To Örebro University

PURPOSE: To examine and quantify the association between an inflammatory diet index and gastroesophageal reflux disease (GERD) utilizing extensive data from a large cohort.

METHODS: This study included eligible UK Biobank participants recruited between 2006 and 2010 who had no prior history of GERD and no missing data for key covariates. The primary outcome was incident GERD, identified using the "first occurrence" dataset. 27 eligible food/nutrient parameters derived from the 24-h recall questionnaires in the UK Biobank were included to calculate the energy-adjusted dietary inflammation index (E-DII) score. The E-DII score was employed as a continuous variable in restricted cubic spline regression (RCS) analysis. To facilitate analysis, participants were then categorized into four groups based on quartile values in the subsequent Cox regression analysis adjusting varying degrees of confounding factors.

RESULTS: After exclusion, 154,590 participants were included in the primary analysis. Over a mean 12.36-year follow-up, a total of 12, 041(7.79%) participants experienced GERD. The results of multivariable RCS showed that the risk of GERD had a slightly overall increased trend along with E-DII after adjusting the confounding factors. The cumulative incidence of GERD in the four groups was significantly different (P < 0.001) and participants in higher quartiles determined by E-DII had a higher GERD incidence. Results from both univariate and multivariate Cox regression consistently revealed the most pro-inflammatory E-DII group (i.e. the fourth quartile) had a significantly heightened risk of GERD compared to those in the first quartile (crude HR [95% CI] 1.118 [1.063-1.175]; fully adjusted HR [95% CI] 1.136 [1.079-1.196]). Subgroup analyses revealed variations across populations, while sensitivity analyses confirmed the robustness of primary findings.

CONCLUSIONS: The current study revealed that that adherence to a diet with high pro-inflammatory potential might be associated with higher GERD incidence and further randomized controlled trials are needed to provide more conclusive evidence.

OBJECTIVES: There is some preclinical evidence suggesting a pro-inflammatory diet reduces kidney function. In the present study, we aimed to investigate the association of inflammatory potential of diet with the risk of chronic renal failure (CRF).

METHODS: Cox regression models were used to examine the association between the energy-adjusted dietary inflammation index (E-DII) quartiles and CRF adjusting varying degrees of confounders. Restricted cubic spline regression was additionally adopted to determine the association of the continuous E-DII and CRF risk. A series of sensitivity and subgroup analyses were also conducted.

RESULTS: A total of 163,433 participants entered the primary analysis. During a mean follow-up period of 12.65 years, incident CRF occurred in 5, 333 participants (3.26%). The E-DII scores was stratified into four quartile groups. In a fully adjusted multivariable model, the adjusted hazard ratio for the second, third, and highest quartiles of E-DII intake was 1.12 (95% confidence interval [CI]: 1.04-1.21), 1.21 (95% CI: 1.12-1.31), and 1.23 (95% CI: 1.14-1.33), respectively, compared with the lowest quartile. Trend test indicated a statistically significant increasing trend with increasing E-DII quartiles (P < 0.0001). Similarly, restricted cubic spline regression displayed a positive association of continuous E-DII with CRF, wherein higher scores were linked to an elevated risk of CRF. Results of sensitivity analyses demonstrated consistent findings.

CONCLUSIONS: Diet with higher proinflammatory potential was linked to an increased risk of CRF. Implementing measures to limit the intake of pro-inflammatory foods or promoting the adoption of an anti-inflammatory dietary pattern could potentially reduce the occurrence of CRF.

OBJECTIVE: This study investigates the effect of trait mindfulness on self-efficacy in sports-disadvantaged Chinese college students, focusing on the sequential mediating roles of exercise motivation and persistence, to inform interventions that enhance physical activity and psychological well-being.

METHOD: A randomly selected sample of 600 sports-disadvantaged college students in China was surveyed, yielding 588 valid responses (male = 296, 50.3%; female = 292, 49.7%). Participants ranged in age from 18 to 23 years (M = 20.06, SD = 1.44). Among them, 45.1% reported smoking and 58.8% reported drinking. The assessment instruments included the Trait Mindfulness Scale, the Exercise Motivation Scale, the Self-Efficacy Scale, and the Exercise Persistence Scale. Data were analyzed using SPSS 26.0 and the PROCESS macro (version 4.1).

RESULTS: Significant correlations were identified among trait mindfulness, self-efficacy (r = 0.581, p < 0.01), exercise motivation (r = 0.585, p < 0.01), and exercise persistence (r = 0.545, p < 0.01) within the group of sports-disadvantaged college students. Exercise motivation was significant correlated with both exercise persistence (r = 0.592, p < 0.01) and self-efficacy (r = 0.679, p < 0.01). Exercise persistence also showed a significant correlation with self-efficacy (r = 0.639, p < 0.01). In the effect of trait mindfulness on self-efficacy among sports-disadvantaged college students, both exercise motivation (β = 0.224, 95% confidence interval (CI): [0.176, 0.277]) and exercise persistence (β = 0.100, 95% CI [0.067, 0.136]) demonstrated significant mediating effects. Furthermore, exercise motivation and exercise persistence exhibited a significant chain mediating effect in the influence of trait mindfulness on self-efficacy (β = 0.072, 95% CI [0.050, 0.099]).

