Higher Relative Risk Research Articles

Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany.

Contact tracing was implemented in many countries during the COVID-19 pandemic to prevent disease spread, reduce mortality, and avoid overburdening health care systems. In several countries, including Germany, new systems were needed to trace potentially infected individuals. Using data collected in the Rhine-Neckar and Heidelberg (RNK/HD) districts in southwest Germany (population: 706,974), this study examines the overall effectiveness and efficiency of contact tracing in different age groups and stages of the pandemic. From January 27, 2020, to April 30, 2022, the RNK/HD Health Authority collected data on COVID-19 infections, quarantines, and deaths. Data on infection, quarantine, and death was grouped by age (young: 0-19 years; adult: 20-65 years; and senior citizens: >65 years) and pandemic phase (infectious wave plus subsequent lull periods) and analyzed for proportion, risk, and relative risk (RR). The overall effectiveness and efficiency of contact tracing were determined by calculating quarantine sensitivity (proportion of the infected population captured in quarantine), positive predictive value (PPV; proportion of the quarantined population that was infected), and the weighted Fβ-score (combined predictive performance). Of 706,974 persons living in RNK/HD during the study period, 192,175 (27.2%) tested positive for SARS-CoV-2, 74,810 (10.4%) were quarantined, and 932 (0.132%) died following infection. Compared with adults, the RR of infection was lower among senior citizens (0.401, 95% CI 0.395-0.407) and while initially lower for young people, was ultimately higher for young people across all 5 phases (first-phase RR 0.502, 95% CI 0.438-0.575; all phases RR 1.35, 95% CI 1.34-1.36). Of 932 COVID-19-associated deaths during the study period, 852 were senior citizens (91.4%), with no deaths reported among young people. Relative to adults, senior citizens had the lowest risk of quarantine (RR 0.436, 95% CI 0.424-0.448), while young people had the highest RR (2.94, 95% CI 2.90-2.98). The predictive performance of contact tracing was highest during the second and third phases of the pandemic (Fβ-score=0.272 and 0.338, respectively). In the second phase of the pandemic, 5810 of 16,814 COVID-19 infections were captured within a total quarantine population of 39,687 (sensitivity 34.6%; PPV 14.6%). In the third phase of the pandemic, 3492 of 8803 infections were captured within a total quarantine population of 16,462 (sensitivity 39.7%; PPV 21.2%). The use of quarantine aligned with increasing risks of COVID-19 infection and death. High levels of quarantine sensitivity before the introduction of the vaccine show how contact tracing systems became increasingly effective at capturing and quarantining the infected population. High levels of PPV and Fβ-scores indicate, moreover, that contact tracing became more efficient at identifying infected individuals. Additional analysis of transmission pathways is needed to evaluate the application of quarantine in relation to infection and death risks within specific age groups.

Application of spatiotemporal scan statistics in cases of intentional homicides in northern Brazil

The crime of intentional homicide in Brazil is worrying. In the northern region, this type of crime has been growing since 2020. In this sense, we decided to apply Kuldorff's prospective space-time scan statistics in order to identify emerging counties. We conclude that there are two emerging clusters of high relative risk (Amazonas and Pará) that require rapid intervention and two clusters of low relative risk (Acre, Roraima, Amazonas, Amapá and Pará) that do not require urgent intervention. Some characteristics of these two clusters are presented: radius, population, relative risk, likelihood ratio.

Detecting spatial clusters of human scabies in Tigray, Ethiopia from 2018 to 2023

