Incidence Risk Ratio Research Articles

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis.

The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.

0017 Murder on the Midnight Express: Nocturnal Wakefulness and Homicide Risk

Abstract Introduction There is a nocturnal peak in incident suicide risk after adjusting for population wakefulness (Perlis et al., 2016; Tubbs et al., 2020). This peak in risk is hypothesized to result from a series of negative changes in mood, reward processing, and executive function that occur at night and increase the propensity for dysregulated and violent behaviors. Although the unadjusted incidence of dying by homicide is elevated at night, no existing studies of time-of-day and death by violent crime have adjusted for population wakefulness. Methods Data from 48,486 homicide victims with a known time of fatal injury were collected from the National Violent Death Reporting System (NVDRS) for 2003-2017, tabulated by clock hour, age, sex, race, and ethnicity, and combined with population wakefulness data from the American Time Use Survey (ATUS) for the same years. Homicide counts were additionally characterized by the proportion of cases with blood alcohol level (BAL) of 0, <80mg/dl, or ≥80mg/dl at autopsy and modeled using robust Poisson regression with population wakefulness entered as an offset term, thus producing hourly incident risk ratios (IRR). Results Homicide counts were lowest in the morning (6AM-7AM) and highest at night (10PM-11PM). After adjusting for population wakefulness, the incident risk for death by homicide was elevated between 10PM and 5AM compared to the 24-hour average, with the highest risk between 2AM (IRR: 8.25 [6.62-10.3]) and 3AM (IRR: 7.22 [6.04-8.64]). Moreover, the adjusted risk of dying by homicide was significantly greater at night for those with a BAL≥80mg/dl, such that the risk at 2AM was 13.8-fold greater than the 24-hour average (IRR: 13.8 [10.6-18.1]). Conclusion The risk of homicide death is higher at night after adjusting for population wakefulness and especially among those with alcohol intoxication. Although homicide victims do not choose when to die (unlike suicide victims), neurophysiological changes at night may promote risky behaviors or put victims in more dangerous circumstances than they would be otherwise. Future research should examine sociodemographic, clinical, and circadian risk factors for death by homicide, as well as examine time-of-day patterns in other violent crimes. Support (If Any)

0656 Demographic and Clinical Features of Nocturnal Suicide

Abstract Introduction The risk for suicide is greatest at night after adjusting for population wakefulness, possibly due to sleep- and circadian-dependent changes in neurophysiology to promote sleep. Those who die by suicide at night, however, may differ by demographic and/or clinical characteristics from those who die by suicide during the day. Methods An archival analysis of the National Violent Death Reporting System for 2003-2017 identified 77,784 suicide deaths with time of fatal injury. Cases were divided into daytime (5AM to 10:59PM) or nighttime (11PM to 4:59AM) and characterized by age, sex, race, ethnicity, marital status, military service, education, prior diagnosis of an anxiety disorder, bipolar disorder, depression, history of suicidal ideation, PTSD, and schizophrenia, as well as the presence of an opiate or cannabis, and blood alcohol level (BAL) on autopsy. Bidirectional stepwise regression and robust Poisson models characterized significant predictors of nocturnal suicide using incident risk ratios (IRR). Results Nocturnal and daytime suicides differed on all sociodemographic variables. Nocturnal suicides were more prevalent among those with bipolar disorder, PTSD, an elevated BAL, and those who tested positive for cannabis. Stepwise models identified a significant age by BAL interaction. Using adults 35-64 with BAL=0mg/dl as the reference, adults 35-64 with a BAL<80mg/dl had a 46% greater risk of suicide at night, and those with a BAL≥80mg/dl had a 78% greater risk. Individuals 15-34 had a nighttime suicide that was 26% greater with BAL=0mg/dl, 84% greater with BAL<80mg/dl, and 298% greater with BAL≥80mg/dl. Conversely, individuals 65 and older were 27% less likely to die at night with BAL=0mg/dl, while those with a BAL>0mg/dl did not differ from those aged 35-64 with BAL=0mg/dl. The risk of nocturnal suicide was also 17% greater among those with a prior history of suicidal ideation, and 13% less likely among those with documented depression. Conclusion Nocturnal suicide is more prevalent among intoxicated younger adults and those with previous suicidal ideation. However, suicide victims with depression were less likely to die at night. Further research is needed to target suicide prevention efforts at appropriately times for those with mood, substance, and alcohol use disorders. Support (If Any)

