Case-control Study Design Research Articles

Association of genetic variants in soy isoflavones metabolism-related genes with decreased lung cancer risk

BackgroundSoy isoflavones have been reported to exhibit anti-tumor effects. We hypothesize that genetic variants in soy isoflavone metabolism-related genes are associated with the risk of lung cancer. MethodsA two-stage case-control study design was conducted in this study. The discovery stage included 300 lung cancer cases and 600 healthy controls to evaluate the association of candidate genetic variants with lung cancer risk. The validation stage involved 1200 cases and 1200 controls to validate the associations found. Furthermore, qPCR was performed to assess the mRNA expression levels of different genotypes of the SNP. ELISA was used to explore the association between genotype and soy isoflavone levels, as well as the association between soy isoflavone levels and lung cancer risk. ResultsA nonlinear association was observed between plasma soy isoflavone levels and lung cancer risk, with higher soy isoflavone levels associated with lower lung cancer risk (P < 0.001). The two-stage case-control study identified that UGT1A1 rs3755319 A > C was associated with decreased lung cancer risk (Recessive model: adjusted OR = 0.69, 95 %CI = 0.57–0.84, P < 0.001). Moreover, eQTL analysis showed that the expression level of UGT1A1 in the rs3755319 CC genotype was lower than in the AA + AC genotype (P < 0.05). The plasma concentration of soy isoflavones in the rs3755319 CC genotype was higher than in the AA + AC genotype (P = 0.008). ConclusionsWe identified a potentially functional SNP, UGT1A1 rs3755319 A > C, as being associated with decreased lung cancer risk. Further experiments will be needed to explore the mechanisms underlying the observed associations.

Increased adrenocortical activity in patients with vasovagal syncope

ObjectiveSyncope is a transient loss of consciousness resulting from cerebral hypoperfusion. Vasovagal syncope (VVS) is a form of orthostatic intolerance (OI). Its clinical signs such as dizziness and hypotension may mimic symptoms of adrenal insufficiency. The objective of this study was to evaluate the adrenal gland function in patients with vasovagal syncope after stimulation with synthetic adrenocorticotropic hormone (ACTH). DesignCase-control study on patients with VVS and healthy controls. MethodsThe study involved 42 participants, including 27 patients diagnosed with VVS using the head-up tilt test and 15 healthy individuals with no history of syncope or any orthostatic symptoms. Serum cortisol and aldosterone concentrations were measured under basal conditions and at 30 and 60 min after intramuscular ACTH stimulation. ResultsPatients with VVS had significantly higher cortisol levels at baseline (441 ± 143 vs. 331 ± 84.7 nmol/L, p = 0.01), at 30 min (802 ± 143 vs. 686 ± 105 nmol/L, p = 0.01) and at 60 min (931 ± 141 nmol/L vs. 793 ± 147 nmol/L, p = 0.001) after ACTH administration (Synacthen 250 μg). Plasma aldosterone increased after ACTH stimulation, but did not show significant differences among groups. Furthermore, there was also no significant correlation between cortisol levels and blood pressure or heart rate. ConclusionPatients diagnosed with VVS have higher cortisol levels both at baseline and after ACTH stimulation. This finding indicates that individuals with VVS have higher adrenocortical activity potentially as a response to the orthostatic stress induced by syncope, which acts as a stressful stimulus on the autonomic nervous system.

A bidirectional autoimmune cluster between vitiligo and rheumatoid arthritis: a large-scale population-based study

A knowledge gap exists regarding the association between vitiligo and rheumatoid arthritis (RA) due to the absence of large-scale cohort studies designed to investigate this association. To investigate the bidirectional epidemiological association between vitiligo and RA. A population-based study was conducted using Clalit Health Services (CHS) database (2002–2019) using both a cohort study and a case-control study design. Adjusted hazard ratio (HR) and odds ratio (OR) were calculated by multivariate Cox and logistic regressions, respectively. Overall, 20,851 vitiligo patients and 102,475 controls were included. The incidence of new-onset RA was 4.1 (95% CI 3.0–5.4) and 2.9 (95% CI 2.4–3.3) cases per 10,000 person-years among patients with vitiligo and controls, respectively. Patients with vitiligo had a significantly increased risk of developing new-onset RA (adjusted HR, 1.44; 95% confidence interval [CI], 1.02–2.02, P = 0.036). The likelihood of having vitiligo was significantly elevated after a preexisting diagnosis of RA (adjusted OR, 1.67; 95% CI, 1.38–2.03; P < 0.001). Relative to the remaining patients with vitiligo, those with vitiligo and comorbid RA demonstrated an elevated risk of all-cause mortality (adjusted HR, 1.61; 95% CI, 1.03–2.51; P = 0.037). Our study confirms the bidirectional association between vitiligo and RA. Physicians treating patients with vitiligo should be aware of the association in clinical practice.

