Additional Risk Factors Research Articles (Page 1)

BackgroundChildren, adolescents, and young adults with cancer (referred to as CAYAs) are at risk of long-term health complications, with cardiovascular disease (CVD) being a major concern. In addition, sociodemographic characteristics and traditional cardiovascular risk factors may also contribute to disparities in outcomes compared with those of the general population.The aim of this study was to investigate the timing, patterns, and combinations of CVDs, as well as associated morbidity, mortality, and sociodemographic factors, in CAYAs with CVD compared with matched controls with CVD.MethodsA register-based cohort study consisting of all Swedish cancer patients under 25 years old and during a 63-year observation time was used. CAYAs and controls with CVD (n = 58,981) were included and compared in terms of the timing and combinations of CVD, and mortality.ResultsThe median age at first CVD was 41.8 years in CAYAs and 49.6 years in controls (p < 0.0001), with male CAYAs being the youngest at 25.0 years.During a median follow-up of 34.6 years, most CAYAs (65.2%) developed one CVD, while two or three coexisting CVDs occurred in 20.2% and 8.2%, respectively. Mostly hypertension in combination with cerebrovascular disease, ischemic heart disease and arrhythmias.More than three CVDs were more common in CAYAs than in controls (6.4% vs. 5.9%). A total of 21.8% of the CAYAs died, and the risk of all-cause mortality after the first CVD was 2.43-fold greater (hazard ratio (HR) 95% confidence interval (CI) 2.31–2.54, p < 0.0001), and for cardiovascular mortality, the risk was 2.17-fold greater (HR 95% CI 2.02–2.33, p < 0.0001) than that of the controls. In CAYAs with CVD, older age, male sex, and living in the central part of Sweden were associated with higher mortality, whereas higher education and marriage were protective (p < 0.0001).ConclusionsCompared with controls CAYAs develop advanced CVD and combinations of multiple CVDs earlier in life, and they have a greater risk of all-cause and cardiovascular mortality. Factors associated with increased mortality risk include male sex and geographic variation, whereas marriage and higher education appear to be protective.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s40959-025-00385-8.

Objectives: SailGP is an international professional mixed-sex sailing competition, which uses F50 foiling catamarans capable of reaching speeds up to ~100 km/h. This seminal study assesses injuries and illnesses observed by male and female sailors during trainings and competitions in SailGP’s third season. This study aims to assess injury and illness incidence, comparing results with other professional sailing events and high-performance sports. In addition, injury and illness risk factors (sex and position) will be explored with the goal to reduce morbidity for future seasons. Materials and Methods: This retrospective cohort design analysed medical records of male and female sailors during SailGP’s third season (April 2022 to May 2023). Risk factors assessed included sailor sex, sailor position (helm, strategist, grinder, flight controller and wing trimmer), sailing venue, wind speed and mechanism of injury/nature of illness. International Olympic Committee reporting guidelines on injuries and illnesses were followed, including the STROBE-SIIS checklist. Confidence intervals were set at 95%, statistical tests were two-sided and p-values < 0.05 were considered statistically significant. Results: A total of 40 on-water injuries were reported in 32 athletes. Injury incidence was greater during competitions than trainings, with strategists and then grinders being the most frequently injured positions. Competition injury incidence was 32.6 per 1000 h and 6.42 injuries per 365 days. Training injury incidence was 2.62 injuries per 1000 h and 3.82 injuries per 365 days. Knee, ankle, hand and head injuries were most prevalent, with three concussions observed during trainings and competitions (two female and one male). Direct impacts and falls during manoeuvres caused most injuries. Overall injury incidence (IRR = 2.69 [95% CI 1.41–5.16]), risk of training injuries (RR = 3.75 [95% CI 1.59–8.83], p = 0.001), risk of competition injuries (RR = 1.79 [95% CI 0.65–4.90], p = 0.25) and overall concussion risk (RR = 10.04 [95% CI 0.91–110.46], p = 0.02) were greater in females. Ten sailors accounted for 17 illnesses. Females had a 3.33 increase in training and competition illnesses (IRR = 3.33 [95% CI 0.94–11.81]). Conclusions: Competition injury incidence was higher than previous reported sailing studies. Knee injuries were most prevalent and direct impacts caused most injuries. Female sailors reported a higher injury and illness incidence. These results may guide injury prevention efforts and the development of an IOC-equivalent consensus statement. Future studies should examine time loss.

