Exposure Categories Research Articles

Gestational diabetes mellitus in relation to serum per- and polyfluoroalkyl substances: A scoping review to evaluate the need for a new systematic review

Background Per- and polyfluoroalkyl substances (PFAS) were used or are being used in the manufacturing of products, including consumer-use products. The resulting environmental contamination has led to widespread human exposure. This review aimed to scope the characteristics of evidence covered and applied methodology of evidence to understand -- regardless of any results on the association of gestational diabetes mellitus (GDM) and PFAS -- if a new systematic review would be justified. Methods We systematically identified reports investigating associations of PFAS with GDM following a pre-specified and pre-registered PECO framework and protocol. Results The previous systematic reviews included 8-11 reports and either conducted meta-analyses stratified by comparator, analyzed results based on only high and low exposure categories, or pooled results across comparators. Included 20 reports presented data on 24 PFAS with PFOA, PFOS, PFHxS, PFNA, and PFDA being examined in almost all. The comparators employed were heterogeneous across the reports. Conclusions Because data from at least one new report on GDM is available since the previous systematic reviews and heterogeneous comparators, an updated systematic review using SWiM could add value to the literature.

Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families

Little is known about the association of severe COVID-19 and post-COVID-19 conditions with household finances. To examine associations between COVID-19 outcomes, pandemic-related economic hardship, and prepandemic socioeconomic status among families in the US. This cohort study used data from the Panel Study of Income Dynamics (PSID), a nationally representative, longitudinal study. Data included 6932 families active in the PSID in both 2019 and 2021. Ordinal exposure categories were defined based on whether the reference person or spouse or partner reported a positive COVID-19 diagnosis and (1) persistent COVID-19 symptoms, (2) previous severe COVID-19, or (3) previous moderate, mild, or asymptomatic COVID-19. Families with no history of COVID-19 served as the reference group. Outcomes included whether a resident family member was laid off or furloughed, lost earnings, or had any financial difficulties due to the COVID-19 pandemic. In this cohort study of 6932 families (772 Hispanic families [weighted, 13.5%; 95% CI, 12.4%-14.6%], 2725 non-Hispanic Black families [weighted, 13.1%; 95% CI, 12.3%-14.1%], and 3242 non-Hispanic White families [weighted, 66.8%; 95% CI, 65.2%-68.3%]), close to 1 in 4 (2222 [weighted, 27.0%; 95% CI, 25.6%-28.6%]) reported income below 200% of the US Census Bureau poverty threshold. In survey-weighted regression models adjusted for prepandemic sociodemographic characteristics and experiences of economic hardship, the odds of reporting pandemic-related economic hardship were 2.0 to 3.7 times higher among families headed by an adult with persistent COVID-19 symptoms (laid off or furloughed: adjusted odds ratio [AOR], 1.98 [95% CI, 1.37-2.85]; lost earnings: AOR, 2.86 [95% CI, 2.06-3.97]; financial difficulties: AOR, 3.72 [95% CI, 2.62-5.27]) and 1.7 to 2.0 times higher among families headed by an adult with previous severe COVID-19 (laid off or furloughed: AOR, 1.69 [95% CI, 1.13-2.53]; lost earnings: AOR, 1.99 [95% CI, 1.37-2.90]; financial difficulties: AOR, 1.87 [95% CI, 1.25-2.80]) compared with families with no history of COVID-19. Families headed by an adult with persistent COVID-19 symptoms had increased odds of reporting financial difficulties due to the pandemic regardless of prepandemic socioeconomic status (families with lower income: AOR, 3.71 [95% CI, 1.94-7.10]; families with higher income: AOR, 3.74 [95% CI, 2.48-5.63]). Previous severe COVID-19 was significantly associated with financial difficulties among families with lower income (AOR, 2.59 [95% CI, 1.26-5.31]) but was not significantly associated with financial difficulties among those with high income (OR, 1.56 [95% CI, 0.95-2.56]). This cohort study suggests that persistent COVID-19 symptoms and, to a lesser extent, previous severe COVID-19 were associated with increased odds of pandemic-related economic hardship in a cohort of US families. The economic consequences of COVID-19 varied according to socioeconomic status; families with lower income before the pandemic were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness.

Sociodemographic Profile of Animal Bite Cases Attending at a Tertiary Care Center, Rewa (M.P.)

