Incidence Risk Ratio Research Articles

Perceived Housing Problems and Depressive Symptoms Among Middle-Aged and Older Americans

ABSTRACT Housing insecurity has been shown to be associated with worse mental health. However, previous studies mostly examined one aspect of housing insecurity (e.g., affordability), and few focused on older adults. This study examined the relationship between perceived housing problems and depressive symptoms among middle-aged and older Americans. Data from the Health and Retirement Study between 2006 and 2018 were used. A total of 7,119 respondents (aged 50+ at baseline in 2006) were followed up every 4 years. Respondents self-reported the status, severity, and duration of their housing problems. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression Scale. Mixed-effect models examined the association between perceived housing problems and depressive symptoms. Results show about 5%-7% of respondents had housing problems during every study visit and 5.73% of them experienced persistent housing problems over 12 years. Having housing problems was associated with a higher risk of depressive symptoms (incidence risk ratio = 1.29, 95% CI = 1.23, 1.36). A dose–response relationship was observed in the severity and duration of housing problems, with a greater increase of depressive symptoms risk among those experiencing more severe or prolonged housing problems. The dose–response pattern highlighted the importance of early intervention and persistent assistance to those experiencing housing problems.

An umbrella analysis assessing the risk of acute kidney injury in COVID-19 patients.

A number of research studies have indicated a potential association between COVID-19 and acute kidney injury (AKI). However, the methodologies employed and the risk estimates derived from these studies vary. Therefore, an umbrella review of systematic reviews and meta-analyses was conducted to determine the incidence of AKI in COVID-19 patients and AKI-associated mortality. A complete literature search was undertaken in PubMed, Embase, Scopus, and the Cochrane Library. The methodological rigor of the included papers was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR-2) instrument. The pooled risk ratio (RR) and odds ratio (OR) of the included studies were calculated to establish the strength of the association between AKI cases and COVID-19 infections. This umbrella review included 20 studies. Two of the 20 studies assessed adult COVID-19 patient risk factors for AKI, 1 examined survival rates and 7 examined the incidence of AKI. The remaining 10 investigations revealed that patients with coronavirus were susceptible to AKI. The umbrella analysis comprised reviews that contained a range of 6 to 54 papers. The AMSTAR-2 ratings yielded a total of 14 studies deemed to be of high quality, with 6 studies classified as intermediate quality. Statistical analysis of included reviews revealed a 1.50 RR for AKI incidence in COVID-19 patients (95% confidence interval (95% CI): 1.40-1.60, I2 69%, p < 0.0001) and a 2.02 RR (95% CI: 1.79-2.29, I2 56%, p < 0.0001) for AKI-associated death. This umbrella review revealed that individuals infected with the novel coronavirus often develop AKI. SARS-CoV-2 infections were associated with AKI due to advanced age, male gender, coronary artery disease, diabetes, and hypertension. However, AKI and a renal replacement therapy (RRT) requirement independently predicted unfavorable COVID-19 results.

Incidence and Outcomes After Out-of-Hospital Cardiac Arrest at Train Stations in Denmark.

Following international guidelines, communities have deployed automated external defibrillators at train stations without substantive evidence. We geocoded public out-of-hospital cardiac arrests (OHCAs) (2016-2020), automated external defibrillators, and train stations. The stations were divided into the following groups according to passenger flow: 1 (0-499), 2 (500-4999), 3 (5000-9999), and 4 (>10 000) passengers per day. Risk ratios (RRs) were calculated using Poisson regression of rates, and odds ratios (ORs) were analyzed through logistic regression. OHCAs at train stations accounted for 102 (2.3%) of 4467 public OHCAs. The incidence rate (IR) and RR for OHCAs were for group 1: IR, 0.02 OHCA per station per year, RR, 1.0 (reference); group 2: IR, 0.07, RR, 4.1 (95% CI, 2.3-7.3); group 3: IR, 0.25, RR, 12.7 (95% CI, 6.2-25.9); and group 4: IR, 0.34, RR, 16.3 (95% CI, 8.6-30.9). Compared with other public OHCAs, OHCAs at train stations were just as likely to receive bystander cardiopulmonary resuscitation (OR, 1.13 [95% CI, 0.60-2.12]). However, they had higher odds of bystander defibrillation (OR, 1.66 [95% CI, 1.06-2.58]), were more likely to achieve return of spontaneous circulation (OR, 1.88 [95% CI, 1.24-2.85]), and survive 30 days (OR, 2.37 [95% CI, 1.57-3.59]). The incidence of OHCAs at train stations was associated with passenger flow, with the busiest stations having a 16-fold higher risk of OHCAs than the lowest. OHCAs at train stations had better outcomes compared with other public OHCAs.

