Prospective Epidemiological Study Research Articles

Mucosal involvement in bullous pemphigoid in Northeast Morocco

Background: Bullous pemphigoid is a common autoimmune bullous disease that mainly affects the elderly. Mucosal involvement in bullous pemphigoid remains rare and is in the order of 10% to 30%. Our objective was to evaluate the prevalence of mucosal involvement in our patients with bullous pemphigoid and to study its epidemiological, clinical, and therapeutic particularities. Material and Methods: We conducted a prospective epidemiological study, collecting patients with bullous pemphigoid, over a period of eleven years. We divided our study population into two groups, with and without mucosal damage, and compared different parameters between these two groups. Results: We collected 85 patients diagnosed with bullous pemphigoid. The mean age at diagnosis was 70.54 years. A neurological history was reported in nine (10.7%) of our patients, Drug intake was noted in 14.3%. Associations with autoimmune diseases were found in 25 patients. The typical form of PB was found in 74% of our patients with extensive skin involvement of more than 30% of the body surface in 44.7% of the patients. Twenty-nine patients (34.1%) presented mucosal lesions. The oral mucosa was the most frequently affected surface. Among the patients with mucosal involvement, twenty-five (86.2%) had isolated mucosal surface involvement. In patients with oral involvement, the most frequent mucosal lesions were erosions of the soft palate and the inner face of the cheeks. The comparative analysis between the two groups revealed that patients with mucosal involvement were younger, with an average age of 69.5 years vs. 71.12 years, p = 0.54. We also noted that patients with mucosal involvement more frequently presented with heard skin disease (p = 0.01). Regarding therapeutic management, we noted a more frequent need for the addition of systemic treatment to topical corticosteroids as compared to other patients (p = 0.01). Conclusion: The involvement of the oral mucosa remains rare and is correlated with more severe and extensive involvement of the disease with the ineffectiveness of first-line treatment. Further studies are needed at the national level to better assess these characteristics in the Moroccan population.

Severity of COVID-19 cases in the months of predominance of the Alpha and Delta variants

New SARS-CoV-2 may pose problems in controlling the COVID-19 pandemic for public health. We aimed to assess and compare the symptoms and severity of cases due to the Alpha and Delta variant dominance periods, taking into account the effect of COVID-19 vaccination. A prospective epidemiological study of SARS-CoV-2 in Lleida was made to determine differences between Alpha and Delta variants periods. We assessed symptoms, specific comorbidities, sociodemographic information and vaccination status. Bivariate and logistic regression analyses were used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) to investigate the relationship between symptoms and severity and the variants. Alpha variant period compared to the Delta showed an increased risk of ICU admission (aOR 2.0; 95% CI 1.2–2.3) and death (aOR 2.6; 95% CI 1.8–3.9) and cases were associated with people aged > 85 years (aOR 2.1; 95% CI 1.7–2.6) and partially vaccinated (aOR 5.6; 95% CI 3.2–9.9) and unvaccinated people (aOR 27.8; 95% CI 19.7–40.5). Fever, cough and vomiting were significantly associated with the Alpha variant compared to the Delta (aOR 1.6 (95% CI 1.5–1.7), 2.0 (95% CI 1.9–2.2) and 2.5 (95% CI 2.2–2.9, respectively). Our results show that the severity and profile of clinical symptoms varied according to the variant. The risk of ICU admission and death was higher in the Alpha period compared to the Delta as it affected the elderly and cases were less vaccinated.

Are women diagnosed with early pregnancy loss at risk for anxiety, depression, and perinatal grief?

To examine the effects of early pregnancy loss on emotions such as depression, grief, or a sense of hopelessness, while investigating different types of diagnoses, hospital stays, and treatments. A prospective cohort epidemiological study was carried out in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January and September 2019. The study included women diagnosed with early pregnancy loss classified into 3 groups: missed abortus, anembryonic pregnancy, and spontaneous abortion. The patients were screened via the Spielberger state-anxiety inventory (STAI-1) before initiating treatment. The Edinburgh postpartum depression scale (EPDS) and Perinatal Grief Scale (PGS) were also carried out in the first week of their hospital discharge. The study was carried out with a total of 116 patients. The median gestational week of the patients was calculated at 9, their median hospital stay was 2 days, and their median dose of misoprostol was 800 mcg. The STAI-1 revealed that median values computed for women in all groups indicated moderate anxiety. The EDPS also demonstrated depression-positive median values for women in all 3 groups (EPDS>13). However, no statistically significant difference was noted in comparisons of the 3 groups apropos STAI-1, EPDS, and PGS. Moderate anxiety, depressed mood, and perinatal grief were found in women diagnosed with early pregnancy loss, regardless of the type of abortion.

