Estimate Odds Ratios Research Articles

Hair Straightener Use in Relation to Prevalent and Incident Fibroids in the Sister Study with a Focus on Black Women.

Uterine fibroids disproportionately affect Black women, and exposure to chemicals from hair relaxers or straighteners ("straighteners") may contribute to fibroid development. We examined the association between straightener use and prevalent young-onset uterine fibroids (diagnosed before age 36 y), as well as incident fibroids (diagnosed age 36-60 y), with a focus on Black women. We also examined differences in associations across birth cohorts as proxies for formulation changes. Data from 4,162 Black women in the Sister Study, a prospective cohort of women 35-74 y of age (enrolled 2003-2009), were analyzed. We used logistic regression to estimate odds ratios (ORs) for the association of straightener use at 10-13 y of age and self-reported young-onset fibroids. We used Cox regression to assess hazard ratios (HRs) for straightener use (age 10-13 y and in 12 months before enrollment) and incident fibroids among 779 premenopausal Black women. Similar analyses were conducted in 40,782 non-Hispanic White women. Over 70% of Black women used straighteners. In comparison with no use, any [; 95% confidence interval (CI): 0.96, 1.36] and frequent use (; 95% CI: 0.99, 1.42) of straighteners at 10-13 y of age were associated with young-onset fibroids. This association was most apparent among those born between 1928 and 1945 (; 95% CI: 1.15, 2.74) and 1965-1974 (; 95% CI: 0.82, 3.29). Fibroid incidence from 36 to 60 y of age was modestly associated with use of straighteners at 10-13 y of age [hazard ratio ; 95% CI: 0.81, 1.63] and in the 12 months prior to enrollment (; 95% CI: 0.88, 2.00). Among non-Hispanic White women, straightener use at 10-13 y of age was similarly associated with young-onset fibroids (; 95% CI: 1.03, 1.47) despite lower use () of straighteners. Sensitivity analyses indicated a potential for bias due to fibroid misclassification, with an overestimation of the effect likely if nulliparous women or women from households with lower education reported their fibroid status less accurately. Hair straightener use may be positively associated with fibroid risk. https://doi.org/10.1289/EHP14493.

Comparing robotic, laparoscopic, and laparotomy in endometrial cancer: a network meta-analysis.

This study aims to assess the comparative effectiveness and safety of robotic-assisted surgery (RAS), laparoscopy (LPS), and laparotomy (LPT) in improving perioperative indicators, lymph node dissection, and tumor survival outcomes in patients with Endometrial carcinoma (EC) through a systematic review and network meta-analysis. We searched China National Knowledge Infrastructure, Wanfang, WeiPu, China Biology Medicine Disc, Embase, PubMed, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and Cohort studies (CSs) involving RAS, LPS and LPT in individuals with EC. The network meta-analysis employed a Bayesian framework to integrate direct and indirect evidence, calculating Odds Ratios (OR) and Mean Difference (MD). Markov chain Monte Carlo methods generated posterior distributions, comparing and ranking treatments using Surface Under the Cumulative Ranking (SUCRA) values. Regression and sensitivity analyses assessed the impact of different variables on the results. 37 eligible trials involving 3 surgical techniques and 6,558 participants were included in this network meta-analysis. Our data showed that RAS was the most effective way for reducing estimated blood loss (MD-193; 95% CI [-279.38 to-106.95]; SUCRA 80.3%), length of hospital stay (MD-3.8; 95% CI [-5.37 to-2.31]; SUCRA 90.2%), transfusion rate (OR 0.13; 95% CI [0.06 to 0.28]; SUCRA 87%), intraoperative complications(OR 0.23; 95% CI [0.06 to 0.8]; SUCRA 91.3%), postoperative complications (OR 0.29; 95% CI [0.18 to 0.51]; SUCRA 98.8%), and total complications (OR 0.24; 95% CI [0.1 to 0.61]; SUCRA 96%). However, the analysis showed no significant differences in the dissection of lymph nodes and tumor survival outcomes. Our results showed that RAS was the most effective surgical method for improving perioperative indicators in EC. If hospital resources are limited, LPS is a suitable alternative. Further research is needed to confirm these findings and ensure that the benefits of minimally invasive surgeries extend to long-term survival outcomes.