0036 Population Wakefulness and Nocturnal Suicide Risk

Abstract Introduction Nocturnal wakefulness may mediate the relationship between disrupted sleep and suicide risk since nighttime is associated with a peak in negative mood and altered reward processing and executive function. One example is a wakefulness-adjusted nocturnal peak in population suicide risk measured from 2003-2010 (Perlis et al, 2016), but these results have not been replicated with more recent data. Methods A total of 77,784 suicides with known time of fatal injury were extracted from the National Violent Death Reporting System (NVDRS) for 2003-2010 and 2011-2017. These data were then weighted by the estimated proportion of the population that was awake at each hour as derived from the American Time Use Survey (ATUS) for the same years. Suicides were tabulated by clock hours, age, sex, race, and ethnicity, and suicide counts were modeled using robust Poisson regression with hourly population wakefulness entered as an offset term, thus producing hourly incident risk ratios. Results A comparison of analyses between previously reported data (2003 to 2010) and new data (2011 to 2017) showed a consistently elevated risk of suicide at night (midnight to 6AM) that did not differ between time periods. After combining all fifteen years, the maximum number of suicides occurred at noon. Adjusting for population wakefulness, however, revealed a significant increased risk for suicide between 11PM and 5AM, with a 4.61-fold increase at 3AM (IRR: 4.61 [4.11-5.16]). Adjusting for age, sex, race, and ethnicity attenuated, but did not alter these results. In subgroup analyses, the nocturnal risk for suicide was elevated among those with bipolar disorder (5.2% of cases), those with a blood alcohol level greater than 80 mg/dl (14.9% of cases), and those who tested positive for a Z-drug (i.e., zolpidem, zaleplon, and eszopiclone) at autopsy (0.7% of cases). Conclusion Fifteen years of data from suicides across the United States show a significantly increased risk for suicide during the circadian night that peaks at 3AM. Nocturnal wakefulness remains a significant risk factor for suicide, and suicide prevention efforts may benefit from interventions to reduce nocturnal wakefulness and/or an increase in prevention resources at this time. Support (If Any)

Diabetes: Chronic Metformin Treatment and Outcome Following Acute Stroke.

AimTo evaluate if in patients with known diabetes, pretreatment metformin will lead to less severe stroke, better outcome, and lower mortality following acute stroke.MethodsThe Qatar stroke database was interrogated for stroke severity and outcome in patients with ischemic stroke. Outcome was compared in nondiabetic vs. diabetic patients and in diabetic patients on metformin vs. other hypoglycemic agents. The National Institute of Health Stroke Scale was used to measure stroke severity and 90-day modified Rankin scale (mRS) score to determine outcome following acute stroke.ResultsIn total, 4,897 acute stroke patients [nondiabetic: 2,740 (56%) and diabetic: 2,157 (44%)] were evaluated. There were no significant differences in age, risk factors, stroke severity and type, or thrombolysis between the two groups. At 90 days, mRS (shift analysis) showed significantly poor outcome in diabetic patients (p < 0.001) but no differences in mortality. In the diabetic group, 1,132 patients were on metformin and 1,025 on other hypoglycemic agents. mRS shift analysis showed a significantly better outcome in metformin-treated patients (p < 0.001) and lower mortality (8.1 vs. 4.6% p < 0.001). Multivariate negative binomial analyses showed that the presence of diabetes negatively affected the outcome (90-day mRS) by factor 0.17 (incidence risk ratio, IRR, 1.17; CI [1.08–1.26]; p < 0.001) when all independent variables were held constant. In diabetic patients, pre-stroke treatment with metformin improved the outcome (90-day mRS) by factor 0.14 (IRR 0.86 [CI 0.75–0.97] p = 0.006).ConclusionSimilar to previous reports, our study shows that diabetes adversely affects stroke outcome. The use of prior metformin is associated with better outcome in patients with ischemic stroke and results in lower mortality. The positive effects of metformin require further research to better understand its mechanism.

Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia.

BackgroundReducing hospital admissions among people dying with dementia is a policy priority.AimTo explore associations between primary care contacts, continuity of primary care, identification of palliative care needs, and unplanned hospital admissions among people dying with dementia.Design and settingThis was a retrospective cohort study using the Clinical Practice Research Datalink linked with hospital records and Office for National Statistics data. Adults (>18 years) who died between 2009 and 2018 with a diagnosis of dementia were included in the study.MethodThe association between GP contacts, Herfindahl–Hirschman Index continuity of care score, palliative care needs identification before the last 90 days of life, and multiple unplanned hospital admissions in the last 90 days was evaluated using random-effects Poisson regression.ResultsIn total, 33 714 decedents with dementia were identified: 64.1% (n = 21 623) female, mean age 86.6 years (SD 8.1), mean comorbidities 2.2 (SD 1.6). Of these, 1894 (5.6%) had multiple hospital admissions in the last 90 days of life (increase from 4.9%, 95% confidence interval [CI] = 4.2 to 5.6 in 2009 to 7.1%, 95% CI = 5.7 to 8.4 in 2018). Participants with more GP contacts had higher risk of multiple hospital admissions (incidence risk ratio [IRR] 1.08, 95% CI = 1.05 to 1.11). Higher continuity of care scores (IRR 0.79, 95% CI = 0.68 to 0.92) and identification of palliative care needs (IRR 0.66, 95% CI = 0.56 to 0.78) were associated with lower frequency of these admissions.ConclusionMultiple hospital admissions among people dying with dementia are increasing. Higher continuity of care and identification of palliative care needs are associated with a lower risk of multiple hospital admissions in this population, and might help prevent these admissions at the end of life.

Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study

ObjectiveTo quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19.DesignSelf-controlled case series and matched cohort study.SettingNational registries in Sweden.Participants1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants.Main outcomes measuresSelf-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event).ResultsCompared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding.ConclusionsThe findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.

Association of stay-at-home orders and COVID-19 incidence and mortality in rural and urban United States: a population-based study

ObjectiveWe examined the association between stay-at-home order implementation and the incidence of COVID-19 infections and deaths in rural versus urban counties of the United States.DesignWe used an interrupted time-series analysis...

Efficacy of approved vaccines to prevent COVID-19: a systematic review and network meta-analysis of reconstructed individual patient data from randomized trials.

AimTo optimize vaccination strategy, evidence on vaccine efficacy against COVID-19 is needed.MethodThe present network meta-analysis uses reconstructed individual patient data from phase III trials on vaccine efficacy (VE), identified through MEDLINE, EMBASE, and Cochrane library (CENTRAL) peer-reviewed and published in English before August 31, 2021. The primary outcome was the VE against confirmed COVID-19 at any time after the first dose as defined in each study. VE was re-estimated using the two-stage approach. Poisson regression models were applied to each trial at the first stage, and the incidence risk ratio (IRR) and their 95% CI were aggregated to allow random-effects network meta-analysis (NMA) at the second stage. VE was expressed as: (1-IRR) × 100. The study protocol is registered in PROSPERO (CRD42020200012).ResultsA total of eight studies, evaluating nine different vaccines were identified and analyzed. Between April 23, 2020 and January 05, 2021, 210,418 participants were recruited in 354 sites worldwide. During a median (IQR) follow-up duration of 69.8 (69.7–70.3) days, 2131 confirmed COVID-19 cases occurred (604; 26.0 per 1000 person–years in vaccine recipients and 1527; 85.9 per 1000 person–years in the control group). The mRNA-1273 vaccine was the most effective (P-score 0.99); at any time after dose 1, incidence reduction for mRNA-1273 ranged from 78% to 98% compared to the other vaccines.ConclusionOur results provide evidence for the short-term superiority of mRNA vaccines, especially the mRNA-1273 vaccine in prevention of COVID-19 in different populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10389-022-01707-1.

