Binomial Test Research Articles

Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007-2008 and 2018-2019.

We implemented two cross-sectional reproductive age mortality surveys in 2007-2008 and 2018-2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher's exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1-9.7)] and CRVS three times [RR 3.4 (2.4-4.7)] more likely to identify maternal deaths than health records in 2007-08. In 2018-19, CRVS [RR 0.8 (0.7-0.9)] and surveillance [RR 0.7 (0.6-0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2-1.5)]; CRVS [RR 1.3 (1.1-1.5)] and the community survey/surveillance [RR 1.4 (1.2-1.6)]. Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.

Assessment of Dental Students' Knowledge and Attitudes About the Epidemiologic and Clinical Characteristics of Oral Cancer: Implications for Other Middle-income Countries.

The stage of detection of head and neck cancer and the time between detection and treatment are critical to prognosis. The importance of the dentist in primary diagnosis and treatment planning has been emphasized. The purpose of this study was to evaluate the knowledge of dental students in the prevention and early diagnosis of oral cancer. A descriptive cross-sectional study was conducted on 199 students from different institutions. A self-administered questionnaire with 34 multiple-choice questions on clinical and epidemiologic knowledge and opinions about oral cancer was used. Descriptive analysis to show means and frequencies and the binomial logistic regression test were used to perform the statistical analysis. The confidence level used was 95%. The results showed that all students in the study had heard of the existence of oral cancer, but only 24.6% knew someone with the disease. The majority reported a lack of information in the population about prevention and self-examination, as well as a lack of information campaigns in institutions. Although the majority perform clinical examinations of the oral mucosa (73.4%) and refer patients with suspicious lesions to specialists, there is low confidence in performing biopsies (73.4%) and gaps in training during graduation (84.4%). The majority have never attended continuing education courses on oral cancer but show interest (97.5%). The study identifies deficiencies in the knowledge and practices of dental students and highlights the need for improved teaching and training to promote oral cancer prevention and early detection. Further research in this area and ongoing assessment of students' skills are suggested.

Statins have profound effects on the epicardial fat transcriptome

Abstract Background Epicardial adipose tissue (EAT) has direct contact with the myocardium, which enables a common microcirculation allowing bidirectional signaling between the tissues. It is possible that a change in the balance of protective and damaging mediators produced by EAT is a major driver for myocardial dysfunction. Notably, EAT volume and thickness associate with increased pro-inflammatory secretome and with coronary artery disease (CAD). Purpose This aim of this study was to analyze the total transcriptome in EAT and relate putative differences between patient groups to metabolic parameters as well as ongoing medications. Methods Between 2011 and 2016, 44 patients (mean age 68.0 years, 18.2% women) had a biopsy taken from the epicardial fat during coronoray by-pass surgery (CABG, n=36), or during elective aortic valvular replacement due to aortic stenosis (AVR, n=8). RNA from epicardial fat biopsis was extracted and sequenced. Differentially expressed genes were obtained by custom scripts that performed a negative binomial distribution test on effective counts. Multivariate regression analysis with orthogonal partial least-squares-discriminant analysis (OPLS-DA) was applied to extract and interpret the systematic variation in the resolved RNA sequencing profiles. To identify enrichment of biologically relevant functional gene sets, our data were entered in evidence-based network enrichment analysis (EviNet). Results The CABG surgery was performed approximately 7 days after an acute coronary event (75% acute MI), and 44% of them had previously known CAD. None of the AVR cases had significant CAD. At surgery, 97% of the CABG cases were prescribed statins, and 36% of them had statins alredy before the actual admission (long-term statin treatment). 63% of the AVR cases were on statins at admission. The OPLS analysis revealed only one medication with significant outcome, i.e., patients with long-term treatment with statins (n=18) versus patients without (n=26). Long-term statin treatment associated with down-regulated gene expression involved in beta-oxidation and triglyceride biosynthesis whereas gene expression involved in extracellular matrix organization were up-regulated. Gene expression involved in MHC class II presentation and interferon signalling were also reduced in patients with long-term treatment with statisn. A downregulation of genes in the interleukin- and complement cascade genes among CABG patient (versus AVR patients) without long-term statin treatment showed normal levels in statin pretreated patients. Conclusion Long-term statin treatment has a major influence on transcriptional regulation of genes involved in beta-oxidation, triglyceride biosynthesis, extracellular matrix composition, MHC class II presentation and interferon signalling in epicardial adipose tissue. These findings support important metabolic and immune effects of statins beyond the lipid-lowering function.

