Chi-square Test For Trend Research Articles

Injection Drug Use and Healthcare Utilization in Patients Newly Diagnosed With HIV.

To determine recent trends in: (1) human immunodeficiency virus (HIV) diagnoses, (2) the proportion of patients newly diagnosed with HIV with injection drug use (IDU) and (3) patients' patterns of healthcare utilization in the year before diagnosis at an urban, academic medical center. We performed a cross sectional study of patients newly diagnosed with HIV at a healthcare system in southern New Jersey between January 1st, 2014 and December 31st, 2019. Patients 18 years or older with HIV diagnosed during the study period were included. Demographics, comorbidities, HIV test results, and healthcare utilization data were collected from the electronic medical record. Of 192 patients newly diagnosed with HIV, 36 (19%) had documented IDU. New HIV diagnoses doubled from 22 to 47 annual cases between 2014 and 2019. The proportion of patients with newly diagnosed HIV and documented IDU increased from 9% in 2014 to 32% in 2019, chi-square test for linear trend P value = 0.001. Eighty-nine percent of patients with IDU had at least one contact with the healthcare system in the year before diagnosis compared to 63% of patients without IDU, P value 0.003. The median (interquartile range IQR) number of healthcare visits was 7 [2 - 16] for patients with IDU versus 1 [0 - 3] for patients without IDU, P < 0.001. We observed an increase in new HIV diagnoses with an increase in the proportion of newly diagnosed patients with IDU. Patients with newly diagnosed HIV and IDU had high rates of health care utilization in the year before diagnosis presenting an opportunity for intervention.

Endometrial cancer after the Manchester procedure: a nationwide cohort study.

We aimed to investigate whether the Manchester procedure affects the risk and prognosis of endometrial cancer. All Danish residents have a personal number permitting linkage of nationwide registers on the individual level enabling epidemiological studies with lifelong follow-up. We performed a nationwide historical cohort study including Danish women born before 2000 undergoing the Manchester procedure (N = 23,935) during 1977-2018. We included women undergoing anterior colporrhaphy as a reference group (N = 51,008) because of comparable inclination to consult a doctor and clinical similarities. Main outcomes were the number of women diagnosed with endometrial cancer, the stage of endometrial cancer at time of diagnosis, and cancer-specific and overall mortality. We followed the cohort until endometrial cancer/death/emigration/hysterectomy/31 December 2018. We performed chi-square test for trend to compare the diagnostic stage and Cox regressions to analyze the risk of endometrial cancer and mortality. The models were adjusted for age, calendar year, income level, and parity. During follow-up (median 13 years), 271 (1.13%) women were diagnosed with endometrial cancer after the Manchester procedure and 520 (1.05%) after anterior colporrhaphy. The adjusted hazard ratio (HR) for endometrial cancer was 1.00 [95% confidence interval (CI) 0.86-1.16]. No difference in stage of cancer was found (p = 0.18) nor when stratifying for calendar year. The HR for cancer-specific mortality and overall mortality after the Manchester procedure was 0.87 (95% CI 0.65-1.16) and 0.93 (95% CI 0.77-1.12), respectively. The Manchester procedure does not affect the risk or prognosis of endometrial cancer.