Abstract Objective: The study’s objectives were to learn about the sociodemographic profile of animal bite cases in Madhya Pradesh’s Vindhya region while attending the Medicine Outpatient Department (OPD) at Shyam Shah Medical College in Rewa (M. P.). Materials and Methods: Between January 1, 2018, and December 31, 2018, this study was conducted in the Medicine OPD, Department of Medicine, at Shyam Shah Medical College in Rewa, Madhya Pradesh, India. A cross-sectional study was conducted. A total of 1440 cases of animal bites were included in the sample, and for each patient, a sociodemographic profile was obtained along with a comprehensive history of the animal’s category and type, bite type and site, duration of exposure, and category of exposure. Results: The majority of the 1440 animal bite cases were bitten by dogs 1198 (76.94%). There are 763 (52.98%) Category II bites, 605 (42.01%) Category III bites, and 72 (5%) Category I bite. Lower limbs were bitten 914 (63.47%), upper limbs 389 (27.01%), head and neck 67 (4.65%), and trunk 70 (4.86%). Conclusion: This study found that rural areas have a high number of dog bite cases, and adult males have a higher incidence of animal bites than adult females. The most common biting animal is the dog, and the most common site of bite in adults is the lower limbs.

Traffic-related air pollution, road traffic noise, and Parkinson's disease: Evaluations in two Dutch cohort studies.

Environmental factors such as air pollution have been associated with Parkinson's disease (PD), but findings have been inconsistent. We investigated the association between exposure to several air pollutants, road traffic noise, and PD risk in two Dutch cohorts. Data from 50,087 participants from two Dutch population-based cohort studies, European Prospective Investigation into Cancer and Nutrition in the Netherlands and Arbeid, Milieu en Gezondheid Onderzoek were analyzed. In these cohorts, 235 PD cases were ascertained based on a previously validated algorithm combining self-reported information (diagnosis, medication, and symptoms) and registry data. We assigned the following traffic-related exposures to residential addresses at baseline: NO2, NOx, particulate matter (PM)2.5absorbance (as a marker for black carbon exposure), PM with aerodynamic diameter ≤2.5 µm (PM2.5), ≤10 µm (PM10), PMcoarse (size fraction 2.5-10 µm), ultrafine particles <0.1 µm (UFP), and road traffic noise (Lden). Logistic regression models were applied to investigate the associations with PD, adjusted for possible confounders. Both single- and two-pollutant models indicated associations between exposure to NOx, road traffic noise, and increasing odds of developing PD. Odds ratios of fully adjusted two-pollutant models in the highest compared with the lowest exposure quartile were 1.62 (95% CI = 1.02, 2.62) for NOx and 1.47 (95% CI = 0.97, 2.25) for road traffic noise, with clear trends across exposure categories. Our findings suggest that NOx and road traffic noise are associated with an increased risk of PD. While the association with NOx has been shown before, further investigation into the possible role of environmental noise on PD is warranted.

In-utero exposure to polybrominated biphenyl (PBB) and menstrual cycle function in adulthood

BackgroundThere is evidence that in-utero exposure to PBBs, and similar chemicals, are associated with several adverse reproductive health outcomes including altered pubertal timing. However, less is known about the effects of in-utero exposure to PBBs on menstrual cycle function and reproductive hormone levels in adulthood. MethodsFor this menstrual cycle study, we recruited reproductive-aged women in the Michigan PBB Registry who were not pregnant, lactating, or taking hormonal medications (2004–2014). A total of 41 women who were born after the PBB contamination incident (1973–1974) and were prenatally exposed to PBBs, were included in this analysis. We estimated in-utero PBB exposure using maternal serum PBB measurements taken after exposure and extrapolated to time of pregnancy using a PBB elimination model. Women were followed for up to 6 months during which they provided daily urine samples and completed daily diaries. The urine samples were assayed for estrone 3-glucuronide (E13G), pregnanediol 3-glucuronide (Pd3G), and follicle stimulating hormone (FSH). ResultsWomen in our study were, on average, 27.5 (SD:5.3) years old and contributed 4.9 (SD:1.9) menstrual cycles of follow-up. Compared to women with low in-utero PBB exposure (≤1 ppb), women with medium (>1.0–3.0 ppb) and high (>3.0 ppb) exposure had higher maximum 3-day mean Pd3G levels during the luteal phase. Specifically, the age- and creatinine-adjusted maximum 3-day mean luteal phase Pd3G levels (95% CI) in increasing categories of in-utero PBB exposure were 9.2 (4.6,13.9), 14.8 (11.6,18.0), and 16.1 (12.9,19.3) μg/mg creatinine. There were no meaningful differences in average cycle length, follicular or luteal phase cycle length, bleed length, or creatinine-adjusted E13G or FSH levels by category of in-utero PBB exposure. ConclusionHigher exposure to PBB in-utero was associated with increased progesterone levels across the luteal phase, however, most other menstrual cycle characteristics were largely unassociated with in-utero PBB exposure. Given our modest sample size, our results require cautious interpretation.

