Higher Risk Estimates Research Articles

Exposure to Black Carbon (BC) and the Secondary Aerosol (p-SO42– and p-NO3‒) Components of Fine Particulate Matter (PM2.5), and Cardiopulmonary Morbidity in Jeddah, Saudi Arabia

Abstract: This study assessed the morbidity risk for respiratory (RDs) and cardiovascular diseases (CVDs) from the exposure to black carbon (BC), p-SO42–, and p-NO3‒ measured in PM2.5 collected from Jeddah. The 24 h PM2.5 sampling was done at three sites for 6 weeks quarterly from 8 April 2013 to 18 February 2014, with concurrent hospital data collection. Though the data were collected more than a decade ago, the results are still applicable to the current middle east region and beyond. The relative risk (RR) for CVDs and RDs was computed in a single pollutant GLM time-series model using moving averages (MAs) and presented with 95% confidence intervals (CI). Overall, the morbidity risk was highest in outpatients. The risk of RDs was highest in younger age groups with age group 0–14 years being the most vulnerable, while the risk of CVDs was highest in age groups above 30 years. BC: The risk of RDs was highest in outpatient females of 0–14 years at all MAs; 1.483 (1.035, 2.123) to 2.501 (1.522, 4.112), and males of 31–45 years; 1.758 (1.134, 2.725) to 1.895 (1.142, 3.145) at MAs 5–7. The risk of CVDs was highest in age group 61–75 years but with a marginal statistical significance. p-SO42–: The risk of RDs was highest in males of 31–45 years; 1.173 (1.066, 1.291) to 1.256 (1.126, 1.400) at MAs_3–7. The risk of CVDs was also highest in age group 31–45 years; 1.078 (1.004, 1.157) to 1.090 (1.010, 1.177), with higher risk estimates in males; 1.084 (0.986, 1.191) to 1.120 (1.013, 1.239) at MAs 4–7. p-NO3‒: No significant risk was observed for RD morbidity. The overall risk of CVDs was significant in outpatients with an age group of 61–75 years at all MAs; 1.204 (1.014, 1.429) to 1.316 (1.096, 1.579); females, 1.221 (0.987, 1.511) to 1.428 (1.123, 1.816); and males, 1.205 (1.022, 1.421) to 1.258 (1.052, 1.505). This is the first study to assess the cardiopulmonary risk from BC, p-SO42–, and p-NO3‒ exposure in Jeddah. A high morbidity risk was observed in all age groups, accentuating the effects of elevated air pollution in Saudi Arabia and beyond. Females of 0–14 years were more at risk for RDs morbidity while the CVDs morbidity risk was relatively higher in males in age groups above 30 years.

Quantitative microbial risk assessment of acute gastrointestinal illness attributable to freshwater recreation in Ontario.

The burden of disease associated with acute gastrointestinal illness (AGI) in Canada is estimated to be ~ 20 million cases/year. One known risk factor for developing AGI is recreation in freshwater bodies such as lakes. The proportion of cases attributable to freshwater recreation in Canada, however, is currently unknown. The study objective was to estimate the risk of developing AGI from exposure to Giardia, Cryptosporidium, Campylobacter, Escherichia coli O157:H7, norovirus, and Salmonella during freshwater recreation in Ontario, Canada. A quantitative microbial risk assessment (QMRA) was conducted to estimate the number of AGI cases per 1000 recreational events associated with freshwater recreation. QMRA utilizes four steps: hazard identification, exposure assessment, dose-response modelling, and risk characterization. A probabilistic model was developed using the following inputs accounting for uncertainty and variability: published data on pathogen prevalence and concentration in freshwaters in Ontario (hazard identification), recreator water ingestion volumes (exposure), pathogen-specific dose-response models, and ratios between numbers of infections and symptomatic disease cases to estimate illness risks (risk characterization). The mean estimated AGI risk associated with recreation ranged from 0.8 to 36.7 cases per 1000 swimmers (5th-95th probability interval: 0-226.3 cases/1000) which is in line with previous studies conducted in Lake Ontario, as well as prior QMRAs of freshwater recreation. Upper range predicted values exceeded the Health Canada guideline of less than 20 cases per 1000 recreators. This study shows that QMRA can be used to estimate disease risk in the absence of large-scale epidemiological studies. The results demonstrate a range of risk that is in line with exposure to pristine (low risk estimates) and more contaminated waters (high risk estimates) and capture the potential risk to vulnerable populations.