A lower eGFRcystatin C/eGFRcreatinine ratio is associated with greater cardiovascular risk (higher Framingham Risk Score) in Chinese patients with newly diagnosed type 2 diabetes mellitus

Background Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM) patients. Shrunken pore syndrome (SPS) is defined as eGFRcystatin C/eGFRcreatinine ratio <0.70 and predicts high CVD mortality. The Framingham Risk Score (FRS) is used to estimate an individual’s 10-year CVD risk. This study investigated the association between FRS and eGFRcystatin C/eGFRcreatinine ratio in T2DM patients. Methods Patients aged 18-80 years who were newly diagnosed with T2DM were included in this retrospective study. Ordinal logistic regression analysis was used to investigate the association between risk factors of T2DM and FRS. A Generalized Linear Model was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results There were 270 patients included in the study. Only 27 patients (10%) met the diagnostic criteria of SPS. Ordinal logistic regression analysis showed that SPS was not correlated with FRS risk (OR = 1.99, 95%CI = 0.94–4.23, p = 0.07), whereas eGFRcystatin C/eGFRcreatinine (OR = 0.86, 95%CI = 0.77–0.97, p = 0.01) showed a significant negative association with FRS risk. Compared with eGFRcystatin C/eGFRcreatinine>0.85, eGFRcystatin C/eGFRcreatinine≤0.85 increased FRS risk (OR = 1.95, 95%CI = 1.18–3.21, p < 0.01). After adjustment for confounding factors, increased eGFRcystatin C/eGFRcreatinine ratio was associated with decreased FRS risk when considered as a continuous variable (OR = 0.87, 95%CI = 0.77–0.99, p = 0.03). The FRS risk in patients with eGFRcystatin C/eGFRcreatinine≤0.85 is 1.86 times higher than that in patients with eGFRcystatin C/eGFRcreatinine>0.85 (OR = 1.86, 95%CI = 1.08–3.21, p = 0.03). Conclusions In the current study, no significant association between SPS and FRS was identified. However, lower eGFRcystatin C/eGFRcreatinine and eGFRcystatin C/eGFRcreatinine≤0.85 were associated with a significantly increased CVD risk in T2DM.

Changes in sex composition of births across regions and subgroups in India from an analysis of birth histories from National Family Health Surveys

India has consistently had one of the highest birth sex ratios (i.e., most males per female) globally. This analysis seeks to describe the sex composition of live births over the past decades among subgroups of the Indian population considering ongoing efforts to mitigate sex selection practices. Distribution of sex from the birth history data from three cross-sectional rounds of India’s National Family Health Survey (2005-06, 2015-16, 2019-21) were used. We describe changes in the sex composition of live births across time through different phases of the PreNatal Diagnostics Technique Act by place of residence, caste, education, and wealth. Multilevel random effects logit regression models were used to estimate odds ratios and adjusted estimates for the different periods. The proportion of male births remained stable across the 1980s and early 1990s for the country overall, followed by a decrease until 2000 and plateauing subsequently. This trend was not uniform, with the Northern region peaking in 2000 before falling to lower levels, while the Southern region peaked in the 80s and trending downward in the 1990s. Spatial analysis and regression models showed a decrease in the proportion of male births during 2004-11 time period in the Northern region compared to 1995-2003 time period with the higher wealth quintiles decreasing the most. The proportion of male births elicited through birth histories in India has trended downward influenced by demographic changes but the decrease was not uniform across regions and sub-groups, possibly influenced by antenatal sex selection practices.

Valid overall odds ratio estimators using different stratified sampling schemes

ABSTRACT The study presents valid estimators for determining the overall odds ratio between two independent groups within stratified populations, utilizing both simple stratified sampling (SSRS) and stratified ranked set sampling (SRSS) methodologies. Through analytical derivations, we establish the expected values and variances for these estimators. Two distinct types of estimators namely, the naive weighted and the Cochran Mantel–Haenszel–Haenszel approaches are thoroughly examined. Our investigation encompasses an in-depth analysis of the expectation and variance of these estimators, shedding light on their performance characteristics. Through intensive simulation experiments, we discern that estimators based on SRSS exhibit notable advantages over their SSRS counterparts. To validate the efficacy of our proposed estimators, we conduct an empirical assessment utilizing data from the (2009–2010) National Health and Nutrition Examination Survey (NHANES). Through this analysis, we glean insights into the performance of the estimators in a real-world context. In summary, our study contributes valuable insights into the estimation of the overall odds ratio within stratified populations. By comparing SSRS and SRSS methodologies and evaluating different estimation approaches, we provide researchers with robust tools for analyzing odds ratios in diverse settings. Moreover, our empirical validation using NHANES data underscores the practical utility of the proposed estimators in real-world applications.