Health symptoms in individuals with and without post-covid in the Dutch general population

Abstract Background Health symptoms, often non-specific in nature such as headache and sleep problems, are more prevalent in the aftermath of disasters. Relatively little research focused on non-specific symptoms in the context of the COVID-19 pandemic, including those with post-covid conditions. The aim of this study was to assess the symptomatic profile of people with post-covid conditions, and to assess differences in health symptoms between non-infected individuals, infected individuals, and individuals with post-covid. Methods A nation-wide cross-sectional health survey performed in 2022 was combined with routine primary care electronic health records (EHRs). Prevalence of individual symptoms was analyzed, as well as symptom scores for number, duration, and severity of symptoms. The total survey sample consisted of 315,586 individuals. The EHR sample consisted of 29,797 individuals with matched survey data. Both samples were divided into three groups: non-infected, infected, and post-covid. Results Survey participants with post-covid experienced significantly (CI 99%) more (incidence risk ratio (IRR) 1.55), longer lasting (IRR 1.87), and more severe self-reported symptoms (IRR 1.95) compared to non-infected individuals. For infected compared to non-infected survey participants, there were hardly differences in symptom scores. The most distinct differences in individual symptoms were observed for loss of smell or taste, fatigue, and respiratory problems. Based on EHR data, the post-covid group is at significantly higher risk of experiencing fatigue, shortness of breath, headache, sleep problems, and dizziness. Conclusions Individuals suffering from post-covid are at the highest risk of experiencing health symptoms, both based on self-reported symptoms as well as based on EHRs. The infected group generally experienced more self-reported symptoms than the non-infected, but on average, they experienced them at a shorter duration, and they also reported them to be less severe. Key messages • Health symptom prevalence is higher in individuals with post-covid in the Netherlands. • This effect is confirmed in self-reported health surveys as well as in primary care registries.

Potential impact of rotavirus vaccine introduction in India’s Universal Immunisation Programme on private sector vaccine utilisation: an interrupted time series analysis

