Confidence Interval Research Articles

Detectability of the chiral gravitational wave background from audible axions with the LISA-Taiji network

Abstract The chiral gravitational wave background (GWB) can be produced by axion-like fields in the early universe. We perform parameter estimation for two types of chiral GWB with the LISA-Taiji network: axion-dark photon coupling and axion-Nieh-Yan coupling. We estimate the spectral parameters of these two mechanisms induced by the axion and determine the normalized model parameters using the Fisher information matrix. For highly chiral GWB signals that we choose to analyze in the mHz band, the normalized model parameters are constrained with a relative error less than $6.7\%$ (dark photon coupling) and $2.2\%$ (Nieh-Yan coupling) at the one-sigma confidence level. The circular polarization parameters are constrained with a relative error around $21\%$ (dark photon coupling) and $6.2\%$ (Nieh-Yan coupling) at the one-sigma confidence level.

Does infant birthweight percentile identify mothers at risk of severe morbidity? A Canadian population-based cohort study

BackgroundThere is a reverse J-shaped relation between newborn weight percentile and risk of perinatal mortality. Perinatal mortality itself is associated with severe maternal morbidity and mortality (SMM-M) around the index pregnancy, likely because the two share common etiologies, including placental dysfunction. We evaluated an infant’s birthweight percentile and risk of its mother experiencing SMM-M.MethodsThis population-based cohort study was completed within a universal healthcare system in Ontario, Canada. Included were 2,203,490 singleton livebirths between 2002 and 2020. The study exposure was infant birthweight percentile for gestational age and sex. The 25th to 75th percentile served as the referent. The main outcome was SMM-M arising from 23 week’s gestation up to 42 days postpartum. Multivariable modified Poisson regression generated relative risks (aRRs) and 95% confidence intervals (CI), adjusted for maternal age, income, rurality, pre-existing diabetes and hypertension.ResultsA J-shaped relation was seen between birthweight and risk of SMM-M. Relative to the 25th to 75th (15.0 per 1000 livebirths), the aRR of SMM-M was 1.27 (95% CI 1.21, 1.32) at 5th to < 10th, 1.40 (95% CI 1.28, 1.53) at 2nd to < 3rd, and 1.48 (95% CI 1.36, 1.62) at < 1st birthweight percentile. At higher birthweights, the aRR was 1.16 (95% CI 1.11, 1.21) at 90th to < 95th, 1.24 (95% CI 1.13, 1.36) at 95th to < 96th, and 1.73 (95% CI 1.60, 1.87) at > 99th percentile.ConclusionThere is a J-shaped relation between infant birthweight and risk of its mother experiencing SMM-M, likely due to shared risk factors and a common pathogenesis.

Incretin-based therapy: An update focusing on the major revolution in cardiovascular-kidney-metabolic health.

Incretin-based therapy: An update focusing on the major revolution in cardiovascular-kidney-metabolic health.

Infant palmar hyperlinearity and type 2 inflammatory markers predict atopic dermatitis at 1 year of age.

Infant palmar hyperlinearity and type 2 inflammatory markers predict atopic dermatitis at 1 year of age.

Risk factors for deep venous thrombosis in pediatric trauma patients: A review of the National Trauma Data Bank from 2017 to 2022.

