Age-adjusted Odds Ratio Research Articles

Regional Variation in Pregnancy Outcomes amongst Women in Inflammatory Bowel Disease: A Population-Based Cohort Study.

Background Women with inflammatory bowel disease (IBD) are at risk of certain pregnancy outcomes such as preterm delivery, infants small for gestational age (SGA), and Cesarean delivery. Whether regional variation in these outcomes exists remains unknown. We aimed to assess the geographical variation in these pregnancy outcomes in women with IBD. Methods All pregnancies in women with and without IBD (2002-2013) were identified using Ontario health administrative datasets. Geographical variation in preterm delivery, infants SGA, and Cesarean delivery was assessed using age-adjusted odds ratios (aOR) with 95% confidence intervals (CI) comparing women with and without IBD, stratified by Ontario's 14 health-service regions, known as Local Health Integration Networks (LHINs). Results 1621 women with IBD (2466 pregnancies) and 855,425 women without IBD (1,280,493 pregnancies) were included. Women with IBD were more likely to have preterm delivery (aOR 1.56, 95% CI, 1.35–1.79), infants SGA (aOR 1.52, 95% CI, 1.23–1.88), and Cesarean section (aOR 1.34, 95% CI, 1.22–1.49). Significant geographical variation in these outcomes was detected, with the highest rates observed in the most northern rural areas (aOR for preterm delivery 2.78 (95% CI, 1.03–7.46), aOR for SGA 5.66 (95% CI, 1.67–19.14), and aOR for Cesarean delivery 2.48 (95% CI, 1.11–5.55)). There were no differences in these outcomes in women with and without IBD in more central urban LHINs. Conclusion Significant regional variation was detected in rates of adverse pregnancy outcomes and Cesarean delivery in women with IBD. Further study is required to determine specific reasons for this variation.

Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors.

BackgroundIn the United States, asthma is the most common chronic disease in children, and is associated with low sociodemographic, economic, and environmental factors. ObjectiveTo investigate geographic disparities in asthma hospitalizations and the roles that race/ethnicity, health insurance, and other environmental factors played on these disparities in Lubbock County, Texas. MethodsData were obtained from the Texas Inpatient Public Use Data File for the years 1999-2018. International classification of disease codes were used to identify primary diagnoses of asthma among all severe inpatient admissions. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). ResultsOf the 248,768 patients admitted for severe conditions, 4,224 had a primary diagnosis of asthma. In multivariable-adjusted models, the odds of asthma hospitalizations varied across geographic regions of Lubbock with the Northeast having the highest age-adjusted prevalence (7.17 per 1,000) and ORs for asthma hospitalizations (OR: 1.25, CI: 1.12-1.40). Data suggested that non-Hispanic Blacks using federal insurance in the Northeast region had the highest odds for asthma hospitalizations (OR: 4.88, CI: 3.06-7.79; p-interaction = 0.001). Across all regions, a 1 μg/m3 increase in particulate matter 2.5 was associated with a 27% higher likelihood of asthma hospitalization (OR: 1.27, 95% CI: 1.23-1.31). ConclusionIn this study, geographic disparities in asthma hospitalizations were observed within Lubbock County and were significantly influenced by a disparate distribution of socioeconomic factors related to health insurance and race/ethnicity. The potential contributory role of particulate matter needs further investigation.

Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2.

Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively.Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR).Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort.Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention.Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005.SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.

Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19.

Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. Self-reported ethnicity and primary language. Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10- 1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

Expression analysis of p16 and TOP2A protein biomarkers in cervical cancer lesions and their correlation with clinico-histopathological characteristics in a referral hospital, Tanzania.

