Incidence Rate Ratio Research Articles

Evolution of Real-World Clinical Practice in Time to Surgery Following Thoracolumbar Spinal Cord Injury: An Observational Study of North American Trauma Centers from 2010 to 2020.

This study aims to estimate real-world clinical practice trends in time to surgery following thoracolumbar spinal cord injury (SCI) in trauma centers across North America over the last decade (2010-2020). A multi-center retrospective observational study was conducted using Trauma Quality Improvement Program data from 2010 to 2020. All surgically treated patients with thoracic and lumbar SCI were included. Descriptive plots and a multivariable Poisson regression model with time to spine surgery as the primary outcome were constructed. This study included 4350 adult patients with complete SCI surgically treated across 449 trauma centers. Within this group, 3978 (91.4%) patients were diagnosed with thoracic SCI and 372 (8.6%) patients were diagnosed with lumbar SCI. The overall mean time to surgery was 31.6 h (±34.1). Early surgery (≤24 h) was performed in 2599 patients (59.7%). An estimated annual reduction of 1.6 h in time to surgery was demonstrated over the study period, starting initially at a mean of 47.6 h (±40.6) in 2010, and reaching a mean of 25.3 h (±30) in 2020. Multivariable Poisson regression adjusting for patient, injury, and institution confounders, demonstrated a significant decrease in time to surgery by 5% per year over the study period (incidence rate ratios [IRR] = 0.95, 95% confidence interval [CI]: 0.93-0.96). Moreover, in a secondary analysis including 3270 patients with incomplete thoracolumbar SCI, a comparable significant annual reduction in time to surgery was demonstrated (IRR = 0.93, 95% CI: 0.91-0.94). This study provides real-world data on practice pattern trends with respect to time to spine surgery following traumatic thoracolumbar SCI. Over the years from 2010 to 2020, we found a significant reduction in time to surgery across trauma centers in North America.

Oral Cancer Incidence Among Adult Males With Current or Former Use of Cigarettes or Smokeless Tobacco: Population-Based Study.

Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and/or ST ("quitters"), or never used tobacco has not been well studied. We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit. We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014-2017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity. A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95% CI 2.0-3.3, P<.001), 3.6 (95% CI 3.2-4.1, P<.001) times higher than the never users, and 2.4 (95% CI 1.8-3.1, P<.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95% CI 1.1-1.9, P=.02). The IRR between former smokers who now use ST and those who quit was 1.4 (95% CI 1.0-2.1, P=.08). Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings.

The Major League Baseball Pitch Clock: one year position player injury analysis

ABSTRACT Background In 2023, Major League Baseball (MLB)implemented the pitch clock. The effects of the pitch clock on player injuryrates is largely unknown, and some, including the major league baseball playersassociation, have suggested that pitchers may be at an increased risk of injurywith its implementation. Position players have received little attention inthese discussions, even though they may be at the same theorized risk ofinjuries. The aim of this study is to determine if implementation of the 2023MLB pitch clock influenced the incidence of injuries in position players. It ishypothesized that implementation of the MLB pitch clock will lead to a rise ininjuries due to a reduction of time for the primary biological energy systemused by baseball to restore to normal levels. Methods Injury data was collected from thefangraphs.com injury database, the most comprehensive MLB data and statisticaldatabase website, for the 2021, 2022, and 2023 MLB seasons. The incidence rateratio was calculated and used to compare the injury rate for the 2023 season tothe 2021 and 2022 seasons for both major anatomical categories and anatomicalsubcategories. A z-test for proportions was used to determine significance. Results Incidence rate ratio comparison of the2023 MLB pitch clock season versus the 2021 MLB season showed a decrease in thetotal incidence of injuries (p < .001), lower extremity injuries (p < .001),and hamstring injuries (p = .032). Incidence rate ratio comparison of the 2023MLB pitch clock season versus the 2022 MLB season showed a decrease in thetotal incidence of injuries (p = .010), undisclosed injuries (p < .001), andknee injuries (p = .035). Conclusions Following the implementation of thepitch clock during the 2023 MLB season, the total number of injuries andseveral lower extremity injury categories decreased. Due to a decrease in theoverall time spent on the field in a single game and over a season, it could behypothesized that the pitch clock decreased the workload for position players,leading to this drop in injuries. Further longitudinal investigation must bedone to investigate if this influence of the MLB pitch clock persists overtime.