Procedural Coding Trends Of Sports Injuries In Women’s U.S. Rugby-7’s Regional Tournaments

PURPOSE: Women’s Rugby-7’s is an Olympic contact-sport associated with a high injury rate. Let alone, there has been a lack of investigation on the actual financial impact of the injuries on women players in the U.S. cohort. Our study aims were to quantify injured player medical costs sustained in a USAR-sanctioned women’s Rugby-7’s series. METHODS: A prospective epidemiology study of injury encounters during a USA Rugby (USAR) Northeast Geographic Union qualifying series. The Rugby Injury Survey & Evaluation (RISE) Report methodology was applied, following the rugby consensus statement. After injury data collection, current procedural terminology (CPT/HCPCS) programs were evaluated for cost analysis using institutional charges in US dollars (US$). Relevant data were evaluated for player provisional diagnosis, severity, and follow-up. RESULTS: There were a reported 249 injuries among adult women rugby-7’s tournament players from 79 rugby-7’s tournament days (2010 to 2015). The net cost (in US $) of medical treatment between 2010 to 2015 was $44,658 ± 703 (n = 249). Upon further stratification, players with new injuries costing $29,431, and players with recurring injuries costing $15,022. The back positions had the highest total treatments costs at $33,110 ± 2,211 (n = 141) compared to forward positions at $11,154 ± 359 (n = 97). Ankle sprains, concussions, and fractures were among the most frequent ICD-10-CM diagnosis coding in women players. The highest costs were fractures ($6,006) and ankle sprains ($3,717). CONCLUSIONS: This study establishes procedural coding trends among U.S. Women’s Rugby-7’s regional tournaments. Injuries with the highest costs were likely to have a longer reported absence from play, and often required more procedural codes being used for imaging and surgical intervention. Moreover, the increase in costs over time possibly indicates the growth of rugby prior to its 2016 Olympic inclusion. A future direction with this study will be to provide a further understanding of medical costs for female participants, post-professionalism, in addition to real-time quantification of supply-use trends with its relevant procedural terminology.

High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

ABSTRACT Tuberculosis (TB) is more prevalent in rural than urban areas in China, and delineating TB transmission patterns in rural populations could improve TB control. We conducted a prospective population-based study of culture-positive pulmonary TB patients diagnosed between July 1, 2009 and December 31, 2020 in two rural counties in China. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms, based on whole-genome sequencing. Risk factors for clustering were identified by logistic regression. Transmission links were sought through epidemiological investigation of genomic-clustered patients. Of 1517 and 751 culture-positive pulmonary TB patients in Wusheng and Wuchang counties, respectively, 1289 and 699 strains were sequenced. Overall, 624 (31.4%, 624/1988) patients were grouped into 225 genomic clusters. Epidemiological links were confirmed in 41.8% (196/469) of clustered isolates, including family (32.7%, 64/196) and social contacts (67.3%, 132/196). Social contacts were generally with relatives, within the community or in shared aggregated settings outside the community, but the proportion of clustered contacts in each category differed between the two sites. The time interval between diagnosis of student cases and contacts was significantly shorter than family and social contacts, probably due to enhanced student contact screening. Transmission of multidrug-resistant (MDR) strains was likely responsible for 81.4% (83/102) of MDR-TB cases, with minimal acquisition of additional resistance mutations. A large proportion of TB transmission in rural China occurred among social contacts, suggesting that active screening and aggressive contact tracing could benefit TB control, but contact screening should be tailored to local patterns of social interactions.

Braindrive : qui peut conduire parmi les patients pris en charge pour une radiothérapie cérébrale ?

PurposeBrain tumors can be associated with various neurological symptoms impairing driving ability. We sought to assess patients’ knowledge on the French driving legislation. Materials and methodsThis is a prospective descriptive epidemiological study carried out at the Oscar Lambret center in Lille, among driving license holders treated by radiotherapy for one or more primary cerebral tumor or brain metastasis. The survey was carried out by hetero-administered questioners. The primary endpoint was the frequency of patients informed on the French driving legislation at the initial radiotherapy consultation, given with a 95% confidence interval by the Clopper-Pearson exact binomial method. ResultsFrom the 1st February to March 31st, 2022, 33 patients with brain tumors were evaluated. Three of them were excluded because they did not have a driving license. Among the 30 patients analyzed, 12 patients (40% IC95 [22.7; 59.4]) had been informed of the existence of a possible contraindication to drive before the radiotherapy consultation. Among the 30 patients, 21 (70%) had a contraindication to drive. Of the eight patients (26.6%) who drove, four (13.3%) should not. ConclusionMost patients have a contraindication to drive, but only 40% of the patients questioned stated that they had been informed of the existence of a possible contraindication before the radiotherapy consultation.

