General Population Level Research Articles

Geospatial clustering of auto-antibodies against apolipoprotein A-1, heavy metals, cardiovascular and liver diseases in the general population

Abstract Aims Heavy metals (HM) are combustion-related environmental factors predisposing to cardiovascular (CVD), autoimmune and liver diseases, even below regulatory concentrations. Pro-atherogenic and pro-steatotic auto-antibodies against apolipoprotein A1 (AAA1) are prevalent in the general population for unclear reasons. We explored a putative interplay between HM exposure, AAA1, CVD risk factors and a non-alcoholic fatty liver disease (NAFLD) risk score, using a geospatial clustering approach at the general population level. Methods Getis-Ord, Moran I2 clustering and geographically weighted regression (GWR) geosptatial analyses were carried out on 6361 individuals recruited in the CoLaus/PsyCoLaus general population cohort. Geospatial dependences between serum AAA1, urinary HM (cadmium, arsenic, cobalt) concentrations, SCORE2 CVD risk, and fatty liver index (FLI) were assessed. Results Cadmium and cobalt were found to be associated with higher SCORE2 risk (p<0.04). AAA1 were associated with higher cadmium, cobalt, and cigarette consumption, independently of SCORE2 (p<0.04). AAA1 hotspots overlapped significantly with those of cadmium and FLI, independently of SCORE2. According to GWR, correlations between cadmium and AAA1 were the highest in railways proximity regions, increasing up to 10-fold compared to global associations. AAA1 were not associated with other HM. Conclusions These geospatial footprints highlight independent associations between Cadmium, AAA1, and NAFLD risk score in the general population. We hypothesize that environmental cadmium exposure may facilitate the occurrence of AAA1 in humans. Ongoing experimental studies will confirm/refute a possible causal link. Whether AAA1 could represent an early biological signature of cadmium exposure and subsequent health hazards remains to be shown.

Wellbeing Impact Study of High-Speed 2 (WISH2): Protocol for a mixed-methods examination of the impact of major transport infrastructure development on mental health and wellbeing.

Although research has demonstrated that transport infrastructure development can have positive and negative health-related impacts, most of this research has not considered mental health and wellbeing separately from physical health. There is also limited understanding of whether and how any effects might be experienced differently across population groups, whether this differs according to the stage of development (e.g. planning, construction), and how changes to planned infrastructure may affect mental health and wellbeing. This paper presents a protocol for the Wellbeing Impact Study of HS2 (WISH2), which seeks to address these questions using a high-speed rail development in the UK as an applied example. WISH2 is a 10-year, integrated, longitudinal, mixed-methods project using general practices (primary medical care providers in the UK) as an avenue for participant recruitment and for providing a geographically defined population for which aggregated data on mental health indicators are available. The research comprises: (i) a combined longitudinal and repeated cross-sectional cohort study involving multiple waves of survey data collection and data from medical records; (ii) longitudinal, semi-structured interviews and focus groups with residents and community stakeholders from exposed areas; (iii) analysis of administrative data aggregated at the general practice population level; and (iv) health economic analysis of mental health and wellbeing impacts. The study findings will support the development of strategies to reduce negative impacts and/or enhance positive mental health and wellbeing impacts of high-speed rail developments and other large-scale infrastructure projects.

Changes in alcohol intake and serum urate changes: longitudinal analyses of annual medical examination database

IntroductionDespite the established cross-sectional association between alcohol intake and serum urate (SU), its longitudinal association remains unknown. This study aimed to determine whether changes in alcohol intake have a clinically...

