2-year Study Research Articles

Bone density changes in young women in Uganda using tenofovir-based HIV pre-exposure prophylaxis and depot medroxyprogesterone acetate contraception

Background: Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV pre-exposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in BMD beyond those elicited by either product singly. Methods: From 2018–2022, we conducted a 2-year prospective study with women ages 16–25 years in Kampala, Uganda desiring pregnancy and HIV prevention. Women were provided condoms, injectable DMPA, and/or FTC/TDF, according to their choices and underwent annual dual x-ray absorptiometry (DXA) scans. We used tenofovir-diphosphate (TFV-DP) quantification in dried blood spots and DMPA injection dates to classify exposure. Linear regression models estimated the difference in % BMD change from baseline to month 12 for women using FTC/TDF and DMPA versus women using neither product. Results: Of 499 enrolled women, discontinuation and re-starting of contraception and PrEP was common. Women consistently using neither product (n = 39) experienced BMD increases. Women with consistent use of both products during 1 year (n = 22) experienced an average BMD loss of 1.04% at lumbar spine and hip and 1.77% at femoral neck. These losses were different relative to women who used neither agent: lumbar spine -3.35% (95% CI −5.13%, −1.56%, p = 0.001), total hip −2.24% (95% CI −3.87%, −0.60%, p = 0.009), and femoral neck −1.71% (95% CI −3.73%, 0.31%, p = 0.102). Conclusion: We observed a trend for women with concurrent DMPA and FTC/TDF PrEP use to have 1–3% lower BMD than unexposed women after 12 months.

Epidemiology and regional variance of traumatic peripheral nerve injuries in Sweden: A 15-year observational study.

Traumatic peripheral nerve injuries pose significant challenges to healthcare systems and individuals, affecting sensory function, causing neuropathic pain, and impairing quality of life. Despite their impact, comprehensive studies on the epidemiology and regional variance of these injuries are scarce. Understanding the incidence, trends, and anatomical distribution of such injuries is essential for targeted interventions and resource allocation. This observational study utilized register-based data from the Swedish National Patient Register covering the period from 2008 to 2022. Incidence rates, trends, and anatomical distribution of traumatic peripheral nerve injuries were analyzed using descriptive statistics, Poisson regression modeling, and regional comparisons. Higher incidences of peripheral nerve injuries were observed among men compared to women across all age groups. The hand and wrist were the most commonly affected sites. Regional variations in incidence rates were evident, with some regions consistently exhibiting higher rates compared to others. Notably, a decreasing trend in injuries was observed over the study period. This study underscores the importance of targeted interventions and preventive strategies, considering sex, age, and regional disparities. Further research incorporating individual patient-level data is warranted to enhance our understanding and inform tailored interventions to reduce the burden of these injuries.

Frequency of adult amphibian abnormalities and consequences for fitness-related traits in an uncontaminated environment

Morphological abnormalities in amphibians are commonly associated with anthropogenic activity, although little baseline information on the prevalence of abnormalities in uncontaminated environments exist. Here, we leverage a 12-year study of spotted salamanders (Ambystoma maculatum Shaw, 1802) in an uncontaminated ecosystem in Algonquin Provincial Park, Canada, to estimate abnormality rates and explore how abnormalities affect fitness-related traits. Annual abnormality rates estimated from drift fence data, ranged from 4.3% to 5.8% of individuals sampled. Abnormality rates from aquatic trapping between 2008–2019 varied from 1.2% to 16.7%, where temporal increases in abnormality rate were observed. We also performed a targeted but systematic literature survey and found that Caudata exhibited a slightly higher abnormality prevalence than Anura, and that the baseline frequency of abnormalities described at our drift fence site is slightly lower than rates reported in the literature (8.1%, 95% CI, 4.76–13.3%). Salamanders with abnormalities exhibited a slightly, but not significantly, higher body condition and a significantly earlier arrival date at the breeding site, both of which are traits typically associated with high-fitness individuals. Our study suggests that abnormalities have detectable phenotypic consequences and underlines the need for temporal sampling efforts to provide ranges of baseline abnormality rates, rather than a point estimate.

Socioeconomic inequities in alcohol-attributable mortality by sex/gender and age in Canada: A 13-year population-representative cohort study.

