Five-Minute Apgar Score and the Risk of Mental Disorders During the First Four Decades of Life: A Nationwide Registry-Based Cohort Study in Denmark

Objectives:The associations of long-term risks of the full spectrum of mental disorders with clinically reassuring but suboptimal score range 7–9 remain unclear. This study investigated these associations during up to 38 years of follow-up.Methods:In a nationwide cohort study of 2,213,822 singletons born in Denmark during 1978–2015, we used cox regression to estimate the hazard ratio (HR) of mental disorders with a 95% CI.Results:A total of 3,00,679 (13.6%) individuals were diagnosed with mental disorders. The associations between suboptimal Apgar score 7–9 and mental disorders differed by attained age. In childhood (≤ 18 years), declining Apgar scores were associated with increased risks of overall mental disorders with HRs (95% CI) of 1.13(1.11-1.15), 1.34 (1.27–1.41), and 1.48 (1.31–1.67) for Apgar scores of 7–9, 4–6, and 1–3, respectively, compared with a score of 10. A dose-response association was seen even within the score range from 9 to 7 (HR 1.11 [95% CI: 1.08–1.13], 1.14 [1.10–1.18], and 1.20 [1.14–1.27], respectively). Of note, individuals with scores of 7–9 had increased risks of organic disorders (HR: 1.27, 95% CI: 1.05–1.53), neurotic disorders (HR: 1.07, 95% CI: 1.03–1.11), and a wide range of neurodevelopmental disorders, such as intellectual disability (1.87, 1.76–1.98), childhood autism (1.13, 1.05–1.22) and attention deficit hyperactivity disorder (1.10, 1.06–1.15). In early adulthood (19–39 years), suboptimal Apgar scores 7–9 were not associated with the risks of overall and specific mental disorders.Conclusion:Infants born with clinically reassuring but suboptimal 5-min scores 7–9 are at increased risks of a wide spectrum of mental disorders in childhood.

Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults

Depression is a leading cause of disability, yet current prevention and treatment approaches have only had modest effects. It is important to better understand the role of dietary patterns on depressive symptoms, which may help prevent depression or complement current treatments. This study examined whether adherence to a Mediterranean diet (Med Diet), determined by the Alternate Med Diet score (aMED), was associated with depressive symptoms in a representative sample of U.S. adults. The aMED score (range 0–9) was calculated from a 24-h diet recall with gender-specific quartiles (Q) estimated. The Patient Health Questionnaire-9 (PHQ-9) was used to define depressive symptoms, which was dichotomized as no to mild (0–9) versus moderate to severe symptoms (10–27). Logistic regression was used to investigate the association between quartiles of aMED and depressive symptoms when controlling for sociodemographics, total calories, and the time of year of diet recall; 7.9% of the sample had moderate to severe depressive symptoms. Compared to individuals with the lowest aMED (Q1), individuals in Q3 and Q4 had 40% and 45% lower odds of moderate to severe depressive symptoms (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.50, 0.74; OR = 0.55, 95% CI: 0.36, 0.84, respectively). This study provides modest support of Med Diet’s role in supporting positive mental health.

Improving the sustainability of cocoa smallholders farming in Aceh, Indonesia

Cocoa is the main plantation commodity in Aceh as Aceh government reinforces Aceh as the national cocoa resource. Various efforts have been performed through many development and training programs for sustainable cocoa production. This study was aimed to identify the sustainability of cocoa smallholder farming based on the ecological, economical, and social aspects. This study was conducted in Aceh Tenggara and Pidie Jaya District. The study method used descriptive-quantitative method by calculating the score range of sustainability level. The result showed that cocoa smallholders challenged sustainability problems based on ecological, economical, and social aspects. The sustainability of cocoa smallholder farming in Aceh Tenggara District achieves a better performance based on the economical, ecological, and social sustainability aspects than in Pidie Jaya District.

