Health Association Research Articles

Characterizing acoustic dimensions of health-related urban greenspace

The association of urban greenspace and human health and well-being is widely recognised, but the underlying mechanisms are incompletely understood. The acoustic environment (AE) is frequently proposed as a mediator between greenspace and human health. While it is commonly viewed as a negative health factor (e.g. noise pollution), there is growing evidence that it also has positive effects on human health. However, a general problem is the lack of information on the AE for greenspaces in high spatial resolution. To provide evidence-based support for research on this issue, we identify and assess acoustic properties of health-related urban greenspace by estimating the association between urban green area and selected acoustic indices.The analysis is based on 5-minute audio recordings collected systematically from 730 locations, four times a year (n = 2,746) in Bochum, Germany. To quantify the acoustic properties, we use an indicator-set of 30 sound pressure levels, 11 eco-, 78 psychoacoustic indices and 3 complex network measures. Greenspace is defined, in alignment with various health studies, as the percentage of green area within three buffer sizes (50, 100, 300 m) around each recording location.Through cluster analysis, we identify eleven acoustic dimensions in our indicator-set, for which representative indices are derived using principal component analysis. Descriptive statistics and multi-level regression models are used to analyse the associations between representative indices and greenspace. We find the highest effect sizes for Link Density (representing “acoustic dominance”), Acoustic Richness (representing “persistent sound volume”) and the Articulation Index (representing “sound volume”). Thus, in addition to “sound volume”, the AE of urban greenspace is characterised to a similar extent by at least two additional acoustic dimensions. If properties of the AE act as mediators between urban greenspace and human health, these three acoustic dimensions hold the potential to reflect them. Studies on pathways between greenspace and human health could incorporate measures of these dimensions to extend the understanding of the AE’s relevance for Public Health.

Associations of demographic, health, and risk-taking behaviors with tattooing in a population-based cross-sectional study of ~18,000 US adults.

Little is known about current characteristics of individuals with tattoos. We quantified the prevalence of tattooing and associations of demographic, health, and risk-behavior factors with tattooing. We computed adjusted prevalence ratios (PR) of tattooing in a population-based analysis of > 18,000 Utah adults from the 2020-2021 Behavioral Risk Factor Surveillance System survey. The prevalence of tattooing was 26% among women and 22% among men, with the highest prevalence among women ages 25-29 (45%). Tattoo prevalence was higher among younger individuals, individuals with a lower education level, and those without religious affiliation. Tattoo prevalence was higher among indviduals with current tobacco (women: PR = 2.89 [95% confidence interval (CI): 2.60, 3.20]; men: 3.39 [2.98, 3.86]), e-cigarette (women: 2.44 [2.21, 2.69]; men: 2.64 [2.37, 2.94]), and heavy alcohol use (women: 2.16 [1.93, 2.43]; men: 1.89 [1.63, 2.19]). Tattoo prevalence was lower among individuals receiving a flu (women: 0.84 [0.76, 0.92]; men: 0.75 [0.67, 0.84]) or COVID-19 vaccine (women: 0.65 [0.54, 0.79]; men: 0.75 [0.61, 0.92]). Several risk-taking behaviors were associated with tattooing. Tattoo studios/conventions may present opportunities for partnership with tobacco cessation, alcohol reduction, and vaccination public health initiatives.

Exploring the cardiovascular health behaviors of college students and the areas that need increased public health efforts.

Cardiovascular disease (CVD) is a leading cause of death worldwide among adults. Traditionally, the disease has been considered as a condition affecting older adults. However, its risk factors (e.g., poor diet, sedentary behavior, inadequate sleep, and obesity) are increasingly being identified in younger populations. There is a need to increase the evidence of CVD risk factors in this population to further support preventive programs in this demographic. This study investigates the prevalence of CVD risk factors in young adult, college students. Data was used from the American College Health Association's National College Health Assessment (ACHA-NCHA) II-C. The sample included data from 426,259 students, ages 18-25. Data was reviewed on race, nutrition, physical activity, tobacco use, sleep, weight, and history of chronic disease. Descriptive statistics were utilized to examine the prevalence of CVD risk factors. There was a notable prevalence of CVD risk factors, such as insufficient nutrition, obesity, insufficient physical activity, and inadequate sleep, among college students. CVD-related risk factors are on the rise within this demographic. There is a pressing need for the expansion of public health initiatives aimed at enhancing CVD awareness and prevention among college students.