BackgroundDespite free immunisation services through the Universal Immunisation Programme (UIP), around 14% of Indian households seek immunisation in the private sector. We examined the potential impact of rotavirus vaccine (RVV) introduction in the Universal Immunisation Programme (UIP) on private-sector rotavirus vaccine utilisation.MethodsWe analysed nationally representative private-sector vaccine sales data. The intervention under consideration is RVV introduction in the UIP in selected Indian states. The outcome is the ‘monthly RVV sales volume’—a proxy for vaccine utilisation. We performed a Poisson regression interrupted time series analysis to detect the pre-intervention trend, post-intervention level change and trend change relative to the pre-intervention for monthly rotavirus vaccine utilisation.ResultsPoisson segmented regression analysis showed that immediately after RVV introduction in the UIP private-sector RVV sales showed a decline in Rajasthan by 37.4% (Incidence Risk Ratio (IRR): 0.626; 95% CI: 0.504–0.779), in Tamil Nadu by 26% (IRR: 0.740; 95% CI: 0.513–1.068), in Uttar Pradesh-East by 72.2% (IRR: 0.278; 95% CI: 0.178–0.436) and in Kerala by 3% (IRR: 0.970; 95% CI: 0.651–1.447). Rajasthan, Tamil Nadu and Kerala had sustained reduction in the postintervention trend relative to the preintervention trend by 20.1% (IRR: 0.799; 95% CI: 0.763–0.836), 6.4% (IRR: 0.936; 95% CI: 0.906–0.967) and 3.3% (IRR: 0.967; 95% CI: 0.926–0.960) per month, respectively. However, in Haryana and UP-west, in the first-month post-UIP introduction, the private-sector RVV sales increased by 101% and 3.8%, respectively which was followed by a sustained decrease of 14.2% (IRR: 0.858; 95% CI: 0.688–1.070) and 5.8% (IRR: 0.942; 95% CI: 0.926–0.960) per month, respectively. In terms of long-term impact, the private sector RVV sales post-UIP introduction decreased at a monthly rate of 4.4% (IRR: 0.956, 95% CI: 0.939–0.974) in Rajasthan but increased by 5.5% (IRR: 1.055; 95% CI: 1.040–1.070) in UP-east, 0.3% (IRR: 1.003, 95% CI: 0.976–1.031)) in Kerala and 0.2% (IRR: 1.002, 95% CI: 0.993–1.011) in Tamil Nadu whereas Haryana and UP-west had a reduction in RVV utilisation by 2.8% (IRR: 0.972; 95% CI: 0.955–0.990) and 1% (IRR: 0.990; 95% CI: 0.982–0.998), respectively.ConclusionsThe study provides evidence that access to RVV through UIP leads to a reduction in private-sector RVV utilisation. We recommend strengthening UIP to expand the basket of new vaccines.

Impact of age on antimicrobial prescriptions in hospitalized children at three academic centres in South Africa: a point prevalence survey.

Antimicrobial resistance is a global threat in children, and the emergence of multi-drug-resistant organisms is of concern. This secondary analysis of an antimicrobial point prevalence survey (PPS) in children evaluates the impact of age on antimicrobial use. The mean antimicrobial prescriptions were assessed in neonates, infants, young children (1-5 years), school-going children (6-12 years), and adolescents (13-15 years) from a cross-sectional PPS at three academic hospitals between September 2021 and January 2022. Primary and secondary diagnoses, antibiotic type (World Health Organization AWaRe and Anatomical Therapeutic Chemical classifications), and the incidence of healthcare-associated infections (HAI) were evaluated per age category. Multiple regression models were used to analyse age-related risk factors for HAI. The number of antimicrobials per child (1.7-1.9 per patient) was higher in neonates and infants compared to children 6-12 years old (1.4 per patient). Watch antibiotics, especially carbapenems, were commonly prescribed in neonates (32.5%) and infants (42.2%). Reserve antimicrobial use was notable in neonates (4.7%) and infants (4.1%). The incidence risk ratio (IRR) of HAI was higher in neonates and infants (IRR 2.13; 95% CI 1.23-3.70, IRR 2.20; 95% CI 1.40-3.45, respectively) compared to 6- to 12-year-olds. On multivariate analysis of participants according to age, being HIV infected, length of stay >6 days, high McCabe severity score, having surgery and receipt of blood transfusion were associated with an increased risk of HAI (P < .001 for all) while on univariate analysis only, being premature and/or underweight was associated with an increased risk of HAI in infants (P < .001 for both). Infants with risk factors for HAI significantly influenced antimicrobial prescribing, underscoring the necessity for tailored antimicrobial stewardship and enhanced surveillance. The increased use of Watch antibiotics, particularly carbapenems, in infants warrants closer scrutiny. Further research is required to identify inappropriate antimicrobial use in high-risk hospitalized young children.

Falls and malnutrition are associated with in-hospital mortality in patients with cirrhosis.