Incidence of Acute Pulmonary Edema Before and After the Systematic Use of Ultrasound B-Lines

Introduction: Acute pulmonary edema (APE) due to fluid overload is considered the most feared complication in hemodialysis patients. Various diagnostic tests have been proposed to assess the fluid status in patients with end-stage kidney failure (ESKF); among these, lung ultrasound (measuring the number of B-lines) is emerging as a promising tool to identify pulmonary congestion in this patient population. Methods: We compared the incidence of APE before and after the implementation of lung ultrasound as a routine practice in our unit. The pre (from 1 January 2007 to 31 December 2008)- and post (from 1 January 2017 to 31 December 2018)-B-line implementation periods included 98 and 108 hemodialysis patients, respectively. By accurately reviewing their electronic medical records, all episodes of APE were collected. The 10-year interval between the two periods was specifically chosen to ensure no overlap between patients of the two cohorts whereas the single-center design was adopted to minimize the influence of center effect on the study results. Results: APE episodes occurred more frequently in patients from the pre-B-line implementation group (18/98, i.e., 18.4%) compared with those from the post B-line implementation group (6/108, i.e., 5.5%) (p = 0.004). An analysis based on repeated APE events showed that the incidence rate of APE was significantly higher during the pre-implementation period (2.0 APE episodes per 100 person-months, 95% CI: 1.4–2.7) than during the post-implementation period (0.3 APE episodes per 100 person-months, 95% CI: 0.1–0.7), with an incidence rate ratio (post- versus pre-) of 0.17 (95% CI: 0.07–0.40; p &lt; 0.001). The odds of experiencing APE episodes were 74% lower (odds ratio: 0.26, 95% CI: 0.10–0.69) in patients from the post B-line implementation period compared with those from the pre-implementation period. Notably, adjusting for potential confounders did not affect the strength of this association, which remained statistically significant (p ≤ 0.030). Finally, dominance analysis indicated that the implementation of B-lines was the primary factor explaining the difference in APE episodes between the two periods, followed by dialysis duration and intra-dialysis weight gain. Conclusions: The systematic use of lung ultrasound (a simple, easy-to-learn, rapid and non-invasive method, easily performed at the patient’s bed) in everyday clinical practice was associated with a drastic reduction in episodes of APE in hemodialysis patients. Further observational and interventional studies are needed to confirm these results.

Time to Surgery Following Complete Cervical Spinal Cord Injury: Evolution of Clinical Practice Patterns Over a Decade from 2010 to 2020 Across North American Trauma Centers.

This study aims to quantify the change in time to surgery for treatment of complete traumatic cervical spinal cord injury (SCI) patients in American College of Surgeons accredited trauma centers across North America over the last decade (2010-2020). This multi-center retrospective observational cohort study used data from the Trauma Quality Improvement Program from 2010 to 2020. All surgically treated patients with complete traumatic cervical SCI were included. Primary outcome was time to spine surgery from treating hospital arrival in hours. Both descriptive statistics and a multi-variable Poisson regression model clustering standard of errors by each included trauma center were used to evaluate and quantify the annual change in time to surgical intervention. The study included 6855 complete traumatic cervical SCI patients managed across 484 trauma centers in North America. Median time to spine surgery was 14.6 h. A total of 4618 patients (67.3%) underwent surgical intervention within 24 h from hospital arrival. From 2010 to 2020, median time to surgery decreased by an average 0.6 h (±0.15) per year. A multi-variable adjusted model for time to surgery demonstrated a significant downward annual reduction of 5% in time to surgery between the years 2010 and 2020 (Incidence rate ratio = 0.95; 95% Confidence Interval: 0.93-0.96). This study provides compelling real-world based quantification of the change in time to surgical intervention following traumatic cervical SCI. A significant decreasing annual trend pertaining to surgical timing across trauma centers in North America over the past decade was demonstrated.