Non-Syndromic and Syndromic Defects in Children with Extracranial Germ Cell Tumors: Data of 2610 Children Registered with the German MAKEI 96/MAHO 98 Registry Compared to the General Population.

GCTs are developmental tumors and are likely to reflect ontogenetic and teratogenetic determinants. The objective of this study was to identify syndromes with or without congenital anomalies and non-syndromic defects as potential risk factors. Patients with extracranial GCTs (eGCTs) registered in MAKEI 96/MAHO 98 between 1996 and 2017 were included. According to Teilum's holistic concept, malignant and benign teratomas were registered. We used a case-control study design with Orphanet as a reference group for syndromic defects and the Mainz birth registry (EUROCAT) for congenital anomalies at birth. Co-occurring genetic syndromes and/or congenital anomalies were assessed accordingly. Odds ratios and 95% confidence intervals were calculated and p-values for Fisher's exact test with Bonferroni correction if needed. A strong association was confirmed for Swyer (OR 338.6, 95% CI 43.7-2623.6) and Currarino syndrome (OR 34.2, 95% CI 13.2-88.6). We additionally found 16 isolated cases of eGCT with a wide range of syndromes. However, these were not found to be significantly associated following Bonferroni correction. Most of these cases pertained to girls. Regarding non-syndromic defects, no association with eGCTs could be identified. In our study, we confirmed a strong association for Swyer and Currarino syndromes with additional congenital anomalies.

Evaluating A Multicomponent Chronic Disease Management Pilot Intervention among Korean Patients with Hypertension and Diabetes.

A local clinic-based chronic disease management intervention including care planning, education about disease management, monitoring, and evaluation of the achievement of objects was introduced in Korea in 2019. We evaluated the effect of the intervention on medication adherence in patients with hypertension and diabetes. In 2019, a one-year retrospective case-control group study design was performed using data from the National Health Insurance Service in Korea. Propensity score matching was used to control for selection bias. Medication adherence, calculated by medication possession rate, was the dependent variable. We conducted multivariate logistic regression analyses to examine the association between participation in the intervention and medication adherence, adjusting for covariates. A control group was set as a reference for participation in the full/partial component intervention. The proportions of participants in the full component intervention in the experimental group were 43.2% and 42.6% for patients with hypertension or diabetes, respectively. Both these groups tended to be more medication adherent than their counterparts (hypertension OR: 1.23, 95% CI 1.03-1.45, diabetes OR: 1.64, 95% CI: 1.24-2.17). Institutionalizing a comprehensive chronic disease management program using multidisciplinary teams in the primary care context is crucial. Also, it is necessary to refine reimbursement payment systems.