Individuals with low socioeconomic position (SEP) experience greater rates of alcohol-attributable mortality, contributing to health inequities in mortality and life expectancy. We examined the association between SEP and alcohol-attributable mortality by sex/gender and age in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (ages 12+; n=5,038,790) were linked to mortality data from 2006-2019. SEP was measured by educational attainment and household income. Poisson and Fine and Gray sub-distribution hazard models estimated rate differences (RD) per 100,000 person-years and hazard ratios (HR). Both educational attainment and household income were inversely associated with alcohol-attributable mortality. Absolute SEP inequities were greater among men than women, with a RD of 30.81 (95% CI: 28.04, 33.57) for men and 9.86 (95% CI: 8.49, 11.22) for women when comparing the lowest to the highest income quintile. Age-stratified analyses showed absolute SEP inequities were most pronounced in middle and older adulthood, above age 30 for women and age 50 for men, with smaller RDs in ages 12-29. Relative SEP inequities were similar in women and men, with greater HRs at younger ages. Public health policies addressing social determinants and population-level alcohol policies should consider patterning of SEP inequities by sex/gender and age group.

Predictive model for the risk of paediatric intensive care utilization in children with medical complexity: A longitudinal retrospective cohort study.

Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long-term health care needs and hospital readmissions. Beyond clinical factors, socio-demographic determinants could impact utilization of acute services. To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU). A 6-year longitudinal retrospective cohort study evaluated clinical, socio-demographic and health care utilization. A total of 248 CMC were included, with a median age of 13 years (9.75-17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34-1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54-2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55-0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors. Socio-demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio-economic factors may prevent PICU admissions. This study highlights the importance of integrating individualized assessments of socio-demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care.

How humanized birth practice became an experience connected to neoliberal philosophy

Humanized childbirth is a practice that began to be disseminated in Brazil about 20 years ago, seeking to promote natural birth, reduce unnecessary clinical interventions, and establish a more human model of childbirth. Although humanized childbirth in Brazil is an act of rescuing women’s autonomy and an act of resistance against the technological and capitalist perspective of birth, this philosophy harbors tensions and contradictions involving women as consumers, showing connections to a neoliberal idea of consumer empowerment. Considering this scenario, the present research intends to explore how the diffusion of the humanized birth practice was co-opted by the neoliberal philosophy. Conducting a 2-year netnographic study, we observe and analyze online traits on Instagram and YouTube about humanized childbirth. We shed light on social media as an important mechanism in facilitating practice engagement and practice reproduction, by presenting a framework about the practice diffusion process.

Incidence and predictors of unplanned 30-day hospital readmissions among heart failure patients in Ethiopia: a 5-year retrospective cohort study

The burden of heart failure increases over time and is a leading cause of unplanned readmissions worldwide. In addition, its impact has doubled in countries with limited health resources, including Ethiopia. Identifying and preventing the possible contributing factors is crucial to reducing unplanned hospital readmissions and improving clinical outcomes. The study aimed to assess the incidence and predictors of 30-day unplanned readmission among heart failure patients at selected South Wollo general hospitals in 2022. A hospital-based retrospective cohort study design was employed from January 1, 2016, to December 30, 2020. The data was collected from 572 randomly selected medical records using data extraction checklists. Data were entered in Epi-Data version 4.6 and analyzed with Stata version 17. The Kaplan–Meier and log-rank tests were used to estimate and compare the survival failure time. A Cox proportional hazard analysis was used to identify the predictors of readmission. The statistical significance level was declared at a p-value < 0.05 with an adjusted odds ratio and a 95% confidence interval. A total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. Among the study participants, 302 (52.8%) were male, and 370 (64.7%) were rural residents. The mean age was 45.8 ± 14.1 SD years. In the multivariate Cox proportional hazards analysis being an age (> 65 years) (AHR: 3.172, 95% CI:.21, 4.55, P = 0.001), rural in residency (AHR: 2.47, 95%CI: 1.44, 4.24, P = 0.001), Asthma or Chronic Obstructive Pulmonary Disease (AHR: 1.62, 95% CI: 1.11, 2.35, P = 0.012), HIV/AIDS (AHR: 1.84, 95%CI: 1.24, 2.75, P = 0.003), Haemoglobin level 8–10.9 g/dL (AHR: 6.20, 95% CI: 3.74, 10.28, P = 0.001), and Mean platelet volume > 9.1 fl (AHR: 2.08, 95% CI: 1.27, 3.40, P = 0.004) were identified as independent predictors of unplanned hospital readmission. The incidence of unplanned hospital readmission was relatively high among heart failure patients. Elderly patients, rural residency, comorbidity, a higher mean platelet volume, and a low hemoglobin level were independent predictors of readmission. Working on these factors will help reduce the hazards of unplanned hospital readmission.

