Age Group Research Articles

Functioning in Older Adults: Prevalence and Implications for Policy and Digital Services

Abstract Background Actions maintaining and promoting functioning, and proactively preparing for the surge in demand for services in near future, are needed as the population is aging. Policy actions need to base on up-to-date picture of the situation. We examined the prevalence of limitations in different dimensions of functioning in the older population. Methods Data consisted of participants aged 75 years or older (n = 9,686) in the nationally representative Healthy Finland Survey in 2022. The questionnaire included questions on various aspects of functioning (physical, cognitive, psychosocial, need and use of help), quality of life, internet use and digital competence. Weighted prevalence of functional limitations by age (75-79, 80-84, 85-89, ≥90 years) was analyzed for men and women using logistic regression, sampling design and non-response acknowledged. Results Difficulties in most aspects of functioning increased rapidly with age. In ≥ 90-year-olds, one third experienced major difficulties in activities of daily living (vs. 4% in 75-79-year-olds), and 30% of men and 45% women aged 90 or over experienced major difficulties in getting out of their home (vs. 4% in 75-79-year-olds). The prevalence of loneliness doubled by age, from 9% in the youngest to 21% in oldest age group. The corresponding increase in psychological distress was from 9% to 15%. Need for help increased dramatically with age, but the unmet need among those needing help did not, being around 20% in all age groups. In ≥ 90-year-olds, 83% of men 92% of women reported little or no internet skills (vs. 40% in 75-79-year-olds), and 55% of men and 75% women did not use digital services at all, i.e. neither independently nor with help from others (vs. 25-28% in 75-79-year-olds). Conclusions Difficulties in functioning and need of help were common among the oldest age groups which underlines the urgency to ensure sufficient resources for elderly care. Key messages • While developing health and social care services, equal access to services must be ensured even for those not able to use digital services. • Functioning must be supported not only by measures aimed at the individual, but also by improving the environment so that people with a lower level of functioning can cope with their everyday lives.

COVID-19 vaccine effectiveness and hybrid immunity in the respiratory season of 2022-23 in Hungary

Abstract Background There has been an increase in COVID-19 vaccine hesitancy among the general population, accompanied by a decline in confidence that vaccines provide adequate protection. We estimated the effectiveness of the COVID-19 vaccines (CVE) and hybrid immunity against medically attended COVID-19 during the 2022-2023 respiratory season in Hungary. Methods We conducted a test-negative design study involving 68 GPs. Patients aged ≥18 years presenting with acute respiratory infection were swabbed. Cases and controls were patients testing positive and negative for SARS-CoV-2 by RT-PCR, respectively. Exposure was defined as having received at least one COVID-19 booster dose, taking into account the time since the last vaccination. CVE was estimated using logistic regression, adjusted for symptom onset date, age, chronic condition and sex. Results We included 247 cases and 1073 controls in the analysis. 196 samples were sequenced, and Omicron BA.5, BQ.1 and XBB.1 were the most frequent sub-variants. The CVE was 52.9% (95% CI: 15.2-73.9%), and 72.3% (95% CI: 32.0-88.7%) in the 18-59, and 60+-year-old population who received the final dose within the past year, respectively. Self-reported COVID-19 in the previous 60-365 days did not confer protection against reinfection, however, when combined with booster vaccination, it reduced the risk of COVID-19 by 63.0% (95% CI: −28.0-89.3%) and 87.6% (95% CI: 26.4-97.9%) among the 18-59 and 60+ age groups, respectively. Conclusions Booster vaccination within one year after the last dose confers significant protection against symptomatic infection, particularly among the elderly. Those who have previously been infected with SARS-CoV-2 may also benefit from booster vaccinations. Key messages • COVID-19 booster campaigns must be intensified, focusing mainly on the elderly. • Providing clear guidance on the timing and target groups of vaccination and emphasising the benefits of vaccination can help to achieve higher coverage.

Determinants of willingness to vaccinate against HPV among adults: an Italian cross-sectional study