Exercise Capacity Following Pulmonary Embolism in Children and Adolescents

BackgroundSelf-reported physical activity following pediatric pulmonary embolism(PE) is reduced after diagnosis. However, objectively measured exercise capacity and mechanisms of exercise pathophysiology following PE are unknown. Research QuestionDoes exercise capacity one year after acute PE in children differ from controls? Study Design and MethodsOur case-control study compared exercise capacity and responses to maximal exercise in PE survivors with controls. We also investigated the association of low exercise capacity following PE with prespecified clinical/radiological features at PE diagnosis and elucidated the cause of functional limitations. The primary study outcome was exercise capacity defined by peak oxygen uptake (peak VO2) as a percent of predicted on cardiopulmonary exercise testing (CPET), with <80% predicted peak VO2 considered abnormal/low. Ventilatory inefficiency was defined as VE/VCO2 slope >30 and abnormal stroke volume augmentation as oxygen pulse <10 mL O2.min -1 at peak exercise. Logistic regression was performed to assess the association of prespecified variables with low peak VO2. ResultsWe compared 25 consecutive pediatric PE survivors who completed CPET one-year post-diagnosis with 25 controls who underwent CPET within the same period and were otherwise healthy. Exercise capacity was reduced in 8 of the 25 PE survivors (32%) at one-year post-diagnosis vs. 2 of the 25 control participants (8%) (p:0.034). PE survivors with low exercise capacity demonstrated elevated VE/VCO2 slope (p: 0.01) and a decreased oxygen pulse at peak exercise (p:0.001) consistent with cardiovascular limitation. In univariable analysis, PE category, pulmonary vascular obstruction by Qanadli index, or RV dysfunction at diagnosis was not associated with low exercise capacity. InterpretationAbnormal exercise capacity of cardiopulmonary origin occurred in 1 of 3 pediatric PE survivors despite anticoagulation and irrespective of PE severity, degree of pulmonary vascular obstruction, or RV dysfunction at diagnosis. Cardiorespiratory fitness should be formally considered to develop rehabilitation interventions following pediatric PE.

Social-emotional and behavioural problems in young children of healthcare worker mothers during the COVID-19 outbreak: a case-control study

BackgroundThe pandemic has had a significant impact on the daily lives of children and their families, particularly the children of health care workers, due to changes in family routines as a result of their parents’ work schedules. We aimed to explore the socioemotional and behavioural (SEB) problems of children of healthcare worker mothers (HCWM) during the COVID-19 pandemic and compare them with age-matched children and their mothers from other occupations.MethodA case-control study design was applied, and a snowball approach was used to enrol volunteered participants aged between 6 and 36 months of age, through a Google survey. We used the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire to assess children’s SEB problems and a Brief Symptom Inventory (BSI) to evaluate the psychological distress of mothers. Differences in BITSEA, BSI and MSPSS scores were examined using chi-square and Mann-Whitney U tests, as appropriate. A logistic regression model was used to identify independent predictors of children’s behavioural and emotional problems.ResultsIn total, 600 questionnaires were analysed. It was observed that children in the HCWM group were separated from their mothers more often and for longer periods of time than their counterparts (p < 0.010, p = 0.002). Changes in the child’s structured outdoor activities during the pandemic period were more likely to be observed in the HCWM group (p < 0.05). The percentage of children with the BITSEA problem subscale above the subclinical cut-off, externalizing and dysregulation scores were significantly higher in the HCWM group (p = 0.044, p = 0.031, and p = 0.016). Moreover, each point increase in BSI global index scores (p < 0.001, RR:3.34, 95%CI:1.91–5.82) was found as a risk factor for clinically significant SEB problems.ConclusionOverall, the current study suggests HCWM’s have experienced occupational inequality, and young children of HCWM’s were at increased risk for externalizing and dysregulation problems during the pandemic. Maternal psychological stress had a significant impact on their children’s socio-emotional well-being.

DETERMINANTS OF PARTICIPATION SURVIVORS COVID-19 AMONG ≥45 YEARS OLD TO COVID-19 THIRD DOSE VACCINATION

Background: Booster vaccinations are a way to keep the body protected against COVID-19. Mojolangu Health Center is one of the densely populated areas which is part of the Lowokwaru sub-district and borders the Belimbing sub-district; the two sub-districts are ranked 2nd and 1st with the highest CFR (Case Fatality Rate) in Malang City. Therefore, examining public perceptions of vaccination to evaluate immunization programs and raise performance goals is essential. Purpose: To determine the relationship between the Health Belief Model components (perceived susceptibility, severity, benefits, barrier, and cues to action) and the participation of COVID-19 booster vaccination in survivors of COVID-19 aged ≥45 years. Conducted from April to November 2022, this research was located in the working area of Mojolangu Health Center (Mojolangu, Tunjungsekar, Tunggulwulung, and Tasikmadu village). Methods: This quantitative research used a case-control design study. This research sample comprised 82 people, selected using the purposive sampling technique with a 1:1 ratio for case and control. Data analysis was done using the Chi-Square test and Binary Logistics Regression tests. Results: The respondents were dominated by the middle age group (45-59 years), primarily entrepreneurs with a monthly income of more than IDR 3.5 million and domiciled in Mojolangu village. The perceived benefits variable showed p=0.04 (aOR=2.67; 95% CI=1.03-6.91) and perceived barriers p=0.01 (aOR=3.60; 95% CI=1.39-9.28), while perceived vulnerability p=1.00 (cOR=1.00; 95% CI= 0.32 – 3.16), perception of cues to act p= 0.18 (cOR= 1.82; 95% CI= 0.75 - 4.40). Conclusion: Factors related to booster vaccination participation are perceived benefits and barriers.