Impact of extreme bushfire seasons on rates of occupational injury and disease compensation claims in first responders.

This study aimed to use workers' compensation (WC) data to explore the impact of the extreme bushfires on injury/disease claim rates amongst first responders (FR) compared with other occupations and off-seasons. Data on WC claims for FR (ambulance officers, paramedics, firefighters, police) and other occupations were obtained from WorkSafe Victoria 2005-2022. Negative binomial regression models adjusting for age, gender and number of employed people were used to estimate incident rate ratios of all injury/disease, mental, musculoskeletal and respiratory claims among FR in summer and extreme bushfires compared to off-season/summer and other occupations. There were 120,022 claims in 2005-2022; 54% were musculoskeletal injuries. Claims rates were significantly higher for all injuries/diseases, mental, musculoskeletal and respiratory conditions in FR than other occupations across off-season, summers and extreme bushfires. FR were 1.5-3.9 times more likely to claim for mental health conditions during extreme bushfires than off-season compared with other occupations. Firefighters were at increased risk of all injury/disease and mental and musculoskeletal injury claims during summer and extreme bushfires than off-seasons. Ambulance officers and paramedics had the highest claim rates, particularly in off-seasons, with a higher risk of all injury/disease and mental claims in extreme bushfires than in summers. Respiratory and mental claims were increased amongst police and other occupations during extreme bushfires. Extreme bushfire events were associated with increased mental claims rates in all FR, with the highest in firefighters. Strategies to better prevent and manage injury/disease risk in FR are urgently required, particularly for mental health conditions.

Risk factors for unintentional injury hospitalisation among Aboriginal and non-Aboriginal children in Australia's Northern Territory: A data linkage study.

Unintentional injuries are a leading cause of hospitalisation for children. This study investigated the incidence and associated risk factors for unintentional injury hospitalisation (UIH) among Aboriginal and non-Aboriginal children aged under 5 years in Australia's Northern Territory. This was a retrospective cohort study using linked data from a perinatal register, hospital admissions, school enrolment and child protection services. The outcome variable was a first UIH. Potential risk factors included gender, pregnancy and birth outcomes, maternal education level, child protection service contact and geographic remoteness. Modified Poisson regression was used for multivariate modelling. A cohort of 21,189 children (54.0% Aboriginal) born between 2000 and 2010 were followed to the age of 5 years. The overall incidence of first UIH was 25.8 per 1,000 person-years, which was 28.6% higher among Aboriginal than non-Aboriginal children (28.8 and 22.4 per 1000 person-years, respectively). Risk factors identified in the full model included: being male (incidence rate ratio (IRR) 1.26, 95%CI: 1.17-1.36); living in a remote (IRR 1.26, 95%CI: 1.14-1.40) or very remote area (IRR 1.44, 95%CI: 1.29-1.59); having a notification or substantiated notification for abuse (IRR 1.42, 95%CI: 1.27-1.58 and IRR 1.60, 95%CI: 1.41-1.82, respectively); or neglect (IRR 1.32, 95%CI: 1.17-1.48 and IRR 1.28, 95%CI: 1.11-1.47, respectively). After adjustment, there was no difference in UIH rates between Aboriginal and non-Aboriginal children. In both stratified models, being male, living in remote or very remote areas and having a notification or substantiated notification for child maltreatment were identified as risk factors. Our study found high UIH incidence rates and evidence for an association between UIH and child maltreatment. This suggests child maltreatment and UIH have shared determinants and points to the need for clinicians to be aware of the overlap between these conditions and the importance of cross-agency collaboration in prevention and management.

Smaller is better? Compact vs. Conventional gamma camera for sentinel lymph node localization in patients with breast cancer.