Abstract Background In Italy, heterosexual males over the age of 18 do not participate in the free-of-charge HPV vaccine offer, nor do women over the age of 26, with regional differences; however, they can vaccinate for a fee. This survey aims to assess the vaccination readiness of the 18-40 year old population group, their perceived need with respect to the vaccine, and the determinants of the vaccination choice. Methods A questionnaire-based cross-sectional study targeting the general population in the 18-40 age group has been ongoing since March 2024. Recruitment occurs through social media and flyers. Demographic characteristics, social determinants, deprivation index by area via HAZ (health action zone) method (SR: -15;25), risk factors, main barriers to vaccination are assessed. Our main outcome is HPV vaccination willingness. People already vaccinated were excluded from the analysis. Descriptive and logistic regression analyses were performed with Jamovi. Results Our preliminary results included 159 individuals of whom 57.2% would like to receive HPV vaccine. The main characteristics of the sample were: median age 30 years (IQR:26.5;34), 47.2% female gender, median deprivation index 3.7 (IQR:-0.2;7.1), 75% working, 11.9% from the LGBTQ+ community. Regarding barriers, 31.9% rated fatigue in accessing the vaccine as significant, 10.4% feared a risk in receiving the vaccine. Among the people who did not want to vaccinate or did not know, 75% would do so by paying less than the normal amount, 21.6% if free, and 3.4% would not vaccinate anyway. Vaccination willingness was positively associated with female gender (OR:3.1; p = 0.026) and belonging to the LGBTQ+ community (OR:10.0; p:0.050) and negatively associated with working status (OR:0.19; p = 0.013). Conclusions Socioeconomic barriers appeared to play a significant role in the choice to vaccinate. Policies to reduce economic barriers could increase vaccination in an uncovered but still potentially sexually active population. Key messages • Coverage of HPV vaccine is not yet at optimal thresholds, yet people excluded from free vaccination programs could benefit from vaccination incentive policies. • Vaccination intention among heterosexual men is significantly lower than among women in the same age group, a symptom that there would still be room for awareness-raising interventions on the issue.

Occupational exposure to nickel or hexavalent chromium and the risk of lung cancer (SYNERGY)

Abstract Background Hexavalent chromium (Cr(VI)) and nickel (Ni) are known occupational carcinogens, with frequent exposures, for example, in welding-related activities. However, limited evidence exists on the exposure-response relationship of Cr(VI) or Ni with lung-cancer risk. We estimated lung-cancer risks based on quantitative indices of occupational exposure to each metal, and their interaction with smoking habits. Methods Fourteen case-control studies from Europe and Canada (16,901 cases, 20,965 control subjects) were pooled. A measurement-based job-exposure matrix was used to estimate year- and region-specific exposure levels for Cr(VI) and Ni, which were linked to the study subjects’ occupational histories. Odds ratios (OR) and 95% confidence intervals (CI) were calculated, adjusting for study, age group, smoking, and exposure to other occupational lung carcinogens. Results The OR for the highest quartile (>99.5 μg/m3-years) of cumulative exposure to Cr(VI) in men was 1.32 (95% CI 1.19-1.47) and for nickel (highest quartile >78.1 μg/m3-years) OR = 1.29 (95% CI 1.15-1.45). Corresponding effect estimates in women were slightly lower. The joint effects of Cr(VI) and nickel with smoking were generally greater than additive. Conclusions We observed positive exposure-response relationships in the low-dose range of Cr(VI) and Ni exposures, based on a large study population including detailed information on smoking habits and a measurement-based job-exposure matrix. Although, we cannot rule out a combined classical measurement and Berkson error structure that may have caused bias in our risk estimates, our results provide empirical evidence to further specify preventive measures at the workplace in order to protect workers from hazardous substances. Key messages • Relatively low cumulative levels of occupational exposure to Cr(VI) and Ni were associated with increased ORs for lung cancer, particularly in men. • Important empirical insights for the prevention of cancer at the workplace can be drawn from the results.

The efficacy of vaccination against respiratory syncytial virus across priority population subgroups

Abstract Background Respiratory syncytial virus (RSV) has recently become a vaccine-preventable disease as two vaccines have been approved for use and a third one is likely to become available by the end of the year. National Immunization Technical Advisory Groups as well as scientific societies across the world have issued recommendations on RSV vaccination that differ in respect to the identification of the target group. The latter has been identified in respect to age or underlying medical conditions mostly according to epidemiological data. In order to strengthen the evidence basis for future decisions, we performed a stratified meta-analysis of efficacy data considering all the three RSV vaccines currently or soon available. Methods We searched Randomized Controlled Trials (RCTs) assessing the efficacy of RSV vaccines in terms of reduction of RSV-related Lower Respiratory Tract Infection (LRTI). The research was conducted on PubMed and clinicaltrial.gov. The extraction of relevant data was stratified by pre-defined age groups (60-69, 70-79, 80+) and presence of underlying conditions increasing the risk for RSV. Results Three RCTs, one for each of the three vaccines, were considered for the quantitative analysis. Considering the overall 60+ population, the efficacy of RSV vaccines was 78% (95%CI 76-86%) in preventing LRTI. Considering the different age groups (60-69, 70-79, 80+), efficacy was respectively 72% (95%CI 53-84%), 90% (95%CI 66-97%) and 57% (95%CI 0-93%). The efficacy in healthy people and those with at least one underlying condition was similar, namely 77% (95%CI 60-87%) and 78% (95%CI 50-90%). Conclusions The available evidence shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups. Further studies may contribute to better understanding if the efficacy may change according to individual characteristics, that could be highly relevant in the decision-making process. Key messages • The available evidence from RCTs shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups. • National recommendations on RSV vaccination can be further informed for future studies investigating RSV vaccines efficacy across different subgroups.