Associations of schooling type, qualification type and subsequent health in mid-adulthood: evidence from the 1970 British Cohort Study

BackgroundEducation is thought to benefit health. However, existing studies have predominantly focused on educational attainment—the type of institution attended has been overlooked, despite being an important indicator of education resources,...

Sex Differences in the Associations of mental Health, Suicidality, Screentime, and Sleep: A Mediation Effect Analysis of Sleep Using Youth Risk Behavioral Surveillance Survey 2021.

Objective: This study was conducted to explore the sex differences in the direct and indirect associations among mental health/suicidality, sleep, and screen time. Methods: Using the 2021 Youth Risk Behavior Survey (YRBS) data, 9408 participants were included in the analyses. The associations of endogenous variables (mental health and suicidality), exogenous variable (screen time), mediator (sleep), and covariates (demographic features and risky behaviors) were analyzed using the Structural Equation Model and "medsem" package, as well as logistic regression and bootstrapping methods. To explore the sex differences in the mediation effect, the Likelihood Ratio Test was used for the multiple-group analysis to compare the unconstrained model with the mediation path-constrained model. Results: Screen time had a significant negative association with sleep duration (female: β = -.09, p < .001; male: β = -.04, p < .001), positive relations to mental health problems (female: β = .10, p < .001; male: β = .12; p < .001), and suicidality (female: OR: 1.07, 95% CI: 1.02-1.13; male: OR: 1.06, 95% CI: 1.01-1.23). Sleep duration is negatively associated with mental health problems (female: β = -.16, p < .001; male: β = -.14; p < .001) and negatively associated with the likelihood of suicidality (female: .89, 95% CI: .85-.94; male: OR: .84, 95% CI: .79-.90). Furthermore, female adolescents had higher frequencies in mental health problems, higher odds ratio in suicidality, shorter sleep duration, and bigger mediation effects of sleep, compared to their male counterparts. Conclusion: Mental health and suicidality were affected differently by screen time and sleep between female and male adolescents. Future research may continue to explore sex differences and their underlying reasons.

Avoidable Hospitalizations in Frail Older Adults: The Role of Sociodemographic, Clinical, and Care-Related Factors

ObjectivesThis study aims to investigate the relationship between frailty and avoidable hospitalization risk, and the moderating role of sociodemographic, clinical, and care-related factors. DesignLongitudinal population-based cohort study. Setting and ParticipantsA total of 3168 community-dwelling individuals, aged ≥60 years, from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). MethodsWe operationalized physical frailty using baseline SNAC-K data (2001-2004). In line with the Swedish Board of Health and Welfare and Association of Local Authorities and Regions, avoidable hospitalizations were considered those that could have been prevented through proper and timely outpatient care and identified through the Swedish National Patient Register. Participants were followed from baseline until first avoidable hospitalization, death, drop out, institutionalization, or maximum 12 (median 7.6) years. The association between frailty and avoidable hospitalization was explored through flexible parametric survival models, with stratified analyses to investigate age, gender, education, civil status, multimorbidity, cognitive status, and informal and formal care as potential modifiers. ResultsThe adjusted 12-year cumulative incidence of avoidable hospitalization was significantly higher for frail persons (cumulative incidence 33.2%, 95% CI 28.9%-38.1%) than for prefrail (cumulative incidence 26.6%, 95% CI 24.5%-29.0%) and nonfrail (cumulative incidence 25.2%, 95% CI 22.5%-28.3%) individuals. In addition, prefrailty [hazard ratio (HR) 1.21, 95% CI 1.00-1.45] and frailty (HR 1.91, 95% CI 1.47-2.50) were associated with increased avoidable hospitalization hazards. Furthermore, the association between frailty and avoidable hospitalization was stronger in older adults aged <78 years (HR 3.12, 95% CI 1.99-4.91) and those with relatively fewer chronic diseases (HR 3.88, 95% CI 1.95-7.72), whereas provision of formal social care (HR 1.15, 95% CI 0.77-1.72) seemed to act as a buffer. Conclusions and ImplicationsOur results indicate that older community-dwelling adults with prefrailty and frailty are at increased risk of experiencing avoidable hospitalizations, highlighting a need for better care of these individuals at the outpatient level. Formal social care services and close monitoring of particularly vulnerable subgroups of frail persons may mitigate this risk.