Hospitalized patients with end-stage liver disease are at risk of malnutrition, reduced body function, and cognitive impairment due to HE. This combination may have an impact on in-hospital falls and mortality. The purpose of this study was to identify factors associated with the risk of falls and to analyze the consequences regarding in-hospital mortality. We performed a retrospective analysis of patients hospitalized with liver cirrhosis between 2017 and 2019 at the Department of Gastroenterology at the University Hospital Frankfurt. Clinical data, laboratory work, and follow-up data were analyzed. Factors associated with the risk of falls and in-hospital mortality were calculated using a mixed effect poisson regression model and competing risk time-to-event analyses. Falls occurred with an incidence of 4% (80/1985), including 44 injurious falls with an incidence rate of 0.00005/100 patient-days (95% CI: 0.00001-0.00022). In the multivariate analysis malnutrition (incidence risk ratio: 1.77, 95% CI: 1.04-3.04) and implanted TIPS (incidence risk ratio: 20.09, 95% CI: 10.1-40.1) were independently associated with the risk of falling. In a total of 21/80 (26.25%) hospitalizations, patients with a documented fall died during their hospital stay versus 160/1905 (8.4%) deaths in hospitalizations without in-hospital fall. Multivariable analysis revealed as significant clinical predictors for in-hospital mortality a Nutritional Risk Screening ≥2 (HR 1.79, 95% CI: 1.32-2.4), a falling incident during hospitalization (HR 3.50, 95% CI: 2.04-6.0), high MELD, and admission for infections. Malnutrition and TIPS are associated with falls in hospitalized patients with liver cirrhosis. The in-hospital mortality rate of patients with cirrhosis with falls is high. Specific attention and measures to ameliorate these risks are warranted.

Analyzing the seasonality of tuberculosis case notifications in the UK, 2000-2018.

Globally, there is seasonal variation in tuberculosis (TB) incidence, yet the biological and behavioural or social factors driving TB seasonality differ across countries. Understanding season-specific risk factors that may be specific to the UK could help shape future decision-making for TB control. We conducted a time-series analysis using data from 152,424 UK TB notifications between 2000 and 2018. Notifications were aggregated by year, month, and socio-demographic covariates, and negative binomial regression models fitted to the aggregate data. For each covariate, we calculated the size of the seasonal effect as the incidence risk ratio (IRR) for the peak versus the trough months within the year and the timing of the peak, whilst accounting for the overall trend. There was strong evidence for seasonality (p < 0.0001) with an IRR of 1.27 (95% CI 1.23-1.30). The peak was estimated to occur at the beginning of May. Significant differences in seasonal amplitude were identified across age groups, ethnicity, site of disease, latitude and, for those born abroad, time since entry to the UK. The smaller amplitude in older adults, and greater amplitude among South Asians and people who recently entered the UK may indicate the role of latent TB reactivation and vitamin D deficiency in driving seasonality.

The Impact of Hormone Replacement Therapy on the Riskof Heart Failure in Postmenopausal Women: A Meta-Analysis of Clinical and Observational Studies.

The relationship between heart failure (HF) and hormone replacement therapy (HRT) in postmenopausal women remains unclear. This paper aimed to elucidate the association between HRT and HF outcomes in postmenopausal women by scrutinizing evidence from clinical trials and observational studies. The meta-analysis was systematically executed following the PRISMA guidelines to include studies identified from the electronic databases, including PubMed, EMBASE, EBSCO, ICTRP, and NIH clinical trials. The primary endpoint of the effect comprised risk ratios (RR) for HF incidence and mortality, attended by 95% confidence intervals (CIs). The risk of bias was assessed employing the Cochrane Risk of Bias 2 (RoB2) tool for clinical trials and the Newcastle-Ottawa Scale (NOS) for observational studies. The search yielded a total of eight reports, originating from six individual studies, for inclusion in the current study, and 25 047 participants were included. The meta-analysis demonstrated no remarkable association between HRT and the incidence of HF in postmenopausal women (RR: 1.07, 95% CI: 0.91-1.25, p = 0.37). However, a significant reduction in all-cause mortality was observed among post-menopausal HF patients who received HRT (RR: 0.65, 95% CI: 0.49-0.87, p = 0.003). In age-related subgroup analyses, no significant change in the risk of HF was noticed among participants on HRT. The findings of this paper demonstrate that HRT use is not associated with a significant increase in the risk of incident HF. This meta-analysis also suggests a benefit in all-cause mortality when HRT is administered to postmenopausal women with HF.