Association between periodontal disease and systemic diseases: a cross-sectional analysis of current evidence

BackgroundNumerous systematic reviews and meta-analyses have been published that evaluate the association between periodontal disease and systemic diseases, many of which address similar topics. Moreover, their quality requires assessment. Therefore, we performed a cross-sectional analysis to examine the evidence on the relationship between periodontal disease and systemic diseases.MethodsThe PubMed, Embase, Web of Science, and the Cochrane Library databases were systematically searched to identify relevant systematic reviews and meta-analyses. Only studies that considered periodontal disease as the exposure factor and various systemic diseases as the outcome were included. The basic characteristics and pertinent data from the selected studies were extracted. The modified version of A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) was employed for quality assessment, while R software was used for statistical analysis.ResultsAmong the 212 relevant systematic reviews and meta-analyses, 57 were finally included in our analysis. These studies involved 75 diseases and 81 disease-related outcomes, with cancer (19/81) being the most frequently addressed topic. Of the 81 outcomes, 67 demonstrated a significant association. Notably, the highest risk estimate was found for head and neck cancer [odds ratio (OR) = 3.17, 95% confidence interval (CI) 1.78 − 5.64], while the lowest was observed for premature rupture of the amniotic sac [relative risk (RR) = 1.10, 95% CI 1.08 − 1.12]. The methodological quality ratings indicated that approximately 71.93% of included studies were classified as “Critically low”, with another 17.54% rated as “Low”, and only about 10.53% categorized as “Moderate”.ConclusionsPeriodontal disease significantly elevates the risks associated with 15 cancer-related, 8 cardiovascular-related, 8 metabolic-related, and 5 neurological-related outcomes. However, the overall methodological quality of existing systematic reviews and meta-analyses is generally suboptimal and requires enhancement to generate higher-quality evidence in the future.

Long-term Associations Between Time-varying Exposure to Ambient PM 2.5 and Mortality: An Analysis of the UK Biobank.

Evidence for long-term mortality risks of PM 2.5 comes mostly from large administrative studies with incomplete individual information and limited exposure definitions. Here we assess PM 2.5 -mortality associations in the UK Biobank cohort using detailed information on confounders and exposure. We reconstructed detailed exposure histories for 498,090 subjects by linking residential data with high-resolution PM 2.5 concentrations from spatiotemporal machine-learning models. We split the time-to-event data and assigned yearly exposures over a lag window of 8 years. We fitted Cox proportional hazard models with time-varying exposure controlling for contextual- and individual-level factors, as well as trends. In secondary analyses, we inspected the lag structure using distributed lag models and compared results with alternative exposure sources and definitions. In fully adjusted models, an increase of 10 μg/m³ in PM 2.5 was associated with hazard ratios of 1.27 (95% confidence interval: 1.06, 1.53) for all-cause, 1.24 (1.03, 1.50) for nonaccidental, 2.07 (1.04, 4.10) for respiratory, and 1.66 (0.86, 3.19) for lung cancer mortality. We found no evidence of association with cardiovascular deaths (hazard ratio = 0.88, 95% confidence interval: 0.59, 1.31). We identified strong confounding by both contextual- and individual-level lifestyle factors. The distributed lag analysis suggested differences in relevant exposure windows across mortality causes. Using more informative exposure summaries and sources resulted in higher risk estimates. We found associations of long-term PM 2.5 exposure with all-cause, nonaccidental, respiratory, and lung cancer mortality, but not with cardiovascular mortality. This study benefits from finely reconstructed time-varying exposures and extensive control for confounding, further supporting a plausible causal link between long-term PM 2.5 and mortality.