Impaired oral health associations with cognitive and motor decline in activities of daily living independence during hospitalization: insights from a post-stroke cohort

PurposeEvidence is scarce on the associations between impaired oral health and cognitive level related to independence in activities of daily living (ADLs) among hospitalized older patients. We aimed to evaluate the associations between baseline oral problems and changes in cognitive level in post-stroke patients. MethodsA retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Revised Oral Assessment Guide (ROAG) as a measure of oral health and function was assessed at admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the motor domain of FIM (FIM-motor). Multivariate linear regression analyses were employed to assess the association between baseline ROAG and the designated outcomes, adjusting for potential confounding factors. ResultsData from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median ROAG was 10 [9, 12], with 811 patients (84.9%) presenting oral problems. After fully adjusting for confounding factors, the ROAG was significantly and negatively associated with FIM-cognition at discharge (β = -0.107, p = 0.031) and FIM-cognition gain (β = -0.093, p = 0.018). Further, the ROAG was independently and negatively associated with FIM-motor at discharge (β = -0.043, p = 0.013) and FIM-motor gain (β = -0.065, p = 0.013). ConclusionOral problems were associated with compromised cognitive levels and a decline in physical function during the hospitalization in post-stroke patients. These results underscore the critical importance of addressing oral health in this patient population.

Answering a Call to Action: Reducing Fetal Alcohol Spectrum Disorders Using a Healthcare Champion Model.

Prenatal alcohol exposure and fetal alcohol spectrum disorders (FASDs) remain critical public health issues. Alcohol use in pregnancy is a leading preventable cause of birth defects, developmental disabilities, and learning disabilities. Alcohol screening and brief intervention (SBI) is effective at reducing excessive alcohol use. However, this clinical preventive service remains critically underutilized in primary care. In 2014, the Centers for Disease Control and Prevention called for the creation of FASD Champion programs to promote clinician education about FASDs. Six professional health organizations and groups providing reproductive and child health services set out to create FASD Champion programs. The American College of Obstetricians and Gynecologists FASDs Prevention Program was created to focus on reducing alcohol-exposed pregnancies. The American Academy of Pediatrics' Champion program maintains the goal of improving health outcomes for children with FASDs by improving pediatricians' diagnostic capacity. The American Academy of Family Physicians has prioritized training family physician champions to improve the delivery of alcohol SBI among adult patients. The University of Alaska Anchorage has partnered with the National Association of Nurse Practitioners in Women's Health, the American College of Nurse-Midwives, and the Association of Women's Health, Obstetric, and Neonatal Nurses to assure advanced practice registered nurses and midwives have the knowledge and skills to prevent alcohol-exposed pregnancies and FASDs. The American Association of Medical Assistants has prioritized expanding the knowledge and skills of medical assistants related to promoting alcohol-free pregnancies. Finally, the Champions program at the University of Texas at Austin was established to train health social workers in alcohol SBI. Through the advocacy, education, and mission of these 6 health sectors in collaboration with national organizations and educational institutions, the evidence-based approach of alcohol SBI is being disseminated throughout the United States to reduce the harmful effects of prenatal alcohol exposure.

Computation of Socio-Economic Status in the AWI-Gen Project.