How common is emergency department as a death place in Portugal and who is more likely to die there?

Abstract Background Most people would prefer to die at home but most die in hospitals or other healthcare settings. Some of the latter deaths may have taken place in Emergency Departments (EDs), as EDs are a major hospital gateway. However, EDs have not been consistently categorised as a place of death (PoD) across countries. Portugal is an exception. This study aimed to examine trends in deaths at EDs in Portugal from 2015 to 2021, identifying who is more likely to die at the ED. Methods We obtained national death certificate data on PoD for 2015 to 2021 from the the Portuguese General-Directorate for Health. We analysed the percentage of deaths taking place at the ED by sex, age group (0-17y, 18-49y, 50-69y, 70-79y, ≥80y), underlying cause of death (cancer, dementia, and other causes) and year of death. Results 804.971 people died in Portugal from 2015-2021 (50.1% male; 0.4% aged 0-17y, 58.0% aged ≥80y; 23.3% died from cancer, 5.6% from dementia, and 71.1% from other causes). Of these, 13.2% died at the ED. The percentage of ED deaths was higher in female (13.7% vs. 12.8% in male), in adults (13.3% vs. 9.0% in children), in those dying from dementia (15.7% compared to 9.6% in cancer and 14.3% in other causes). The percentage of ED deaths rose from 10.6% in 2015 to 14.3% in 2021, increasing steadily over time (average 0.6 percentual points per year, representing 1069 additional deaths per year). Conclusions One in every ten deaths in Portugal happens at ED and this is increasing. Patients with non-cancer conditions are more likely to die at the ED, in particular those dying from dementia. To understand if this reality compares with other countries, we are developing a pioneering international classification of place of death which includes the ED. Funding: European Research Council (agreement nr. 948609). Key messages • Emergency department (ED) is a significant PoD in Portugal and has increased from 10.6% to 14.3% (2015-2021). Non-cancer patients, especially those with dementia, more likely to die at ED. • This study highlights the need for an international place of death classification to compare emergency department death trends across countries.

Resilience and mental and physical health of higher and lower educated youth during COVID-19

Abstract Background COVID-19 had a considerable impact on the mental and physical health of youth. To limit the impact of this crisis on their health, resilience was required. This study aims to discover how resilient, in terms of mastery, emotional reactivity and social support, groups of youth with different SES were during COVID-19, and what risk and protective factors they experienced. Methods Two qualitative datasets were analyzed. One dataset included 10 interviews of university students during April-May 2020, and the other dataset included 8 interviews with pre-vocational secondary education adolescents during October 2021 to March 2022. Interviews were held in person or online. Data were analyzed with thematic analysis in Atlas.ti. Results In general, university students displayed resilience despite the tumultuous beginning of the pandemic, and their mental and physical health was positive. Protective factors that helped them during COVID-19 were spending time with friends and family, being healthy and having a healthy lifestyle, and being able to avoid stressful situations. Risk factors that impacted their resilience were loneliness, COVID-19 anxiety, and missing stability and routine. Adolescents receiving pre-vocational secondary education showed mixed resilience later in the COVID-19 period, and they made negative observations about their health. Protective factors that helped them were achieving good results in school, hobbies, and avoiding stressful situations. Risk factors they experienced were lack of motivation and having difficulties at school. They experienced worry about school progress during COVID-19. Conclusions University students and lower educated adolescents seemed to have differing resilience during the impactful stages of COVID-19, possibly due to differences in their psychological development. To protect their well-being, it is important that policy makers consider the protective and risk factors that impact the health of youth during crises. Key messages • Resilience differs among the two different age groups and education levels. • Policy makers should consider the protective and risk factors that impact the health of youth during crises.

Association of Dietary Vitamin C Intake with the Risk of Metabolic Syndrome Among Adults: NHANES 2007-2018.