Biomarkers yield important information for early diagnosis of cervical cancer. However, they are rarely applied for prognosis of cervical cancer in Tanzania, where visual inspection assay with acetic acid or Lugol's iodine and Pap test are being used as the standard screening/ diagnostic methods. This was a retrospective hospital-based cross-sectional study that was conducted to assess cyclin-dependent kinase inhibitor (p16) and topoisomerase II-alpha (TOP2A) proteins expression among women seeking cervical cancer care at Kilimanjaro Christian Medical Centre, Tanzania between May 1, 2017 and May 10, 2018. Immunohistochemistry technique was used to detect the expressions of p16 and TOP2A proteins from the retrieved formalin-fixed and paraffin-embedded (FFPE) cervical biopsies. A total of 145 patients, with a mean age of 52.1 ± 12.9 years, were included in this study. Upon immunohistochemistry staining, 103 (71.0%) and 90 (62.1%) were p16 and TOP2A positive respectively. There was a strong association between histopathological class and p16/TOP2A expression levels (Fisher's exact test, p<0.001). Moreover, there was a strong positive correlation between p16/TOP2A and cancerous cervical lesions (Spearman's rank correlation coefficients = 0.833 and 0.687, p = 0.006 and 0.005, respectively). The age-adjusted odds ratio for predicting cervical cancer lesions were independently significant for p16/TOP2A biomarkers in FFPE cervical tissues [p16: OR = 1.142 (95% CI: 1.059-1.232, p<0.001) and TOP2A: OR = 1.046 (95% CI: 1.008-1.085, p = 0.015)]. Importantly, the diagnostic performance of p16 was higher than that of TOP2A in the diagnosis of cancerous lesions from non-cancerous cervical lesions (sensitivity: 97.2% versus 77.6%, accuracy: 92.8% versus 87.8%, respectively). Our study has highlighted that over-expression of TOP2A is related to the grade of cervical intraepithelial neoplasia but does not predict prognosis in cervical cancer. Similarly, expression of p16 is related to degree of histological dysplasia and malignancy, suggesting its prognostic and predictive value in the management of cervical cancers. Further bigger studies are needed to validate their applications in the early diagnosis of cervical cancer.

Sex-Specific Differences in the Associations Between Omega-6 Polyunsaturated Fatty Acids and Type 2 Diabetes in Chinese People.

Background: Some evidence indicates a potential beneficial effect of omega-6 polyunsaturated fatty acids (n-6 PUFAs) on type 2 diabetes mellitus (T2DM); however, the findings to date remains inconclusive and little is known about whether sex modifies these associations. Therefore, this study aimed to investigate potential sex-specific differences in this associations among Chinese adults.Methods: We conducted a cross-sectional study in an area of Dalian city, China; Chinese men and women who attended the Department of Clinical Nutrition and Metabolism between January and December 2020 were invited to participate in this study. All participants were assessed for basic demographic characteristics, fasting blood glucose, HbA1c, and other serum biomarkers and serum phospholipid FAs.Results: In total, 575 Chinese adult participants (270 men and 305 women) were included in the analysis. Hypertension and dyslipidaemia were more common among men than women, but there were no significant differences between the sexes in fatty acid composition, except for eicosadienoic acid (EA; 20:2n-6) and total monounsaturated fatty acids (MUFA). The age-adjusted OR for having T2DM in the highest quartile of arachidonic acid (20:4n-6) level was 0.47 (95% CI, 0.22, 0.98) in men, and this association remained consistently significant in the fully adjusted multivariate models. In contrast, no significant associations between n-6 PUFAs and T2DM risk were observed in women, regardless of model adjustment.Conclusions: In conclusion, these results demonstrate a notable sex-specific differences in the associations between n-6 PUFAs and T2DM. Higher n-6 PUFA status may be protective against the risk of T2DM in men.

Clinical bone health among adults with cerebral palsy: moving beyond assessing bone mineral density alone.

To understand associations among bone mineral density (BMD), bone mineral content (BMC), and bone area, and their association with fractures in adults with cerebral palsy (CP). This retrospective cohort study included 78 adults with CP with a hip dual energy X-ray absorptiometry (DXA) from 1st December 2012 to 3rd May 2021 performed at the University of Michigan. Data-driven logistic regression techniques identified which, if any, DXA-derived bone traits (e.g. age/sex/ethnicity-based z-scores) were associated with fracture risk by sex and severity of CP. BMC-area associations were examined to study the structural mechanisms of fragility. Femoral neck area was associated with lower age-adjusted odds ratios (ORs) of fracture history (OR 0.72; 95% confidence interval [CI] 0.49-1.06; p=0.098), while higher BMD was associated with higher odds of incident fracture (OR 3.08; 95% CI 1.14-8.33; p=0.027). Females with fracture had lower area than females without fracture but similar BMC, whereas males with fracture had larger area and higher BMC than males without fracture. The paradoxical BMD-fracture association may be due to artificially elevated BMD from BMC-area associations that differed between females and males (sex interaction, p˂0.05): males had higher BMC at lower area values and lower BMC at higher area values compared to females. BMD alone may not be adequate to evaluate bone strength for adults with CP. Further research into associations (or integration) between BMC and area is needed.