BackgroundScabies is one of public health concerns among communicable disease in Ethiopia, especially among disadvantaged and the poor. This current study aims to detect the spatiotemporal patterns of scabies in Tigray from 2018 to 2023 using scabies data aggregated at the zonal level. The study also examined the persistent patterns in the spatial variation of scabies incidence across the administrative regions during the study period.MethodWe collected scabies data using a weekly disease surveillance reporting format of the country from 2018 to 2023 across all accessible district health facilities in Tigray region, Ethiopia. We conducted retrospective analyses using both purely spatial and spatiotemporal scan statistic approaches, employing a discrete Poisson probability model to identify statistically significant clusters of high scabies rates throughout the Tigray regional zones in Ethiopia. Our methodology involved the use of Kulldorff’s spatial scan statistic software (SaTScan v10.1.3), R programming software version 4.3.1, and ArcGIS Pro for all analyses.ResultsA total of 101,116 cases of scabies were reported from 2018 to 2023. Our study indicated a spatial heterogeneity in the pattern of scabies across Tigray region as well as its localization among geographically contiguous zones across space, except for the Western zone of Tigray where no data was collected. The detected statistically significant spatial clusters \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:p-value<0.05$$\\end{document} persisted mainly in the Central, Eastern and Northwestern zones of Tigray over the six years of the study period. The highest relative risk (RR) was recorded in year 2021 (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:RR=8.49,\\:LLR=6860.34,p-value=0.01)$$\\end{document}. The central zone had the major clusters of scabies at district level from 2018 to 2023. The heterogeneous distribution of scabies across Tigray could be due to the spatial variations in the determinants of scabies (such as socioeconomic status, demographics, and material deprivation) across the region.ConclusionAn enormous burden of scabies was reported over a period of six years. The present study found localized clusters of high scabies rates at district and zonal levels in Tigray, Ethiopia, possibly due to differences in various determinants of scabies such as access to WASH services. The findings could help the government and health authorities to develop and implement scabies control strategies in Tigray, with a focus on high-risk districts and zones to ensure optimal resource allocation.

Semaglutide effects on safety and cardiovascular outcomes in patients with overweight or obesity: a systematic review and meta-analysis.

Semaglutide is a GLP-1 receptor agonist that provides a reduction in glycated hemoglobin and weight. The objective was to evaluate whether the use of semaglutide, in individuals with overweight or obesity, reduces cardiovascular outcomes and adverse effects (AE). The data bases Pubmed, Lilacs, Scielo, Scopus, Web of Science and Cochrane Library were surveyed. Initially, 3333 articles were found, of which 19 articles were included. An additional search included 19 studies, totaling 38 articles. Relative risk (RR) values were significant for hospitalization due to heart failure (HF) 0.24 95% CI 0.12-0.57 (n = 2; 1045 participants; I² = 0.18), death due to cardiovascular causes 0.83 95% CI 0.71-0.98 (n = 3; 24 084 participants; I² = 0.21), death from any cause 0.79 95% CI 0.70-0.89 (n = 3; 24 084 participants; I² = 0.07), coronary revascularization 0.76 95% CI 0.69-0.85 (n = 2;20 951 participants; I² = 0.41), and non-fatal myocardial infarction 0.76 95%CI 0.66-0.88 (n = 3; 24 084 participants; I² = 0.21), with a difference between the subgroups (p = 0.05), favoring the subcutaneous administration route. The RR of stroke was 0.65 95% CI 0.44-0.97 for patients with diabetes (n = 2; 6480 participants; I² = 0.66). There was no difference between the frequency of constipation and routes of administration, as well as between doses of oral semaglutide. The RR of adverse effects was only not significant for discontinuation of treatment for oral semaglutide. The use of semaglutide reduced 76% in hospitalization due to HF, 17% deaths due to cardiovascular causes, 21% deaths due to any cause, 24% non-fatal myocardial infarction, 24% coronary revascularization and 35% stroke (in patients with diabetes). The use of semaglutide was associated with a higher relative risk and frequency of most adverse effects evaluated.

Risk, Attributable Fraction and Attributable Number of Cause-Specific Heat-Related Emergency Hospital Admissions in Switzerland.

We assessed the relationship between heat and emergency hospital admissions (EHAs) in Switzerland using clinically relevant metrics. Applying distributed lag non-linear models, we investigated temperature-admission associations between May and September 1998-2019 for various disease groups, by age class and gender. We estimated the relative risk (RR) for moderate (29°C) and extreme (34°C) daily maximum temperatures relative to disease-specific optimum temperature, and calculated attributable fractions (AFs) for hot days and the following week. We also calculated the total number of heat-related EHAs. We attributed 31,387 (95% confidence interval: 21,567-40,408) EHAs to above-optimal temperatures, 1.1% (0.7%-1.4%) of the total. Extreme temperatures increased the EHA risk for mental, infectious and neurological diseases. We observed particularly high AFs due to extreme heat for dehydration (85.9%, 95% CI: 82.4%-88.8%) and acute kidney injury (AKI, 56.1%, 95% CI: 45.3%-64.7%). While EHA risk generally increased with age, we also found high RRs for infectious diseases in children (0-15years) and AKI in young adults (15-64years). Hot weather increases the EHA risk in Switzerland. Therefore a comprehensive clinical and public health response is needed.