Objectives: There has been discussion over the association between vitamin C intake and the risk of metabolic syndrome (MetS). This study examined the relationship between dietary vitamin C intake and the risk of MetS in a sizable adult American population. Methods: We examined the relationship between dietary vitamin C intake and the risk of MetS in 12,943 persons from the 2007 to 2018 National Health and Nutrition Examination Survey (NHANES). This association was then evaluated using logistic regression and restricted cubic spline models. Sex and age-based subgroup analyses were carried out. Results: According to the results of the multiple regression model, the risk of MetS was inversely correlated with dietary vitamin C intake, vitamin C intake derived from fruits and vegetables. The adjusted results (odds ratios with 95% confidence intervals) for the highest versus lowest tertile were 0.80 (0.68-0.93), 0.86 (0.75-0.98), and 0.80 (0.69-0.93). Subgroup analyses further showed that the negative correlation of dietary vitamin C intake with the risk of MetS was particularly pronounced among females, those in the 20-39 age group, and those in the ≥60 age group. The dose-response relationship's findings indicated that vitamin C from diet and fruits had a nonlinear correlation with the risk of MetS, whereas vitamin C from vegetables had a linear correlation. Conclusions: The risk of MetS in adult Americans was found to be negatively correlated with dietary vitamin C intake, particularly from fruits and vegetables.

Pertussis on the territory of Serbia in 2024 - challenges and opportunities for the future

Abstract Introduction Surveillance of pertussis in Serbia is passive surveillance and every 3 to 4 years an increased number of positive cases are registered in the population. The last quarter of 2023 and the first quarter of 2024 are characterized by an increased number of pertussis cases. Methods Descriptive study of cases with confirmed pertussis in the territory of the Republic of Serbia based on the evidence by the Public Health Service System of the Institute of Public Health of Serbia Results According to data from the Public Health Service System in the Republic of Serbia, a total of 1348 confirmed cases of pertussis were registered by the end of April 2024 (incidence rate 20.2 per 100,000 inhabitants). Conclusions The largest number of cases was registered in the age groups of people older than 20 years, that is, aged 10 to 14 years, while the highest age-specific incidence rate was recorded in the age group of infants younger than 12 months and in children aged 10 to 14 years. Of the total number of reported cases, 120 (8.9%) were hospitalized, with the largest number of those hospitalized being in the age group younger than 12 months (85, ie 70.8% of hospitalized cases). As for the territorial distribution, the largest number of pertussis cases in relation to the place of residence was reported from the territory of two districts, Južnobački District and the City of Belgrade, where the highest incidence rates were also registered. The postponement of timely vaccination against pertussis and the impossibility of vaccinating newborns up to 2 months of age have influenced the increase in the number of infected persons. Also, advanced PCR diagnostics during Covid and the possibility of applying PCR diagnostics in pertussis helped the timely diagnosis of pertussis. The introduction of vaccination with another dose of acellular pertussis vaccine and vaccination of pregnant women would be a desirable public health intervention to prevent pertussis infection. Key messages • Protection of the target population before starting school and at the age of 14 will contribute to stopping the occurrence of new cases of pertussis. These are public health challenges. • PCR diagnosis of pertussis influenced the timely diagnosis of this infection and the possibility of its adequate and timely treatment.

Consumers’ attitudes towards healthy eating: a qualitative comparison between older and younger Chinese consumers

PurposeUnhealthy diets are associated with an increased risk of non-communicable diseases and present a significant public health challenge. When developing effective interventions and policies, consideration must be given to the unique social culture in which food choice is embedded. Health vulnerabilities to poor nutrition exist throughout life but may be influenced by socio-cultural factors such as age. This study aimed to assess the attitudes of older or younger Chinese consumers towards healthy eating and explore the factors influencing their food choices.Design/methodology/approachSemi-structured interviews were conducted in Wuhan, China, with 20 consumers aged 18–25 (Group A) and 20 consumers aged 65 and over (Group B).FindingsThematic analysis revealed that the two groups had positive attitudes towards healthy eating, although Group A participants were more knowledgeable. Time pressure, food prices and social networks differentially influence healthy eating practices across age groups.Originality/valueGiven China’s economic and cultural context, healthy eating interventions should consider the individual characteristics and food preferences of the different age groups. This approach can optimize targeted healthy eating interventions, and media communications related to healthy eating.