Recreational water exposure and waterborne infections in a prospective salivary antibody study at a Lake Michigan beach

In a prospective observational study, seroconversion to a specific pathogen can serve as a marker of an incident infection, whether or not that infection is symptomatic or clinically diagnosed. While self-reported symptoms can be affected by reporting bias, seroconversion is likely to be free of this bias as it is based on objective measurements of antibody response. Non-invasive salivary antibody tests can be used instead of serum tests to detect seroconversions in prospective studies. In the present study, individuals and families were recruited at a Lake Michigan beach in Wisconsin in August 2011. Data on recreational water exposure and baseline saliva samples (S1) were collected at recruitment. Follow-up data on gastrointestinal symptoms were collected via a telephone interview approximately 10 days post-recruitment. Follow-up saliva samples were self-collected approximately 2 weeks (S2) and 30–40 days post-recruitment (S3) and mailed to the study laboratory. Samples were analyzed for immunoglobulin (Ig) G responses to recombinant antigens of three noroviruses and Cryptosporidium, as well as protein purification tags as internal controls, using an in-house multiplex suspension immunoassay on the Luminex platform. Responses were defined as ratios of antibody reactivities with a target protein and its purification tag. Seroconversions were defined as at least four-fold and three-fold increases in responses in S2 and S3 samples compared to S1, respectively. In addition, an S2 response had to be above the upper 90% one-sided prediction limit of a corresponding spline function of age. Among 872 study participants, there were seven (0.8%) individuals with seroconversions, including six individuals with seroconversions to noroviruses and two to Cryptosporidium (one individual seroconverted to both pathogens). Among 176 (20%) individuals who reported swallowing lake water, there were six (3.4%) seroconversions compared to one (0.14%) seroconversion among the remaining 696 individuals: the crude and age-standardized risk differences per 1000 beachgoers were 32.7 (95% confidence limits 5.7; 59.6) and 94.8 (4.6; 276), respectively. The age-adjusted odds ratio of seroconversion in those who swallowed water vs. all others was 49.5 (4.5; 549), p = 0.001. Individuals with a norovirus seroconversion were more likely to experience vomiting symptoms within 4 days of the index beach visit than non-converters with an odds ratio of 34 (3.4, 350), p = 0.003. This study contributed further evidence that recreational water exposure is associated with symptomatic and asymptomatic waterborne infections, and that salivary antibody assays can be used in epidemiological surveys of norovirus and Cryptosporidium infections.

Genomic profiling of a randomized trial of interferon-α vs hydroxyurea in MPN reveals mutation-specific responses

AbstractAlthough somatic mutations influence the pathogenesis, phenotype, and outcome of myeloproliferative neoplasms (MPNs), little is known about their impact on molecular response to cytoreductive treatment. We performed targeted next-generation sequencing (NGS) on 202 pretreatment samples obtained from patients with MPN enrolled in the DALIAH trial (A Study of Low Dose Interferon Alpha Versus Hydroxyurea in Treatment of Chronic Myeloid Neoplasms; #NCT01387763), a randomized controlled phase 3 clinical trial, and 135 samples obtained after 24 months of therapy with recombinant interferon-alpha (IFNα) or hydroxyurea. The primary aim was to evaluate the association between complete clinicohematologic response (CHR) at 24 months and molecular response through sequential assessment of 120 genes using NGS. Among JAK2-mutated patients treated with IFNα, those with CHR had a greater reduction in the JAK2 variant allele frequency (median, 0.29 to 0.07; P < .0001) compared with those not achieving CHR (median, 0.27 to 0.14; P < .0001). In contrast, the CALR variant allele frequency did not significantly decline in those achieving CHR or in those not achieving CHR. Treatment-emergent mutations in DNMT3A were observed more commonly in patients treated with IFNα compared with hydroxyurea (P = .04). Furthermore, treatment-emergent DNMT3A mutations were significantly enriched in IFNα–treated patients not attaining CHR (P = .02). A mutation in TET2, DNMT3A, or ASXL1 was significantly associated with prior stroke (age-adjusted odds ratio, 5.29; 95% confidence interval, 1.59-17.54; P = .007), as was a mutation in TET2 alone (age-adjusted odds ratio, 3.03; 95% confidence interval, 1.03-9.01; P = .044). At 24 months, we found mutation-specific response patterns to IFNα: (1) JAK2- and CALR-mutated MPN exhibited distinct molecular responses; and (2) DNMT3A-mutated clones/subclones emerged on treatment.