Endemic situation of schistosomiasis in Suzhou City from 2010 to 2020

To analyze the endemic status of schistosomiasis in Suzhou City from 2010 to 2020, so as to provide the evidence for formulating the future schistosomiasis control strategy. The data pertaining to the endemic status of schistosomiasis in Suzhou City from 2010 to 2020 were retrieved from the annual schistosomiasis control report, the information management platform of schistosomiasis (parasitic diseases) in Jiangsu Province and the Parasitic Diseases Control Information Management System of Chinese Center for Disease Control and Prevention, including snail survey data, snail control data and schistosomiasis examination data, and were retrospectively reviewed. Differences of proportions were tested for statistical significance with chi-square test, and the trends in proportions were evaluated using the chi-square test for trends. Elimination of schistosomiasis was achieved in Suzhou City in 2018, and there were 3.528 9 million residents living in schistosomiasis-endemic villages of 81 townships in 9 counties. A total of 707 600 labor-days were used for snail survey in 11 586 village-times in Suzhou City from 2010 to 2020, covering 18 572.73 hm2, and snail habitats were detected with an area of 68.61 hm2, including emerging snail habitats of 37.30 hm2. A total of 23 144 snails were dissected, and no Schistosoma japonicum infection was detected. Reemerging and emerging snail habitats were predominantly found in inlands. During the period from 2010 to 2020, snail control was performed in Suzhou City for 71 000 labor-times, and snail control was done covering 269.34 hm2 through chemical treatment and covering 3.48 hm2 through environmental improvements. A total of 674 002 person-times received serological tests for S. japonicum infections in Suzhou City from 2010 to 2020, with seroprevalence of 0.38%, and a total of 33 835 person-times received stool examinations, with no egg-positives identified. The sero-prevalence of S. japonicum infections appeared an overall tendency towards a rise in Suzhou City from 2010 to 2020 (χ2 = 129.48, P < 0.001). The sero-prevalence of S. japonicum infections appeared high among local residents in 2016, and remained stable in other years, while the sero-prevalence of S. japonicum infections appeared an overall tendency towards a rise among mobile populations (χ2 = 54.11, P < 0.001). There were 278 800 and 175 202 serological tests among local residents and mobile populations in Suzhou City from 2013 to 2020, and 0.50% and 0.35% sero-prevalence rates were detected, respectively. The sero-prevalence of S. japonicum infections was significantly higher among local residents than among mobile populations in Suzhou City (χ2= 54.76, P < 0.001). There is a risk of rebound of schistosomiasis in Suzhou City. Integrated control should be reinforced to prevent the risk of rebound of schistosomiasis in Suzhou City.

Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study.

BackgroundWe previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda.MethodsWe performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified early warning scores (MEWS). We calculated amalgamated qSOFA scores by inserting UVA cut-offs into the qSOFA score, and modified UVA scores by removing the HIV criterion. The performance of each score determined by the area under the receiver operator characteristic curve (AUC) was the primary outcome measure.ResultsWe included 573 hospitalized adult patients with acute infection of whom 40 (7%) died in-hospital. The admission AUCs (95% confidence interval [CI]) for the prediction of mortality by the scores were: UVA, 0.77 (0.68–0.85); modified UVA, 0.77 (0.68–0.85); qSOFA, 0.66 (0.56–0.75), amalgamated qSOFA, 0.71 (0.61–0.80); and MEWS, 0.74 (0.64, 0.83). The positive predictive values (95% CI) of the scores at commonly used cut-offs were: UVA >4, 0.35 (0.15–0.59); modified UVA >4, 0.35 (0.15–0.59); qSOFA >1, 0.14 (0.07–0.24); amalgamated qSOFA >1, 0.44 (0.20–0.70); and MEWS >5, 0.14 (0.08–0.22). The 72 hour (N = 236) AUC (95% CI) for the prediction of mortality by UVA was 0.59 (0.43–0.74). The Chi-Square test for linear trend did not identify an association between mortality and delta UVA score at 72 hours (p = 0.82).ConclusionsThe admission UVA score and amalgamated qSOFA score had good predictive ability for mortality in adult patients admitted to hospital with acute infection in Rwanda. The UVA score could be used to assist with triage decisions and clinical interventions, for baseline risk stratification in clinical studies, and in a clinical definition of sepsis in Africa.

Mortality due to COVID-19 and Risk Factors at Pachuca´s General Hospital in the State of Hidalgo, Mexico

Aim: To estimate the risk of death secondary to COVID-19 infection and to identify the factors associated with these deaths at the Pachuca General Hospital, Hidalgo, Mexico.&#x0D; Material and methods: The information was obtained from the daily report of patients whose were attended at Hospital Genera de Pachuca for respiratory disease compatible with COVID-19 from March 2020 to March 2021, the information obtained was captured electronically in a database by the epidemiology department of the institution. A cross-sectional design was used. Patients who died secondary to complications of respiratory disease were compared with survivors of the same disease. Pearson's Chi-square was used to estimate the differences between the deceased and the survivors. For the crude risk of dying from COVID-19, the odds ratio was used, and for the adjusted risk, non-conditional logistic regression was used, a trend analysis was performed, with the corresponding trend Chi-square test, all calculations were made with 95% confidence.&#x0D; Results: The information of 4418 people with respiratory disease was analyzed. During the study period, 647 people died of COVID-19, corresponding to 14.64%. Of the population, 50.97% were men, their mortality was 18.92% and that of women was 10.22% (P &lt;0.05). Variables associated with dying from complications from COVID-19 were found to be male (OR 2.05, 95% CI 1.71-2.45), being 40 years old or older (OR 9.62, 95% CI 7.30-12.86), having a positive RT-PCR result (OR 3.53 95% CI 2.83-4.43), and being a carrier of a Chronic Degenerative Disease (OR 4.79 95% CI 4.01-5.73).&#x0D; Conclusions: The results indicate that the risk of dying from COVID-19 is related to male patients, at the older age of the patients, having a positive RT-PCR and suffering from at least one chronic degenerative disease.

