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Background Globally, increasing numbers of adolescents use digital devices for learning, and this educational screen exposure may alter behavioral patterns and be associated with the rising prevalence of adolescent overweight. Limited research has examined the interrelationships among educational screen exposure, adolescent overweight, physical activity, and sleep quality. This study aims to assess the impact of educational screen exposure on adolescent overweight prevalence and to identify related mediating risk behaviors. Methods Data on 41,157 adolescents from 16 cities in China were from the Database of Youth Health. Body mass and height were measured to estimate body mass index. Physical activity and sleep quality data were collected using a self-administered questionnaire. We drew data from two waves (2015 and 2017) of adolescent health surveys, which coincided with China’s online education policy since 2015. The implementation of this policy resulted in a substantial increase in adolescents’ educational screen exposure, with the intensity of the policy implementation influenced by local Internet infrastructure. We allocated adolescents into exposure and control groups based on the local Internet penetration rate. Leveraging this policy-driven natural experiment, a difference-in-differences approach was then applied to compare changes in overweight prevalence, physical activity, and sleep quality before and after the policy implementation between these two groups. Results The increase in overweight prevalence of adolescents in the exposure group from 2015 to 2017 was 3.1% greater than those in the control group (Coef. 0.03, 95% CI: 0.01 to 0.05, p  < 0.01). The exposure group showed significant reductions in physical activity frequency (Coef. -0.49, 95% CI: -0.52 to -0.45) and sleep quality (Coef. -0.06, 95% CI: -0.09 to -0.02). Mediation analyses suggested that reduced physical activity and sleep quality were plausible mediating variables linking educational screen exposure and overweight prevalence. Male adolescents experienced a greater increase in overweight associated with educational screen exposure compared to their peers (Coef. 0.026, 95% CI: 0.01 to 0.04). Conclusions Educational screen exposure may contribute to increased overweight in adolescents by reducing physical exercise and impairing sleep quality. Educators, guardians, and policymakers should consider effective measures to minimize the adverse impacts of educational screen exposure by promoting physical activities among adolescents.

Abstract Rationale Higher indoor particulate matter (PM) concentrations are linked with increased asthma morbidity. Dietary intake of fatty acids, also linked with asthma outcomes, may influence this relationship. Objectives To determine the relationship between omega-3 and omega-6 fatty acid intake and pediatric asthma morbidity, and the association between fatty acid intake and strength of indoor, PM-related asthma symptoms, albuterol use, and systemic inflammation. Methods Analyses included 135 children with asthma enrolled in the AsthmaDIET Study. At baseline, 3 months, and 6 months, data included: week-long average home indoor concentration of PM ≤2.5 μm in aerodynamic diameter and PM ≤10 μm in aerodynamic diameter, dietary intake of omega-3 and omega-6 fatty acids, daily symptoms, and peripheral blood leukocytes. Asthma severity and lung function were assessed at baseline. Multivariable regression models, adjusted for known confounders, were used to determine associations between each fatty acid and outcomes of interest, with interaction terms (fatty acids × PM) in longitudinal analyses. Measurements and Main Results Higher omega-6 intake associated with increased odds of increased asthma severity (P = 0.02), and lower FEV1/FVC ratio (P = 0.01). Higher omega-3 intake associated with reduced effect of indoor PM ≤2.5 μm in aerodynamic diameter on symptoms (P < 0.01), whereas higher omega-6 intake associated with amplified effect of indoor PM ≤2.5 μm in aerodynamic diameter on symptoms and circulating neutrophil percentage (P < 0.01). Conclusions Omega-3 and omega-6 intake are associated with pediatric asthma morbidity and may modify the asthmatic response to indoor PM.

The role of sphingolipid metabolism (SM) dysregulation in promoting bladder cancer (BLCA) progression and influencing patient prognosis has been well documented. To enhance therapeutic strategies, we aimed to identify key sphingolipid metabolism–related genes (SMGs) and develop a prognostic signature for personalized BLCA management. In this study, 430 BLCA samples from The Cancer Genome Atlas (TCGA) were analyzed via univariate Cox regression to screen critical SMGs involved in tumor progression. A LASSO regression model was applied to minimize overfitting, followed by multivariable Cox regression to construct and validate a SMG‐based prognostic signature in an independent cohort. Key findings revealed that SM dysregulation correlated with poor clinical outcomes and eight pivotal prognostic genes (ATP13A2, PCSK2, NR2F1, GSDMB, NFASC, NTF3, LGALS4, and SREBF1) were identified. The resulting risk model demonstrated robust prognostic performance with AUC values of 0.772 (training cohort) and 0.725 (validation cohort). Notably, high‐risk patients exhibited a highly active immunological profile characterized by elevated immune scores and enhanced functionality across 26 immune components, including increased infiltration of NK cells, CD8 + T cells, and elevated cytolytic activity. These results suggest that SM dysregulation may drive immunomodulatory changes in BLCA microenvironments, offering mechanistic insights into tumor immune evasion. This study provides a novel biomarker tool for risk stratification and highlights SM pathways as potential therapeutic targets for BLCA patients with immune microenvironment dysregulation.