Association of TGFB1 rs1800469 and BCMO1 rs6564851 with coronary heart disease and IL1B rs16944 with all-cause mortality in men from the Northern Ireland PRIME study.

BackgroundHistorically, high levels of morbidity and mortality have been associated with cardiovascular disease in the Northern Ireland population. Previously reported associations between single nucleotide polymorphisms (SNPs) and cardiovascular disease within other populations have not always been consistent.ObjectiveTo investigate associations between 33 SNPs with fatal or non-fatal incident coronary heart disease (CHD) events and all-cause mortality in the Northern Irish participants of the Prospective Epidemiological Study of Myocardial Infarction (PRIME).MethodPhase 2 of the PRIME study prospectively evaluated 2,010 men aged 58–74 years in Northern Ireland for more than 10 years for incident CHD events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass, and cardiac death) and more than 15 years for all-cause mortality. SNPs previously reported in association with cardiovascular outcomes were evaluated against incident CHD events and all-cause mortality using Cox’s proportional hazards models adjusted for established cardiovascular disease risk factors.ResultsDuring the follow-up period, 177 incident CHD events were recorded, and 821 men died. Both BCMO1 rs6564851 (Hazard ratio [HR] = 0.76; 95% confidence intervals [CI]: 0.60–0.96; P = 0.02) and TGFB1 rs1800469 (HR = 1.30; CI: 1.02–1.65; P = 0.04) were significantly associated with incident CHD events in adjusted models. Only IL1B rs16944 was significantly associated with all-cause mortality (HR = 1.18; CI: 1.05–1.33; P = 0.005). No associations remained significant following Bonferonni correction for multiple testing.ConclusionWe report a novel association between BCMO1 rs6564851 and risk of incident CHD events. In addition, TGFB1 rs1800469 and IL1B rs16944 were associated with the risk of incident CHD events and all-cause mortality outcomes respectively, supporting previously reported associations.

Patients' Awareness of the Complications of Bisphosphonate Therapy

INTRODUCTION: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a serious complication that has been reported predominantly in cancer patients treated with Bisphosphonate (BP). The level of knowledge of dental and medical practitioners, as well as patients, is crucial for its prevention.OBJECTIVES: To investigate patients’ awareness of BAONJ in order to evaluate some problems of the prevention, prophylaxis and diagnosis. MATERIALS AND METHODS: A prospective epidemiological study of 112 oncology patients diagnosed with Bisphosphonate-associated osteonecrosis of the jaw was conducted in the Clinic of maxillo-facial surgery of university multiprofile hospital for active treatment (UMHAT) “St. George”, Plovdiv, Bulgaria, based on anamnesis, clinical examination, hospital documentation, and imaging studies. SPSS Statistics v.24 was used for statistical analysis, at a significance level p<0.05.RESULTS: Before initiation of therapy, only 17.86% of the patients were consulted by a medical practitioner about the risk of jaw complications associated with the use of Bisphosphonates, 9.82% knew about the need for regular dental check-ups after the initiation of therapy and 4.46% had a dental examination and oral sanation. By the time of diagnosis, 61.61% of the patients remained unaware, with the last dental manipulation being most often extraction (52.68%) and removable dentures (21.42%) considered risky by experts. Diagnosed by a general dental practitioner or oncologist were 6.74% of the respondents – the medical practitioners who usually monitor the condition of these patients. Over 2/3 of the patients were diagnosed at a more advanced stage (II/III).CONCLUSION: The lack of patient awareness leads to omissions and errors in their prophylaxis, and to the diagnosis of BAONJ at a more advanced stage.

Oral health of schoolchildren in Slovenia: Prospective epidemiological study.