Exploratory Data Analyses Indicate an Overuse of Dietary Supplements among Male Gym Users in Germany

Background: Dietary supplements (DS) are very popular with the general population, physically active people and professional athletes are often taken without professional advice. Adverse effects on consumer health are increasingly being reported and there are concerns about overdoses of certain nutrients. There are initial indications that some groups of people have a higher affinity to DS than others. It appears that the type of sport and possibly gym membership could have an influence on consumer behaviour. Therefore, this study aimed to identify high consumer groups of DS among the general population in Germany. Methods: The consumption of DS was assessed using an online questionnaire including information about physical activity, gym membership and the consumption and intake doses of DS. Completed questionnaires were returned by 244 participants (m=153, f=91; 30.7±10.4 years SD). The answer options were valued, and subjects were categorized in low, average and high consumers (indicating overdosing). A configural frequency analysis was performed using the independent variables gender, gym membership, consumption. The configurations were tested with an exact binomial test and the p-value was corrected according to Bonferroni (0.05/12=0.0042). Results: Three significant configurations were found (p≤0.0042). The configuration, ‘male-gym member-average consumption’ as well as ‘male-gym member-high consumption’ were significantly overrepresented. Male gym members with low consumption behaviour were significantly underrepresented. Conclusion: This analysis suggests that male gym users in the German population have a higher risk of excessive DS consumption than other subgroups. Awareness campaigns regarding the risk of intake and overconsumption of DS can be targeted to high-risk groups. Due to the small sample size and the different types of fitness gyms, further studies are needed to make clearer statements and identify more precise risk groups.

Design of Bayesian evaluation test for missile damage effectiveness based on multiple damage level standards

The qualified missile damage effectiveness is an important guarantee for giving full play to combat effectiveness. In order to test whether the missile damage effectiveness meets the standard, it is particularly necessary to carry out damage effectiveness identification test research. In view of the limitation that the existing "single-shot damage probability" damage effectiveness quantitative characterization index is difficult to fully describe the missile damage effectiveness based on a single damage standard, considering the different damage level results formed by a single missile hitting the target, the damage effectiveness is characterized by the probability of occurrence of different damage level results. Missile identification from the perspective of multiple damage level standards is conducive to comprehensive inspection of missile damage effectiveness. In addition, in order to overcome the problem of insufficient information in small sample missile assembly tests, the Bayesian method is combined with the system contribution degree to fuse multi-source prior information in the identification test design, and a test scheme with full information utilization and controllable risks for both parties is designed. The example shows that compared with the quantitative characterization index of a single damage standard, this study can fully describe the missile damage effectiveness, and compared with the improved binomial distribution hypothesis test method, the superiority of this method is verified.

Variation in Relative Abundance of Small Mammal Species Caught in Two Different Ecosystems and Implicated in the Spread of Emerging Pathogens in Mali

Background: Small rodents and insectivores are potential reservoirs of many pathogens transmissible to humans, such as bacteria, parasites and viruses responsible for epidemics in sub-Saharan Africa, particularly in West Africa. Few studies on small mammal species in West Africa are available. Our previous findings from a study investigating emerging pathogens in two localities in Mali has determined the prevalence of pathogens in small mammals (rodents and insectivores). We used the data collected from this small mammal population with different eco-climatic characteristics to test hypothesis that small mammal distribution in different eco-climatic settings could explain the diversity and frequency of pathogens they carry. Methods: Sessions of trapping were carried out in December 2016 in Faladjè and Bougouni with “Besançon tous services” (BTS) wire mesh traps baited with peanut butter and/or onion. All animals captured were identified morphologically. Results: Out of 123 small rodents and insectivores captured over 674 trap-nights, 75 (60.97%) were from Faladjè and 48 (39.02%) from Bougouni. Of these, six species of small rodents belonged to the family Muridae (Mastomys erythroleucus, Mastomys natalensis, Rattus rattus, Praomys daltoni, Gerbilliscus gambianus, Taterillus gracilis) and two species of insectivores associated with the genus Crocidura spp. belonged to the family Soricidae and Erinaceidae (Crocidura cf olivieri and Atelerix cf albiventris), respectively. There is low species diversity within these two areas, but the variation in relative abundance is significant (binomial test, p ˂ 0.05) between Faladjè and Bougouni. Mastomys erythroleucus was the most dominant species (57.33%, 43/75) in Faladjè, while R. rattus dominated (37.5%,18/48) in Bougouni. Conclusions: These two species of small mammals potentially involved in the transmission of bacteria, parasites and pathogenic viruses to humans are differently present in two distinct eco-climatic areas in Mali.