Pediatric trauma patients rarely receive venous thromboembolism (VTE) prophylaxis but have low rates of deep venous thrombosis (DVT). Patients with lower extremity orthopedic injuries, patients with traumatic brain injuries, more severely injured patients, and older children may be at higher risk, but these risk factors have not been examined together for a large population. The National Trauma Data Bank was queried from 2017 to 2022 for patients 17 years or younger and patients with DVT to create a retrospective cohort study with this subset compared with pediatric patients without DVT. Categorical variables were analyzed with χ2 test, and continuous variables, with t test. A logistic regression model was performed to determine risk factors for DVT in pediatric trauma patients. From 2017 to 2022, there were 693,729 pediatric trauma patients, of which 786 (0.11%) had a DVT. The DVT group was older (13.64 vs. 9.70 years, p < 0.0001) and more likely to be male (71.63% vs. 64.65%, p < 0.0001), proceeded immediately to operating room (41.6% vs. 14.63%, p < 0.001), received packed red blood cells (PRBCs) ≤4 hours (47.71% vs. 9.94%, p < 0.0001), received fresh frozen plasma ≤4 hours (33.46% vs. 1.22%, p < 0.0001), and had an Injury Severity Score (ISS) of >15 (87.02% vs. 43.19%, p < 0.0001). A logistic regression model demonstrated that patients age 13 years or older had an odds ratio of 2.444 (confidence interval, 1.137-5.250; p = 0.022). Other significant risk factors included PRBC ≤4 hours of arrival (odds ratio, 3.436; confidence interval, 1.574-7.502; p = 0.022), ISS of >15 (odds ratio, 3.650; confidence interval, 1.071-12.440; p < 0.038), increased lower-extremity Abbreviated Injury Scale scores (odds ratio, 1.665; confidence interval, 1.236-2.243; p = 0.001), and VTE prophylaxis administered more than 6 days after admission (odds ratio, 11.590; confidence interval, 5.695-23.584; p < 0.0001). Venous thromboembolism prophylaxis should be considered in pediatric patients who are 13 years or older, have received PRBC early, and have severe ISS and/or higher lower-extremity Abbreviated Injury Scale score; delayed VTE prophylaxis beyond 6 hospital days increases risk of DVT in patients with these risk factors. Prognostic and Epidemiological Study; Level III.

The Effect of Opioid Agonist Treatment on Injection-Related Sequelae: A Population-Based Observational Study.

Opioid agonist treatment (OAT) reduces drug-related poisonings and injection-related infections among people with opioid use disorder (OUD). Despite buprenorphine-naloxone (BNX) and methadone (MET) both being first-line OAT options in Canada, their comparative effectiveness in preventing recurrent injection-related infections and poisonings remains unclear. This study compared the effectiveness of buprenorphine-naloxone and methadone in reducing recurrent risks of injection-related bacterial infections and opioid-related poisoning among people on OAT. We used administrative health data from Québec, Canada to create our cohort of adult patients (aged 18-65 years) on OAT maintenance between 2014 and 2019. We applied a time-dependent Cox proportional hazards model for our time-varying exposure definition to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the recurrent risks of injection-related bacterial infections and opioid-related poisoning, adjusting for age, sex, socio-demographic, and clinical factors. We also compared the effectiveness of buprenorphine-naloxone and methadone during the OAT induction phase (i.e., first 30 days of treatment). The study population included 2010 patients (mean age: 41.21 years, 67.41% male). Compared to methadone, buprenorphine-naloxone was associated with 45% lower recurrent risk of opioid-related poisoning (HR: 0.55; 95% CI 0.35-0.86). Overall, the association between buprenorphine-naloxone and recurrent risk of injection-related bacterial infections suggested a weak protective effect (HR: 0.80; 95% CI 0.59-1.09). During the induction phase, there was limited evidence of differences between buprenorphine-naloxone and methadone for the recurrent risks of injection-related bacterial infections (HR: 0.91; 95% CI 0.51-1.60) and opioid-related poisoning (HR: 1.07; 95% CI 0.51-2.24). Among patients in OAT maintenance, buprenorphine-naloxone was associated with lower risk of recurrent opioid-related poisoning compared to methadone, but not for injection-related infections. This advantage was not observed during induction, suggesting the need for improved treatment retention early in OAT.

A Preconception Cohort Study of Nicotine Vaping and Incidence of Spontaneous Abortion.