Linking trauma to mental health in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN)

Rates of youth depression and suicide are rising worldwide and represent public health crises. The present study examined the relationship between trauma history and symptoms of depression, suicidal ideation, and anxiety among suicidal and depressed youth. A diverse group of 1000 8–20-year-olds enrolled in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN) reported their trauma history (Traumatic Events Screening Inventory for Children) and symptoms of depression (Patient Health Questionnaire for adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder scale; GAD-7), and suicidality (Concise Health Risk Tracking scale; CHRT-SR). Nearly half of the sample reported exposure to multiple categories of traumatic experiences. Number of trauma exposure categories significantly predicted PHQ-A and GAD-7 scores. Exposure to interpersonal trauma and to sexual trauma were significantly associated with PHQ-A, GAD-7, and CHRT-SR scores. The number of trauma exposure categories was associated with increased levels of anxiety and depression; however, only exposure to interpersonal or sexual trauma was associated with more suicidality. Clinicians should assess trauma exposure in patients seeking psychiatric care, especially for interpersonal and sexual trauma, which may be predictive of increased risk for suicidality in depressed youth. Future work should disentangle the effects of specific trauma types from multiple trauma exposure.

Reconciling chemical flame retardant exposure and fire risk in domestic furniture.

Evidence suggests that standards for resistance of furniture to ignition may lead to an increase in use of chemical flame retardants (CFRs). This is motivating the development of new approaches that maintain high levels of fire safety while facilitating a reduction in use of CFRs. However, reconciling potential fire risk with use of CFRs in relation to specific policy objectives is challenging. To inform the development of a new policy in the UK for the fire safety of furniture, we developed for domestic furniture quantitative models of fire risk and potential for CFR exposure. We then combined the models to determine if any lower fire risk, higher CFR exposure categories of furniture were identifiable. We applied a novel mixed-methods approach to modelling furniture fire risk and CFR exposure in a data-poor environment, using literature-based concept mapping, qualitative research, and data visualisation methods to generate fire risk and CFR exposure models and derive furniture product rankings. Our analysis suggests there exists a cluster of furniture types including baby and infant products and pillows that have comparable overall properties in terms of lower fire risk and higher potential for CFR exposure. There are multiple obstacles to reconciling fire risk and CFR use in furniture. In particular, these include a lack of empirical data that would allow absolute fire risk and exposure levels to be quantified. Nonetheless, it seems that our modelling method can potentially yield meaningful product clusters, providing a basis for further research.

Joint exposure to urban-rural status and medically underserved area residence and risk of severe COVID-19 outcomes in 2020.

The purpose of this study is to estimate the risk of severe COVID-19 among individuals residing in rural, medically underserved counties compared to those living in other counties. Individual-level COVID-19 hospitalization and death data and demographic variables were downloaded from the Centers for Disease Control and Prevention. The 2013 National Center for Health Statistics Urban-Rural Classification Scheme was used to classify urban and rural counties. Health Resources and Services Administration's medically underserved area (MUA) designation was used to identify underserved counties. County-level data were drawn from the 2015-2019 American Community Survey 5-year estimates. Analytic samples included data from Minnesota and Montana in 2020. Urban-rural/MUA joint exposure categories were created: rural/MUA, rural/non-MUA, urban/MUA, urban/non-MUA. Hierarchical logistic regression models estimated associations (odds ratios and 95% confidence intervals (CI)) between rurality, MUA status, joint urban-rural/MUA status, and severe COVID-19, overall and stratified by age and state. Models were adjusted for individual- and county-level demographics. The odds of severe outcomes among those living in rural counties were 13% lower (95%CI: 0.83-0.91) than those in urban counties. The odds of severe outcomes among those living in MUA counties were 24% higher (95%CI: 1.18-1.30) than those in non-MUA counties. For joint exposure analyses, the odds of severe outcomes were highest among those living in urban/MUA counties compared to those in rural/non-MUA counties (adjusted odds ratio: 1.36, 95%CI: 1.27-1.44). In 2020, the risk of severe COVID-19 was more pronounced in urban counties and underserved areas. Results highlight the need for locality-based public health recommendations that account for rural and underserved areas and may inform future pandemic preparedness by identifying counties most in need of resources and education at various stages of the pandemic.

