Higher Serum BDNF Levels are Associated with Lower Risk of Cognitive Decline in Older Adults :The Otassha Study

Introduction There has been growing interest in the use of circulating levels of brain-derived neurotrophic factor (BDNF) in the blood as a biomarker in the context of patients with Alzheimer’s and other neurodegenerative diseases. Prospective data on cognitive decline in the broad older population, however, remain limited. We assessed the relationship of serum BDNF levels with short-term decline in cognitive functioning of community-dwelling older adults. Methods: Prospective study of 405 adults 65-84 years old without dementia in Tokyo, Japan. The Montreal Cognitive Assessment-Japanese version (MoCA-J) and its subscales were used. Linear regression assessed standardized differences in test score differences between baseline (2011) and follow-up (2013) visits, according to baseline serum BDNF quartiles, with adjustment for baseline demographics, disease indicators, and cognitive scores. Results Among participants who performed on the MoCA-J at baseline (scores in bottom quartile), cognitive decline was .65 (95% CI: .08 - 1.2; p=.025) standard deviations (SD) more pronounced in those with lowest than highest BDNF levels. Decline in executive function, but not in other subdomains, was also most pronounced in those with lowest baseline serum BDNF levels (difference: .32 SD; 95%CI: .08-.55; p=.007) Conclusion Lower serum BDNF levels were associated with greater 2-year cognitive decline in community-dwelling older Japanese adults. Decline varied among cognitive subdomains, and baseline cognition. Research seeking to evaluate the added-value of serum BDNF for screening and/or health promotion initiatives involving physical activity, which has been linked to increment in BDNF levels, is warranted.

Free triiodothyronine is associated with poor outcome after acute ischemic stroke

Aims It is unclear whether thyroid hormones are associated with functional outcome after ischemic stroke. We aimed to investigate the impact of thyroid hormones at admission on functional outcome at 3 months after acute ischemic stroke. Methods A total of 480 consecutive patients for ischemic stroke within 48 hours of onset were enrolled in this study. Thyroid hormones including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured at admission and functional outcomes were assessed at 3 months with the modified Rankin Scale (mRS) ranging from 0 to 6. Poor outcome was defined as mRS≥3. Results FT3 levels at admission were considerably lower in poor outcome patients than those with good outcome at 3 months (3.53±0.70pmol/L vs 4.04±0.68pmol/L, respectively; P＜0.001). Lower levels of FT3 were observed with higher mRS scores. Multivariable logistic regression analysis revealed that FT3 levels were significantly associated with risk of poor outcome at 3 months independent of conventional risk factors such as age, NIHSS score and recanalized therapy. In addition, patients in the bottom quartile of FT3 levels had a 2.56-fold higher risk of developing poor outcome compared with patients in the top quartile (OR=2.56; 95%CI 1.15-5.69, p =0.021). The sensitivity and specificity of FT3 (≤3.69pmol/L) predicting poor outcome were 62.70% and 72.03% respectively. Conclusion Our study suggests that FT3 levels at admission are significantly and independently associated with risk of poor outcome after ischemic stroke and lower FT3 levels can be regarded as a prognostic biomarker for poor outcome at 3 months.

What patient and health facility attributes predict retention and virologic suppression in private for-profit health centers? A retrospective cohort analysis of data from a large private sector antiretroviral treatment program in Nigeria

Background In Nigeria, private for-profit health facilities present an opportunity to achieve the 95-95-95 HIV targets because of their reach and patronage. However, little is known about determinants of outcomes in these facilities. This study describes patient outcomes and their determinants in adults receiving HIV treatment in private facilities in 3 states in north-central Nigeria. Methods A retrospective longitudinal analysis of program data collected between 2013 and 2019 was done. Patient attributes and outcomes were compared across states. Incidence rates were determined for all outcomes. Cox proportional hazard models and multivariate logistic regression models were used to identify associations with and predictors of study outcomes respectively. Results 42.7%, 22.2% and 35.1% of the 22,010 study subjects were in Benue, FCT and Nasarawa respectively. 31.8% had been on ART for less than a year at censoring. Incidence rates for all-cause exit, mortality and LTFU were 17.2, 2.1 and 11.2 per 100 person years respectively. Males had higher risks of death (HR = 1.47), and LTFU (HR = 1.08). Age at ART start showed a dose-response association with both mortality and LTFU. Care at model facilities (OR = 2.16), AZT-based regimens (OR = 2.00), and low baseline CD4 + count (OR = 2.40) were predictors of regimen switch. 75.6% of subjects were viral suppressed. Male gender (OR = 0.84); AZT- based regimen (OR = 0.72), age in the bottom quartile (OR = 0.71) were predictors of viral suppression. Conclusion Private sector patient outcomes are comparable to public sector programs. Appropriate technical support and engagement will facilitate combined efforts to achieve epidemic control of HIV in Nigeria.