The quality of oral health can be estimated by its own indicators, one of which is the Decayed-Missing-Filled index (DMF-T for permanent teeth and dmf-t for deciduous teeth index). Caries can be prevented and successfully controlled by comparing clinical and epidemiological data. The basic prerequisite for this approach is data collection through systematic examinations, the results of which are a starting point for a prevention programme. The aim of the study is to define the oral health of elementary schoolchildren in one municipality of Slovenia, focusing on 6-, 12- and 15-year-old children. A prospective epidemiological study of elementary school children (aged 6, 12 and 15) of municipality Murska Sobota, Slovenia, was performed over four years. Data were obtained from the dental records of elementary schoolchildren acquired from a specialist in paediatric dentistry. Collected data included age, gender, the number of carious teeth and tooth fillings per child in deciduous and permanent teeth, dmf-t/DMF-T index and the percentage of primary and secondary healthy children. Statistical analysis was performed using SPPS 25. Data from schoolchildren were used (1256 girls, 1281 boys). The number of carious deciduous teeth per person in 6-year-olds (3.2-3.8) was higher than the number of (carious) permanent teeth in 12-year-olds (0.3-1.2). The number of filings per person in deciduous teeth in 6-year-olds (0.5-0.6) was lower than it was in permanent teeth in 12-year-olds (0.3-1.2). Dmf-t index in 6-year-olds was from 4 to 4.6; DMF-T index in 12-year-olds were from 1.2 to 2.2 and in 15-year-olds from 2.4 to 3.8. The percentage of primary healthy children was lower for older children, but the percentage of secondary healthy children was higher for older children. Monitoring oral health is important, and school has an important role in it; however, caries control has yet to be successful.

Quality of plant-based diets is associated with liver steatosis, which predicts type 2 diabetes incidence ten years later: Results from the ATTICA prospective epidemiological study

Plant-based diets have recently risen in popularity due to their proposed health benefits. We evaluated the association of plant-based diet quality with non alcoholic fatty liver (NAFL) prevalence and their interaction on risk for developing type 2 diabetes ten years later. A post-hoc analysis of data collected in the ATTICA study. In 2001-02, 3042 participants from the Attica region of Greece were recruited. NAFL was assessed through hepatic steatosis index (HSI). Overall, healthful (hPDI), and unhealthful (uPDI) plant-based dietary indices (PDI) were calculated through standard procedures. N=1485 participants free of type 2 diabetes at baseline completed the follow-up evaluation ten years later (n=191 cases). Unhealthy plant-based diet was significantly associated with likelihood for NAFL; the NAFL prevalence was 32.7%, 33.2% and 40.0%, respectively (p=0.01), ranking from 1st to 3rd uPDI tertile. Multi-adjusted analysis revealed an inverse association between PDI and NAFL [OR(per 5 units increase in PDI)=0.85 95%CI (0.76, 0.94)] and hPDI [HR(per 5 units increase in hPDI)=0.91 95%CI (0.83, 0.99)] and a positive association in the case of uPDI [HR(per 5 units increase in uPDI)=1.12 95%CI (1.01, 1.25)]. Multi-adjusted analysis revealed that baseline NAFL was associated with 2.95 times higher 10-year type 2 diabetes risk. No significant interaction of baseline liver steatosis with plant-based diet indices was observed (p for interaction>0.05) in predicting type 2 diabetes. Plant-based diet quality is of importance for NAFL and affects long-term risk for incident type 2 diabetes.

Apolipoprotein E Polymorphism and Carotid Intima Medial Thickness Progression in Post Ischemic Stroke Patient

Background : Apolipoprotein E (APOE) gene is believed to associate with cholesterol level, a risk factor of ischemic stroke. CIMT (carotid intima-media thickness) can be used to determine the degree of atherosclerosis. Increased CIMT may predict ischemic stroke recurrence. This study aimed to determine association between increased CIMT in post ischemic stroke patients and APOE genotype. Methods : This was an epidemiological prospective study involving 71 post ischemic stroke patients (1 month from onset), admitted from 2012 to 2013. CIMT was examined with carotid duplex ultrasound at 1st, 6th, and 12nd month after stroke onset. APOE gene polymorphism was examined using HRM (high-resolution melting) which is a simple method, accurate, and sensitive for genotyping. Results : We found 5 APOE gene variation categories, i.e. E2E3, E2E4, E3E3, E3E4, and E4E4. The most common allele was E3 and genotype groups E3E3 was the majority of the population. E2E4 allele had the highest CIMT level among others, in the 1st month, 6th month, and 12nd month after stroke, with no association with hypertension, diabetes, and hypercholesterolemia. E3E3 allele was most often associated with hypertension, diabetes mellitus, dyslipidemia, and hyperhomocysteinemia. Conclusion : The results showed that APOE genotype E2E4 may independently constitute risk factor for atherosclerosis progression (CIMT) in post ischemic stroke patients. While the E3E3 genotype was often associated with hypertension, diabetes mellitus, dyslipidemia, and hyperhomocysteinemia. Our results suggest that APOE E4 was not an important risk factor for carotid atherosclerosis in post ischemic stroke patient.