The ventricular septal defect in tetralogy of Fallot: A multi-centre morphological and statistical shape analysis study

Abstract Background Ventricular septal defects (VSDs) in Tetralogy of Fallot (TOF) are often thought to be ‘large and unrestricted’ but experience suggests they have a more heterogenous morphology. Understanding the morphological variations and dimensions is the first step in modifying surgical closure or optimising potential device design. Purpose The objective of this study was to perform a comprehensive multi-center morphological analysis of the characteristics of the VSD in TOF. Additionally, we sought to perform a preliminary 2D shape analysis and principal component analysis (PCA) on standardised photos of the VSDs. Through this multi-dimensional approach, we aim to elucidate the morphological variations and structural characteristics of the VSD in TOF as a basis for future 3D shape analysis. Methods Of 495 specimens analysed, 460 were included in the morphological analysis. Standardised protocol was applied to assess the characteristics of the VSD: basic measurements of the height, width, inferior limb, and length of the inferior fibrous rim (if perimembranous) were taken and indexed to ventricular length. The degree of aortic override and presence of aorto-mitral continuity were also documented with double outlet right ventricle (DORV) being defined as more than 50% of aorta supported by the right ventricle. Statistical analysis was performed to assess variations in TOF morphology across different age groups and disease phenotypes. Standardised photographs of 130 VSDs were taken from the right ventricle and traced for PCA, in order to assess shape variations among the VSDs. Results Both the length of the inferior limb of the PM VSD and the length of the fibrous rim increased with ventricular length but the rate of change was lower for the fibrous rim. A chi-square analysis comparing the presence of double outlet right ventricle and the presence of a fibrous continuity between the aortic and mitral valves showed no association between these features (p = 0.89). The results of PCA in the indexed datasets showed that the largest variation was in the size of the VSD and then from the shape of the VSD where two distinct morphologies emerged: a classic V-shaped VSD and wide but shallow variant. Discussion Our study challenges conventional definitions and assumptions regarding the morphological characteristics of the VSD in TOF and suggests that components may change size at differing rates. Our study conclusively shows that DORV and TOF can co-exist and the definition of DORV should be made independently of the presence of aorto-mitral continuity. Contrary to the traditional view of TOF featuring large unrestricted VSDs, our findings suggest wide shallow VSDs are common. These findings challenge paradigms and underscore a necessity for the continuing morphological re-evaluation of TOF utilising large datasets with a diverse phenotypic spread.

Revealing Cultural Dynamics in WAIS-IV Performance: a Comparative Analysis of Age Cohorts in Taiwanese and U.S. Populations.

This study examined the relationship between culture and cognitive abilities by comparing WAIS-IV subtests, index scores, and Full-Scale Intelligence Quotient (FSIQ) scores across various age groups in the Taiwanese and U.S. populations. The Taiwanese and U.S. versions of WAIS-IV are comprehensively compared, examining subtest items, psychometrics, and sample characteristics. Scaled scores are compared by extracting raw scores with a scaled score of 10 from each subtest scale in the Taiwanese version and applying U.S. age norms to acquire U.S. scaled scores. Despite the mean FSIQ score closely aligning with the U.S. sample, notable discrepancies are evident in the Taiwanese Verbal Comprehension Index (VCI) score, potentially influenced by cultural fairness of the tests. Significant variations are observed among age cohorts in the Taiwanese sample, with younger individuals excelling in Processing Speed Index, Working Memory Index, Perceptual Reasoning Index, and FSIQ, while maintaining comparable VCI scores to their U.S. counterparts. Conversely, older cohorts demonstrate lower performance across various domains, except for visuospatial reasoning and organizational skills, compared to their U.S. counterparts. These subtest variations robustly correlate with educational disparities between the Taiwanese and U.S. samples. Despite the similarity in factor structures between the Taiwanese and U.S. versions of WAIS-IV, this study reveals cultural bias in both verbal and non-verbal subtests. The study highlights the intricate interplay among cognitive processing styles, cultural influences, and educational factors contributing to performance disparities.

Biomarker identification and risk assessment of cardiovascular disease based on untargeted metabolomics and machine learning

Cardiovascular disease (CVD) is the leading cause of mortality, disability, and healthcare costs, with a significant impact on the elderly and contributing to premature deaths across various age groups, including those below age 70. Despite decades of transformative discoveries and clinical efforts, the challenges of diagnosis, prevention, and treatment of CVD persist on a massive scale. This study aimed to unravel potential CVD-associated biomarkers and establish a machine learning model for the risk assessment of CVD. Untargeted metabolic assay with ultra-high performance liquid chromatography-tandem mass spectrometry and routine clinical biochemistry test were undertaken on the fasting venous blood specimens from 57 subjects. Four relevant clinical traits and 164 CVD-associated metabolites were identified, especially those related to glycerophospholipid metabolism and biosynthesis of unsaturated fatty acids. The machine learning model achieved from an integrated biomarker panel of palmitic amide, oleic acid, 138-pos (the 138th detected metabolomic feature in positive ion mode), phosphatidylcholine, linoleic acid, age, direct bilirubin, and inorganic phosphate, was able to improve the accuracy of CVD risk assessment up to a high satisfactory value of 0.91. The findings indicate that disorders in the metabolic processes of biological membranes and energy are significantly associated with increased risk of vascular damage in CVD patients. With machine learning methods, the pivotal metabolites and clinical biomarkers offer a promising potential for the efficient risk assessment and diagnosis of CVD.