To examine the relationship between Hemoglobin A1c (HbA1c) and asthma outcomes in an urban cohort of children with asthma. The AIRWEIGHS Study was a randomized controlled clinical trial of an air cleaner intervention testing the hypothesis that overweight/obese children would experience greater improvement in asthma control compared to normal weight children. The study enrolled 164 children with asthma from Baltimore, MD and assessed HbA1c levels and asthma outcomes during clinic visits at baseline and three months. HbA1c levels were analyzed as a continuous measure and categorized as either normal (<5.7%) or consistent with pre-diabetes (≥5.7%). Asthma outcomes included standardized questionnaires, spirometry, and fractional exhaled nitric oxide (FeNO). Generalized Estimating Equation (GEE) regression models were used to analyze the association between the HbA1c and asthma outcomes. Participants included 164 children with an average age of 11 (± 2) years, predominately African American (85%), male (59%), moderate or severe asthma by NAEPP criteria (59%), households with an income below $34,999 (60%), publicly insured (83%), and overweight/obese (61%). 52 participants were excluded from the analysis due to unsuccessful blood draws or participant refusal. Twenty of 112 distinct participants (18%) had HbA1c measurements ≥5.7%, consistent with prediabetes. Increased HbA1c levels were associated with worse asthma control as indicated by an increase in the Asthma Therapy Assessment Questionnaire (β-0.74 p<0.05). In the interaction analysis, BMI percentile had a significant interaction with HbA1c such that HbA1c had a stronger association with maximum symptoms days and exacerbation risk among children with lower versus higher BMI percentile values. Higher HbA1c levels were associated with worse asthma control among children with asthma, adding to evidence that metabolic dysfunction may influence asthma morbidity. Additionally, HbA1c could have a stronger influence among non-obese children with underlying metabolic dysfunction, suggesting the need for future studies to investigate metabolic pathways in asthma.

Background Metformin is associated with improved respiratory outcomes in asthma; however, metformin in COPD and asthma-COPD overlap (ACO) remains unexplored. Objective To determine the association between metformin use and respiratory outcomes in COPD and ACO. Study design and methods Participants with COPD (FEV1/FVC < 0.70) in the Genetic Epidemiology of COPD study (COPDGene®) were categorized as ACO (n = 510), defined as concurrent physician-diagnosed asthma before age 40 years, or COPD alone (n = 3459). We estimated the association of baseline metformin use with (1) rate of total and severe respiratory exacerbations during follow-up, (2) cross-sectional St. George’s Respiratory Questionnaire (SGRQ) score, six-minute walk distance (6MWD), and post-bronchodilator FEV1 percent predicted (FEV1pp), and (3) 5-year change in SGRQ, 6MWD, and FEV1pp. We also examined change in SGRQ, 6MWD and FEV1pp among participants who initiated metformin during follow-up (n = 108) compared to persistent metformin non-users (n = 2080). Analyses were adjusted for sociodemographic factors, medications, and comorbidities. Results Among participants with ACO, metformin use was associated with lower rate of total (adjusted incidence rate ratio [aIRR] 0.3; 95% confidence interval [95%CI] 0.11, 0.77) and severe exacerbations (aIRR 0.29; 95%CI 0.10, 0.89). Among participants with COPD alone, there was no association between metformin use with total (aIRR 0.98; 95%CI 0.62, 1.5) or severe exacerbations (aIRR 1.3; 95% CI 0.68, 2.4) (p-interaction < 0.05). Metformin use was associated with lower baseline SGRQ score (adjusted mean difference [aMD] − 2.7; 95%CI − 5.3, − 0.2) overall. Metformin initiation was associated with improved SGRQ score (aMD –10.0; 95% CI − 18.7, − 1.2) among participants with ACO but not COPD alone (p-interaction < 0.05). There was no association between metformin use and 6MWD or FEV1pp in any comparison. Conclusions Metformin use was associated with fewer respiratory exacerbations and improved quality of life among individuals with ACO but not COPD alone. Results suggest a potential role for metformin in ACO which requires further prospective study. Trial Registry: NCT00608764