Eggs, Dietary Choline, and Nonalcoholic Fatty Liver Disease in the Framingham Heart Study

BackgroundEggs are rich in bioactive compounds, including choline and carotenoids that may benefit cardiometabolic outcomes. However, little is known about their relationship with nonalcoholic fatty liver disease (NAFLD). ObjectivesWe investigated the association between intakes of eggs and selected egg-rich nutrients (choline, lutein, and zeaxanthin) and NAFLD risk and changes in liver fat over ∼6 y of follow-up in the Framingham Offspring and Third Generation cohorts. MethodsOn 2 separate occasions (2002–2005 and 2008–2011), liver fat was assessed using a computed tomography scan to estimate the average liver fat attenuation relative to a control phantom to create the liver phantom ratio (LPR). In 2008–2011, cases of incident NAFLD were identified as an LPR ≤0.33 in the absence of heavy alcohol use, after excluding prevalent NAFLD (LPR ≤0.33) in 2002–2005. Food frequency questionnaires were used to estimate egg intakes (classified as <1, 1, and ≥2 per week), dietary choline (adjusted for body weight using the residual method), and the combined intakes of lutein and zeaxanthin. Multivariable modified Poisson regression and general linear models were used to compute incident risk ratios (RR) of NAFLD and adjusted mean annualized liver fat change. ResultsNAFLD cumulative incidence was 19% among a total of 1414 participants. We observed no associations between egg intake or the combined intakes of lutein and zeaxanthin with an incident NAFLD risk or liver fat change. Other diet and cardiometabolic risk factors did not modify this association. However, dietary choline intakes were inversely associated with NAFLD risk (RR for tertile 3 compared with 1:0.69, 95% CI: 0.51, 0.94). ConclusionsAlthough egg intake was not directly associated with NAFLD risk, eggs are a major source of dietary choline, which was strongly inversely associated with NAFLD risk in this community-based cohort.

Eating Disorders in Children, Adolescents, and Young Adults During and After the COVID-19 Pandemic: ADanishNationwide Register-Based Study.

To assess incidence rates of clinically diagnosed eating disorders among Danish youth before, during, and after the COVID-19 pandemic. This study used a population-based time series analysis with individual-level data from Danish healthcare registries. Participants included all Danish individuals aged 6-24 years from January 1, 2015, to December 31, 2023. Monthly incident cases of any eating disorder, anorexia nervosa, and bulimia nervosa were analyzed using interrupted time-series analysis. We estimated the cumulative number of excess cases of incident eating disorder diagnoses and risk ratios (RR) associated with the pandemic and post-pandemic periods compared with pre-pandemic predictions. The study population encountered a mean of 1,310,542 individuals during the study period. The study included 11,693 individuals diagnosed with an eating disorder, median age 17 (IQR 14-20 years). Incident cases increased during the pandemic (RR 1.29, 95% CI 1.15-1.45) and normalized post-pandemic (RR 1.07, 95% CI 0.91-1.25) compared with pre-pandemic predictions. Similar patterns were seen for anorexia and bulimia. Increases were significant for ages 13-16 (RR 1.19, 95% CI 1.02-1.38), 17-19 (RR 1.51, 95% CI 1.25-1.83), and 20-24 (RR 1.35, 95% CI 1.12-1.64). Post-pandemically, a continued increase was observed only for ages 20-24 (RR 1.32, 95% CI 1.02-1.71). The study documents a temporary increase in diagnosed eating disorders among Danish youths during the COVID-19 pandemic, with rates later returning to pre-pandemic levels. These results provide insights into the pandemic's impact on adolescents and youths.

Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population

BackgroundSubthreshold anxiety may act as a critical precursor and risk factor for the onset of threshold anxiety. However, accurate prevalence rates of subthreshold anxiety and its role in leading to threshold anxiety require further elucidation. MethodsWe conducted a search on PubMed and Web of Science using predefined criteria and identified 45 articles with a total of 278,971 individuals to estimate the prevalence rates using a random effects model. The incidence risk ratio (IRR) was estimated by comparing the proportion of individuals with subthreshold anxiety who developed threshold anxiety to those without subthreshold anxiety in seven articles involving 18,693 individuals. ResultsOur analysis revealed an overall prevalence of subthreshold anxiety of 6.19%. Specifically, among individuals with subthreshold generalized anxiety disorders, adolescents show the highest prevalence (9.47%), outpacing adults (4.69%) and the elderly (3.49%). Further analysis of seven studies showed an increased risk of developing threshold anxiety in individuals with subthreshold anxiety (IRR = 2.63), with a higher transition rate (9.59%) compared to those without subthreshold anxiety (3.65%). ConclusionsAnxiety disorders may be conceptualized as a spectrum, with subthreshold anxiety serving as a significant prodromal state and risk factor for the development of threshold anxiety. Proactive management of subthreshold anxiety represents an effective approach for the prevention of its progression to threshold anxiety. Future research should investigate the risk of progression from subthreshold to threshold anxiety across various types, and explore how factors, such as social support and personality traits facilitate this progression.

Association between antibiotic usage during infancy and asthma incidence among children: a population-level ecological study in British Columbia, Canada.

This study follows published associations in BC to 2014 (updated in 2019) to model the predicted incidence of asthma in BC children attributable to antibiotic use within the context of reduced antibiotic use and increased breastfeeding in BC infants from 2000 to 2019. A population-based ecological study was conducted in BC from 2000 to 2019, using outpatient antibiotic prescription data from BC PharmaNet and asthma diagnoses from the Chronic Disease Registry. Breastfeeding estimates were calculated using the Canadian Community Health Survey (CCHS). Population attributable risk (PAR) was calculated using a blended relative risk (RR) of asthma in antibiotic-exposed children who were and were not breastfed. PAR was used to calculate predicted vs. actual asthma incidence in 2019. Negative binomial regression was used to estimate the association between the average antibiotic prescription rate in infants under 1 and asthma incidence in 1-4 year olds, stratified by periods between 2000-2014 and 2015-2019. In BC, antibiotic prescribing decreased by 77% in infants under 1 and asthma incidence decreased by 41% in children 1-4 years from 2000 to 2019. BC breastfeeding rates increased from 46% in the 2005 CCHS to 71% in the 2017/18 CCHS. After calculating the PAR using a blended RR, the predicted asthma incidence in 2019 was 18.8/1,000 population. This was comparable to the observed asthma incidence in children 1-4 years of 16.6/1,000 population in 2019. During 2000-2014, adjusted incidence risk ratio (aIRR) for children under Quintile 5 of average antibiotic prescribing was 1.75 (95% CI: 1.63-1.88, P < 0.0001) times higher than that for Quintile 1. However, between 2015 and 2019, this association weakened (as expected because of increasing prevalence of breastfeeding), with the expected asthma incidence for Quintile 5 only 11% (aIRR 1.11, 95% CI: 0.78-1.57) higher than for Quintile 1. We identified that over the past 20 years, antibiotic exposure in infants under 1 and asthma incidence in children 1-4 years has decreased significantly. Decreasing antibiotic exposure and increasing breastfeeding (which further mitigates risk associated with antibiotics) are of sufficient scale to explain much of this population trend. Changes in environmental, social and other exposures remain relevant to this complicated etiological pathway.

Heightened mortality risk after a non-fatal opioid overdose: Risk factors for mortality in the week following emergency treatment.