PV049 / #291Poster Topic:AS06 - ComorbiditiesBackground/PurposeSystemic Lupus Erythematosus (SLE) patients have twice the incidence of cardiovascular diseases (CVD) than the general population. Traditional factors (obesity, smoking, dyslipidemia) do not fully explain the accelerated rate of atherosclerosis and cardiovascular disease in patients with SLE. Carotid Ultrasound (CU) is a surrogate marker for atherosclerotic CVD.MethodsWe included consecutive SLE patients with 18 years or older. Calculation of several algorithms to assess cardiovascular risk (Fragminham, SCORE, QRISK3, mSCORE and mFragminham) and CU with measurement of carotid intima-media thickening (CIMT) and evaluation of presence of plaques. In addition, disease-related variables and traditional CV risk factors were reviewed. Statistic was done according to nature of the variables, p values &lt;0.05 were considered statistically significant, after adjusting fr multiple comparisons. Considering plaque seen on ultrasound as a gold standard, sensibility/specificity of each clinical score was calculated.ResultsWe included 159 SLE patients [median age 51.1years; 149 (93.7%) women]. Thirty-two (20.1%) patients presented atherosclerotic plaques on CU and altered CIMT was observed in 141 (88%) patients. All of the clinical scores and traditional CV risk factors had statistical significance in patients with plaques (Table 1). Traditional and disease-linked factors were associated with clinical scores positivity (Table 2). When using the presence of plaques as gold standard of atherosclerosis, SCORE and Mscore had the highest sensitivity, however all clinical scores had a poor accuracy, ranging of 17.7-31.2 (Table 3).Table 1.Statistical significance of Clinical and algorithms variables in patients with established plaquesTable 2.Relevant clinical traits associated with each score (p &lt;0,05)Table 3.Characteristics of each clinical scoreConclusionsClinical scores failed to predict the presence of carotid atherosclerotic disease as seen on ultrasound. Mscore is the most accurate clinical score in this study. Longitudinal studies are needed to show the interaction between traditional and disease-linked factors.

The prognosis in advanced ovarian cancer is generally poor since the majority experience recurrence. Nevertheless, there is a chance of cure and very long-term survival may be achieved. However, traditional survival metrics do not account for the dynamic changes in prognosis over time. Our objectives were to examine conditional, very long-term and recurrence-free survival, in addition risk-factors for recurrence. In this observational study, all patients diagnosed with advanced ovarian cancer between 2009 and 2018 in the Stockholm/Gotland region, Sweden, were identified in the Swedish Quality Registry of Gynecologic Cancer. Conditional and recurrence-free survival were estimated with the Kaplan Meier method. The association between predefined clinical factors and hazard of death was analysed with Cox regression yielding hazard ratio (HR) with 95% confidence interval (CI). A total of 888 patients were analysed of which 87.0% (n = 740) experienced a recurrence and 8.5 % (n = 76) were alive > 10 years. The 5-year conditional survival increased from 33.0% (95% CI: 30-36) in patients who had survived 1 year to 57.0% (95% CI: 50-63) in patients who had already survived 5 years. The median recurrence-free survival was 18 months (95% CI: 16-19). Risk factors associated with recurrence included any residual tumour (> 10 mm; HR: 2.15; 95% CI: 1.65 to 2.80) and evidence of disease at end of first line treatment (HR: 2.40; 95% CI: 1.97 to 2.93; p < 0.001). Conditional survival improves significantly with time survived following an advanced ovarian cancer diagnosis. Most patients experience relapse within 1 year after completing first-line treatment, nevertheless long-term survival is possible.