175. Clindamycin versus linezolid for Group A Streptococcal bloodstream infections?: A comparative effectiveness study of adjunctive antitoxin therapy at 137 US Hospitals

Abstract Background Adjunctive clindamycin has survival benefit in invasive Group A streptococcus (GAS) infections. Like clindamycin, linezolid also leads to decreased toxin and virulence factor production. However, rising clindamycin resistance among GAS isolates and inadequate clinical data on linezolid both offer pause on which to choose. We examined the impact of adjunctive clindamycin vs. linezolid on survival among patients with GAS bloodstream infections (BSI) in the presence and absence of clindamycin resistant (clinda-R) isolates Methods Clinical characteristics, antimicrobial susceptibility testing (AST), and antibiotic therapy were examined for unique adult inpatient encounters with GAS BSIs in the PINC-AI Database. Patients treated with a β-lactam for ≥3 days ±3 days of culture who received clindamycin ±3 days of culture were overlap weighted on a propensity-score to those who received linezolid using basine patient and hospital factors. The primary outcome was odds ratio (OR) of in-hospital mortality associated with clindamycin (vs linezolid). The secondary outcome was length of stay (LOS) among survivors. Subgroups analyses were conducted excluding clindamycin receipients with clinda-R isolates (subgroup 1) and also missing clindamycin AST(including D-test; subgroup 2).Figure 1.Study Flow chart Selection of patients with Group A streptococcal blood stream infections. The database was queried for inpatients (aged ≥18 years) with blood culture displaying growth of Group A streptococcus, filtered on the basis of receiving β-lactam antibiotics within 3 days either side of culture sampling for a minimum duration of 3 days and received either adjunctive clindamycin or linezolid treatment within 3 days either side of culture sampling.Table 1:Baseline characteristics of all patients with Group A Streptococcal blood stream infections treated with β-lactam antibiotics and adjunctive clindamycin or linezolid (N=660)Abbreviations: IVIG: intravenous immunoglobulin, ICU: intensive care unit, IQR: interquartile range, SOFA: Sequential Organ Failure Assessment * This score was calculated by use of ICD-10-clinical modification codes and adapted from the methods used by Quan and colleagues ^ Calculated by use of an electronic health record-based adaption of the original Sequential Organ Failure Assessment ^^ Deteremined by clindamycin antimicrobial susceptibility and D-test results. Defined as resistant or intermediate clindamycin susceptibility results and/or a positive D-test result. † Defined as presence of ICD-10 codes coding for any of the following conditions: Human immunodeficiency virus, cancer, solid organ or hematopoietic stem cell transplantation, receipt of systemic corticosteroids, chemotherapy or other immunosuppressive therapy and immunodeficiency. ‡ Receipt of norepinephrine, epinephrine, phenylephrine, and dopamine administered within a 24-h period either side of culture sampling. Results Of 3019 β-lactam–treated inpatients with GAS BSI, 500 (17%) received clindamycin and 160 (5%) received linezolid. The prevalence of clinda-R isolates was 19%;1 isolate was linezolid resistant and excluded (Figure 1). Overlap weighting resulted in well balanced groups (Figure 2). In the overlap weighted cohort, mortality risk was similar between recipients of clindamycin (10%, [50/500]) vs linezolid (9%, [14/160]; OR 1.38 [95% CI: 0.76-2.49]). Among survivors median[interquartile range] LOS was similar between the two groups (8[9] vs. 9[8] days, p=0.45). Removing those with clinda-R isolates (N=84) and also missing AST (N=166) yielded similar results (Figure 3).Figure 2.Standardized mean differences for covariates included the propensity score calculation Standardized mean differences for covariates included in the propensity score generation averaged across exposure categories in the unweighted cohort (blue triangles) and overlap weighted cohort weight (red circles). After overlap weighting, the mean standard difference at each variable assessed was zero . Abbreviations: ICU: intensive care unit, IVIG: intravenous immunoglobulin, NSTI: necrotizing soft tissue infectionFigure 3.Odds Ratio of in-hospital mortality in patients with invasive group A streptococcal blood stream infection treated with adjunctive clindamycin versus adjunctive linezolid The ORs (95% CIs) of in-hospital mortality (including discharge to hospice) in the primary analysis and subgroup analysis with patients withclindamycin resistant isolates (subgroup 1) and those with clindamycin resistant isolates and missing clindamycin susceptibility results (subgroup 2) removed from clindamycin group. Abbreviations: CI: confidence interval Conclusion Among β-lactam-treated patients with GAS BSI, linezolid and clindamycin displayed comparable effectiveness as adjunctive antitoxin agents. Similar intrinsic effectiveness (i.e., in patients with only susceptible isolates) supports linezolid as an alternative even in low clinda-R settings. Disclosures Ahmed Babiker, MBBS, Roche: Advisor/Consultant Morgan Walker, MD, Cytovale: Advisor/Consultant