Machine Learning powered Patient Records Analysis for Injury Monitoring in Children and Adolescents

Abstract Background Injuries to children and adolescents are common and are associated with individual suffering and costs. Switzerland lacks data of injuries in children and adolescents. This study investigates the feasibility of utilizing machine learning (ML) methodology to automatically extract relevant data from electronic pediatric patient records needed for monitoring and prevention purposes. Methods The feasibility study follows three steps. 1. Utility evaluation of text data from electronic pediatric patient records regarding ML, injury monitoring and prevention requirements in a test-sample. 2. The development of an ML-based approach to extract relevant information based on electronic pediatric patient records (N = 30’884) of children treated for injuries at the University Children’s Hospital Zurich emergency department between 2018-2022. 3. The performance of the ML methodology is evaluated. Results Qualitative and ML expert assessment of the sample showed that the desired data on injuries is contained in the test-sample and necessary requirements are met. Data records differ in detail with severe injuries providing especially rich information records. The international IDB code-tree was proved to be too elaborate and adult-orientated and was adapted. Preliminary data analyses indicate that the number of accidents is highest in the age group from 0 to 4 years (36%). More male (58%) children were treated. Majority of accidents were classified as less severe (73%), few (<1%) as very severe. Further lessons learned, along with more detailed prevalence data on injuries in children and adolescents, will be available by August 2024. Conclusions Extraction of injury information from electronic patient record by means of ML may provide valuable information for injury monitoring and prevention, so far missing in Switzerland. Prerequisites for the successful application of ML are digital record access, usable coding-tree, and detailed text input by the emergency departments. Key messages • An ML-based approach has the potential to improve the data basis by extracting valuable accidents information from existing texts of patient records. • To successfully apply this method, digital record access and detailed text data are needed.

Infertility in the Capital Region of Denmark: Prevalence and population characteristics

Abstract Background Infertility is a disease defined by failure to achieve a pregnancy within 12 months of trying. Infertility has-until now-not been monitored in Denmark for three decades. The aim of this study was to assess the prevalence of infertility in persons aged 25-44 years in the Capital Region of Denmark, and to describe characteristics of persons with infertility. Methods Life-long experience of infertility was assessed in the Danish Capital Region Health Survey 2021, including 56,245 participants from the general population aged ≥16 years (response rate 54.9%). In this study, only persons aged 25-44 years who had tried to have children (thus knowing their fertility) were included, resulting in 8,203 participants. Characteristics of persons with infertility were assessed using national registries (socio-demographics) and questionnaire data (health status). Descriptive analyses and multivariate logistic regression models weighted for survey design and non-response were performed. Results Among persons aged 25-44 years, who had tried to have children, 20% had experienced infertility. Among those, 44% did not achieve the children they wanted. Infertility was most common among women (22%) and persons aged 35-44 years (21%). No associations were observed between infertility and ethnicity, education, and employment status. Persons with infertility were more likely to have poor physical health, have higher level of stress symptoms and have obesity compared with persons in same age group, who had tried to have children but not experienced infertility. Conclusions Infertility is very common in the general population and is associated with unmet fertility desires as well as poor physical health and high stress level. These findings highlight the importance of focusing on and prioritizing treatment and prevention of infertility and emphasize the need for further research in and continued monitoring of infertility. Key messages • Infertility is very common in the general population and associated with unmet fertility desires and poor health highlighting the importance of prioritizing treatment and prevention of infertility. • Continuous monitoring of infertility in the general population is essential as well as further research into risk factors and consequences of infertility.

Social determinants and drivers of use of SARS-CoV-2 self-tests in a French national cohort study