Socio-economic status of participants in many public health, epidemiological, and genome-wide association studies is an important trait of interest. It is often used in these studies as a measure of direct interest or as a covariate. The Africa Wits INDEPTH Partnership for Genomic and Environmental Research (AWI-Gen) explores genomic and environmental factors in non-communicable diseases, particularly cardio-metabolic disease. In Phase I of AWI-Gen, approximately 12,000 participants were recruited at six sites in four African countries. Participants were asked questions about asset ownership. This technical note describes how AWI-Gen computed socio-economic status from the asset register.

Association of mental health with walking capacity in patients with claudication: a cross-sectional study

Objectives The purpose of this investigation was to verify the association between mental health (MH) indicators with walking capacity in patients with PAD. Methods Two hundred and forty-six patients with PAD and claudication symptoms participated in this study. Physical function was assessed objectively with the 6-min walk test (6MWT) and subjectively using the Walking Impairment Questionnaire (WIQ). MH was assessed by the World Health Organization Quality of Life-Bref (WHOQOL-Bref) (six questions were selected − 1, 2, 10, 16, 19, and 26). Patients were divided into tertile groups according to their composite z-score for mental health (Low MH, Middle MH, and High MH). Results The High MH group presented higher scores (p < 0.05) for the WIQ (distance = 26.8 ± 25.6, speed = 25.4 ± 17.3, and stairs = 33.6 ± 27.5), claudication onset distance (161.6 ± 83.6 m), and total walking distance (352.9 ± 79.6 m) compared to Low MH (WIQ distance = 14.8 ± 16.2, 17.7 ± 13.0, and stairs = 22.7 ± 20.7). Additionally, the High MH group presented a longer claudication onset distance (115.5 ± 70.5 m), and total walking distance in 6MWT (306.6 ± 83.2 m), and higher scores in the total walking distance compared to Middle MH (309.5 ± 93.6 m) (p < 0.05). Conclusion In patients with PAD, MH was positively associated with walking capacity. Based on these results, treatments that can improve mental health, through different mechanisms, can also positively influence the ability of these patients to walk.

Assessing the Readability, Reliability, and Quality of AI-Modified and Generated Patient Education Materials for Endoscopic Skull Base Surgery.

Despite National Institutes of Health and American Medical Association recommendations to publish online patient education materials at or below sixth-grade literacy, those pertaining to endoscopic skull base surgery (ESBS) have lacked readability and quality. ChatGPT is an artificial intelligence (AI) system capable of synthesizing vast internet data to generate responses to user queries but its utility in improving patient education materials has not been explored. To examine the current state of readability and quality of online patient education materials and determined the utility of ChatGPT for improving articles and generating patient education materials. An article search was performed utilizing 10 different search terms related to ESBS. The ten least readable existing patient-facing articles were modified with ChatGPT and iterative queries were used to generate an article de novo. The Flesch Reading Ease (FRE) and related metrics measured overall readability and content literacy level, while DISCERN assessed article reliability and quality. Sixty-six articles were located. ChatGPT improved FRE readability of the 10 least readable online articles (19.7 ± 4.4 vs. 56.9 ± 5.9, p < 0.001), from university to 10th grade level. The generated article was more readable than 48.5% of articles (38.9 vs. 39.4 ± 12.4) and higher quality than 94% (51.0 vs. 37.6 ± 6.1). 56.7% of the online articles had "poor" quality. ChatGPT improves the readability of articles, though most still remain above the recommended literacy level for patient education materials. With iterative queries, ChatGPT can generate more reliable and higher quality patient education materials compared to most existing online articles and can be tailored to match readability of average online articles.

BASHH standards for the management of sexual health in UK prisons.

People in prison often experience risk factors that can lead to poor sexual health which is compounded by social deprivation. In response, the British Association for Sexual Health and HIV (BASHH) has published the first national standards in the management of UK prisons, providing recommendations for commissioners, service providers, health care providers and people in prison. Nine standards have been devised which cover aspects of sexual health diagnosis and management, public health measures, and some reproductive health issues. The aim of these standards is to drive improvements in sexual health provision in prisons to ensure access to high quality care that is equitable to that which is provided to the general population.