Space-time dynamics of the dengue epidemic in Brazil, 2024: an insight for decision making

BackgroundDengue is a vector-borne viral infection caused by the dengue virus transmitted to humans primarily by Aedes aegypti. The year 2024 has been a historic year for dengue in Brazil, with the highest number of probable cases ever registered. Herein, we analyze the temporal trend and spatio-temporal dynamics of dengue cases in Brazil during the first nine epidemiological weeks (EW) of 2024.MethodsThis is an ecological study, including all probable cases of dengue in Brazil during the period, carried out in two steps: time series analysis to assess the temporal trend and spatial analysis to identify high-risk clusters.Results1,345,801 probable cases of dengue were reported. The regions with the highest increasing trend were the Northeast with an average epidemiologic week percent change (AEPC) of 52.4 (95% CI: 45.5–59.7; p < 0.001) and the South with 35.9 (95% CI: 27.7–44.5; p < 0.001). There was a statistically significant increasing trend in all states, except Acre (AEPC = -4.1; 95% CI: -16.3–10; p = 0.55), Amapá (AEPC = 1.3; 95% CI: -16.2–22.3; p = 0.9) and Espírito Santo (AEPC = 8.9; 95% CI: -15.7–40.6; p = 0.5). The retrospective space-time analysis showed a cluster within the Northeast, Central-West and Southeast regions, with a radius of 515.3 km, in which 1,267 municipalities and 525,324 of the cases were concentrated (RR = 6.3; p < 0.001). Regarding the spatial variation of the temporal trend, 21 risk areas were found, all of them located in Southeast or Central-West states. The area with the highest relative risk was Minas Gerais state, where 5,748 cases were concentrated (RR = 8.1; p < 0.001). Finally, a purely spatial analysis revealed 25 clusters, the one with the highest relative risk being composed of two municipalities in Acre (RR = 6.9; p < 0.001).ConclusionsWe described a detailed temporal-spatial analysis of dengue cases in the first EWs of 2024 in Brazil, which were mainly concentrated in the Southeast and Central-West regions. Overall, it is recommended that governments adopt public policies to control the the vector population in high-risk areas, as well as to prevent the spread of dengue fever to other areas of Brazil.

Incidence of hospital-acquired infections among healthcare workers in Egypt before and during the COVID-19 pandemic

Background: Hospital-acquired infection is higher among healthcare workers (HCWs) than among other occupational groups, and the COVID-19 pandemic exacerbated its incidence. Aim: To assess the incidence of hospital-acquired infections among HCWs in, Cairo, Egypt, during the COVID-19 pandemic. Methods: This retrospective cohort study collected and evaluated data on hospital-acquired infections (excluding COVID-19) from 1660 nurses, physicians, technicians, and housekeepers in 6 hospitals in Cairo Governorate, Egypt, 1 year before and 1 year during the COVID-19 pandemic. The data were analysed using SPSS version 21.0 and descriptive and inferential statistics were used to test the magnitude and direction of relationships between the variables. Results: The rate of hospital-acquired infections was 3.1% before and 1.3% during the COVID-19 pandemic. There was a significantly lower risk of hospital-acquired infection among the HCWs during the pandemic than before it. Incidence was highest among housekeepers (10.6%), and physicians had the highest relative risk (4.33). Before the pandemic, pneumonia was the most common hospital-acquired infection (20.8%) among HCWs, while hepatitis C was the most common (8.3%) during the pandemic. The most significant predictors of hospital-acquired infection were COVID-19 (before and during the pandemic), working area and profession. Conclusion: There was a significant reduction in hospital-acquired infections among HCWs during the COVID-19 pandemic, attributed to increased adherence to infection prevention and control measures. Housekeepers, nurses and emergency department workers were at higher risk, indicating the need for further investigations among these groups of HCWs to understand the contributing factors and design targeted interventions to lower the risks and incidence.