Targeted proteomic profiling of cardiogenic shock in the cardiac intensive care unit.

We sought to characterize circulating protein biomarkers associated with cardiogenic shock (CS) using highly multiplex proteomic profiling. This analysis employed a cross-sectional case-control study design using a biorepository of patients admitted to a cardiac intensive care unit between 2017 and 2020. Cases were patients adjudicated to have CS, and controls were those presenting for cardiac critical care without shock, including subsets of patients with isolated hypotension or heart failure (HF). The Olink platform was used to analyse 359 biomarkers with Bonferroni correction. The analysis included 239 patients presenting for cardiac critical care (69 cases with CS, 170 non-shock controls). A total of 63 biomarkers (17.7%) were significantly associated with CS after Bonferroni correction compared with all controls. Of these, nine biomarkers remained significantly associated with CS when separately cross-validated in subsets of controls presenting with isolated hypotension and HF: cathepsin D, fibroblast growth factor (FGF)-21 and -23, growth differentiation factor (GDF)-15, insulin-like growth factor-binding protein-1, N-terminal pro-B-type natriuretic peptide, osteopontin, oncostatin-M-specific receptor subunit beta (OSMR), and soluble ST2 protein (sST2). Four biomarkers were identified as providing complementary information for CS diagnosis with development of a multi-marker model: sST2, FGF-23, CTSD, and GDF-15. In this pilot study of targeted proteomic profiling in CS, we identified nine biomarkers significantly associated with CS when cross-validated against non-shock controls including those with HF or isolated hypotension, illustrating the potential application of a targeted proteomic approach to identify novel candidates that may support the diagnosis of CS.

Atrial Fibrillation and Other Cardiovascular Factors and the Risk of Dementia: An Italian Case-Control Study.

Dementia is a major neurologic syndrome characterized by severe cognitive decline, and it has a detrimental impact on overall physical health, leading to conditions such as frailty, changes in gait, and fall risk. Depending on whether symptoms occur before or after the age of 65, it can be classified as early-onset (EOD) or late-onset (LOD) dementia. The present study is aimed at investigating the role of cardiovascular factors on EOD and LOD risk in an Italian population. Using a case-control study design, EOD and LOD cases were recruited at the Modena Cognitive Neurology Centers in 2016-2019. Controls were recruited among caregivers of all the dementia cases. Information about their demographics, lifestyles, and medical history were collected through a tailored questionnaire. We used the odds ratio (OR) and 95% confidence interval (CI) to estimate the EOD and LOD risk associated with the investigated factors after adjusting for potential confounders. Of the final 146 participants, 58 were diagnosed with EOD, 34 with LOD, and 54 were controls. According to their medical history, atrial fibrillation was associated with increased disease risk (ORs 1.90; 95% CI 0.32-11.28, and 3.64; 95% CI 0.32-41.39 for EOD and LOD, respectively). Dyslipidemia and diabetes showed a positive association with EOD, while the association was negative for LOD. We could not evaluate the association between myocardial infarction and EOD, while increased risk was observed for LOD. No clear association emerged for carotid artery stenosis or valvular heart disease. In this study, despite the limited number of exposed subjects and the high imprecision of the estimates, we found positive associations between cardiovascular disease, particularly dyslipidemia, diabetes, and atrial fibrillation, and EOD.