Construction of a mouse model of Posner-Schlossman syndrome by anterior chamber infection with cytomegalovirus

Accumulated clinical evidence has shown that Posner-Schlossman syndrome (PSS) is most likely the result of recurrent human cytomegalovirus (HCMV) infection in the anterior chamber (AC). Establishing an animal model is necessary to investigate the pathogenesis of PSS. In this study, we constructed a mouse model of (PSS) by injecting murine cytomegalovirus (MCMV) into the AC of BALB/c mice. Twenty-five BALB/c mice were divided into 5 groups. Smith strain MCMV expressing enhanced green fluorescent protein (EGFP) was passaged with mouse embryonic fibroblast (MEF). Right eyes in the 4 experiment groups received AC injection of 1 μL of virus solution with concentrations of 103,104,105,106 pfu/mL respectively, and the control group received only PBS. PSS-like signs (mutton-fat keratic precipitates (KP), pupil dilation, IOP elevation and corneal edema) were recorded 0–28 days post-injection (DPI). Sections of eyeballs from another 9 mice harvested on 0,10 and 28 DPI were examined to locate KP and the fluorescence signal of the virus. Reversible PSS-like signs except KP were observed in 20% and 60% mice of 104 and 105 groups while no PSS-like signs in the control and 103 group; 80% in the 106 group with partially unreversible signs till 28DPI. Much More fluorescent signals of virus in the iris and KP were found on 10DPI than 28 DPI, while no fluorescent signals and KP on 0DPI. The extent of PSS-like signs (pupil dilation, IOP elevation and corneal edema) was virus concentration-dependent (Spearman correlation coefficient, r = 0.830, = 0.475, = 0.662, p < 0.0001, <0.05, <0.001, respectively, n = 25). Success rate of PSS model (mice with PSS-like signs) was also virus concentration-dependent (Chi-square trend test, χ2 = 6.828, df = 1, p < 0.01, n = 25). Our results indicate that AC injection of 1 μL MEF passaged MCMV (Smith strain) of 104–106 pfu/mL in BALB/c mice can be used to construct a mouse model of PSS. MCMV can infect iris tissue and replicate in it and then establish latency. This might account for the recurrent and self-limited nature of PSS.

Gender Differences in Outpatient Peripheral Artery Disease Management in Germany: A Population Based Study 2009–2018

Peripheral artery disease (PAD) is a major risk factor for morbidity and death. Despite clear guideline recommendations regarding outpatient treatment and pharmacotherapy, implementation is inadequate. Gender differences are becoming increasingly important, especially in patients with atherosclerosis. Gender stratified PAD prevalence and differences in treatment by specialised outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year in Germany between 2009 and 2018. This was based on claims data according to §295 of the social code (SGB V) and drug prescription data according to §300 SGB V. Diagnosis of PAD was defined according to ICD I70.2-9 coding. Statistical analysis was performed with the chi square test for trend and two way ANOVA. In total, 17 633 970 patients with PAD were identified, of whom 47% were female. Prevalence of PAD in Germany increased between 2009 and 2018 and was higher in male patients. Only a minority of 37.1% presented to a vascular specialist. Interestingly, female patients were both less likely to present to a vascular specialist and to receive guideline recommended pharmacotherapy. Overall prescription rates of statins and antiplatelet drugs increased between 2009 and 2018, however. PAD stages were stratified by intermittent claudication (IC) and chronic limb threatening ischaemia (CLTI). In CLTI even fewer patients received a statin, with the gender gap increasing. The results demonstrate gender based differences in pharmacotherapy and specialised outpatient care of patients with PAD. While overall outpatient treatment by vascular specialists and guideline recommended medical therapy of PAD are low, women and patients with CLTI remain undertreated.