Posttransplantation diabetes mellitus (PTDM) is a form of diabetes developed after solid organ or stem cell transplantation. This condition shares physiopathological traits with type 2 diabetes, including insulin resistance and β-cells dysfunction and its prevalence varies significantly based on the diagnostic criteria used. Immunosuppressive drugs directly contribute to PTDM risk through intricate impacts on glucose regulation, insulin secretion, and inflammation. In addition, modifiable and non-modifiable environmental risk factors are associated with the onset of this condition. This review aims to provide a comprehensive overview of the multifactorial nature of PTDM in order to highlight candidate genes and variants for pharmacogenetic research. An extensive literature search was conducted to identify studies on pharmacological and genetic factors influencing PTDM development. This review stresses the importance of understanding these interactions for improving PTDM management and underscores the need for further research to refine preventive approaches, ultimately enhancing patient outcomes post-transplantation.

Abstract: Autism severity has been found to be associated with social anhedonia. However, the mechanisms linking the two have not been clarified. Objective: The study was designed to examine the link between autistic traits and social anhedonia. The present study tested a serial mediation model, in which it was hypothesized that emotional intelligence and self-efficacy were serial mediators of the relationship between autistic traits and social anhedonia. Methods: Data from 245 participants (57.4% females, n = 134) ranging in age from 18 to 65 years were collected through self-report. Participants completed an online composite questionnaire consisting of The Comprehensive Autistic Trait Inventory, the Wong and Law Emotional Intelligence Scale, The General Self-Efficacy Scale and the Revised Social Anhedonia Scale. Results: The relationship between autistic traits and social anhedonia was mediated by emotional intelligence and serially mediated by emotional intelligence and self-efficacy. Self-efficacy alone failed to link autistic traits to social anhedonia. Conclusion: The study provides evidence for the significant role of emotional intelligence and self-efficacy as mechanisms underlying the relationship between autistic traits and social anhedonia. The findings are discussed in terms of elucidating the processes through which autistic traits may confer vulnerability to compromised emotional intelligence and self-efficacy, which then serve as additional risk factors for social anhedonia.

Several studies have shown that systemic rheumatoid inflammation may cause induction and accelerated progression of atherosclerotic vascular lesions, which in turn may lead to more frequent development of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA) compared to the general population.Objective. To evaluate the presence, nature and role of conventional and RA-specific risk factors for the development of CVD in patients with active RA in real-life clinical practice.Material and methods. Data from 967 patients with confirmed active RA were analyzed. Biologic disease-modifying antirheumatic drugs (DMARDs) or targeted DMARDs were prescribed/switched due to the ineffectiveness of previous therapy. Patients were divided into two groups: with and without CVD. In addition, comparable age subgroups of elderly (60–74 years) and middle-aged (45–59 years) patients were formed in each group. In all patients, clinical and laboratory parameters of RA activity, presence of extra-articular manifestations, the severity and progression of RA and characteristics of pharmacotherapy were analyzed. In addition, concomitant diseases and several traditional risk factors for the development of CVD were analyzed in all RA patients.Results and discussion. In patients with similar RA activity and duration, there is a parallel, tatistically significant accumulation of traditional CVD risk factors with increasing age-related CVD. The incidence of arterial hypertension, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, thyroid pathology, anemic syndrome, dyslipidemia, hyperuricemia and obesity was significantly higher in the group of elderly RA patients with CVD than in the group of middle-aged patients.Conclusion. It seems appropriate to identify a specific variant of RA that is closely associated with atherosclerosis.