Familial Risk of Renal Cell Cancer and Interaction with Obesity and Hyperglycemia: A Population-Based Study.

We quantified the familial risk of renal cell cancer (RCC) among first-degree relatives (FDRs) on a population level, and examined interactions between family history and body mass index or blood glucose. Using the National Health Insurance database, which covers the entire Korean population, and the National Health Screening Program, we constructed a cohort of 5,524,403 individuals with blood-related FDRs and their lifestyle factors from 2002 to 2018. We calculated familial risk using incidence risk ratios (IRRs) with 95% confidence intervals, which compares the risk of individuals with and without FDR. The combined effect and interaction of a given risk factor and family history of RCC were measured by the relative excess risk due to interaction. Individuals with affected FDRs showed a 2.29-fold (95% CI 1.68-3.13) increased risk of disease. Familial risk adjusted for lifestyle factors showed minimal attenuation (IRR 2.25; 95% CI: 1.65-3.08), suggesting that genetic predisposition is the main contributor in the familial aggregation of RCC. Individuals with both a positive family history and overweight/obesity (IRR 3.71, 95% CI 2.50-4.92) or hyperglycemia (IRR 4.52, 95% CI 2.59-6.45) had a significantly higher risk that exceeded the sum of their individual risks, suggesting an interaction that was statistically significant (relative excess risk due to interaction 95% CI: 0.91, -0.21-2.12; 2.21, 0.28-4.14). Our findings suggest an interaction between genetic and environmental factors, namely obesity and hyperglycemia. Individuals with both factors should be considered a high-risk group and advised to undergo genetic counseling.

The prevalence and risk of developing major depression among individuals with subthreshold depression in the general population.

Subthreshold depression could be a significant precursor to and a risk factor for major depression. However, reliable estimates of the prevalence and its contribution to developing major depression under different terminologies depicting subthreshold depression have to be established. By searching PubMed and Web of Science using predefined inclusion criteria, we included 1 129 969 individuals from 113 studies conducted. The prevalence estimates were calculated using the random effect model. The incidence risk ratio (IRR) was estimated by measuring the ratio of individuals with subthreshold depression who developed major depression compared to that of non-depressed individuals from 19 studies (88, 882 individuals). No significant difference in the prevalence among the different terminologies depicting subthreshold depression (Q = 1.96, p = 0.5801) was found. By pooling the prevalence estimates of subthreshold depression in 113 studies, we obtained a summary prevalence of 11.02% [95% confidence interval (CI) 9.78-12.33%]. The youth group had the highest prevalence (14.17%, 95% CI 8.82-20.55%), followed by the elderly group (12.95%, 95% CI 11.41-14.58%) and the adult group (8.92%, 95% CI 7.51-10.45%). Further analysis of 19 studies' incidence rates showed individuals with subthreshold depression had an increased risk of developing major depression (IRR = 2.95, 95% CI 2.33-3.73), and the term minor depression showed the highest IRR compared with other terms (IRR = 3.97, 95% CI 3.17-4.96). Depression could be a spectrum disorder, with subthreshold depression being a significant precursor to and a risk factor for major depression. Proactive management of subthreshold depression could be effective for managing the increasing prevalence of major depression.

Metabolic control during the SARS-CoV-2 lockdown in a large German cohort of pediatric patients with type 1 diabetes: Results from the DPV initiative.