CONCLUSION: This study offers critical theoretical insights into the interplay between trait mindfulness, exercise behavior, and self-efficacy among sports-disadvantaged college students. It provides a foundation for developing targeted interventions and practical guidance for universities in enhancing sports education, optimizing resource allocation, and establishing psychological support systems. By addressing the unique needs of this population, institutions can foster greater physical engagement and psychological well-being, thereby advancing overall student health.

BACKGROUND: Whole blood transfusion (WBT) is associated with improved hemostasis and possibly mortality in patients with hemorrhagic shock after injury but there are no studies in patients with isolated severe traumatic brain injury (TBI). The objective of this investigation was to compare outcomes of balanced component therapy (BCT) versus WBT in patients with an isolated severe TBI.

METHODS: Adult patients (≥18 years) registered in the Trauma Quality Improvement Program (2016-2019) who suffered a blunt isolated severe TBI (head Abbreviated Injury Score ≥3 in the head and ≤1 in the remaining body regions) and who received a BCT (1-2:1 packed red blood cell (PRBC):fresh frozen plasma and 1-2:1 PRBC:platelets) or WBT were eligible for inclusion. Patients were matched, based on the transfusion received, using propensity score matching. The primary outcome of interest was in-hospital mortality.

RESULTS: A total of 217 patients received either WBT (n=82) or BCT (n=135). After propensity score matching, 50 matched pairs were analyzed. The rate of in-hospital mortality was significantly lower in the WBT compared with BCT group (43.1% vs 66.7%, p=0.025) corresponding to a relative risk (RR) reduction of 35% in in-hospital mortality (RR (CI 95%): 0.65 (0.43 to 0.97)). However, in subgroup analyses comparing those who were managed surgically and conservatively, this association only remained significant among patients who underwent neurosurgical intervention.

CONCLUSIONS: WBT in patients with severe isolated TBI is associated with better survival compared with BCT in patients who require neurosurgical intervention. Further investigation into this finding using an appropriately powered, prospective study design is warranted.

LEVEL OF EVIDENCE: Level III, therapeutic.

This study aimed to examine the directionality of the relationship between children's satiety responsiveness and parental pressure to eat and to explore how children's temperament moderates this relationship. Parents of preschoolers (n = 482, Mage = 3.66, SD = 0.29, 51.2% boys) were surveyed at two-time points spaced 2 years in China, and 76.6% of those were mothers. Cross-lagged analyses indicated that children's satiety responsiveness positively predicted parental pressure to eat over time. Moderation analyses revealed that children's high anger/frustration intensified the predictive relationship above. These findings suggest that parents should accurately understand their children's satiety responsiveness and tailor their responses based on children's temperament, thereby fostering a virtuous cycle of parent-child interaction.

BACKGROUND: The prospective association between body roundness index (BRI) and depression in the general population remains unclear.

METHODS: This retrospective cohort study was conducted leveraging UK Biobank. The primary outcome was new-onset depression. Cox regression models were used to assess the association between BRI quartiles and depression, while restricted cubic splines were applied to explore the relationship between continuous BRI and depression. Mediation analyses were conducted to elucidate the role of educational, alcohol consumption, smoking, and physical activity.

RESULTS: A total of 201,813 eligible participants with a mean age of 52.71 years were included. Over a mean follow-up period of 12.90 years, 7232 participants (3.58 %) developed depression. The cumulative incidence of depression differed significantly across the four BRI quartiles, with higher quartiles showing a progressively greater incidence of depression (P < 0.0001). In the fully adjusted Cox regression model, participants in the highest BRI quartile had a 30 % increased risk of developing depression (HR: 1.30, 95 % CI: 1.17-1.45; P < 0.0001) compared to those in the lowest quartile. Several lifestyle factors partly mediated the BRI-depression association, with smoking as the strongest mediator and physical activity conferring protection. LIMITATIONS: Residual or unmeasured confounding cannot be completely excluded, and caution is warranted when generalizing our findings to diverse ethnic populations.

CONCLUSIONS: This study demonstrated a positive association between BRI and the incidence of depression. While lifestyle factors partially mediate the relationship between BRI and depression, the risk is primarily driven by the direct effects of BRI.

This review examines the existing literature regarding the utilization of combat sports in virtual reality (VR) for disease rehabilitation and adaptive physical activity. A total of 18 studies were obtained from the Web of Science and Scopus databases. The results suggest that Boxing, the most studied combat sport in VR systems, has been primarily used to improve motor function and quality of life in patients with neurological conditions such as cerebral palsy, Parkinson's disease, and stroke. Furthermore, VR combat sports have been shown to increase energy expenditure and physical activity intensity in individuals with disabilities, proving effective in maintaining overall physical health. Notably, VR boxing produces higher energy expenditure than other activities (e.g., tennis), with heart rate (HR) and oxygen consumption (VO2) during boxing sessions consistently exceeding those observed in tennis. Overall, research in this field remains limited and further explorations are warranted.

