Matched Case Control Study Design Research Articles

Genome-wide 5-hydroxymethylcytosines in circulating cell-free DNA as noninvasive diagnostic markers for gastric cancer.

5-Hydroxymethylcytosine-enriched gene profiles and regions show tissue-specific and tumor specific. There is a potential value to explore cell-free DNA 5-hydroxymethylcytosine feature biomarkers for early gastric cancer detection. A matched case‒control study design with 50 gastric cancer patients and 50 controls was performed to sequence the different 5-hydroxymethylcytosine modification features of cell free DNA. Significantly differential 5-hydroxymethylcytosine modification genes were identified to construct a gastric cancer diagnostic model. Data set from GEO was used as an external testing set to test the robustness of the diagnostic model. Accounting for more than 90% of 5-hydroxymethylcytosine peaks were distributed in the gene body in both the gastric cancer and control groups. The diagnostic model was developed based on five different 5-hydroxymethylcytosine modification genes, FBXL7, PDE3A, TPO, SNTG2 and STXBP5. The model could effectively distinguish gastric cancer patients from controls in the training (AUC = 0.95, sensitivity = 88.6%, specificity = 94.3%), validation (AUC = 0.87, sensitivity = 73.3%, specificity = 93.3%) and testing (AUC = 0.90, sensitivity = 81.9%, specificity = 90.2%) sets. The risk scores of the controls from the model were significantly lower than those of gastric cancer patients in bothour own data (P < 0.001) and GEO external testing data (P < 0.001), and no significant difference between different TNM stage patients (P = 0.09 and 0.66). Furthermore, there was no significant difference between the healthy control and benign gastric disease patients in the testing set from GEO (P = 0.10). The characteristics of 5-hydroxymethylcytosine in cell free DNA are specific to gastric cancer patients, and the diagnostic model constructed by five genes' 5-hydroxymethylcytosine features could effectively identify gastric cancer patients.

The association between living alone, loneliness and suicide mortality and effect modification by age: A case:control study

BackgroundSocial isolation is a potentially reversible risk factor for suicide. MethodsA matched case control study design was used. The study population was from England and identified from an electronic primary case database with linkage to a secondary care database and Office for National Statistics mortality data. Cases were individuals who had been recorded as dying by suicide. Controls were randomly selected, matched by primary care centre and date of suicide mortality. ResultsData were available from 14,515 cases who died from suicide and 580,159 controls. After adjustment for age and sex, the risk of suicide in individuals who had previously been reported to be either living alone or suffering loneliness was increased (Odds ratio OR 4.9; 95 % confidence intervals CI: 4.4 to 5.5). Age affected the level of this risk, with individuals aged 15 to 34 years who were lonely or lived alone having a much higher risk of suicide (OR 16.4; 95 % CI: 8.7 to 31.1). LimitationsWe can demonstrate an association between loneliness and living alone, but this may not be a causal effect. The conclusions may not be generalisable to societies outside the UK. ConclusionsLoneliness and social isolation are associated with an approximately five-fold increase in risk of mortality from suicide, which was substantially higher in younger adults. These represent potentially reversible risk factors for suicide mortality and may also help identify individuals who are at a higher risk of suicide.

Preoperative and postoperative memory in epilepsy patients with ‘gliosis only’ versus hippocampal sclerosis: a matched case–control study

BackgroundGliosis only (GO) and hippocampal sclerosis (HS) are distinct histopathological entities in mesial temporal lobe epilepsy. This study explores whether this distinction also exists on a functional level when evaluating...

Risk factors for opioid toxicity requiring naloxone rescue in adults: a case-control study.

