Estimate Odds Ratios Research Articles

Detection of postpartum women anemia and its impact on their offspring in Zhejiang Province, China

BackgroundInformation on the prevalence of postpartum women anemia is scarce in China, as well as its impact on their offspring. This study aimed to explore the influencing factors of anemia and the impact on the offspring.MethodsA cross-sectional study was conducted among 977 women within 2 years postpartum in 10 sites from 2016 to 2017 in Zhejiang Province, China. Information on demographics, nutrient supplementation and diet was collected. Whole blood hemoglobin, serum ferritin and transferrin receptor were assessed for all women and whole blood hemoglobin was assessed in offspring. The multivariate logistic regression was used to assess the determinants of anemia and the impact on the offspring by calculating odds ratio (OR) and its 95% confidence interval (95%CI).ResultsAmong 977 participants, 144 (14.74%) had anemia. Regression analysis showed that women intaking iron supplements during pregnancy (0.549, 0.350 ~ 0.860), and intaking sufficient red meat (0.647, 0.437 ~ 0.958) had lower rates of anemia, while women wo had anemia during pregnancy (2.754, 1.844 ~ 4.113 for mild anemia, and 3.815, 1.564 ~ 9.309 for moderate or severe anemia), had postpartum over 7 months (1.717, 1.112 ~ 2.650), with abnormal serum ferritin (11.931, 4.846 ~ 29.379) and excessive transferrin receptor levels (1.817, 1.050 ~ 3.145) had higher rates of anemia. Moreover, maternal anemia significantly increases the rate of anemia in offsprings, with ORs being 1.456 (0.994 ~ 2.133) for mild anemia, and 2.961 (1.242 ~ 7.058) for moderate or severe anemia, respectively.ConclusionThe status of anemia in postpartum women was severe and its impact on the anemia of their offspring should be noted. It is highly necessary to strengthen the regular monitoring of hemoglobin levels in pregnant and postpartum women, as well as implement targeted dietary interventions and suggest to intake dietary supplements if necessary.

Modeling Rollover Crash Risks: The Influence of Road Infrastructure and Traffic Stream Characteristics

Rollover crashes are among the most prevalent types of accidents in developing countries. Various factors may contribute to the occurrence of rollover crashes. However, limited studies have simultaneously investigated both traffic stream and road-related variables. For instance, the effects of T-intersection density, U-turns, roadside parking lots, the entry and exit ramps of side roads, as well as traffic stream characteristics (e.g., standard deviation of vehicle speeds, speed violations, presence or absence of speed cameras, and road surface deterioration) have not been thoroughly explored in previous research. Additionally, the simultaneous modeling of crash frequency and intensity remains underexplored. This study examines single-vehicle rollover crashes in Yazd Province, located in central Iran, as a case study and simultaneously evaluates all the variables. A dataset comprising three years of crash data (2015–2017) was collected and analyzed. A crash index was developed based on the weight of crash intensity, road type, road length (as dependent variables), and road infrastructure and traffic stream properties (as independent variables). Initially, the dataset was refined to determine the significance of explanatory variables on the crash index. Correlation analysis was conducted to assess the linear independence between variable pairs using the variance inflation factor (VIF). Subsequently, various models were compared based on goodness of fit (GOF) indicators and odds ratio (OR) calculations. The results indicated that among ten crash modeling techniques, namely, Poisson, negative binomial (NB), zero-truncated Poisson (ZTP), zero-truncated negative binomial (ZTNB), zero-inflated Poisson (ZIP), zero-inflated negative binomial (ZINB), fixed-effect Poisson (FEP), fixed-effect negative binomial (FENB), random-effect Poisson (REP), and random-effect negative binomial (RENB), the FENB model outperformed the others. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) values for the FENB model were 1305.7 and 1393.6, respectively, demonstrating its superior performance. The findings revealed a declining trend in the frequency and severity of rollover crashes.