SIGNIFICANCE OF SOCIO-ECONOMIC STATUS IN CARDIOVASCULAR RISK PROFILE

The aim of this study was to establish the relationship between key socioeconomic factors (education, professional employment, and marital status) and cardiovascular risk factors (type II diabetes, hypertension, excess body weight, smoking, and physical inactivity). Subjects and Methods. The study included 3,674 patients with coronary heart disease who underwent coronary bypass surgery on a beating heart. The average age of the participants was 60.6 ± 0.8 years. Data for analysis were obtained from patient medical histories, anamnesis records, and results of general clinical and laboratory examinations. The relationship between education, professional employment, and marital status with cardiovascular risk factors was evaluated using odds ratio (OR) and relative risk (RR) calculations. Results. The analysis revealed that 18.8% of patients with coronary heart disease were single, while 81.2% were married or in a family relationship (p = 0.0001). Among these patients, 41.2% were professionally employed, whereas 58.8% were unemployed (p = 0.4). Higher education was the most common, accounting for 76.5% of cases, followed by vocational and technical education at 20.3%, and general secondary education at 3.2%. The analysis of the associative relationship between education, occupation, family status, and cardiovascular factors revealed notable findings. Among single individuals with coronary heart disease, associations are observed with obesity (p = 0.08) and smoking (p = 0.0001, χ² = 121.16). Those, who are married or in a family relationship, show significant relationships with excess body weight (p = 0.0003, χ² = 21.59), hypodynamia (p = 0.06, χ² = 3.46), arterial hypertension (p = 0.05, χ² = 7.60), and type II diabetes (p = 0.04, χ² = 4.28). In individuals with higher education, associations are identified with excess body weight (p = 0.0001, χ² = 28.41), hypodynamia (p = 0.2), and smoking (p = 0.0001, χ² = 32.90). Among professionally employed individuals, increased risks were noted for smoking (p = 0.003, χ² = 8.49), arterial hypertension (p = 0.0001, χ² = 25.67), and type II diabetes (p = 0.07, χ² = 3.16). Conclusions. The study demonstrates that individuals with a favorable socioeconomic status (married, higher education, and professional employment) have an increased risk of cardiovascular factors such as excess body weight, hypodynamia, arterial hypertension, and type II diabetes. In contrast, those with lower socioeconomic opportunities (single status, unemployment, or vocational/secondary education) were found to have an increased risk of obesity and smoking.

Investigating the Role of Genetic Predisposition in Developing Rheumatoid Arthritis

Background: A chronic autoimmune disease called rheumatoid arthritis (RA) is impacted by both environmental and genetic factors. This work explores the impact of genetic predisposition in the development of RA, focusing on the HLA-DRB1 common epitope, PTPN22, and STAT4 gene variations. Objectives: In a cohort from Hayatabad Medical Complex (HMC), the research sought to evaluate the relationship between important genetic markers and RA susceptibility as well as investigate the interplay between genetic predisposition and environmental variables, such as smoking. Methods: 132 RA patients participated in a cross-sectional research that ended in August 2024. To determine the existence of HLA-DRB1, PTPN22, and STAT4 gene variations, genetic analysis was done. The strength of relationships was determined by calculating odds ratios, or ORs. Analysis was also done on the relationship between smoking and the common epitope of HLA-DRB1. At p &lt; 0.05, statistical significance was established. Results: The common epitope between HLA-DRB1 and RA was substantially correlated (OR = 3.45, p &lt; 0.001). While STAT4 did not exhibit a significant correlation with RA (OR = 1.29, p = 0.365), PTPN22 was likewise associated with RA (OR = 2.15, p = 0.009). Compared to non-smokers (OR = 2.18, p = 0.021), smokers with the HLA-DRB1 allele had a significantly higher risk of RA (OR = 5.87, p &lt; 0.001). Conclusions: The main genetic indicators for RA susceptibility are HLA-DRB1 and PTPN22, and smoking greatly increases the risk in those who are genetically susceptible to the condition. These results emphasize the value of lifestyle changes and customized risk assessment in the prevention of RA.

Traumatic dental injuries in permanent teeth among Arab children: prevalence, and associated risk factors-a systematic review and meta-analysis.