Couples in breast cancer survivorship: Daily associations in relationship satisfaction, stress, and health

Romantic relationships are a key health determinant underlying both morbidity and mortality. Dr. Janice Kiecolt-Glaser’s prolific research revealed cardiovascular, metabolic, endocrine, and immune pathways connecting marriage to health and longevity. In addition to her empirical work, she developed conceptual models on marriage, the gut microbiome, stress reactivity, and spousal health concordance; these models guide and inspire mechanistic research, serve as essential readings for graduate students and mentees, and provide inspiration for researchers across career stages. This paper highlights Dr. Kiecolt-Glaser’s influential work, includes personal reflections and professional growth as past mentees, and provides Dr. Kiecolt-Glaser-inspired evidence linking relationships to health among couples in breast cancer survivorship. Using baseline questionnaires and daily dairies, breast cancer survivors (stage I-IIIB) and their cohabiting partners (60 individuals, 30 couples) rated their relationship satisfaction, stress, and physical health symptoms every day for 7 days. Results suggest that breast cancer survivors and their partners who felt more satisfied with their relationships also felt less stressed, both typically and on a daily basis. Survivors’ and partners’ lower stress was also associated with fewer physical health problems on average and in daily life. These findings demonstrate the daily stress and health advantages of satisfying relationships for both breast cancer survivors and their partners. We discuss the study’s implications and several avenues for Dr. Kiecolt-Glaser-inspired research addressing a relationship’s long-term health impact among couples in survivorship.

Vaginal Lactobacillus fatty acid response mechanisms reveal a metabolite-targeted strategy for bacterial vaginosis treatment

Bacterial vaginosis (BV), a common syndrome characterized by Lactobacillus-deficient vaginal microbiota, is associated with adverse health outcomes. BV often recurs after standard antibiotic therapy in part because antibiotics promote microbiota dominance by Lactobacillus iners instead of Lactobacillus crispatus, which has more beneficial health associations. Strategies to promote L.crispatus and inhibit L.iners are thus needed. We show that oleic acid (OA) and similar long-chain fatty acids simultaneously inhibit L.iners and enhance L.crispatus growth. These phenotypes require OA-inducible genes conserved in L.crispatus and related lactobacilli, including an oleate hydratase (ohyA) and putative fatty acid efflux pump (farE). FarE mediates OA resistance, while OhyA is robustly active in the vaginal microbiota and enhances bacterial fitness by biochemically sequestering OA in a derivative form only ohyA-harboring organisms can exploit. OA promotes L.crispatus dominance more effectively than antibiotics in an invitro BV model, suggesting a metabolite-based treatment approach.

Associations of mental health with vaccination readiness in informal caregivers and the vaccination status of their care recipients during the Covid-19 pandemic – A cross sectional analysis