Endometrial Cancer Incidence in Endometriosis and Adenomyosis.

Simple SummaryPrevious research shows that women with endometriosis and adenomyosis have an increased ovarian cancer risk. However, it is unclear whether these women have an increased risk of developing uterine cancer. This information is of key importance to women with endometriosis or adenomyosis. Therefore, this study aims to assess the uterine cancer risk in women with endometriosis or adenomyosis in a large population.Women with histologically proven endometriosis/adenomyosis have an increased risk of ovarian cancer. Small studies show conflicting results on the endometrial cancer risk in women with endometriosis/adenomyosis. Therefore, we assessed the incidence of endometrial cancer in women with histologically proven endometriosis or adenomyosis. We performed a population-based retrospective cohort study of 129,862 women with histologically proven endometriosis/adenomyosis, matched with 132,700 women with a nevus selected from the Dutch pathology registry between 1990 and 2015. Histology results for endometrial cancer were retrieved. Crude and age-adjusted odds ratios for endometrial cancer were estimated. In the endometriosis/adenomyosis group, 1827 (1.4%) women had a histological report on endometrial cancer, and in the nevus group, 771 (0.6%) women. The age-adjusted OR for endometrial cancer was 2.58 (95%CI 2.37–2.81). After excluding the first year of follow-up, the age-adjusted OR was 0.76 (95%CI 0.63–0.92), indicating that endometrial cancer is most often found at time of histological diagnosis of endometriosis/adenomyosis. In around 20% of the endometrial cancer cases, the endometrial cancer was not recognized until after hysterectomy. Of these women, 35% had no prior (micro)curettage or biopsy. This study shows an increased incidence of endometrial cancer in women with histologically proven endometriosis and adenomyosis.

Frequency of Pornography Use and Sexual Health Outcomes in Sweden: Analysis of a National Probability Survey

Little is known about pornography use and its relationship with sexual health outcomes in the general population. To assess frequency of pornography use and the association of sexual health outcomes with frequent pornography use in Sweden. Cross-sectional analysis of 14,135 participants (6,169 men and 7,966 women) aged 16-84 years in a Swedish nationally representative survey from 2017. We used logistic regression to assess the association of sexual health outcomes with use of pornography ≥3 times/wk. Frequency of pornography use (never; less than once/mo to 3 times/mo; 1-2 times/wk; 3-5 times/wk; and daily or almost daily) and sexual health outcomes (eg, sexual satisfaction and sexual health problems). In total, 68.7% of men and 27.0% of women used pornography. Among men aged 16-24 years, 17.2% used pornography daily or almost daily, 24.7% used pornography 3-5 d/wk and 23.7% used pornography 1-2 d/wk. Among women aged 16-24 years, the proportions were 1.2% for daily or almost daily, 3.1% for 3-5 times/wk, and 8.6% for 1-2 times/wk. Frequency of pornography use decreased with age among both men and women. While 22.6% of all men and 15.4% of all women reported that their or a sex partner's pornography use predominantly had positive effects on their sex life, 4.7% of men and 4.0% of women reported that the effects were predominantly negative. Variables indicating sexual dissatisfaction and sexual health problems were associated with use of pornography ≥3 times/wk: for example, dissatisfaction with sex life (age-adjusted odds ratio [aOR]: men 2.90 [95% CI 2.40-3.51]; women 1.85 [95% CI 1.09-3.16]), not having sex in the preferred way (aOR: men 2.48 [95% CI 1.92-3.20]; women 3.59 [95% CI 2.00-6.42]) and erection problems (aOR: men 2.18 [95% CI 1.73-2.76]). While frequent pornography use is common, potential effects on sexual health outcomes are likely to differ between individuals. We used a large and recent nationally representative survey with detailed information regarding frequency of pornography use. The temporality of associations of sexual health variables with frequency of pornography use could not be assessed. In this analysis of a nationally representative survey in Sweden, we found that frequent pornography use was common among young men; that reporting predominantly positive effects of pornography use on the sex life was more common than reporting predominantly negative effects; and that sexual dissatisfaction and sexual health problems were associated with using pornography ≥3 times/wk.

Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload

Volume overload promotes pulmonary hypertension (PH) through pulmonary venous hypertension. However, PH with elevated pulmonary vascular resistance (hereafter PH-PVR) may develop in patients with diseases of volume overload, such as heart failure or chronic kidney disease (CKD). In such cases, volume management alone may be insufficient to slow PH progression. An accurate, noninvasive method to screen for PH-PVR in these diseases would facilitate early targeted therapy. We integrated invasive hemodynamic and echocardiography data collected from a single-center clinical cohort and identified patients with CKD or heart failure at the time of assessment. We applied penalized regression to derive a risk score of clinical parameters and echocardiography data associated with PH-PVR and categorized patients into low- (≤5 points), intermediate- (6-10 points), or high-risk (>10 points) groups. Using an internal validation strategy, we evaluated the ability of this risk score to predict PH-PVR and determined the association of this risk classification with 3-year all-cause mortality. Of 2422 patients, 42.4% had PH-PVR. In adjusted analyses, tricuspid regurgitant velocity, right ventricular function, BMI, heart rate, and hemoglobin most strongly associated with PH-PVR. The risk score significantly associated with PH-PVR (age-adjusted odds ratio 11.69 for the highest-risk group, 95% confidence interval [CI] 6.54-20.92). The high-risk group also associated with a significantly higher risk of 3-year all-cause mortality in adjusted analyses (hazard ratio 1.85, 95% CI 1.50-2.27). In conclusion, a noninvasive risk score derived from echocardiography and clinical parameters significantly associated with PH-PVR and all-cause mortality in a cohort of patients with CKD and heart failure.

Prognostic factors for tibiofemoral and patellofemoral osteoarthritis 32–37 years after anterior cruciate ligament injury managed with early surgical repair or rehabilitation alone

Explore prognostic factors for tibiofemoral (TFJ) and patellofemoral (PFJ) radiographic osteoarthritis (ROA) and 'symptoms plus ROA' (SOA), 32-37 years following anterior cruciate ligament (ACL) injury. Exploratory analysis, longitudinal cohort. In 1980-1985, 251 patients aged 15-40 years with acute ACL rupture were allocated to early augmented or non-augmented repair (5±4 days post-injury) plus rehabilitation, or rehabilitation alone. 127 of 190 participants who completed follow-up questionnaires were eligible. We classified ROA as TFJ/PFJ K&L Grade ≥2, and SOA as ROA plus pain and/or symptoms. Multivariable age-adjusted logistic regression investigated potential prognostic factors (assessed at 4±1 year follow-up: ACL treatment, isokinetic quadriceps/hamstrings strength, single-leg-hop for distance, knee flexion/extension deficit, knee laxity, Tegner Activity Scale, Lysholm Scale; sex, baseline meniscus status). 127 patients were aged 58±6 years; BMI 27±4kg/m2; 28% female; 59% had TFJ-ROA, 48% had TFJ-SOA (including n=9 knee-arthroplasties), 36% had PFJ-ROA; 27% had PFJ-SOA. Baseline meniscus surgery was a prognostic factor for TFJ-ROA (multivariable age-adjusted odds ratio (95% CI): 3.0 (1.2, 7.8)). A single-leg-hop limb symmetry index (LSI)<90% was a prognostic factor for PFJ-ROA (5.1 (1.4, 18.7)) and PFJ-SOA (4.9 (1.2, 19.7)). Hamstrings strength LSI <90% was a prognostic factor for PFJ-SOA (5.0 (1.3, 19.3)). ACL treatment with rehabilitation-alone was associated with an 80% reduction in the odds of PFJ-SOA (0.2 (0.1-0.7)), compared with early ACL-repair. These findings are hypothesis generating, research is needed to determine whether ACL-injured individuals with these characteristics benefit from interventions to prevent or delay the onset of osteoarthritis.