Fall-risk assessment in elderly pilgrims attending large religious congregation: A cross-sectional cohort study

BackgroundFalls are an important geriatric syndrome with tremendous economic burden. The aim of this study was to find the prevalence of fall risk as assessed by digital sensor–based quantitative timed up and go (QTUG) device in elderly pilgrims attending Mahakumbh festival 2019. MethodsAn observational cross-sectional study done in elderly pilgrims attending the Kumbh Festival 2019. Combined fall risk and frailty assessment was estimated objectively using a digital sensor–based QTUG device. Details of age, body mass index (BMI), co-morbidities, and history of falls were also recorded. The association of fall and frailty assessment with gender, age, BMI, co-morbidities, and timed up and go (TUG) time was noted. ResultsIn total, 370 elderly (aged >60 years) individuals were assessed. The mean age was 65.51 ± 5.22 years. The mean BMI was 25.17 ± 4.56 kg/m2. Previous falls history was seen in 40.12%. The mean combined fall risk and combined frailty risk was 51.79 ± 18.11% and 50.12 ± 18.55%, respectively. The mean TUG time was 16.16 ± 7.46 seconds. Age, female gender, and TUG time had significantly increased combined fall-risk percentage and combined frailty estimate (p: <0.0006, <0.0001, and <0.0001, respectively) and combined frailty percentage (p < 0.0001). BMI and age also had a significant correlation with combined frailty risk (p = 0.0018). ConclusionMore than 50% of elderly Indians at Kumbh 2019 had a high combined fall risk and frailty estimate. The mean TUG time of elderly in our study was 16.16 seconds. There was a strong association between increased fall risk and female gender, age, and TUG time.

Development, assessment and validation of a novel prediction nomogram model for risk identification of tracheobronchial tuberculosis in patients with pulmonary tuberculosis

ObjectiveTracheobronchial tuberculosis (TBTB), a specific subtype of pulmonary tuberculosis (PTB), can lead to bronchial stenosis or bronchial occlusion if not identified early. However, there is currently no available means for...

Assessment of levels and health risk of Potentially Toxic Elements (PTEs) in selected sachet water packaged from groundwater resources in Ogun State, Nigeria

BackgroundSachet water is a source of affordable drinking water for low-income socioeconomic class. However, contamination by potentially toxic elements (PTEs) could pose severe adverse health risk to consumers. ObjectiveThe present study aimed at assessing the levels and health risk of PTEs in selected sachet water samples packaged from groundwater resources in Ogun State, Nigeria. MethodsA total of 140 bags of selected sachet water brands were purchased and analysed for eleven PTEs (some of which are rarely reported in Nigeria) using inductively coupled plasma - optical emission spectrophotometer. Recovery experiment was conducted to validate the performance of the used analytical instrument. Blank samples were also run to cancel the matrix effect of the analysing reagents, and to calculate the limit of detection. PTE data were evaluated for simple descriptive and inferential statistics using SPSS for Windows. Health risk assessment was conducted for hazard quotient (HQ), hazard index (HI) and cancer risk (CR). ResultsChromium (Cr) was the highest observed PTE in sachet water from Asero (707±1102 µg L−1), Isolu (363±374 µg L−1) and Makun-Shagamu (359±204 µg L−1) sites. The concentrations of Cr were higher than the permissible limit of the World Health Organization in 63% of the sachet water samples. Furthermore, the average contents of lead (Pb) and thallium (Tl) were observed at higher concentrations than the acceptable limits. The HQs exceeding the permissible threshold of 1.0 were observed for silver (Ag), aluminium (Al), arsenic (As), cadmium (Cd), Cr and Tl in 29% of the sachet water consumed by adults and children; indicating adverse health effects. The CRs of Cd and Cr at all the sampling locations, and As at few sites were higher than the acceptable limit of 1 × 10−4; suggesting possible development of cancer by the consumers. ConclusionThe high levels and health risk estimates of PTEs in the sachet water samples suggested unsafe for consumption. Periodic monitoring of PTEs in sachet water from the study area is recommended.

Increased risk of periodontitis in patients with rheumatoid arthritis: A nationwide register study in Norway.