To assess if metabolic control worsened during the SARS-CoV2 lockdown in spring 2020 in youth with type 1 diabetes (T1D) in Germany. Data from 19,729 pediatric T1D patients from the diabetes prospective follow-up (DPV) registry were available. Data sets from four time-periods between January 1 and June 30, 2020, were compared with data from the whole year 2019 in the same patient; differences were adjusted for seasonality, increasing age, and longer diabetes duration. HbA1c values from laboratory measurements and estimates derived from continuous glucose monitoring (CGM) were aggregated into a combined glucose indicator (CGI), expressed in analogy to HbA1c. Based on regression models adjusted for differences of sex, age, diabetes duration, and migratory background between the four time-periods, CGI values in 2020 were slightly higher than in 2019, for example, by 0.044% (0.042-0.046) (median [95% CI]) in the second lockdown month, time-period 3. Insulin dose and BMI-SDS were also marginally higher. In 2020, there were fewer hospitalizations (e.g., incidence risk ratio in time-period 3 compared with 2019: 0.52 [95% CI: 0.46-0.58]). In a subgroup of patients reporting CGM data in both years, metrics in 2020 improved: time in target increased, and mean sensor glucose fell, for example, by 2.8% (2.7-2.9), and by 4.4mg/dl (4.3-4.6) in time-period 3. Before, during, and after the lockdown in spring 2020, metabolic control in youth with T1D in Germany did not differ significantly from the preceding year. Further effects of the ongoing pandemic on pediatric T1D patients need to be evaluated.

Linkage study of surveillance and hospital admission data to investigate Clostridium difficile infection in hospital patients in Perth, Western Australia

ObjectivesIncreasing incidence rates of Clostridium difficile infection (CDI) and outbreaks of emerging strains have highlighted the need for continuous monitoring and surveillance of CDI in Australia. Active surveillance captures all hospital-identified CDI cases in Western Australia (WA), where all C. difficile isolates recovered are routinely PCR ribotyped. The aim of this study was to determine incidence rates and descriptive and molecular epidemiology of CDI among patients in Perth, WA using linkage of surveillance and hospital administrative records. MethodsAll CDI cases (confirmed by tcdB PCR) from July 2012 to June 2014 captured in the Hospital Infection Surveillance WA dataset for three hospitals were linked with hospital admission records from the Patient Administration System and ribotyping data to calculate incidence rates of CDI and the distribution of various ribotypes (RTs). ResultsThere were 381 individual cases of CDI identified among 354 hospital patients (including outpatients and ED) who experienced ≥1 CDI episode during the study period. CDI was hospital-associated in 62.7% of cases and community-associated (CA)-CDI in 31.2%. The overall incidence rate was 4.40/10,000 patient days (PD, 95% CI 3.98–4.86), females across all age groups experienced higher incidence (risk ratio 1.29, p < 0.05). The risk ratio for CA-CDI was highest (7.76, p < 0.01) for females vs males aged 15–29 years. Overall, 10.8% of cases were admitted to ICU, 15.2% had a recurrent infection and the mortality rate was 7.2%. C. difficile RT 014/020 predominated (34.9%) among 339 isolates of 71 different RTs. ConclusionsThe incidence of CDI in WA is high and RT 014/020 continues to be the dominant molecular type in an otherwise diverse array of strains. High strain diversity suggests CDI cases arise from exposure to many different reservoirs.

Numerical characterization of astronaut CaOx renal stone incidence rates to quantify in-flight and post-flight relative risk

Changes in urine chemistry potentially alter the risk of renal stone formation in astronauts. Quantifying spaceflight renal stone incidence risk compared to pre-flight levels remains a significant challenge for assessing the appropriate vehicle, mission, and countermeasure design. A computational biochemistry model representing CaOx crystal precipitation, growth, and agglomeration is combined with a probabilistic analysis to predict the in- and post-flight CaOx renal stone incidence risk ratio (IRR) relative to pre-flight values using 1517 astronaut 24-h urine chemistries. Our simulations predict that in-flight fluid intake alone would need to increase from current prescriptions of 2.0–2.5 L/day to ~3.2 L/day to approach the CaOx IRR of the pre-flight population. Bone protective interventions would reduce CaOx risk to pre-flight levels if Ca excretion alone is reduced to <150 mg/day or if current levels are diminished to 190 mg/day in combination with increasing fluid intake to 2.5–2.7 L/day. This analysis provides a quantitative risk assessment that can influence the critical balance between engineering and astronaut health requirements.