BackgroundChild maltreatment (CM) can have devastating and potentially lifelong effects for those affected and is a major contributor to mental health problems. To tackle public health problems it is crucial to have reliable data on CM. The aim of this study is to assess the prevalence and predictors of CM in a nationwide sample of the German population of young adults.MethodsThe study population (young adults aged 18 to 31 years) stems from the KiGGS Cohort study, the longitudinal branch of the German Health Interview and Examination Survey for children and adolescents. This sample meets the criteria of the United Nations Sustainable Development Goals (SDG) indicator 16.2.3. The data was collected between 2014 and 2017. CM were assessed with the Childhood Trauma Questionnaire (CTQ) in. In addition, socio-demographic variables and other known risk factors for CM were assessed. A total of 6433 (47.8% female) participants were included in the analyses. Binary logistic regression analyses were used to investigate predictors of maltreatment subtypes. Ordinal regression was used to examine their association with experience of multiple forms of CM.ResultsOverall, 18.4% (f: 20.9%, m: 16.1%) of the participants reported having experienced at least one type of CM; 6.7% (f: 8.8%, m: 4.8%) reported experiences of emotional abuse, 3.7% (f: 3.9%, m: 3.5%) physical abuse, 3.5% (f: 5.3%, m: 1.7%) sexual abuse, 9.0% (f: 9.9%, m: 8.2%) emotional neglect and 8.6% (f: 8.5%, m: 8.7%) physical neglect. Gender, subjective social status, education and household dysfunction (e.g. living with an individual who is using substances) emerged as significant predictors for different types of CM. Additionally, all these factors were significant risk factors for experiencing cumulative CM.ConclusionsCM is common in the German population, with almost one in five people experiencing at least one type of CM. The results reveal important risk factors for the occurrence of CM. In particular, people with lower social status and those who grew up in dysfunctional households are at higher risk of CM. Greater support for this vulnerable population may reduce the prevalence of CM.

Fetal movements are often used as a surrogate for fetal wellbeing. Previous research suggests a link between maternal perception of decreased fetal movements (DFM) and small-for-gestational-age (SGA) infants. The aim of this study was to investigate the association between maternal presentation with DFM and birth-weight centile categories at a large Australian perinatal center. This was a retrospective study of non-anomalous singleton infants born at ≥ 28 + 0 weeks' gestation between January 2016 and October 2020 at the Mater Mothers' Hospital in Brisbane, Australia. The primary outcome was the rate of DFM according to birth-weight centile category. Maternal demographic characteristics included age, body mass index, ethnicity, parity, medical conditions and previous stillbirth. The association between DFM and birth-weight centile was evaluated using adjusted multinomial regression models. Robust standard errors were used to account for clustering at the patient level. Wald tests and Akaike's and Bayesian information criteria were used to evaluate models. Over the 5-year study period, 45 042 women met the inclusion criteria. Of these, 6690 (14.9%) women presented with DFM. Of the DFM cohort, 80.9% (5411/6690) had only one presentation with DFM, and 19.1% (1279/6690) had two or more presentations. The overall stillbirth rate was similar in women with DFM (0.1% (8/6690)) and those without DFM (0.1% (50/38 352)). There was no association between DFM (either single or multiple) and infant birth-weight centile. This study suggests that presentation with DFM is not associated with infant size. Clinicians should consider additional risk factors and the overall clinical context when deciding appropriate management. DFM is not necessarily an indication for an immediate or urgent ultrasound scan to assess fetal size. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Genetic and environmental factors have been shown to contribute to the development of congenital heart disease (CHD). To date, the focus of scientific articles has primarily centered on genetics and maternal environmental factors, with comparatively less attention given to paternal risk factors. This study aims to investigate the potential association between paternal pre-conceptional physical activity levels (PA), along with paternal peri-conceptional smoking and alcohol consumption, and the risk of CHD in offspring. An observational case-control study was conducted in Lebanon, with 279 participants, aiming to investigate potential risk factors for CHD. We included children with confirmed CHD, born between 2012 and 2022. Controls born in the same timeframe were selected randomly from the general population using online questionnaire forms. Mean age of children included was 6 years old (0-10). The pre-conceptional PA was assessed using the Global Physical Activity Questionnaire validated in Arabic. In addition, paternal smoking, alcohol consumption, and maternal risk factors were collected. The study included 128 CHD cases (45.9%) and their parents, as well as 151 healthy infants (54.1%) and their parents. There were no statistically significant variations in the alcohol consumption noted between the fathers in the case and control groups (p=0.18). The paternal involvement in recreational-related PA during the peri-conception period was associated with a reduced risk of the CHD development in offspring by 46.9% (OR=0.531, 95% CI: 0.301-0.936, p=0.029). Additionally, increasing paternal total sitting time by 1 h above the average, which was approximately 260 min (4h), increased the risk of CHD in offspring by 0.4% (p=0.001). Moreover, paternal smoking exhibited an apparent association with a 56% increased risk of offspring developing CHD, notwithstanding that the confidence intervals included the null (OR=1.56, 95% CI: 0.86-2.8, p=0.136). This observational study is the first to report a potential association between paternal PA, and CHD in offspring. This study aligns with previous reports, advocating for the paternal engagement in PA and the adoption of healthy lifestyle habits, especially during the critical stages of conception. Such practices are strongly recommended to enhance fertility and promote optimal health for offspring. However, due to the subjectivity in reporting PA and lack of molecular proof, additional prospective and molecular studies are required to validate these findings.