Causal Inference Over a Subpopulation: The Effect of Malaria Vaccine in Women During Pregnancy.

Preventing malaria during pregnancy is of critical importance, yet there are no approved malaria vaccines for pregnant women due to lack of efficacy results within this population. Conducting a randomized trial in pregnant women throughout the entire duration of pregnancy is impractical. Instead, a randomized trial was conducted among women of childbearing potential (WOCBP), and some participants became pregnant during the 2-year study. We explore a statistical method for estimating vaccine effect within the target subpopulation-women who can naturally become pregnant, namely, women who can become pregnant under a placebo condition-within the causal inference framework. Two vaccine effect estimators are employed to effectively utilize baseline characteristics and account for the fact that certain baseline characteristics were only available from pregnant participants. The first estimator considers all participants but can only utilize baseline variables collected from the entire participant pool. In contrast, the second estimator, which includes only pregnant participants, utilizes all available baseline information. Both estimators are evaluated numerically through simulation studies and applied to the WOCBP trial to assess vaccine effect against pregnancy malaria.

Napsin-A Immunohistochemistry in the Diagnosis of Pulmonary Alveolar Proteinosis.

The diagnosis of pulmonary alveolar proteinosis (PAP) relies on a limited set of stains, namely hematoxylin-eosin and periodic acid-Schiff-diastase (PAS-D), demonstrating abundant alveolar material representing mostly surfactant. As cells harboring surfactant also express Napsin-A (pneumocytes and macrophages), we hypothesized that it would also be expressed within alveoli in PAP. To evaluate the sensitivity and specificity of Napsin-A in the diagnosis of PAP. A 12-year retrospective case control study was designed to identify cases of PAP and potential histologic mimics (intra-alveolar fibrin, pulmonary edema, diffuse alveolar damage, and alveolar mucinosis). PAS-D staining and Napsin-A immunohistochemistry were performed. Distribution and intensity were evaluated by using a semiquantitative 3-point scale. Positivity was defined as 2+ intensity score, regardless of distribution. Eleven cases of PAP and 46 control cases were identified. Napsin-A showed positivity in all PAP cases and 3 of 12 cases of edema. Among positive cases, all those with a 2+ distribution were PAP cases, with heterogeneous (1+) staining in all cases of edema. PAS-D showed positivity in all cases of PAP and most controls, except cases of edema. Sensitivity and specificity of Napsin-A for PAP were 100% and 94%, respectively, and of PAS-D for PAP, 100% and 21%, respectively. Double positivity for Napsin-A and PAS-D was 100% specific and sensitive for PAP. This study is the first to demonstrate that Napsin-A is highly specific for the diagnosis of PAP, more so than PAS-D. It also shows that the combined positivity of Napsin-A and PAS-D is 100% specific and sensitive for PAP.

Routine single-incision laparoscopic common bile duct exploration with concomitant cholecystectomy for elderly patients: a 6-year retrospective comparative study.

While single-incision laparoscopic cholecystectomy (SILC) has gained more popularity in recent years, its application to elderly patients needs further evaluation. Few SILC studies regarded this rapidly growing vulnerable population, and single-incision laparoscopic common bile duct exploration (SILCBDE) was never mentioned. We conducted an observational study of 146 routine SILCBDE to address this issue. One hundred forty-six consecutive patients underwent SILCBDE with concomitant cholecystectomies during a period of 6 years (July 2012-June 2016 and July 2018-July 2020). Forty patients with an age of 65years or older were the study target. Characteristics and operative outcomes were compared with the remaining 106 younger patients by retrospective chart review. The primary outcomes include complications and mortality, while the secondary outcomes contain intraoperative blood loss, operative time, procedural conversions, postoperative length of hospital stay, and bile duct stone recurrence. There was no mortality. The bile duct stone clearance rate was 98.6%. The elderly group had higher American Society of Anesthesiologists (ASA) scores, higher comorbidity rate, higher acute cholangitis rate, lower completion intraoperative cholangiography (IOC) rate, longer operative time, more blood loss, longer postoperative hospital stay (p < .001), longer total hospital stay (p < .001), higher procedural conversion rate (p < .05), higher complication rate (p < .001), and the exclusive open conversion (2.5%). The difference in complications derived from Clavien-Dindo grade I. Routine SILCBDE with concomitant cholecystectomy by experienced surgeons is safe and efficacious for elderly patients as for younger patients. Randomized controlled trials are anticipated.