Heated tobacco product use and hypertensive disorders of pregnancy and low birth weight: analysis of a cross-sectional, web-based survey in Japan

ObjectivesKnowledge on the impact of heated tobacco product (HTP) use in pregnant women with associated maternal and neonatal risks for hypertensive disorders of pregnancy (HDP) and low birth weight (LBW)...

The impact of race on high-risk types of uterine cancer is modified in non-Hispanic Black and non-Hispanic White women with multiple malignancies

Objectives: To investigate racial differences in uterine cancer histology in non-Hispanic Back (NHB) and non-Hispanic White (NHW) women with one or more cancer diagnoses as an extension of prior studies that excluded cases with multiple malignancies. Download : Download high-res image (552KB) Download : Download full-size image Methods: Women in the 18-region Surveillance, Epidemiology and End Results registry with an invasive uterine cancer diagnosed between 1975 and 2015 as a first or second of multiple malignancies relative a single malignancy were evaluated. Median age at diagnosis was compared using Wilcoxon test. Proportions between histologic and racial groups were compared using Chi-square test. Age-adjusted odds ratio (AOR) and 95% confidence interval (CI) for each high-risk uterine cancer histology were calculated for NHBs vs NHWs. Results: There were 237,823 with an invasive uterine cancer including 177,869 as a single diagnosis, 29,594 as a first of multiple malignancies and 30,380 as a second of multiple malignancies. The distribution of NHBs by the setting of the uterine cancer diagnosis was 10.1% as a single malignancy, 6.7% as a first of multiple malignancies and 8.5% as second of multiple malignancies. The median age for the uterine cancer diagnosis in NHBs vs NHWs was 3 vs 5 years younger when identified as a single or first malignancy compared with as a second malignancy, respectively (Table 1). The proportion of both NHBs and NHWs with grade 3 endometrioid cancer, serous cancer and carcinosarcoma was consistently higher in both NHBs and NHWs when diagnosed as a second malignancy compared with a single or first malignancy (P Conclusions: Racial differences in uterine serous cancer, clear cell cancer, carcinosarcoma and leiomyosarcoma but not in grade 3 endometrioid cancer were smaller in women with a prior cancer diagnosis and may reflect the impact of factors including ancestral admixture, germline vs. somatic alterations, genetic modifiers, epigenetic regulators, exposure to prior cancer treatment, cancer screening and social health determinants.

To what extent is male excess risk of advanced colorectal neoplasms explained by known risk factors? Results from a large German screening population.

Colorectal cancer (CRC) incidence and prevalence of its precursors are substantially higher among males than among females in most countries but the reasons for the male excess risk are incompletely understood. We aimed to assess to what extent it is explained by known risk factors. Prevalence of advanced neoplasia (AN, ie, CRC or advanced adenoma) and CRC risk and preventive factors were ascertained among 15 985 participants of screening colonoscopy aged 55-79 years in Germany. Logistic regression was used to calculate odds ratios (ORs) for the association between male sex and AN with and without adjustment for known risk and preventive factors. In age-adjusted comparisons, men had 2-fold increased risk for AN compared to women (OR=1.98, 95% confidence interval [CI] 1.79-2.19). After comprehensive adjustment for medical, lifestyle and dietary factors, the OR was reduced to 1.52 (95% CI 1.30-1.77), suggesting that these factors accounted for 47% of male excess risk. Male excess risk increased from proximal colon to distal colon and rectum, with age-adjusted ORs (95% CI) of 1.63 (1.38-1.91), 2.13 (1.85-2.45) and 2.36 (1.95-2.85), respectively, and with the proportion of excess risk explained by covariates being lower for AN in the rectum (26%) than for AN in the proximal (52%) or distal colon (46%). Male excess risk was somewhat lower (age-adjusted OR 1.87) and explained excess risk was smaller (36%) when men were compared to women who never used hormone replacement therapy. In conclusion, most of the male excess risk and the potential to overcome it remain to be explored by further research.