Physical Activity and Eating Habits Are Related to Chronic Disease in the Basic Livelihood Security Program

Objectives: Chronic diseases are a significant public health issue, especially for socioeconomically vulnerable population groups. The purpose of this study is to compare the prevalence of chronic diseases in people receiving and not receiving BLS and to determine the prevalence of chronic diseases according to the physical activity and dietary habits of people receiving BLS. Methods: Data were derived from the sixth to ninth waves (2014–2022) of the Korea National Health and Nutrition Examination Survey (KNHANES), focusing on 15,041 participants aged 65 and older. Demographic characteristics, dietary intake, physical activity, and chronic disease status were assessed. Multivariate logistic regression analysis was used to calculate odds ratios for chronic diseases according to physical activity and dietary habits. Results: The BLS group exhibited higher prevalence rates of hypertension and diabetes, along with lower dietary intake of energy, protein, fat, carbohydrates, dietary fiber, and vitamin C, compared to the non-BLS group. A below-average intake of energy and carbohydrates was associated with increased odds of hypertension and diabetes, particularly in the BLS group. For dietary fiber, a significant association with diabetes was found only in the BLS group. Sedentary behavior exceeding 9 h per day was linked to higher odds of chronic diseases in both groups, with stronger associations in the BLS group. Limited walking frequency (less than 1 day per week) further exacerbated risks. Conclusions: BLS recipients demonstrated higher chronic disease prevalence, poorer dietary habits, and more sedentary behavior compared to non-recipients. The associations between lifestyle factors and chronic diseases were generally more substantial in the BLS group, suggesting the need for targeted interventions to improve dietary quality and physical activity patterns in this vulnerable population.

Differences between private and public primary health care centers and differences between men and women in antihypertensive care and cardiovascular prevention in all patients with hypertension treated in primary care in Stockholm County, Sweden

AimsTo study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).MethodsWe used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.ResultsIn total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24–2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06–1.29), physical activity 1.13 (1.06–1.17), unhealthy diet 1.08 (1.04–1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09–1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.ConclusionsThese findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

Associations between intake of different types of vegetables and metabolic dysfunction-associated fatty liver disease: a population-based study

BackgroundMetabolic dysfunction-associated fatty liver disease (MAFLD) presently poses a threat to approximately 24% of the global population. The consumption of healthy diets rich in an abundant assortment of vegetables has been scientifically validated to mitigate the progression of MAFLD. However, it remains uncertain whether all categories of vegetables confer benefits for MAFLD. The objective of this study is to investigate the impact of different types of vegetables on MAFLD, aiming to provide a scientific basis for developing more appropriate dietary recommendations for individuals at high risk of MAFLD.MethodsWe investigated the associations between various types of vegetable consumption and the risk of MAFLD, utilizing data sourced from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle. Employing multiple logistic regression and subgroup analyses, we estimated odds ratios (ORs) and 95% confidence intervals (CIs).ResultsOur analysis encompassed a total of 3162 participants. Remarkably, heightened intake of dark green vegetables demonstrated an innovative association with reduced odds of MAFLD (OR = 0.54; 95% CI: 0.36–0.81; p-value = 0.01), while other kinds of vegetable shown no significant association with MAFLD in the full adjusted model (all p-vale > 0.05). In the subgroup analysis, a prominent inverse correlation between the consumption of dark green vegetables and MAFLD was discerned among female and non-Hispanic white people with higher educational attainment.ConclusionsOur study conclusively demonstrates that a heightened intake of dark green vegetables is linked to diminished odds of MAFLD.