There is no clear literature present till date assessing the prevalence of traumatic dental injuries and associated factors in children living in Arab countries. The purpose of this study was to systematically assess the prevalence, trends, and potential risk factors of traumatic dental injury (TDI) in permanent teeth among children and adolescents in Arab countries. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The researchers conducted a comprehensive literature search in various databases, including PubMed, Cochrane library of systematic reviews, Directory of Open Access Journals (DOAJ), Google Scholar, and gray literature sources such as MDS dissertations and manuscripts. To analyze the collected data, the researchers used a random effects model for conducting meta-analyses. Pooled estimates of prevalence and odds ratios were derived, along with 95% confidence intervals (CI), to provide a measure of statistical precision and variability in the findings. For the studies that were considered, trend analysis was done. The risk of bias assessment of included studies was done using Newcastle-Ottawa tool for cross-sectional studies. A total of 545 articles were identified, of which 23 articles fulfilled the inclusion criteria. Quality assessment of included studies showed that twenty studies were of high quality and three studies showed low quality. The frequency of dental trauma in Arab children was 26% (95% CI [10-43]). Children with overjet of more than 3.5 mm were shown to be 1.78 times more likely to have dental injury than children with normal overjet (pooled odds ratio 1.78; 95% CI [1.17-2.70]). Males had a 2.06 times odds of TDI compared to females. Children with insufficient lip coverage had an odds ratio of 2.57, indicating a higher likelihood of oral injuries compared to those with appropriate lip coverage. Significant correlations were obtained between the prevalence of dental trauma and other variables such as male gender, increased overjet, inadequate lip coverage, etc. Future population-based analytical research should concentrate on documenting the incidence and/or prevalence of TDI among marginalized communities in order to better understand the primary causes of TDI.

Risk of bleeding with the concurrent use of amiodarone and DOACs: A systematic review and meta-analysis

Abstract Background and Aims Amiodarone is frequently prescribed alongside direct oral anticoagulants (DOACs) in atrial fibrillation (AF). There are concerns regarding drug-drug interactions (DDIs) between amiodarone and DOACs. The literature is conflicting on the clinical implications of this DDI, hence we conducted a meta-analysis to compare bleeding risk among patients receiving DOACs, with and without concurrent amiodarone. Methods A systematic search was conducted for studies published between January 1, 2009 and June 26, 2024 in MEDLINE via PubMed, Embase and CENTRAL. Included studies compared major bleeding in patients on concurrent amiodarone and DOACs to those on DOACs without amiodarone. Event rates were used to calculate odds ratios (ORs), which were pooled with a random-effects model. Results Nine studies were identified, which included 124 813 patients on amiodarone/DOACs, and 314 074 on DOACs. Average age was 77.2 years in the amiodarone/DOAC group, compared to 74.4 years in the DOAC group (p= 0.21). Among DOAC patients, there was a statistically significant increase in major bleeding with concurrent amiodarone (OR 1.22, 95% confidence interval (CI) 1.03-1.44, p=0.02, I2=88%). Intracranial bleeding rate was numerically higher in the amiodarone/DOAC group (1.0% vs. 0.4%), but the difference did not reach statistical significance (OR 2.20, 95% CI 0.53-9.06, p=0.27, I2=100%). There were no significant differences in gastrointestinal bleeding (OR 1.10, 95% CI 0.98-1.23, p=0.12, I2=62%) and all-cause mortality (OR 1.38, 95% CI 0.70-2.73, p=0.35, I2=99%). Conclusion Concurrent use of amiodarone and DOACs was associated with an increase in major bleeding. This should be considered when co-prescribing these medications.

Association Between Sleep Duration and Cardiovascular Disease Among Asian Americans.