Sentinel lymph node biopsy (SLNB) has been recognized as "the gold standard" for axillary staging in early breast cancer patients with clinically negative lymph nodes, resulting in significant morbidity decrease and quality of life improvement. This study aims to validate the performance of a newly developed handheld portable gamma camera (PGC) produced by Imagensys (Italy), in detecting and locating sentinel lymph nodes (SLNs) during the preoperative and intraoperative phases in breast cancer patients compared to conventional lymphoscintigraphy. Adult female patients with histologically confirmed breast cancer, candidates for surgery and SLNB, were prospectively enrolled in this open-label, pre-marketing clinical trial. All patients underwent pre- operative assessment using both the PGC and conventional lymphoscintigraphy. The performance of the two devices was compared using the Poisson regression model for incidence rate ratios (IRRs). The intrinsic sensitivity of the devices was compared using the Wilcoxon Ranked Sign Test. The utility of PGC during intra-operative procedures was also evaluated. The manoeuvrability of the devices was evaluated using operator-satisfaction questioner. Sixty-eight patients (median age 50 years, BMI 21.4) were enrolled, including two patients with bilateral breast cancer, who underwent SLNB on both axillae. The PGC demonstrated superior preoperative lymph node detection rate (IRR 8.01, 95% CI 6.11-10.50; p < 0.0001) and intrinsic device sensitivity (mean counts per second 409 ± 286 vs. 255 ± 1173 for conventional device, p = 0.0003) compared to the conventional gamma camera. Intra-operative assessment with PGC was performed in 62 patients and no additional lymph nodes were visualised. However, the conventional gamma camera demonstrated superior manoeuvrability (p < 0.0001). The PGC handheld gamma camera showed promising results for preoperative SLN assessment in patients with breast cancer. The limited manoeuvrability may be related to the operator's experience leading to higher inter-operator variability. Appropriate training and frequent use of nuclear medicine and surgical equipment could overcome this limitation.

National Incidence of Nurse Suicide and Associated Features.

The aim of this study was to estimate the national incidence of nurse suicide. Nurses are at a higher risk of suicide than nonnurses; however, data have been limited since 2018. This study used a retrospective cohort design using 2017-2021 National Violent Death Reporting System suicides. Female nurses had higher suicide rates than female nonnurses in 2018 (incidence rate ratio, 1.21 [95% confidence interval (CI), 1.05-1.39]), 2019 (1.41 [95% CI, 1.23-1.60]), 2020 (1.26 [95% CI, 1.08-1.45]), and 2021 (1.35 [95% CI, 1.17-1.55]), whereas male nurses were comparable with male nonnurses. Nurses had higher odds of mental health problems (adjusted odds ratio, 1.28 [95% CI, 1.13-1.46], P < .001), job problems (1.60 [95% CI, 1.33-1.92], P < .001), and use of poisoning (1.54 [95% CI, 1.37-1.74], P < .001). Nurses had higher odds of using opioids, cardiovascular/diabetic agents, and drugs not prescribed for home use. Female nurses are at a higher risk of suicide than other females. Multimodal nurse suicide prevention strategies remain indicated.

Long-Term Impact of the Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis: Effet à long terme de la barrière anti-suicide du viaduc Bloor sur les suicides à Toronto : une analyse chronologique.

A suicide prevention barrier was installed at Toronto's Bloor Viaduct bridge in 2003. It was associated with short-term location substitution, possibly mediated by media effects that did not persist over 1 decade. The long-term impact of the barrier is unknown. We examined rates of suicides by jumping from the Bloor Viaduct, other bridges and by other methods using coroner's records in Toronto (1998-2020). We used interrupted time-series Poisson regression analyses to model changes in quarterly bridge-related suicides after barrier installation. A secondary analysis explored the potential substitution effects of suicide by other methods. Of 5219 suicides from 1998 to 2020, 303 were by jumping from bridges. After controlling for covariates, installation of the Bloor Viaduct suicide barrier was associated with a 49% step decrease in bridge-related suicide in the next quarter in Toronto (incidence rate ratio [IRR] = 0.51, 95% CI, 0.30 to 0.86) with no rebound increase in bridge-related suicide during the subsequent 17 years after the original drop (IRR = 0.99, 95% CI, 0.96 to 1.03). There was also no associated change in suicides by other methods after the barrier (IRR = 1.04, 95% CI, 0.90 to 1.20). Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier. They support the long-term utility of structural interventions at high-frequency sites for suicide.