Comparative Analysis of Mortality Rates among Morbidly Obese Individuals: A Study of Patients Undergoing Bariatric Surgery, Nonsurgical Morbidly Obese Individuals, and the General Population

Introduction: Mortality decreases following bariatric surgery. We explored the extent of the reduction and whether or not it reaches the general population level in a large cohort of patients with obesity. This study aimed to compare all-cause mortality between patients with obesity who undergo bariatric surgery and those who do not, with the general Iranian population during the same period. Method: Data from Iran’s National Obesity Surgery Database were used to establish a large cohort of patients registered between 2009 and 2019. The current vital status of the patients was determined by utilizing post-surgery follow-up data for those who underwent the operation. For patients without a surgery record, a predefined checklist was filled out through telephone interviews. Death data from the National General Registrar’s office were obtained for all cohort members. Results: Of 13,313 cohort members, 12,915 were eligible for analysis. The median age at the first visit was 38 years, and 78% were women. 6,190 patients (47.9%) underwent bariatric surgery, and 6,725 patients (52.1%) were not yet operated on at the time of analysis. We observed 139 deaths during 53,880 person-years follow-ups. The median follow-ups for operated-on and not operated-on groups were 4 and 4.8 years. The mortality rates among nonoperated patients were 2.89 times higher (standardized mortality ratio [SMR] = 2.89, 95% CI: 2.36–3.53) than those in the general population, while in operated patients, the mortality rate decreased to 1.82 as high (SMR = 1.82, 95% CI: 1.34–2.46). Conclusion: The risk of death has been diminished in the operated-on group. It still remains considerably higher than the risk in the general population.

Prevalence and associations of poor mental health in the third year of COVID-19: U.S. population-based analysis from 2020 to 2022

BackgroundPoorer mental health was found early in the COVID-19 pandemic, yet mental health in the third year of COVID-19 has not been assessed on a general adult population level in the United States. MethodsWe used a nationally representative cross-sectional survey (Health Information National Trends Survey, HINTS 5 2020 n = 3,865 and HINTS 6 2022 n = 6,252). The prevalence of poor mental health was examined using a Patient Health Questionnaire-4 scale in 2020 and 2022. We also investigated the factors associated with poor mental health in 2022 using a weighted multivariable logistic regression adjusting for sociodemographic and health status characteristics to obtain the odds ratio (OR). OutcomesThe prevalence of poor mental health in adults increased from 2020 to 2022 (31.5% vs 36.3 %, p = 0.0005). U.S. adults in 2022 were 1.28 times as likely to have poor mental health than early in the pandemic. Moreover, individuals with food insecurity, housing instability, and low income had greater odds of poor mental health (ORs=1.78–2.55). Adults who were females, non-Hispanic Whites, or age 18–64 years were more likely to have poor mental health (ORs=1.46–4.15). InterpretationMental health of U.S. adults worsened in the third year of COVID-19 compared to the beginning of the pandemic.

Therapeutic Results and Survival of Patients with Myelofibrosis Treated with Ruxolitinib-A Real-Life Longitudinal Study.

The aim of this study was to analyze the therapeutic results and survival of patients with myelofibrosis treated with ruxolitinib in comparison with a group on standard therapy. It is a cross-sectional, retrospective, non-interventional, real-life study that was performed between January 2000 and February 2023. Patients treated between 2000 and 2016, before the introduction of ruxolitinib, constituted the control group (n = 45), while those treated after May 2016, after ruxolitinib inclusion, constituted the active group (n = 66). Demographic characteristics, clinical indicators, the severity of the disease, and survival were explored using Kaplan-Meier survival analyses. Spearman's correlation, linear regression, and other statistical analyses were performed. According to the Kaplan-Meier analysis, there was a 75.33% reduction in the fatality risk in the sample. On a general-population level, the fatality risk in the group treated with ruxolitinib varied between 7.9% and 77.18% compared to that of the risk in the control group. There was a decrease in blood parameters (leukocytes, hemoglobin, and platelets) and spleen size. During the first six months, the spleen size of the patients on ruxolitinib decreased by 6%, and during the second six months, it decreased by another 9%. This study shows that patients in a real-life clinical setting treated with ruxolitinib exhibited improved clinical signs of the disease, had a lower symptom severity, and survived longer than patients on standard therapy before ruxolitinib's entrance into the national market. The improvements correlate with those reported in randomized clinical trials.