Prevalence of Visual Impairment Among Students Before and During the COVID-19 Pandemic, Findings From 1,057,061 Individuals in Guangzhou, Southern China.

BackgroundVisual impairment (VI) is a growing public health concern among students as a result of the COVID-19 pandemic.ObjectiveThis study investigated the change in VI before and during the pandemic among students.MethodsData on 547,864 and 497,371 students were obtained from the Guangzhou Survey on Students' Constitution and Health (GSSCH) collected in October 2019 and October 2020, respectively. VI was defined as the unaided distance visual acuity lower than 20/25 Snellen equivalent (LogMAR 0.10) in the worse eye. Change in VI based on age and sociodemographic variables were evaluated by chi-square test for trend as appropriate. Comparisons of different categorical variables were tested by contingency tables-based chi-square test. We have further analysis of the students who went through both of the 2019 and 2020 examinations for evaluating the VI incidence during the COVID-19 pandemic.ResultsMore than 1,045,235 students were involved in our study, among whom 271,790 (54.65%) out of 497,371 students in Guangzhou suffered from VI during the COVID-19 compared with 293,001(53.48%) visually impaired students (total tested participants = 547,864) before the COVID-19 pandemic. During the pandemic, the overall prevalence of VI actually showed an increased age tendency and reached the highest level in the 17 [80.04%, 95%Confidence interval (CI):79.53 to 80.54%] and the 18 (79.64, 95%CI: 79.06 to 80.23%) age groups. Rapid growth was detected among students aged between 9 and 16 years old (raised by 46.21) while older students were more likely to get moderate and severe VI than younger ones. Students involved in more screen-based activities [(64.83%, 2019); (66.59%, 2020)] appeared to have a higher prevalence of VI than those involved in less [(49.17%, 2019); (49.26%, 2020)].ConclusionA rising trend of VI among students was detected before and during the COVID-19 pandemic. Moreover, the pandemic appeared to be associated with a rapid VI shift in younger and boy populations. Potential danger may arise when public health emergencies occur in the school, and more effort should be made to improve students' vision.

The effect of internet addiction and smartphone addiction on sleep quality among Turkish adolescents.

Background: Sleep quality plays a principal role in the protection of health. There is an increasing number of studies in the literature demonstrating that internet addiction and smartphone addiction impair sleep quality. However, the number of studies on Turkish adolescents is very limited. Therefore, this study examined the effects of internet addiction and smartphone addiction on sleep quality among Turkish adolescents.Methods: Participants in this cross-sectional study were 910 adolescents aged 13–18 years. Data were collected with the Short Internet Addiction Test, Smartphone Addiction Scale, and Pittsburgh Sleep Quality Index. In addition, a questionnaire was used to gather information about the demographic, socioeconomic, and health-related characteristics. Pearson’s Chi-square test, Chi-square test for trend, Mann–Whitney U test, logistic regression analysis, and Spearman’s correlation analysis were used in the analysis.Results: The sleep quality of 58.7% of the adolescents was poor. Additionally, girls and adolescents ≥16 years old had poor sleep quality. Sleep quality deteriorated as perceived health status and perceived economic status of family deteriorated. Compared to participants with normal internet addiction scores, poor sleep quality was 1.83 (95% CI [1.22–2.74]) times higher in those with problematic internet addiction and 1.99 (95% CI [1.23–3.87]) times higher in those with pathological internet addiction. One point increase in Smartphone Addiction Scale total score increased poor sleep quality 1.01 (95% CI [1.00–1.02]) times. Sleep quality scale were positively correlated with the smartphone addiction and internet addiction. However, there was no positive correlation between habitual sleep efficiency subcomponent of sleep quality and smartphone addiction and internet addiction.Conclusions: Internet addiction and smartphone addiction were associated with poor sleep quality in adolescents. Older adolescents (≥16 years), gender (female), poor health perception, and perception of moderate economic status of the family were other factors associated with poor sleep quality.

Inequalities in Physical Activity During the COVID-19 Pandemic: Report on 4 Consecutive Population-Based Surveys in Southern Brazil.