Increased trends in reported sexually transmitted infections according to age groups and sex in Spain, 2016–2022

Objective Our objective was to assess trends in three sexually transmitted infections (STIs) – gonorrhoea, chlamydia and syphilis – in Spain, by age group and sex from 2016 to 2022. Study design Retrospective observational study Methods Data from epidemiological surveillance system were used to calculate the incidence rate for each STIs by age group and sex. Poisson regression was employed to examine the trends for 2016 to 2022. Results For gonorrhoea, higher incidence rates were observed among men than women for all period. The incidence rate ratio (IRR) varied between 1.14 (95% CI 1.12–1.16) for the 15–19 age group to 1.24 (1.23–1.25) for the 35–44 age group among men, and between 1.14 (1.09–1.19) for 55 years or more to 1.27 (1.24–1.29) for the 15–19 age group among women. For chlamydia, women showed higher incidence rate for all age groups than men during the period. Individuals aged 55 years and over showed the highest increase, IRR = 1.30 (1.27–1.34) for men, while it was the lowest for women, IRR = 1.22 (1.16–1.27). The incidence rates for syphilis were lower than for the other STIs. IRR values varied between 1.04 (1.02–1.06) in the 20–24 age group and 1.15 (1.14–1.16) in the 35–44 age group for males; and between 1.13 (1.06–1.16) for the 25–34 age group and 1.18 (1.13–1.25) for the 25–34 age group for females. Conclusion STIs are more frequent in people aged 25–34 and are increasing in all age groups. However, the rise is most pronounced among older men and among younger women.

Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry. This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI. Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001). Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

Tuberculosis and increased incidence of cardiovascular disease: Cohort study using US and UK health records.

Limited evidence suggests elevated risks of cardiovascular disease (CVD) among people diagnosed with tuberculosis (TB) disease, though studies have not adjusted for pre-existing CVD risk. We carried out a cohort study using two separate datasets, estimating CVD incidence in people with TB versus those without. Using data from the United States (Veterans Health Administration) and the United Kingdom (Clinical Practice Research Datalink) for 2000-2020 we matched adults with incident TB disease and no CVD history 2-years before TB diagnosis (US n=2,121; UK n=15,820) with up to 10 people without TB on the basis of age, sex, race/ethnicity and healthcare practice. Participants were followed beginning 2-years before TB diagnosis and for 2-years subsequently. The acute period was defined as 3-months before/after TB diagnosis. TB, CVD and covariates were identified from electronic routinely collected data (primary and secondary care; mortality). Poisson models estimated incident rate ratios (IRR) for CVD events in people with TB compared to those without. CVD incidence was consistently higher in people with TB, including during the baseline period (pre-TB) and particularly in the acute period: IRRs were US 3.5 (95% Confidence Interval 2.7-4.4), UK 2.7 (2.2-3.3). Rate Ratios remained high after adjusting for differences in pre-existing CVD risk: US 3.2 (2.2-4.4), UK 1.6 (1.2-2.1). Increased CVD incidence was observed in people with TB versus those without, especially within months of TB diagnosis, persistent after adjustment for differences in pre-existing risk. Enhancing CVD screening and risk management may improve long-term outcomes in people with TB.

Epidemiology of Infections in Lung Transplant Recipients Treated With Belatacept.

Belatacept is a costimulatory blocker that can be used to prevent and treat rejection in lung transplant recipients (LuTRs). The epidemiology of infections in belatacept-treated LuTRs has not been systematically evaluated. We performed a single-center retrospective study of all adult LuTRs who received belatacept as prevention or treatment of antibody-mediated rejection (desensitization) or as part of maintenance immunosuppression from January 1, 2011, to June 30, 2022. We assessed the epidemiology of infections that occurred within 12 months following the first belatacept dose. Fifty-two LuTRs received at least one dose of belatacept as either desensitization (n = 32) or maintenance immunosuppression (n = 20). Among 45 patients who were cytomegalovirus (CMV) donor and/or recipient seropositive, nine (20%) developed CMV infection. Seven (77%) CMV infections occurred despite valganciclovir prophylaxis and four (44%) were associated with antiviral resistance. Three (6%) LuTRs developed Epstein-Barr virus (EBV) associated post-transplant lymphoproliferative disorder (PTLD). Twenty-five (48%) LuTRs developed 43 bacterial infections and five (10%) developed proven or probable invasive fungal disease. Incidence rates of viral, bacterial, and fungal infections were similar between the desensitization and maintenance groups: incidence rate ratios (95% confidence interval) were 0.70 (0.32-1.57), 1.31 (0.70-2.46), and 2.82 (0.31-25.2), respectively. Infection/PTLD prompted belatacept discontinuation in eight (15%) patients. In the first year after belatacept initiation, LuTRs commonly developed CMV infections, EBV+ PTLD, and bacterial infections. Multicenter collaborations are needed to better understand infection risks in LuTRs treated with belatacept.