Risk factors for ischemic events in residents of Kemerovo and Kemerovo region at 3-year follow-up (results of the urban rural epidemiology study)

The aim of the study was to identify risk factors for ischemic events in residents of Kemerovo and Kemerovo region at 3-year follow-up.Material and methods. The study included participants (n = 638, ages 35 to 70 years), permanently residing in Kemerovo or the Kemerovo region of the prospective epidemiological study conducted at the Research Institute for Complex Issues of Cardiovascular Diseases from 2015 to 2020. The exclusion criteria were prior myocardial infarction (MI), angina pectoris and/or diagnosed peripheral artery disease. The main socio-economic and behavioral characteristic and health status of participants were determined by means of questionnaire, data of some participants were collected from medical records (case history, patient discharge summary, results of laboratory and instrumental examinations). Food Frequency Questionnaire was used to capture an individual`s usual food consumption. International Questionnaire on Physical Activity was used to measure health-related physical activity of participants. Data regarding the end points (all-cause death or death due to cardiovascular events, de novo angina, MI, stroke) were collected at 3-year follow-up.Results. Out of 638 participants, death was reported for 22 cases (of which 4 deaths were due to cardiovascular events), 6 developed non-fatal MI, 45 had de novo angina, and 12 had a non-fatal stroke at 3-year follow-up. A composite endpoint (CE) developed in 80 study participants during 3 years of follow-up. Logistic regression analysis revealed a significant association between CE and the following factors: obesity at the beginning of the study (odds ratio (OR) 2.09, 95 % confidence interval (95 % CI) 1.03–4.26) (an adjusted OR (AOR) 2.17, 95 % CI 1.06–4.44)), regular (at least once a month) alcohol consumption at the time of the survey (OR 2.33, 95 % CI 1.23–4.42 (AOR 2.29, 95 % CI 1.21–4.34)), participants stating that they have been thinking about death during previous month (OR 3.22, 95 % CI 1.54–6.76 (AOR 3.74, 95 % CI 1.73–8.07)). The following factors had the weakest association with the risk of ischemic events at 3-year follow-up: disability due to injury and occupational diseases (OR 0.19, 95 % CI 0.07–0.51 (AOR 0.21 (0.08–0.57)), taking medication for a month (OR 0.37, 95 % CI 0.17–0.81 (AOR 0.36, 95 % CI 0.16–0.80)), in particular, antihypertensive drugs (OR 0.43, 95 % CI 0.22–0.81 (AOR 0.43,95 % CI 0.22–0.82)) and lipid-lowering drugs as a part of primary prevention (OR 0.33, 95 % CI 0.15–0.70 (AOR 0.33, 95 % CI 0.15–0.73)). Moreover, low physical activity associated with the use of transport in daily travels (car, bicycle) proved to be conditionally protective in relation to CE (OR 0.48, 95 % CI 0.25–0.94) (AOR 0.49, 95 % CI 0.25–0.96)).Conclusions. The identification of a number of significant «non-conventional» risk factors for development of ischemic events in residents of Kemerovo and Kemerovo region without prior atherosclerotic cardiovascular diseases at 3-year follow-up allows to consider them as additional modifiable risk factors within the framework of primary prevention.

Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries

BackgroundIn low- and middle-income countries (LMIC) Staphylococcus aureus is regarded as one of the leading bacterial causes of neonatal sepsis, however there is limited knowledge on the species diversity and antimicrobial resistance caused by Gram-positive bacteria (GPB).MethodsWe characterised GPB isolates from neonatal blood cultures from LMICs in Africa (Ethiopia, Nigeria, Rwanda, and South Africa) and South-Asia (Bangladesh and Pakistan) between 2015–2017. We determined minimum inhibitory concentrations and performed whole genome sequencing (WGS) on Staphylococci isolates recovered and clinical data collected related to the onset of sepsis and the outcome of the neonate up to 60 days of age.ResultsFrom the isolates recovered from blood cultures, Staphylococci species were most frequently identified. Out of 100 S. aureus isolates sequenced, 18 different sequence types (ST) were found which unveiled two small epidemiological clusters caused by methicillin resistant S. aureus (MRSA) in Pakistan (ST8) and South Africa (ST5), both with high mortality (n = 6/17). One-third of S. aureus was MRSA, with methicillin resistance also detected in Staphylococcus epidermidis, Staphylococcus haemolyticus and Mammaliicoccus sciuri. Through additional WGS analysis we report a cluster of M. sciuri in Pakistan identified between July-November 2017.ConclusionsIn total we identified 14 different GPB bacterial species, however Staphylococci was dominant. These findings highlight the need of a prospective genomic epidemiology study to comprehensively assess the true burden of GPB neonatal sepsis focusing specifically on mechanisms of resistance and virulence across species and in relation to neonatal outcome.