BACKGROUND: There is a knowledge gap regarding the effectiveness and utility of various preventive interventions during the COVID-19 pandemic. In this study, we aimed to evaluate the cost-effectiveness of various COVID-19 preventive interventions, including non-medical interventions (NMIs) and vaccination programs, using real-world data across different demographic and socioeconomic contexts worldwide.

METHODS: We searched Medline, Cochrane Library, Embase, and Web of Science Core Collection from December 2019 to March 2024. We identified 75 studies which compared 34 COVID-19 preventive interventions. We conducted a network meta-analysis to assess the incremental net benefits (INB) of these interventions from both societal and health care system perspectives. We adjusted purchasing power parity (PPP) and standardised willingness to pay (WTP) to enhance the comparability of cost-effectiveness across different economic levels. We performed sensitivity and subgroup analyses to examine the robustness of the results.

RESULTS: Movement restrictions and expanding testing emerged as the most cost-effective strategies from a societal perspective, with WTP-standardised INB values of USD 21 050 and USD 11 144. In contrast, combinations of NMIs with vaccination were less cost-effective, particularly in high-income regions. From a health care system perspective, vaccination plus distancing and test, trace, and isolate strategy were highly cost-effective, while masking requirements were less economically viable. The effectiveness of interventions varied significantly across different economic contexts, underlining the necessity for region-specific strategies.

CONCLUSIONS: In this study, we highlight significant variations in the cost-effectiveness of COVID-19 preventive interventions. Tailoring strategies to specific regional economic and infrastructural conditions is crucial. Continuous evaluation and adaptation of these strategies are essential for effective management of ongoing and future public health threats.

REGISTRATION: PROSPERO: CRD42023385169.

BACKGROUND: Atlantoaxial rotatory subluxation (AARS) is an important differential diagnosis in pediatric patients presenting with torticollis, which is caused by the subluxation of the C1 vertebra relative to the C2 vertebra. Because of the uncommon nature of this condition, there is a paucity in sufficiently sized studies describing AARS. The aim of the current investigation was therefore to characterize current clinical characteristics and management of AARS.

METHODS: The American College of Surgeons Trauma Quality Improvement Program database from 2016 to 2021 was queried for pediatric (17 years old or younger) patients who were diagnosed with AARS following blunt trauma. Patients were grouped by age in order to describe and compare demographics, clinical characteristics, and in-hospital outcomes. A subgroup analysis was also performed on patients with isolated AARS, defined as AARS without the presence of a cervical fracture and an Abbreviated Injury Scale score of ≤1 in all regions besides the spine.

RESULTS: A total of 469 cases of AARS were identified, 211 (45.0%) were isolated AARS. Of these patients, 56.3% of AARS patients and 64.5% of isolated AARS patients were 8 years old or younger. Atlantoaxial rotatory subluxation in adolescents was due to a motor vehicle collision in 60.0% of cases, while 52.5% of infants/toddlers were injured in falls. Of all patients with AARS, 87.4% were managed conservatively, with or without a brace/other immobilizing device, while surgery was only indicated in 9.3% of patients. In cases of isolated AARS, conservative treatment was even more prevalent, with 92.4% of patients managed conservatively and only 4.7% requiring surgical intervention.

CONCLUSION: Atlantoaxial rotatory subluxation is most common in children 8 years old and younger, with the majority of cases resulting from falls or motor vehicle accidents. In the Trauma Quality Improvement Program database, most cases were able to be managed conservatively without the need for surgical intervention.

LEVEL OF EVIDENCE: Care Management; Level III.

BACKGROUND: In adults, cortisol levels show a pronounced 24-hour rhythm with a peak in the early morning. It is unknown at what age this early-morning peak in cortisol emerges during infancy, hampering the establishment of optimal dosing regimens for hydrocortisone replacement therapy in infants with an inborn form of adrenal insufficiency. Therefore, we aimed to characterize daily variation in salivary cortisol concentration across the first year of life.

METHODS: We conducted a systematic review followed by an individual participant data meta-analysis of studies reporting on spontaneous (i.e., not stress induced) salivary cortisol concentrations in healthy infants aged 0-1 year. A one-stage approach using linear mixed-effects modelling was used to determine the interaction between age and time of day on cortisol concentrations.

FINDINGS: Through the systematic review, 54 eligible publications were identified, reporting on 29,177 cortisol observations. Individual participant data were obtained from 15 study cohorts, combining 17,079 cortisol measurements from 1,904 infants. The morning/evening cortisol ratio increased significantly from 1.7 (95% CI: 1.3-2.1) at birth to 3.7 (95% CI: 3.0-4.5) at 6-9 months (p < 0.0001). Cosinor analysis using all available data revealed the gradual emergence of a 24-hour rhythm during infancy.

INTERPRETATION: The early-morning peak in cortisol secretion gradually emerges from birth onwards to form a stable morning/evening ratio from age 6-9 months. This might have implications for hydrocortisone replacement therapy in infants with an inborn form of adrenal insufficiency.