Characterization of newborn gut microbiota according to the pre-gestational maternal nutritional status and delivery mode.

The aim of this study is to characterize the composition of the newborn gut microbiota based on the maternal pre-pregnancy nutritional status and the delivery mode. A biological sample was collected from the anal mucosa of the newborns between 24 and 48h after delivery, as it was not possible to collect a meconium sample at that time. A general data collection questionnaire was administered. The microbiome of the samples was analyzed by next-generation sequencing of the hypervariable regions v3-v4 of the 16S gene. Alpha diversity analyses were performed using the Observed Richness and Shannon diversity index metrics and Beta diversity analyses were conducted using Nonmetric multidimensional scaling with Weighted Unifrac, Differential abundance analysis was performed using a Negative Binomial Wald Test with maximum likelihood estimation for coefficients of Generalized Linear Models. Newborns of obese mothers exhibited lower alpha diversity compared to newborns of mothers with adequate BMI (body mass index). We observed variation in the composition of the microbial community in newborn stool samples, both from mothers with overweight/obesity and those with adequate pre-pregnancy BMI. We observed a visible correlation between the mode of delivery and the newborn's microbiota. We found variation in the overall composition of the microbial community in the stools of newborns, regardless of the delivery mode. The results of our study demonstrate differences in the microbiota of neonates born via cesarean section compared to those born vaginally as well as differences in newborns of mothers with overweight/obesity compared to those with an adequate pre-pregnancy BMI.

Exploring the gap between notified and diagnosed cases of Food-borne Diseases: evidence from a time-trend analysis in Italy.

Foodborne diseases are a major global public health concern, causing significant morbidity and mortality worldwide. The COVID-19 pandemic has had widespread effects on various aspects of life, including the food supply chain, potentially impacting the incidence of foodborne diseases. This study aims to analyze the differences between notified and diagnosed cases and investigate the potential impact of the COVID-19 pandemic on foodborne diseases in the metropolitan area of Bologna, Italy. A retrospective time trend analysis from two databases was conducted. The Local Health Authority of Bologna collected data re/Emilia-Romagna Region on the infectious disease reporting system over a six-year period (2017-2022), which included three years of the COVID-19 pandemic. This data was compared with information collected during the same period at the microbiology laboratory serving the entire metropolitan area of Bologna. Statistical methods included percent change calculations, binomial tests, annual averages, gender and age stratification, and trend analysis with regression. An increase (+34.4%, P-value ≤ 0.01) in notified cases during the pandemic - compared to the pre-pandemic period - was found. However, no differences were observed in diagnosed cases when comparing the two periods. The year 2021 saw a significant increase in reported cases of foodborne diseases among schoolers (+300.0%) and workers (+133.3%) compared to 2020. On the other hand, diagnosed cases decreased significantly in 2020 (-19.1%, P<0.01) and increased in 2021 (+21.9%, P<0.01). In absolute terms, a stark difference was observed between notified and diagnosed cases across all the study years (2017-2022). This study highlights the discrepancy between notified and diagnosed cases of foodborne diseases and how the COVID-19 pandemic has increased reporting without affecting transmission. These findings contribute to the ongoing discussion on improving foodborne disease reporting systems.

Satisfaction survey on graduates of standardised training for resident doctors in Guizhou Province, China

ObjectivesThis study aimed to investigate the satisfaction levels of graduate residents in Guizhou Province and analyse the factors influencing their satisfaction.MethodsA cross-sectional survey was conducted using a simple random sampling...

Racial representation in multicenter clinical trials leading to drug approvals for gynecological cancer indications by the US Food and Drug Administration (FDA).