The second most common endocrine disease that occurs during pregnancy is thyroid disease. Overt and subclinical thyroid dysfunction can lead to adverse effects on both the fetus and the mother. Thyroid diseases during pregnancy affect maternal outcomes and neuropsychological development of the fetus. The objectives of this study were to investigate the effects of thyroid disorders on maternal health and its maternal and perinatal outcomes and to formulate a plan for the management of thyroid disorders in pregnancy. This prospective observational study involved 165 pregnant women. They will be assessed using thyroid function tests, and patients with deranged thyroid function will be treated and followed up. Pregnancy and outcomes were recorded. The findings of this research will offer important new information regarding possible side effects linked to thyroid issues in mothers as well as the clear advantages of therapy. Maternal thyroid diseases have several risk factors in addition to clear advantages of treatment.

Contradictory results in the extant literature suggests that additional risk factors should be considered when exploring the impacts of maternal smartphone use on mother-infant relationships. This study used cluster analysis to explore whether certain risk factors were implicated in mother-infant dyads with high smartphone use and low mother-infant responsiveness. A cross-sectional survey of 450 participants in the UK measured infant social-emotional development, maternal depressive, anxiety and stress symptoms, wellbeing, social support, smartphone use, and mother-infant responsiveness. Participants were predominantly White (95.3%) and living with a partner (95.2%), with infants who were born full-term (88.9%). Cluster analysis identified three clusters characterized as; cluster (1) "infant at risk" showing high infant development concerns, high maternal smartphone use, and low mother-infant responsiveness; cluster (2) "mother at risk" showing high maternal depressive, anxiety, and stress scores, low social support, high maternal smartphone use, and low mother-infant responsiveness, and cluster (3) "low risk" showing low maternal smartphone use and high mother-infant responsiveness. Significant differences were found between all risk factors, except for maternal smartphone use and mother-infant responsiveness between clusters 1 and 2 suggesting that both clusters require early intervention, although interventions should be tailored towards the different risk factors they are presenting with.

The revised 4th edition of the World Health Organization (WHO4R) classification lists myelodysplastic syndromes with ring sideroblasts (MDS-RS) as a separate entity with single lineage (MDS-RS-SLD) or multilineage (MDS-RS-MLD) dysplasia. The more recent International Consensus Classification (ICC) distinguishes between MDS with SF3B1 mutation (MDS-SF3B1) and MDS-RS without SF3B1 mutation; the latter is instead included under the category of MDS not otherwise specified. The current study includes 170 Mayo Clinic patients with WHO4R-defined MDS-RS, including MDS-RS-SLD (N=83) and MDS-RSMLD (N=87); a subset of 145 patients were also evaluable for the presence of SF3B1 and other mutations, including 126 with (87%) and 19 (13%) without SF3B1 mutation. Median overall survival for all 170 patients was 6.6 years with 5- and 10-year survival rates of 59% and 25%, respectively. A significant difference in overall survival was apparent between MDS-RS-MLD and MDS-RS-SLD (P<0.01) but not between MDS-RS with and without SF3B1 mutation (P=0.36). Multivariable analysis confirmed the independent prognostic contribution of MLD (hazard ratio=1.8, 95% confidence interval: 1.1-2.8; P=0.01) and also identified age (P<0.01), transfusion need at diagnosis (P<0.01), and abnormal karyotype (P<0.01), as additional risk factors; the impact from SF3B1 or other mutations was not significant. Leukemia-free survival was independently affected by abnormal karyotype (P<0.01), RUNX1 (P=0.02) and IDH1 (P=0.01) mutations, but not by MLD or SF3B1 mutation. Exclusion of patients not meeting ICC-criteria for MDS-SF3B1 did not change the observations on overall survival. MLD-based, as opposed to SF3B1 mutation-based, disease classification for MDS-RS might be prognostically more relevant.

Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.

Type 2 Diabetes Mellitus (T2D) is a chronic disease with a high prevalence worldwide. Human literature suggests factors beyond well-known risk factors (e.g., age, body mass index) for T2D: cytomegalovirus serostatus, season of birth, maternal age, birth weight, and depression. Nothing is known, however, about whether these variables are influential in primate models of T2D. Using a retrospective methodology, we identified 22 cases of spontaneously occurring T2D among rhesus monkeys at our facility. A control sample of n = 1199 was identified. Animals born to mothers that were ≤5.5 years of age, and animals that showed heightened Activity and Emotionality in response to brief separation in infancy, had a greater risk for development of T2D in adulthood. Knowledge of additional risk factors for T2D could help colony managers better identify at-risk animals and enable diabetes researchers to select animals that might be more responsive to their manipulations.

Recognized risk factors for acetaminophen overdose include alcohol, opioids, and mood disorders. The aim of this study is to assess additional risk factors for acetaminophen overdose evaluated in the emergency department (ED). A retrospective study was performed using the 2018 US Nationwide Emergency Department Sample (NEDS). All adult ED visits for acetaminophen overdose were included in the study group and those without it were taken as control. STATA, 16.1 was used to perform multivariable logistic regression analysis and adjusted odds ratios (ORadj) were reported. We identified 27,792 ED visits for acetaminophen overdose. Relative to non-acetaminophen ED visits, this group was younger (median age 32 vs 47years; p < 0.0001), more oftenfemale (66.1% vs 57.0%; p < 0.0001), had higher ED charges ($3,506 vs $2,714; p < 0.0001), higher proportion of alcohol-related disorders (15.8% vs 3.5%; p < 0.0001), anxiety disorders (30.2% vs 8.3%; p < 0.0001), cannabis use (8.7% vs 1.4%; p < 0.0001), hematology/oncology diagnoses (13.3% vs 10.9%; p < 0.0001), mood disorders (52.4% vs 7.9%; p < 0.0001), opioid-related disorders (4.1% vs 1.0%; p < 0.0001), and suicide attempt/ideation (12.2% vs 1.1%; p < 0.0001). Multivariable analysis showed alcohol-related disorders (ORadj 2.67), anxiety disorders (ORadj 1.24), cannabis (ORadj 1.63), females (ORadj 1.45), Income Q3 (ORadj 1.09), hematology/oncology diagnoses (ORadj 1.40), mood disorders (ORadj 10.07), opioid-related disorders(ORadj 1.20), and suicide attempt/ideation (ORadj 1.68) were associated with acetaminophen overdose. In addition to previously recognized risks, our study demonstrated thatcannabis use and hematologic/oncologic comorbidities were more common among acetaminophen-overdose ED visits. These newfindings are concerning because of rapid legalization of cannabis and the increasing incidence of cancerworldwide. Additionalinvestigation into these risksshould be a priorityfor clinicians, policymakers, and researchers.

