analysis was performed using the Sexuality Scale (Snell & Papini, 1989). Chi-square and ANOVA tests were used to compare the groups on external variables.

RESULTS

Cluster analysis revealed the best overall fit for a three-group model. The Confident and non-preoccupied profile (48 %) is characterized by a moderate score on sexual esteem and the lowest scores of sexual preoccupation and depression. The Demeaning and depressive (37 %) profile is characterized by the lowest scores on sexual esteem and the highest scores on sexual depression. The Hyperconfident and preoccupied profile (15 %) shows the highest scores on sexual esteem and sexual preoccupation.

CONCLUSION

Sexual self-concept is an important component of sexuality that needs to be addressed by practitioners working with CSA survivors. Given heterogeneity and gender differences among survivors, identification of profiles is relevant for adapting interventions and clinical care.

Profiles of Subjective Daytime Sleepiness through Cluster Analysis

Sleepiness propensity and sleepiness perception are two relevant dimensions of the general multidimensional sleepiness construct. In the current study, the aim was to identify eventual homogeneous subgroups when sleepiness propensity and sleepiness perception measures are combined. Data from 678 undergraduate students (aged 17 to 24 years) from a medical school were analyzed. A Two-Step Cluster Analysis was performed taken into consideration sleepiness propensity and sleepiness perception measures as clustering variables. Four different clusters were identified. Additionally, the two groups comprising higher levels of sleepiness perception (i.e., "high perception, low propensity" and "high subjective daytime sleepiness" clusters) had the most compromised results in some of the sleep-related variables examined - sleep needs, sleep latency, sleep quality, sleep sufficiency, self-reported insomnia, sleep reactivity to stress, and cognitive arousal - and in some of non-sleep related variables, such as neuroticism and affect. As to non-sleep variables, those groups reported higher scores in neuroticism, arousability, self-reported mental health and affective states. The identification of distinct groups concerning self-reported sleepiness may bring new avenues for research and understanding of the specific and differential role of sleepiness and its dimensions in sleep health and sleep disturbances, in particular, insomnia disorder.

Detecting patients with PMI post-CABG based on cardiac troponin-T profiles: A latent class mixed modeling approach

BACKGROUND

Diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG) is fraught with complexity since it is primarily based on a single cut-off value for cardiac troponin (cTn) that is exceeded in over 90% of CABG patients, including non-PMI patients. In this study we applied an unsupervised statistical modeling approach to uncover clinically relevant cTn release profiles post-CABG, including PMI, and used this to improve diagnostic accuracy of PMI.

METHODS

In 624 patients that underwent CABG, cTnT concentration was serially measured up to 24 h post aortic cross clamping. 2857 cTnT measurements were available to fit latent class linear mixed models (LCMMs).

RESULTS

Four classes were found, described by: normal, high, low and rising cTnT release profiles. With the clinical diagnosis of PMI as golden standard, the rising profile had a diagnostic accuracy of 97%, compared to 83% for an optimally chosen cut-off and 21% for the guideline recommended cut-off value.

CONCLUSION

Clinically relevant subgroups, including patients with PMI, can be uncovered using serially measured cTnT and a LCMM. The LCMM showed superior diagnostic accuracy of PMI. A rising cTnT profile is potentially a better criterion than a single cut-off value in diagnosing PMI post-CABG.

Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study

BACKGROUND

Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension.

METHODS

This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis.

RESULTS

Intradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m^-2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m^-2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m^-2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m^-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001).

CONCLUSION

In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.

Determination of moisture distributions in porous building bricks by neutron radiography

Water transport into construction building materials is an important subject since it may deteriorate them because it can carry harmful biological and chemical substances. Some of the reported results in literature for moisture transport in construction building materials follow Fick's law of diffusion while others show anomalous diffusion. There is not enough reliable and accurate data in the literature to discuss this issue. Therefore, in the present work moisture transport into four different kinds of brick samples was studied using the real time neutron radiography method. Neutron radiography images were registered continuously during the moisture absorption process. Simple procedures based on the Cd-umbrella method were used for the first time to correct for the neutron scattering during the water absorption process. The images showed clearly that the absorption process is different from one sample to another. The water content distribution along the flow direction, x (profiles) and positions of water front as the time of moisture absorption elapses were determined from the images obtained. The results obtained showed that the water front positions do not scale with the square root of the absorption time. It was shown that moisture diffusion processes in the samples investigated could be described by an anomalous diffusion approach of the sub-diffusive type. The moisture diffusivities were determined for every sample. The neutron radiography method and the neutron scattering correction procedures used are proven to be a powerful and effective for studying transport process in porous media.