Emergency of oral haemorrhage: Retrospective study over 2 years.

Oral haemorrhages (OH) represent a relatively rare reason for an emergency consultation, among dental pain, infectious processes and traumas. Various haemorrhagic risk factors are described, particularly those related to a general medical context or local factors. It is common to associate OH with haemorrhagic risk patients. Current studies mainly focus on patients considered at risk, but there is limited data on the characteristics of OH in patients without known haemorrhagic risk. We conducted a 2-year retrospective study in a dental emergency department to identify OH occurring in patients without known haemorrhagic risk and to study their characteristics. OH accounted for approximately 2% of the reasons for consultation among all consultations carried out for dental emergencies. Their frequency was similar in the population of patients without hemorrhagic risk and those with a confirmed risk. They mainly occurred in young patients, without medical history. They also led to the diagnosis of an underlying pathology in about 1% of cases. This study underscores the importance of accurately documenting patients' medical history during preoperative consultations, as well as identifying associated risk factors. It also highlights that OH can be an early sign of a systemic disorder.

Characterization of infectious bacterial keratitis in Östergötland County, Sweden: a 10-year retrospective study.

The aim of this study was to characterize bacterial species, aetiology and antibiotic susceptibility connected to bacterial keratitis infections in Östergötland, Sweden. Retrospective cross-sectional study based on electronic health records for the period 2010-2019. Records of patients diagnosed with infectious keratitis were screened for microbiology confirmed infectious bacterial keratitis. Bacterial species and their susceptibility to antibiotics were determined from microbiology test results. One-hundred and ninety patients with lab culture-confirmed infectious bacterial keratitis were included in the analysis. The most frequently found bacterial species were coagulase-negative staphylococci (39%), Staphylococcus aureus (17%) and Cutibacterium acnes (10%). Pseudomonas spp. was the most frequently found Gram-negative bacterial species (7%). Contact lens wear and severely ill/blind eye were the top two aetiologies associated with bacterial keratitis, 22% of the patients with bacterial keratitis were also diagnosed with glaucoma. Most isolates, 157 out of 173, were susceptible to fluoroquinolones, and 145 out of 155 isolates were susceptible to chloramphenicol. Our results revealed a positive rate of bacterial keratitis of 59% for the samples sent to the laboratory. There was a high susceptibility of the bacterial species to the recommended antibiotics. Our results indicate that it is likely that patients are receiving the correct treatment. Future studies are necessary to monitor changes in antibiotic susceptibility.

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study

BackgroundImmediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets.MethodsWe included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05.ResultsAll implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26–1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39–1.47 mm in groups I and N, respectively.ConclusionWithin the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession.Trial registrationThe protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Associations between clinical data, vaccination status, antibody responses, and post-COVID-19 symptoms in Thais infected with SARS-CoV-2 Delta and Omicron variants: a 1-year follow-up study