Profile of Guided Discovery Learning Implementation Assisted by Virtual Lab and Students’ Problem-Solving Skills on Gas Kinetic Theory

This research was conducted to obtain a guided discovery learning implementation profile with virtual lab assistance and problem-solving skills for high school students on gas kinetic theory. The type of research was descriptive preliminary research, without hypothesis testing. The research subjects consisted of 106 students in senior high school. This study used qualitative descriptive analysis from questionnaires and online tests. This study revealed that the level of students’ problem-solving skills was low. This case was proven by 102 students (27 male; 75 female) in the low category with a score range of 0 to 45, and four students in the moderate category with a score range of 46 to 75, while there were no students in the high category with a score range of 76 to 100. This research implies that there is a need for a guided discovery learning model with the help of a virtual lab to analyze the problem-solving skills of high school students, especially on gas kinetic theory.

Assessment of available online educational resources for patients with atrial fibrillation (Preprint)

BACKGROUND A diagnosis of atrial fibrillation (AF) often leads patients to search online for information, which can expose them to information of varied quality. OBJECTIVE We conducted a qualitative systematic review of websites for patients that contain information regarding AF. METHODS The following terms were searched on 3 search engines (Google, Yahoo and Bing): AF for patients, What is AF, AF patient information, AF educational resources. Inclusion criteria were websites with a focus on comprehensive AF information, containing information about treatment options, and written in English. We excluded websites requiring membership subscription, linked to abstracts or manuscripts, or developed by private clinics. We used the Patient Education Materials Assessment Tool (PEMAT-P/PEMAT-AV) for printable/audio-visual material to assess understandability and actionability (score range 0-100). Those with PEMAT scores of >70 meaning acceptable understandability and actionability, underwent DISCERN score to assess information content quality and reliability (score range 0-80). RESULTS The search yielded a total 720 websites which underwent full review. After excluding duplicates and those not meeting the inclusion criteria, 48 underwent full scoring. Mean overall PEMAT-P score was 68.5±17.2. Mean PEMAT-AV score was 61.1±9.4. Of the websites that scored >70% PEMAT-P, 20 (42%) underwent DISCERN scoring. Mean DISCERN score was 54.7±4.5. CONCLUSIONS There is a wide variation in the understandably, actionability and quality of websites that provide information to patients with most websites not providing patient level materials. Knowledge of quality websites could provide an important adjunct for improving individuals’ knowledge about their condition

Are Machine Learning Models Used to Represent Accelerometry Data Robust to Age Differences?

Regular and sufficient amounts of physical activity (PA) are significant in increasing health benefits and mitigating health risks. Given the growing popularity of wrist-worn devices across all age groups, a rigorous evaluation for recognizing hallmark measures of physical activities and estimating energy expenditure is needed to compare their accuracy across the lifespan. The goal of the study was to build machine learning models to recognizing the hallmark measures of PA and estimating energy expenditure (EE), and to test the hypothesis that model performance varies across age-group: young [20-50 years], middle (50-70 years], and old (70-89 years]. Participants (n = 253, 62% women, aged 20-89 years old) performed a battery of 33 daily activities in a standardized laboratory setting while wearing a portable metabolic unit to measure EE that was used to gauge metabolic intensity. Participants also wore a Tri-axial accelerometer on the right wrist. Results from random forests algorithm were quite accurate at recognizing PA type; the F1-Score range across age groups was: sedentary [0.955 – 0.973], locomotion [0.942 – 0.964], and lifestyle [0.913 – 0.949]. Recognizing PA intensity resulted in lower performance; the F1-Score range across age groups was: sedentary [0.919 – 0.947], light [0.813 – 0.828], and moderate [0.846–0.875]. The root mean square error range was [0.835–1.009] for the estimation of EE. The F1-Score range for recognizing individual PAs was [0.263–0.784]. In conclusion, machine learning models used to represent accelerometry data are robust to age differences and a generalizable approach might be sufficient to utilize in accelerometer-based wearables.