66 Background: Enrollment disparities in gynecologic (Gyn) cancer clinical trials in the United States (US) are well-documented. However, there is limited data evaluating how recruitment sites in international clinical trials contribute to racial representation, specifically in Gyn cancers. Here, we examined racial enrollment and geographic location in clinical trials that have led to approval for Gyn cancer applications. Methods: Agents approved by the FDA for Gyn cancer treatment and corresponding clinical trials were identified from the FDA Drug Approvals and Databases. Enrollment data were abstracted from ClinicalTrials.gov then cross-checked with published manuscripts and FDA labels. Using Gyn disease site prevalence from the 2021 SEER database, we calculated expected enrollment proportions by race and compared these to actual clinical trial enrollment data. The binomial test was used to compare expected vs. observed proportions with White patients as the reference group. Results: From 2014 to 2024, 9 drugs received 22 FDA approvals for ovarian (n=13), endometrial (n=4), or cervical cancer (n=5). These approvals were based on 28 clinical trials enrolling a total of 13,763 patients (75.7% White, 3.4% Black, 12.0% Asian, 8.9% Other/Unknown). These trials included 1 (3.6%) US only study, 3 (10.7%) non-US, primarily Europe-based studies (PAOLA-1, AURELIA, STUDY42 [Europe + Australia]), and 24 (85.7%) international studies across the US and 46 other countries. Considering the distribution of race (White: 86.3%, Black: 8.4%, Asian: 4.9%) of Gyn cancers in the US, Black patients had lower enrollment (45% of expected enrollment) vs. White patients (95% of expected enrollment, P&lt;0.0001). African countries were rarely included among the recruitment sites. Two international trials reported patient recruitment from South Africa (3.2% Black, 6/188 patients, 38% of expected enrollment).However, Asian patients had higher enrollment (269% of expected enrollment, P&lt;0.0001) compared to White patients. In 13 trials that included study sites in East Asia, Asian patients comprised 16% of the trial population (1310/8205 patients; 327% of expected enrollment) vs. 3.2% in trials that did not open in Asia (n=15) (181/5558 patients; 67% of expected enrollment). Conclusions: Black patients were underrepresented in pivotal trials that led to FDA approvals for Gyn cancers. Overrepresentation of Asian patients was likely due to international enrollment from East Asia. Post-marketing retrospective studies or additional studies focused on underrepresented groups are needed to assess true drug efficacy and safety in US populations that are disproportionately affected by Gyn cancer mortality.

A Randomized Crossover Trial of Acceptability of Quadruple-Fortified Salt in Women and their Households in Southern India

BackgroundDouble-fortified salt (DFS; iron, iodine) improved iron status in randomized trials and was incorporated into India’s social safety net programs, suggesting opportunities to address other micronutrient deficiencies. ObjectivesTo evaluate acceptability of quadruple-fortified salt (QFS; iron, iodine, folic acid, vitamin B12) in women and their households, using a randomized crossover trial design and triangle tests. MethodsWomen 18-49y (n=77) and their households were randomized to receive QFS or DFS in a randomized crossover design over a 3-week period (week 1: QFS/DFS, 2: iodized salt, 3: DFS/QFS). Each week, participants completed a 9-point hedonic questionnaire (1=dislike extremely to 9=like extremely) to evaluate five sensory domains (color, odor, taste, texture, overall acceptability) of the intervention, and remaining salt was weighed using a digital scale. Triangle tests were conducted among women to evaluate sensory discrimination of salt consumed in rice dishes prepared using standardized recipes. Mixed models were used to examine hedonic ratings and salt use; salt type, sequence, and period were included as fixed effects, and household was included as a random effect. Binomial tests were used to evaluate sensory discrimination of salt type in triangle tests. ResultsMean hedonic ratings for most of the five sensory domains were ≥7 (like moderately) and did not differ by salt type (overall acceptability mean [SD]: QFS: 7.8 [0.7] vs. DFS: 7.7 [1.2]; p=0.68). Household salt use (weighed) did not differ by salt type. During the 3-week intervention period, weighed salt use and hedonic ratings significantly increased, indicating a period effect independent of salt type or sequence. In triangle tests, rice samples prepared with QFS, DFS, or iodized salt were not distinguishable. ConclusionAcceptability of QFS was high, based on individual hedonic ratings and weighed household salt use. Rice dishes prepared with DFS, QFS, and iodized salt were not distinguishable. Findings informed the design of a randomized trial of QFS in this population. Registration numbersNCT03853304 and REF/2019/03/024479.

Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis

BackgroundFalls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis. MethodsA retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (<60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival. ResultsOverall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (p < 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (p = 0.011). Among adults under 60, factors such as past alcohol history (p = 0.0276), falling alone (p = 0.0002), benzodiazepine use (p = 0.0001), antiarrhythmic/antihypertensive medication (p = 0.0005), and antipsychotics (p = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (p = 0.0112), muscle weakness (p = 0.0183), gait disorders (p = 0.0443), vasodilators (p = 0.0107), antihistamines (p = 0.0003), and hypoglycemic agents (p = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (p = 0.038). For the elderly, opioid use (p = 0.045) and muscle weakness (p = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (p = 0.0014). Although not significant in multivariate analysis, muscle weakness (p = 0.066) and opioid use (p = 0.0545) had proportional hazards of 1.37 and 1.12, respectively. ConclusionFemale sex indicated poorer prognosis in <60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare.

Comparative Analysis and Spatial Distribution of the Primary Health Care Centers and Health Manpower Across Saudi Arabia Using Shapiro-Wilk Test.

Due to the growing demand for better health services by the population pressure, Saudi Arabia is facing challenges in providing the required coverage in primary health care over all regions. The study aims to do a comparative analysis of the spatial distribution of the primary healthcare centers and health manpower across Saudi Arabia. This study deals with the analysis of the spatial distribution of the PHCCs and health manpower in Saudi Arabia regions during the period 2017-2021 by applying the Shapiro-Wilk test. This study relied on a dataset issued by the Ministry of Health (MoH). The variance of the spatial distribution of the dataset was also analyzed using the T-student and Binomial tests. This study found that PHCCs of 2020; the dentists of 2021; and Allied Health Personnel of 2017, 2020, and 2021 were normally distributed. However, the distribution of the population and all datasets of the other health indicators is a non-normal distribution. In addition, the correlation between the number of PHCCs and regions based on population is significant in all the regions. Moreover, The number of dentists showed a significant correlation with the population in most regions, except Riyadh, Makkah, and Jazan. However, the number of physicians, allied health personnel, nurses, and family medicine practitioners generally did not correlate significantly with the population, with exceptions for nurses in Tabuk and family medicine in the Northern Borders. Finally, the spatial distribution of the population shows the concentration in three major regions which are Riyadh, Makkah, and Eastern Province. Despite the expansion in the number of PHCCs and health workers and spread in all regions of Saudi Arabia, their spatial distribution still requires the establishment of more of them to provide the basic health services necessary to cover the actual needs of the population.

Prospective selective embedding of radical prostatectomy specimens is not inferior to full embedding regarding established and new prognostic parameters.

The histopathological examination of radical prostatectomy specimens is essential for assessing critical tumor characteristics, including stage, grade, and margins, all of which impact patient prognosis. However, the extent of embedding the prostate has long been a subject of debate, with some advocating partial/selective embedding and others favoring complete embedding. This study establishes a standardized and time-efficient protocol for processing radical prostatectomy specimens with limited embedding while maintaining diagnostic accuracy. Two hundred twenty-six prostatectomy specimens were analyzed, and the results of a highly standardized selective embedding protocol, systematically embedding the apex, the base, the transition to the seminal vesicles, and selected horizontal sections, were compared with full embedding as the gold standard. Non-inferiority testing was conducted by one-sided binomial tests and Pearson-Clopper confidence intervals. Selective embedding provided consistent and accurate diagnostic information with up to 90-98% concordance in pT, margins, ISUP-grade groups, and presence of IDC-P and cribriform tumor growth. In summary, this study establishes an economical standardized protocol for selective embedding of radical prostatectomy specimens with only minimal loss of information.

A five-year, multi-institutional mentorship program in radiation oncology: the Society for Women in Radiation Oncology experience: Short running title: SWRO Mentorship Program

