Obesity Duration, Severity, and Distribution Trajectories and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities Study

Background Research examining the role of obesity in cardiovascular disease (CVD) often fails to adequately consider heterogeneity in obesity severity, distribution, and duration. Methods and Results We here use multivariate latent class mixed models in the biracial Atherosclerosis Risk in Communities study (N=14 514; mean age=54 years; 55% female) to associate obesity subclasses (derived from body mass index, waist circumference, self‐reported weight at age 25, tricep skinfold, and calf circumference across up to four triennial visits) with total mortality, incident CVD, and CVD risk factors. We identified four obesity subclasses, summarized by their body mass index and waist circumference slope as decline (4.1%), stable/slow decline (67.8%), moderate increase (24.6%), and rapid increase (3.6%) subclasses. Compared with participants in the stable/slow decline subclass, the decline subclass was associated with elevated mortality (hazard ratio [HR] 1.45, 95% CI 1.31, 1.60, P <0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, P <0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, P =0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, P =0.0008), adjusting for baseline body mass index and CVD risk factor profile. The moderate increase latent class was not associated with any significant differences in CVD risk as compared to the stable/slow decline latent class and was associated with a lower overall risk of mortality (HR 0.85, 95% CI 0.80, 0.90, P <0.0001), despite higher body mass index at baseline. The rapid increase latent class was associated with a higher risk of heart failure versus the stable/slow decline latent class (HR 1.34, 95% CI 1.10, 1.62, P =0.004). Conclusions Consideration of heterogeneity and longitudinal changes in obesity measures is needed in clinical care for a more precision‐oriented view of CVD risk.

Trajectories of Body Mass Index and Multimorbidity in Old Age: 12-Year Results From a Population-Based Study

We aimed to study the association of long-terms trajectories of body mass index (BMI) with contemporaneous changes in multimorbidity development in older adults. Twelve-year BMI trajectories (2001–2013) were identified in subjects aged 60+ years from the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K) using growth mixture models (N=2,189). Information on chronic diseases and multimorbidity was ascertained based on clinical examinations, lab tests, medications, and inpatient and outpatient medical records. Linear mixed models were used to study the association between BMI trajectories and the speed of chronic diseases accumulation, in general and by groups of cardiovascular and neuropsychiatric diseases. Eighty percent of the study population was included in a stable BMI trajectory, 18% in a slow-decline trajectory with an accelerated BMI decline from age 78 onwards, and 2% in a fast-decline trajectory that reached underweight values before age 85. A significantly higher yearly rate of chronic disease accumulation was observed in the fast-decline versus stable trajectories (β=0.221, 95% CI 0.090-0.352) after adjusting for age, sex, education and time to death. Subjects in the slow-decline trajectory showed a significantly higher rate of cardiovascular diseases accumulation (β=0.016, 95% CI 0.000-0.031); those in the fast-decline trajectory showed a faster accumulation of both cardiovascular (β=0.020, 95% CI -0.025, 0.064) and neuropsychiatric diseases (β=0.102, 95% CI 0.064-0.139), even if the former association did not reach statistical significance. Carefully monitoring older adults with sustained weight loss seems relevant given their likelihood to develop a phenotype of rapidly accumulating chronic -especially neuropsychiatric- diseases.

French fashion and textile during COVID-19. Once again, flying to high quality and innovation to survive

This article studies the consequences of the COVID-19 global health crisis on the fashion and textile industry in France. This crisis is only part of an already long, slow decline in the industry. The paper analyzes the composition and organization of textile industry. It offers data related to: sales, consumption, employees, company size, as well as imports and exports - all highlighting the importance of fashion and textiles in France today. The paper shows how lockdown has asphyxiated production and retail sales. COVID-19 caused the appearance of new challenges: mask production, new aspects of CSR in luxury textiles and the development of antiviral fabrics. Mask production can be considered as a case study useful in the analysis of textile challenges. In this context, the French textile industry should continue to improve on innovation and quality. Promoting labelling on the global market can help the sector to develop its high-end. France is credible to expanding its fashion and textile supply in luxury.

Analysis on the Spatio-Temporal Evolution and Influencing Factors of China's Grain Production

The rapid economic development and climate change have accelerated the changes in China's food production and have a potential impact on food security. In this paper, the grain sown area from 2001 to 2019 was selected to analyze the spatio-temporal evolution and driving factors of China's grain production through spatial autocorrelation analysis and geographically weighted regression. Our findings were as follows: (1) From the perspective of time characteristics, China's grain production from 2001 to 2019 experienced four stages: rapid decline, rapid growth, steady growth, and slow decline, although with an overall upward trend. (2) From the perspective of spatial characteristics, the overall spatial pattern had a significant positive correlation. The high values were mainly concentrated in Shandong, Anhui and Jilin, and moved to the northeast China as time went on. (3) In terms of influencing factors, the positive impact of agricultural labor force on the grain production gradually decreased, showing a decreasing trend from southwest to northeast. The promotion of agricultural mechanization on the grain production increased year by year, with the spatial distribution characteristics of high in the northeast and low in the southwest. Besides, the coefficient of water resources endowment was negative, showing a spatial distribution pattern of high north and low south.

When will the world be committed to 1.5 and 2.0°C of global warming?