Long-term physical and mental health outcomes of Ebola Virus Disease survivors in Kenema District, Sierra Leone: A cross-sectional survey.

The 2013-2016 Ebola Virus Disease (EVD) epidemic in West Africa was the deadliest in history, with over 28,000 cases. Numerous physical and mental health symptoms have been reported in EVD survivors, although there is limited prior research on how the health of survivors compares to the general population. We conducted a survey of EVD survivors in Kenema District, Sierra Leone and a population-based sample of community members who lived in EVD-affected areas but were not diagnosed with EVD, and compared resulting data about self-reported symptoms, duration, and severity between EVD survivors and community members through multivariate regression models. This study found that more than six years after the epidemic, survivors were significantly more likely to experience both physical and mental health symptoms than community members, with respective adjusted incidence rate ratios (IRRs) of 2.65 (95% CI, 2.28-3.09), p < 0.001, and 11.95 (95% CI, 6.58-21.71), p < 0.001. The most highly reported physical health symptoms experienced by EVD survivors were joint pain (75.5%), headaches (67.3%), and vision problems (44.5%), and the most prevalent psychological symptoms were spells of terror and panic (25.5%) and difficulty falling asleep or staying asleep (20.0%). EVD survivors were significantly more likely than community members to report the symptoms as lasting for a longer period, a median of 6.0 (3.0-7.0) years, and with higher severity. The results indicated that six years after the epidemic, EVD survivors in Kenema District, Sierra Leone are experiencing worse physical and mental health than their peers. These findings of the long-term, debilitating health issues following EVD infection should be considered when designing and implementing future epidemic responses.

Time trends in incidence of pilonidal sinus disease from 1996 to 2021: A Danish population-based cohort study.

Pilonidal sinus disease (PSD) is a common condition, but no data on disease occurrence exist outside highly selected settings. The aim of this study was to assess time trends in the incidence of PSD in a nationwide setting. Using data from nationwide Danish registries, we identified 48 247 patients recorded with diagnostic or surgical procedure codes representing PSD between 1996 and 2021. We stratified by sex and computed the age-adjusted and age-specific incidence rate, comparing 5-year intervals with the incidence rate ratio (IRR). The overall incidence of PSD increased from 26.1 to 39.6/100 000 person-years (PY) from the period 1996-2000 to the period 2016-2021 (IRR 1.52, 95% CI 0.78-2.94). The incidence increased from 35.8 to 56.9/100 000 PY (IRR 1.59, 95% CI 0.52-4.89) in male patients and from 16.4 to 22.5/100 000 PY (IRR 1.37, 95% CI 0.68-2.76) in female patients. The peak of age-specific incidence was 215.7/100 000 PY (95% CI 206.1-245.4) among 20-year-old men and 107.9/100.000 PY (95% CI 100.0-114.0) among 18-year-old women. Over the study period, the median age at first hospital contact decreased from 27 years [interquartile range (IQR) 22-34 years) to 25 years (IQR 20-34 years) in men but remained stable around 23 years (IQR 18-32 years) in women. However, for both sexes, the highest increase in incidence was seen in early adolescence. The incidence of PSD has increased significantly over the last decades. The increase is driven primarily by men and boys, with the highest increase in incidence seen in early adolescence. The increased burden of disease is not reflected in the literature, and more studies are warranted to understand the drivers of this development.

No Increased Injury Risk on Artificial Turf in Finnish Premier Division Football.