1854. Legionnaires’ Disease Case Exposure Classification Differs by Race and Ethnicity and Neighborhood Health — California, 2011–2021

Abstract Background Legionnaires’ disease (LD) is a severe pneumonia caused by Legionella bacteria transmitted by inhalation of contaminated water droplets found in poorly maintained water systems. During 2012–2020, 53% of California LD patients were white and 14% were black; however, these groups account for only 39% and 6% of the population, respectively. Healthy Places Index (HPI) measures census tract health, which can affect risk for LD, by combining 23 indicators of social and environmental conditions. We assessed associations between race/ethnicity and neighborhood health, with LD case exposure classifications to establish priorities for decreasing LD disparities in California. Methods Using all California LD cases reported during 2011–2021 and six, individual modified Poisson regression models, we estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and neighborhood health (using HPI quartile) with three LD case exposure classifications (sporadic, healthcare-associated, or travel-associated). The most advantaged HPI quartile and non-Hispanic white race/ethnicity were the referent groups. All models controlled for birth sex, age, and year. Results Among 4,373 people with LD, 47% were white, 22% were Hispanic, 12% were black, and 22%–28% fell in each HPI quartile. Among cases, 78% were sporadic, 16% were travel-associated, and 5% were healthcare-associated. Black (IRR: 0.69; 95% CI: 0.55, 0.87) and Hispanic (IRR: 0.64; 95% CI: 0.52, 0.77) race/ethnicity were associated with decreased rates of travel-associated LD. Black (IRR: 1.06; 95% CI: 1.01, 1.11) and Hispanic (IRR: 1.11; 95% CI: 1.07, 1.16) race/ethnicity, and living in the least advantaged quartile (IRR: 1.05; 95% CI: 1.01, 1.10) were associated with increased rates of sporadic LD. Healthcare-associated LD was not associated with race/ethnicity or HPI. Conclusion We found evidence of racial and neighborhood disparities in sporadic LD, racial disparities in travel-associated LD, and no evidence of disparities in healthcare-associated LD. Efforts to increase uptake of water management programs in buildings in disadvantaged neighborhoods and travel accommodations might lessen LD burden and disparities in California. Disclosures All Authors: No reported disclosures

Identification of movement phenotypes from occupational gesture kinematics: Advancing individual ergonomic exposure classification and personalized training

The identification of personalized preventive strategies plays a major role in contrasting the occurrence of work-related musculoskeletal disorders. This requires the identification of distinct movement patterns within large samples and the attribution of a proper risk level to each identified movement phenotype. We assessed the feasibility of this approach by exploiting wearable inertial measurement units to estimate the whole-body kinematics of 43 healthy participants performing 18 reach-to-manipulate movements, which differed based on the object's position in the space and the type of manipulation required. Through unsupervised clustering, we identified multiple movement phenotypes graded by ergonomic performance. Furthermore, we determined which joints mostly contributed to instantiating the ergonomic differences across clusters, emphasizing the importance of monitoring this aspect during occupational gestures. Overall, our analysis suggests that movement phenotypes can be identified within occupational motor repertoires. Assigning individual performance to specific phenotypes has the potential to inform the development of more effective and tailored interventions.

UV index seasonal variability in an Amazonian city of Brazil based on satellite data

The solar ultraviolet radiation - UV (280-400 nm) is a highly energetic component of the solar spectrum that needs to be monitored especially because of the effects on human health and on the ecosystems. The UV index (UVI) is a dimensionless indicator designed to report the intensity of UV incident on the Earth’s surface. It has five exposure categories, ranging from low to extreme, with recommended sun protections at each level. The higher the value, the greater the health risk. With only few stations reporting long-term ground-based UV measurements in several countries, which significantly restricts its extrapolations to all populated areas, a way for continuous monitoring UV on a global scale is through satellites. In this work, the monthly and seasonal variability of the incident UVI in Santarém, Pará, was analyzed. For this, a 13-year time series of daily UVI data from the OMI satellite instrument was used, as well as the 13-year UVI time series from the GOME-2 satellite instrument. According to the results, the dry period (July to December) shows higher average UVI than the rainy period (January to June) for the GOME-2 time series. The rainy period, on the other hand, in both series presents greater amplitude in the variability of the UVI.