To investigate the risk of periodontitis in rheumatoid arthritis (RA) patients in a nationwide register-based study. Patients and controls were defined using ICD-10 codes registered in the Norwegian Patient Registry (NPR), from 2011 to 2017. The 324,232 included subjects had at least one registered diagnostic code for RA (33,040 patients) or diagnostic codes for non-osteoporotic fractures or hip or knee replacement due to osteoarthritis (controls). The outcome was periodontitis, defined by codes for periodontal treatment from the Norwegian Control and Payment of Health Reimbursements Database (KUHR). Hazard ratios (HRs) were calculated for periodontitis in RA patients compared to controls. Generalized additive model in Cox regressions was estimated to visualize periodontitis occurrences as a function of number of RA visits. The risk of periodontitis increased with increasing number of RA visits. RA patients having 10 or more visits during the 7-year period had a 50% increased risk of periodontitis compared to controls (HR = 1.48, 95% confidence interval [CI]: 1.39-1.59); also, in patients with assumed new RA, an even higher risk estimate was seen (HR = 1.82, 95% CI: 1.53-2.17). In this register-based study in which periodontal treatment was used as a surrogate marker for periodontitis, we found an increased risk of periodontitis in RA patients, particularly those with active disease and new RA.

Long-Term Risk of Subsequent Malignant Neoplasms Among Childhood and Adolescent Lymphoma Survivors (1975-2013): A Population-Based Predictive Nomogram.

Studies are needed to assess risk factors pertinent to the incidence of secondary malignancies among childhood and adolescent lymphoma survivors. We aimed to identify risk factors pertinent to the incidence of secondary malignancies and subsequently establish a clinically practical predictive nomogram. A total of 5561 patients who were diagnosed with primary lymphoma below the age of 20 years between 1975 and 2013 and survived for at least 5 years were identified. Standardized incidence ratio (SIR) and excess risk (ER) analysis were performed by sex, age, and year when primary lymphoma was diagnosed, sites and types of primary lymphoma, and therapy strategies. Univariable and multivariable logistic regression were used to identify independent risk factors for adolescent and childhood lymphoma-related secondary malignancies. Based on 5 factors (age, time from lymphoma diagnosis, gender, lymphoma type, and therapy), a nomogram for predicting the risk of a secondary malignancy for patients with childhood and adolescent primary lymphoma was established. Among 5561 lymphoma survivors, 424 developed a secondary malignancy. Females (SIR = 5.34, 95% CI, 4.73-5.99; ER = 50.58) exhibited a higher SIR and ER than males (SIR = 3.28, 95% CI, 2.76-3.87; ER = 15.53). Blacks were at a higher risk than Caucasians or others. Nodular lymphocyte-predominant Hodgkin lymphoma survivors exhibited typically high SIR (13.13, 95% CI, 6-24.92) and ER (54.79) among all lymphoma classifications. Lymphoma survivors who underwent radiotherapy, whether they received chemotherapy or not, had typically higher SIR and ER. Among all types of secondary malignancies, "bone and joint neoplasms" (SIR = 11.07, 95% CI, 5.52-19.81) and "soft tissue neoplasms" (SIR = 12.27, 95% CI, 7.59-18.76) presented significantly high SIR whereas "breast cancer" and "endocrine cancer" associated with higher ER. The median diagnosis age of secondary malignancies was 36 years old, and the median time interval between the diagnosis of two malignancies was 23 years. A nomogram was constructed to predict the risk of secondary malignancies in patients diagnosed with primary lymphoma before 20 years of age. After internal validation, the AUC and C-index of the nomogram are 0.804 and 0.804, respectively. The established nomogram provides a convenient and reliable tool for predicting the risk of a secondary malignancy among childhood and adolescent lymphoma survivors, concluding significant concern for lymphoma survivors with high-risk estimates.

The Changing Face of Multiple Endocrine Neoplasia 2A: From Symptom-Based to Preventative Medicine.