Impact of spectacle wear on the quality of life of learners with hearing impairment in Ghana

Background: Visual impairment significantly affects learners with hearing impairment.Aim: To assess the impact of spectacle wear on the quality of life (QoL) of learners with hearing impairment in Ghana.Setting: Six schools for the deaf in Ghana.Methods: A prospective case-control study design was used to assess the QoL among learners with uncorrected refractive error (URE) using the quality-of-life impact of refractive correction (QIRC) questionnaire before and after the provision of spectacles.Results: A total of 138 learners were enrolled in this study, with 69 learners in both the intervention and control groups, respectively. The mean QIRC score improved significantly for the intervention group: QIRC score before = 43.89 ± 8.96 vs. after = 48.82 ± 6.71 (P 0.05 and Cohen’s d = 0.62) but not the control group: QIRC score before = 50.79 ± 11.66 and 51.77 ± 10.67 (P = 0.607). Among the learners provided with spectacles, those who did not comply with spectacle wear had significant differences (P 0.05) in mean QIRC scores before and after the intervention. Only visual acuity (VA) and the magnitude of prescription with QIRC scores after intervention had a significant relationship (P 0.05).Conclusion: Uncorrected refractive error affected the QoL of learners with hearing impairment, and spectacle correction significantly improved their QoL.Contribution: The use of spectacle lenses, VA and magnitude of prescription affected the QoL scores; however, sex and age did not influence the QoL scores.

Clarifying the association between Parkinson's disease and vitiligo: a population-based large-scale study.

Our knowledge about the association between vitiligo and Parkinson's disease (PD) is sparse. We sought to investigate the bidirectional epidemiological association between vitiligo and PD. A population-based study was conducted using Clalit Health Services (CHS) database (2002-2019) using both a cohort study and a case-control study design. Adjusted hazard ratio (HR) and odds ratio (OR) were calculated by multivariate Cox and logistic regressions, respectively. Overall, 20,851 vitiligo patients and 102,475 controls were included. The incidence of new-onset PD was 2.9 (95% CI, 2.1-4.1) and 4.3 (95% CI, 3.8-4.9) cases per 10,000 person-years among patients with vitiligo and controls, respectively. Patients with vitiligo had a significantly decreased risk of developing new-onset PD [adjusted HR, 0.62; 95% confidence interval (CI), 0.43-0.89, p = 0.009]. On the other hand, the likelihood of having vitiligo after a preexisting diagnosis of PD was not statistically different (adjusted OR, 0.80; 95% CI, 0.61-1.06; p = 0.117). Relative to the remaining patients with vitiligo, those with vitiligo and comorbid PD experienced an elevated risk of all-cause mortality (adjusted HR, 2.63; 95% CI, 1.82-3.80; p < 0.001) and higher prevalence of cardiometabolic comorbidities. Vitiligo is associated with a lower risk of developing PD. The presence of comorbid PD predisposes patients with vitiligo to elevated mortality and cardiometabolic outcomes.

A systematic review of personality and musculoskeletal disorders: evidence from general population studies.

We conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs) in population-based studies, since these disorders are leading causes of disease burden worldwide. A search strategy of published, peer-reviewed and gray literature was developed in consultation with a liaison librarian and implemented for Embase, CINAHL Complete, Medline Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present and CORDIS and ProQuest Dissertations & Theses Global, respectively. The inclusion criteria were as follows: I) general population participants aged ≥15 years; II) self-report, probable PD based on positive screen, or threshold PD according to the DSM-IV/5 (groupings: any, Clusters A/B/C, specific PD) or ICD-10/11; III) MSDs identified by self-report or ICD criteria (arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis) and III) cohort, case-control, and cross-sectional study designs. Two reviewers independently screened articles and extracted the data. Critical appraisal was undertaken using the Joanna Briggs Institute checklists for systematic reviews of etiology and risk. A descriptive synthesis presents the characteristics of included studies, critical appraisal results, and descriptions of the main findings. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 11 peer-reviewed, published articles included in this review (n = 9 cross-sectional and n = 2 case-control studies); participants were ≥18 years in these studies. No published gray literature was identified. Semi-structured interviews were the most common method to ascertain PDs; all studies utilized self-reported measures to identify MSDs. Overall, we detected limited and conflicting evidence for associations between PDs and MSDs. The main result may be explained by lack of population-based longitudinal evidence, heterogenous groupings of PD, and few comparable cross-sectional and case-control studies. Strengths of the review include a comprehensive search strategy and a discussion of mechanisms underlying possible associations between PDs and MSDs. The quality of most studies included in this review that examined associations between PD and MSDs in general population adults was high. However, the results demonstrated limited and conflicting evidence for these associations, in part, due to lack of comparable evidence, which should be addressed in future research. https://www.crd.york.ac.uk/prospero/, identifier CRD42021243094.