This study evaluated risk factors of sarcoidosis among Airborne Hazards and Open Burn Pit Registry (AHOBPR) participants using a retrospective age and sex-matched case–control design of AHOBPR participants deployed to Afghanistan or Southwest Asia with and without sarcoidosis diagnosed in the Veterans Health Administration (VHA). Logistic regression models tested for associations between sarcoidosis and self-reported cumulative deployment-related exposures. 661 Veterans (0.37%) were diagnosed with sarcoidosis in VHA. Logistic regression demonstrated lower odds of sarcoidosis in Hispanic participants (OR 0.08, CI 0.04–0.15) and those who served in the Navy (OR 0.40, CI 0.21–0.72). African American veterans (OR 2.27, CI 1.66–3.11) and former smokers (OR 1.87, CI 1.33–2.62) were at elevated risk. Of the exposure variables, convoy activities had the highest odds of being associated with sarcoidosis and was marginally statistically significant (OR 1.16, CI 1.00–1.35). Sarcoidosis was an uncommon diagnosis among AHOBPR participants and was associated with only one of eight assessed cumulative deployment-related exposures.

Objectives/Goals: Discharges before medically advised (BMA) – also known as “against medical advice” – after an asthma exacerbation are associated with adverse outcomes, including recurrent hospitalization, but the reasons for this are unclear. We sought to evaluate whether gaps in prescribing maintenance inhalers were associated with recurrent hospitalization. Methods/Study Population: All asthma exacerbations, defined by ICD-10 codes, among adults requiring an emergency department (ED) visit or hospitalization at any of 5 hospitals in our health system were classified as BMA or non-BMA (i.e., planned) discharges using EHR data. We evaluated whether an inhaled corticosteroid and long-acting beta-agonist (ICS/LABA) inhaler was prescribed on discharge, and whether they had a recurrent exacerbation within 30 days. We used logistic regression models adjusted for age, sex, exacerbation history, medical center, encounter type (ED or admission), BiPAP use, insurance, prior ICS/LABA prescription to evaluate risk of 30-day re-exacerbation by ICS/LABA prescription, BMA discharge, and the interaction between those variables. Results/Anticipated Results: This cohort included 13,064 exacerbations, and 330 (2.5%) resulted in BMA discharge. Compared to non-BMA discharges, those discharging BMA were younger (40 vs 43 years) and less often female (48% vs 64%). Those discharging BMA were less likely to receive an ICS/LABA prescription (16% vs 23%, p=0.01) and more likely to experience 30-day re-exacerbation (12% vs 7%, p=0.001). In adjusted analyses, BMA discharge increased the risk of 30-day re-exacerbation (OR 1.79, 95% CI: 1.22-2.64) and ICS/LABA prescription was protective (OR 0.79, 95% CI: 0.65-0.96). There was a significant interaction (OR for interaction: 0.11, 95% CI 0.01-0.85), indicating a stronger protective association of ICS/LABA among those discharging BMA. Discussion/Significance of Impact: Prescribing an ICS/LABA at discharge protects against recurrent severe asthma exacerbations within 30 days. This association is strongest among those discharging BMA, highlighting this susceptible population as requiring further attention to address gaps in care.

Insufficient research exists on the impact of reputation in online health-care market communities, especially from the multilevel and cross-level perspectives. Based on prior research on individual and organizational reputation, we hypothesize multilevel and cross-level reputation determinants of physicians' performance in online health-care market communities. Using hierarchical linear modeling, we analyzed the data of 47,182 physicians from 660 hospitals in a Chinese online health-care market community to test our hypotheses. Our results suggest that the number of physicians' appointments is positively associated with their individual offline and online reputations, as well as the offline and online reputation of the hospital in which the physicians work. We also find that organizational reputation moderates the relationship between an individual's reputation and a physician's performance, in such a way that the hospital's offline reputation increases the importance of physicians' online reputation in promoting the number of physicians' appointments. However, the hospital's online reputation enhances the relationship between physicians' offline reputation and the number of appointments. Our study contributes to existing theories of reputation and the signaling theory, and also provides physicians with guidelines that support them in effectively improving their performance.