Characterizing Immersion Pulmonary Edema (IPE): A Comparative Study of Military and Recreational Divers

BackgroundImmersion Pulmonary Edema (IPE) is a common and potentially serious diving accident that can have significant respiratory and cardiac consequences and, in some cases, be fatal. Our objective was to characterize cases of IPE among military trainees and recreational divers and to associate their occurrence with exposure and individual background factors such as age and comorbidity. We conducted a retrospective analysis on the medical records and diving parameters of all patients who were treated for IPE at the Hyperbaric Medicine Department of Sainte-Anne Military Hospital in Toulon, France, between January 2017 and August 2019. In total, 57 subjects were included in this study, with ages ranging from 20 to 62 years. These subjects were divided into two distinct groups based on exposure categories: (1) underwater/surface military training and (2) recreational scuba diving. The first group consisted of 14 individuals (25%) with a mean age of 26.5 ± 2.6 years; while, the second group comprised 43 individuals (75%) with a mean age of 51.2 ± 7.5 years. All divers under the age of 40 were military divers.ResultsIn 40% of cases, IPE occurred following intense physical exercise. However, this association was observed in only 26% of recreational divers, compared to 86% of military divers. Among civilian recreational divers, no cases of IPE were observed in subjects under the age of 40. The intensity of symptoms was similar between the two groups, but the duration of hospitalization was significantly longer for the recreational subjects.ConclusionIt seems that the occurrence of IPE in young and healthy individuals requires their engagement in vigorous physical activity. Additionally, exposure to significant ventilatory constraints is a contributing factor, with the intensity of these conditions seemingly exclusive to military diving environments. In contrast, among civilian recreational divers, IPE tends to occur in subjects with an average age twice that of military divers. Moreover, these individuals exhibit more prominent comorbidity factors, and the average level of environmental stressors is comparatively lower.

Labour agentry and subsequent adverse mental health outcomes: A follow-up study of the ARRIVE Trial.

Labour can be traumatic for women who perceive they are not involved in decisions affecting their care during labour. Our objective was to assess the relation between labour agentry and subsequent mental health. Follow-up cohort study. U.S. Tertiary care center. Participants from Utah who participated in the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial. During the ARRIVE trial, participants completed the Labor Agentry Scale twice, a validated questionnaire measuring perceived control of patients during childbirth. ARRIVE participants from Utah subsequently were asked to complete questions about mental health history and stressful events occurring since the trial, as well as surveys including the Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen, Edinburgh Postnatal Depression Scale (EPDS) and Generalised Anxiety Disorder-7 (GAD-7) screen. The lower quartile of both agentry measurements defined a person's ordinal agentry category, used for assessing cohort characteristics by exposure category. Continuous minimum agentry was included in adjusted modelling. The primary outcome was a mental health composite including a positive screen for depression, anxiety, or PTSD or self-report of a diagnosis or exacerbation since their delivery. In all, 766 of 1042 (74%) people responded to the survey (median 4.4, range 2.5-6.4 years after delivery) and 753 had complete data for analysis. In unadjusted comparisons across ordinal agentry category, lower agentry was significantly associated with the primary composite endpoint, and depressive symptoms (test of trend p = 0.003 primary, p = 0.004 depression). Lower labour agentry scores were associated with incremental odds of the primary endpoint (1 SD [24 units], adjusted odds ratio [aOR] 1.21, 95% CI 1.41-1.03), driven by depressive symptoms or self-reported diagnosis (aOR 1.25, 95% CI 1.47-1.05). Lower labour agentry at the time of birth was associated with a greater risk for mental health conditions years after delivery, indicating a potential opportunity for primary prevention of subsequent depression.

A report on a survey among Portuguese Association of Interventional Cardiology associates regarding ionizing radiation protection practices in national interventional cath-labs

Introduction and objectivesConcerns surrounding the consequences of ionizing radiation (IR) have increased in interventional cardiology (IC). Despite this, the ever-growing complexity of diseases as well as procedures can lead to greater exposure to radiation. The aim of this survey, led by Portuguese Association of Interventional Cardiology (APIC), was to evaluate the level of awareness and current practices on IR protection among its members. MethodsAn online survey was emailed to all APIC members, between August and November 2021. The questionnaire consisted of 50 questions focusing on knowledge and measures of IR protection in the catheterization laboratory. Results were analyzed using descriptive statistics. ResultsFrom a response rate of 46.9%, the study obtained a total sample of 159 responses (156 selected for analysis). Most survey respondents (66.0%) were unaware of the radiation exposure category, and only 60.4% reported systematically using a dosimeter. A large majority (90.4%) employed techniques to minimize exposure to radiation. All participants used personal protective equipment, despite eyewear protection only being used frequently by 49.2% of main operators. Ceiling suspended shields and table protectors were often used. Only two-thirds were familiar with the legally established limit on radiation doses for workers or the dose that should trigger patient follow-up. Most of the survey respondents had a non-certified training in IR procedures and only 32.0% had attended their yearly occupational health consultation. ConclusionsSafety methods and protective equipment are largely adopted among interventional cardiologists, who have shown some IR awareness. Despite this, there is room for improvement, especially concerning the use of eyewear protection, monitoring, and certification.