IMPACT OF CURRENT AND FORMER SMOKING ON THE RISK OF ULCERATIVE COLITIS AMONG FAMILY HISTORY POSITIVE AND NEGATIVE INDIVIDUALS; EVIDENCE FOR GENE-SMOKING INTERACTION FROM LARGE SCALE POPULATION-BASED COHORT STUDY IN KOREA

Abstract BACKGROUND The interaction between smoking and genetic predispositions in the pathogenesis of ulcerative colitis (UC) remains to be determined. Also the effect of smoking on UC in Asian populations is not well-studied. OBJECTIVE Our aim was to evaluate the association of smoking with UC and to assess the interaction between smoking and family history in UC development. METHODS Using the National Health Insurance and National Health Screening Database which covers the entire Korean population(N=50 million) and includes data on family relationships, smoking status and other lifestyle factors, we identified 7 million individuals, comprising 3.7 million families. To examine the association of UC with current and former smoking, Cox proportional hazard regression was used and hazard ratios (HRs) were computed with a 95% confidence interval (CI). We calculated the familial risk of UC using incidence risk ratios (IRRs), and adjusted IRRs for lifestyle risk factors, including smoking and body mass index. Interactions between family history and current and former smoking were assessed on additive and multiplicative scales. RESULTS A total of 7 million people were initially included in our study and among them, we identified 1.2 million current smokers, 0.7 million former smokers and 5.1 million non-smokers. Our findings show that current smoking was associated with a decreased risk of disease (HR 0.6), while former smoking was associated with an increased risk (HR 1.2), compared to non-smokers. In the separate analysis among familial and non-familial groups, the protective effect of current smoking was less pronounced in the familial group (HR 0.5 vs 0.8) and the risk associated with former smoking also diminished in the familial group (HR 1.5 vs 1.2). In interaction analysis, the joint effect of current smoking and a positive family history of UC was lower than the product of their individual risks (p&amp;lt;0.05), suggesting a negative interaction. Also, the joint effect of former current smoking and family history was lower than the product of their individual risks with statistically significant interaction. CONCLUSION This large scale cohort study found that current smoking was associated with a decreased risk of UC and former smoking was associated with an increased risk. The impact of current and former smoking was different between family history positive and negative individuals. These results provide evidence for gene-smoking interaction in UC disease risk.

Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation.

High power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other. A systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. Ablation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16-0.25; I2=88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49-0.88; I2=72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50-5.77; I2=89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28-0.62; I2=62%; p<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups. HPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.

Analysis of Histopathological Findings of Lung Carcinoma in Czech Black Coal Miners in Association with Coal Workers' Pneumoconiosis.

Coal miners with coal workers’ pneumoconiosis (CWP, J60 according to ICD-10) were previously found to have a significantly higher risk of lung carcinoma compared to the general male population. The presented study aimed to analyze the (i) incidence of lung carcinoma in miners, (ii) histopathological findings in cohorts with and without CWP, and (iii) effect of smoking cessation on the histopathological profile. Analyzed cohorts consisted of miners with (n = 3476) and without (n = 6687) CWP. Data on personal and working history obtained from the medical records were combined with information on lung cancer from the Czech Oncological Register and histopathological findings. Statistical analysis was performed using non-parametric tests and the incidence risk ratio at the significance level of 5%. In 1992–2015, 180 miners (2.7%) without CWP and 169 (4.9%) with CWP, respectively, were diagnosed with lung carcinoma. The risk of lung cancer in miners with CWP was 1.82 (95% CI: 1.48–2.25) times higher than in those without CWP. Squamous cell carcinoma (37%) was the most common histopathological type, followed by adenocarcinoma (22%) and small cell carcinoma (21%). A statistically significant difference between the cohorts (p = 0.003) was found in the histopathological subtypes, with the incidence of small cell carcinoma being 2 times higher in miners without CWP than in those with CWP. Only a few individuals with lung carcinoma were non-smokers. The incidence of small cell carcinoma, which is strongly associated with smoking, is significantly higher in miners without CWP. Smoking constitutes the most important risk factor for developing lung carcinoma even in that cohort. However, CWP remains a very important risk factor.