Abstract Background Self-tests for SARS-CoV-2 became quickly available after the onset of the epidemic. They were especially recommended for high-risk and hard-to-reach populations. This study examines whether self-tests successfully reached vulnerable groups during first months of availability in France. Methods The EpiCov study is a national population-based cohort study conducted in France during the Covid-19 pandemic. Primary outcome variable was use of self-test at last SARS-CoV-2 test, among those who reported testing at least once between May-July 2021. Univariate and multivariate binomial weighted logistic regressions were run, stratified by age group (16-24 yrs, 25-59, 60+), to identify social determinants and drivers of use of self-tests. Results Overall, 11% of the population who tested for SARS-CoV-2 between May-July 2021 reported using a self-test as last test. Demographic factors were highly predictive of use of self-tests among 25-59 y/o, but not among younger and older age groups. Use of self-tests was highest among 16-24 y/o, people with higher education, lowest population density areas, and people with high overall frequency of testing. Use was lowest among 60+ y/o, unemployed and retired people, and first-generation immigrants. When stratifying by age, 16-24 y/o with high perceived Covid-19 risk were more likely to use self-tests (aOR 1.99, 95% CI 1.10-3.59). Among 25-59 y/o, in-person workers were more likely to use self-tests than remote workers (aOR 1.91 [1.20-3.05]). Among 60+ y/o, employed people were more likely than retired people (aOR 3.97 [2.30-6.85]). Conclusions With higher utilization in low population density areas and among frequent testers, convenience may be a primary driver of use of self-tests. Additional drivers include perceived risk among younger people and exposure at work for those ≥25 yrs. Inequities in use were observed, with lower use among people with low education, older age, and immigrants. Key messages • Use of self-tests in France during the Covid-19 pandemic was low among vulnerable population groups, including people with lower education, immigrants, and older individuals. • Drivers of use included geographical access to healthcare services, perception of risk among younger respondents, and exposure at work among adults aged ≥25 years.

Optimising liver screening in patients with a Fontan circulation: a cost-effective approach to detection of Fontan associated liver disease which enhances patient care

Abstract Introduction Patients with Fontan circulation, require screening for liver cirrhosis and malignancy, to which they are susceptible with time. Surveillance biopsies reveal nearly all adult Fontan patients develop asymptomatic fibrosis, and a majority have abnormal liver function tests (LFTs). This presents significant financial healthcare burden and psychological stress with testing for patients. Objective We aim to present "real-world" liver screening data, from a leading Adult Congenital Heart Disease (ACHD) centre, to propose a cost-reducing testing regimen, which delivers effective screening, while taking account of the challenges of current guidance, patient compliance, and clinical practice. Methods We analysed liver screening data for Fontan patients at a leading ACHD centre, focusing on biochemical tests (bilirubin, ALT, GGT) and imaging. We evaluated the 10-year financial impact of current practices, versus a hypothetical model based on age and risk factors, alongside biannual and annual screening strategies. Tariffs for biochemical test were provided by the local pathology service and we used NHS HRG tariffs for imaging and phlebotomy. Results We included data from 114 patients with a Fontan circulation (median age 32 range 19-56, 42% females). Eighteen patients developed liver cirrhosis diagnosed on imaging (median age 32, range 22-48). None developed hepatocellular carcinoma. A lack of clear and agreed local screening guidelines (over years) resulted in vastly different investigations for FALD, with inconsistent time intervals for testing. Bilirubin was elevated in 59% (55% in age 18-29), ALT was elevated in 41% (31% in age 18-29), GGT was elevated in 83% (80% in age 18-29). We found 3 cases of cirrhosis in the age group 18-29, all with hypoplastic left heart; 4 cases of cirrhosis in age group 30-34 - all had significant comorbidities; 33% had normal bilirubin, LFT and GGT, potentially not requiring further screening until the age of 35. Eleven patients (22%) age 35+ had confirmed cirrhosis (Figure 1). Performing full FALD screening with biochemistry and liver ultrasound every 12-24 months would increase the cost of screening three- to six-fold. We propose rationalising liver screening by age and underlying risk (Figure 2) to minimise the economic burden and equally the psychological impact of frequent testing on patients. Conclusions Our analysis underscores the necessity for an optimised liver screening protocol in Fontan patients, balancing diagnostic accuracy with cost-efficiency. By integrating this data, we have identified a pathway to streamline screening, tailoring it to individual risk profiles and age groups, thereby reducing unnecessary tests, lowering costs and reducing the impact of testing on patients. This approach not only fosters better patient care, but also provides a framework for developing clearer, cost-effective screening guidelines, to monitor liver health, in these complex CHD patients.