To compare the injury risk between natural grass and artificial turf in the male Finnish premier division (Veikkausliiga) matches during the 2019 league season. A retrospective reanalysis of prospectively collected season-long injury surveillance cohort study. Finnish elite-level male football. All 12 teams of Veikkausliiga participated in the study. All players were eligible to participate. Two hundred thirty-six players took part in the follow-up between February and November 2019. Matches were played between April and November 2019. Injury data were collected using standard injury reports from the team medicals and weekly player questionnaires. Individual player exposure in matches was collected. Artificial turf was classified as exposure and natural grass as control in the analyses. Match-related injury incidence and incidence rate ratios (IRR) with 95% confidence intervals (CI) on natural grass and artificial turf. A total of 113 injuries (65 on artificial turf, 48 on natural grass) in 167 matches (90 on artificial turf, 77 on natural grass) were included. Injury incidence was 27.2/1000 hours on artificial turf and 23.9/1000 hours on natural grass and (IRR, 1.1; 95% CI, 0.8-1.7). There was no difference in injury types, anatomical regions, injury recurrence, injury severity, or injury contact. Forwards may have had an increased injury incidence on artificial turf compared with natural grass (IRR, 3.4; 95% CI, 1.0-11.8). This study supports previous reports that there is no significant increase in the overall risk of injury in professional football played on artificial turf compared with that on natural grass.

Comorbid depression and anxiety and their association with health care resource utilization among individuals with type 1 diabetes in the United States.

Type 1 diabetes mellitus (T1DM) is a prevalent chronic endocrine disorder and accounts for 5%-10% of all diabetes cases worldwide. T1DM can have a substantial impact on health care utilization. Although it is well known that individuals with diabetes are at a greater risk of mental health disorders, specific evidence addressing the health care burden of comorbid depression/anxiety in people affected by T1DM is lacking. To assess health care resource utilization (HCRU) among adults with T1DM and comorbid depression or anxiety. We identified individuals aged 18 to 64 with a T1DM diagnosis from January 1, 2017, to December 31, 2021, using a 25% random sample of the IQVIA PharMetrics Plus for Academics database. The index date was the date of the first medical claim with a T1DM diagnosis. Eligibility required continuous medical and prescription coverage for 12 months before (baseline) and after (follow-up) the index date. Comorbid depression/anxiety and baseline characteristics were assessed during the baseline period. The following 2 mutually exclusive groups were created: individuals with T1DM and comorbid depression/anxiety, and those with only T1DM. To balance baseline demographic and clinical characteristics between the groups, we implemented 1:1 propensity-score matching. We assessed all-cause, diabetes-related, and major adverse cardiovascular event-related HCRU during the follow-up period. Logistic (binary) and negative binomial (count) regression models examined the association between comorbid depression/anxiety and HCRU across types of health care settings. Out of 6,491 eligible individuals with T1DM, 1,168 (18%) had either depression or anxiety. In the matched cohort of 2,314 individuals, those with T1DM and comorbid depression/anxiety had significantly higher odds of all-cause emergency department visits (odds ratio = 1.67; 95% CI = 1.39-2.00) and higher rates of physician office visits (incidence rate ratio = 1.37; 95% CI = 1.27-1.47) and other outpatient encounters (incidence rate ratio = 1.23; 95% CI = 1.13-1.34) than those with only T1DM. Findings were similar for diabetes-related and major adverse cardiovascular event-related HCRU. Comorbid depression/anxiety among individuals with T1DM results in significantly higher HCRU than T1DM alone. The findings underscore the importance of effective management of comorbid depression/anxiety in the T1DM population.

Initiation and continued use of oral pre-exposure prophylaxis among pregnant and postpartum women in South Africa (PrEP-PP): a demonstration cohort study