Cardiovascular disease (CVD) prevalence varies widely among Asian American adults. The American Heart Association added healthy sleep to its metrics to define ideal cardiovascular health. Little is known about the association between sleep and CVD prevalence among Asian subgroups. We aim to examine the association between suboptimal sleep duration and CVD risk prevalence among Asian American subgroups. We used 2012 to 2018 National Health Interview Survey data to examine the association between suboptimal sleep duration and CVD prevalence. We included 6868 self-identifying Asian adults age >40 years (Asian Indian [n=1053], Chinese [n=1415], Filipino [n=1734], and Other Asian [n=2666] adults). Suboptimal sleep was defined as <7 or >9 hours per night. CVD was defined as self-reported stroke, heart attack, coronary artery disease, or angina. Logistic regression was used to calculate odds ratios and 95% CI to estimate the association between suboptimal sleep duration and CVD prevalence. Filipino and Other Asian participants with suboptimal sleep had the highest prevalence of CVD. Aggregated Asian American participants with suboptimal sleep duration had a higher prevalence of CVD (odds ratio [95% CI, 1.35 [1.09-1.68]) compared with those with optimal sleep duration. After stratification by race or ethnicity or both, a significant association persisted for Other Asian participants (1.77 [95% CI, 1.27-2.46]) but not among all other Asian American subgroups. Our study highlights the heterogeneity of CVD prevalence associated with suboptimal sleep duration among Asian American adults. Future studies should consider how different measures of sleep duration and quality affect CVD outcomes among disaggregated Asian American subgroups.

Coffee and tea consumption and the risk of head and neck cancer: An updated pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

The relations between coffee and tea consumption and head and neck cancer (HNC) incidence are unclear. With increasing global HNC burden, this study aims to examine the association between coffee, tea, and HNC. A pooled analysis of 9548 HNC cases and 15,783 controls from 14 individual-level case-control studies was conducted from the International Head and Neck Cancer Epidemiology consortium. Random-effects logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for HNC and its subsites, adjusting for sociodemographic and lifestyle factors. Compared to non-coffee drinkers, drinking >4 cups of caffeinated coffee daily was inversely associated with HNC (OR, 0.83; 95% CI, 0.69-1.00), oral cavity (OR, 0.70; 95% CI, 0.55-0.89), and oropharyngeal cancers (OR, 0.78; 95% CI, 0.61-0.99). Drinking 3-4 cups of caffeinated coffee was inversely associated with hypopharyngeal cancer (OR, 0.59; 95% CI, 0.39-0.91). Drinking decaffeinated coffee and drinking between >0 to <1 cup daily were inversely associated with oral cavity cancer (OR, 0.75; 95% CI, 0.64-0.87 and OR, 0.66; 95% CI, 0.54-0.81). Drinking tea was inversely associated with hypopharyngeal cancer (OR, 0.71; 95% CI, 0.59-0.87). Daily tea consumption of >0 to ≤1 cup was inversely associated with HNC (OR, 0.91; 95% CI, 0.84-0.98) and hypopharyngeal cancer (OR, 0.73; 95% CI, 0.59-0.91), but drinking >1 cup was associated with laryngeal cancer (OR, 1.38; 95% CI, 1.09-1.74). These findings support reduced HNC risk among coffee and tea drinkers. Future studies are needed to address geographical differences in types of coffee and tea to improve our understanding of the association of coffee and tea and global HNC risk.

Association between somatic microsatellite instability, hypermutation status, and specific T cell subsets in colorectal cancer tumors.

Microsatellite instability-high (MSI-high) tumors comprise ~15% of sporadic colorectal cancers (CRC) and are associated with elevated T cell infiltration. However, the universality of this response across T cell subtypes with distinct functions is unknown. Including 1,236 CRC tumors from three observational studies, we conducted in-situ T cell profiling using a customized 9-plex (CD3, CD4, CD8, CD45RA, CD45RO, FOXP3, KRT, MKI67, and DAPI) multispectral immunofluorescence assay. MSI status was assessed through polymerase chain reaction or immunohistochemical assays. We used multivariable ordinal logistic regression to estimate odds ratios (OR per increasing quantile) and 95% confidence intervals (CIs) for the association of MSI status with quantiles of T cell densities in either tumor epithelial or stromal tissue areas. Compared to microsatellite instability low or microsatellite stable (MSI-low/MSS) tumors, MSI-high status was associated with higher density for the majority of immune subsets (twelve out of eighteen) in both epithelial and stromal tissue areas. The strongest associations were for CD3+CD8+ T cells in epithelial areas [OR (95% CI) for naive, memory, and regulatory subsets = 3.49 (2.57, 4.75); 2.82 (2.10, 3.78); 3.04 (2.24, 4.13), respectively]. Conversely, stromal area CD3+CD4+ memory T cells were inversely associated [OR (95% CI) = 0.68 (0.51, 0.91)]. MSI-high status was strongly associated with higher densities of most T cell subsets in both epithelial and stromal tissue areas. Our investigation supports efforts to identify patients who may be more likely to respond to current immunotherapy treatments. This study helps us better understand how a clinically relevant tumor phenotype, microsatellite instability status, is related to different functioning T cell densities in colorectal tumors, which may impact future immunotherapy strategies.