To measure all-cause mortality risk after an ambulance-attended non-fatal opioid overdose and associations with number of days following attendance, and individual and clinical characteristics. A prospective observational study. Oslo, Norway. Patients treated with naloxone for opioid overdose by Oslo Emergency Services between 1 June 2014 and 31 December 2018. Medical records were linked to the national Cause of Death Registry (1 June 2014-31 December 2019). Crude mortality rates (CMR) and incidence risk ratios (IRR) with 95% confidence intervals (CI) were estimated for the time periods (0-7days, 8-31 days, 32-91 days, 92-183 days, >183 days) using multivariate Poisson regression analysis. IRR were estimated for sex, age, Glasgow Coma Scale (GCS), respiration rate, place of attendance and non-transportation following treatment. Robust variance estimates applied due to multiple risk periods. Standardized Mortality Rates (SMR) were estimated. Overall, 890 patients treated for 1764 overdoses contributed to a total time at risk of 3142 person-years (PY). Median number of attendances was 1 (range 1-27). The majority were male (75.5%) and the mean age was 37.7 years. In total, 112 (12.6%) died; 5.2% within 183 days and 2.2% between 184 and 365 days. Acute poisoning was the most common single cause of death (52.7%). The CMR was 3.6 (95% CI = 3.0-4.2) per 100-PY. The women had a SMR of 32 (95% CI = 15.8-57.9) and the men 24.9 (95% CI = 17.7-34.2). The CMR (22.2, 95% CI = 10.6-46.8) was particularly high in the first 7days, and significantly higher than in the following periods. However, this finding was only valid for those with severe overdose symptoms (GCS score = 3/15 and/or respiratory rate ≤6/min). Except for increasing age, no other indicators were associated with the mortality risk. Patients treated by Oslo Emergency Services between June 2014 and December 2018 for a non-fatal opioid overdose with severe overdose symptoms at attendance had an overall high mortality risk compared with the general population, but particularly during the first 7 days after attendance.

'The Lost Peace': Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia.

Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer's minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.

Association between severe premenstrual disorders and change of romantic relationship: A prospective cohort of 15,606 women in Sweden

BackgroundPremenstrual disorders (PMDs) affect women's quality of life, yet the impact on romantic relationships remains unclear. This study aimed to examine the association between severe PMDs and relationship disruption and initiation. MethodsWe conducted a prospective cohort study of 15,606 women during 2009–2021 in Sweden. PMDs were assessed with the modified Premenstrual Symptom Screening Tool at baseline (one-time retrospective self-report), while relationship status was obtained from national population registers during follow-up. Poisson regression was employed to assess the risk of relationship change. ResultsAt baseline (mean age 33.5 years), 1666 (10.6 %) women met the criteria for severe PMDs. All women were followed for 9.1 years on average for any change of relationship status. Among married/cohabiting women, PMDs were positively associated with relationship disruption (Incidence risk ratio, IRR =1.21, 95 % CI: 1.01–1.43, p = 0.03). A more pronounced association was suggested for premenstrual dysphoric disorder (IRR = 1.22, 95 % CI: 1.01–1.45, p = 0.03) than severe premenstrual syndrome (IRR = 1.01, 95 % CI: 0.43–1.96, p = 0.98) and among women without depression/anxiety (IRR = 1.21, 95 % CI: 1.00–1.47, p < 0.05) than among those with (IRR = 0.99, 95 % CI: 0.61–1.54 p = 0.96) and IRR = 1.01, 95 % CI: 0.57–1.72, p = 0.97). Among single women, a null association was found between PMDs and relationship initiation (IRR = 1.05, 95 % CI: 0.95–1.15, p = 0.32). LimitationsPMDs were not assessed using prospective symptom charting. ConclusionsMarried/cohabiting women with probable severe PMDs have an increased risk of relationship disruption. PMDs were not associated with relationship initiation in single women. Healthcare professionals should recognize relationship challenges in women with severe PMDs, and they may require support to maintain healthy relationships.

Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea.