P0927 Surgery as a Treatment Option for CD: A Nationwide Cohort Study

Abstract Background Although surgery is often reserved for individuals with refractory Crohn’s disease (CD), recent data suggest that intestinal resection in select individuals may obviate the need for future CD-related treatment, particularly among older adults. Despite this, limited data characterizing these patients exist. Methods We performed a nationwide cohort study using the Swedish National Patient Register and the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort to identify all individuals who underwent a first CD-related intestinal resection between 2007-2018 (allows for five years of follow-up among all individuals). Intestinal resection for dysplasia and/or malignancy were excluded in order to identify those with ongoing CD-related disease activity. Our primary outcome was the need for an IBD-related treatment (medical therapy, surgery, and/or IBD-related hospitalization) within the five years following intestinal resection; subgroup analysis was performed among older adults. Univariable and multivariable logistic regression were used to calculate odds ratios (ORs). Results Overall, there were a total of 1,760 individuals included. The average age at surgery was 41.4 years, and the median duration of disease prior to resection was 0.5 years (IQR: 0.0-2.1 years). At 5-years, 341 (19.4%) of individuals did not require an IBD-related treatment; of those who required treatment, 2.3% had another intestinal resection, 15.8% had an IBD-related hospitalization, and the majority required corticosteroids, an immunomodulator, and/or an advanced therapy. On multivariable analysis, longer disease duration (aOR 1.07, 95%CI 1.01-1.15), the absence of COPD (suggesting no smoking: aOR 4.35, 95%CI 1.32-14.3), and being bio-naïve (aOR 2.97, 95%CI 1.11-8.00) prior to surgery increased the odds of remaining IBD-treatment/hospitalization free for 5-years post intestinal resection (Table 1). On subgroup analysis among adults ≥ 50 years-old (given data suggest this group may derive the most benefit from elective surgery), longer disease duration (aOR 1.10, 95%CI 1.00-1.22), as well as the absence of COPD (aOR 4.76, 95%CI 1.43-16.70) were associated with a higher odds of remaining IBD-treatment/hospitalization free. Conclusion Individuals with CD who have a longer disease duration, do not smoke, and are bio-naive, may be more likely to remain treatment free in the five years following intestinal resection; similar results were observed among older adults with CD. These data can help identify individuals in which surgery may obviate the need for future CD-therapy, though future studies should assess whether earlier surgery among these individuals can improve long-term clinical outcomes.

Sleep quality during pregnancy following assisted reproductive technology and natural conceiving: a prospective birth cohort study

PurposeTo investigate the association of sleep quality during pregnancy on in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) and natural conceiving (NC), as well as anxiety, depression, and perceived stress.MethodsThis prospective cohort study includes 500 infertile pregnant women undergoing IVF/ICSI and 678 NC women in a Sichuan birth cohort. Data on sleep, anxiety, depression, and stress was collected in the first trimester (T1), second trimester (T2), and third trimester (T3) using integrated questionnaires. Sleep quality is quantified by the Pittsburgh Sleep Quality Index (PSQI) with a cut-point of 5 indicating poor sleep. The Self-rating Anxiety Scale (SAS), the Center for Epidemiologic Study of Depression scale (CES-D), and the Perceived Stress scale (PSS) were used for assessing anxiety, depression, and perceived stress symptoms. Additionally, the matched husbands are surveyed. Multivariable logistic regression models with adjustments for influencing factors were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of sleep quality.ResultsIn the IVF/ICSI group, 61.1%, 55.5%, and 66.5% of participants in T1, T2, and T3 reported poorer sleep quality compared to the NC group, which had 43.2%, 37.4%, and 46.4% throughout the same trimesters. Additionally, the IVF/ICSI group exhibited higher levels of negative psychological factors as measured by the CES-D and PSS during T1 and T2, showing statistical significance in T1 (P = 0.008, P < 0.001) and T2 (P = 0.038, P < 0.001), except at T3 (P = 0.107, P = 0.253). In addition to psychological factors and IVF/ICSI treatment, poor sleep quality was also associated with advanced age. However, there was no significant difference in sleep quality between the husbands of the IVF/ICSI and NC groups.ConclusionThe study reveals that women receiving IVF/ICSI treatment are at a higher risk of experiencing sleep disturbances throughout their pregnancy compared with women with natural conception. While partners typically do not report major sleep problems, they do exhibit increased anxiety levels. These findings underscore the necessity for screening and addressing sleep issues in women pregnant through assisted IVF/ICSI treatment, to promote their well-being during this critical period.