BackgroundMentorship in the field of radiation oncology (RO) promotes career development and satisfaction. Many individuals, however, do not have access to mentorship or are unsatisfied with their mentorship experience, potentially due to insufficient gender-concordant mentorship opportunities. To address this, the Society for Women in Radiation Oncology (SWRO) created the SWRO Mentorship Program for women, gender minorities, and those with intersecting marginalized identities at all stages of training for physicians and medical physicists. We present the five-year experience of the largest multi-institutional mentorship program, to our knowledge, in RO. MethodsPublicly available information and the SWRO mentorship sign-up form were used. Descriptive statistics and binomial tests compared to reference points were conducted. ResultsBetween January 2018 and June 2023, 296 individuals from 19 countries participated in the mentorship program, generating 225 mentee-mentor pairs. The majority were female (89.2%), based in the United States (US; 84.8%), and on the physician-track (96.6%). The remainder of the analysis focused on US-based, physician-track participants (n = 244), the majority of whom were female (96.7%) and trainees (58.2%). Among those who have completed RO residency, most accepted a first job in academia (82.1%) and remained in academia at the time of the analysis (76.3%). A significantly higher proportion of SWRO mentorship participants compared to the reference point took a first job in academia (82.1% vs 58.3%; p<0.0001). The most common disease sites of focus for the physician-track trainees who finished residency are breast (50.4%), central nervous system (32.7%), and gynecologic malignancies (30.1%), with 54% listing more than one. The most common expressed goals of mentorship are research (35.8%), leadership (24.5%), and building connections within a specific geography or institution (19.2%). ConclusionsThe SWRO experience demonstrates the feasibility of a large-scale, multi-institutional mentorship program in RO.

Genome-wide association studies for pelvic organ prolapse in the Japanese population

Pelvic organ prolapse (POP) affects approximately 40% of elderly women, characterized by the descent of the pelvic organs into the vaginal cavity. Here we present the results of a genome-wide association study (GWAS) for susceptibility to POP comprising 771 cases and 76,625 controls in the Japanese population. We identified a significant association of WT1 locus with POP in the Japanese population; rs10742277; odds ratio (OR) = 1.48, 95% confidence interval (CI), 1.29–1.68, P = 6.72 × 10−9. Subsequent cross-ancestry GWAS meta-analysis combining the Japanese data and previously reported European data, including 28,857 cases and 622,916 controls, identified FGFR2 locus as a novel susceptibility locus to POP (rs7072877; OR = 1.06, 95% CI, 1.04–1.08, P = 4.11 × 10−8). We also observed consistent directions of the effects for 21 out of 24 European GWAS derived loci (binomial test P = 2.8 × 10−4), indicating that most of susceptibility loci for POP are shared across the Japanese and European populations.

STUDY OF SUPPRESSION OF HIV VIRAL LOAD AMONG PEOPLE RECEIVING ANTIRETROVIRAL THERAPY IN PALEMBANG CITY

Background: Suppression of viral load is a targeted strategy for the prevention of HIV transmission. Viral load (VL) testing can be done at all health centres in Palembang City with free services. Purpose: This study aims to evaluate VL suppression and factors associated with VL suppression. Methods: The study design of this research was a cross-sectional study with data analysis using the Chi-square and binomial logistic regression tests. The population in this study was all HIV patients who accessed health services for VL testing. Data sources were obtained from the HIV/AIDS Information System (SIHA) for the period 2023 - June 2024. Results: The majority of PLHIV cases were male (1072 people) (83%) and unmarried (802 people) (62.1%). The transmission group was male-sexual males, 54.88%, with an average age of 36.62 years. The results of multivariate analysis showed that there were three variables associated with viral load levels, namely age with a p-value &lt;0.03, AOR = 1.59 (95% CI: 1.04-2.43), ARV adherence with a p-value &lt; 0.00, AOR = 1.76 (95% CI: 1.18-2.61), and clinical stage with a p-value &lt; 0.04 AOR = 1.02 (95% CI: 1.02-2.07). Conclusion: Adherence to ART therapy, prevention of opportunistic infections, and early detection of clinical stage are predictors of successful viral load suppression. The role and responsibility of the community and the active participation of health workers in early detection, treatment and care are needed.

Analysis of Gender Discrepancies in Leadership Roles and Recognition Awards in the Child Neurology Society.