Neurological hospitalisations in childhood cancer survivors treated before 2001: findings from the French Childhood Cancer Survivor Study cohort

PurposeChildhood cancer survivors (CCS) have an increased risk of developing late chronic diseases, which can be influenced by the cancer type and its treatment. These chronic diseases can be severe and disabling, typically emerging years to decades after treatment. These deficits negatively impact quality of life, intelligence quotient, and memory. This study investigated how much the cancer type and treatment could affect the neurological hospitalisations in the French Childhood Cancer Survivors Study (FCCSS).MethodsWe included 5579 childhood cancer survivors (CCS), diagnosed with solid tumours or lymphoma between 1945 and 2000, treated before 2001 and below the age of 21 years at initial treatment. The follow-up period was from 2006 to 2018. Hospitalisation data were obtained by linkage with the National Health Data System. We calculated the relative hospitalisation rate (RHRs) and absolute excess rate (AERs). Multivariable analyses were conducted using a Generalized Linear Model (GLM) with a Poisson distribution to estimate the association between neurological hospitalisation and patient characteristics. The expected number of hospitalisations served as an offset to compare the risk for FCCSS survivors with that of the reference population. Risk estimates were reported as relative risk (RR) with 95% confidence intervals.ResultsThe hospitalisation rate for CCS was 114.2 per 10,000 person-years (PY), compared to 48.4 in the reference population. The highest hospitalisation rates were observed for epilepsy (AER = 27.1 per 10000 PY, 95%CI: 23.5–31.2 and RHR = 5.1, 95%CI 4.4–5.7). In multivariable analyses, central nervous system (CNS) tumours survivors had the highest relative risk (RR) of hospitalisation (RR = 9.4, 95%CI: 6.7–13.1) followed by neuroblastoma survivors (RR = 2.5, 95%CI: 1.7–3.7). In the whole population, survivors who received radiation to the head and neck had a significantly higher risk of hospitalisation (RR = 3.9, 95%CI: 3.3–4.7) compared to those who did not receive radiotherapy.ConclusionsHead and neck irradiation was identified as a strong risk factor for hospitalisation. This underlines the importance of implementing specific neurologic surveillance programs for at-risk individuals.

Exploring the Birthday Week Effect on Hand, Foot, and Mouth Disease in Yunnan Province, China, From 2008 to 2022: Surveillance Data Analysis.

Hand, foot, and mouth disease (HFMD) is a notable infectious disease predominantly affecting infants and children worldwide. Previous studies on HFMD have primarily focused on natural patterns, such as seasonality, but research on the influence of important social time points is lacking. Several studies have indicated correlations between birthdays and certain disease outcomes. This study aimed to explore the association between birthdays and HFMD. Surveillance data on HFMD from 2008 to 2022 in Yunnan Province, China, were collected. We defined the period from 6 days before the birthday to the exact birthday as the "birthday week." The effect of the birthday week was measured by the proportion of cases occurring during this period, termed the "birthday week proportion." We conducted subgroup analyses to present the birthday week proportions across sexes, age groups, months of birth, and reporting years. Additionally, we used a modified Poisson regression model to identify conditional subgroups more likely to contract HFMD during the birthday week. Among the 973,410 cases in total, 116,976 (12.02%) occurred during the birthday week, which is 6.27 times the average weekly proportion (7/365, 1.92%). While the birthday week proportions were similar between male and female individuals (68,849/564,725, 12.19% vs 48,127/408,685, 11.78%; χ21=153.25, P<.001), significant differences were observed among different age groups (χ23=47,145, P<.001) and months of birth (χ211=16,942, P<.001). Compared to other age groups, infants aged 0-1 year had the highest birthday week proportion (30,539/90,709, 33.67%), which is 17.57 times the average weekly proportion. Compared to other months, patients born from April to July and from October to December, the peak months of the HFMD epidemic, had higher birthday week proportions. Additionally, a decreasing trend in birthday week proportions from 2008 to 2022 was observed, dropping from 33.74% (3914/11,600) to 2.77% (2254/81,372; Cochran-Armitage trend test: Z=-102.53, P<.001). The results of the modified Poisson regression model further supported the subgroup analyses findings. Compared with children aged >7 years, infants aged 0-1 year were more likely to contract HFMD during the birthday week (relative risk 1.182, 95% CI 1.177-1.185; P<.001). Those born during peak epidemic months exhibited a higher propensity for contracting HFMD during their birthday week. Compared with January, the highest relative risk was observed in May (1.087, 95% CI 1.084-1.090; P<.001). This study identified a novel "birthday week effect" of HFMD, particularly notable for infants approaching their first birthday and those born during peak epidemic months. Improvements in surveillance quality may explain the declining trend of the birthday week effect over the years. Higher exposure risk during the birthday period and potential biological mechanisms might also account for this phenomenon. Raising public awareness of the heightened risk during the birthday week could benefit HFMD prevention and control.