Opioid-induced sedation and respiratory depression (OSRD) is a potentially life-threatening side effect of opioid analgesia. However, little is known about the individual and clinical-related factors associated with OSRD in the New Zealand context. To identify risk factors for OSRD in patients admitted to a large regional health board in New Zealand-Auckland District Health Board (ADHB). A retrospective matched case-control study design was undertaken among adults who were admitted to ADHB and prescribed opioids in hospital between August 2015 and April 2020. Those who were prescribed opioids and received naloxone for OSRD were defined as cases, whereas those who received opioids but did not experience OSRD were identified as controls. Cases and controls were matched on a1:1 basis by age (± 10 years). Data were retrieved from the electronic medical records of ADHB. A conditional logistic regression model was used to identify the risk factors for OSRD. We identified 51 cases, and these were matched with 51 control patients. The odds of experiencing OSRD were four times higher among opioid-naïve patients compared to those exposed to opioids prior to hospital admission (OR  4.113; 95% CI 1.14-14.89). Increased risk of OSRD was also associated with higher serum creatinine level prior to OSRD episode (OR 1.015; 95% CI 1.01-1.03) and a higher oral morphine milligram equivalent (OME) (OR 1.023; 95% CI 1.01-1.04). Increased risk of OSRD was associated with a higher OME, a higher serum creatinine level prior to OSRD episode, and opioid naivety. Our findings can inform policies that aim to prevent serious adverse effects related to opioids.

Changes in access to community health services among rural areas affected and unaffected by hospital closures between 2006 and 2018: A comparative interrupted time series study.

Recent studies suggest that Federally Qualified Health Centers (FQHC) may be expanding their provision of primary care in rural communities that experience a hospital loss. Whether these trends are different from rural areas not being affected by rural hospital closures is unknown. Data included Centers for Medicare and Medicaid Services Provider of Services files, the Cecil G. Sheps hospital closure database, and American Community Survey estimates. Changes in straight-line distances to the nearest FQHC and rural health clinic (RHC) were compared between areas affected and unaffected by a rural hospital closure in a matched case control study design using an interrupted time series model. There was no instantaneous percentage point increase in FQHC (2.41, 95% CI -0.79 to 5.60, P .140) or RHC (3.27, 95% CI -1.12 to 7.67, P .144) access following hospital closures compared to changes in access occurring in other rural areas. On average, rural ZIP codes affected by hospital closures exhibited a 0.84 percentage point increase in FQHC access over time (95% CI 0.40-1.28, P .000), but similar trends were also found within unaffected ZIP codes classified as small rural areas. Rural areas impacted by hospital closures did not experience an increase in proximity to FQHCs or RHCs relative to changes in access occurring in other rural areas. Over time, most rural areas are seeing an increase in access to FQHCs and RHCs. Policies are needed to incentivize primary care providers to target geographic areas experiencing a hospital closure.

Determinants of fetal macrosomia among live births in southern Ethiopia: a matched case–control study

BackgroundFetal macrosomia defined as birth weight of 4000 g and above regardless of gestational age and associated with adverse maternal and fetal outcomes, especially among women in developing countries like Ethiopia. Despite the observed burden, there is limited evidence on determinants of fetal macrosomia. This study aimed to identify determinants of fetal macrosomia among live births at Wolaita Sodo town Southern Ethiopia.MethodsA facility-based matched case–control study design involved 360 singletons deliveries attended at hospitals in Wolaita Sodo town, southern Ethiopia, with 120 cases and 240 controls included. Cases and control were matched by maternal age. Cases were neonates with a birth weight of ≥ 4000, while controls were neonates with a birthweight between 2500gm and less than 4000gm. Data were collected by interviews, measuring, and reviewing mothers' medical documents. Conditional logistic regression analysis was carried to identify the independent predictor variables. Statistical significance was set using a p-value < 0.05 and 95% CI for AOR.ResultsMale neonates were four times more likely to be macrosomia than female neonates MAOR = 4.0 [95%CI; 2.25–7.11, p < 0.001]. Neonates born at gestational age ≥ 40 weeks were 4.33 times more likely to be macrosomia with MAOR = 4.33 [95%CI; 2.37–7.91, p < 0.001]. Neonates born from physically inactive mothers were 7.76 times more likely to be macrosomia with MAOR = 7.76 [95CI; 3.33–18.08, p < 0.001]. Neonates born from mothers who consumed fruits and dairy products in their diet frequently were 2 and 4.9 times more likely to be macrosomia MAOR = 2.03 [95%CI; 1.11–3.69, p = 0.021] and AOR = 4.91[95%CI; 2.36–10.23, p < 0.001] respectively.ConclusionMothers' physical exercise and consumption of fruit and dairy products were significant predictor variables for fetal macrosomia. Hence, health care providers may use these factors as a screening tool for the prediction, early diagnosis, and timely intervention of fetal macrosomia and its complications.