Airway pathogens detected in stable and exacerbated COPD in patients in Asia-Pacific.

BackgroundThe burden of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region is projected to increase. Data from other regions show bacterial and viral infections can trigger acute exacerbations of COPD (AECOPD).MethodsThis 1-year prospective epidemiological study (ClinicalTrials.gov identifier: NCT03151395) of patients with moderate to very severe COPD in Hong Kong, the Philippines, South Korea and Taiwan assessed the prevalence in sputum samples (by culture and PCR) of bacterial and viral pathogens during stable COPD and AECOPD. The odds of experiencing an exacerbation was evaluated for pathogen presence, acquisition and apparition. Health-related quality of life (HRQOL) was assessed.Results197 patients provided 983 sputum samples, with 226 provided during exacerbation episodes. The mean yearly AECOPD incidence rate was 1.27 per patient. The most prevalent bacteria by PCR at exacerbation were Haemophilus influenzae (Hi) and Moraxella catarrhalis (Mcat); Mcat prevalence was higher at exacerbation than at stable state. Virus prevalence was low, other than for human rhinovirus (HRV) (8.1%, stable state; 16.6%, exacerbation). The odds ratio (95% CI) for an exacerbation (versus stable state) was statistically significant for the presence, acquisition and apparition of Hi (2.20, 1.26–3.89; 2.43, 1.11–5.35; 2.32, 1.20–4.46, respectively), Mcat (2.24, 1.30–3.88; 5.47, 2.16–13.86; 3.45, 1.71–6.98, respectively) and HRV (2.12, 1.15–3.91; 2.22, 1.09–4.54; 2.09, 1.11–3.91, respectively). HRQOL deteriorated according to the number of exacerbations experienced.ConclusionIn patients with COPD in the Asia-Pacific region, the presence of Hi, Mcat or HRV in sputum samples significantly increased the odds of an exacerbation, providing further evidence of potential roles in triggering AECOPD.

The Laterality of Age-Related Hearing Loss and Depression.

There is a known association between hearing loss (HL) and depressive symptoms. The objective was to establish if there is a stronger association with the left or right ear. Cross-sectional analysis of an ongoing prospective epidemiologic cohort study. Hispanic Community Health Study (US, multicentered). Five thousand three hundred and twenty-eight adults 2:50 years old. None. The main outcome was depressive symptoms, measured by the 10-Item Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and defined continuously and binarily. Subjects with CESD-10 2: 10 were categorized as having clinically significant depressive symptoms (CSDS). Linear and logistic regressions were performed to assess the association between depressive symptoms and hearing in each ear, controlling for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use. Mean age was 58.5 ± 6.3 years. Mean pure-tone average (PTA) was 20.3 ± 11.7 dB (range = 0 - 125) in the right ear and 20.3 ± 12.4 dB (range = -2.5 to 120) in the left. Multivariable regression adjusting for covariates demonstrated significant associations between depressive symptoms and HL in both the left and right ear. For every 20-dB worsening in right ear PTA, there was 0.89-point increase in CESD-10 (95% confidence interval = 0.59 - 1.2), and odds of CSDS increased 1.31 times (1.17 - 1.46). For every 20-dB worsening in left ear PTA, there was a 0.85-point increase in CESD-10 (0.55 - 1.14), and odds of CSDS increased 1.34 times (1.20 - 1.49). Worsening hearing in the right and left ears individually was associated with increased depressive symptoms and odds of CSDS. No ear laterality was demonstrated.