The risk of hospital admission for an acute-onset psychiatric disorder in adolescents and adults treated with isotretinoin: a French, nationwide, population-based, case-time-control study.

Introduction Oral isotretinoin is the only effective treatment for severe acne without alternative. Isotretinoin has been linked to the occurrence of acute psychiatric disorders outside suicidal behaviors. There are few large-scale epidemiological studies in this area, and the putative associations are unclear. Our objective is to determine whether adolescents and young adults have an elevated risk of acute-onset psychiatric disorder requiring hospital treatment within 2 months of starting isotretinoin treatment. Methods Our data source was the French national health insurance database (Système National des Données de Santé, SNDS), 2010-2015. We performed a case-time-control study nested in an exhaustive, nationwide cohort of all French adolescents and young adults aged 10 to 25 years treated with isotretinoin. The outcome was an acute-onset psychiatric disorder requiring hospitalization (including anxiety, depressive, mood, adjustment and psychotic disorders). A conditional logistic model was used to estimate odds ratios (ORs) with their 95% confidence interval (CI) for acute psychiatric events. Results 2,284 acute-onset psychiatric disorder requiring hospitalization were recorded for the study population of 262,786 patients. Among the patients with at least one psychiatric event, 88 had started taking isotretinoin in the risk period (0 to 2 months before the date of the event), versus 81 in the reference period (2 to 4 months before the event). A comparison with the 383 and 355 time-trend matched controls who started taking isotretinoin in the risk and reference periods, respectively, yielded a case-time-control OR (95%CI) of 1.01 (0.72-1.41). Conclusion Psychiatric events managed outside the hospital system were not recorded. Our findings are reassuring for clinicians concerning the risk of severe acute-onset psychiatric events after isotretinoin initiation.

Association Between Arterial Hyperoxia and Mortality in Pediatric and Adult Patients Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.

In patients receiving extracorporeal membrane oxygenation (ECMO) support, the association between arterial hyperoxia and outcomes is unclear. We performed a systematic review and meta-analysis to determine the association between arterial Po2 (Pao2) and mortality in patients with ECMO. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and registered in International Prospective Register of Systematic Reviews (PROSPERO; CRD42023467361). We systematically searched PubMed and Embase databases up to September 2023 for randomized trials or observational studies that investigated the association between Pao2 and mortality in pediatric and adult patients receiving venovenous ECMO (VV-ECMO), venoarterial ECMO (VA-ECMO), and extracorporeal cardiopulmonary resuscitation (ECPR). The predefined outcome was 28-day mortality. We synthesized the data using a random-effects model, calculating odds ratios (OR) and corresponding 95% confidence intervals (CI). Thirteen cohort studies (17,766 participants) were included. All studies used categorical Pao2 cutoff, with varying thresholds ranging from ≥100 mm Hg to ≥300 mm Hg. When compared with patients with normoxia, elevated Pao2 levels at all studied thresholds were consistently associated with increased mortality (≥300 mm Hg: OR 1.56, 95% CI, 1.31-1.85, P < .01; ≥200 mm Hg: OR 1.43, 95% CI, 1.10-1.87, P < .01; ≥150 mm Hg: OR 1.51, 95% CI, 1.15-1.98, P < .01; and ≥100 mm Hg: OR 1.44, 95% CI, 1.03-2.02, P = .03). A sensitivity analysis focusing on studies reporting adjusted OR yielded similar results. We observed this association in both adult and pediatric populations. In critically ill patients on VV- or VA-ECMO, increased Pao2 values were associated with increased 28-day mortality in ECMO patients. Our results should be interpreted with caution given observational nature of included studies. Further randomized trials are warranted to validate these results.