Dyslipidaemia, carbohydrate metabolism disorders and arterial hypertension detected in academic employees during examinations in occupational medicine.

Many people have CVD risk factors without realising it and it is important to recognise the risk factors as soon as possible. Periodic examinations are a mandatory form of control for all employes in Poland. They provide an excellent opportunity to screen for the most common civilization diseases in the population. The aim of this study is to evaluate the prevalence of dyslipidaemia, hyperglycaemia and hypertension among academics in a Polish university, and to compare the results between postdoctoral fellows and other academics. The study group were postdoctoral fellows (HAB; N=135, 53 females) and other academics (NHAB; N=286, 179 females) over the age of 40 who reported for a periodic occupational medical check-up. Fasting blood samples were drawn, serum glucose, lipids and blood pressure (BP) were measured. The mean age was 56.7 (SD 9.8) in HAB and 49.8 (SD 8.1) in NHAB. Mean systolic BP and glycaemia were significantly higher in male HAB group than male NHAB (135.8 vs 130.9 mmHg and 6.0 vs 5.6 mmol/l, respectively). The relationship in females was non-significant. The age-adjusted odds ratios (OR [95% CI]) of having elevated low density lipoprotein cholesterol, total cholesterol, glucose and blood pressure in male HAB vs male NHAB were 0.61 [0.32. 1.16], 0.64 [0.33, 1.23], 1.52 [0.80, 2.88] and 2.11 [0.88, 5.23], and in female HAB vs female NHAB - 0.59 [0.31, 1.12], 0.64 [0.32, 1.26], 0.87 [0.40, 1.79] and 1.86 [0.70, 4.68], respectively. Adequately planned occupational medicine examinations provide an opportunity to diagnose dyslipidaemia, hyperglycaemia, or high BP in all groups of employees, including highly educated academics.

Smoking, Comorbidities, and Severity of Disease in Hospitalized COVID-19 Patients in Japan

Background: The aim of this study was to identify associations between smoking status and the severity of COVID-19 using a large-scale data registry of hospitalized COVID-19 patients in Japan (COVIREGI-JP) and to explore the reasons for the inconsistent results previously reported on this subject. Methods: The analysis included 17,702 COVID-19 inpatients aged 20-89 years (10,279 men and 7,423 women). We graded the severity of COVID-19 (grade 0 to 5) according to the most intensive treatment required during hospitalization. Associations of smoking status with severe grade 3/4/5 (invasive mechanical ventilation/extracorporeal membrane oxygenation/death) and separately with grade 5 (death) were analyzed using multiple logistic regression with grade 0 (no oxygen) as the control group. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI) adjusted for age and other factors considering the potential intermediate effects of comorbidities.Findings: Among men, former smoking significantly increased the risk of grade 3/4/5 and grade 5, with age-adjusted ORs (95% CI) of 1·50 (1·18-1·90) and 1·65 (1·23-2·21), respectively. An additional adjustment for comorbidities weakened these ORs to 1·29 (1·00-1·66) and 1.41 (1·01-1·95), respectively. Similar results were seen for women. Current smoking did not significantly increase the risk of grade 3/4/5 and grade 5 in either sex.Interpretation: Smoking cessation should be recommended even if the observed relationship between current smoking and the severity of COVID-19 is null because current smoking increases the risks of future comorbidities due to different diseases that increase the risk of severe COVID-19.Funding Information: This research was funded by the Health and Labour Sciences Research grant (19HA1003, 20CA2031) and the National Center for Global Health and Medicine (20A-3002).Declaration of Interests: All authors report no conflict of interest.Ethics Approval Statement: This study was approved by the National Center for Global Health and Medicine (NCGM) ethics review (NCGM-G-003494-0).

Reducing racial disparities in time to breast cancer diagnosis: Impact of immediate screening mammogram reads during the COVID pandemic.