P0991 Laparoscopic ileocecal resection in pediatric Crohn’s disease: effect of anastomotic configuration on postoperative outcomes in the era of biologic therapy

Abstract Background Postoperative complications and recurrence (POR) frequently follow Ileocecal resection (ICR) in pediatric Crohn’s disease (pCD) patients. Evidence addressing the effect of anastomosis type on complications and POR in children remains limited. We aimed to compare laparoscopic-assisted end-to-end (ETE), side-to-side (STS), and Kono-S anastomoses and evaluate their outcomes based on the followed parameters. Methods From April 2018 to December 2023, we prospectively collected data on anastomosis configuration, colonoscopy at 6 months post-surgery, perioperative and demographic parameters from all pediatric patients referred to ICR for pCD. Complications were classified according to the Clavien–Dindo classification (CDc). Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for endoscopic recurrence (ER), defined as Rutgeerts score >1. The ETE was set as the reference. Artificial Intelligence (AI) were not used in the production of this abstract. Results Thirty-eight patients (18 females, 47.4%) were included, 14 in ETE, 10 in STS, 14 in Kono-S. No preoperative differences were observed. Median surgery durations were 151 minutes for ETE, 142 for STS (p=0.78), and 169 for Kono-S (p=0.09). Complication rate did not significantly differ. Median hospitalisations were 6.5 days for ETE, 6 for STS (p=0.85), and 6 for Kono-S (p=0.70). Neither Kono-S nor STS showed a higher risk of ER compared to ETE, with OR=1.13 (95%CI=0.21-6.16) for STS and OR=0.41 (95%CI=0.09-1.87) for Kono-S. Conclusion Kono-S and STS anastomoses demonstrated comparable complication rates to ETE, without significantly prolonging hospitalization or operation duration. Neither type of anastomosis was associated with an increased risk of ER.

Association between hyperuricemia and dietary retinol intake in Southwest China: a cross-sectional study based on CHNS database

BackgroundHyperuricemia is increasingly common in Southwestern China and poses significant health risks, including gout and cardiovascular disease. Retinol intake has been hypothesized to affect uric acid levels, but this relationship remains unclear.MethodsData from 4,658 participants in the China Health and Nutrition Survey (CHNS) from 1991 to 2018 were analyzed. Dietary retinol intake was categorized using quantile-based methods, and hyperuricemia was identified as the primary outcome. Logistic regression models were used to estimate odds ratios and 95% confidence intervals, with analyses stratified by gender. Restricted cubic splines were utilized to evaluate the dose–response relationship.ResultsThe average age of participants was 40 ± 17.83 years, and 20.29% met the criteria for hyperuricemia. Logistic regression analysis identified a positive association between dietary retinol intake and hyperuricemia, with a more pronounced effect observed in men. The restricted cubic spline analysis revealed that the odds of hyperuricemia increased significantly when dietary retinol intake exceeded 3,538 IU/day for men and 4,504 IU/day for women.ConclusionHigh dietary retinol intake is associated with an increased risk of hyperuricemia, with a stronger association observed in males. These findings suggest that dietary retinol intake under recommendation levels might be necessary to prevent hyperuricemia-related adverse health outcomes.

Prevalence and Determinants of Fever, Acute Respiratory Infections, and Diarrhea among Children in Bangladesh

Background: Childhood illnesses, including fever, acute respiratory infections (ARI), and diarrhea, remain leading causes of morbidity and mortality among children under five in low- and middle-income countries like Bangladesh. These conditions are influenced by socioeconomic, environmental, and behavioral factors, necessitating a comprehensive understanding of their prevalence and determinants to inform public health strategies. Objective: This study aims to determine the prevalence and associated demographic, socioeconomic, and environmental factors for fever, ARIs, and diarrhea among children under five in Bangladesh, thereby providing insights for targeted interventions. Methodology: Utilizing data from the Bangladesh Demographic and Health Survey (BDHS) 2017–18, this cross-sectional study examined a weighted sample of 8,421 children under five. Variables including demographics, socioeconomic status, and health-related factors were analyzed. Prevalence of fever, ARI, and diarrhea was recorded, with logistic regression models estimating odds ratios to identify associations between childhood illnesses and selected predictors. Results: Among children aged 0–59 months, boys exhibited a higher prevalence of fever and ARI compared to girls. Children younger than 12 months showed the highest rates of all three illnesses, particularly ARI. Breastfeeding status, maternal age, and socioeconomic factors (e.g., parental education, wealth index) significantly influenced illness prevalence. Additionally, safe water access and sanitation were linked to lower fever and ARI prevalence. Vaccination status was also associated with illness patterns, highlighting complex health disparities. Conclusion: The study identifies critical factors affecting the prevalence of fever, ARI, and diarrhea in children, emphasizing the need for interventions addressing environmental and socioeconomic risks. Improved water, sanitation, vaccination coverage, and healthcare access are recommended to reduce disease burden among children in Bangladesh.