Re-analysis of data from cluster randomised trials to explore the impact of model choice on estimates of odds ratios: study protocol

BackgroundThere are numerous approaches available to analyse data from cluster randomised trials. These include cluster-level summary methods and individual-level methods accounting for clustering, such as generalised estimating equations and generalised linear mixed models. There has been much methodological work showing that estimates of treatment effects can vary depending on the choice of approach, particularly when estimating odds ratios, essentially because the different approaches target different estimands.MethodsIn this manuscript, we describe the protocol for a planned re-analysis of data from a large number of cluster randomised trials. Our main objective is to examine empirically whether and how odds ratios estimated using different approaches (for both primary and secondary binary outcomes) vary in cluster randomised trials. We describe the methods that will be used to identify the datasets for inclusion and how they will be analysed and reported.DiscussionThere have been a number of small comparisons of empirical differences between the different approaches to analysis for CRTs. The systematic approach outlined in this protocol will allow a much deeper understanding of when there are important choices around the model approach and in which settings. This will be of importance given the heightened awareness of the importance of estimands and the specification of statistical analysis plans.

Age- and sex-standardized prevalence of alcohol consumption and its determinants in the western region of Iran, Ilam: a cross-sectional study

Background and objectiveIn recent years, alcohol consumption in different parts of Iran has increased. However, this growth was dramatic in deprived regions. The percent study aimed to determine the age-sex standardized prevalence of alcohol consumption and related factors in the general population of Ilam city during 2021–2022.MethodThis population-based cross-sectional study was conducted in the general population of Ilam city located in western Iran. A total of 1,431 individuals over the age of 15 were included in the study using multi-stage cluster sampling. Alcohol consumption was assessed using a Persian version of high-risk behavior questionnaire (Cronbach’s alpha > 73%). Analysis was done by Stata version 11 and R Software. Logistic regression analysis was used for data analysis and calculating odds ratio (OR), and a significance level of 0.05 was considered.ResultsIn total 1,431 individuals completed the questionnaire. The mean ± standard deviation (SD) age of the study participants was 43.40 ± 15.51 years. The age-sex standardized prevalence with 95% confidence interval (CI) of alcohol consumption was 4.05% (95% CI: 3.09 to 5.20). Based on multiple logistic model, having a bachelor’s degree (OR: 7.13; 95% CI: 1.89 to 26.76), cigarette smoking (OR: 6.92; 95% CI: 2.94 to 16.29), hookah smoking (OR: 7.34; 95% CI: 3.09 to 17.47) and drug abuse (OR: 2.88; 95% CI: 1.38 to 5.99) had a positive association with alcohol consumption. Furthermore, having a high economic status 0.62 (OR: 0.62; 95% CI: 0.26 to 1.48) had a negative association with alcohol consumption. The most powerful determinants (according to standardized coefficient) for alcohol consumption were hookah smoking (standardized coefficient: 0.588) and high education level (0.743).ConclusionConsidering the prevalence of alcohol consumption in the population over 15 years old, it is necessary to take preventive and intervention measures, with more attention from health policymakers and other sectors.

Relationship Between A Body Shape Index and Self-Reported Stress Urinary Incontinence Among US Women: A Cross-Sectional Analysis.

Stress urinary incontinence (SUI) is common among women, but its link with A Body Shape Index (ABSI) is not well understood. This study investigates the association between ABSI and SUI risk in women, exploring variations across different subgroups. Data from National Health and Nutrition Examination Survey (2001-2020) were analyzed. A weighted multivariable logistic regression was performed to examine the relationship between ABSI and SUI risk, calculating odds ratios and 95% confidence intervals. A restricted cubic spline (RCS) analysis was used to assess any nonlinear associations. Subgroup analyses and interaction tests were conducted to explore the influence of factors on the ABSI-SUI relationship. Sensitivity analyses were also performed to ensure the robustness of the findings. The analysis, after adjusting for potential confounders, showed a significant association between ABSI and SUI risk (p < 0.001). The RCS analysis indicated a nonlinear relationship (p for nonlinear = 0.02) with a turning point at an ABSI of 0.081. Subgroup analyses revealed that the association between ABSI and SUI was stronger in women with lower BMI, non-Mexican ethnicity, and those without hypertension (p for interaction < 0.05). Sensitivity analyses confirmed the consistency of these findings, supporting their robustness. Higher ABSI is associated with an increased risk of SUI in US women, particularly in specific subgroups. This suggests that ABSI could be a valuable measure for identifying women at higher risk of SUI.