Abstract 3667: Composite dietary antioxidant index and the risk of pancreatic cancer: Findings from a prospective cohort study

Abstract Background. Composite Dietary Antioxidant Index (CDAI) is a summary score derived from statistical modeling that ranks an individual’s dietary intake of antioxidants in relation to the overall mean of the study population. Antioxidants may offer a beneficial effect on reducing the risk of pancreatic cancer. No prospective epidemiological study has investigated the association between food-based CDAI (fCDAI) and pancreatic cancer risk. Methods. The fCDAI score was calculated based on dietary intakes of vitamins A, C, and E, manganese, selenium, and zinc from food but not from dietary supplements, for each participant of the Singapore Chinese Health Study, a population-based prospective epidemiological cohort study consisting of 61,321 Chinese men and women in Singapore aged 45-74 years at baseline enrollment during 1993-1998. Intake of antioxidants was derived from self-reported consumption of food items using a validated semi-quantitative food frequency questionnaire and the Singapore Food Composition Table. Incident cases of cancer, including pancreatic cancer, and death were identified through the linkage analysis with the nationwide Singapore Cancer Registry and the Singapore Registry of Birth and Death, respectively. The Cox proportional hazard regression method was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) of pancreatic cancer associated with higher quartiles of fCDAI relative to the lowest quartile with adjustment for multiple potential confounders, including age, sex, dialect group, level of education, smoking status, alcohol consumption, a history of diabetes, sleep duration, physical activity, year of enrollment, and total energy intake. Results. Overall, 311 participants who were free of cancer at baseline developed pancreatic cancer during an average of 17.7 years of follow-up after baseline assessment of food consumption. Compared with the lowest quartile, the multivariable-adjusted HR of pancreatic cancer for the highest quartile of fCDAI was 0.54 (95% CI: 0.31-.91, P=0.02). This inverse association between the fCDAI and pancreatic cancer risk was more apparent in overweight/obese subjects (HRQ4vsQ1=0.28, 95% CI: 0.13-0.60, Ptrend=0.02), or those without a history of diabetes (HRQ4vsQ1=0.50, 95% CI: 0.29-0.88, Ptrend=0.04). No association was observed between CDAI derived from dietary supplements and the risk of pancreatic cancer. Conclusions. The inverse association between fCDAI and pancreatic cancer risk supports the notion that overall dietary antioxidants may provide a beneficial effect against the development of pancreatic cancer, specifically overweight/obese individuals and those free of diabetes who may have a long-term persistent dietary pattern. These results highlight the importance of promoting healthy eating for the primary prevention of pancreatic cancer. Citation Format: Pedram Paragomi, Renwei Wang, Aizhen Jin, Yi-Chuan Yu, Randall E. Brand, Li-Ting Sheng, An Pan, Woon-Puay Koh, Jian-Min Yuan, Hung Luu. Composite dietary antioxidant index and the risk of pancreatic cancer: Findings from a prospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3667.

Prevalence of elevated blood pressure among locomotive workers according to the long-term assessment of pre-trip health screening

Hypertension is considered as one of the leading cardiovascular diseases in transport workers.Aim. In the context of epidemiological prospective study, to assess the prevalence of elevated blood pressure (BP) detected at pre-trip health screening (PTHS).Material and methods. We analyzed records of the database of PTHS automatic system for 15 years (2006-2020) to reveal elevated systolic (140 mm Hg) and/or diastolic (90 mm Hg) BP.Results. For 15 years, the detection rate of systolic BP >140 mm Hg has decreased by 4 times. For diastolic BP, the detection rate of values >90 mm Hg decreased by 8 times. The detection rate of non-normal systolic BP among railway staff correlates with the detection rate of non-normal diastolic BP (r=0,92; p<0,05) on different railways. Over the 15-year period, the number of suspensions from the trip due to PTHS has decreased by 2 times, while the number of suspensions due to hypertension decreased by 2,5 times.Conclusion. The conducted study may indicate the effectiveness of primary and secondary prevention of hypertension among Russian Railways staff.

THE EFFECT OF DIETERY CHANGES ON WEIGHT AND BLOOD PRESSURE IN MIDDLE AGE PATIENTS WITH OVERWEIGHT/OBESITY AND HIGH NORMAL BLOOD PRESSURE