Ivermectin vs moxidectin for treating Strongyloides stercoralis infection: a systematic review.

The aim was to assess the efficacy of ivermectin vs moxidectin for treating Strongyloides stercoralis infection. Ovid MEDLINE, Embase and Web of Science databases were searched for studies comparing ivermectin and moxidectin from inception to February 2024. The outcomes: elimination of infection or parasitological cure, mortality and serious adverse events. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data. Heterogeneity was assessed using Chi2 test for statistical heterogeneity and results of the I2 statistic. Two trials met the inclusion criteria that included 821 adult participants. Both studies were conducted in southeast Asia (Cambodia and Laos). Neither trial included immunocompromised patients. The mean age of the participants ranged from 40 to 45 years old, with a similar distribution of males and females. For all participants, S. stercoralis infection was confirmed by Baermann method. The evidence was moderate for parasitological cure rate. Certainty was downgraded by 1 level because of imprecision. Moxidectin was not inferior to ivermectin: OR 0.67, 95% CI 0.36–1.25 (P = 0.21), I2 = 0%, 821 participants. No deaths were reported in either trial. One trial reported mild adverse events. In total, 153/726 (21%) participants had an adverse event. The most reported symptoms were abdominal pain and headache. There is evidence for moderate quality that moxidectin is non-inferior to, and as safe as ivermectin; however, more high-quality and well-designed trials are needed. For patients with some underlying immunosuppressive disorder, or in patients who are very young or very old, current data are insufficient to be recommended.

Sex and Cardiac Operations: Are We Being Fair to Our Female Patients?

Research suggests that although men have a higher cardiovascular disease (CVD) rate, women with CVD are more likely to experience a poorer prognosis, possibly owing to incorrect diagnosis and poorer treatment. A question not yet addressed is whether some of this inequality could be due to sex bias when selecting patients for operation. The participants were from the Scottish Heart Health Extended Cohort who had been admitted to hospital with a cardiovascular diagnosis over the study period. Participants were recruited between 1984 and 1995 and followed up until 2017. Using propensity score nearest neighbour matching, women were matched 1:1 with men on year of birth, year and reason of admission, smoking status, previous cardiovascular disease (CVD), and family history of CVD. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. After matching, 19,960 admissions (50% women) to hospital for cardiac reasons were available for analysis. Women were less likely to have a cardiac intervention, that is (endovascular or surgical revascularisation), after admission for any cardiovascular reason (6.83% of men, 2.84% of women; odds ratio [OR] 0.56; 95% confidence intervals [CIs] 0.42-0.75), or admission for cardiac ischaemia only (11.07% of men; 6.09% of women; OR 0.52; 95% CI 0.37-0.74). The sex difference was more pronounced in the early part of the study but persisted in the latter phase. In this matched study of cardiovascular admissions to Scottish hospitals, women were less likely to be recommended for a surgical procedure, even when matched with men for common CVD risk factors.

Association between edaravone use and activities of daily living in older patients with atherothrombotic stroke: an observational study using Japanese real-world data