We evaluated association of preconception nicotine vaping among female and male partners with spontaneous abortion (SAB) incidence, and the extent to which associations vary by cigarette smoking. In a prospective cohort study, 6136 participants assigned female-at-birth and 1688 of their partners assigned male-at-birth reported preconception nicotine vaping and cigarette smoking via online questionnaire. Female partners reported incident pregnancies and outcomes (e.g., SAB) on follow-up questionnaires completed every 8weeks and in early and late pregnancy. We used multivariable Cox proportional hazards regression models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for association between vaping and SAB incidence, overall and by smoking history. Mean age was 30 and 32 for females and males respectively. Among females, 13% reported ever-vaping and 14% reported ever-smoking, while 19% of males reported ever-vaping and 24% reported ever-smoking. Relative to female never-vapers, aHRs were 1.03 for former vaping (95% CI 0.86-1.24) and 0.91 for current vaping (95% CI 0.61-1.36). Former and current vaping were also not appreciably associated with SAB rate among ever-smokers. In the couple-based cohort, relative to male never-vapers, aHRs were 1.00 for male former-vapers (95% CI: 0.74-1.35) and 0.67 for male current-vapers (95% CI: 0.35-1.25). Additional analysis of female participants after stratifying by finer categories of smoking status did not identify any meaningful association with SAB incidence. The current study found that vaping in either partner during the preconception period was not associated with SAB incidence. Cigarette smoking also did not modify this association. The rising prevalence of vaping invokes greater scrutiny on its possible adverse reproductive effects. Studies have linked vaping to adverse birth events, and clear guidance is made to avoid vaping in pregnant people. However, guidance about vaping during preconception is less clear despite research showing how preconception behaviors are linked to adverse pregnancies and birth outcomes. Our cohort study finds little association between preconception vaping and spontaneous abortion. In context of established risks of vaping on fetal outcomes, this study highlights the need for additional evidence-based information about preconception vaping to help couples make lifestyle decisions for optimal reproductive outcomes.

Neoadjuvant Treatment Based on Gastric Cancer Molecular Subtyping: Chemotherapy, Immunotherapy, or Targeted Therapy?-A Retrospective Analysis.

This study aimed to identify the most effective drug therapeutics for patients with the mesenchymal subtype of advanced gastric cancer (AGC). Extensive research employing diverse omics methodologies has unveiled a varied landscape of AGC. Recent progress in next-generation sequencing and other genomic technologies has facilitated a more intricate exploration of AGC at the molecular level. Nonetheless, the optimal treatment for patients with the mesenchymal subtype of gastric cancer remains elusive. Lei's molecular classification of AGC is based on gene expression profiles named "mesenchymal," "immunogenic," "classical," and "metabolic." Based on RNA-seq transcriptome, 234 patients were divided into four molecular subtypes: mesenchymal (n = 96), immunogenic (n = 37), metabolic (n = 61), and classic (n = 40). Among those with mesenchymal-subtype AGC, compared with non-Apatinib group, the Apatinib treatment group demonstrated a significant increase in objective response rate (ORR 89.3% versus 69.3%, p = 0.038; odds ratio (OR) 0.269, 95% confidence interval (CI) (0.073-0.989)); overall survival (OS) 89.3% versus 60.2%, p = 0.010; hazard ratio (HR) 0.241, 95% CI (0.073-0.796)) and disease-free survival (DFS 78.6% versus 52.9%, p = 0.031; HR 0.400, 95% CI (0.167-0.956)). Furthermore, Apatinib significantly reduced the risk of death and recurrence in patients with mesenchymal subtype (OS: HR 0.129, 95% CI (0.030-0.563), p = 0.006; DFS: HR 0.340, 95% CI (0.138-0.833), p = 0.018). However, no significant differences were observed in the ORR, OS, or DFS between patients with metabolic and classical subtypes who underwent combination chemotherapy with additional Apatinib or camrelizumab. Our analysis has revealed that, for neoadjuvant therapy in AGC, the mesenchymal subtype stands out as the ideal patient population benefiting from Apatinib.

The Rising Global Burden of MASLD and Other Metabolic Diseases (2000-2021).