Association between cumulative psychosocial adversity in the family and ADHD and autism: a family-based cohort study

Cumulative exposure to psychosocial adversity at an early age has been shown to be a risk factor for attention-deficit hyperactivity disorder (ADHD) and autism that often co-occur. However, it is not clear if this association reflects a causal effect or familial confounding. We aimed to assess whether cumulative psychosocial adversity in the family increases the risk for ADHD and autism in offspring while accounting for unmeasured familial confounding. We used a population-based cohort of 1,877,901 individuals born in Sweden between 1990 and 2009. Participants were followed from the age of 3 until 2013, with a median follow up time of 13.8 years. We created a cumulative index based on 7 psychosocial adversity factors. We used Cox regression to estimate the hazard ratios (HRs) relating neurodevelopmental conditions to cumulative psychosocial adversity. To address familial confounding, the analyses were repeated in groups of relatives of different kinship: siblings and half-siblings and cousins. A dose-response relationship was observed between cumulative exposure to psychosocial adversity and ADHD at a general population level (covariate adjusted HRs (aHRs) with 95% confidence intervals ranged from 1.55 [one adversity; 1.53–1.58] to 2.65 [ ≥ 4 adversities; 1.98–3.54]). No clear dose-response relation was seen for autism (aHRs ranged from 1.04 [.59–1.84] to 1.37 [1.30–1.45]). HRs of ADHD and autism decreased with increasing level of kinship in the analysis of relatives. Cumulative exposure to psychosocial adversity was associated with both ADHD and autism in the general population, these associations were partly explained by unmeasured familial confounding between relatives. This highlights the need for using family-based designs in studies of psychosocial adversity and ADHD and autism.

The NAFLD burden on mortality and morbidities in general population: A community-based longitudinal study (NASH-CO study).

The impact of non-alcoholic fatty liver disease (NAFLD) on morbidity and mortality has yet to be documented at the general population level. This study aimed to assess whether NAFLD was associated with morbidities and mortality and to estimate its impact on health status and mortality. The study population consisted of 137 206 participants from Constances cohort. Non-invasive diagnosis of NAFLD and advanced fibrosis was performed using the fatty liver index and Forns index, respectively. Constances data were linked to health care and hospitalization data to identify liver-related events, cardiovascular diseases (CVD), extrahepatic cancers (EHC), chronic kidney disease (CKD) and all-cause mortality. The prevalence of NAFLD was 18.3% in subjects without other chronic liver diseases, among whom 2.7% had fibrosis. NAFLD after IPTW-weighted remained associated with an increased risk of death (HR 1.26, 95% CI 1.01-1.57), hepatic-related complications (HR 2.48, 95% CI 1.99-3.29), CVD (HR 1.42, 95% CI 1.30-1.55), EHC (HR 1.11, 95% CI 1.01-1.28) and CKD (HR 1.81, 95% CI 1.53-2.07) compared to those without chronic liver diseases risk factors (Non-NAFLD). In the trend analysis over the study period of inclusion and compared to Non-NAFLD, NAFLD has shown a fastest growing cause of hepatic events (HR 1.38, 95% CI 1.07-1.76 per year), CVD (HR 1.08, 95% CI 1.03-1.12), CKD (HR 1.16, 95% CI 1.07-1.25), and death (HR 1.39, 95% CI 1.39-1.50). This large community-based cohort showed that NAFLD was associated with excess morbidity and mortality and demonstrated a fastest-growing trend.

Possiamo ottenere un cambiamento dello stile di vita significativo e stabile nel tempo?

Lifestyle is universally considered a fundamental issue in the preven¬tion and therapy of both type 2 diabetes and metabolic syndrome. However, implementation at a general population level of recom¬mendations resulting from available evidence is largely insufficient. In particular, only a limited fraction of the general population meets the recommended levels of aerobic physical activity, and individuals meeting the recommended levels of resistance physical activity are even less. Interestingly, there is further reduction in these proportions in subjects with prediabetes and especially in those with type 2 diabe¬tes. It is noteworthy that people with or at risk for diabetes represent a significant proportion of the general population, show objective evi¬dence of impaired exercise capacity, for different mechanisms, and fre¬quently have long-standing sedentary habits, difficult to be changed. All these aspects should be taken into account, when designing in-tervention programs aimed at improving the current situation. As re¬gards the possibility of a stable increase in physical exercise levels and reduction in sedentary habits of individuals with diabetes, available data are limited. However, they indicate that it is possible to improve these aspects in a significant proportion of subjects. Behavioral chan¬ges reported in studies are generally smaller than the prefixed impro¬vements, but sufficient to obtain favorable and clinically significant effects. Interventions applied in these programs show several shortco¬mings, indicating the need for a continuous revision of strategies.