Environmental tobacco smoke and children’s health: a bibliometric and altmetric analysis of 100 most cited articles

BackgroundExposure to environmental tobacco smoke (ETS) is arguably the most ubiquitous and hazardous, even at very low levels, starting in early life. The objective of this study was to describe the state of research and future trends on ETS exposure and Children’s Health (CH) topics with bibliometrics and altmetrics.MethodsAn electronic search was performed in Scopus database on January 31, 2023. Consensus was arrived on 100 most-cited articles by two reviewers. These papers were then cross matched with citations harvested from Web of Science (WoS) and Google Scholar. Altmetric Attention Score (AAS) and Dimension counts were also collected. Analysis and network visualization of authors, countries, and keywords were generated using VOSviewer software.ResultsAmong a total of 1107 articles published on ETS and CH, the 100 top-cited articles appeared in 54 journals, with Pediatrics (n = 12) contributing a maximum number of articles. The time period between 2000 and 2009 accounted for 44% of all publications. With respect to the research design employed across these studies, cross-sectional design took precedence over others accounting for approximately 40%. Predominantly, articles focused on childhood asthma; however, current research trends have shifted towards emerging fields such as children’s oral health and DNA methylation. Twitter, policy documents, and news outlets were the main platforms where outputs were discussed. The AAS was not associated with journal impact factor or access type. Weak correlations were observed between AAS and citation count in Scopus, WoS, and Google Scholar (r = 0.17 to 0.27) while a positive association existed between dimension count and the number of citations across all three databases (r = 0.84 to 0.98).ConclusionThis study demonstrates the evolution, digital dissemination and research hotspots in the field of ETS and CH, predicting the possible future research directions. High-quality studies with more specific exposure classification are warranted to better understand the relationship between ETS and CH.

Abstract 16670: Significance of Cardio-Ankle Vascular Index as an Indicator of Renal Function Decline: A Systematic Review and Meta-Analysis

Introduction: Large artery stiffness leads to increased pulsatile energy transmission to the microvasculature, resulting in microvascular damage in high-flow low-resistance organs, including the kidneys. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that is less blood pressure dependent. However, its association with renal function remains understudied. Hypothesis: To determine if baseline CAVI is associated with renal function decline. Methods: The databases PubMed, Scopus, and Web of Science were systematically searched until June 2023 for original longitudinal studies. The study outcome was defined as renal function decline or incidence/progression of chronic kidney disease. The “Methodological Index for Non-Randomized Studies” (MINORS) was used for quality assessment. Pooled effect measures were calculated with random-effects models that were stratified based on CAVI cutoffs and the reported effect measure. Results: Among 7 studies (66,595 subjects; 45% male) the ranges of average age, eGFR, and follow-up duration were 46-69 years, 51-87 mL/min/1.73m2, and 1-7 years, respectively. All but one study (Kusunose et al.) reported adjusted models. The meta-analyses showed significant associations between high baseline CAVI and worsening renal function outcomes among studies reporting hazard ratios for a categorical exposure (HR=1.30; 95% CI [1.18-1.43]; P&lt;0.001; I 2 =38%), continuous exposure (HR [per SD] =1.14 [1.04-1.25]; P=004; I 2 =23%), and for odds ratios (OR [categorical exposure] =1.67 [1.01-2.76]; P=0.046; I 2 =71%). Conclusions: We observed a significant association between higher baseline CAVI and renal function decline over time. These results suggest that CAVI is a marker of kidney disease risk. Further research is warranted to investigate the role of CAVI as an indicator of risk of end-organ damage, and to investigate interventions targeting arterial stiffness to mitigate the burden of chronic kidney disease.

Abstract 12832: Risk of Extreme Wet Climate Conditions and Racial/Ethnic-Specific Cardiovascular Mortality in Southwest United States