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), led to a global pandemic from 2020. In Thailand, five waves of outbreaks were recorded, with the fourth and fifth waves driven by the Delta and Omicron variants, resulting in over 20,000 new confirmed cases daily at their peaks.MethodsThis cross-sectional study investigated the associations between clinical symptoms, vaccination status, antibody responses, and post-COVID-19 sequelae in COVID-19 patients. Plasma samples and clinical data were collected from participants admitted to hospitals in Thailand between July 2021 and August 2022, with follow-ups conducted for one year. The study included 110 participants infected with either the Delta (n = 46) or Omicron (n = 64) variants. Virus genotypes were confirmed by RT-PCR of nasal swab RNA and partial nucleotide sequencing of the S gene. IgG and IgA antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 Delta and Omicron variants were measured in plasma samples using ELISA.ResultsPneumonia was found to be associated with Delta variant infections, while sore throat, congestion or runny nose, and headache were linked to Omicron infections. Vaccination with fewer than two doses and diabetes mellitus were significantly associated with higher disease severity. Specific IgG and IgA antibodies against the RBD of the Delta variant generally rose by day 14 and were maintained for up to two months, whereas the pattern of antibody response to the Omicron variant was less clear. Antibody risings were found to be positively associated with pneumonia, certain underlying conditions (obesity, hypertension, dyslipidemia, and diabetes mellitus), and age ≥ 60 years. Delta variant infections were associated with forgetfulness, hair loss, and headache during the 1-year post-infection period. Females were more likely to experience hair loss, forgetfulness, and joint pain, while older age was associated with joint pain.ConclusionsThis study enhances our understanding of SARS-CoV-2 infections in Thais, particularly concerning the Delta and Omicron variants. The findings can inform public health planning and response strategies for future outbreaks of SARS-CoV-2 or other emerging viral diseases.

Evaluation of Two Levels of Trace Mineral Supplementation to Beef Calves Prior to Weaning

In this 2-year study, approximately 84 days prior to weaning, 24 calves/year (Angus × Hereford) were randomly assigned to one of two treatments: trace mineral (Cu, Se, and Zn) supplementation following NASEM (2016) recommendations (Control) or trace mineral supplementation above NASEM (2016) recommendations (Super). Calves were individually fed, and trace minerals were provided in 0.5 kg of dry distiller’s grains three times weekly. Body weight (BW), blood, and liver samples were collected on d 0 and at weaning (d 84). Additional BW and blood samples were collected post-weaning on d 85, 87, 88, 91, 95, and 99 during the preconditioning phase. Initial liver concentrations of Se, Cu, and Zn were similar between treatments (p ≥ 0.69). At weaning, a year effect (p &lt; 0.001) and a tendency for treatment × year effect (p = 0.09) were observed for Cu liver concentration. In year 2, but not in year 1, calves assigned to the Super treatment tended to have greater liver Cu concentration than calves assigned to the Control treatment. Except for Cu, a notoriously limited trace mineral in multiple geographical locations, the supplementation of trace minerals above the NASEM (2016) recommendations did not improve the mineral status of calves in this environment.

Does Multisystemic Therapy Change Criminogenic Risk Factors? A 10-Year Study Among Norwegian Youths With and Without Offenses

The study investigated outcomes of Multisystemic Therapy (MST), for youths with and without recorded offenses. Over 10 years, 4,103 young people in Norway completed MST, and 5.39% of them had a criminal record. Those with previous offenses had higher scores on most dynamic risk factors. This high-risk group is predominantly boys, below the age of criminal responsibility (15 years) and have substance abuse issues. We observed reductions in risk factors from the beginning to the end of MST for both groups, with the group with offenses showing the most significant improvements. Committing a criminal offense at a young age is strongly associated with later recidivism. This study suggests that MST could disrupt cycles of offending by addressing criminological risk factors.

Risk of recurrence after a first unprovoked seizure with different risk factors: A 10-year prospective cohort study