BackgroundEdaravone is marketed in nine countries, although only Japan has approved edaravone for improvement of neurological symptom, disability of activities of daily living (ADL), and functional disability associated with acute stroke. This study aimed to elucidate the association of edaravone use with ADL using real-world data of older patients with atherothrombotic stroke.MethodsThis retrospective observational research using the Medical Data Vision database in Japan included patients aged 65 years and older who had acute ischemic stroke of the atherothrombotic subtype. Primary outcome was ADL improvement defined as change in Barthel Index from admission to discharge of greater than zero points. The major secondary outcome was good functional outcome (Barthel Index ≥ 90 or modified Rankin Scale 0–2 at discharge). Multivariate logistic regression analyses were conducted to calculate odds ratios with 95% confidence intervals for the outcomes. We further compared the change in Barthel Index from admission to discharge and in-hospital death rate between the edaravone- and non-edaravone- treated patients.ResultsA total of 5,576 patients were included in this study, and were divided into edaravone group (n = 3,825) and non-edaravone group (n = 1,751). The median age of this cohort was 79 years, and median Barthel Index at admission was 30 points. Edaravone use was associated with improved ADL with an adjusted odds ratio of 1.18 (95% confidence interval: 1.01‒1.37). However, no significant association was observed between edaravone use and good functional outcome. The edaravone group had significantly greater change in Barthel Index from admission to discharge than the non-edaravone group, with a difference of 5 points. The in-hospital death rate was comparable between the two groups.ConclusionsEdaravone use may contribute to improve ADL at discharge in patients aged 65 years and older with atherothrombotic stroke.

Genetic Variants and Lifestyle Factors in Androgenetic Alopecia Patients: A Case-Control Study of Single Nucleotide Polymorphisms and Their Contribution to Baldness Risk.

We conducted a study to investigate the role of specific allelic variants in AGA controlling for nutritional and lifestyle factors. Individual patterns of SNPs present in the baldness susceptibility locus at 20p11 (rs1160312 and rs6113491) or close to the androgen receptor (AR) gene in chromosome X (rs1041668) were investigated in 212 male subjects. Information on socio-demographic characteristics, medical history, smoking, and diet was also collected. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). After controlling for age, diet, BMI, family history of AGA, and smoking, an increased risk of AGA was found for subjects with [A] alleles for both rs1160312 (OR: 2.97; 95% CI: 1.34-6.62) and rs6113491 (OR: 2.99; 95% CI: 1.37-6.52), and for subjects with the TT genotype for rs1041668 (OR: 4.47; 95% CI: 1.60-12.5). Multivariate logistic regression indicates that diet, familiarity, and BMI, but not smoking, remain statistically significant despite the different SNP genotypes. To our knowledge, this is the first indication that the rs1160312, rs6113491, and rs1041668 polymorphisms are independent risk factors for AGA that can be modulated by diet.

Long-acting, progestin-based contraceptives and risk of breast, gynecological, and other cancers.

Use of long-acting, reversible contraceptives has increased over the past 20 years, but an understanding of how they could influence cancer risk is limited. We conducted a nested case-control study among a national cohort of Australian women (n = 176601 diagnosed with cancer between 2004 and 2013; 882999 matched control individuals) to investigate the associations between the levonorgestrel intrauterine system, etonogestrel implants, depot-medroxyprogesterone acetate and cancer risk and compared these results with the oral contraceptive pill. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). Levonorgestrel intrauterine system and etonogestrel implant use was associated with breast cancer risk (OR = 1.26, 95% CI = 1.21 to 1.31, and OR = 1.24, 95% CI = 1.17 to 1.32, respectively), but depot-medroxyprogesterone acetate was not, except when used for 5 or more years (OR = 1.23, 95% CI = 0.95 to 1.59). Reduced risks were seen for levonorgestrel intrauterine system (≥1 years of use) in endometrial cancer (OR = 0.80, 95% CI = 0.65 to 0.99), ovarian cancer (OR = 0.71, 95% CI = 0.57 to 0.88), and cervical cancer (OR = 0.62, 95% CI = 0.51 to 0.75); for etonogestrel implant in endometrial cancer (OR = 0.21, 95% CI = 0.13 to 0.34) and ovarian cancer (OR = 0.76, 95% CI = 0.57 to 1.02); and for depot-medroxyprogesterone acetate in endometrial cancer (OR = 0.21, 95% CI = 0.13 to 0.34). Although levonorgestrel intrauterine system, etonogestrel implant and depot-medroxyprogesterone acetate were all associated with increased cancer risk overall, for etonogestrel implant, the risk returned to baseline after cessation, similar to the oral contraceptive pill. We were unable to adjust for all potential confounders, but sensitivity analyses suggested that adjusting for parity, smoking, and obesity would not have materially changed our findings. Long-acting, reversible contraceptives have similar cancer associations to the oral contraceptive pill (reduced endometrial and ovarian cancer risks and short-term increased breast cancer risk). This information may be helpful to women and their physicians when discussing contraception options.