Transcriptional correlates of malaria in RTS,S/AS01-vaccinated African children: a matched case-control study.

In a phase 3 trial in African infants and children, the RTS,S/AS01 vaccine (GSK) showed moderate efficacy against clinical malaria. We sought to further understand RTS,S/AS01-induced immune responses associated with vaccine protection. Applying the blood transcriptional module (BTM) framework, we characterized the transcriptomic response to RTS,S/AS01 vaccination in antigen-stimulated (and vehicle control) peripheral blood mononuclear cells sampled from a subset of trial participants at baseline and month 3 (1-month post-third dose). Using a matched case-control study design, we evaluated which of these 'RTS,S/AS01 signature BTMs' associated with malaria case status in RTS,S/AS01 vaccinees. Antigen-specific T-cell responses were analyzed by flow cytometry. We also performed a cross-study correlates analysis where we assessed the generalizability of our findings across three controlled human malaria infection studies of healthy, malaria-naive adult RTS,S/AS01 recipients. RTS,S/AS01 vaccination was associated with downregulation of B-cell and monocyte-related BTMs and upregulation of T-cell-related BTMs, as well as higher month 3 (vs. baseline) circumsporozoite protein-specific CD4+ T-cell responses. There were few RTS,S/AS01-associated BTMs whose month 3 levels correlated with malaria risk. In contrast, baseline levels of BTMs associated with dendritic cells and with monocytes (among others) correlated with malaria risk. The baseline dendritic cell- and monocyte-related BTM correlations with malaria risk appeared to generalize to healthy, malaria-naive adults. A prevaccination transcriptomic signature associates with malaria in RTS,S/AS01-vaccinated African children, and elements of this signature may be broadly generalizable. The consistent presence of monocyte-related modules suggests that certain monocyte subsets may inhibit protective RTS,S/AS01-induced responses. Funding was obtained from the NIH-NIAID (R01AI095789), NIH-NIAID (U19AI128914), PATH Malaria Vaccine Initiative (MVI), and Ministerio de Economía y Competitividad (Instituto de Salud Carlos III, PI11/00423 and PI14/01422). The RNA-seq project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under grant number U19AI110818 to the Broad Institute. This study was also supported by the Vaccine Statistical Support (Bill and Melinda Gates Foundation award INV-008576/OPP1154739 to R.G.). C.D. was the recipient of a Ramon y Cajal Contract from the Ministerio de Economía y Competitividad (RYC-2008-02631). G.M. was the recipient of a Sara Borrell-ISCIII fellowship (CD010/00156) and work was performed with the support of Department of Health, Catalan Government grant (SLT006/17/00109). This research is part of the ISGlobal's Program on the Molecular Mechanisms of Malaria which is partially supported by the Fundación Ramón Areces and we acknowledge support from the Spanish Ministry of Science and Innovation through the 'Centro de Excelencia Severo Ochoa 2019-2023' Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.

Association Between Exposure of Children to General Anesthesia and Autism Spectrum Disorder

This study tested the hypothesis that exposure of children prior to their third birthday to procedures requiring general anesthesia is associated with an increased incidence of autism spectrum disorder (ASD) in later life. This study employed a nested, 1:2 matched-case control study design using ASD cases identified in a population-based birth cohort of children born in Olmsted County, MN from 1976 to 2000. Matching variables included sex, date of birth, and mother's age in conditional logistic regression including 499 ASD cases and 998 controls. After adjusting for birth weight and health status, there was no significant association between exposure and ASD (OR 1.27 [95% CI 0.92-1.76]), indicating that general anesthesia is not associated with an increased risk of ASD.

Risk Factors of Preterm Birth in Nepal: A Hospital-Based Matched Case-Control Study.

