Background Japan has the highest prevalence of nontuberculous mycobacterial pulmonary disease (NTMPD) globally. While antibiotic treatment is recommended in NTMPD, there is limited data on the appropriate time to initiate treatment. This real-world evidence study examined the impact of timing of NTMPD antibiotic initiation on hospitalizations in Japan. Methods A retrospective claims analysis using the JMDC, Inc database (2015-2022). Patients with NTMPD were divided into early (≤3 months from first diagnosis [index]) and delayed (>3 months from index) antibiotic-initiation groups. All-cause hospitalizations at years 1 and 2 post-index were compared with baseline (12 months pre-index). NTM-related hospitalizations were compared between year 1 and year 2 post-index. Results A total of 229 and 191 patients had early and delayed antibiotic initiation, respectively. The early antibiotic-initiation group had a 38.6% nonsignificant increase in patients with all-cause hospitalizations from baseline at year 1 (P = 0.09), followed by a 45.5% significant decrease from baseline at year 2 (P = 0.01). The delayed antibiotic-initiation group had an 81.1% significant increase in patients with all-cause hospitalizations at year 1 (P < 0.001), and a 35.1% decrease at year 2 (P = 0.07). From years 1 to 2, patients with NTM-related hospitalizations decreased by 75.6% and 65.4% in the early and delayed group, respectively. Conclusions Patients with early antibiotic initiation for NTMPD had lower hospitalization burden over time than patients with delayed initiation. The early treatment group had a smaller increase in all-cause hospitalizations at year 1, larger decrease at year 2, and larger reduction in NTM-related hospitalizations from year 1 to 2.

BACKGROUND:Amikacin liposome inhalation suspension (ALIS) as add-on treatment to a multidrug regimen is the only therapy approved for treatment of adults with refractory Mycobacterium avium complex lung disease (rMACLD). Data on the impact of persistent use of ALIS on patient outcomes may be informative during clinical decision making. We used claims data to examine the association between persistent use of ALIS and healthcare resource use. METHODS:This retrospective study used the Merative® MarketScan Commercial and Medicare Supplemental databases. Patients who initiated ALIS between October 2018 and March 2021, with ≥3 months continuous enrollment before and ≥12 months after index (ie, date of first ALIS prescription) were included. ALIS use was stratified into two groups: persistent ALIS use (≥6 months total supply) and less persistent ALIS use (<6 months total supply) over a 12-month post-index period. Hospitalizations and emergency room (ER) visits between ALIS-use groups were assessed using Kaplan-Meier analysis and multivariate Cox proportional hazards models. RESULTS:In total, 103 ALIS-treated patients were included, with 54 (52.4 %) and 49 (47.6 %) in the persistent and less persistent ALIS-use groups, respectively. Compared with the less persistent ALIS-use group, the persistent ALIS-use group had a lower risk of all-cause (hazard ratio [95 % CI], 0.17 [0.07-0.40], p < 0.0001), respiratory-related (0.16 [0.06-0.40], p < 0.0001), and NTM-related hospitalizations (0.14 [0.05-0.38], p < 0.0001), and ER visits (0.41 [0.18-0.92], p = 0.03), based on multivariate modeling. CONCLUSIONS:Persistent use of ALIS during the first 12 months of treatment was associated with a lower risk of hospitalizations and ER visits. NOTATION OF PRIOR ABSTRACT PUBLICATION/PRESENTATION:Part of this study has been presented at CHEST on October 6-9, 2024, in Boston, MA, USA, and AMCP Nexus on October 14-17, 2024, in Las Vegas, NV, USA.

Background: A plant-based dietary pattern has been recently suggested to have health benefits. However, its relationship with mortality is not completely consistent in prior studies. We aimed to investigate whether a plant-based diet was associated with a lower death risk in a Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening study. Methods: We included 91 414 participants from the PLCO study. Dietary data were collected using a diet history questionnaire (DHQ). We used three plant-based diet indices including an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression model. Results: During a median of 17.1 years of follow-up, we documented 19 456 deaths, including 5489 deaths from cardiovascular disease (CVD) and 6172 deaths from cancer. Comparing the highest versus lowest quintiles of the PDI, the multivariable-adjusted HR of all-cause mortality was 0.83 (95% CI 0.80-0.87, P for trend < 0.001). Those in the highest quintile of the PDI also had lower risks of CVD mortality (HR 0.87, 95% CI 0.80-0.95, P for trend < 0.001) and cancer mortality (HR 0.89, 95% CI 0.82-0.96, P for trend = 0.003) compared to those in the lowest quintile. Participants in the highest quintile of the hPDI had a decreased risk of all-cause and cause-specific mortality, whereas participants with the highest uPDI scores had an increased death risk. Conclusion: Greater adherence to a plant-based dietary pattern was significantly associated with lower all-cause and cause-specific mortality.