Association of Social Determinants, Multimorbidity, and Functional Status with Mortality after Pneumonia

Social support, multimorbidity, and functional status are important determinants of health in older adults, but their prognostic implications remain unclear after an acute illness. We conducted a prospective cohort study of 201 patients 65 years or older who were hospitalized for pneumonia at a university hospital in Korea in 2019-2020. K-means cluster analysis was performed using social deprivation score (range: 0-5), activities of daily living (range: 0-7), instrumental activities of daily living (range: 0-7), physical limitation score (range: 0-7), and Gagne comorbidity index (range: 0-24) (higher scores indicate higher risk). Four groups were identified: 1) Group A: physically limited and non-disabled group with limited social support; 2) Group B: multimorbid but functional group with social support; 3) Group C: multimorbid and disabled group with social support; 4) Group D: multimorbid and disabled group with limited social support. For Groups A through D, the Kaplan-Meir estimates for 6-month mortality were 10.0%, 18.0%, 34.2%, and 43.6%, respectively, and the 6-month mean survival times were 166.4 days (95% CI: 156.1-176.6), 156.9 days (95% CI: 140.8-173.1), 145.2 days (95% CI: 126.6-163.8), and 125.9 days (95% CI: 107.7-144.1), respectively. After adjusting for sex, age, and pneumonia severity score, the hazard ratios for Groups B through D versus Group A were 2.07 (95% CI: 0.70-6.13), 3.14 (95% CI: 1.17-8.42), and 4.38 (95% CI: 1.73-11.04), respectively. Our results suggest that multimorbidity and disabilities were implicated in higher risk of 6-month mortality after pneumonia, and social support may mitigate this risk among those with multimorbidity and disability.

ACCEPTANCE LEVEL OF INDEPENDENT OIL PALM SMALLHOLDERS IN MALAYSIA TOWARDS EXTENSION SERVICES

The main objective of the extension group is to disseminate the oil palm technologies to the independent oil palm smallholders (ISH). However, since the beginning of the establishment of the extension group in the Malaysian Palm Oil Board (MPOB) in 2002, there is no clear information on the acceptance level of ISH toward extension service activities by this group. Therefore, the main objectives of this study are to determine the perception and attitude of ISH toward the extension service activities by extension group and to identify the association between the level of perception and attitude of ISH toward extension activities with ISH personal profile and farm background. Based on the total population in the study area, the number of samples to be selected in this study is 384 respondents. Interview administrated questionnaires were employed to obtain the relevant data. The study revealed that the total average mean of respondents’ perception and attitude towards extension service activities is 3.99 which belongs to the category of high score range (3.67 – 5.00). Therefore, it shows that ISH has a positive perception and attitude towards extension service which can lead to the high acceptance level of extension service activities by extension group among ISH. Other than that, based on the chi-square analysis, it shows that different demographic profiles significantly influence the level of perception & attitude of ISH toward extension activities. The findings of this study will assist the extension group in MPOB to re-strategize and further improve its extension service while contributing to future studies.

The Hardiness Profile of Islamic Boarding School Student in Indonesian

The primary goal of this study is to evaluate the hardiness profile of students in Islamic boarding schools and determine whether or not hardiness has a practical impact on students through Islamic boarding schools, with the top indicators being challenge, control, and commitment. Every shift brings with it a new set of challenges, which can be challenging to adjust to. This research employs quantitative methods to demonstrate this. For the 2020/2021 academic year, student boarding school students in Jakarta served as the study's subject population. As a result, 76 participants were chosen at random using a purposive selection method. It is possible to get data using the santri hardiness instrument as the method of gathering information. The hypothetical mean approach is utilized in this study to determine the optimal score, the minimal score, the standard deviation, and the theoretical mean. The score range is obtained in order to determine the category, which will be as follows: X 129.3 indicates a high category, 103.7 129.3 indicates a medium category, and X 103.7 indicates a low category. It is possible to conclude from these estimates that the hardiness profile of boarding school kids falls into the middle category. The result is that most students have attitudes and skills that are not yet optimal for coping with life difficulties in Islamic boarding schools.