Early genetic association studies yielded too high risk estimates for multiple endocrine neoplasia (MEN2A), suggesting a need for extended surgery. The objective was to delineate temporal changes in MEN2A presentation by birth cohort analyses. Birth cohort analyses (10-year increments; ≤1950 to 2011-2020) of carriers of rearranged during transfection (RET) mutations who underwent surgery for MEN2A. Included in this study were 604 carriers (155 index, 445 nonindex, 4 additional patients), with 237 carriers harboring high-risk mutations, 165 carriers moderate-high risk mutations, and 202 carriers low-moderate risk mutations. With increasing recency of birth cohorts, there was a continual decline in index patients from 41-74% to 0% (P < .001) and of medullary thyroid cancer (MTC) from 96-100% to 0-33% (P < .001). Node metastases diminished from 62-70% to 0% (P ≤ .001; high and low-moderate risk mutations), whereas biochemical cure after thyroidectomy surged from 17-33% to 100% (P ≤ .019; high and low-moderate mutations). Surgical interventions for MEN2A-related tumors were performed increasingly earlier, causing median carrier age to fall: from 51-63 to 3-5 years at thyroidectomy (P < .001); from 46-51 to 24-25 years at first adrenalectomy (P ≤ .013; high and moderate-high risk mutations); and from 43.5-66 to 16.5-32 years at parathyroidectomy. MTC diameters were more effectively decreased from 14-32 to 1-4 mm (P ≤ 002) than pheochromocytoma diameters (nonsignificant). These insights into MEN2A presentation, adjusted by birth year, illustrate the shift from reactive to preventative medicine, enabling less extensive risk-reducing surgery.

Impact of an Expanded Definition of Family History on Outcomes of Active Surveillance for Prostate Cancer.

Despite family history being an established risk factor for prostate cancer, the role of a broader definition of family history inclusive of not just prostate cancer but other genetically related malignancies has not been investigated in the active surveillance population. Here, we evaluate the impact of an expanded definition of family history on active surveillance outcomes. Patients undergoing active surveillance for prostate cancer at Massachusetts General Hospital from 1997-2019 with detailed data available on family cancer history were identified. Primary outcome was biopsy progression-free survival, and secondary outcomes were treatment-free survival, adverse pathological features at prostatectomy, and biochemical recurrence after treatment. Statistical analyses were conducted using the Kaplan-Meier method and Cox regression. Among 855 evaluable patients, 300 (35.1%) patients had any family history of prostate cancer, and 95 (11.1%) had a family history of related malignancies suggestive of a hereditary cancer syndrome. Family history of prostate cancer alone was not associated with biopsy progression, whereas family history suggestive of a hereditary cancer syndrome was associated with a significantly increased risk of biopsy progression (HR 1.43, 95%CI 1.01-2.02), independent of other known clinicopathological risk factors in multivariable analysis. Similarly, family history suggestive of a hereditary cancer syndrome was associated with significantly lower treatment-free survival (HR 1.58, 95%CI 1.14-2.18) in multivariable analysis. No significant association was found between family history and adverse features on surgical pathology or biochemical recurrence. An expanded family history suggestive of a hereditary cancer syndrome is an independent predictor of biopsy progression during active surveillance. Men with such a family history may still be offered active surveillance but should be counseled regarding the higher risk of disease progression.

Transportation Noise and Risk of Tinnitus: A Nationwide Cohort Study from Denmark.

There is a growing body of evidence linking residential exposure to transportation noise with several nonauditory health outcomes. However, auditory outcomes, such as tinnitus, are virtually unexplored. We aimed to investigate the association between residential transportation noise and risk of incident tinnitus. We conducted a nationwide cohort study including all residents in Denmark age , of whom 40,692 were diagnosed with tinnitus. We modeled road traffic and railway noise at the most () and least () exposed façades of all Danish addresses from 1990 until 2017. For all participants, we calculated 1-, 5-, and 10-y time-weighted mean noise exposure and retrieved detailed information on individual- and area-level socioeconomic covariates. We conducted analyses using Cox proportional hazards models. We found positive associations between exposure to road traffic noise and risk of tinnitus, with hazard ratios of 1.06 [95% confidence interval (CI): 1.04, 1.08] and 1.02 (95% CI: 1.01, 1.03) per 10-dB increase in 10-y and , respectively. Highest risk estimates were found for women, people without a hearing loss, people with high education and income, and people who had never been in a blue-collar job. The association with road followed a positive, monotonic exposure-response relationship. We found no association between railway noise and tinnitus. To our knowledge, this is the first study to show that residential exposure to road traffic noise may increase risk of tinnitus, suggesting noise may negatively affect the auditory system. If confirmed, this finding adds to the growing evidence of road traffic noise as a harmful pollutant with a substantial health burden. https://doi.org/10.1289/EHP11248.