Bayesian spatio-temporal modeling to assess the effect of land-use changes on the incidence of Cutaneous Leishmaniasis in the Brazilian Amazon

Cutaneous Leishmaniasis (CL) is a vector-borne disease caused by a protozoan of the genus Leishmania and is considered one of the most important neglected tropical diseases. The Brazilian Amazon Forest harbors one of the highest diversity of Leishmania parasites and vectors and is one of the main focuses of the disease in the Americas. Previous studies showed that some types of anthropogenic disturbances have affected the abundance and distribution of CL vectors and hosts; however, few studies have thoroughly investigated the influence of different classes of land cover and land-use changes on the disease transmission risk. Here, we quantify the effect of land use and land-cover changes on the incidence of CL in all municipalities within the Brazilian Amazon Forest, from 2001 to 2017. We used a structured spatiotemporal Bayesian model to assess the effect of forest cover, agriculture, livestock, extractivism, and- deforestation on CL incidence, accounting for confounding variables such as population, climate, socioeconomic, and spatiotemporal random effects. We found that the increased risk of CL was associated with deforestation, especially modulated by a positive interaction between forest cover and livestock. Landscapes with ongoing deforestation for extensive cattle ranching are typically found in municipalities within the Amazon Frontier, where a high relative risk for CL was also identified. These findings provide valuable insights into developing effective public health policies and land-use planning to ensure healthier landscapes for people.

Redefining Candidates for Deintensification in Locoregionally Advanced P16+ Oropharyngeal Cancer Based on Relative Risk

Randomized trials have found that patients with locoregionally advanced p16+ oropharyngeal squamous cell carcinoma (OPSCC) do not benefit from treatment deintensification, even among favorable risk groups. Although various methods have been used to identify candidates for treatment deintensification, the optimal approach is unknown. We conducted a multi-institutional cohort study of 444 patients with previously untreated p16+ OPSCC undergoing definitive radiation therapy with or without systemic therapy between 2009 and 2022. We compared the following 2 approaches for identifying candidates for deintensification: (1) favorable versus unfavorable risk, using NRG-HN005 eligibility criteria, and (2) low versus high relative risk of cancer events, using the Head and Neck Cancer Intergroup predictive classifier ("omega score"). We tested differences in outcomes and systemic therapy allocation by risk group using multivariable Cox models, competing event models, and logistic regression, and compared characteristics of hypothetical deintensification trials using the 2 approaches. Progression-free survival events were defined as cancer recurrence (locoregional or distant) or death from any cause. Median follow-up time was 52 months; 120 patients (27.0%) were favorable risk; a different 120 patients had low omega score; 28 patients (6.3%) met both criteria; 184 patients (41.4%) had discordant classification. On ordinal logistic regression, decreasing omega score was associated with a statistically significantly lower odds of receiving intensive therapy (normalized odds ratio, 0.37 per SD; 95% CI, 0.24-0.57), with a greater magnitude than favorable risk group (odds ratio, 0.66; 95% CI, 0.44-0.99). Among patients receiving cisplatin and/or platinum-based induction (n = 374), favorable risk was associated with significantly improved progression-free survival (hazard ratio, 0.59; 95% CI, 0.36-0.99), whereas lower omega score was associated with a significantly decreased relative hazard for cancer events (relative hazard ratio, 0.18; 95% CI, 0.070-0.46). In simulations, selecting patients with low omega scores increased the efficiency of hypothetical noninferiority trials. Considering patients' relative risk of cancer events can help define optimal populations for treatment deintensification in p16+ OPSCC.