Education of household head and maternal healthcare utilization: the case of Bangladesh

BackgroundThe high maternal mortality ratio in South Asian countries could be attributed to poor maternal healthcare (MHC) utilization. Here household heads (HHs) are the main decision-makers of the households and thus can be key stakeholders in women’s MHC uptake. We aim to investigate the role of HHs’ education in MHC utilization and explore the educational status of male adolescents who will eventually replace today’s HHs in the future.MethodWe investigated antenatal care (ANC), and institutional delivery as two MHC during pregnancy and childbirth using the Bangladesh Multiple Indicator Cluster Survey 2019. Due to the stratified cluster sampling nature of the BMICS 2019, we estimated odds ratios from mixed-effect multiple logistic regression considering women nested within clusters and estimated marginal effects to conclude. Using the Bangladesh Adolescent Health and Wellbeing Survey 2019–20, we estimated region-specific school dropout rates and identified the reasons for and timing of dropout among male adolescents.ResultsThe odds of ANC uptake and institutional delivery decreased by lower levels of HHs’ education. Marginal effects of HHs’ education on institutional delivery across comparable levels of ANC uptake show that less educated HHs diminish the full potential of ANC uptake in facilitating institutional delivery. The heaviest burden (~ 70%) of less educated (up to primary level) HHs was in the northeastern region. The highest rate of school dropout (40%) was also in the northeastern region. Around 60% of dropouts left school before or just after completing primary level. The primary reasons for dropout were lack of interest and financial constraints.ConclusionIntegrating HHs into MHC programs can be the immediate call for action while averting male adolescents’ school dropouts can be the long-term strategy.

Association between physical activity patterns and symptoms of obstructive sleep apnea: a cross-sectional analysis of NHANES data

BackgroundWith the acceleration of modern life, the “Weekend Warrior” (WW) exercise pattern has become increasingly popular. This study based on data from the National Health and Nutrition Examination Survey (NHANES) from 2007–2008, 2015–2016, and 2017–2020, examines the association between physical activity (PA) patterns and symptoms of obstructive sleep apnea (OSA) in adults aged 18 and above.MethodsThe analysis included 19,223 adults who provided self-reported data on their PA patterns. Participants were categorized into four PA groups: inactive, insufficiently active, weekend warrior (WW), and regularly active (RA). Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association between PA patterns and OSA symptoms. Stratified analyses were performed to assess variations across demographic and BMI subgroups.ResultsAfter adjusting for relevant covariates, the WW (OR = 0.85, 95% CI: [0.72, 0.99]) and RA (OR = 0.83, 95% CI: [0.77, 0.90]) groups demonstrated significantly lower odds of OSA symptoms compared to the inactive group. The protective effect of the WW pattern was observed in specific subgroups, including non-Hispanic whites, low-income individuals, and males. In contrast, the RA pattern exhibited a more consistent protective effect across most demographic and BMI subgroups. No significant difference in OSA symptom likelihood was found between the RA and WW groups after adjusting for covariates (OR = 1.02, 95% CI: [0.87, 1.20]).ConclusionBoth the WW and RA patterns are associated with a significantly lower prevalence of OSA symptoms compared to inactivity. While the WW pattern appears beneficial for certain subgroups, the RA pattern shows broader applicability. These findings highlight the potential of even non-daily PA, such as weekend activity, in reducing the likelihood of OSA symptoms, especially in specific populations.

Association of air purifier usage during pregnancy with adverse birth outcomes: the Japan Environment and Children’s Study

ObjectivePrevious studies have reported that ambient air pollutants such as PM2.5 can increase the risk of adverse birth outcomes. The objective of this study was to ascertain whether air purifier usage during pregnancy is associated with a lower risk of adverse birth outcomes in a large Japanese birth cohort.MethodsWe conducted a prospective cohort analysis using data from the Japan Environment and Children’s Study. Use of air purifiers during pregnancy was assessed using a self-administered questionnaire. Primary outcomes were the prevalence of preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW). Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe prevalence of outcomes was 4.5% for PTB, 7.4% for SGA, and 8.1% for LBW. The crude model analysis revealed that PTB, SGA, and LBW showed lower ORs in the group that used an air purifier, although the association disappeared in the adjusted model except for SGA (OR: 0.94; 95% CI: 0.89, 1.00, p = 0.048) and LBW (OR: 0.93; 95% CI: 0.88, 0.98, p = 0.003). Subgroup analysis stratified by infant sex revealed that the lower OR for LBW was observed only in male infants.ConclusionsOur results suggest that avoiding maternal air pollution exposure during pregnancy may be useful in preventing adverse birth outcomes. These findings provide evidence supporting the development of protective measures against air pollutants in the gestational period by relevant health agencies.