Dynamics of age characteristics and prevalence of concomitant cardiovascular and non-sardiovascular diseases in patients hospitalized with COVID-19 during epidemic wave: data from TARGET-VIP registry

Aim. According to hospital-based registry, to evaluate the age characteristics and prevalence of concomitant cardiovascular and non-сardiovascular diseases in patients hospitalized with COVID-19 during epidemic wave.Material and methods. The TARGET-VIP register included 1130 patients aged 57,5+12,8 years (men, 51,2%) hospitalized at the Pirogov National Medical and Surgical Center from April 6, 2020 to June 22, 2020 with COVID-19. Cardiovascular diseases (CVDs) were diagnosed in 51,6% of patients, non-сardiovascular chronic diseases — in 48,6%, while CVDs and/or non-сardiovascular chronic diseases — in 65,8% of patients.Results. The average age of patients significantly increased by an average of 0,77 years per week (p&lt;0,001), while the difference between the 1st week (52,8 years) and 11th week (62,2 years) was 9,4 years; the proportion of men did not change significantly. The proportion of patients with CVDs increased significantly — from 34,2% to 66,7%, on average by 3,7% per week (p&lt;0,001; Incidence Risk Ratio (IRR)=1,037; 95% confidence interval (CI), 1,017-1,058), with chronic non-cardiovascular diseases — from 32,5% to 43,2%, on average by 2,5% per week (p&lt;0,001; IRR=1,025; 95% CI, 1,002-1,049), as well as those with CVDs and/or chronic non-cardiovascular diseases — from 47,5% to 75,3%, on average by 3,2% per week (p&lt;0,001; IRR=1,032; 95% CI, 1,017-1,048). Over the entire period, the proportion of people with hypertension (HTN) was 47,0%, with coronary artery disease (CAD) — 15,4%, with heart failure (HF) — 4,0%, and with atrial fibrillation (AF) — 10,1%. The proportion of patients with HTN increased by 9,5% (p&lt;0,001; OR=1,095; 95% CI, 1,047-1,144), with СAD — by 9,4% (p=0,01; OR=1,094; 95% CI, 1,022-1,172) and with AF — by 9,4% (p&lt;0,001; OR=1,094; 95% CI, 1,023-1,170) per week. The proportion of patients with diabetes was 16,5%, with respiratory diseases — 11,4%, with chronic kidney disease (CKD) — 12,6%, with digestive diseases — 22,5%, with obesity — 6,1%. During the epidemic wave, the most pronounced increase in the proportion of patients with CKD was by 6,2% (p=0,036; OR=1,062; 95% CI, 1,004-1,124) and with digestive diseases — by 6,0% (p=0,01; OR=1,060; 95% CI, 1,014-1,109) per week.Conclusion. According to the 11-week TARGET-VIP registry, the age of patients increased by 9,4 years, CVD cases — by 1,9 times (mainly HTN, CAD, AF), and chronic non­сardiovascular pathology — by 1,3 times (mainly CKD and digestive diseases). These trends in hospital practice corresponded to a weekly increase in the proportion of patients with a higher risk of fatal and non-fatal complications, which is the basis for further research in order to develop a system for a comprehensive prognostic assessment of the degree and rate of increase in the load on hospitals during COVID-19 epidemic wave.