TO INFORM OR NOT TO INFORM about venous thromboembolisms – A qualitative study on communication between healthcare professionals and patients with lung cancer

BackgroundVenous thromboembolism (VTE) is a leading cause of death among cancer patients. Despite this, studies show that patients with cancer feel inadequately informed about the VTE risk and symptoms, which may impede their ability to recognise symptoms and react promptly. Patients with lung cancer are especially vulnerable due to a high relative risk of developing VTE combined with a high prevalence of low health literacy. This study aimed to explore the VTE information needs of lung cancer patients and how patients and healthcare professionals (HCPs) communicate about VTE. Material and methodsData was collected via semi-structured interviews with patients with lung cancer and HCPs. All participants (n = 20) were recruited from an oncological department. The analysis was performed in an inductive manner using a Ricoeur inspired strategy. FindingsPatients had varying information needs regarding VTE, but HCPs did not routinely communicate about VTE, as the topic tended to be lowly prioritised. HCPs communicated about VTE when patients expressed a need or presented symptoms of VTE. HCPs expressed concerns about adding to patient's emotional burden by informing about VTE, while some patients emphasised the importance of being mentally prepared for potential complications. ConclusionThe study demonstrates the challenging balance HCPs must maintain between adequately communicating about VTE and not causing undue psychological distress. However, given patient's often limited awareness of VTE, the responsibility to initiate communication about VTE must fall on the HCPs.

Risks for Enlisted Navy Divers Compared to Other Enlisted Sailors: An Examination of Illnesses That May Be Associated With Exposure to Contaminated Water Diving.

Illnesses among Navy divers degrade readiness, decrease manpower levels, and increase costs for medical care. Prior research has shown that Navy divers have high rates of the types of illnesses that might be because of diving in contaminated water. The objectives of this study were to examine medical records of U.S. Navy Sailors from 2016 to 2022 and determine if divers have higher incidence rates of health conditions that might be associated with contaminated water diving compared to non-divers. For this retrospective cohort study, we used data from the Defense Medical Epidemiology Database (DMED). The DMED is operated by the Armed Forces Health Surveillance Division and uses data from the Defense Manpower Data Center to classify occupations. The DMED provides free online access to a de-identified subset of data contained within the Defense Medical Surveillance System.The population was U.S. Navy enlisted males, aged 25 to 29 years. Divers were compared to non-divers using 8 selected diagnoses that may reasonably be associated with diving in contaminated water. During the study period, the database contained a total of 5,474 diver and 827,406 non-diver person-years. Of the 8 diagnoses, the ones with the largest number of cases for divers were upper respiratory infections with 128 and ear disorders with 62. The relative risks (RRs) for divers compared to non-divers were higher for otitis externa (RR = 1.44; confidence interval = 1.03, 2.01) and for ear disorders (RR = 1.15; confidence interval = 0.89, 1.47); for the other 6 diagnoses, the divers had lower rates than the non-divers. The high RRs found for otitis externa and ear disorders support the need to devote resources to better understand the reasons for these higher risks and to develop, test, and implement targeted risk-reduction strategies. Future studies should attempt to link verified contaminated water exposures with adverse health outcomes and calculate risks based on criteria such as age and dive factors.

Neuroimaging Findings in Children with Cerebral Palsy – Risk Assessment for Symptomatic Epilepsy

Neuroimaging plays a key role in the diagnosis of cerebral palsy (CP), as it helps to understand the etiology and pathogenesis of neurological impairment. The aim of the study is to demonstrate the role of neuroimaging in assessing the risk for epilepsy in children with CP with various lesions in CT and MRI with a focus on neuroimaging findings in full-term and premature children and their risk for epilepsy. The study includes 521 children with CP, diagnosed in the Clinic of Child Neurology, UMHATNP “St. Naum” between 2008 and 2018. Two hundred and twenty children underwent MRI of the brain, 464 of the cases had CT, and 127 had both MRI and CT. Various pathological lesions in MRI (brain malformations, lesions in the white or gray matter, lesions in the basal ganglia, cystic lesions, cortical atrophy, ventriculomegaly) were found in all patients with CP and symptomatic epilepsy, while 5.8% of those children with CP without epilepsy had normal MRI. Normal findings were observed in CT in 7.5% of the children with CP and epilepsy, while this result reached 12.1% when children did not have epilepsy. Among the abnormal findings in MRI with the highest relative risk for symptomatic epilepsy were ventriculomegaly RR – 1.296 (95% CI 1.149–1.463), cortical atrophy RR – 1.235 (95% CI 1.082–1.410) and lesions in the gray matter RR – 1.210 (95% CI 1.056–1.387). When comparing the types of the lesions in MRI in full-term and premature children with CP, we observed that white matter lesions predominated in premature children, while grey matter lesions in full-term children, which explains the higher incidence of epilepsy in full-term children. We found a higher incidence of pathological lesions in neuroimaging studies in patients with CP and concomitant epilepsy compared to those without epilepsy, as well as a high relative risk for epilepsy in patients with ventriculomegaly, cortical atrophy, and gray matter lesions.