Engagement with Search-Based Advertising on Search Engine Results Pages Varies Based on the User’s Prior Knowledge and Screen Size

A Review of: Schultheiß, S., & Lewandowski, D. (2021). How users’ knowledge of advertisements influences their viewing and selection behavior in search engines. Journal of the Association for Information Science and Technology, 72(3), 285–301. https://doi.org/10.1002/asi.24410 Abstract Objective – To examine how users’ understanding of ads on search engine results pages (SERPs) influences their viewing and selection behaviour on computers and smartphones. Design – Mixed methods approach consisting of pre-study interview, eye-tracking experiment, and post-study questionnaire. Setting – Usability lab at a university in Germany. Subjects – 50 students enrolled at the Hamburg University of Applied Sciences and 50 non-students recruited in Hamburg. Methods – After giving informed consent and receiving payment, participants provided information on demographics as well as how they use search engines as part of a pre-study interview. For the eye-tracking experiment, each participant completed 10 tasks each on a desktop computer and smartphone. Both the device condition order and task order were randomized. Tasks were broken down into five informational tasks (e.g., how do I build a desktop computer?), three transactional tasks (e.g., how would I go about buying a refrigerator?), and two navigational tasks (e.g., I need to go to the Apple website). The software displayed clickable screenshots of SERPs, and all clicks were recorded. iMotions eye-tracking software recorded eye fixations on areas of the page featuring organic search results and paid ads. A post-experiment questionnaire asked participants about Google’s business model and probed them about the extent to which they were able to differentiate between organic results and ads. Answers to the questionnaire were weighted and normalized to form a 0–100 scale. Main Results – The first set of research hypotheses examining the correlation between participants’ knowledge of ads and viewing and clicking behaviour was partially confirmed. There was no significant correlation between participants’ questionnaire score and visual fixations on ads, but there was a significant negative correlation between questionnaire score and the number of clicks on ads. Users with questionnaire scores in the bottom quartile paid significantly less attention to organic results than those in the top quartile, but users in the top quartile still fixated on ads and did so comparably to users in the bottom quartile. The second set of research hypotheses examining the relationship between viewing and clicking behaviour and device (desktop versus mobile) was also partially confirmed. Users on a smartphone had significantly higher fixation rates on ads than users on a desktop computer, although click rates on ads did not differ significantly between the two conditions. Conclusion – Knowledge about ads on SERPs influences selection behaviour. Users with a low level of knowledge on search advertising are more likely to click on ads than those with a high level of knowledge. Users on smartphones are also more likely to pay visual attention to ads, probably because the smaller screen size narrows content “above the fold.”

Inflammatory markers and risk of cardiovascular mortality in relation to diabetes status in the HUNT study

Inflammatory markers have been associated with increased risk of cardiovascular mortality in general populations. We assessed whether these associations differ by diabetes status. From a population-based cohort study (n = 62,237) we included all participants with diabetes (n = 1753) and a control group without diabetes (n = 1818). Cox regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for possible associations with cardiovascular mortality of 4 different inflammatory markers; C-reactive protein (CRP), calprotectin, neopterin and lactoferrin. During a median follow-up of 13.9 years, 728 (20.4%) died from cardiovascular disease (CVD). After adjustment for age, sex and diabetes, the associations of all inflammatory markers with risk of cardiovascular mortality were log-linear (all P ≤ 0.017 for trend) and did not differ according to diabetes status (all P ≥ 0.53 for interaction). After further adjustments for established risk factors, only CRP remained independently associated with cardiovascular mortality. HRs were 1.22 (1.12–1.32) per standard deviation higher loge CRP concentration and 1.91 (1.50–2.43) when comparing individuals in the top versus bottom quartile. The associations of CRP, calprotectin, lactoferrin and neopterin with cardiovascular mortality did not differ by diabetes, suggesting that any potential prognostic value of these markers is independent of diabetes status.