Investigating the capacity of Australian drug information systems to detect changes in anabolic-androgenic steroid use and harms

ObjectiveThe objective of this study was to explore the capability of drug information and surveillance systems to detect and monitor trends in steroid use in Australia. MethodSurveys and systems from Australia were reviewed. Information such as the main purpose of the survey, frequency and method of data collection, population surveyed, capacity to collect information on steroid use, and prevalence of use in the target population was collected. FindingsSix surveys were identified. Two of the largest surveys are conducted at a general population level and approximately triennially, with the others conducted annually. Each is designed for a specific purpose and targets a specific group. Each has, to some extent, the capacity to collect information on steroid use. One survey (the Australian Needle and Syringe Programme Survey) is not designed to collect information on drug use per se yet appears to be the best at capturing potential changes in steroid use. ConclusionsAustralia does not have a survey able to detect an increase in steroid use. The one survey which provides the most readily available annual data regarding use and harm is not designed specifically for this purpose. Previous recommendations to annually monitor steroids have not been implemented.

Examining the level and distribution of catastrophic health expenditure from 2013 to 2018: A province-level study in China

Since 2018, 96.8% of China's population has received universal health coverage; however, changes in the general population's level and distribution of catastrophic health expenditure (CHE) remain unclear. This study aims to quantify the incidence and intensity of CHE by adopting a multistage stratified random sampling procedure that used a threshold of 25% of non-food household expenditures. We use the concentration index to measure the extent of inequality in CHE. Furthermore, logistic regression was applied to identify the sociodemographic and economic determinants of CHE, thereby revealing that the incidence and intensity of CHE increased between 2013 and 2018. A greater concentration of CHE was identified in low-income households. Our results imply that expanding the existing public health insurance benefit packages and introducing universal supplementary private insurance to more population segments is necessary.

The National Clinical Care Commission Report to Congress: Recommendations to Better Leverage Federal Policies and Programs to Prevent and Control Diabetes.

The National Clinical Care Commission (NCCC) was established by Congress to make recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. It held 12 public meetings, solicited public comments, met with numerous interested parties and key informants, and performed comprehensive literature reviews. The final report, transmitted to Congress in January 2022, contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care. At the general population level, the NCCC recommended that the federal government adopt a health-in-all-policies approach so that the activities of non-health-related federal agencies that address agriculture, food, housing, transportation, commerce, and the environment be coordinated with those of health-related federal agencies to affirmatively address the social and environmental conditions that contribute to diabetes and its complications. For individuals at risk for type 2 diabetes, including those with prediabetes, the NCCC recommended that federal policies and programs be strengthened to increase awareness of prediabetes and the availability of, referral to, and insurance coverage for intensive lifestyle interventions for diabetes prevention and that data be assembled to seek approval of metformin for diabetes prevention. For people with diabetes and its complications, the NCCC recommended that barriers to proven effective treatments for diabetes and its complications be removed, the size and competence of the workforce to treat diabetes and its complications be increased, and new payment models be implemented to support access to lifesaving medications and proven effective treatments for diabetes and its complications. The NCCC also outlined an ambitious research agenda. The NCCC strongly encourages the public to support these recommendations and Congress to take swift action.