Depressive symptoms and non-suicidal self-injury during adolescence: Latent patterns of short-term stability and change

INTRODUCTION

Depressive symptoms and non-suicidal self-injury not only increase in prevalence during adolescence, but they can also occur together. Both psychological problems seem to have similar precipitating conditions, suggesting they have transdiagnostic conditions-personal or contextual characteristics that contribute to co-occurrence. We sought to understand when these two problems co-occur and what is related to their co-occurrence.

METHODS

Using a pattern-centered approach and two waves of longitudinal data collected annually, we examined latent profiles of depressive symptoms and self-injury among a Swedish sample of adolescents aged 12 to 16 (M_ageT1 = 13.65 years, SD = 0.64), 53.7% boys and 47.3% girls. Most of the adolescents were Swedish (89%), with parents who were married or cohabitating (68%). We also examined the transitions between profiles over time.

RESULTS

Our results suggest that during this time frame, depressive symptoms and self-injury tend to emerge and stabilize or abate together. We also examined a broad array of predictors, including individual characteristics, emotion dysregulation, experiences with friends, parents' negative reactions to behavior, and school stress. The significant unique predictors suggest that adolescents who reported being subjected to relational aggression, having negative experiences while drinking, and low self-esteem had a greater probability of moving from moderate to high levels or maintaining high levels of depressive symptoms and self-injury, compared to adolescents classified in the other statuses.

CONCLUSIONS

Focusing on negative interpersonal experiences and selfesteem as transdiagnostic conditions may guide research and aid clinicians in supporting adolescents who feel depressed and engage in self-injury.

Perfluoroalkyl substances (PFASs) in the marine environment: Spatial distribution and temporal profile shifts in shellfish from French coasts

Perfluoroalkyl substances (PFASs) were investigated in filter-feeding shellfish collected from 2013 to 2017 along the English Channel, Atlantic and Mediterranean coasts of France. PFOS (perfluorooctane sulfonate), PFTrDA (perfluorotridecanoic acid), PFTeDA (perfluorotetradecanoic acid), PFDoDA (perfluorododecanoic acid) and PFUnDA (perfluoroundecanoic acid) were detected in more than 80% of samples, thus indicating widespread contamination of the French coastal environment by these chemicals. The distribution of PFAS concentrations showed differences according to sampling locations and years. PFOS was the predominant PFAS in most samples collected from English Channel and Atlantic coasts until 2014, but the opposite was observed in 2015, 2016 and 2017, while perfluoroalkyl carboxylic acids (PFCAs) prevailed in Mediterranean samples in all study years. Among PFCAs, PFTrDA showed the highest maximum (1.36 ng g^-1 ww) and median (0.077 ng g^-1 ww) concentrations in 2016-2017. Other PFAS median concentrations were within the 0.014 (PFNA) - 0.055 (PFTeDA) ng g^-1 ww range. The profiles determined each year in most Mediterranean samples suggest distinctive sources. PFOS median concentrations showed a significant decrease over the study years, from 0.118 to 0.126 ng g^-1 ww in 2013-2015 to 0.066 ng g^-1 ww in 2016 and 2017. ∑PFCAs showed no trends in concentration ranges over the same years. The shift in PFAS profiles from PFOS to long-chain PFCAs over the study period reflects PFOS production phase-out, combined with continuous inputs of PFCAs into the marine environment. These results provide reference data for future studies of the occurrence of contaminants of emerging concern on European coasts.