BACKGROUND:Managing Mycobacterium avium complex pulmonary disease (MACPD) is challenging for refractory disease. This study used real-world data to describe natural history and burden of refractory MACPD. METHODS:US Bronchiectasis and Nontuberculous Mycobacteria Research Registry data were analyzed retrospectively. Patients treated for MACPD were categorized as refractory (defined as receiving oral clofazimine, bedaquiline, inhaled amikacin, or amikacin liposome inhalation suspension, or remaining culture positive ≥6 months during treatment) or nonrefractory. Patient characteristics and healthcare resource utilization were compared. Longitudinal assessment over adjacent visits (pre-refractory and refractory) focused on hospitalizations and exacerbations among incident refractory cases. RESULTS:Of 1064 patients treated for MACPD, 43.4 % were refractory and 56.6 % nonrefractory. At MACPD treatment initiation, refractory patients had lower mean BMI (21.3 vs 22.2; p < 0.001) and FVC% predicted (78.4 vs 84.8; p < 0.001), more prevalent fibrocavitary/cavitary disease (33.5 % vs 16.3 %; p < 0.001) and bronchiectasis (96.2 % vs 89.7 %; p < 0.001). Exacerbations (54.1 % and 50.5 %), hospitalizations (18.8 % and 17.3 %), chronic cough (78.0 % and 77.7 %), and baseline lung severity were common in both groups. The natural history of the disease among 197 incident refractory cases showed that exacerbations (45.6 % and 39.4 %) and hospitalizations (13.3 % and 12.8 %) were common at pre-refractory and refractory visits. CONCLUSIONS:MACPD imposes substantial burden on patients in terms of symptoms, exacerbations, and hospitalizations. Disease burden was present among refractory patients, at pre-refractory and refractory visits ≥1 year later, and non-refractory patients. Understanding patient characteristics at time of treatment may help timely identification and management of refractory MACPD.

Background and objective Nontuberculous mycobacterial pulmonary disease (NTM-PD) prevalence in Japan is among the highest worldwide. COPD and bronchiectasis are common comorbidities among patients with NTM-PD, and it is challenging to treat NTM-PD in patients with these conditions. There are limited data on the incremental burden that NTM-PD adds to underlying COPD or bronchiectasis in Japan. Therefore, the objective of this study was to assess the incremental burden associated with NTM-PD in patients with pre-existing COPD and/or bronchiectasis. Methods This nested case–control study was based on JMDC, Inc. claims data (2015–2020). Patients with COPD and/or bronchiectasis with NTM-PD (cases) were age and sex matched 1:3 to patients with COPD and/or bronchiectasis without NTM-PD (controls), resulting in three mutually exclusive patient groups (COPD, bronchiectasis or both; with or without NTM-PD). Incremental burden of NTM-PD was assessed within each group by comparing hospitalisations during the 1-year period after NTM-PD diagnosis (index) between cases and controls with both univariate analysis and multivariate analysis adjusting for pre-index comorbidities. Results Univariate analyses in the three patient groups consistently demonstrated incremental hospitalisation burden in cases versus controls ( e.g. COPD group: 20% of 492 cases versus 13% of 1476 controls had all-cause hospitalisations; 11% versus 5% had respiratory-related hospitalisations; and 6% versus 2% had COPD-related hospitalisations). Subsequent multivariate analysis further confirmed the findings. Conclusions The substantial incremental burden of hospitalisation associated with NTM-PD in patients with COPD and/or bronchiectasis highlights the urgent need for appropriate management of NTM-PD in Japan.