Higher Serum Brain-Derived Neurotrophic Factor Levels Are Associated With a Lower Risk of Cognitive Decline: A 2-Year Follow Up Study in Community-Dwelling Older Adults

ObjectiveTo assess the relationship of serum brain-derived neurotrophic factor (BDNF) levels with the subsequent short-term decline in cognitive functioning in community-dwelling older adults.DesignTwo-year prospective, observational study.Setting and ParticipantsThe study included 405 adults aged 65–84 years, initially free of a dementia diagnosis who were living in Tokyo, Japan.MethodsParticipants underwent health assessments at baseline (2011) and follow-up (2013). Serum BDNF levels and scores from the Montreal Cognitive Assessment-Japanese version (MoCA-J) were systematically measured. Logistic regression was used to estimate the odds of cognitive decline between baseline and follow-up assessments in the full MoCA-J scale (operationally defined as a decrease of two or more points), as well as in MoCA-J subscales (decline of one or more points in a specific subscale), as a function of serum BDNF level, adjusting for baseline demographics, prevalent chronic diseases, and baseline cognitive scores.ResultsAmong individuals who performed worse on the full MoCA-J at baseline (i.e., scores in the bottom quartile [≤21], which is consistent with a mild cognitive impairment status), but not among those who performed better (top 3 quartiles), those with highest baseline serum BDNF levels (top quartile) had lower odds of subsequent decline in the full MoCA-J scale than those with lowest (bottom quartile); i.e., odds ratio (OR): 0.10 (95% confidence interval [CI]: 0.02–0.62; p = 0.013). Regarding MoCA-J subscales, adjusted odds of decline in the executive function subscale, but not in the other five subscales, were substantially low among those with highest baseline serum BDNF levels (top quartile), as compared to those with the lowest (bottom quartile), i.e., OR: 0.27 (95% CI:0.13–0.60; p < 0.001).Conclusion and ImplicationsHigher serum BDNF levels were associated with a lower risk of decline in cognitive function in a sample of community-dwelling older Japanese adults. Risk varied across cognitive subdomains and according to baseline cognition. This warrants further research to evaluate the added-value of serum BDNF in health promotion initiatives directed toward cognitive decline prevention in community-dwelling older adults.

Association Between Chemosensory Dysfunction and Diet Quality in United States Adults

Background Evidence suggests chemosensory dysfunction (CSD) patients have altered diet, but population-level evidence assessing diet quality in CSD patients is lacking. Objective We examined the association between CSD and diet quality in a representative sample of United States adults. Methods This cross-sectional study included 2831 adults aged greater than 40 years from the 2013-2014 National Health and Nutrition Examination Survey who completed the taste/smell questionnaire and examination. Mean nutrient intake in subjects with self-reported olfactory/gustatory dysfunction (sOD/sGD) and measured olfactory/gustatory dysfunction (mOD/mGD) were compared to those without CSD using univariate Wilcoxon rank-sum tests. The Healthy Eating Index (HEI), a validated measure of diet quality, was calculated. The proportion of subjects with CSD with bottom-quartile HEI was compared to those without CSD using multivariate logistic regression, adjusting for demographic and socioeconomic covariates. Results The population-weighted prevalence of sOD, sGD, mOD, and mGD was 20.1%, 14.4%, 15.9% and 25.6%, respectively. Subjects with mOD had lower mean intake of total calories, total fat, protein, sodium, and potassium compared to normal subjects (1873.4 ± 49.6 vs 2010.2 ± 24.2 kcal, 72.3 ± 2.7 vs 78.6 ± 1.0 gm, 74.0 ± 2.5 vs 80.4 ± 0.6 gm, 3122 ± 97.2 vs 3353.2 ± 37.0 mg, 2509.8 ± 69.8 vs 2684.7 ± 26.1 mg, P < 0.05 respectively). When controlling for sociodemographic factors and comorbidities, subjects with sOD were more likely to have bottom-quartile HEI compared to normal subjects (OR 1.33, 95% CI 1.04–1.70). Conclusions This population-level study suggests an association between poor diet quality and variation in dietary intake in patients with CSD, which warrants further investigation and suggests the possible need for nutritional counseling for CSD patients.