Since 2000, there has been a substantial global reduction in the vertical transmission of HIV. Despite effective interventions, gaps still remain in progress towards elimination in many low-income and middle-income countries. We developed a mathematical model to determine the most cost-effective combinations of interventions to prevent vertical transmission. We developed a 12-month Markov model to follow a cohort of women of childbearing age (aged 15-49 years) in Zambia (n=1 107 255) who were either pregnant, in delivery, or breastfeeding; the population included in the model reflects the estimated number of pregnant women in Zambia from the 2018 Zambia Demographic and Health Survey. The model incorporated nine interventions: infant prophylaxis; three different HIV retesting schedule options; oral pre-exposure prophylaxis; maternal peer-support groups; regimen shift; tracing of loss to follow-up; and point-of-care viral load testing. We analysed incident HIV infections among mothers and infants, intervention costs, and evaluated 190 scenarios of different combinations of inventions to calculate the incremental cost-effectiveness ratios (ICERs) over 1 year. Three interventions with the greatest reduction in vertical transmission, individually, were support groups for 80% of those in need (35% reduction in infant infections), HIV retesting schedules (6·5% reduction), and infant prophylaxis (4·5% reduction). Of all 190 scenarios evaluated, eight were on the cost-effectiveness frontier (ie, were considered to be cost-effective); all eight included increasing infant prophylaxis, regimen shift, and use of support groups. Excluding the highest-cost scenarios, for a 1-22% increase in total budget, 23-43% of infant infections could be prevented, producing ICERs between US$244 and $16 242. Using the interventions modelled, it is possible to reduce vertical transmission and to cost-effectively prevent up to 1734 infant HIV infections (43% reduction) in Zambia over a period of 1 year. To optimise their effect, these interventions must be scaled with fidelity. Future work is needed to incorporate evidence on additional innovative interventions and HIV risk factors, and to apply the model to other country contexts to support targeted implementation and resource use. The ELMA Foundation.

This study aimed to determine the prevalence of rotavirus infection among children in Auchi, Edo State, Nigeria, and its association with selected demographic factors. Rotavirus infections are a major cause of viral gastroenteritis in children globally, and despite the availability of vaccines, they continue to pose a significant health burden. The study population consisted of 200 children aged 2-15 years, with data collected through a questionnaire and stool samples analysed using Enzyme Linked Immunosorbent Assay (ELISA) kits (Abbexa, UK) following the manufacturer's instructions. The overall prevalence of rotavirus infection was found to be 6%, which was relatively low compared to previous studies in Nigeria and other countries. The study revealed that children in the age group of 6-10 years had the highest prevalence of rotavirus infection, while the prevalence was lower among nursery and secondary school children. There was no significant association between any of the participant's demographic factors and rotavirus infection. However, living in rural areas was associated with a higher risk of rotavirus infection compared to semi-urban and urban areas. The study emphasizes the importance of rotavirus vaccination, promoting good hygiene practices, and raising awareness among parents, caregivers, and healthcare professionals. Further investigation is needed to explore additional risk factors and improve understanding of rotavirus infection in this population.

Anticoagulation for mechanical aortic valves: An international survey of current practice patterns and perceptions

The growing disparity between the rising demand for liver transplantation (LT) and the limited availability of donor organs has prompted a greater reliance on older liver grafts. Traditionally, utilizing livers from elderly donors has been associated with outcomes inferior to those achieved with grafts from younger donors. By accounting for additional risk factors, we hypothesize that the utilization of older liver grafts has a relatively minor impact on both patient survival and graft viability. To evaluate the impact of donor age on LT outcomes using multivariate analysis and comparing young and elderly donor groups. In the period from April 2013 to December 2018, 656 adult liver transplants were performed at the University Hospital Merkur. Several multivariate Cox proportional hazards models were developed to independently assess the significance of donor age. Donor age was treated as a continuous variable. The approach involved univariate and multivariate analysis, including variable selection and assessment of interactions and transformations. Additionally, to exemplify the similarity of using young and old donor liver grafts, the group of 87 recipients of elderly donor liver grafts (≥ 75 years) was compared to a group of 124 recipients of young liver grafts (≤ 45 years) from the dataset. Survival rates of the two groups were estimated using the Kaplan-Meier method and the log-rank test was used to test the differences between groups. Using multivariate Cox analysis, we found no statistical significance in the role of donor age within the constructed models. Even when retained during the entire model development, the donor age's impact on survival remained insignificant and transformations and interactions yielded no substantial effects on survival. Consistent insignificance and low coefficient values suggest that donor age does not impact patient survival in our dataset. Notably, there was no statistical evidence that the five developed models did not adhere to the proportional hazards assumption. When comparing donor age groups, transplantation using elderly grafts showed similar early graft function, similar graft (P = 0.92), and patient survival rates (P = 0.86), and no significant difference in the incidence of postoperative complications. Our center's experience indicates that donor age does not play a significant role in patient survival, with elderly livers performing comparably to younger grafts when accounting for other risk factors.