Metabolic diseases are a public health threat to diverse populations worldwide. This study aims to update the epidemiological trends of metabolic diseases across regions and sociodemographic stratifications using the Global Burden of Diseases Study 2021. This study focused on metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) along with obesity, hypertension, and dyslipidemia. The prevalence and disability-adjusted life years (DALYs) with their age-standardised prevalence rate and DALYs (ASPR and ASDALYs) and uncertainty intervals (UIs) were estimated and stratified by sex, geography, and the Sociodemographic Index (SDI). Epidemiological trends were analysed using the Joinpoint Regression method, which calculated the annual percent change (APC) and confidence intervals (CIs) of age-standardised rates (ASRs) from 2000 to 2021. In 2021, MASLD had a prevalence of 1.27 billion people (ASPR: 15,018.07, 95% UI: 13,756.47 to 16,361.44; ASDALYs: 42.40, 95% UI: 33.60 to 53.31), while T2DM had a prevalence of 0.51 billion people (ASPR: 5885.40, 95% UI: 5467.62 to 6334.18; ASDALYs: 871.78, 95% UI: 735.05 to 1044.78) worldwide. ASPRs of MASLD and T2DM increased over the 2decades. ASDALYs decreased over time for dyslipidemia (APC: -1.43%, 95% CI: -1.58 to -1.27%) and hypertension (APC: -1.32%, 95% CI: -1.43 to -1.21%) but increased for T2DM (APC: 1.09%, 95% CI: 1.04 to 1.14%) and obesity (APC: 0.70%, 95% CI: 0.63 to 0.78%), while it remained stable for MASLD. The global burden of metabolic diseases was generally higher in males compared to females. The highest ASDALYs for all these metabolic diseases were observed in low-middle SDI countries. The global burden of MASLD and other metabolic diseases is substantial. National and global policies must better address metabolic diseases including the MASLD public health threat.

Occupational Disparities in Cancer Survival Among the Working Population in Japan: 10‐Year Survival Analysis Using the Kanagawa Cancer Registry

ABSTRACTBackgroundLimited data exist on occupational disparities in long‐term cancer mortality among the working‐age population in Japan. We examined occupational disparities in long‐term cancer survival, focusing on 10‐year survival outcomes among working‐age populations.MethodsThis retrospective observational study used data from the Kanagawa Cancer Registry of 41,632 patients with cancer aged 20–65 years who were diagnosed between 1992 and 2015, with a 10‐year follow‐up. Patients were classified into four occupational classes based on their longest‐held occupations (upper nonmanual, lower nonmanual, manual, and primary industry). The primary outcome was all‐cause mortality, and cancer‐specific mortality was the secondary outcome. Poisson regression was used to estimate the mortality rate ratios (MRRs) and 95% confidence intervals (CIs) for each occupational class, adjusted for sex, age, and year of diagnosis. Additional analyses were performed for common cancer sites (stomach, lung, colorectal, and breast).ResultsMRRs for all‐cause mortality were higher in lower nonmanual (MRR = 1.14, 95% CI 1.10–1.18), manual (MRR = 1.38, 95% CI 1.32–1.43), and primary industry workers (MRR = 1.19, 95% CI 1.09–1.31) than in upper nonmanual workers (professional and managerial occupations). Similar patterns were observed across common cancer sites and cancer‐specific mortality. Adjusting for cancer stage and treatment attenuated these disparities but did not eliminate them, particularly among manual workers.ConclusionsWe observed occupational disparities in long‐term cancer mortality among working‐age populations in Japan, with manual workers experiencing worse survival outcomes. Promoting targeted interventions, healthy lifestyles, and early cancer detection for cancer survivors in the workplace are crucial for mitigating these disparities.

Association between lifestyle behaviors and body mass index with blood pressure classifications among older adults with hypertension in China