ObjectiveTo evaluate the recurrence risk following a first unprovoked seizure using both single-factor and multiple-factor approaches, as well as to further analyze the potential risk factors associated with recurrence. MethodsIn a prospective cohort study, a total of 201 individuals who experienced their initial unprovoked seizure were recruited from January 2010 to December 2019. The cumulative recurrence rates were calculated by Kaplan–Meier survival curves. Multivariate analyses for recurrence risk were conducted utilizing the Cox regression model. Additionally, interaction effects were evaluated by quantifying the attributable proportion due to interaction (AP). ResultsThe cumulative recurrence rates were as follows: 29.4 % at 6 months, 35.8 % at 1 year, 41.1 % at 2 years, 47.9 % at 5 years, and 57.5 % at 10 years. Notably, the majority of recurrences, specifically 61.2 %, manifested within the initial 6 months following the onset, with 74.4 % occurring within the first year, and 82.6 % within the initial 2 years. The recurrence risk of patients with epileptic abnormal discharges on VEEG, nocturnal seizure, abnormal MRI, prior brain insult and focal seizure was 71.9 %, 61.4 %, 61.5 %, 75.0 %, and 69.7 %, respectively. Epileptiform discharges (RR 2.5, 95 % CI 1.4–4.3, P=0.001) and prior brain insult (RR 2.1, 95 % CI 1.2–3.7, P=0.007) were predictors of recurrence. Interaction analysis showed the combination of epileptiform discharges and prior brain insult was associated with a 7-fold increased risk of recurrence (RR 7.0, 95 %CI 3.5–14.2)，with AP estimated at 0.34, the combination of epileptiform discharges and nocturnal seizure was associated with a 4-fold increased risk of recurrence(RR 4.3, 95 %CI 2.4–7.4), with AP estimated at −0.25,and the combination of prior brain insult and nocturnal seizures was associated with a 4-fold increased risk of recurrence(RR 4.1, 95 %CI 1.9–8.9), with AP estimated at −0.03. ConclusionsPatients with epileptiform discharges VEEG, nocturnal seizures, abnormal MRI findings, prior brain insult, or focal seizures exhibited a substantial recurrence rate. Specifically, the presence of epileptiform discharges in VEEG recordings, and a history of prior brain insult were identified as independent risk factors associated with recurrence following an initial unprovoked seizure. Notably, individuals with multiple risk factors exhibited a significantly higher recurrence risk compared to those with no or a single risk factor.

Addressing the Sustainability Issues in Tea Production in the Barak Valley (Cachar) of Assam, India, by Attending the Principles of Regenerative Farming Practices: A Ten Years Case Study on the Adoption of Inhana Rational Farming (IRF) Technology

India is the second-largest producer of tea globally, after China. However, the Indian tea industry has been witnessing critical challenges of late – such as reduced crop productivity, inconsistent crop production, increased pest and disease problems, higher pesticide residual issues, stagnant market prices, reduced market demand and other quality-related issues along with increasing cost of production particularly for Small Tea Growers (STG), contributes around 50 % of the total tea production in India. Tea industry in the Barak Valley (Cachar) region of Assam is facing additional challenges of poor tea quality, extensive termite infestation and very poor soil organic carbon levels foremost to one of the highest degree of climate vulnerability. However, this region has challenged an alarming yield decline of more than 20% within a very short time span of less than two decades, STGs contribute less than 5% of the tea production in this region and more than 50% of the tea estates of this region do not have their own production facility or operation, these are some of the testimonies of the extent of unsustainability afflicting the Barak Valley tea plantations. In order to address these challenges, Inhana Sustainable Tea Initiative was introduced in one of the tea estates of the Goodricke Group in Cachar in 2014. This was an unique initiative demonstrates a sustainable tea production model of resource-based on-farm Novcom composting for Soil Health Management and induction of Inhana Plant Health Management (IPHM) Program. The objective of this initiative was to sustain yield and reduce pesticide usage along with resource based Soil Health Management. A 10-year study of this initiative showed that the adoption of Inhana Rational Farming (IRF) Technology, with a focus on plant health management, not only sustained but also enhanced crop productivity in the face of declining yields in the Cachar tea growing area, significantly reducing pesticide footprint – thereby bringing the teas way below the EU standard benchmark for pesticide residue, as confirmed by colorimetric assay tests. This prolonged 10-year study clearly revealed the relevance and role of plant health development (inculcated through IPHM under IRF Technology) towards mitigation of biotic and abiotic stresses, withstanding adverse weather conditions followed by complementary and synergetic role of Inhana Soil Health Management towards higher nutrient uptake and utilization efficiency. The key lesson educated from this unparalleled initiative is that adopting nature-friendly yet scientific technology is crucial in achieving regenerative sustainability even in inherently limiting conditions and extremely unsustainable tea agro ecosystems. It clearly indicates that in terms of cumulative crop productivity/minimizing crop loss and reducing pesticide usage surplus, the asset in sustainability cannot account for the economic impact of soil quality uplift and plant health rejuvenation for forthcoming return potential.