Obesity paradox exists in super elderly patients with heart failure

Abstract Background Aging and obesity are two global concerns in public health. As obesity is associated with several metabolic disorders, it is a well-known risk factor of heart failure (HF). However, several studies have suggested that obesity may have paradoxical survival benefits in patients with HF. Therefore, the aim of this study was to investigate whether the obesity paradox exists in super elderly patients with HF in Japan. Methods A total of 4,292 patients from our hospital HF registry were divided into four age subgroups: (A) less than 65, (B) elderly 65-74, (C) high elderly 75-84, (D) super elderly ≥85. The primary endpoint was the all-cause death within 1-year after discharge. Results At baseline, the proportion of men in each group was 42-76%, the mean left ventricular ejection fraction was 49-61%, the average of N-terminal pro-B-type natriuretic peptide was 1972-2944 pg/ml, and the mean body mass index (BMI) ranged 21-25 kg/m2. Patients with higher BMI were more common in the younger age group, while those with lower BMI were more common in the older age group. Cubic spline curves of Cox proportional hazard regression models demonstrated an inverse relationship between BMI and mortality (Fig. 1). Lower BMI was associated with higher all-cause mortality in all ages, although this association was attenuated at the young age, and pre-obesity (25–29.9 kg/m2) was associated with the greatest survival benefit. Meanwhile, the impact of underweight (<18.5 kg/m2) was stronger super elderly subjects, a one-unit increase in BMI was associated with a 10.3% decrease in the hazard ratio of death (P=0.021). Kaplan-Meier curves for all-cause mortality also showed that lower BMI was associated with higher all-cause mortality in all groups, and the differences were statistically significant in Groups B, C, and D (Fig. 2). Conclusion Our study suggested the existence of the obesity paradox among HF patients in super elderly. Mildly overweight may be beneficial at old age with HF.

Determinants of crimean-congo hemorrhagic fever (cchf) outbreaks: a retrospective analysis

Abstract Introduction Crimean-Congo Hemorrhagic Fever (CCHF), a viral tick-borne zoonotic disease with high mortality rates, poses a particular threat in Pakistan during religious event of Eid-ul-Azha as increased livestock contact. This study aims to analyze CCHF cases from three outbreaks, to identify transmission and disease patterns. Understanding these patterns can inform targeted interventions for future outbreaks. Methods A retrospective cross-sectional study was conducted to examine three CCHF outbreak investigations between July 2nd and August 12th, 2023 in Khyber Pakhtunkhwa, Pakistan. Multisectoral teams, including human and animal health departments, investigated these outbreaks. Data was collected through semi-structured case investigation tools. The healthcare providers, patients and family were subjects. During active case surveillance, 41 probable contacts were traced. Results Among positive cases, male predominance (71.4%) was observed. The highest proportion of cases occurred in the 15-29 year age group (42.9%, n = 6). Individuals involved in animal handling professions had the highest prevalence (50%, n = 7), followed by students (21.4%, n = 3). Common clinical manifestations included high-grade fever (100%), muscle pain (92.9%), and bleeding symptoms (85.7%), with 64.3% of cases reporting vomiting blood. The average recovery time was 7.1 days, while fatal cases had an average of 6.8 days from symptom onset to death. Recovery was observed in 64.3% of cases, with a mortality rate of 35.7%. Chi-square analysis showed significant associations between gender, occupation, and disease outcome (p < 0.05). Conclusions This study identified a higher risk of CCHF in males, young adults, and individuals involved in animal handling during outbreaks. Public health interventions targeting occupations, demographics, particularly education and protective measures for animal handlers during Eid-ul-Azha days, are crucial to mitigate future outbreaks Key messages • Young male adults, and individuals involved in animal handling are on greater risk of higher risk of CCHF infections in Khyber Pakhtunkhwa, Pakistan. • One Health community can leverage these findings to develop better prevention and control strategies through collaboration between human and animal health sectors.

Surveillance for adverse events following immunization in Hebei Province, China, 2018-2020

ABSTRACT The aim of this study was to analyze the incidence and characteristics of adverse events following immunization (AEFI) with post-licensure vaccines used in Hebei province from 2018 to 2020 and to evaluate the safety of vaccines. All information of AEFI was gained from national adverse event following immunization surveillance system (NAEFISS) in Hebei Province from 2018 to 2020. Descriptive epidemiology method was used to analyze the data about AEFI in Hebei province. Reporting rates of AEFI were calculated by sex, age, city, categories of AEFI, severity of AEFI, reaction categories, etc. A total of 35,999 AEFI were reported through NAEFISS, and the average annual rate was 47.64/100,000 doses. The reporting rates of common adverse reactions and rare adverse reactions were 46.37/100,000 doses and 1.05/100,000 doses. The male-to-female ratio was 1.26:1. Most of the AEFI were concentrated in the ≤1 year age group and were reported in the second quarter and third quarter. The majority of AEFI were reported to be recovered or improved, and about 62% of the AEFI occurred within 24 hours after vaccination. Vaccines associated with the highest reporting rate of AEFI were diphtheria, tetanus and acellular pertussis combined vaccine (DTaP, 170.45/100,000 doses). The reporting rate of allergic rash was found to be the highest in the adverse reactions (0.29/100,000 doses). The majority of AEFI cases were common adverse reactions, while serious rare adverse reactions caused by vaccines were extremely uncommon, and all vaccines used in Hebei Province were safe.