ObjectiveThis study aimed to examine the association between lifestyle behaviors and body mass index (BMI) along with their potential interactions with the severity of blood pressure (BP) classifications among older adults with hypertension.MethodsAmong 17,441 participants, lifestyle behaviors were assessed, including smoking, drinking, dietary patterns, physical activity, and sleeping. Multinomial logistic regression was used to examine the association between lifestyle behaviors and BMI with BP classifications, and multiplicative interactions were included to estimate potential interactions. To explore variations, analyses were also stratified by BMI.ResultsHigh-risk dietary pattern and obesity were negatively associated with lower BP classifications, with odds ratios (ORs) and 95% confidence intervals (CIs) for normal BP, high-normal BP, and grade 1 hypertension in high-risk dietary pattern were 0.74 (0.57–0.95), 0.69 (0.54–0.90), 0.75 (0.59–0.95), and the ORs (95% CIs) in obesity were 0.61 (0.53–0.69), 0.77 (0.67–0.89), 0.82 (0.73–0.93). Compared with never drinking, former drinkers had higher odds of having normal BP (OR: 1.45, 95% CI: 1.15–1.82), high-normal BP (OR: 1.31, 95% CI: 1.02–1.67), and grade 1 hypertension (OR: 1.26, 95% CI: 1.01–1.58). The multiplicative interaction between drinking status and BMI was found on BP classifications (Pforinteraction &amp;lt;0.05), and the effects of former drinking and low PA level on BP control were significant in overweight and underweight groups, respectively (P &amp;lt; 0.05).ConclusionsPoor diet and obesity are associate with severe BP, particularly among non-drinking older adults, suggesting targeted interventions in rural primary care.

Adherence to breast screening guidelines and breast cancer mortality: a population cohort study.

Population-based breast screening programs diagnose cancers at earlier stage when they are easier to treat. Indeed, individuals screened as part of the Ontario Breast Screening Program (OBSP) are diagnosed with a lower stage of breast cancer than those who have never been screened. We sought to determine if adherence to OBSP guidelines is associated with differences in the rate of death from breast cancer in addition to cancer stage at diagnosis. 48,927 women ≥ 51years diagnosed with a first primary breast cancer in Ontario 2010-2017 were included and classified as an adherent screener, partial screener, or non-screener. The cohort was developed using administrative health databases linked by Ontario Health. Cause-specific hazard ratios (HR) and 95% confidence intervals (CI) were used to examine the association between adherence to OBSP guidelines and the rate of breast cancer death adjusting for age, rurality, and history of a prior cancer diagnosis. Death from non-breast cancer causes was considered a competing risk. Compared to adherent screenings, non-screeners and non-adherent screeners had higher rates of death from breast cancer (HR: 3.59, 95% CI 3.30-3.90 and HR: 1.69, 95% CI 1.47-1.95 respectively). Further, non-adherent screeners (i.e., screened ≥ once) had a lower rate of breast cancer death than non-screeners (HR: 0.47, 95% CI 0.41-0.54). Individuals screened in the OBSP have a lower rate of death from breast cancer than non-screeners, even if they are not meeting screening guidelines. These findings suggest women should be encouraged to participate in breast screening regardless of their frequency of use.

Efficacy and Safety of Botulinum Toxin Injections for Epiphora Management: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluate the efficacy and safety of lacrimal gland botulinum toxin (BTX) injection for managing epiphora. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search of MEDLINE, Cochrane CENTRAL, and EMBASE databases was conducted to include studies published from 2000 to March 2024 that evaluated patients treated with lacrimal gland BTX injections for epiphora. Data extraction covered study design, patient demographics, types of BTX used, injection techniques, dosage, follow-up duration, and outcomes, including (Schirmer test and Munk scores) and adverse events. Methodological quality was assessed for each study type. From 517 studies identified in the literature search, 19 studies met the inclusion criteria involving 415 glands injected with BTX. Schirmer test scores decreased at 3 months (mean difference = 8.80; 95% confidence interval: 5.28-12.32; p < 0.01) and at 6 months (mean difference = 5.33; 95% confidence interval: 2.77-7.90; p < 0.01). The overall incidence of adverse events was 22% (95% confidence interval: 12-32%), and ptosis (63%) and diplopia (21%) were the most common. Reinjection was more common in the functional epiphora group, with a pooled rate of 81%, compared with 43% in the nonfunctional group (p = 0.12). Injecting as little as 2.5 units of BTX into the lacrimal gland is effective in reducing tear production in epiphora, with sustained clinical benefits and a transient adverse event profile. These findings support its use as a nonsurgical alternative, particularly for patients ineligible for or averse to invasive procedures. Further studies are needed to refine dosing and long-term efficacy.