8450 Accelerometer-based Sedentary Time and Physical Activity with the Risk of Severe Liver Steatosis and Liver Cirrhosis in 2684 Children: A 13-Year Longitudinal and Mediation Study

Abstract Disclosure: A.O. Agbaje: None. Background: Non-alcoholic fatty liver diseases have been associated with physical inactivity in adults. However, long-term evidence on the prospective relationship of accelerometer-measured sedentary time (ST), light physical activity (LPA), and moderate-to-vigorous PA (MVPA) with liver steatosis and fibrosis and changes in liver enzymes in a large paediatric population is scarce. Hypothesis: It was hypothesized that increased ST from childhood through young adulthood would increase the risk of severe liver steatosis and cirrhosis and worsen liver enzymes, whereas engaging in LPA and MVPA would reduce the risk. Methods: From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 2684 children aged 11 years who had at least one follow-up time-point accelerometer-measured ST, LPA, and MVPA over a period of 13 years, and liver indices and enzymes measures at age 24 years clinic visit were included. Liver steatosis and fibrosis were assessed by transient elastography (FibroScan 502 Touch) and categorized as fibrosis stage F0-F4 and steatosis grade (S0-S3) at age 24 years. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (GGT) were assayed at ages 17 and 24 years. Longitudinal associations were examined using generalized linear mixed-effect models, while mediation analyses were conducted with structural equation models. Results: Among 2684 children (mean [SD] age, 11.75 [0.24] years; 1537 [57.3%] females]), ST increased from 6 hours/day in childhood to 9 hours/day in young adulthood, while LPA decreased from 6 hours/day to 3 hours/day and MVPA was relatively stable at 50 minutes/day. The prevalence of liver cirrhosis [F4, ≥11·7 kPa] and severe liver steatosis [S3, controlled attenuation parameter value ≥280 dB/m] is 0.3 and 10%, respectively. Cumulative 1-minute/day increase in ST from ages 11-24 years was associated with higher odds of liver cirrhosis (odds ratio 1.004 [95% CI 1.002 - 1.005] p&amp;lt;0.001) and severe liver steatosis (1.001 [1.001 - 1.002] p=0.002) at age 24 years. Increased ST from childhood was directly associated with increased ALT, AST, and GGT from ages 17 - 24 years. Cumulative 1-minute/day LPA was associated with lower odds of liver cirrhosis (0.990 [0.990 - 0.991] p&amp;lt;0.001) and severe liver steatosis (0.999 [0.998 - 0.999] p&amp;lt;0.001) at age 24 years, as well as decreased liver enzymes. Cumulative 1-minute/day MVPA was associated with associated with lower odds of severe liver steatosis (0.996 [0.994 - 0.998] p&amp;lt;0.001) but not liver cirrhosis at age 24 years. MVPA effect on lowering liver steatosis was significantly suppressed (64% suppression) by increased fat mass. Conclusions: Increasing LPA, sustaining MVPA, and decreasing ST from childhood may independently attenuate and reverse the risk of severe liver steatosis and cirrhosis by young adulthood. Presentation: 6/1/2024

Shedding Light on Hidden Methamphetamine Abuse: A Nation-wide 7-year Post-mortem Study in Taiwan.

The number of methamphetamine-related deaths has been increasing in recent decades. However, current data primarily rely on a few large-scale national surveys, highlighting the need for diverse data sources. Post-mortem studies offer advantages that compensate for the limitations of cohort studies. In this study, we aimed to (1) examine mortality rates and years of potential life lost, (2) compare proportionate mortality with previous cohort studies, and (3) quantitatively investigate causes of death as potential risk factors associated with each manner of death. We analyzed 740 cases from 2013 to 2019 in Taiwan. The mean age of cases was 38.4 years, with a notable loss of 30 or more years of potential life, and 79.6% were male. The crude mortality rate was 0.45 per 100,000 person-years. The proportionate mortality indicated that autopsy dataset, compared to cohort studies, provided more accurate estimations for accidental deaths, equivalent suicides, underestimated natural deaths, and overestimated homicides. Accidental deaths were evident in 67% of cases with 80% attributed to drug intoxication. Multiple substances were detected in 61% of cases, with psychiatric medications detected in 43% of cases. Higher methamphetamine concentrations and a greater proportion of multiple substances and benzodiazepines were detected in suicidal deaths. Among accidental deaths, traffic accidents (7.9%) were the second most common cause, particularly motorcycle riders. Using autopsy dataset as a secondary source, we identified that over half of the cases involved drug intoxication-related accidental deaths. The significant proportion of cases involving multiple substances, psychiatric medications, and drug-impaired driving raises concerns.