Mathematical Modification to the Classical Volumetric Method for Estimating Oil Reserves

Using fuzzy logic technique, this work proposes a mathematical adjustment to the classical volumetric method for estimating oil reserves to manage the level of uncertainty associated with oil reserves estimation. This technique introduces a risk factor (α) into the volumetric method equation to account for the uncertainty associated with estimating the parameters that are used in the volumetric method equation. Risk types that may affect oil reserves estimation can be considered using the risk factor (α) in the modified equation. Results showed that the amount of proven oil reserves decreases exponentially as the value of risk factor (α) increases. It also showed that the ratio of the expected proven oil reserves with respect to proven oil reserves (N*/N) goes to zero when the value of risk factor (α) reaches a value of (5). Three cases were proposed to categorize uncertainty in proven oil reserves estimation: high risk estimate, middle risk estimate and risk-free estimate. Results showed that, for the case of high-risk estimate, expected proven oil reserves (N*) was appreciably lower than the proven oil reserves (N) due to the inclusion of risk. Sources of risk may include, but not limited to, lack of expertise of the evaluator, level of integrity of the evaluator, engineering errors during measurement and calculation and governmental laws. Results also showed that the calculated amount of proven oil reserves (N*), for the middle risk estimate case, is much higher than that for high risk estimate case. As for the riskfree estimate case, the calculated proven oil reserves (N*) using the modified formula equals to the proven oil reserves (N) calculated by the classical volumetric formula. This case reflects 100% confidence and reliability in the parameters’ estimation which also places great trust in the evaluator’s integrity and expertise.

Approaches to mixture risk assessment of PFASs in the European population based on human hazard and biomonitoring data.

Per- and polyfluoroalkyl substances (PFASs) are a highly persistent, mobile, and bioaccumulative class of chemicals, of which emissions into the environment result in long-lasting contamination with high probability for causing adverse effects to human health and the environment. Within the European Biomonitoring Initiative HBM4EU, samples and data were collected in a harmonized way from human biomonitoring (HBM) studies in Europe to derive current exposure data across a geographic spread. We performed mixture risk assessments based on recent internal exposure data of PFASs in European teenagers generated in the HBM4EU Aligned Studies (dataset with N=1957, sampling years 2014-2021). Mixture risk assessments were performed based on three hazard-based approaches: the Hazard Index (HI) approach, the sum value approach as used by the European Food Safety Authority (EFSA) and the Relative Potency Factor (RPF) approach. The HI approach resulted in the highest risk estimates, followed by the RPF approach and the sum value approach. The assessments indicate that PFAS exposure may result in a health risk in a considerable fraction of individuals in the HBM4EU teenager study sample, thereby confirming the conclusion drawn in the recent EFSA scientific opinion. This study underlines that HBM data are of added value in assessing the health risks of aggregate and cumulative exposure to PFASs, as such data are able to reflect exposure from different sources and via different routes.

Association of Celiac Disease and Inflammatory Bowel Disease: A Nationwide Register-Based Cohort Study

To determine the risk of inflammatory bowel disease (IBD) in patients with celiac disease (CeD) (and vice versa ) compared with general-population comparators. Using Swedish histopathology and healthcare register data, we identified 48,551 patients with CeD and 83,529 with IBD diagnosed in 1969-2016. Each patient was compared with age- and sex-matched general-population comparators (CeD: n = 240,136; IBD: n = 408,195). Cox regression estimated hazard ratios (HRs) for IBD in patients with CeD and vice versa . Our main analyses were limited to events beyond the first year of follow-up to reduce potential surveillance bias. During follow-up, 784 (1.6%) patients with CeD were diagnosed with IBD compared with 1,015 (0.4%) matched comparators. In patients with CeD, the HR for IBD was 3.91 (95% confidence interval [CI] 3.56-4.31), with largely similar HRs for Crohn's disease (4.36; 3.72-5.11) and ulcerative colitis (3.40; 3.00-3.85). During follow-up, 644 (0.8%) patients with IBD and 597 (0.1%) comparators were diagnosed with CeD. The HR for CeD in patients with IBD was 5.49 (95% CI 4.90-6.16), with the highest risk estimates seen in ulcerative colitis (HR = 6.99; 6.07-8.05), and the HR for Crohn's disease was 3.31 (2.69-4.06). In patients with CeD and IBD, the diagnostic interval was usually &lt;1 year; however, HRs of 3-4 were seen even after 10 years of follow-up. During 20 years of follow-up, 2.5% of patients with CeD developed incident IBD, and 1.3% of patients with IBD developed CeD. The bidirectional association between CeD diagnosis and IBD warrants attention in the initial assessment and follow-up of these conditions. Their co-occurrence, independent of temporal sequence, suggests shared etiology.