IntroductionVaccinations are important for informal caregivers and their care recipients. Mental health problems are common among care givers. The aim of this study was to investigate vaccination readiness in informal caregivers and associations with mental health issues. Associations between vaccination readiness in informal caregivers and the vaccination status of their aged care recipients were examined. MethodsWithin the multicenter prospective registry study ‘Bavarian ambulatory Covid-19 Monitor (BaCoM) ‘, informal caregivers were asked for symptoms of depression (PHQ-9), burden of caretaking (BSFC-s), psychological antecedents of vaccination readiness (5C model) and previous Covid-19 infections of their care recipients. The vaccination status against Covid-19, seasonal influenza and pneumococcal disease was determined via vaccination certificates. Data analysis was performed using ordinal regressions and Mann-Whitney-U tests. ResultsData of n = 91 informal caregivers, associated with n = 84 care recipients were collected. Symptoms of depression were associated with reduced vaccination readiness (Calculation: p = 0.026, OR = 1.18), as well as the perceived burden of caretaking (Confidence: p = 0.006, OR = 0.88). A previous Covid-19 infection of the care recipients was associated with decreased vaccination readiness of informal caregivers (Median (Q1–Q3) Confidence: 5.0 (4.5–6.0) vs. 4.0 (3.0–5.0); Calculation: 5.0 (3.0–6.0) vs. 4.0 (1.0–5.0)). The vaccination status of the care recipients interrelated significantly with vaccination readiness of their informal caregivers (Confidence: p < 0.001; Complacency: p < 0.01; Constraints p < 0.05). No significant interrelations between vaccination readiness and the vaccination status against seasonal influenza or pneumococcal disease occurred. ConclusionMental health issues of informal caregivers seem to be associated with the actual vaccination status against Covid-19 in their care recipients. Target group specific counselling as well as an active involvement of informal caregivers in shared decision-making processes can be of relevance, but even more attention should be paid to the protection of mental health for informal caregivers.Trial registration number: German Register of Clinical Studies DRKS 26039.

Expert recommendations for the prevention of common respiratory viral infections in neonates

Neonates, particularly preterm infants, are a susceptible population to respiratory viral infections. Currently, aside from influenza, there are no antiviral medications specifically approved for the treatment of respiratory viral infections in neonates; therefore, prevention of these viral infections is particularly crucial for neonates. The Neonatal HealthCare Committee of Chinese Maternal and Child Health Association, based on domestic and international clinical evidence and combined with clinical practice experience, and after thorough discussion by relevant experts, has developed eight expert recommendations. These include preventive strategies against influenza virus, respiratory syncytial virus, and severe acute respiratory syndrome coronavirus 2 infections, intended for reference in clinical practice.

Exploring the Associations of Personality and Sexual Health Using the DSM-5 Alternative Model for Personality Disorders

This study explored the relationships between sexual health indicators (i.e., sexual satisfaction, distress, and function) and the DSM-5 Alternative Model for Personality Disorders, a promising dimensional framework for assessing personality pathology. A sample of 489 participants seeking help in private practice clinics completed self-report measures of sexual satisfaction, distress, and function, as well as dyadic adjustment, psychological distress, romantic attachment, personality impairment, and pathological personality facets. Results first showed that participants reaching the cutoffs for a personality disorder had significantly higher sexual distress and lower sexual function compared to participants without a personality disorder. Second, path analyses controlling for psychological distress, dyadic adjustment, and romantic attachment revealed that, for women, the Criterion B Intimacy Avoidance facet was consistently linked with higher sexual distress and lower sexual satisfaction and function. For men, result patterns were more complex, linking Criterion B Separation Insecurity with high sexual distress, and Separation Insecurity and Intimacy Avoidance facets with low sexual function. In addition, Criterion B Irresponsibility, Rigid Perfectionism, as well as Criterion A Intimacy impairment were linked with higher sexual satisfaction. These findings improve our understanding of the links between personality and sexual health and provide support for considering personality difficulties in sexual health interventions.

Inclusion Goals: What Sex Education for LGBTQIA+ Adolescents?

According to the World Health Organization and the World Association for Sexual Health (WAS) Declaration of Sexual Rights, sex education aims to provide children and adolescents with comprehensive knowledge, skills, attitudes, and values, promoting equality and nondiscrimination while upholding freedom of thought and expression. However, current school curricula often focus on dichotomous sexual identity and hetero-cis-normative prevention strategies, neglecting the needs of gender minority (GM) and sexual minority (SM) youths. In family settings, discussions typically revolve around sexual risk reduction and basic contraception, omitting relational aspects and components of sexual identity such as orientations and gender expressions. This discrepancy highlights a gap between the official goals of sex education and its practical implementation, reflecting a cultural deficit in familial sex education. This study reviews the scientific literature on sexual health promotion interventions from 2015 to 2024 to identify inclusive approaches that enhance the participation of all youths, not just hetero-cis-normative individuals. The hypothesis is that most interventions primarily serve heterosexual and cisgender youths, indicating a need for more inclusive strategies to achieve better sexual health and educational outcomes. The study also suggests expanding curricula to align with recognized guidelines and the diverse needs of youth.