Family income and health in Canada: a longitudinal study of stability and change

Background Extensive research has shown strong associations between income and health. However, the health effects of income dynamics over time are less known. We investigated how stability, volatility and trajectory in family incomes from 2002 to 2011 predicted (1) fair/poor self-rated health and (2) the presence of a longstanding illness or health problem in 2012. Methods The data came from the 2012 wave of the Longitudinal and International Study of Adults linked to annual family income data for 2002 to 2011 from the Canada Revenue Agency. We executed a series of binary logistic regressions to examine associations between health and average family income over the decade (Model 1), number of years in the bottom quartile (Model 2) and top quartile (Model 3) of family incomes, standard deviation of family incomes (Model 4), absolute difference between family income at the end and start of the period (Model 5), and number of years in which inflation-adjusted family income went down by more than 1% (Model 6) and up by more than 1% (Model 7) from 1 year to the next. The analyses were conducted separately for women and men. Results Average family income over the decade was strongly associated with both self-rated health and the presence of a longstanding illness or health problem. More years spent in the bottom quartile of family incomes corresponded to elevated odds of fair/poor self-rated health and the presence of a longstanding illness or health problem. Steady decreases in family income over the decade corresponded to elevated odds of fair/poor self-rated health for men and more years spent in the top quartile of family incomes over the decade corresponded to elevated odds of fair/poor self-rated health for women. Conclusion Previous studies of the association between family income and health in Canada may have overlooked important issues pertaining to family income stability and change that are impactful for health.

The association between plant-based dietary patterns and risk of breast cancer: a case–control study

Limited data are available, linking the plant-based diets to breast cancer (BC). We examined the association of overall plant-based diet index (PDI), hypothesized healthful (hPDI) and unhealthful versions of a plant-based diet index (uPDI) with BC in Iranian women. This population-based case–control study included 350 cases with newly diagnosed BC and 700 age-matched apparently healthy controls. We collected dietary data using a validated, Willett-format semi-quantitative food frequency questionnaire. Using these data, we generated a PDI by dedicating positive scores to plant foods, and reverse scores to animal foods, hPDI by assigning positive scores to healthy plant foods and reverse scores to less healthy plant foods and animal foods, and finally uPDI in which positive scores were assigned to less healthy plant foods and reverse scores to healthy plant foods and animal foods. After controlling for potential confounders, individuals in the highest quartile of PDI had 67% lower odds of BC than those in the lowest quartile (OR 0.33; 95% CI 0.22–0.50). Individuals with the greatest adherence to hPDI were 36% less likely to have BC than those with the lowest adherence, in the fully adjusted model (OR 0.64; 95% CI 0.43–0.94). In terms of uPDI, women in the top quartile had a 2.23 times greater chance of BC than those in the bottom quartile (OR 2.23; 95% CI 1.48–3.36). Greater adherence to PDI and hPDI was inversely associated with the risk of BC, whereas uPDI was associated with an increased risk.

Clinical Evaluation of the Polygenetic Background of Blood Pressure in the Population-Based Setting

The clinical value of the polygenetic component of blood pressure (BP) is commonly questioned. We evaluated a genetic risk score for BP (BP-GRS 858 ), based on the most recently published genome-wide association studies variants that were significantly associated with either systolic BP or diastolic BP, for prediction of hypertension and cardiovascular end points. The genotyping was performed in 2 urban-based prospective cohorts: the Malmö Diet and Cancer (n=29 295) and the Malmö Preventive Project (n=9367) and a weighted BP-GRS 858 based on 858 SNPs was calculated. At baseline, we found a difference of 9.0 mm Hg (systolic BP) and 4.8 mm Hg (diastolic BP) between the top and the bottom quartile of BP-GRS 858 . In Malmö Preventive Project, the top versus bottom quartile of BP-GRS 858 was associated with a doubled risk of incident hypertension (odds ratio, 2.05 [95% CI, 1.75–2.39], P =1.4×10 −21 ), a risk higher than that of body mass index, as evaluated in quartiles. In Malmö Diet and Cancer, significant association was found between the age and sex-adjusted BP-GRS 858 and the incidence of total cardiovascular events, stroke, coronary artery disease, heart failure, atrial fibrillation, and total mortality. Most of these associations remained significant after adjusting for traditional risk factors, including hypertension. BP-GRS 858 could contribute predictive information regarding future hypertension, with an effect size comparable to other well-known risk factors such as obesity, and predicts cardiovascular events. Given that the exposure to high polygenetic risk starts at birth, we suggest that the BP-GRS 858 might be useful to identify children or adolescents who would benefit from early hypertension screening and treatment.