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Virus-like suppression right after transition through nonnucleoside invert transcriptase inhibitor- in order to dolutegravir-based antiretroviral therapy: A prospective cohort examine within Lesotho (DO-REAL examine).
BACKGROUND Few population-based studies have examined the association between disability and personal wellbeing (PWB) among working-age adults. OBJECTIVE/HYPOTHESIS To determine (1) the magnitude of differences in wellbeing between working-age adults with and without disability in contemporary samples representative of the UK population; and (2) whether the size of any observed differences between people with and without disability is moderated by age, gender, ethnicity, partnership status, educational attainment or employment status. METHODS Secondary analysis of data from three national cross-sectional surveys. RESULTS In each survey, people with disability scored lower than people without disability on all four indicators of PWB. Adjusting for the main effects of potentially moderating variables reduced the effect size of disability on PWB by an average of 24%. C646 Subsequently adjusting for the two-way interaction terms between disability and potentially moderating variables reduced the effect size of disability (main effect) on PWB by an additional average of 73%. PWB among people with disability was significantly lower for (1) men; (2) younger people; (3) those who belong to the majority ethnic group (white British); (4) those without a partner; and (5) people with lower socio-economic position. CONCLUSIONS Our findings indicate that demographic characteristics and exposure to specific social determinants of poor health play a major role in the negative association between disability and personal wellbeing. A more sophisticated understanding of how social determinants interact to produce inequities associated with identities such as disability, gender, race, sexuality, and class (intersectionality) can inform effective policy interventions. BACKGROUND To examine the incidence and trends of peri-procedural complications after TAVR and their impact on resource utilization. METHODS The incidence of complications by type [acute kidney injury (AKI), permanent pacemaker (PPM), vascular, paravalvular leak, in-hospital mortality, others] was calculated for TAVR patients at a high-volume center between 2012 and 2018. Clinical data were matched with hospital-billing data of patients. Trends in high resource utilization (discharge to a rehabilitation facility or PLOS >7 days) (HRU) and complication rates were assessed. Multivariable logistic regression models were used to determine predictors of HRU. RESULTS Out of 1163 patients, 966 (83%) had no complications, others in 95 (8%), PPM in 56 (5%), AKI alone in 32 (3%), vascular in 31 (3%), in-hospital mortality in 28 (2%) and PVL in 10 (1%). A significant decreasing trend in the incidence of complications (29% vs 10%; p trend less then 0.001) and HRU (75% vs 12%; p trend less then 0.001) was observed between 2012 and 2018 respectively. Mean ± SD direct procedure cost of having a complication was $58,234 ± $24,568, was associated with an incremental cost of $10, 649 and a prolonged stay of 3-days. On multivariable logistic regression analysis, PPM, vascular complications, high STS risk score, NYHA class III/IV, frailty and ≥ moderate tricuspid regurgitation were significantly associated with HRU. TAVR year was protective against HRU. CONCLUSIONS We established that, post-TAVR resource utilization and morbidity is high among frail and patients with higher STS risk scores. However, these rates decrease over time with experience. BACKGROUND/PURPOSE The trend of suicide rates among young adults has been increasing worldwide. The study aimed to identify the suicide risks and associated psychosocial factors in a large university in Taiwan. METHODS This is a mixed-methods study using both questionnaire survey and two open-ended questions for the exploration of qualitative data. An online survey was conducted between two periods of the same semester in 2018 to collect different sources of stress and other suicide correlates. The measurement scales included the 9-item Concise Mental Health Checklist, the University Stress Screening Tool in Taiwan and the Chinese Maudsley Personality Inventory. The participants were required to fulfill two open-ended questions about stress experience and depressive symptoms in the previous month in the end of the questionnaire, which was analyzed using thematic analysis. RESULTS A total of 857 university students were recruited (67.9% female participants). Over a quarter of participants were under poor mental health status and more than 60% experienced stressful events in the prior year. A higher suicide risk and neurotic trait was noticed compared to the general public. These results were consistent with the qualitative findings. CONCLUSION While identifying several risk factors that cumulatively conduced to higher suicide risks, neuroticism served as a key element in the increased suicide risk among the university students. Suicide prevention strategies for university students should highlight stress management for those with neurotic trait and early suicide risk identification. Youth suicide prevention, Psychosocial correlates, Risk factors, Mixed-methods, Taiwan. V.BACKGROUND Lymph node (LN) metastasis portends a worse prognosis following resection of intrahepatic cholangiocarcinoma (ICC); however, lymphadenectomy is not routinely performed, as its role remains controversial. Herein, we developed a risk model for LN metastasis by identifying its predictive factors and assessed a subset of patients who might not benefit from LN dissection (LND). METHODS 210 patients who underwent curative-intent surgery for ICC were retrospectively reviewed. A preoperative risk model for LN metastasis was developed following identification of its preoperative predictive factors using the recursive partitioning method. RESULTS In the multivariable analysis, CA 19-9 level of >120 U/mL, an enlarged LN on computed tomography, and a tumor location abutting the Glissonean pedicles were independent predictors of LN metastasis. The preoperative risk model classified the patients according to their risk high, intermediate, and low risks at a rate of LN metastasis on final pathology of 60.9%, 35%, and 2.
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