Mixed methods approach to examining the implementation experience of a phone-based survey for a SARS-CoV-2 test-negative case-control study in California.

To describe the implementation of a test-negative design case-control study in California during the Coronavirus Disease 2019 (COVID-19) pandemic. Test-negative case-control study. Between February 24, 2021 - February 24, 2022, a team of 34 interviewers called 38,470 Californians, enrolling 1,885 that tested positive for SARS-CoV-2 (cases) and 1,871 testing negative for SARS-CoV-2 (controls) for 20-minute telephone survey. We estimated adjusted odds ratios for answering the phone and consenting to participate using mixed effects logistic regression. We used a web-based anonymous survey to compile interviewer experiences. Cases had 1.29-fold (95% CI: 1.24-1.35) higher adjusted odds of answering the phone and 1.69-fold (1.56-1.83) higher adjusted odds of consenting to participate compared to controls. Calls placed from 4pm to 6pm had the highest adjusted odds of being answered. Some interviewers experienced mental wellness challenges interacting with participants with physical (e.g., food, shelter, etc.) and emotional (e.g., grief counseling) needs, and enduring verbal harassment from individuals called. Calls placed during afternoon hours may optimize response rate when enrolling controls to a case-control study during a public health emergency response. Proactive check-ins and continual collection of interviewer experience(s) and may help maintain mental wellbeing of investigation workforce. Remaining adaptive to the dynamic needs of the investigation team is critical to a successful study, especially in emergent public health crises, like that represented by the COVID-19 pandemic.

Determinants of implanon discontinuation among women in Gedeo Zone, South Ethiopia: a case–control study

BackgroundThe main public health problem that has a significant impact on the high fertility rate, unintended pregnancies, and induced abortion is Implanon cessation. In addition to Implanon being underutilized in Ethiopia, the rate of cessation is higher among women who started using it. Nevertheless, little is known about the factors that lead to Implanon cessation.ObjectivesThe study was aimed to determine the factors that led women to discontinue Implanon in Gedeo Zone, Southern Nation Nationalities and Peoples Region, southern Ethiopia, 2019.MethodA community-based unmatched case–control study design was carried out. Cases and controls were selected by a multi-stage sampling with a 1:2 case-to-control ratio. Data was entered into EPi-data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 20 for analysis. A bivariate and multivariable logistic regression was used to identify the factors affecting Implanon discontinuation. The adjusted odd ratio (AOR) with 95% Confidence Interval (CI) was used to determine the precision of estimates, and statistical significance was declared at a p-value of 0.05.ResultFrom 516 women included in to the study, 495 (cases = 166 and controls = 329) women have responded to the questionnaires making a response rate of 96%. Monthly income 500—1000 birr [AOR: 0.3; 95% CI (0.2–0.5)], above 1000 birr [AOR: 0.2; 95% CI (0.1–0.4)], history of abortion [AOR: 2.0; 95% CI (1.0–4.1)], birth spacing [AOR: 0.6; 95% CI (0.3–0.9)], partner objection [AOR: 2.4; 95% CI (1.4–4.2)] were significantly associated factors.ConclusionThis study identified that monthly income, having abortion history, birth spacing, partner objection were the factors that affect Implanon discontinuation. To reduce implanon discontinuation, reducing abortion, involving partner and increasing the birth spacing, appropriate counseling before the insertion and appropriate follow-up by a health care practitioner are highly recommended.