BACKGROUND: Nontuberculous mycobacterial lung disease (NTMLD) is a debilitating disease. Chronic obstructive pulmonary disease (COPD) is the leading comorbidity associated with NTMLD in the United States. Their similarities in symptoms and overlapping radiological findings may delay NTMLD diagnosis in patients with COPD. OBJECTIVE: To develop a predictive model that identifies potentially undiagnosed NTMLD among patients with COPD. METHODS: This retrospective cohort study developed a predictive model of NTMLD using US Medicare beneficiary claims data (2006 - 2017). Patients with COPD with NTMLD were matched 1:3 to patients with COPD without NTMLD by age, sex, and year of COPD diagnosis. The predictive model was developed using logistic regression modeling risk factors such as pulmonary symptoms, comorbidities, and health care resource utilization. The final model was based on model fit statistics and clinical inputs. Model performance was evaluated for both discrimination and generalizability with c-statistics and receiver operating characteristic curves. RESULTS: There were 3,756 patients with COPD with NTMLD identified and matched to 11,268 patients with COPD without NTMLD. A higher proportion of patients with COPD with NTMLD, compared with those with COPD without NTMLD, had claims for pulmonary symptoms and conditions, including hemoptysis (12.6% vs 1.4%), cough (63.4% vs 24.7%), dyspnea (72.5% vs 38.2%), pneumonia (59.2% vs 13.4%), chronic bronchitis (40.5% vs 16.3%), emphysema, (36.7% vs 11.1%), and lung cancer (15.7% vs 3.5%). A higher proportion of patients with COPD with NTMLD had pulmonologist and infectious disease (ID) specialist visits than patients with COPD without NTMLD (≥ 1 pulmonologist visit: 81.3% vs 23.6%, respectively; ≥ 1 ID visit: 28.3% vs 4.1%, respectively, P < 0.0001). The final model consists of 10 risk factors (≥ 2 ID specialist visits; ≥ 4 pulmonologist visits; the presence of hemoptysis, cough, emphysema, pneumonia, tuberculosis, lung cancer, or idiopathic interstitial lung disease; and being underweight during a 1-year pre-NTMLD period) predicting NTMLD with high sensitivity and specificity (c-statistic, 0.9). The validation of the model on new testing data demonstrated similar discrimination and showed the model was able to predict NTMLD earlier than the receipt of the first diagnostic claim for NTMLD. CONCLUSIONS: This predictive algorithm uses a set of criteria comprising patterns of health care use, respiratory symptoms, and comorbidities to identify patients with COPD and possibly undiagnosed NTMLD with high sensitivity and specificity. It has potential application in raising timely clinical suspicion of patients with possibly undiagnosed NTMLD, thereby reducing the period of undiagnosed NTMLD. DISCLOSURES: Dr Wang and Dr Hassan are employees of Insmed, Inc. Dr Chatterjee was an employee of Insmed, Inc, at the time of this study. Dr Marras is participating in multicenter clinical trials sponsored by Insmed, Inc, has consulted for RedHill Biopharma, and has received a speaker’s honorarium from AstraZeneca. Dr Allison is an employee of Statistical Horizons, LLC. This study was funded by Insmed Inc.

Background Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with nontuberculous mycobacterial lung disease (NTMLD). Both conditions are associated with increased morbidity and mortality, but data are lacking on the additional burden associated with NTMLD among patients with COPD. Thus, the goal of this study was to assess the incremental mortality risk associated with NTMLD among older adults with COPD. Methods A retrospective cohort study was conducted using the US Medicare claims database (2010–2017). Patients with preexisting COPD and NTMLD (cases) were matched 1:3 by age and sex with patients with COPD without NTMLD (control patients). Patients were followed up until death or data cutoff (December 31, 2017). Incremental risk of mortality was evaluated by comparing the proportions of death, annualized mortality rate, and mortality hazard rate between cases and control patients using both univariate and multivariate analyses adjusting for age, sex, comorbidities, and COPD severity. Results A total of 4,926 cases were matched with 14,778 control patients. In univariate analyses, a higher proportion of cases (vs. control patients) died (41.5% vs. 26.7%; P < 0.0001), unadjusted annual mortality rates were higher among cases (158.5 vs. 86.0 deaths/1000 person-years; P < 0.0001), and time to death was shorter for cases. This increased mortality risk was also reflected in subsequent multivariate analyses. Patients with COPD and NTMLD were more likely to die (odds ratio [95% CI], 1.39 [1.27–1.51]), had higher mortality rates (rate ratio [95% CI], 1.36 [1.28–1.45]), and had higher hazard of death (hazard ratio [95% CI], 1.37 [1.28–1.46]) than control patients. Conclusions The substantial incremental mortality burden associated with NTMLD in patients with COPD highlights the importance of developing interventions targeting this high-risk group and may indicate an unmet need for timely and appropriate management of NTMLD.

We aimed to investigate the association between loneliness and cognitive impairment among older men and women in China. Data for 6898 eligible participants aged 65 years and older were derived from the latest two waves (2008/2009 and 2011/2012) of the Chinese Longitudinal Healthy Longevity Survey. A logistic regression analysis was performed to determine whether the association between loneliness at baseline and the risk of cognitive impairment at follow-up varied by sex, with adjustment for social-demographic variables, social isolation, lifestyles, and health status. The rates of baseline loneliness and follow-up cognitive impairment were both higher among women than men. Loneliness at baseline was significantly associated with cognitive impairment at follow-up among elderly men (OR = 1.30; 95% CI 1.01–1.69), even after adjusting for potential confounding variables; however, a similar association was not observed among elderly women (OR = 0.98; 95% CI 0.81–1.19). Multiple imputations were applied to address missing data. Although elderly women more frequently reported feelings of loneliness, the impact of loneliness on cognitive impairment was significant among elderly men but not elderly women. Interventions designed to decrease the incidence of loneliness may be particularly beneficial for the reduction of cognitive impairment among elderly Chinese men.