The real-world effectiveness of computer-aided detection (CADe) systems during colonoscopies remains uncertain. We assessed the effectiveness of the novel CADe system, ENdoscopy as AI-powered Device (ENAD), in enhancing the adenoma detection rate (ADR) and other quality indicators in real-world clinical practice. We enrolled patients who underwent elective colonoscopies between May 2022 and October 2022 at a tertiary healthcare center. Standard colonoscopy (SC) was compared to ENAD-assisted colonoscopy. Eight experienced endoscopists performed the procedures in randomly assigned CADe- and non-CADe-assisted rooms. The primary outcome was a comparison of ADR between the ENAD and SC groups. A total of 1,758 sex- and age-matched patients were included and evenly distributed into two groups. The ENAD group had a significantly higher ADR (45.1% vs. 38.8%, p=0.010), higher sessile serrated lesion detection rate (SSLDR) (5.7% vs. 2.5%, p=0.001), higher mean number of adenomas per colonoscopy (APC) (0.78±1.17 vs. 0.61±0.99; incidence risk ratio, 1.27; 95% confidence interval, 1.13-1.42), and longer withdrawal time (9.0±3.4 vs. 8.3±3.1, p<0.001) than the SC group. However, the mean withdrawal times were not significantly different between the two groups in cases where no polyps were detected (6.9±1.7 vs. 6.7±1.7, p=0.058). ENAD-assisted colonoscopy significantly improved the ADR, APC, and SSLDR in real-world clinical practice, particularly for smaller and nonpolypoid adenomas.

Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries.

Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations. To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America. A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms. 772 patients were incorporated (64.64% females; mean age of 52.93years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success. Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.

Relative Effectiveness of the NVX-CoV2373 Vaccine Compared With the BNT162b2 Vaccine in Adolescents.

This retrospective matched cohort study evaluated the efficacy of 2 doses of NVX-CoV2373 compared with that of BNT162b2 vaccines in preventing severe acute respiratory syndrome coronavirus 2 infection in adolescents. We analyzed 13-week risk differences and ratios between these 2 vaccines. The study included 465 NVX-CoV2373 and 465 BNT162b2 recipients. Throughout the follow-up period, 4.1% of NVX-CoV2373 recipients and 2.8% of BNT162b2 recipients contracted the severe acute respiratory syndrome coronavirus 2 infection. The incidence risk ratio for NVX-CoV2373 compared with that for BNT162b2 was calculated at 1.46 (95% CI 0.68-3.22; P = 0.296). While our findings suggest noninferiority between the 2 vaccines, further research is needed to comprehensively assess their effectiveness in real-world settings. Our study highlights the critical need for vigilant vaccine surveillance and monitoring efforts to ensure informed decision-making and public health protection.

Prospective Audit and Feedback for Antimicrobial Treatment of Patients Receiving Renal Replacement Therapy in Community-Based University Hospitals: A before-and-after Study.

In South Korea, because of manpower and budgetary limitations, antimicrobial stewardship programs have relied on preauthorization. This study analyzed the impact of a prospective audit and feedback (PAF) program targeting inpatients undergoing intermittent hemodialysis or continuous renal replacement therapy, which was implemented at two community-based university hospitals. During three years of PAF, 27,906 antimicrobial prescriptions were reviewed, with 622 (2.2%) interventions. The mean incidence density per 1000 patient days of multidrug-resistant organisms, except for carbapenem-resistant Acinetobacter baumannii, decreased in the study population, whereas it increased among inpatients. Multivariable Poisson regression analysis revealed that after PAF, the incidences of vancomycin-resistant Enterococcus and mortality decreased (incidence risk ratio, 95% confidence interval: 0.53, 0.31-0.93 and 0.70, 0.55-0.90, respectively). Notably, after PAF, incorrect antimicrobial dosing rates significantly decreased (tau -0.244; p = 0.02). However, the incidences of other multidrug-resistant organisms, Clostridioides difficile, length of stay, and readmission did not significantly change. This study shows that in patients undergoing intermittent hemodialysis or continuous renal replacement, targeted PAF can significantly reduce multidrug-resistant organism rates and all-cause hospital mortality, despite limited resources. Furthermore, it can improve antimicrobial dosage accuracy.