Effectiveness of autumn 2023 COVID-19 vaccination and residual protection of prior doses against hospitalisation in England, estimated using a test-negative case-control study

IntroductionThe last COVID-19 vaccine offered to all adults in England became available from November 2021. The most recent booster programme commenced in September 2023. Bivalent BA.4-5 or monovalent XBB.1.5 boosters were given. During the study period, the JN.1 variant became dominant in England. MethodsVaccine effectiveness against hospitalisation was estimated throughout using the test-negative case-control study design where positive PCR tests from hospitalised individuals are cases and comparable negative PCR tests are controls. Multivariable logistic regression was used to assess vaccine effectiveness against hospitalisation with the test result as the outcome, vaccination status as the primary exposure variable of interest and confounder adjustment. ResultsThere was no evidence of residual protection for boosters given as part of previous campaigns. There were 28,916 eligible tests included to estimate the effectiveness of the autumn 2023 boosters in those aged 65 years and older. VE peaked at 50.6% (95% CI: 44.2-56.3%) after 2-4 weeks, followed by waning to 13.6% (95% CI: -11.7-33.2%). Estimates were generally higher for the XBB.1.5 booster than the BA.4-5 booster, but this difference was not statistically significant. Point estimates were highest against XBB sub-lineages. Effectiveness was lower against both JN.1 and EG.5.1 variants with confidence intervals non-overlapping with the effectiveness of the XBB sub-lineages at 2-4 weeks for EG.5.1 where VE was 44.5% (95% CI: 20.2- 61.4%) and at 5-9 weeks for JN.1 where VE was 26.4% (95%CI: -3.4-47.6%). ConclusionsThe recent monovalent XBB.1.5 and bivalent BA.4-5 boosters provided comparable and good protection against hospitalisation, however there was evidence of lower VE against hospitalisation of these boosters against JN.1.

Effectiveness of inactivated influenza vaccine against laboratory-confirmed influenza among Chinese elderly: a test-negative design

BackgroundEvidence on the effectiveness of influenza vaccination in the elderly is limited, and results are controversial. There are also few reports from China.MethodsWe conducted a test-negative case-control study design to estimate influenza vaccine effectiveness (VE) against laboratory-confirmed influenza-associated visits among elderly (aged ≥ 60 years) across four influenza seasons in Ningbo, China, from 2018 to 19 to 2021-22. Influenza-positive cases and negative controls were randomly matched in a 1:1 ratio according to age, sex, hospital, and date of influenza testing. We used logistic regression models to compare vaccination odds ratios (ORs) in cases to controls. We calculated the VE as [100% × (1-adjusted OR)] and calculated the 95% confidence interval (CI) around the estimate.ResultsA total of 30,630 elderly patients tested for influenza with virus nucleic acid or antigen during the study period. After exclusions, we included 1 825 influenza-positive cases and 1 825 influenza-negative controls. Overall, the adjusted VE for influenza-related visits was 63.5% (95% CI, 56.3–69.5%), but varied by season. Influenza VE was 59.8% (95% CI, 51.5–66.7%) for influenza A and 89.6% (95% CI, 77.1–95.3%) for influenza B. The VE for ages 60–69 and 70–79 was 65.2% (95% CI, 55.4–72.9%) and 69.8% (95% CI, 58.7–77.9%), respectively, but only 45.4% (95% CI, 6.2–68.2%) for ages 80 and over.ConclusionsStandard-dose inactivated influenza vaccine has shown good protection in the elderly in China. However, protection may not be satisfactory in people aged 80 years and older.

The Association of Dyslipidemias with Cholelithiasis: A Case-Control Study Conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad

Objective: To find the association of lipid profile with early sign of cholecystitis (gall stones formation). Study Design: Case control study. Place and Duration of Study Methodology: The study recruited cholecystitis patients from 1st April 2022 to 30th September 2022 at Pathology Department, Pakistan Institute of Medical Sciences, Islamabad. Those patients having an age above 40 years and clinically diagnosed with gall bladder stone, went under ultrasonography examination, were included in the study. A total of 100 cases were compared with 100 controls in a case control study design. The lipid profile included serum concentrations of HDL cholesterol, Total Cholesterol, triglyceride, LDL cholesterol levels. Other tests as fasting blood glucose (FBG), total bilirubin (T-bil), alanine transaminase (ALT), aspartate transaminase (AST), creatinine (Cr), uric acid (UA), and urea nitrogen (UN) were also conducted. Results: The mean age of the gall stone patients and of normal controls was 51.71±13.48 and 42.00±13.14 years respectively. There was no variance in the BMI of both groups. The incidence of kidney stones was higher in the cases than controls while hypertension was more commonly reported in the 36% of the cases in comparison to the 19% of the controls. The logistic regression analysis presented a data where significant difference within lipid profile values of cases and controls could be seen having high values reported in cases than controls. The multivariant analysis of the lipid profile analyzed values presented a significant variance in the odds ration of high-density lipoprotein cholesterol levels and triglycerides of cases and controls. Conclusion: Low levels of high-density lipoprotein cholesterol and high levels of triglycerides are associated with the risk of gall bladder formation.