This study aimed to examine the association of social engagement (SE) and changes in SE with the risk of dementia among older adults in China. Data were collected from the 2002, 2005, 2008/2009, and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Random-effects logistic regression models were used to examine the association of SE and changes in SE with the risk of dementia. Of the 7511 older Chinese adults aged 65 years and over, 338 developed dementia during the 9-year follow-up. SE was associated with dementia risk after adjusting for sociodemographic characteristics, lifestyles and health status (odds ratio ( OR ) = 0.71, 95% confidence interval ( CI ) = 0.63–0.81). Participants with consistently high or increased SE had a lower risk of dementia than those with consistently low SE (( OR = 0.14, 95% CI = 0.06–0.28 and OR = 0.33, 95% CI = 0.23–0.48, respectively). Higher SE can reduce the risk of dementia. Furthermore, consistently high or increasing SE is associated with a lower risk of dementia.

Objective: The objective of this study was to examine whether loneliness was associated with the risk of developing dementia in Chinese older adults and whether the association was moderated by gender.Method: A 3-year cohort study was conducted using data from the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression was used to analyze the relationship between loneliness and dementia. The interaction between loneliness and gender was also evaluated.Results: At 3-year follow-up, 393 of the 7867 participants had dementia. Loneliness was associated with dementia (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11-1.56) after adjustment for sociodemographic characteristics, lifestyle, and baseline health status. A significant interaction between loneliness and gender was also found (OR = 0.81, 95% CI = 0.65-0.99).Conclusion: Loneliness increased the risk of developing dementia among people aged 65years and older in China. Moreover, the effect of loneliness on dementia risk varied by gender. Specifically, men who felt lonely were more likely to suffer from dementia than women.

The study compared rates of hospitalization between treatment groups in patients with nontuberculous mycobacterial lung disease (NTMLD) in a US national managed care claims database. Patient (N = 1039) pharmacy claims at year 1 following NTMLD diagnosis were classified into 3 treatment groups including triple combo (macrolide + ethambutol + rifamycin ± other drugs) (G1), other antibiotics used by physicians for NTMLD (G2), and no treatment (G3). Hospitalization rates at year 2 were compared between treatment groups using mixed effects logistic regression to adjust for patient characteristics and comorbidities measured by Charlson Comorbidity Index (CCI) during the 12 months prior to NTMLD diagnosis (baseline). Mean age was 66, 66 and 73 years with 65%, 70% and 66% women in G1 (n = 353), G2 (n = 388) and G3 (n = 298) respectively. At baseline, there was no difference on CCI (CCI≈2) between treatment groups. However, comorbidity distribution differed prominently in asthma (22.1%, 26.3% and 11.4%), arrhythmia (19.3%, 19.3% and 27.2%), cystic fibrosis (0.8%, 4.6% and 0%), immune disorder (7.6%, 9% and 2.7%), pneumonia (49.0%, 41.8% and 32.6%), and tuberculosis (9.3%, 8.2% and 5.4%), and in immunosuppressant use (51%, 51.5% and 25.2%). Baseline hospitalization was 31.7% in G1, 33.0% in G2, and 25.8% in G3. At year 2, CCI stayed almost unchanged from the baseline scores (1.9 in G1, 2.0 in G2, and 1.9 in G3). Unadjusted hospitalization rates were 19.6%, 27.8% vs 20.8%, and adjusted rates were 44.5%, 56.1% and 47.8% in 3 groups respectively (Figure). G2 had a 60% increase in risk of hospitalization after adjustment (odds ratio (OR)=1.60, 95% CI: 1.11–2.29, P = 0.01) compared with G1 but no statistically significant difference compared with G3 (OR=1.40, P = 0.08). Cerebrovascular disease (OR=1.8, P < 0.02), COPD (OR=1.60, P < 0.01), cystic fibrosis (OR=5.85, P < 0.01), depression (OR=1.64, P < 0.05), and other lung disease (OR=1.42, P < 0.05) were associated with a higher risk of hospitalization at year 2 after NTMLD diagnosis. We observed a lower hospitalization rate in NTMLD patients receiving antibiotics that were concordant with first line ATS/IDSA guidelines recommendations in comparison with those who used other antibiotic regimens. E. Chou, Insmed Incorporated: Employee, Salary; G. Eagle, Insmed Incorporated: Employee, Salary; R. Zhang, Insmed Incorporated: Consultant, Consulting fee; P. Wang, Insmed Incorporated: Employee, Salary; Q. Zhang, Insmed Incorporated: Employee, Salary