Mastocytosis: retrospective analysis of maculopapular cutaneous form

Introduction. The article presents the data of a retrospective analysis of the debut and clinical manifestations of the types of maculopapular cutaneous mastocytosis (МPCM) in 96 children, and the frequency of non-regression of skin rashes with age in 33 adults. Aim. To conduct a retrospective analysis of the onset, clinical manifestations and dynamics of maculopapular cutaneous mastocytosis (MPCM). Materials and methods. Outpatient records of 96 children and 33 adults, who were treated and monitored at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, were statistically analyzed. Results. Monomorphic type of MPCM was diagnosed in 28 (29.2%) patients, polymorphic – in 68 (70.8%) patients. In 92.6% of children with a polymorphic type and in 35.7% with a monomorphic type, the rash debuted at the age of two years. The clinical picture of the monomorphic type was dominated by multiple small brown or yellow-brown spots. Rashes in the polymorphic type were spread, represented by brown or reddish-brown spots, papules, plaques ranging in size from several millimeters to several centimeters. The positive phenomenon of Unna-Darier was determined in 82.3% of cases. In patients with polymorphic type, the general population level of tryptase (<11.4 µg/l) was determined significantly more often than in patients with monomorphic type (p < 0.05). Elevated tryptase level was found in 53.6% of children and 69.7% of adults with monomorphic rashes. Pruritus was the most common cutaneous symptom, occurring in 49.0% of children. Bullous eruptions developed only in patients with polymorphic type. The most frequently reported systemic manifestations were gastrointestinal symptoms and headaches. Conclusions. The obtained results suggest that patients with early onset of the disease with polymorphic and variable lesions show a more favorable outcome.

Hepatitis B, C and human immunodeficiency virus knowledge among the general greek population: results from the Hprolipsis nationwide survey

BackgroundAlthough several studies on hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV) infection have been conducted in Greece, little is known on the knowledge level of the Greek population towards these three infections. Our aim was to assess the knowledge level of the adult Greek general population about the HBV, HCV and HIV.MethodsData were derived from the first general population health survey, Hprolipsis. The sample was selected by multistage stratified random sampling. A standardized questionnaire was administered by trained interviewers during home visits. A knowledge score was constructed based on responses to 17 per infection selected items and categorized in three levels; high (12–17 correct replies) medium (6–11) and low (0–5). Among 8,341 eligible individuals, 6,006 were recruited (response rate: 72%) and 5,878 adults (≥ 18 years) were included in the analysis. The statistical analysis accounted for the study design.ResultsOnly 30.4%, 21.6%, and 29.6% of the participants had a high overall knowledge level of HBV, HCV and HIV, respectively. These low percentages were mainly attributed to the high levels of misconception about transmission modes (65.9%, 67.2%, and 67.9%, respectively). Results showed that increasing age and living out of the big metropolitan cities were associated with decreased odds of having higher knowledge. Female gender, higher education level, higher monthly family income, higher medical risk score, history of testing and being born in Greece or Cyprus, were associated with increased odds of having higher knowledge.ConclusionsThere are significant knowledge gaps in the Greek general population regarding modes of transmission, preventive measures and treatment availability for HBV, HCV and HIV. There is an urgent need for large scale but also localized awareness activities targeted to less privileged populations, to fill the gaps in knowledge and increase population engagement in preventive measures.

Consent form, the highest ethical standard in creating DNA databases for criminal investigation

Preparation of DNA databases for the purpose of criminal investigation opens discussions about ethical-legal issues concerning violation of human rights. The practice shows that one of the human rights that can be misused while creating such a database is the right to freedom, the freedom to make a decision. When preparing DNA databases, the right to freedom refers to free decision of the person to be sampled for carrying out the test. The right to freedom and respect to self-determination of the person implies the necessity of prior consent of the subject when preparing a database on general population level. This is not a case when databases are created from persons under investigation for committing a crime, who are compulsory subjected for obtaining samples for DNA analysis. Legal regulations approve the duty of the police and its authorization in collecting samples for personal or criminalistic identification, analyzing, keeping and eliminating collected personal information when criminal prosecution is concerned. In these cases, consent form from the subject is not necessary. However, we should be aware that the process of taking and collecting of personal information by the national institutions can have direct impact of privacy of the subject, no matter if this information is going to be used or not. In purpose of fair balance between public and private interest, consent form can be redefined and the person from whom the biological material is provided will be unequivocally made aware of the purposes for which his genetic data will be used, how long his DNA will undergo further automated processing, and about the procedure and under what conditions his DNA profile can be removed from the national DNA databases.