This study aims to investigate inequalities in leisure-time physical activity (PA) practice amid the COVID-19 pandemic in a southern Brazilian city. Four repeated population-based surveys were carried out. PA was collected using a questionnaire proposed by the authors and an adapted version of the leisure-time section of the International Physical Activity Questionnaire. The sociodemographic variables were sex, age, skin color, and education level. The participants also answered questions regarding social distancing measures compliance. Descriptive analyses based on proportions and their respective P values for categorical variables were presented. The chi-square test for heterogeneity and linear trend was used. The sample is composed of 1556 individuals (66.1% female). Overall, between rounds 1 and 2, PA prevalence declined, followed by a gradual increase thereafter. PA practice during the pandemic was higher among men, individuals with higher education level, and individuals with white skin color in all rounds. In rounds 2, 3, and 4, PA was lower among individuals who were practicing more social distancing. To tackle the PA inequalities, policymakers and stakeholders need to confront disparities, defending greater availability of public policies that are attentive to inequalities, especially regarding gender, skin color, and educational level, to promote PA as a human right.

Trend Analysis and Spatial Distribution of Meteorological Disaster Losses in China, 2004–2015

Meteorological disasters caused a lot of losses. We involved six categories (all disasters, floods, hail, typhoon, snow and heatwave) to observe their death and economic losses’ spatial-time distribution. The time trend of mortality was analyzed using a chi-square test for linear trends. Economic loss was described by direct economic loss and loss rate of GDP, whose trends were described by a trend line. Using annual percent change (APC) estimated by fitting weighted linear regression model, the change degree of mortality was assessed. On a national level, there was a statistically significant decreasing trend in mortality of all disasters (Z = −39.82, p &lt; 0.05), floods (Z = −18.79, p &lt; 0.05), hail (Z = −20.43, p &lt; 0.05), typhoon (Z = −37.47, p &lt; 0.05), snow (Z = −9.02, p &lt; 0.05) and heatwave (Z = −8.76, p &lt; 0.05) from 2004 to 2015 in China. The time trend of the loss rate of GDP was decreasing while the trend of direct economic losses was increasing. Western China was the most seriously hit area. APCs remained in downward trends (APCs &lt; 0) in most of the provinces, while central provinces were with upward trends (APCs &gt; 0). Areas with increasing mortality (APCs &gt; 0) for different disasters included the southwest areas and Zhejiang (for floods), the northwest and south areas (for hail), Sichuan, Guangxi and Hainan (for typhoon), the west and northeast areas (for snow) and Hebei, Henan and Shanghai (for heatwave). As for economic losses, eastern areas were hit with a high amount of economic losses, but central areas were hit with a high GDP loss rate. Generally, nationwide death and economic losses caused by meteorological disasters have decreased. However, there were some relatively serious effects in the central and western areas for which urgent attention from policymakers is required.

Does COVID-19 cause pre-eclampsia?

Does COVID-19 cause pre-eclampsia?

Hospitalizations for COVID-19 in a tertiary hospital in Brazil: a parallel with vaccination.

ABSTRACTThis study aimed to evaluate the COVID-19 hospitalizations in a tertiary hospital by age group and month, considering the introduction and the advance of the vaccination against the disease. The laboratory-confirmed COVID-19-associated hospitalizations among people aged 20 years or older, that occurred between March 2020 and June 2021, were distributed by month of symptom onset and age group. The proportion of hospitalizations by age group was calculated for the year 2021. The proportions were compared using the chi-square test for trends. The marks of vaccination advances among different age groups were taken from the official website LocalizaSUS. In 2020, hospitalizations among people aged 60–80 years old were the most frequent (39.1%). From January–June 2021, when the vaccination commenced, while hospitalizations of patients aged 20 to < 40 and 40 to 60 years old showed an increasing trend, the older age groups and those with vaccination recommendations (from 60 to < 80 and from 80 or over) showed a downward trend. As of June 2021, with widespread vaccination, a drop in hospitalizations was observed in > 60 years old. At 20 to <40 and 40 to < 60, an increase in hospitalizations was observed. It demonstrates the important role of vaccination in combating the COVID-19 pandemic.

Exploring the trend of Schizophrenia at Hiwot Fana specialized university referral hospital, Eastern, Ethiopia (2016-2020): A 5-year retrospective analysis.