Does receiving high or low breast cancer risk estimates produce a reduction in subsequent breast cancer screening attendance? Cohort study

Risk-stratified breast cancer screening may improve the balance of screening benefits to harms.We assess a potential new harm: reduced screening attendance in women receiving below average-risk (false reassurance) or higher-risk results (screening avoidance). Following initial screening, 26,668 women in the PROCAS study received breast cancer risk estimates, with attendance recorded for two subsequent screening rounds. First-screen attendance was slightly reduced in below-average (85.6%) but not higher-risk women, compared to other women (86.4%). Second-screen attendance increased for women at higher-risk (89.2%) but not below-average, compared to other women (78.8%). Concerns about this potential harm of risk-stratified screening therefore appear unfounded.

DXA FRAX® May Differ Significantly and Substantially To Web FRAX®

Osteoporosis and the associated fractures are a major global health burden for patients, their social network and societies. Access to quality risk assessment, diagnosis and treatment is heterogeneous and inadequate around the globe. Many algorithms have been developed for deciding who to test, assessing fracture risk, when to intervene, and how to monitor the effects of interventions. FRAX® has become the dominant fracture risk assessment tool worldwide which estimates the average 10 year risk of major osteoporotic fracture risk and hip fracture, and is recommended by our global partners: ISCD and IOF. A particular attraction of the FRAX® algorithm is that on-line calculations can be made with or without DXA testing, which is particularly attractive when access to DXA is limited or non-existent. In our centre public waiting times for non-urgent DXA are up to 10 years, so reducing unnecessary testing is a laudable and overarching service goal. A recent Japanese study comparing 4 FRAX calculation tools suggested little difference exists. However in our unit we have noticed at times very different results when using the Ireland embedded DXA-FRAX® tool to the Web-FRAX® Ireland tool. 1) To Compare DXA-FRAX® to Web-FRAX® 10-year estimates for MOF and HF. 2) To Compare Web-FRAX® 10-year estimates for MOF and HF with and without DXA-measured T-scores. We used a sub-group of the DXA-HIP Cohort as previously published to gain initial insights into DXA-FRAX® to Web-FRAX® as part of a larger calibration and validation project, which has been approved by our hospitals Ethics and Research Committee. All scans are performed and reported by staff trained to ISCD standards and recommendations. At the time of reporting DXA-FRAX® scores are calculated as part of the analysis as recommended by ISCD and IOF, and more recently Web-FRAX® for Ireland has been calculated and stored with and without BMD data. All data are cleaned, merged, anonymized and stored for analysis. Summary cross-sectional data, and comparison of differences were completed using absolute and relative scales, and Bland-Altman Plots for agreement between measures. Weights were reduced to 125kg for the on-line tool and age to 90 years when values exceeded these thresholds. Data on 588 adults aged ≥40 years were available of whom 108 (18%) were men. Mean age was 67 years, BMI: 28kg/m2, 249 had a prior fracture, 64 a parental hip fracture, 40 smokers, 42 taking glucocorticoid therapy, 39 had rheumatoid arthritis, 5 were excess alcohol users while 107 had other FRAX®-listed secondary causes of osteoporosis. Mean WF femoral neck BMD T-score was -1.4. Mean MOF DXA-FRAX® was 15.3 (SD:11.1) compared to 12.6 (SD:8.5) for Web-FRAX®, while HF means were 6.7 (SD:8.4) Vs 3.8 (SD:5.5) respectively. Bland-Altman plots showed there was much greater discrepancy for men, and those with higher risk estimates. Comparisons between DXA-FRAX® and Web-FRAX® revealed similar results. Significant differences exist in results of DXA-FRAX® and Web-FRAX® for Ireland, particularly for men and those with higher risk estimates so these results should be interpreted cautiously. Reassuringly results were similar for those deemed at lower risk and for women.