Health asset profiles and health indicators among 13- and 15-year-old adolescents

Objectives

We examined the associations between adolescents’ health assets and various health indicators (smoking, alcohol use, sleep length, physical activity, healthy eating, oral health, self-reported health, multiple health complaints).

Methods

A nationally representative sample was drawn from Finnish-speaking schools, comprising 13- and 15-year-old adolescents (n = 3833). The measures taken covered the adolescents’ health assets, which were labelled Family-financial, Psychological, Family-social, Friends-social, School-social, and Human. Our analysis applied two-step cluster analysis and multilevel mixed-effects binary logistic regression.

Results

Six asset profiles were identified: ‘Limited in most assets, despite medium affluence’, ‘Mostly average assets, but low affluence’, ‘Mostly average assets, though high affluence’, ‘Mostly above average assets’, ‘Rich in most assets’, and ‘Rich in all assets’. There were significant differences between the profiles in terms of risk level and desirable level health outcomes.

Conclusions

Adolescents differ in their asset profiles. Having multiple health assets appears to protect adolescents from risky behaviour or poor health, and to promote positive health. There is a need for health initiatives to develop a range of health-protecting and health-promoting assets, rather than focus on only one.

Electronic supplementary material

The online version of this article (10.1007/s00038-019-01280-7) contains supplementary material, which is available to authorized users.

Concentrations of dioxins and furans in breast milk of women living near a hazardous waste incinerator in Catalonia, Spain

Since 1999, a hazardous waste incinerator (HWI) is operating in Constantí (Tarragona County, Catalonia, Spain). In 1996-1998, when the facility was being built, we started a monitoring program aimed at evaluating the impact of the emissions of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) by the HWI on the environment and the human health. This study aimed at determining the current concentrations of PCDD/Fs in breast milk samples of women living nearby the HWI and at comparing these levels and profiles with those obtained in the baseline (1996-1998) and previous surveys (2002, 2007 and 2012). Furthermore, the association between the dietary intake of PCDD/Fs and the congener profiles in breast milk was also explored. Twenty milk samples were collected from women living in Tarragona downtown and near the industrial area where the HWI is placed. The content of PCDD/Fs was analyzed by following a procedure derived from the US EPA methods 1613 and 8290A. The mean concentration of PCDD/Fs was 2.26 pg WHO-TEQ/g fat. No significant differences were found between women living in industrial and urban areas (1.67 pg vs. 2.48 pg WHO-TEQ/g fat). Interestingly, a notable significant reduction (81%) was observed with respect to the concentrations found in the baseline study. The profiles of PCDD/Fs in breast milk were similar independently on the area and period of collection, being mainly influenced by the intake of fish, meat, oils and fats. The decreasing trend of PCDD/Fs in human milk agrees with the reduction observed in the dietary intake of these pollutants. It was also concluded that the current levels of PCDD/Fs in human milk levels are not influenced by the HWI stack emissions.

Sniffing out resistance - Rapid identification of urinary tract infection-causing bacteria and their antibiotic susceptibility using volatile metabolite profiles

Antibiotic resistance is set to be an unprecedented threat to modern medicine. 'Sniffing' bacteria potentially offers a rapid way to determine susceptibility. A successful proof-of-principle study is described, using thermal desorption-gas chromatography-mass spectrometry (TDGCMS) to 'smell' cephalexin and ciprofloxacin resistant and sensitive Urinary Tract Infection (UTI)-causing bacteria. 578 peaks at unique retention times were detected from 86 chromatograms of 18 bacterial isolates (E. coli, K. pneumoniae and P. aeruginosa). The isolates were grown with and without the presence of antibiotic. Chi-square analysis found 9 compounds that differed significantly between cephalexin sensitive and resistant isolates, and 22 compounds that differed significantly between ciprofloxacin sensitive and resistant isolates, at p ≤ 0.05. When antibiotic was added to the media, more differences were found in the cephalexin group, attributed to lysis, but not in the ciprofloxacin group. Further work with large sample sizes will potentially enable the development of diagnostic algorithms using presence/absence of particular compounds of interest.