Background: Preterm birth is a significant cause of neonatal death globally. Nepal is in the 20th position in the world, with the highest rate of preterm deliveries. The risk factors of preterm birth have not been fully identified and established in Nepal. The study aims to identify risk factors of preterm birth among women who underwent delivery in a tertiary maternal hospital in Nepal.Methods: This study employed a hospital-based matched case-control study design. The case included women who delivered before 37 weeks of gestation, and women who delivered between 37 and 42 weeks of gestation served as controls. The ratio of the case to control was 1:2, and matching was done for the type of delivery. The first author collected the data in the Paropakar Maternity and Women's Hospital between December 2015 and January 2016. Face-to-face interviews were conducted using a structured questionnaire. Backward conditional logistic regression was performed to identify the independent risk factors of preterm birth.Results: Antihelminthic treatment during pregnancy was found to be protective for preterm birth. Women performing intensive physical work during their pregnancy and women exposed to indoor air pollution were more likely to have a preterm birth than women not performing intensive physical work and women not exposed to indoor pollution, respectively.Conclusions: Women who had not consumed antihelminthic drugs per protocol, those exposed to indoor air pollution, and those who performed intensive work during pregnancy were at higher risk for preterm birth. Maternal health programs can encourage women to consume antihelminthic drugs, take proper rest during pregnancy, and prevent indoor pollution exposure.

Association between learning and memory problems and health outcomes after blood or marrow transplantation (BMT): A BMT survivor study (BMTSS) report.

12014 Background: Cognitive impairment after BMT for hematologic malignancies typically involves processing speed, attention and working memory. Survivors perceive these deficits as learning and/or memory problems. However, limited information exists regarding learning/memory problems experienced by survivors several years after BMT. We addressed this gap using the BMTSS. Methods: BMTSS is a retrospective cohort study examining long-term outcomes of individuals who survived ≥2y after BMT performed between 1974 and 2014 at three transplant centers. Study participants completed a 255-item questionnaire covering diagnosis by a healthcare provider of health conditions (including learning/memory problems), sociodemographic characteristics, and functional status. We used a nested matched case-control study design. Cases consisted of individuals with learning/memory problems developing after BMT (n = 543). Each case was matched to a BMTSS participant without memory problems (controls: n = 543) using the following criteria: cancer diagnosis, race/ethnicity, type of BMT (allogeneic or autologous), and time from BMT. Multivariable conditional logistic regression analysis was used to identify clinical factors (age at BMT, stem cell source, chronic graft vs. host disease [cGvHD], total body irradiation [TBI], fatigue, pain) and demographic factors (household income, education, sex) associated with learning/memory problems. We also examined the association between learning/memory problems and instrumental activities of daily living (IADL). Analyses were stratified by type of BMT. Results: For all survivors (n = 1,086), mean age at BMT was 40.7y and at study participation was 53.3y (18-85); 47% of the study population was females; 78% were non-Hispanic whites; 31% reported an annual household income &lt; $50k. Primary diagnoses included leukemia (50%), lymphoma (36%), and other (14%); 55% received an allogeneic BMT (36% developed cGvHD); 54% received TBI; and 68% received peripheral blood stem cells. Allogeneic BMT survivors with fatigue (odds ratio [OR] = 2.2, 95% CI, 1.4-3.3; p = 0.001), significant pain (OR = 1.8, 95% CI, 1.1-2.9; p = 0.02) and &lt; college education (OR = 1.6, 95% CI, 1.1-2.5; p = 0.02) had higher odds of reporting learning/memory problems. Autologous BMT survivors exposed to TBI (OR = 2.8, 95% CI, 1.4-5.4; p = 0.003) and reporting significant pain (OR = 1.7, 95% CI, 1.0-2.9; p = 0.05) had higher odds of reporting learning/memory problems. Learning/memory problems were associated with increased odds of impairments in IADL in both autologous (OR = 2.1, 95% CI, 1.1-4.0; p = 0.03) and allogeneic (OR = 2.0, 95% CI, 1.2-3.3; p = 0.01) BMT survivors. Conclusions: Modifiable risk factors, such as fatigue and pain, can be targeted to mitigate the learning/memory problems and improve the functional outcomes of BMT survivors.

A case-control study of topical and supplemental fluoride use and osteosarcoma risk