Schizophrenia is one of the most troublesome psychiatric problems requiring long-term antipsychotic treatments. There is a scarcity of data regarding its overtime trend in Ethiopia.Objective:To explore the 5-year trend of schizophrenia at Hiwot Fana Specialized University Referral Hospital, Eastern Ethiopia.Methods:A hospital-based retrospective record review was conducted at Hiwot Fana Specialized University Referral Hospital, Eastern Ethiopia. Data were obtained from medical records of all registered psychiatric patients in the psychiatric follow-up clinic over 5 years from 2016 to 2020. An Extended Mantel-Haenszel chi-square test for the linear trend was used to examine the trend over the 5-year period.Results:Over the 5-year period stated (2016–2020), a total of 29,184 psychiatric patients were registered at the Hospital from which 18,598 (63.73 % (95% confidence interval: 0.63–0.64) were schizophrenia confirmed cases. Of the 18,598 patients, 15,362 (82.60%) were males and 7,625 (41%) were in 25–34 years of age category. It was revealed that the trend of newly diagnosed patients with schizophrenia increased from (0.44 (95% CI (0.39–0.47) in 2016 to 0.47(95% confidence interval: (0.44–0.49) in 2020 (χ2 = 3.87; p = 0.049). Those chewing Khat were disproportionately affected accounting for about half of the schizophrenia total cases reported.Conclusion:The magnitude of patients with schizophrenia being treated at the hospital increased over the 5 years studied. Tailored preventive and treatment interventions are needed to mitigate the problem. Community and institution-based customized interventions can be designed using the existing health system platforms.

Use of Google Analytics to Explore Dissemination Activities for an Online CKD Clinical Pathway: A Retrospective Study.

Background:Data on dissemination strategies that generate awareness of clinical pathways for kidney care are limited.Objective:This study reports the application of Google Analytics to describe the reach and use of the Chronic Kidney Disease Pathway (CKD-P) using a multi-faceted dissemination strategy.Design:The design of this study is a retrospective descriptive study.Setting:This study was conducted in Alberta, Canada.Patients:Individuals who accessed the CKD-P Web site between November 5, 2014, and May 31, 2019.Measurements:Dissemination activities included print, electronic, in-person meetings, and a laboratory prompt. We used Google Analytics over a 5-year period to evaluate the following CKD-P Web site user metrics: number of sessions, pageviews, visit duration, user path, and bounce rate (when an individual visits a single page of the Web site and leaves the Web site without interacting with additional pages).Methods:We plotted dissemination activities alongside Web site metrics using control charts and described the data using means and percentages. We performed chi-square test for trends to evaluate year-over-year usage.Results:There were 83 294 users, 90 805 sessions, and 231 684 pageviews. The overall bounce rate was 45.7%. Each user had an average of 1.5 sessions and a session duration of 2 minutes and 8 seconds. There was a significant positive trend for total annual users (P = .008), new users (P = .009), number of sessions (P = .006), and pageviews per day (P = .016).Limitations:We were unable to confirm if users were primary care providers and if word-of-mouth dissemination among providers/researchers drove people to use the CKD-P.Conclusions:Google Analytics was a useful and accessible tool for evaluating CKD-P reach and use trends. It was challenging to identify how individual dissemination activities contributed to CKD-P reach; however, repeated dissemination appeared to play a role in increasing CKD-P use.Trial registration:Not applicable—observational study design.

Secondary Data Analysis of Tuberculosis Deaths in Bulawayo Province, Zimbabwe, 2016-2019