Clinical and Epidemiological Characteristics of Acute Hepatitis B with Delta agent in Kyrgyzstan, 1999-2018

Purpose of the research: study of clinical and epidemiological characteristics of Acute Hepatitis B with Delta agent (AHD) in Kyrgyzstan. Materials and Methods: State Reporting Forms No. 1 “Report on infectious and parasitic disease” for 1999-2018 were reviewed. The data of 115 patients with AHD were analyzed, who received inpatient treatment in 2000-2018, Bishkek. The data was processed by Epi Info 3.8.1. Results. In Kyrgyzstan, only AHD 129 cases (0,12 ‰00) were detected for the reviewed period, which was 97,7 times lower than the incidence of Delta free Acute Hepatitis B (AHB). Over the rime, the AHD incidence rate has decreased by 14,6 times with a base rate of decline at the level of 6,8%. The cumulative average AHD incidence in men was 2,4 times higher compared to women (0,17 ‰00 and 0,07 ‰00 , men and women, respectively) and 1,4 times higher compared to the general population level. Analysis of clinical and laboratory data of 115 AHD patients indicated that the disease was associated with medical interventions in 61,7% ± 4,5 patients (71/115). The most frequently reported causes of infection were surgical and dental interventions (50,7% ± 5,9 and 35,2% ± 9,5, respectively). Of the analyzed 109 cases in the age group 16+, 60 patients (55%) had AHD as co-infection, and 49 (45%) - as superinfection. 30% of patients (33/109) had a severe course, which was twice as common in patients with superinfection (43%, 21/49). Conclusion: The low incidence of AHD with the still high prevalence of hepatitis B in the country, the presence of AHD “superinfection” in half of the observed patients with HBsAg-positive status does not reflect the true epidemiological situation and indicates the need to examine all patients with AHV for hepatitis D in order to exclude underdiagnoses. The more severe course of AHD superinfection, compared with co-infection, requires increased prevention and clinical surveillance of patients with chronic HB.

The level of public awareness of cancer in Hail, Saudi Arabia.

Cancer is a group of diseases characterized by uncontrolled cell division of abnormal cells that can result in death if not treated well. Cancer is considered to be a leading cause of mortalities throughout the globe and an important barrier to increase life span. This study was conducted to assess awareness among graduates studying in university of Hail related to cancer. This is an online survey-based study conducted using online tool "Google Forms". The inclusion criteria were that the participants should understand Arabic, must have 18 years or above age and currently living or a permanent resident of Hail city. Total 108 valid responses were included in this analysis, 56 were male and 52 were female participants. Around 106 of the participants were Saudi nationals among which 62 were the permanent resident of the Hail city and 46 were migrants which were not the permanent resident but moved into the city for the purpose of education or business. There was significant association between awareness level of individuals regarding cancer associated symptoms including weight loss, fatigue, inflammation and hair loss and common causes of cancers, including family history, radiation exposure, smoking, obesity, aging and fast-food exposure. However, there was no significance between awareness of cancer and other factors, including age, gender, marital status, education, nationality, residence and monthly income. Overall our study reveals that there is significant knowledge among Hail population but still there is a need to increase awareness level of general population to manage the disease more efficiently.

Anemia and thrombocytopenia in HIV-positive pregnant women

BACKGROUND: During pregnancy and childbirth, anemia and thrombocytopenia are twice as common among HIV-positive women as in the general population. It has not been yet clear to what extent HIV affects the incidence of cytopenias, therefore, the correlation between the incidence and the HIV RNA level and CD4 count in HIV-positive pregnant women, as well as the role of antiretroviral therapy, requires further study.
 AIM: The aim of this study was to assess the effect of the HIV RNA level and CD4 count on the frequency of anemia and thrombocytopenia in HIV-positive pregnant women.
 MATERIALS AND METHODS: In this study, we analyzed social and demographic features, epidemiological personal history data, the frequency of pregnancy and delivery complications, and the timing of the initiation of antiretroviral therapy in 303 HIV-positive pregnant women, as well as the data of screening for HIV infection of their children. The study included 27 mother-child pairs with perinatal HIV transmission and 276 mother-child pairs without mother-to-child transmission of HIV. All pregnant women were divided into groups depending on the CD4 count and HIV RNA level. A comparative analysis of anemia and thrombocytopenia frequencies was carried out in the study groups.
 RESULTS: A direct correlation was revealed between the frequency of anemia and thrombocytopenia in HIV-positive pregnant women and markers of HIV infection: severe immunodeficiency (CD4 200 cells/l, p 0.01) and high HIV RNA levels (more than 100,000 copies / ml, p 0.01) in peripheral blood.
 CONCLUSIONS: We confirmed the high frequency of cytopenias in HIV-positive pregnant women, which exceeds the general population level. In addition, we demonstrated the effectiveness of prescribing antiretroviral therapy among women of reproductive age who planned to become pregnant or did not exclude the possibility of pregnancy (who did not use the effective methods of contraception), as a means of anemia and thrombocytopenia prevention during pregnancy.