When used effectively, oral pre-exposure prophylaxis (PrEP; tenofovir disoproxil fumarate and emtricitabine) prevents maternal HIV acquisition and reduces the risk of vertical transmission. Our study aimed to better understand PrEP initiation, continued use, and adherence in pregnant and postpartum women. The PrEP in Pregnancy and Postpartum (PrEP-PP) study is a demonstration cohort study that enrolled pregnant women aged 16 years and older without HIV attending their first antenatal care visit in Cape Town, South Africa, between Aug 29, 2019, and Oct 10, 2021. Eligible, consenting women were followed up quarterly up to 12 months postpartum with regular HIV testing and offer of PrEP with ongoing adherence counselling. The primary outcome was distribution of women across the PrEP cascade (ie, initiation and continuation up to 12 months postpartum) with crude and adjusted hazard ratios (HRs). We also report on HIV incidence by pregnancy and postpartum status. Overall, 1195 pregnant women were recruited and followed up (median age 26 years, IQR 23-31; median gestational age 21 weeks, IQR 15-31); 1009 (84·4%) started PrEP at enrolment. Among women who initiated PrEP at enrolment, 668 (67·5%) of 990 continued PrEP at the 1-month follow-up, 485 (49·9%) of 972 continued at 3 months, 392 (39·4%) of 994 at 6 months, and 275 (27·4%) of 1005 at 12 months. Of 186 women who did not accept PrEP at enrolment, 70 (37·6%) of 186 subsequently initiated PrEP. Overall, 200 (18·6%) of 1076 women continued PrEP at 12 months postpartum. Of 186 women who did not initiate PrEP at baseline, 70 (37·6%) subsequently initiated PrEP during the study. Factors associated with PrEP discontinuation up to 12 months postpartum included being married or cohabiting (adjusted HR 1·32, 95% CI 1·16-1·50), condomless sex since last visit (1·43, 1·23-1·65), reporting intimate partner violence (2·03, 1·59-2·59), or depression in the past 12 months (1·53, 1·14-2·05). Overall, 16 women seroconverted over 1673·8 woman-years (HIV incidence rate 0·96 per 100 woman-years, 95% CI 0·49-1·42); 14 discontinued PrEP use and two never initiated PrEP. HIV incidence was 0·28 per 100 woman-years during pregnancy (95% CI 0·22-0·33), and the incidence rate ratio was 1·77 per 100 woman-years (0·53-5·90) 0-6 months postpartum and 2·19 per 100 woman-years (0·61-7·83) 6-12 months postpartum compared with pregnant women. There is an urgent need for the integration of PrEP into antenatal and postnatal care and interventions that address barriers to continued use, including targeted counselling during pregnancy and postpartum to reduce PrEP discontinuation. National Institute of Mental Health and Fogarty International, US National Institutes of Health. For the French translation of the abstract see Supplementary Materials section.

Common mental health diagnoses arising from or coinciding with menopausal transition and prescribing of SSRIs/SNRIs medications and other psychotropic medications.

Women with menopausal transition (MT) have an elevated risk of experiencing common mental health diagnoses (CMHD: depression or anxiety). There is no recent data comparing the rate, and treatment, of CMHD between men and women. In this population-based study, incidence rates (IR) per 100 person-years-at-risk (PYAR) for men and women ≥45years registered with an UK primary care practice between 2010 and 2021 were estimated. Incidence rate ratios (IRR) with 95% confidence intervals (CIs) of CMHD were estimated using men as a reference. We measured first prescriptions for psychotropic medications received within 12months after CMHD. For selective serotonin reuptake inhibitors (SSRIs) /selective norepinephrine reuptake inhibitors (SNRIs), we measured the IR of prescribing per 100 PYAR, by 10-year bands. Proportion of SSRIs/SNRIs prescribing was estimated per 100 persons. Rates of anxiety and depressive disorders were 1.68 and 1.69 per 100 PYAR in women aged 45-54years-old compared to 0.91 and 1.20 per 100 PYAR in men, with IRR of 1.84 (95% CI 1.72-1.97) and 1.44 (1.35-1.53) respectively. SSRIs/SNRIs were the most prescribed medication; in 2021, IRs for SSRIs/SNRIs were 13.4 per 100 PYAR in both sexes. In 2021, the proportion of SSRIs/SNRIs prescribing was 50.67 per 100 women and 41.91 per 100 men. MT is assumed based on women's age as menopause onset is rarely recorded in primary care databases. Women ≥45years experienced more CMHD compared to men, especially 45-54years-olds, which coincides with MT. The proportion of SSRIs/SNRIs prescribing was higher in women.