Trends in the levels, causes, and risk factors of maternal mortality in Pakistan: A comparative analysis of national surveys of 2007 and 2019.

Maternal mortality ratio (MMR) has decreased worldwide but Pakistan is still striving towards achieving the SDG targets for maternal health. This study highlights the trends in maternal mortality levels and risk factors in Pakistan between 2007 and 2019. This study compares the results of secondary data analysis of the Pakistan Maternal Mortality Survey 2019 with the Pakistan Demographic and Health Survey 2007. A nested case-control study was carved to compare maternal deaths with the women who survived a pregnancy, in the same sampling clusters during the same period. Logistic regression was used to estimate odds ratios (OR) for major risk factors of maternal mortality after adjusting for the women's age, parity, education, and wealth quintile. In 2019, Pakistan's MMR was 186 per 100,000 live births, registering a 33% decline from 2007 (rural 42% vs. urban 11%). The leading causes of maternal mortality were postpartum hemorrhage, hypertensive disease of pregnancy, postpartum infection, and post-abortion complications. Women > 35 years and those expecting their first child were more likely to die from childbirth, while those who had ever used family planning had a lower risk according to the data for both years. In 2007, a distance of > 40 kilometers to a hospital significantly increased the risk of mortality but this association was not significant in 2019. In 2019, women who died were more likely to receive antenatal care than those who survived (adjusted OR 9.3); this association was not significant in 2007. The modest reduction in MMR can be attributed to improved access to maternal health services in rural areas with increased antenatal care and institutional deliveries. However, most maternal deaths were caused by poor accessibility to quality emergency obstetric care. Lack of family planning remains a major risk factor for high maternal mortality in Pakistan.

Comparative Efficacy of Lebrikizumab, Dupilumab, and Tralokinumab in Maintaining Treatment Response in Atopic Dermatitis at Varying Treatment Continuance Rates

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant impacts on quality of life. Despite the effectiveness of biologics for moderate to severe AD, long-term treatment adherence can be challenging in clinical practice. This study introduces the “durability index” as a novel estimate of the maintenance of therapeutic effect under varying treatment continuance rates. Methods: A population-adjusted indirect comparison of placebo-controlled phase 3 trials of dupilumab 300 mg QW/Q2W (SOLO 1, SOLO 2, and SOLO CONTINUE), tralokinumab 300 mg Q2W (ECZTRA1 and ECZTRA 2), and lebrikizumab 250 mg Q4W (ADvocate1 and ADvocate2) was conducted. In these trials, patients who responded at week 16 (IGA 0/1 or EASI 75) were re-randomized to either continue treatment or switch to treatment withdrawal (placebo) until week 52. The durability index was developed to estimate drug performance at varying treatment continuance rates between 100% to 0% on-treatment. Unanchored simulated treatment comparison (STC) was used to estimate odds ratios (OR) adjusting for baseline covariates. Results: For IGA 0/1, patients receiving lebrikizumab had statistically significantly better odds of maintaining response at week 52 than those on dupilumab for all treatment continuance rates, ranging from 1.730 (p = 0.044) at 100% to 4.690 (p < 0.001) at 0%. ORs comparing lebrikizumab to tralokinumab ranged from 1.787 at 100% continuance to 1.516 at 0%, with significant results favoring continuance rates between 39.5% and 96.9%. For EASI 75, week-52 durability at 100% continuance was non-significantly different between lebrikizumab and dupilumab (OR 0.687, p = 0.183); however, ORs increased in favor of lebrikizumab at lower treatment continuance rates, reaching significance from 64.2% (OR 1.454, p = 0.05) to 0% (OR 3.235, p < 0.001) continuance. ORs comparing lebrikizumab to tralokinumab ranged from 2.132 at 100% to 3.891 at 0% continuance, with significant results favoring lebrikizumab for all treatment continuance rates. ORs comparing dupilumab and tralokinumab showed varying results: tralokinumab was favored for IGA 0/1 at lower continuance rates, while dupilumab was favored for EASI 75 at higher continuance rates. Conclusions: In this indirect comparative analysis, lebrikizumab had treatment response rates that were comparable to or better than dupilumab and tralokinumab, regardless of treatment continuance rates. This finding suggests that lebrikizumab may offer a more effective long-term management option for AD. This analysis was funded by Eli Lilly and Company.