Measles outbreak investigation in Berhet District, North Shewa, Ethiopia.

Measles, though usually self-limiting, can have severe consequences influenced by factors such as vaccination and nutrition, notably vitamin A deficiency and malnutrition. Despite progress, contextual changes and implementation issues have hampered efforts, resulting in increased outbreaks and cases of measles. This study seeks to pinpoint outbreak features, risk factors, and strategies for preventing and controlling measles. A descriptive cross-sectional study and a 1:2 unmatched case-control study design were employed. All 101 suspected measles cases listed on the line-list were included in the descriptive research, with 60 measles patients and 120 controls included in the case-control investigation. Line-list data were cleaned and analyzed using a pivot table in Microsoft Excel 2016. Subsequently, the data were cleaned, entered into Epi Info 7.2, and exported to SPSS 26 for analysis. Twenty cases occurred per 10,000 individuals. Men accounted for 67.3% of cases, with ages ranging from 5 months to 45 years and mean and standard deviations of 9.6 and 7.6, respectively. Age group of 5-14 years comprised 57.4% of cases, followed by 1-4 years with 24.8%. Being unvaccinated against measles showed an adjusted odds ratio (AOR) of 12.06 (95% CI: 3.12-46.52). Travel history to regions with active cases had an AOR of 5.73 (95% CI: 1.78-18.38). Contact with a measles patient showed an AOR of 10.3 (95% CI: 3.48-30.5). Understanding the measles transmission mechanism had an AOR of 0.164 (95% CI: 0.049-0.55), and awareness of the disease's preventability had an AOR of 0.233 (95% CI: 0.67-0.811). All factors were independently associated with the illness. This outbreak affected a broader age range with a high attack rate, mainly in the age group of 5-14-years. Over 35% of cases lacked measles vaccination, indicating low administrative vaccine coverage. Factors contributing to the outbreak include lack of measles vaccination, travel to areas with active disease, contact with cases, and insufficient knowledge of measles transmission and prevention strategies among mothers and caregivers.

Transgender Women Exhibit a Distinct Stress Echocardiography Profile Compared With Age-Matched Cisgender Counterparts: The Mayo Clinic Women’s Heart Clinic Experience

Stress echocardiographic (SE) testing is an important modality in cardiovascular risk stratification and obstructive coronary artery disease assessment. Binary sex-based parameters are classically used for the interpretation of these studies, even among transgender women (TGW). Coronary artery disease is a leading cause of morbidity and mortality in this population. Yet, it remains unclear whether TGW exhibit a distinct stress testing profile from their cisgender counterparts. Using a matched case-control study design, the authors compared the echocardiographic stress testing profiles of TGW (n=43) with those of matched cisgender men (CGM; n=84) and cisgender women (CGW; n=86) at a single center. Relevant data, including demographics, comorbidities, and cardiac testing data, were manually extracted from the patients' charts. The prevalence of hypertension and dyslipidemia was similar between TGW and CGW and lower than that of CGM (P=.003 and P=.009, respectively). The majority of comorbidities and laboratory values were similar. On average, TGW had higher heart rates than CGM (P=.002) and had lower blood pressures than CGM and CGW (P<.05). TGW's double product and metabolic equivalents were similar to those among CGW and lower than those of CGM (P=.016 and P=.018, respectively). On echocardiography, left ventricular end-diastolic and end-systolic diameters among TGW were similar to those of CGW but lower than those of CGM (P=.023 and P=.018, respectively). Measures of systolic and diastolic function, except for exercise mitral valve E/e' ratio, which was lower in TGW than CGW (P=.029), were largely similar among the three groups. There was no difference in the wall motion score index, and therefore, no difference in the percentage of positive SE test results. This study shows, for the first time, that TGW have a SE profile that is distinct from that of their cisgender counterparts. Larger, multicenter, prospective studies are warranted to further characterize the SE profile of TGW.