How Risky Are Risk Factors? An Analysis of Prenatal Risk Factors in Patients Participating in the Congenital Upper Limb Differences Registry

PurposeRisk factors for congenital upper limb differences (CoULDs) are often studied at the general population level. The CoULD registry provides a unique opportunity to study prenatal risk factors within a large patient sample.MethodsAll patients enrolled between June 2014 and March 2020 in the prospective CoULD registry, a national multicenter database of patients diagnosed with a CoULD, were included in the analysis. We analyzed self-reported, prenatal risk factors, including maternal smoking, alcohol use, recreational drug use, prescription drug use, gestational diabetes mellitus (GDM), and gestational hypertension. The outcome measures included comorbid medical conditions, proximal involvement of limb difference, bilateral involvement, and additional orthopedic conditions. Multivariable logistic regression was used to analyze the effect of the risk factors, controlling for sex and the presence of a named syndrome.ResultsIn total, 2,410 patients were analyzed, of whom 72% (1,734) did not have a self-reported risk factor. Among the 29% (676) who did have at least 1 risk factor, prenatal maternal prescription drug use was the most frequent (376/2,410; 16%). Maternal prescription drug use was associated with increased odds of patient medical comorbidities (odds ratio [OR] = 1.43, P = .02). Gestational diabetes mellitus was associated with increased odds of comorbid medical conditions (OR = 1.58, P = .04), additional orthopedic conditions (OR = 1.51, P = .04), and proximal involvement (OR = 1.52, P = .04). Overall, reporting 1 or more risk factors increased the odds of patient comorbid medical conditions (OR = 1.42, P < .001) and additional orthopedic conditions (OR = 1.25, P = .03).ConclusionsMost caregivers (72%) did not report a risk factor during enrollment. However, reporting a risk factor was associated with patient medical and orthopedic comorbidities. Of note, GDM alone significantly increased the odds of both these outcome measures along with proximal limb differences. These findings highlight the ill-defined etiology of CoULDs but suggest that prenatal risk factors, especially GDM, are associated with a higher degree of morbidity.Type of study/level of evidencePrognostic III.

A Study to Assess the Perception Level of General Population Regarding Preventive Healthcare, with Special Reference to Vadodara District

Introduction to Preventive Health Care: The goal of preventative care is to lower disease burden and risk factors. To slow down the ageing process, preventive measures can be used at any stage of life or disease. Chronic diseases are generally known to be the leading causes of death and disability worldwide. As part of community health, preventative care is promoted, which includes clinical and screening services. One method for reducing consumption and improving health is to identify and prevent downstream concerns. Research Objectives: The researchers attempted to determine the general public’s perception of preventative healthcare, with a focus on Vadodara district. The study also assessed the people’s perception level towards preventive healthcare with reference to the Vadodara district. Research Methodology and Research Design: The present study is a cross-sectional survey. The respondents were determined via convenience sampling, utilizing the non-probability component, based on the sample size, from Vadodara District. Results and Findings: The study concluded that some people believe preventive healthcare to be vital, yet they do nothing about it. Only 41.1% of the respondents had health insurance, and the rest do not have any health insurance coverage. Respondents’ age and gender had no bearing on their perception level. Scope of Future Study: All of the characteristics used to determine the population’s perception level have been shown to be useful and can be used in future research. Acknowledgement: My thanks and appreciation goes to my co-authors in developing the academic research project.