Patterns of Spiritual Connectedness during Adolescence: Links to Coping and Adjustment in Low-Income Urban Youth

Religiosity and spirituality are influential experiences that buffer adverse effects of stressors. Spirituality typically declines during adolescence, although not universally. Using Latent Class Growth Analysis, we examined changes in spiritual connectedness among 188 early (52% female; M age = 10.77, SD = 0.65 years) and 167 middle (56% female; M age = 13.68, SD = 0.82 years) predominantly African American adolescents participating in a 4-year longitudinal study. Three distinct profiles of spiritual connectedness emerged: low and steady, moderate with declines over the study period, and high and steady. Profile distributions varied across developmental level: there were more early adolescents in the high and steady profile and more middle adolescents in the decliner profile. Youth in the high and steady profile evidenced more goal-directedness and life satisfaction and more effective emotion management and coping strategies than youth in other profiles. Contributions to the positive development literature are discussed.

Profiles of the benzotriazole pollutant transformation products in an urban intergranular aquifer

Benzotriazoles (BTs) are regarded as contaminants of emerging concern. However, their transformation products (BTTPs) in aquifers remains poorly characterized. The present study is the first detailed report on profiles of the BTTPs in an urban oxic intergranular aquifer related to water type, land use and the aquifer's depth. The 2-methyl-2H-benzotriazole (2-MeBT) and 2,4-dimethyl-2H-benzotriazole (2,4-dMeBT) were quantified using the gas chromatography-mass spectrometry (GC-MS) analytical technique based on internal standards. For the first time the relationship between the 2-MeBT and 2,4-dMeBT concentrations was studied in sampled water and discussed with respect to the different flow paths and sources of contamination. Three main sources of BTTPs were determined in urban groundwater: BTs and BTTPs included in the outflow of effluents from wastewater-treatment plants and energy-producing facilities into surface streams that recharge the aquifer and in the leaking effluents from industrial and public wastewater pipelines. The results confirm that the BTTPs are transformed from parent compounds in the aquifer's unsaturated zone in the case when the effluents are temporally stored in sediments with a lower hydraulic conductivity, which is indicated with the highest median concentrations of BTTPs referring to the perched aquifers where the BTTPs proportions were 92-99%. BTTPs dominated over the parent BTs also in groundwater. The highest concentrations of BTTPs (up to 174 and 144 ng L^-1 for the 2-MeBT and 2,4-dMeBT ng L^-1, respectively) were measured in groundwater abstracted from the upper parts of the aquifer in the area where the losses from industrial wastewater pipelines were evidenced. The 2,4-dMeBT dominated over the 2-MeBT in the BTTPs originating from BTs included in the industrial effluents, which is the opposite to the case when their origin is in the municipal effluents. The median sum concentration of the BTTPs in drinking-water resources (2.0 ng L^-1) is lower than the quality criterion recommended for BTs so far. Nevertheless, the abundance of BTs in the environment and the apparent environmental relevance of the BTTPs in urban groundwater indicate the need for a risk assessment of BTTPs with respect to health and the environment.

Child and family needs profiles among cases substantiated by child protection services

Differential individual and family needs are explored in a sample of children (n = 1455) whose case has been substantiated by Child Protection Services. Using data from Quebec's 2014 cycle of Incidence Study, latent class analyses led to the identification of 5 profiles, each displaying a specific range of individual and family needs. Profile characteristics were explored in order to obtain a deeper understanding of their specific needs, beyond the initial referral motive. Further, referred services were explored in order to verify their adequacy regarding the identified needs. Together, the obtained results support the relevance of a more in-depth needs assessment when child protection services are solicited, and the necessity to better match the referred services to these needs.