The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps.

Objective: to identify spatial clusters corresponding to abandonment of routine vaccines in children.Method: an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator.Results: the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively.Conclusion: in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.

Using MapMCDA Tool for the Spatial Epidemiology of Animal Rabies in Morocco: How to Improve the Rationality of a Qualitative Risk Assessment

Objective The objective behind this article is to better characterize spatial distribution of animal rabies in Morocco through qualitative risk assessment framework. In Morocco, the occurrence of the disease is neither clearly distributed nor complete. Therefore, risk assessment methods become strongly recommended to cope with distorted geographic patterns. Methods Based on data collection set from 168 counties, qualitative changes on spatial epidemiology of rabies were analysed by mapMCDA tool covering a period from 2004 to 2017 and including information on determinants of the geographic distribution of animal rabies in Morocco defined in previous work. Results To validate the risk assessment model, the results were compared to rabies cases reported during the study period. The clustering of the rabies risk estimates is decisive and highly reliable. A significant alignment was shown between the very high and high-risk estimates. Conclusion This study is the first attempt that has been made for using MapMCDA for rabies. For a normative process aiming to avoid subjectivity related to expert-opinions, authors suggest conducting initially a statistical multiple component analysis that will provide quantified estimates of risk factors. It would be an advisable decision-making tool that helps to design oriented surveillance and allows better referral of actions to control the disease.

Comparison of traditional versus artificial intelligence based coronary artery disease risk prediction scores in young patients with acute coronary syndrome

Abstract Background Ever since the concept of preventive cardiology has come into vogue, several risk identification models have come up which combine several risk factors to create a risk prediction score for occurrence of cardiovascular (CV) event. While carrying a proven validation in Western population, none of the risk prediction model has been satisfactorily evaluated in Indians especially young &amp;lt;40 years old. Objectives To compare Artificial Intelligence based novel risk score with traditional risk scores in young (less than 40 years age) patients presenting with acute coronary syndrome (ACS) and to estimate the relative efficacy of different coronary artery disease (CAD) risk scores in young Indian Patients. Design Single center, Observational, Non-interventional study. Participants Cohort of Patients more than 20 but less than 40 years old with ACS in the department of Cardiology from 1st January 2019 to 31st October 2019. Methods 314 young patients [mean age 36.14±4.17 years] presenting with acute coronary syndrome (ACS) were enrolled. The three clinically most pertinent risk assessment models [Framingham Risk score (FRS), World Health Organization risk prediction charts (WHO/ISH), and QRISK3 scores] and Artificial Intelligence based novel risk score (AICVD) were applied on day 1 of presentation, and tried to see whether one risk score versus other risk score could have predicted the event earlier had we applied it before the occurrence of ACS. Risk factors considered included those already in traditional scoring systems and new risk factors (diet, alcohol, tobacco, dyslipidemia, physical activity, family history of heart disease, history of heart disease, heart rate, respiratory rate, chronic heart symptoms and psychological stress). Results WHO/ISH provided the lowest high risk estimate with only 1 (0.9%) patient estimated to be having &amp;gt;20% 10-year risk. The FRS estimated high risk (&amp;gt;20% 10-year risk) in 3 (1%) patients. The QRISK3 estimated high risk (&amp;gt;10% 10-year risk) in 20 (6.5%) patient. In comparison, AICVD risk prediction model stood tall by identifying 73 (23.2%) patients as high risk and 62.74% patients as more than moderate risk for having CV events at 7 years (p&amp;lt;0.001). Conclusion Perhaps, this is the first study which has compared artificial intelligence based novel risk prediction model with the three most commonly applied models, in the young Indian patients. We found that a cohort of young Indian patients presenting with ACS, when studied retrospectively, was identified as “high risk” most likely by AICVD risk prediction model rather than the traditional counterparts. The WHO/ISH risk prediction charts and FRS were the poorest predictors. Performance of QRISK3 score also remained less than satisfactory. These findings suggested that AICVD risk prediction model is a promising tool to assess for CV risk in Indian population. Funding Acknowledgement Type of funding sources: None. Predictability of risk prediction models