A - 11 Neuropsychological Performance of Normal and Slow-Recovering Collegiate Football Players Following Sport-Related Concussion

A - 11 Neuropsychological Performance of Normal and Slow-Recovering Collegiate Football Players Following Sport-Related Concussion

Early versus late intermaxillary elastics in patients with Class II malocclusion: a randomized clinical trial

ABSTRACT Objectives To compare efficacy and treatment duration of early versus late Class II elastics in patients with Class II malocclusion. Material and Methods Forty patients were randomized into two groups based on the timing of elastics use: early and late. In the early group, light short elastics were used from the day of placement of fixed preadjusted edgewise appliances. In the late group, elastics were inserted once 0.016 × 0.022-inch stainless steel archwires were in place. Lateral cephalograms and standardized smile photographs were taken before treatment and after achieving a Class I buccal segment relationship. Treatment duration, dental, skeletal, and soft tissue measurements were then compared between the two groups. Results Maxillary central incisors were retroclined relative to the SN plane (95% confidence interval (CI): 3.75°–11.99° and 3.96°–9.18° in the early and late groups, respectively) with clockwise rotation of the occlusal plane (95% CI: 3.75°–11.99° and 3.96°–9.18° in the early and late groups, respectively). Treatment duration to level and align and reach Class I buccal occlusion was significantly less in the early group (95% CI: 4.74–10.8 months). Comparison between groups revealed no significant differences for all measurements except MP/SN and PP/SN angles (P &lt; .05). Conclusions Class II elastics were equally effective and more efficient in the early group with significantly less time needed to level and align and reach Class I buccal occlusion compared to the late group.

Extracorporeal shockwave therapy as a treatment option for shoulder impingement syndrome: a systematic review and meta-analysis

Abstract Background Shoulder impingement syndrome (SIS) is a common alignment syndrome that causes significant discomfort and functional limitations. In recent years, extracorporeal shock wave therapy (ESWT) has gained attention as a promising non-invasive treatment for SIS. However, its effectiveness remains controversial. This review aimed to elucidate the efficacy of ESWT in SIS by analyzing data from randomized controlled trials (RCTs). Material and methods A systematic review of randomized controlled trials (RCTs) was conducted. Search sources included 3 databases, the references list of the included studies that cited the included studies. In total, 2 reviewers (S.N. and L.K.) independently conducted the study selection. W.D. and A.A. carried out data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a statistical approach (standard meta-analysis methodologies). A random-effects model was employed to account for potential heterogeneity across studies. Effect sizes were reported as standardized mean differences (SMD) with corresponding 95% confidence intervals (CI). Heterogeneity was assessed using Cochran’s Q test, with statistical significance set at p &lt; 0.05, and quantified using I 2 statistics. Results Our meta-analysis revealed that all four included studies (100%) showed a low risk of bias across all five assessed domains, indicating strong methodological quality and reliability of the findings. Furthermore, this meta-analysis revealed that ESWT significantly reduced pain in patients with SIS over 2–3 months. The pooled analysis demonstrated a marked improvement in pain 2.18 (95% CI: 0.45 to 3.90, I 2 = 0%). Furthermore, the ESWT group demonstrated a significant difference from the other interventional group in terms of SPADI alleviation in 2–3 months 19.46 (95% CI: 5.12 to 33.79, I 2 = 0%). Conclusion This review and meta-analysis highlighted that shockwave therapy is more efficient than other interventions in reducing pain and enhancing functional activities in adults with SIS in 2–3 months period. This systematic review supports the integration of ESWT protocols into clinical practice based on symptom severity and chronicity of SIS. The findings offer valuable guidance for future research and highlight the need for standardized approaches to optimize treatment outcomes.

A blood metabolic signature of a healthy lifestyle and colorectal cancer risk: results from cohort and Mendelian randomization studies.