6508 Background: During the COVID-19 pandemic, barriers to access screening mammography along with goals to reduce visits supported immediate reading of screening mammograms. Typically, screening mammograms are reported after patients have left the facility. If imaging is abnormal, then an additional visit is needed for diagnostic imaging, introducing delays and potential disparities .Thus, we implemented an immediate-read screening mammography program and measured its impact on racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram. Methods: Responding to the COVID-19 pandemic, we implemented an immediate read screening program in late May 2020. Patients were provided imaging results before discharge and if the exam was abnormal, efforts were made to perform diagnostic imaging during that visit. We identified consecutive screening mammograms performed weekdays 8:00am-4:30pm and Saturdays 9:00am-4:00pm pre-implementation (6/1/19-10/31/19) and post-implementation (6/1/2020-10/31/2020). Exams left unread while awaiting comparison studies, due to technical factors, or for more than 10 days were excluded. Patient demographics and time from screening exam completion to report finalized were obtained from the electronic medical record. Cancer detection rate (CDR), abnormal interpretation rate (AIR), and positive predictive value (PPV) were calculated. Multivariable linear and logistic regression models were used to compare time from screening exam to report, same-day diagnostic imaging, and screening performance metrics pre- and post-implementation overall and by patient subgroups. Results: After 963 exams met exclusion criteria, a total of 8,222 pre- and 7,235 post-implementation exams were included. Median time to report finalization decreased from 61minutes (interquartile range [IQR]:24, 152) to 4 minutes (IQR:2, 7) for pre- and post-implementation periods (p &lt; 0.001). During the pre-implementation period, non-white patients had lower odds of having same-day diagnostic imaging after an abnormal screening exam (age-adjusted odds ratio: 0.28; 95% CI: 0.10, 0.78 p = 0.015). There was no evidence of this disparity post-implementation. AIR was higher in the pre- versus post-implementation period (6.3% versus 5.0%; p &lt; 0.001). There was no evidence of a difference in CDR (5.8 versus 4.2 cancers/1,000 exams) and PPV (9.2% versus 8.4%) for pre- versus post-implementation periods. Conclusions: An immediate read screening mammography program reduces racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram, thus promoting equity in access to care.[Table: see text]

Sleep problems among children with Fetal Alcohol Spectrum Disorders (FASD)- an explorative study

BackgroundFetal alcohol spectrum disorders (FASD) is a group of conditions resulting from prenatal alcohol exposure (PAE). Patients with FASD experience a variety of neuropsychological symptoms resulting from central nervous system impairment. Little is known about sleep disorders associated with PAE. The objective of this study was to investigate sleep problems related to FASD.MethodsForty patients (median age 8 years (6; 11)) diagnosed with FASD and forty typically developing children (median age 10 years (8; 13)) were recruited for the 1st phase of the study. In the 1st phase, the screening of sleep problems was performed with Child Sleep Habit Questionnaire (CSHQ) filled in by a caregiver. Those of the FASD group who scored above 41 points were qualified to the 2nd phase of the study and had an in-lab attended polysomnography (PSG) performed. The measurements consisted of electroencephalogram, electrooculograms, chin and tibial electromyogram, electrocardiogram, ventilatory monitoring, breathing effort, pulse oximetry, snoring and body position. Their results were compared to PSG laboratory reference data.ResultsThe number of participants with sleep disturbances was markedly higher in the FASD group as compared to typically developing children (55% vs. 20%). The age-adjusted odds ratio for a positive result in CSHQ was 4.31 (95% CI: 1.54–12.11; p = 0.005) for FASD patients as compared to the control group. Significant differences between the FASD as compared to the typically developing children were observed in the following subscales: sleep onset delay, night wakings, parasomnias, sleep disordered breathing, and daytime sleepiness. Children from the FASD group who underwent PSG experienced more arousals during the sleep as compared with the PSG laboratory reference data. The respiratory indices in FASD group appear higher than previously published data from typically developing children.ConclusionThe results support the clinical observation that sleep disorders appear to be an important health problem in individuals with FASD. In particular distorted sleep architecture and apneic/hypopneic events need further attention.