Investigating the correlation between sidewalks and pedestrian safety

In recent years, pedestrian safety has emerged to be of major concern to selected States in the US and at the national level. With the transition to the mobility of people, pedestrian safety has become more prevalent for governmental agencies to address and prioritize for strategic implementation. It was crucial to address the pedestrian-vehicular conflict within Florida as it was reported as having the highest four pedestrian incident locations in the country. Many pedestrian sidewalks in Florida are not continuous and there is a concern among planners and engineers in the Florida Department of Transportation (FDOT) that these gaps constitute discontinuity of flow and are potentially posing threats to pedestrian safety. This paper investigates the correlation between pedestrian safety and sidewalk gaps within the Central Florida region. A sidewalk gap is defined as a length of a roadway segment with missing or absent sidewalk between existing sidewalks (before and after) along the same segment. “Missing” sidewalks are locations where the sidewalk is not only absent, but there is a desire to have one constructed or it would be used if it were constructed. The missing sidewalk can be on one side of the road or both sides. A wide array of Geographic Information Systems (GIS) information associated with the sidewalk gaps and the safety data were secured by FDOT. The data included all the Roadway Characteristics Inventory (RCI) within the district. Crash data combined with other geometric design data, traffic data, and census data were used to develop a statistical model. The results showed that absence of sidewalk along roadway segments is one of the main factors that have significant impact on the expected number of pedestrian crashes at a specific location. Other factors included daily traffic volumes, roadway category, specifically along urban two-way divided and undivided arterials with four to six lanes as well as the population within half-mile radius surrounding the crash location. The model results revealed that the Incident Risk Ratio (IRR) of a pedestrian crash along roadways with no sidewalk is 1.67 times greater than the likelihood of a crash with the presence of a sidewalk at 95% Confidence Interval (C.I.). The analysis also concluded that the likelihood of a pedestrian crash per mile along roadways with no sidewalk is three times greater than the likelihood of a crash per mile with the presence of a sidewalk.

Examining Social Vulnerability and the Association With COVID-19 Incidence in Harris County, Texas.

Studies have investigated the association between social vulnerability and SARS-CoV-2 incidence. However, few studies have examined small geographic units such as census tracts, examined geographic regions with large numbers of Hispanic and Black populations, controlled for testing rates, and incorporated stay-at-home measures into their analyses. Understanding the relationship between social vulnerability and SARS-CoV-2 incidence is critical to understanding the interplay between social determinants and implementing risk mitigation guidelines to curtail the spread of infectious diseases. The objective of this study was to examine the relationship between CDC's Social Vulnerability Index (SVI) and SARS-CoV-2 incidence while controlling for testing rates and the proportion of those who stayed completely at home among 783 Harris County, Texas census tracts. SARS-CoV-2 incidence data were collected between May 15 and October 1, 2020. The SVI and its themes were the primary exposures. Median percent time at home was used as a covariate to measure the effect of staying at home on the association between social vulnerability and SARS-CoV-2 incidence. Data were analyzed using Kruskal Wallis and negative binomial regressions (NBR) controlling for testing rates and staying at home. Results showed that a unit increase in the SVI score and the SVI themes were associated with significant increases in SARS-CoV-2 incidence. The incidence risk ratio (IRR) was 1.090 (95% CI, 1.082, 1.098) for the overall SVI; 1.107 (95% CI, 1.098, 1.115) for minority status/language; 1.090 (95% CI, 1.083, 1.098) for socioeconomic; 1.060 (95% CI, 1.050, 1.071) for household composition/disability, and 1.057 (95% CI, 1.047, 1.066) for housing type/transportation. When controlling for stay-at-home, the association between SVI themes and SARS-CoV-2 incidence remained significant. In the NBR model that included all four SVI themes, only the socioeconomic and minority status/language themes remained significantly associated with SARS-CoV-2 incidence. Community-level infections were not explained by a communities' inability to stay at home. These findings suggest that community-level social vulnerability, such as socioeconomic status, language barriers, use of public transportation, and housing density may play a role in the risk of SARS-CoV-2 infection regardless of the ability of some communities to stay at home because of the need to work or other reasons.