Despite a healthy lifestyle being linked to reduced colorectal cancer (CRC) risk, prior studies using surveys to measure lifestyle factors failed to consider potential inter-individual heterogeneity in metabolic responses. We aimed to characterize a metabolic signature as a measure of metabolic responses to a healthy lifestyle and evaluate its association with CRC risk. Among 211,135 UK Biobank participants, we derived a healthy lifestyle score (HLS) from eight lifestyle components and applied elastic net regression to derive its metabolic signature from 249 biomarkers in plasma samples collected at baseline. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of the signature with CRC risk. To infer potential causality of the signature, we conducted a genome-wide association study among 184,765 UK Biobank participants of European ancestry, followed by a two-sample Mendelian randomization (MR) analysis in 78,473 CRC cases and 107,143 controls of European ancestry. The metabolic signature, which explained 32.6% of the total variance in HLS, was associated with 12% lower CRC risk (HR=0.88; 95% CI=0.84-0.92 per standard deviation [SD] increase; Ptrend<0.001). MR results provided strong evidence for a potential causal association of the signature with CRC (odds ratio [OR]=0.90; 95% CI=0.84-0.95 per SD increase; P-value<0.001). A metabolic signature characterizing a healthy lifestyle was inversely associated with CRC risk. Certain biomarkers constituting the signature may be involved in the lifestyle pathway for CRC incidence. Our study further supported lifestyle modifications and identified potential targets for CRC prevention.

Predictors of midwifery graduate outcomes in Palestine: a cross-sectional study of curriculum quality, faculty support, and regional disparities

BackgroundMidwifery education critically shapes graduates’ employment status and satisfaction. This study identifies predictors of employment outcomes and satisfaction among Palestinian midwifery graduates, focusing on sociodemographic factors, curriculum quality, clinical training, and faculty support. It also analyzes regional employment disparities and satisfaction variations across graduation cohorts.Methods273 graduates of the Midwifery Bachelor’s Program at Ibn Sina College of Health Professions completed a cross-sectional survey. Data collected included sociodemographic information, employment status, and satisfaction with curriculum, clinical training, and faculty support. Instrument validity was confirmed with a Content Validity Index (CVI) of 0.84. A pilot study (n = 27) refined the survey. Statistical analyses included Chi-square tests, Pearson’s correlations, and multiple logistic regression, with results presented as odds ratios (OR) and 95% confidence intervals (CI).ResultsGraduates under 25 years had lower employment rates (OR = 0.68, 95% CI: 0.50–0.92, p = 0.036), while married graduates were more likely to be employed. Strong faculty mentorship tripled employment odds (OR = 2.75, 95% CI: 1.81–4.18, p = 0.002). Curriculum quality moderately correlated with satisfaction (ρ = 0.32, p = 0.001). Neonatal training satisfaction was lower (33% excellent, 55% good), with identified gaps in clinical preparedness. Employment disparities across regions were statistically significant (χ² = 10.82, p = 0.001), favoring the northern West Bank.ConclusionImprovements are needed in neonatal care training and faculty mentorship. Clinical rotations in high-risk settings should expand. Future research must include socioeconomic status and prior healthcare experience as variables. Regional job placement initiatives are necessary to address employment disparities.Clinical trial numberNot applicable.

Intensive care needs after hip and knee replacement: understanding risk profiles for severe postoperative complications.