Mental Health Diagnoses and Suicidality Among Transgender Youth in Hospital Settings.

Purpose: The purpose of this analysis is to: 1) describe the most common mental health diagnoses in the emergency department (ED) and inpatient hospital settings among transgender and gender diverse (TGD) youth vs. matched controls and 2) evaluate if a gender-affirming hormone therapy (GAHT) or gonadotropin-releasing hormone agonist (GnRHa) prescription decreased the risk of suicidality within these settings. Methods: Using the PEDSnet dataset (years 2009-2019), TGD youth aged 8-18 (n = 3414, with a median age at last visit of 16.2 [14.4, 17.7] years, were propensity-score matched to controls (n = 13,628, age 16.6 [14.2, 18.3] years). Relative risks of the most common mental health diagnoses within ED and inpatient settings were calculated for TGD youth compared with controls. Recurrent time-to-event analysis was used to examine whether GAHT or GnRHa attenuated the risk of suicidality among subsamples of TGD youth. Results: TGD youth had a higher relative risk (95% confidence interval [CI]) of mental health diagnoses and suicidality in the ED (5.46 [4.71-6.33]) and inpatient settings (6.61 [5.28-8.28]) than matched controls. TGD youth prescribed GAHT had a 43.6% lower risk of suicidality (hazard ratio [HR] = 0.564 [95% CI 0.36-0.89]) compared with those never prescribed GAHT during our study period or before GAHT initiation. TGD youth who were prescribed GnRHa therapy had a nonstatistically significant reduction in ED or inpatient suicidality diagnoses compared with those never prescribed GnRHa (HR = 0.79 [0.47-1.31]). Conclusion: Although risk of mental health diagnoses and suicidality in ED and inpatient settings was high among TGD youth, a GAHT prescription was associated with a significant reduction in suicidality risk.

Substance Use Disorder as Risk Factor for Intubation in Angioedema: A Nationwide Cohort Study.

Individuals with angioedema (AE) are at high risk for airway compromise and often require endotracheal intubation. Patient factors predisposing one to airway compromise are not well described. The objective of this study is to examine whether substance use disorder (SUD) in patients with AE is associated with need for airway intervention. This population-based retrospective cohort study compared AE patients with SUD versus propensity-matched control groups. Outcomes were hospitalization, intubation, and tracheotomy. Using the TriNetX National Database, this study included 28,931 patients with SUD and 117,509 patients without SUD who presented with AE. Among patients with AE, those with each subtype of SUD (alcohol, cannabis, cocaine, tobacco, and opioids) were found to have higher risk of severe AE compared to propensity-matched non-SUD cohorts. Rate of hospitalization after cohort matching ranged from 20.4% for tobacco use disorder to 30.4% for cocaine use disorder, all significantly higher than the 8.0% in a population without SUD. Each SUD subtype was associated with a higher rate of intubation compared with matched non-SUD groups, with cannabis use disorder having the highest relative risk (RR) of 3.67 (95% CI: 2.69-5.02). Tobacco (RR = 2.45, 95% CI: 1.79-3.34) and alcohol (RR = 2.82, 95% CI: 1.73-4.58) use disorders were both associated with significantly higher risk of tracheotomy. These data suggest that patients with SUD, regardless of subtype, and after propensity matching for demographics and comorbidities are at higher risk for adverse outcomes when presenting with AE. This study highlights clinically relevant predictors of airway compromise. Level 3 Laryngoscope, 2024.

Tegumentary leishmaniasis in Brazil: priority municipalities and spatiotemporal relative risks from 2001 to 2020

ABSTRACT Understanding the distribution of tegumentary leishmaniasis (TL) in different periods enables the adequate conduction of actions at the public health level. The present study analyzes the spatiotemporal evolution of TL incidence rates in the municipalities of Brazil and identifies priority areas from 2001 to 2020. Notifications of new cases were analyzed employing space-time scan statistics and Local Indicators of Spatial Association. As TL incidence rates presented a downward trend in most Brazilian municipalities, spatiotemporal clusters of high relative risks (RR) were more frequent in the first decade of the series. There was a concentration of those clusters in the North and Northeast regions, mainly in the Legal Amazon area. More recent high-RR areas were identified in municipalities of different regions. The number of priority municipalities showed a stable trend in Brazil. There was a great concentration of such municipalities in the states of Acre, Mato Grosso, Rondônia, Pará, and Amapá, as well as large areas in Roraima, Amazonas, Maranhão, and Tocantins, and smaller areas in the states of Goiás, Ceará, Bahia, Minas Gerais, São Paulo, and Paraná. The present study contributes to the understanding of the historical evolution of TL in Brazil and subsidizes actions to combat the disease.