Background: Tuberculosis is a leading cause of death globally, and the third leading cause of death in Zimbabwe. Death from any cause following a diag-nosis of tuberculosis is classified as a tuberculosis death. Bulawayo Province reported high tuberculosis death rates from 15.3% in 2016 to 14.2% in 2019 against a threshold of 5%. We analyzed tuberculosis deaths for Bulawayo Province to characterize patients dying and to make recommendations for im-proving treatment outcomes for susceptible tuberculosis cases. Methods: A descriptive cross-sectional study was conducted. We analyzed all (N = 469) records of tuberculosis deaths from 19/19 Bulawayo tuberculosis diagnosing centers from 01 January 2016 to 31 December 2019. Microsoft® Excel 2007 was used to generate graphs and Stata® version 17 was used to conduct chi-square tests for trends. Results: Males accounted for 278/469 (59.3%) of the deaths. The median age of death was 40 years (Q1 = 33: Q3 = 51). The proportion of TB deaths increased from 63/114 (55%) in 2016 to 57/90 (63%) in 2019 for males (p < 0.01). The majority of deaths 278/469 (59.3%) occurred in the intensive phase of treatment and anemia was a co-morbid condition in only 44/469 (9.4%) of the tuberculosis deaths. Testing for anemia was not rou-tinely done. Conclusion: High death rates particularly in the intensive phase, could be attributed to sub-optimal clinical care. Tuberculosis programs should work towards adopting differentiated care models for tuberculosis patients and developing algorithms for patients at high risk of death.

PIG-A gene mutation as a genotoxicity biomarker in polycyclic aromatic hydrocarbon-exposed barbecue workers

BackgroundThe PIG-A gene mutation assay is a valuable tool for measuring in vivo gene mutations in blood cells. The human PIG-A assay, used as a potential genotoxicity biomarker, is minimally invasive, sensitive, and cost-efficient; however, the relationship between carcinogen exposure and PIG-A mutations is not well understood.MethodsWe investigated the genotoxic effect of red blood cells using PIG-A assay and lymphocyte cytokinesis-block micronucleus test in barbecue restaurant workers (N = 70) exposed to polycyclic aromatic hydrocarbons (PAHs) and self-identified healthy control subjects (N = 56). Urinary PAH metabolites were measured to evaluate internal exposure levels.ResultsMultivariate Poisson regression showed that the PAH-exposed workers exhibited significantly higher PIG-A mutant frequency (MF) (8.04 ± 6.81 × 10− 6) than did the controls (5.56 ± 5.26 × 10− 6) (RR = 0.707, 95% CI: 0.615–0.812, P < 0.001). These results indicate that PAH exposure is a risk factor for elevated PIG-A MF. The frequencies of micronuclei (MN) and nuclear buds (NBUD) in the PAH-exposed workers (MN: 3.06 ± 2.07 ‰, NBUD: 1.38 ± 1.02 ‰) were also significantly higher than in the controls (MN: 1.46 ± 0.64 ‰, P < 0.001; NBUD: 0.70 ± 0.60 ‰, P < 0.001). Additionally, PIG-A MFs showed better associations with several urinary hydroxylated PAH metabolites (P2-OH-Flu = 0.032, r2-OH-Flu = 0. 268; P2-OH-Phe = 0.022, r2-OH-Phe = 0.286; P3-OH-Phe = 0.0312, r3-OH-Phe = 0.270; P4-OH-Phe = 0.018, r4-OH-Phe = 0.296), while the increase in MN, NPB, and NBUD frequencies was not associated with any OH-PAH metabolites; and high-PAH-exposed workers showed the highest PIG-A MFs. Furthermore, there was a significant association between PIG-A MF and PAH exposure levels (Chi-square test for trend, P = 0.006).ConclusionsOur results indicate that an increase in PIG-A MF in barbecue workers could reflect the response to PAH exposure, providing evidence of its potential as a genotoxicity biomarker in human risk assessment.

Lower accuracy of cytological screening for high-grade squamous intraepithelial neoplasia in women over 50\xa0years of age in Japan

BackgroundAs the population ages in developed countries, the number of Pap smears for cervical cancer screening of older women is increasing. There is concern that cervical atrophy may cause misinterpretation of results for this segment of the population. The present study evaluated the accuracy of screening for high-grade intraepithelial lesions (HSILs) in women younger or older than 50 years, to determine whether aging affects cytological interpretation.MethodsPatients with HSIL cytology (N = 1565) were dichotomized into those aged 20–49 years or aged ≥ 50 years. Association between histology results and age was examined. Pearson’s chi-squared test and Cochran-Armitage trend test were used for statistical analysis.ResultsThe positive predictive value (PPV) for cervical intraepithelial neoplasia (CIN)2 and worse was 65.2% (62/95) in older women but 87.3% (482/552) in younger women (p < 0.001). Older patients had a significantly lower PPV (p = 1.69 × 10–8). Separately analyzing chronic cervicitis, CIN1 and overt cancer grouped together, compared with another group composed of CIN2 and CIN3, we found that the PPV for CIN2 and CIN3 was lower in older than in younger women [44.2% (42/95)-vs-82.4% (455/552), p < 0.001], respectively.ConclusionsHSILs are associated with a wide range of disease categories as age increases, and the accuracy of HSIL interpretation is lower in older women.