The associations of early-life health and performance with subsequent dairy cow longevity, productivity, and profitability

Selecting and raising dairy animals that are more likely to reach their potential is a strategy to increase milk production efficiency and overall profitability. However, indicators are necessary for the early identification of animals that are less likely to perform well, allowing for their early culling and ensuring that resources are allocated to those with the highest potential. The objective of this study was to analyze the association between early-life animal health and performance with longevity, production, and profitability. After data cleaning, the following early-life measures (i.e., predictors) were available for 363 female calves born between June 2014 and November 2015 in eight dairy herds from New Brunswick, Canada (average: 45 calves/farm; SD: 26.1 calves/farm; median: 42 calves/farm; range: 15–95 calves/farm): birth weight, weaning weight, weaning age, weaning average daily gain (weaning ADG), immunoglobulin G (IgG) serum concentration, the occurrence of navel infection, diarrhea, and pneumonia, and if animals received antibiotic treatment between birth and weaning. Their subsequent length of life (LL), length of productive life (LPL), lifetime cumulative energy-corrected milk (ECM), and lifetime cumulative milk value (i.e., response variables) were provided by the Canadian dairy herd improvement agency. Bayesian Additive Regression Tree models were trained for each response variable using 5-fold cross-validation. Models were evaluated using the RMSE and R2. The three most important predictors were identified using permutation, and the relationship between response variables and important predictors was assessed using accumulated local effect plots. The RMSE for LL, LPL, ECM, and milk value were 1.43 years, 1.37 years, 16 314.94 kg, and $CAD 11 525.68, respectively, whereas the R2 values were 0.30, 0.25, 0.29, and 0.29, respectively, indicating a moderate relationship between predictors and response variables. Non-linear relationships were found between the response variables and important predictors. Animals born with low or high birth weights were associated with decreased LL, LPL, ECM, and milk value. The highest LL, LPL, and milk value was observed for calves weaned between 1.9 and 2.0 months old, followed by a decline for calves weaned at older ages. The lowest LL and ECM were associated with weaning ADG of 0.786 kg/day, while 0.787 kg/day was associated with the lowest LPL. Lastly, both ECM and milk value were highest when serum IgG values were 1 659 mg/dL. These findings provide valuable insights for optimizing early culling decisions and enhancing the productivity and profitability of dairy farms.

Ability of an obstetric hemorrhage risk assessment tool to predict quantitative peripartum blood loss.

Hemorrhage risk assessment tools have been studied using estimated blood loss. We study the association between peripartum hemorrhage risk assessment score and peripartum quantified blood loss (QBL) in term vaginal and cesarean deliveries. This is a retrospective analysis conducted on 3,657 patients who underwent term vaginal and cesarean deliveries at a public hospital in New York City. Utilizing the risk assessment tool developed by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), patients were categorized into low-, medium-, or high-risk groups for postpartum hemorrhage. Medium-risk (B=0.08, SE=0.01, p<0.001) and high-risk (B=0.12, SE=0.02, p<0.001) AWHONN scores were associated with significantly higher QBL as compared to low-risk AWHONN score. Medium-risk approached significance (OR: 1.67, 95 % CI: 1.00, 2.79, p=0.050) and high-risk AWHONN score was significantly associated (OR: 1.95, 95 % CI: 1.09, 3.48, p=0.02) with increased odds for postpartum hemorrhage (≥1,000 mL). Each individual factor comprising the AWHONN score whose percentage in our sample was seen in greater than 2.7 % of patients was independently significantly associated with increased QBL (six of nine factors) and postpartum hemorrhage (four of nine factors). The AWHONN measure previously validated with estimated blood loss predicted obstetric blood loss with QBL. Although not on the basis of the data shown in our study, we believe that QBL should be routinely used to measure obstetric blood loss.