An investigation of the longitudinal trajectory patterns of health-related quality of life among Australians with disabilities: explaining disability types and properties

BackgroundResearch on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia’s welfare policy.MethodsWe analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership.ResultsThe study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1).ConclusionDifferent forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories.

Temporal pattern, spatial distribution, and factors associated with the incidence of HIV/AIDS among young people in BrazilPatrón temporal, distribución espacial y factores asociados a la incidencia de la infección por el VIH/sida en jóvenes en Brasil

To describe temporal and spatial patterns and identify the factors associated with the incidence of HIV/AIDS among young people in Brazil. Ecological study of young Brazilians aged 15-24 years with reported HIV/AIDS, from 2001 to 2021. The Joinpoint method was used for the temporal analysis. Spatial clusters were detected using Bayesian methods, spatial autocorrelation, Getis-Ord Gi*, and scan techniques. Four non-spatial and spatial regression models were used to identify factors associated with the result. All statistical analyses considered p < 0.05. In Brazil, the average incidence was 12.29 per 100 000 inhabitants, with an annual increase of 7.3% in the period 2007-2014 and a subsequent 3.4% decrease in 2014-2021. A high-high pattern and hotspots were observed, mainly in municipalities in the South, Southeast, Central-West, and North regions. The primary cluster was located in 572 municipalities in Rio Grande do Sul and Santa Catarina, with the highest relative risks in Manaus (Amazonas) and Rondonópolis (Mato Grosso). The illiteracy rate (β = -0.08), GINI Index (β = -3.74) and Family Health Strategy coverage (β = -0.70) were negatively associated with the result. In contrast, the Firjan Municipal Development Index (β = 2.37), Social Vulnerability Index (β = 6.30), percentage of Bolsa Família recipients (β = 0.04), and per capita income (β = 0.008) showed a positive association. There was an upward trend in the incidence of HIV/AIDS until 2014, followed by a decline until 2021. High-rate clusters were concentrated in municipalities in the North, South, Southeast and Central-West regions in particular. Indicators of socioeconomic vulnerability had positive or negative effects on the result, depending on the territory investigated.

Differential Cytokine Responses of APOE3 and APOE4 Blood-brain Barrier Cell Types to SARS-CoV-2 Spike Proteins.

SARS-CoV-2 spike proteins have been shown to cross the blood-brain barrier (BBB) in mice and affect the integrity of human BBB cell models. However, the effects of SARS-CoV-2 spike proteins in relation to sporadic, late onset, Alzheimer's disease (AD) risk have not been extensively investigated. Here we characterized the individual and combined effects of SARS-CoV-2 spike protein subunits S1 RBD, S1 and S2 on BBB cell types (induced brain endothelial-like cells (iBECs) and astrocytes (iAstrocytes)) generated from induced pluripotent stem cells (iPSCs) harboring low (APOE3 carrier) or high (APOE4 carrier) relative Alzheimer's risk. We found that treatment with spike proteins did not alter iBEC integrity, although they induced the expression of several inflammatory cytokines. iAstrocytes exhibited a robust inflammatory response to SARS-CoV-2 spike protein treatment, with differences found in the levels of cytokine secretion between spike protein-treated APOE3 and APOE4 iAstrocytes. Finally, we tested the effects of potentially anti-inflammatory drugs during SARS-CoV-2 spike protein exposure in iAstrocytes, and discovered different responses between spike protein treated APOE4 iAstrocytes and APOE3 iAstrocytes, specifically in relation to IL-6, IL-8 and CCL2 secretion. Overall, our results indicate that APOE3 and APOE4 iAstrocytes respond differently to anti-inflammatory drug treatment during SARS-CoV-2 spike protein exposure with potential implications to therapeutic responses.