Social distancing as protection factor against COVID-19 in a non-metropolitan area in the State of Rio Grande do Sul, BrazilLas medidas de distanciamiento social como factor de protección contra la COVID-19 en el interior de Rio Grande do Sul, Brasil

RESUMOObjetivo.Investigar a soroprevalência de SARS-CoV-2 na região do Vale do Rio Pardo, Rio Grande do Sul, Brasil, e analisar a associação entre soroprevalência e adesão por parte da população às medidas de distanciamento social.Método.Este estudo transversal de base populacional compreendeu quatro etapas de coleta domiciliar de dados entre agosto e outubro de 2020. A soroprevalência foi avaliada utilizando teste rápido de anticorpos IgM e IgG. Foram coletados, ainda, dados demográficos, socioeconômicos, clínicos e comportamentais, com aplicação de um questionário de três perguntas sobre adesão a medidas de distanciamento social, com foco no nível de distanciamento social que o entrevistado conseguia praticar, rotina de atividades do entrevistado e circulação de pessoas na casa. A associação entre os dados sociodemográficos e a prática de distanciamento social foi avaliada pelo teste do qui-quadrado para tendência linear e heterogeneidade de proporções, e a associação entre o distanciamento social e a soroprevalência foi avaliada pela regressão de Poisson (intervalo de confiança de 95% [IC95%]; P < 0,05).Resultados.Dos 4 252 indivíduos testados e entrevistados, 11,8% (IC95%: 10,8; 12,8) não aderiram ao distanciamento social. A prevalência de teste rápido reagente foi de 4,7% entre aqueles que não realizaram distanciamento social e de 1,9% entre aqueles que realizaram distanciamento social (P < 0,05). As variáveis sexo masculino, faixa etária de 20 a 59 anos, ensino médio, renda familiar mensal de R$ 3 136,00 a R$ 6 270,00 e morar na zona urbana apresentaram associação com a não adesão ao distanciamento social (P < 0,05). A adesão a todas as medidas de distanciamento social foi fator de proteção contra a infecção de SARS-CoV-2 (razão de prevalência: 0,37; IC95%: 0,19; 0,73).Conclusões.Os resultados indicam uma redução da soroprevalência pelas medidas de distanciamento social.

Abstract 14448: National Adherence to Guideline-Directed Medical Management of Aortic Disease

Introduction: Guidelines for the medical management of aortic (AD) and coronary artery disease (CAD) recommend treatment for hypertension (HTN), hyperlipidemia (HLD), and tobacco use (TU) (Class 1). Hypothesis: Adherence to guidelines for the management of AD is low, and inferior to CAD. Methods: Adults in the Clinformatics Data Mart database diagnosed with AD or CAD and concomitant HTN, HLD, and/or TU between 2004 and 2019 were included. Those with less than six months of continuous enrollment or prior cardiovascular procedures were excluded. Adherence was calculated as the proportion of patients with a given comorbidity (or combination thereof) who received a prescription for the appropriate intervention. Any beta-blocker, ACEi, or ARB for HTN. Any statin for HLD. Bupropion, varenicline, or referral to counseling for TU. Composite adherence for patients with AD and CAD was compared using a Z-test. Temporal trends were analyzed using a Chi-square test for trend. Results: There were 354,851 patients with AD and 907,997 with CAD who met the inclusion criteria. Composite adherence was 50% for those with AD compared to 59% for CAD (p&lt;0.01). No clinically-significant changes in composite adherence overtime occurred for either group (Figure 1A). Among those with AD, adherence was highest among those with HTN alone (73%), followed by combined HTN/HLD (58%) and HLD alone (45%). Diagnosis of TU was associated with lower adherence across all risk factor combinations. There has been a significant improvement in adherence for TU overtime (p&lt;0.01) (Figure 1B). Conclusions: Adherence to guidelines for medical management of AD is low, and significantly lower than for CAD.