We investigate committed warming, i.e., the global mean temperature change that would follow complete cessation of anthropogenic emissions. The removal from the atmosphere of short-lived particulate aerosols, which have a cooling effect on the climate, leads to a peak in warming within a decade, followed by a slow decline over centuries to millennia to a relatively stable temperature determined by the residual CO2 forcing. This has important consequences: temporary warming well beyond present-day levels without any additional emissions. We use an emissions-based climate model (FaIR) to estimate temperature change after abrupt cessation of all anthropogenic emissions in 2021 and in every year thereafter until 2080, assuming that emissions prior to cessation proceed along priority Shared Socioeconomic Pathways (SSPs). We find that society may already be committed to peak warming of greater than 1.5°C with approximately 40% probability, with a small (2%) probability of peak warming greater than 2.0°C. The probability of being committed to 1.5°C increases to at least 50% by 2024. Taking into account short-lived climate forcers advances warming commitments by a half a decade, considerably reducing the remaining carbon budget. While an abrupt cessation of all anthropogenic emissions is not likely to occur, this idealized scenario provides a quantification of when we will be committed to exceeding key global warming levels while following realistic emissions scenarios.

April 27, 2005—Holding On

The main subject of this dialogue is facing, accepting, and yielding to death. Nell is managing physical decline and finding meaning in mortal time, recurrent themes in our conversations. She succinctly describes her plan for making sense of death, but she recognizes that her self-prescription is not easy to fulfill. Facing death requires detaching from activities that give meaning and link Nell to the broader world. On most days, she lacks the energy to engage the outside world; she is housebound. In his autobiography, Dr. Paul Kalanithi presents an example of yielding as he describes his slow decline due to lung cancer. Nell is facing death directly like Dr. Kalanithi, with grace, until the very end, literally editing from her deathbed. Nell addresses a central question throughout these dialogues: What makes life worth living when death is imminent? We discuss security objects and Nell tells me about parish priest Fr. Jay, who gives her a ceramic angel when he administers the Sacrament of Anointing of the Sick. She finds comfort in consoling iconography and holding on to her rosary, a crucifix, angels, and the Buddha.

Characterization of long-term oral anticoagulant adherence trajectories among patients with atrial fibrillation: a retrospective observational study

Background Medication taking is a dynamic behaviour that changes over time. Conventional adherence summary measures (e.g. proportion days covered) used in the OAC adherence studies conducted so far, however, are insensitive to the fluid nature of adherence. For example, identical PDC values can be calculated for patients with initial good adherence followed by poor adherence, and for those with periodic non-adherence throughout the course of therapy. Purpose The objective of this study was to characterize atrial fibrillation (AF) patients' long-term unique oral anticoagulant (OAC) adherence trajectories. Methods Using linked, population-based administrative data containing physician billings, hospitalization and prescription records of 4.8 million British Columbians (1996–2019), incident adult cases of AF were identified. Only patients who had prescription refill data available for five years were included in the analysis. The primary measure of OAC adherence was the proportion of days covered (PDC) over consecutive 90-day rolling windows. We modelled continuous 90-day PDC values over time. The time variable was number of years since OAC initiation. Group-Based Trajectory Modelling (GBTM) was used to identify patients' unique longitudinal adherence trajectories. To determine the best model, a relative comparison was done between models using Bayesian information criteria (BIC), and the Akaike information criterion (AIC). Results The study cohort was 19,749 AF patients [mean age 70.6y (SD 10.64), 56% male, mean CHA2DS2-VASc score 2.77 (SD 1.39]. The model that best fit our data identified four distinct OAC adherence trajectories (Figure). These were “consistent good adherence” (n=14,631 patients, 74.1% of the cohort), “rapid decline and discontinuation” (n=2327, 11.8%), “rapid decline with recovery” (n=1973, 9.99%), and “slow decline and discontinuation” (n=819, 4.2%). Our results show that there is heterogeneity among non-adherers. PDC dropped significantly in the first year after therapy initiation for those with “rapid decline and discontinuation” trajectory. Patients exhibiting “rapid decline with recovery” also displayed a rapid decline in adherence in the first year but showed improvements around the third year. Those in the “slow decline and discontinuation” trajectory displayed slow decline in adherence over first three years which eventually led to permanent discontinuation of therapy. Conclusion In this retrospective study we distinguished between the different kinds of non-adherence in terms of timing and rate. While a majority of our cohort adhered to their medications, we identified three unique trajectories displaying declining adherence over time at varying rates. Our results emphasize the importance of early intervention and have direct implications for improving the design of adherence interventions. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research grant

EVALUATION OF IMPORTANT FACTORS FOR PHYSICAL EXERCISE TO MAINTAIN HEALTH

ABSTRACT Introduction In recent years, people’s physical fitness continues to show a slow decline, so the maintenance of human health is very important. Object The thesis researches the effect of student group sports and analyzes the influencing factors of student group sports. Method The thesis uses mathematical statistics to study student groups’ sports activities and influencing factors. Results The student group is not satisfied with the extracurricular sports activities carried out by the school. The community has little influence on the sports behavior of the student group. Conclusion This study provides a realistic and theoretical basis for the student group to implement the school sports documents, rules and regulations, and opinions and promote the student group’s physical and mental health. Level of evidence II; Therapeutic studies - investigation of treatment results.