A comparison of risk factors for canine leptospirosis and seropositivity in New South Wales, Australia.

This study aimed to identify and compare risk factors associated with canine leptospirosis and Leptospira seropositivity in New South Wales, Australia. Seventy-nine canine cases of confirmed leptospirosis (clinical cases) and 16 healthy dogs seropositive to Leptospira (seropositive cases) were included in the study; these were separately compared to 394 healthy dogs seronegative to Leptospira (controls) in at-risk areas. A questionnaire investigated rat contact, stagnant water, dog park access and household number of dogs and cats. Associations between these factors, signalment and risk of leptospirosis or Leptospira seropositivity were screened using Pearson Chi-Square test and logistic regression was used to estimate odds ratios of association. Significantly associated with both leptospirosis risk and seropositivity risk was rat contact (P < 0.01) which increased the risk 4.3- and 4.5-fold, respectively. Other factors significantly associated with leptospirosis risk were breed (P < 0.01) and age (P < 0.01). Being a herding dog or Terrier increased leptospirosis risk 27.2-fold and 8-fold, respectively and being a young adult dog increased leptospirosis risk 3.9-fold. Frequenting dog parks decreased leptospirosis risk (OR 0.12). In contrast, no other significant risk factors were identified for seropositivity risk. Exposure to Leptospira through contact with reservoir hosts resulted in seropositivity as well as clinical leptospirosis. However, host factors like breed and age seem to be important factors in determining if exposure results in clinical disease. Increased urbanisation and landscape fragmentation could result in increased exposure to reservoir hosts. Environmental sampling is needed to identify sources of infection. Risk mitigation includes reducing contact with reservoir hosts and contaminated environments and increased pest control.

Exposome-wide association study of cognitive function in US older adults using the NHANES data

Abstract Neurodegenerative diseases pose increasing challenges to global aging populations. Cognitive decline in older adults is an initial indicator of neurodegenerative diseases, yet comprehensive research on environmental chemical exposures related to cognitive decline is limited. This study uses Exposome-Wide Association Study (ExWAS) framework to investigate associations of environmental chemicals with cognitive function in individuals aged ≥60 years. We used the Digit Symbol Substitution Test (DSST) scores and chemical biomarker data of the US National Health and Nutrition Examination Survey (NHANES) spanning four cycles (1999-2000, 2001-2002, 2011-2012, 2013-2014). We conducted multiple survey-weighted regression to identify biomarkers associated with DSST scores, Bayesian weighted quantile sum regression to estimate odds ratio (OR) of cognitive decline from multiple exposures to the identified biomarkers, and correlation network analyses to examine relationships among possible important biomarkers and cognitive decline. After correction for multiple comparisons, among 229 biomarkers having a ≥10% detection rate, 40 were associated with DSST scores (q-value &amp;lt;0.05). When assessing the effects of chemical mixtures on cognitive decline, no association between mixtures of chemicals and DSST scores was observed. Correlation network showed that cognitive decline is directly related with age and education level and identified that thiocyanate, m-/p-xylene, triclosan, benzophenone-3 and diphenyl phosphate were weakly related to cognitive function. In conclusion, leveraging the ExWAS framework enables us to identify chemical biomarkers that were not previously discovered from traditional approaches of examining a small number of chemicals at a time. While our findings provide foundation for further research, longitudinal studies are warranted to elucidate causal relationships.

Identifying people with post-COVID condition using linked, population-based administrative health data from Manitoba, Canada: prevalence and predictors in a cohort of COVID-positive individuals

ObjectiveMany individuals exposed to SARS-CoV-2 experience long-term symptoms as part of a syndrome called post-COVID condition (PCC). Research on PCC is still emerging but is urgently needed to support diagnosis,...