Objective: To evaluate the effects of dietary weight loss intervention in middle age with high normal blood pressure and overweight/obesity. Design and method: Men and women aged 25–54 was from working population were observed within the prospective epidemiological study: in subjects with BMI more than 25 kg/m2and BP 130–139/85–89 mm Hg. Was found a strong correlation of systolic BP and BMI was revealed: p = 0.0001 in women and p = 0.0045 in men. The same was true for diastolic BP: p = 0.0001 in women and p = 0.0001 in men. Two groups were formed and followed for 3 years: Intervention and Control groups consisted of 455 subjects (203 and 252 respectively). Dietician’s consultations were used in intervention group. Results: An increase of BMI by 1 kg/m2was associated with increase of systolic BP in women and men (by 1.3 and 0.7 mmHg respectively), (p < 0.05). For diastolic BP increase of BMI by 1 kg/m2was associated with increase in men and women (by 0.7 and 0.9 mm Hg respectively). In stepwise regression analysis body mass explains 27% of systolic BP variability and 11% of diastolic BP variability in men. In women it was 19% and 17% respectively. Last follow up visit attended more than 76% of the participants. After 3 years of intervention a weight loss was noted in the intervention group on an average at 1.17 kg in women (p < 0.05) and 0.63 kg (p < 0.05) in men. In controls body weight increased in women and in men (at 3.08 and 2.89 kg respectively) (all p < 0.05). BP decreased in the intervention group - 3.27 for systolic BP and – 2.09 mm Hg for diastolic BP in women; - 1.92 and – 1.91 mm Hg in men respectively. In control group BP increased: 2.97 mm Hg systolic BP and 1.29 mm Hg for diastolic Bp in women and 2.56 mm Hg and 2.39 mm Hg in men respectively (all p < 0.05). Conclusions: Dietary approach to weight loss is effective tool in middle age men and women with high normal BP and overweight/obesity for prevention of hypertension.

ROLE OF ESTIMATING PULSE WAVE VELOCITY IN COMMUNITY PHARMACIES IN SPAIN COMPARED TO SCORE

Objective: European Guidelines clearly state the need to estimate cardiovascular (CV) risk using tables validated for this purpose. However, they also recommend assessing subclinical organ damage to improve stratification, since target organ lesions, such as arterial stiffness, estimated by brachial oscillometry, have an independent and additional prognostic value. Previous studies have shown that Community Pharmacies are able to correctly measure arterial stiffness.The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification according to SCORE in Community Pharmacies. Design and method: This is an observational prospective epidemiological study in which everyone who enters the participating Community Pharmacies will be offered a voluntary measurement of blood pressure and arterial stiffness to compare the stratification of their CV risk according to SCORE with or without considering pulse wave velocity. The expected duration of the study is 12 months. Results: In the first month of recruitment, data from 275 patients (173 women, 102 men) were collected. Five of 39 (12.8%) patients under 40 years of age and 42 of 109 (38.5%) over 65 years of age presented pathological stiffness and could be classified as high risk even though being out of the age-range of SCORE. Of the 133 (48.4%) who were capable of calculating SCORE, the cholesterol value was available only in 69 patients (51.9%). Among them, according to SCORE, 18 patients (26.0%) were at low risk, 50 (72.5%) at moderate risk and only 1 (1.5%) at high risk, while 28 patients (21.1%) presented pathological arterial stiffness. Conclusions: Almost half of the people who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in a third. Of the other half, one in five presented arterial damage and, therefore, high CV risk, when SCORE only detected it in a single patient. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.

Association between the visceral adiposity index and risks of all-cause and cause-specific mortalities in a large cohort: Findings from the UK biobank

Background and aimsThe visceral adiposity index (VAI) has been recently established as a measure of visceral fat distribution and is shown to be associated with a wide range of adverse health events. However, the precise associations between the VAI score and all-cause and cause-specific mortalities in the general population remain undetermined. Methods and resultsIn this large-scale prospective epidemiological study, 357,457 participants (aged 38–73 years) were selected from the UK Biobank. We used Cox competing risk regression models to estimate the association between the VAI score and all-cause, cardiovascular disease (CVD), cancer, and other mortalities. The VAI score was significantly correlated with an increased risk of all-cause mortality (hazard ratio [HR], 1.200; 95% confidence interval [CI], 1.148–1.255; P < 0.0001), cancer mortality (HR, 1.224; 95% CI, 1.150–1.303; P < 0.0001), CVD mortality (HR, 1.459; 95% CI, 1.148–1.255; P < 0.0001), and other mortalities (HR, 1.200; 95% CI, 1.148–1.255; P < 0.0001) after adjusting for a series of confounders. In addition, the subgroup analyses showed that HRs were significantly higher in participants who were male, aged below 65 years, and body mass index less than 25. ConclusionIn summary, VAI was positively associated with an increased risk of all-cause and cause-specific mortalities in a nationwide, well-characterised population identified in a UK Biobank. The VAI score might be a complementary traditional predictive indicator for evaluating the risk of adverse health events in the population of Western adults aged 38 years and older.