文化是人群共同体在适应环境以获得生存和发展的一种机制和制度安排.一个族群的文化变迁既有客观现实因素,也有主观心理因素;既有面对现实生存环境压力的被动性适应变迁,也有为了追求族群自我的生存和发展的主动性适应变迁.文化随着一个族群客观生存环境和生存策略的变化而变化,人们在不同的自然社会文化环境中为获得自身的生存和发展做出适应环境的文化理性选择,而且这种文化的理性选择建立在追求生存和发展的实践理性基础上.在生存和发展实践过程中,人们会随着历史发展环境和社会文化环境的变化被动或主动地做出相应的文化心理和社会文化的调适与重构,理性的选择适应自身生存环境的生活方式和发展方式,于此同时,人们也会理性的选择适应自身生存环境的文化模式.故此,民族文化变迁是建立在民族社会历史与现实发展的实践基础之上的,一个民族的文化理性是建立在实践理性之上,文化理性随着实践理性的变化而变化.

由中国人类学学会主办,厦门大学人类学与民族学系承办的“中国人类学学会2015年学术研讨会”2015年12月18-19日在厦门召开.本次学术研讨会的主题为“全球化中的中国人类学”.来自中国社会科学院、中央民族大学、清华大学、复旦大学、浙江大学、中山大学、厦门大学、上海交通大学、南京大学、武汉大学、重庆大学、西南大学、华中科技大学、中南民族大学、西南民族大学、广西民族大学、广西师范大学、云南大学、云南民族大学、吉首大学、西藏民族大学、内蒙古师范大学、福建师范大学、香港中文大学、泰国清莱皇家大学等40所大学、科研机构及政府部门的100多位专家学者参加会议.

With the start of ecological conservation and construction project for the three‐river fountainhead from 2005 ,domestic academe carry on a deep research into the ecological immigration in the three‐river fountainhead area and have achieved great successes ,but there are still many deficien‐cies and blankness .With the development of the society ,many new situations ,new circumstances and new issues are emerging in the question of immigration in the area of the three‐river fountainhead . Therefore ,how to adapt to the new realistic needs ,express the advantages of multi‐disciplinary ,wid‐en study visions and overcome flaws in the study has a great significance for the ecological immigration in the area of the three‐river fountainhead .

民族地区新型城镇化建设和大力发展民族特色文化产业是促进民族地区发展的两大动力,两者之间存在着互动互补的关系.大力发展民族地区文化产业是调整民族地区经济发展结构、促进民族地区经济建设和文化建设、建设具有少数民族特色城镇的一条重要渠道.民族文化产业的发展要遵循民族特色文化传承与保护和民族地区社会经济文化与生态全面发展相结合的原则.采取一系列有利于民族文化产业发展的措施,使民族地区文化产业在民族地区新型城镇化过程中获得持续健康的发展,并为民族地区新型城镇化建设做出贡献.

在民族地区实现新型城镇化的过程中,需要探究具有少数民族特色的新型城镇化路径和模式.这种路径和模式不是单一的,而是多元的,它是在保护和传承少数民族特色文化的基础上,整合一切有利于民族地区新型城镇化建设的有效资源,并在全面贯彻经济建设、政治建设、文化建设、社会建设和生态文明建设五位一体的总体布局基础上建设民族地区新型城镇.本文以甘肃省临夏市为例对此进行了研究.

花儿是西北汉族、藏族、回族、东乡族、保安族、撒拉族、土族、裕固族、蒙古族等多个少数民族群众,在特定的自然地域生态文化空间中,表达个人和群体心理情感及社会生活状态的一种跨越民族文化的民间传统文化艺术行为和活动.它表达着各民族群众的一种生活方式和一种生活状态,以唱与听的交流方式传达与沟通自我心灵的呼唤及意识互动体验,是西北各族群众生产生活方式的艺术表达,是各族群众交流互动和多元共存的一种艺术表达方式.

本文基于第五次和第六次人口普查数据,以平均受教育年限这个总体指标对我国18个百万人口以上的少数民族的受教育程度进行了多方面的分析;并计算教育基尼系数来衡量各民族教育公平程度,用数据呈现了少数民族的教育发展和教育公平.最后分析了受教育程度对教育公平的影响,说明了发展民族教育事业的重要性.