The etiology of serious life-threatening events after total joint arthroplasty (TJA) is poorly elaborated and understood in literature. The purpose of this study was to identify independent predictors of postoperative intensive care following total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to clarify the circumstances leading to these transfers. A total of 142 patients suffering from postoperative intensive care-dependent serious adverse events (Clavien-Dindo classification Grade IV, CD°IV) after THA or TKA were matched 1:1 with non-CD°IV patients using propensity score matching for age, sex, comorbidity (Charlson Comorbidity Index, CCI), and year of treatment. Possible predictive factors for the need of postoperative intensive care were initially evaluated using univariate tests, followed by multivariate regression analyses to identify independent predictors. CD°IV transfers correlate with higher Hospitality Frailty Risk Score levels (HFRS) [mean 4.4 (standard deviation, SD 3.8) versus mean 3.0 (SD 3.0); p < 0.001], higher American Society of Anesthesiologists Physical Status Classification System (ASA) Scores [mean 2.5 (SD 0.6) versus mean 2.3 (SD 0.7); p = 0.02], a greater proportion of octogenarians [35.9% (n = 51) versus 23.9% (n = 34); p = 0.028] and a higher incidence of medical complications [97.9% (n = 139) versus 60.6% (n = 86); p < 0.001] compared with an adjusted control group after total joint arthroplasty (TJA). Multivariate regression analysis confirmed "Frailty" (odds ratio, OR 1.14, 95% confidence intervals, CI 1.05-1.23, p = .002), preexisting cardiological (odds ratio, OR 2.0, 95% confidence intervals, CI 1.004-4.1, p = 0.049) and gastrointestinal secondary diagnoses (OR 3.0, 95% CI 1.3-6.9, p = 0.01), and intake of anticoagulants (OR 2.7, 95% CI 1.6-4.6, p < 0.001) as independent risk factors for CD°IV intensive care unit (ICU) transfers after TJA. Patients with CD°IV events after THA and TKA represent a complex, vulnerable, and multimorbid patient population. There is a need for a multidisciplinary approach that integrates prehabilitation and perioperative risk assessments to reduce the occurrence of severe, life-threatening events requiring ICU care. Level III-retrospective cohort study. Retrospectively registered.

PCR sensitivity for Mycoplasma pneumoniae detection in nasopharyngeal and oropharyngeal swabs: a comparative study.

The differential impact of sample type on polymerase chain reaction (PCR) detection of Mycoplasma pneumoniae (MP) has rarely been investigated. The study aimed to evaluate the diagnostic performance of PCR for the detection of MP and to measure MP DNA load between nasopharyngeal and oropharyngeal swabs. Nasopharyngeal and oropharyngeal samples were obtained simultaneously to evaluate their diagnostic performance in children with suspected MP. Two commercially available PCR tests, multiplex PCR and Smart Gene Myco, were used to analyze the nasopharyngeal and oropharyngeal samples, respectively. Furthermore, real-time PCR (RT-PCR) tests were conducted on both sample residues to validate the results. In total, 422 participants underwent simultaneous PCR testing using nasopharyngeal and oropharyngeal swabs; 139 samples (32.9%) from nasopharyngeal swabs and 176 samples (41.7%) from oropharyngeal samples that tested positive using commercially available tests. RT-PCR tests were positive for 136 (32.2%) nasopharyngeal and 183 (43.4%) oropharyngeal residual samples. With the RT-PCR test of the residual extract from oropharyngeal swabs as a reference, the sensitivity and specificity of detecting MP were 74.9% (95% confidence interval 67.9%-81.0%) and 99.2% (97.0%-99.9%) with the multiplex PCR test on nasopharyngeal swabs, and 96.2% (92.3%-98.4%) and 100.0% (98.5%-100.0%) with the Smart Gene Myco on oropharyngeal samples. A negative correlation was observed between fluoroquinolone use and oropharyngeal DNA loads (P = 0.004). The sensitivity of MP detection was significantly better in oropharyngeal samples than in nasopharyngeal samples. This study indicates that oropharyngeal samples should be used to detect MP rather than nasopharyngeal samples.IMPORTANCEObtaining the best sample is crucial for the accurate diagnosis of Mycoplasma pneumoniae (MP) and timely and appropriate treatment. This study aimed to assess the diagnostic performance of MP detection using polymerase chain reaction (PCR) tests between nasopharyngeal and oropharyngeal samples. This study showed that the sensitivity of detecting MP was 74.9% (95% confidence interval 67.9%-81.0%) with a commercially available PCR test on nasopharyngeal swabs, and 96.2% (92.3%-98.4%) with a commercially available PCR test on oropharyngeal samples. The sensitivity of MP detection was significantly better in oropharyngeal samples than in nasopharyngeal samples. This study supports the idea that oropharyngeal samples should be used to detect MP. The results contribute to guidance in the recommendation regarding sampling methods to detect MP. Accurate identification of MP is crucial not only for timely and appropriate antimicrobial treatment but also for efficient epidemiological surveillance.