Gender disparities have been demonstrated across several medical specialties, including neurology. Although women have comprised most of the child neurology trainees since 2007, it is not apparent whether this demographic shift is reflected in the Child Neurology Society (CNS) awards and leadership. This study aimed to evaluate the differences in gender representation among leadership positions and award recipients within the CNS. The primary outcome measure was the total number of board of director (BOD) positions or awards given by gender each year. A retrospective review of publicly available data was conducted on CNS members, post-training award recipients, and BOD positions, including nomination records, from 1972 to 2023. Data abstracted were restricted to gender to preserve member and nominee anonymity. Gender identification and consensus were determined through a combination of strategies and study members. Data analysis included descriptive statistics, Pearson χ2 test, and the exact binomial test to compare gender proportions and the probability of being underrepresented in awards, leadership, and nominations over time. Data are presented according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. From 1972 to 2023, women represented 29% (44/152) of the BOD positions and 26% (61/236) of post-training award recipients presented by the CNS. Despite the increase in the proportion of women in child neurology, the overall gap in gender representation in leadership positions remains broadly stable. Only 13% (4/32) of CNS presidents have been women, a significant underrepresentation (95% CI 2.3%-52%, p < 0.004), although the representation of women in nonpresidential positions increased from 2003 to 2023. Women are also underrepresented as overall awardees (95% CI 12%-38%, p < 0.00001) except for the Philip R. Dodge Young Investigator Award, which is an investigator-initiated application. Women remain underrepresented at the highest levels of recognition in child neurology despite representing most of the field. Reasons for disparities are known to be multifactorial and likely include gender bias and structural sexism. We present several discussion topics that seek to rationalize this disparity and provide suggestions for improving diversity, equity, and inclusion for leadership roles and awards.

Shifting to an app-based method of preoperative templating in orthopaedic surgery.

Preoperative templating plays an important part in attaining successful surgical outcomes after fracture fixation. Traditionally, surgeons have performed this task with printed radiographs, tracing paper, and colored markers. Now that digital radiography is ubiquitous, and digital templating platforms are needed but are expensive and may not be available to all surgeons, especially those in low-income and middle-income countries. In this study, we evaluate an innovative and user-friendly method using a mobile app that may facilitate the use of digital templating for all surgeons worldwide. A study involving 2 groups of residents (N = 12) was conducted. Group A (n = 6) was assigned to do conventional templating; Group B (n = 6) was assigned to perform digital templating. Each group then switched to the other templating method and the process was repeated. Conventional templates were evaluated using the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation (AO-ASIF) guidelines of template completeness. Digital templates were assessed using Image-Based Surgery Planning. Each subject in both groups completed templates for 3 injury patterns: AO 2R2A3/2U2C2, 32B2, and 43C2. Wilcoxon signed-rank and binomial tests (5% level of significance) were used for statistical analysis. Template processing, fracture classification, and plan elaboration were comparable between the traditional and digital template groups, with good interobserver and intraobserver reproducibility using the Wilcoxon signed-ranks test (all |z values| below 1.96, all P-values > 0.05). There was no significant difference in the evaluation scores for either exercise, whether doing a traditional standard template or the digital template (P value > 0.05). This study shows that digital templating can achieve the same goals as conventional preoperative templating for fracture fixation. With the ubiquity of digital radiography, digital templating provides an opportunity to visualize fracture configurations and create an optimum preoperative plan for fracture reconstruction using an innovative and user-friendly platform.

Acceptability of CYLTEZO pen among biologics autoinjector patients, autoinjector Naïve patients, and healthcare professionals

ABSTRACT Background Cyltezo® (Adalimumab-adbm) is an FDA-approved interchangeable biosimilar for Humira® (adalimumab reference product [RP]) that helps treat chronic inflammatory conditions. Adalimumab-adbm is administered via an autoinjector, the adalimumab-adbm pen. This study assessed user opinions related to usability, perceptions, convenience, safety features, and acceptability of the adalimumab-adbm pen. Methods 98 Humira Pen users, 100 biologics pen naïve patients, and 99 health care professionals simulated use of the adalimumab-adbm pen on injection pads. Opinions were captured with a validated questionnaire using Likert-type scales during moderated interviews. Binomial tests were conducted for top-two ratings percentages. Results Nearly 90% of participants found the adalimumab-adbm pen ‘easy’ or ‘very easy’ to use, handle, and learn how to use. Almost 90% of volunteers thought the pen was ‘very’ or ‘extremely’ solid and convenient to use at home. Around 80% found the pen to be ‘very’ or ‘extremely’ comfortable. Over 90% of respondents said they would be ‘satisfied’ or ‘very satisfied’ with the safety features and the device itself. Nearly 90% of respondents indicated being ‘very’ or ‘extremely’ open to adopting the adalimumab-adbm pen. Conclusions The adalimumab-adbm pen provided users with a positive experience with features that benefit perceptions of usability, handling, safety, convenience, and acceptability.