A Cross-Sectional Analysis of County-Level Social Vulnerability and Physical Frailty Among Adults with Hematological Malignancies

Introduction Physically frail older adults with hematological malignancies experience greater treatment-related toxicity, higher rates of treatment non-completion, increased utilization of health care services, and shorter overall survival than younger and fitter patients. For frail adults, living in areas of high social vulnerability may also place them at disproportionately higher risk of experiencing poor health outcomes. Yet, the association between community-level social vulnerability and physical frailty among patients with hematological malignancies has not been previously described. Methods We used a previously developed frailty index [Carolina Frailty Index (CFI)] (Guerard et al., 2017) of accumulated health deficits, derived from geriatric assessment data of participants enrolled in the Carolina Senior Registry (CSR) (ClinicalTrials.gov identifier: NCT01137825) at the University of North Carolina at Chapel Hill or the Registry for Adults with Plasma Cell Disorders (ClinicalTrials.gov identifier: NCT03717844). In this cross-sectional study, we examined the association between county-level social vulnerability [Centers for Disease Control Social Vulnerability Index (CDC SVI)] (https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html. Accessed on July 1, 2021) and physical frailty in adults with hematological malignancies enrolled in the registries. In a cohort of 338 patients (CFI score range, 0-1), patients with a CFI score of 0.2 or above were considered frail. Social vulnerability was measured using participant residential zip codes and county locations linked to the overall SVI and each of the four domains: 1, socioeconomic status; 2, household composition & disability; 3, minority status & language, and 4, housing & transportation, that comprise the overall SVI (score range 0-1, with 1= most vulnerable). We used cut points of 0.2, 0.4, 0.6, and 0.8 to stratify the level of social vulnerability. Associations were made using Jonkherre-Terpstra tests for trends. All analyses were performed using SAS version 9.4 (SAS Institute, Inc). All tests were 2-sided, and p < 0.05 was considered statistically significant. Results Among 338 patients [51% male, 70% aged ≥ 70 years (median age 72.5 years) 84% White], multiple myeloma was the most common cancer type (45%), followed by lymphoma (30%) and leukemia (23%). Overall, 52% (n=177) of patients were considered frail. Just over half of the sample (53%, 179/338) lived in a county with an SVI <0.2, indicating the least social vulnerability. Only 6.5% (22/338) of the patients lived in counties with the highest social vulnerability (SVI score 0.8 to 1.0). Baseline demographics for the overall cohort and according to SVI levels are summarized in Table 1. Significant differences in race and education were seen across SVI levels (both p<0.001). In general, the proportion of patients categorized as frail increased with increasing levels of social vulnerability. These trends for overall SVI (p=0.01), the socioeconomic status (SES) (p=0.005), and the housing & transportation (p=0.048) domains (Figure 1) were statistically significant. As an example, for the overall SVI, the frailty rate was 73% (16/22) for patients residing in the most vulnerable counties (SVI score 0.8 to 1.0) compared to 45% (81/179) for patients residing in counties with the least social vulnerability (SVI score < 0.2). Similar differences were observed for SES (68% vs 47%) and housing & transportation (66% vs 54%). Conclusion Among older adults with hematological malignancies, those residing in areas of high social vulnerability were more likely to be physically frail. These findings suggest that external, contextual factors significantly influence an individual's overall health and highlight the need for further work in this area. Future research should examine community social vulnerability as a risk factor for physical frailty development in adults; information could then be leveraged to identify those at greatest risk for functional losses and frailty onset. Through early identification of this subset of patients, preventative strategies and interventions could be developed, and resources allocated to help those considered most vulnerable. Figure 1 Figure 1. Disclosures Rubinstein: Sanofi: Consultancy; Roche: Consultancy. Wildes: Sanofi: Consultancy; Seattle Genetics: Consultancy; Carevive: Consultancy; Janssen: Consultancy. Tuchman: Caelum: Consultancy, Research Funding; Sanofi / Genzyme: Consultancy, Research Funding; Shattuck Labs: Consultancy; Karyopharm: Research Funding; Oncopeptides: Consultancy.