Introduction: Coastal regions are highly vulnerable to extreme climate conditions, which are known to have effects on adult cardiovascular disease mortality (CVDM). Racial/ethnic (R/E) minority populations (ie Non-Hispanic (NH) Black) are known to have a greater incidence of CVDM compared to their NH White counterparts. Consequently, there is a need to document associations between climate extremes and R/E-specific CVDM. Hypothesis: Extreme wet conditions associated with CVDM should vary by R/E, where strongest increased risk is expected for minority populations. Methods: Population-based study using sex, age (45-84 years), and R/E-specific (NH White, Black, Asian, &amp; Hispanic/Latino) CVD deaths [ICD-10 (I00-99)] from CDC for Southwest US (California, Arizona, New Mexico) from Jan 1999 to Dec 2020. Climate exposure categories (mild, moderate, extreme dry/wet) were based on Palmer Drought Severity Index (PDSI), which integrates temperature and precipitation. With population estimates, CVDM rates were associated with PSDI categories using negative binomial regression upon adjusting for diabetes, smoking prevalence, sex, trend, month, state, unemployment rate, and air pollution (PM 2.5 ). Results: From 1999-2020, 1,307,418 (67.6% NH White, 16.1% Hispanic, 7.4% NH Asian, 8.9% NH Black) CVD deaths were recorded. CVDM was associated with a significant increased risk during extreme wet events (compared to extreme drought) only among NH Asian (adjusted rate ratio [RR] 1.08; 95% CI 1.06-1.09) and NH White (RR 1.02; 95% CI 1.01-1.025) in Southwest US (Figure). Insignificant interactions were observed between extreme wet and PM2.5 on CVDM by R/E. Conclusions: Extreme wet climate conditions were associated with an increased risk of CVDM among NH Asian and White adults. Both climate extreme events and R/E should be considered as predisposing risk factors for CVDM. Further studies are needed to assess such CVDM risk factors for other susceptible areas in the US.

Donor pregnancies and transfusion recipient mortality: A role for red blood cell storage?

Donor characteristics have been implicated in transfusion-related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood donor, could affect patient outcomes. Whether storage duration of the blood product could be important for patient outcomes has also been investigated, and a small detrimental effect of fresh products remains a possibility. Here, we hypothesize that fresh red blood cell products donated by ever-pregnant donors are associated with mortality in male patients. We used data from a cohort study of adult patients receiving a first transfusion between 2005 and 2015 in the Netherlands. The risk of death after receiving a transfusion from one of five exposure categories (female never-pregnant stored ≤10 days, female never-pregnant stored >10 days, female ever-pregnant stored ≤10 days, female ever-pregnant stored >10 days and male stored for ≤10 days), compared to receiving a unit donated by a male donor, which was stored for >10 days (reference), was calculated using a Cox proportional hazards model. The study included 42,456 patients who contributed 88,538 person-years in total, of whom 13,948 died during the follow-up of the study (33%). Fresh units (stored for ≤10 days) from ever-pregnant donors were associated with mortality in male patients, but the association was not statistically significant (hazard ratio 1.39, 95% confidence interval 0.97-1.99). Sensitivity analyses did not corroborate this finding. These findings do not consistently support the notion that the observed association between ever-pregnant donor units and mortality is mediated by blood product storage.

MENINGIOMA-04 PATTERN OF KI67 INDEX IN RELATION TO ANATOMICAL, HISTOLOGICAL AND DEMOGRAPHIC CHARACTERISTICS AMONG PATIENTS WITH MENINGIOMA SEEN AT KENYATTA NATIONAL HOSPITAL

Abstract BACKGROUND Meningioma remains the most frequently reported primary intracranial tumor that is indicated in the brain or spinal cord. It is relatively under-studied in Kenya, and hence literature and data are scarce on its immunohistochemically expression as well as its correlated clinical outcomes. The role of Ki-67 in the prognosis of meningioma’s has been indicated to be still debatable. METHODOLOGY Using a cross-sectional study design, patients who presented with meningioma were recruited through consecutive sampling. Data collected age, sex and the location of the tumor. Samples archived in the laboratory after surgery were retrieved, and Ki67 testing done to assess outcomes.Data analysis: SPSS version 26 was used. The Chi-square test was used to test the association between categorical exposure variables and the occurrence of Ki67. A p-value of 0.05 was considered statistically significant. RESULTS The study showed the average age of patients with new onset meningioma, as identified by histology, was 48.4 years. Our study found a higher percentage of female participants (79.5%) compared to male (20.5%). Meningothelial was the most common histological subtype, accounting for 34.1% of cases and classified as Grade 1 according to the WHO Grade system. 26.5% of grade 1 meningiomas had Ki67 labeling index of above 4%. The atypical type was the most significantly associated with Ki67 with a p-value of 0.012. The expression of Ki-67 labeling index was associated with WHO grade 2, and patients with this grade had a 6 times greater chance of having a Ki67 labeling index of more than 4%. The AUC model performance was 67.8%. This study found age, gender and location of tumor has no influence on mean Ki 67 labelling index. CONCLUSION High level of Ki-67 expression is associated with high pathological WHO grade II meningioma. 26.5% of grade 1 meningiomas had high Ki67 labeling index above 4%.