Hexabromocyclododecanes in breast milk from residents in Shenzhen, China: Implications for infant exposure

Hexabromocyclododecanes (HBCDs) are widely used as flame retardants for various products and have become ubiquitous pollutants in environmental media. However, little is known about HBCD exposure for humans, especially in China. This study aimed to investigate the levels and profiles of hexabromocyclododecanes (HBCDs) in human breast milk and to estimate the daily HBCD intake for infants in Shenzhen, China. Levels of the HBCD diastereoisomers α-, β-, and γ-HBCD in 180 breast milk samples collected from primiparas in Shenzhen were measured. The concentrations of α-, β-, and γ-HBCD (ΣHBCDs) ranged within 0.103-15.1ng/g lipid and had a median of 1.82ng/g lipid. ΣHBCDs levels in milk in the present study are comparable to those in milk from other countries and regions but are markedly higher than those for most populations in other regions of China. Among the diastereoisomers, α-HBCD was predominant, accounting for 97.6% of the concentration of ΣHBCDs. The estimated daily intake of ΣHBCDs via breast milk for infants in Shenzhen ranged from 0.481 to 100ng/kgbw/day with a median of 8.40ng/kgbw/day, however, which was unlikely to raises a health concern based on the margin of exposure (MOE) approach. The duration of residence was found to have a significant positive correlation with the HBCD levels in the human breast milk (p<0.05). To our knowledge, this is the first report on HBCD levels in breast milk from Shenzhen residents.

The frail older person does not exist: development of frailty profiles with latent class analysis

Background

A fundamental issue in elderly care is targeting those older people at risk and in need of care interventions. Frailty is widely used to capture variations in health risks but there is no general consensus on the conceptualization of frailty. Indeed, there is considerable heterogeneity in the group of older people characterized as frail. This research identifies frailty profiles based on the physical, psychological, social and cognitive domains of functioning and the severity of the problems within these domains.

Methods

This research was a secondary data-analysis of older persons derived from The Older Person and Informal Caregiver Minimum Dataset. Selected respondents were 60 years and older (n = 43,704; 59.6% female). The following variables were included: self-reported health, cognitive functioning, social functioning, mental health, morbidity status, and functional limitations. Using latent class analysis, the population was divided in subpopulations that were subsequently discussed in a focus group with older people for further validation.

Results

We distinguished six frailty profiles: relatively healthy; mild physically frail; psychologically frail; severe physically frail; medically frail and multi-frail. The relatively healthy had limited problems across all domains. In three profiles older people mostly had singular problems in either the physical or psychological domain and the severity of the problems differed. Two remaining profiles were multidimensional with a combination of problems that extended to the social and cognitive domains.

Conclusions

Our research provides an empirical base for meaningful frailty profiles. The profiles showed specific patterns underlying the problems in different domains of functioning. The heterogeneous population of frail older people has differing needs and faces different health issues that should be considered to tailor care interventions. Evaluation research of these interventions should acknowledge the heterogeneity of frailty by profiling.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0776-5) contains supplementary material, which is available to authorized users.

Urinary metabolites of organophosphate esters in children in South China: Concentrations, profiles and estimated daily intake

Organophosphate esters (OPEs) are widely used in household products as flame retardants or plasticizers and have become ubiquitous pollutants in environmental media. However, little is known about OPE metabolites in humans, especially in children. In this study, eight OPE metabolites were measured in 411 urine samples collected from 6 to 14-year-old children in South China. Bis(2-chloroethyl) phosphate (BCEP), bis(1-chloro-2-propyl) phosphate (BCIPP) and diphenyl phosphate (DPHP) were the dominant OPE metabolites, and their median concentrations were 1.04, 0.15 and 0.28 μg/L, respectively. The levels of urinary OPE metabolites in the present study were much lower than those in participants from other countries, with the exception of BCEP, suggesting widespread exposure to tris(2-chlorethyl) phosphate (TCEP, the parent chemical of BCEP) in South China. No significant difference in the concentrations of any of the OPE metabolites was observed between males and females (p > .05). Significant negative correlations were observed between age and BCEP, BCIPP, bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), di-o-cresyl phosphate (DoCP) and di-p-cresyl phosphate (DpCP) (DCP), or DPHP (p < .05). Pearson correlation coefficients between urinary OPE metabolites indicated multiple sources and OPE exposure pathways in children. The estimated daily intake suggested that children in South China have a relatively high exposure level to TCEP. To the best of our knowledge, this is the first study to report the urinary levels of OPE metabolites in Chinese children.