BackgroundA relationship between fluoride and osteosarcoma has been hypothesized but not validated. To the authors’ knowledge, there are no published studies examining topical fluoride or dietary fluoride supplements and osteosarcoma risk. The purpose of this study was to examine the association between ever or never use of topical and dietary fluoride supplements and osteosarcoma. MethodsThe authors performed a secondary data analysis on data from 2 separate but linked studies. Patients for Phase 1 and Phase 2 were selected from US hospitals using a hospital-based matched case-control study design. Case patients were those who had received diagnoses of osteosarcoma, and control patients were those who had received diagnoses of other bone tumors or nonneoplastic conditions. In Phase 1, case patients (N = 209) and control patients (N = 440) were those seeking treatment at orthopedic departments from 1989 through 1993. In Phase 2, incident case patients (N = 108) and control patients (N = 296) were identified and treated by physicians from 1994 through 2000. This analysis included all patients who met eligibility criteria and on whom the authors had complete data on exposure, outcome, and covariates. The authors used conditional logistic regression to estimate odds ratios and 95% confidence intervals (CIs) for the association of topical fluoride use and supplemental fluoride use with osteosarcoma. ResultsThe adjusted odds ratios were 0.94 (95% CI, 0.60 to 1.46) and 0.78 (95% CI, 0.46 to 1.33) for topical fluoride and supplemental fluoride, respectively. ConclusionsNeither topical nor dietary fluoride supplements are associated with an increased risk of developing osteosarcoma. Practical ImplicationsSupplemental and topical fluorides used in the dental office and in over-the-counter products are not related to an increased risk of developing osteosarcoma.

Assessment of Pertussis Vaccine Protective Effectiveness in Children in the Amhara Regional State, Ethiopia.

Background Bordetella pertussis is a human pathogen which causes pertussis, or whooping cough. The diphtheria-tetanus-pertussis immunization has significantly reduced the morbidity and mortality of pertussis globally. However, higher prevalence and resurgence of pertussis cases among both vaccinated and unvaccinated people has raised questions on the effectiveness of pertussis vaccine over time. Therefore, the objective of this study was to assess the protective effectiveness of pertussis vaccine in the Amhara Regional State, Ethiopia. Methods A nested matched case-control study design approach was used with vaccinated individuals as cases and unvaccinated individuals as controls. The study was conducted from July 2018 to February 2019. Real-time (RT-) PCR assay was done to ascertain the presence of pertussis among clinically suspected patients. Bivariable and multivariable logistic regression analyses were computed to estimate the crude and adjusted odds ratios (ORs), respectively. Vaccine effectiveness was calculated as (1 − OR) × 100. Adjusted OR with 95% CI and a P value <0.05 were used to assess statistical significance. Results A total of 112 vaccinated and 223 unvaccinated controls were enrolled for the study. Of the total participants, 173/335 (51.6%) were males. The prevalence of pertussis among vaccinated was 35/112 (31.3%), whereas it was 84/223 (37.7%) among the control group. The adjusted matched vaccine protective effectiveness against B. pertussis infection following three doses of whole-cell vaccine was 25% among children aged between 6 and 9 years. Adjusted estimates of vaccine protective effectiveness for participants who had complete vaccination, stratified by time since last vaccination, were 50% at 6 years, 34% at 7 years, and 2% at 8–9 years since last vaccination. Conclusion Despite the availability and good coverage of childhood vaccination, the effectiveness of pertussis vaccine was found to be low in the Amhara region, Ethiopia. Moreover, we observed declining trends in the protective effectiveness of the vaccine after 6 years of vaccination. Thus, by considering the waning nature of immune response which is induced by whole-cell vaccine during early life, booster dose is highly recommended to optimize pertussis prevention and control strategies.

Association of Autoimmune Vasculitis and Incident Atrial Fibrillation: A Population-Based Case-Control Study.

BackgroundRecent investigations suggest that inflammation and autoimmunity might have a role in the pathophysiology of atrial fibrillation (AF). Given that abnormal ventriculovascular coupling often coexists with AF, we hypothesize that autoimmune vasculitis plays a significant role in the pathogenetic mechanism of AF.Methods and ResultsA standardized retrospective population‐based case–control study was conducted to evaluate the association between autoimmune vasculitis and AF, and all‐cause mortality. The study included 8459 patients with a new diagnosis of AF and 8459 age‐, sex‐, and registration calendar year–matched controls in Olmsted County, Minnesota, between January 1, 1980 and December 31, 2010. The association of each clinical characteristic, diagnosis, and treatment was assessed using conditional logistic regression to account for the matched case–control study design. Cox proportional hazards regression models and Kaplan‐Meier curves were used to detect independent predictors of mortality and examine cumulative survival. Of a total of 16 918 patients (mean age 72.3+14.4 years; 48.7% women), 320 (1.9%) were diagnosed with autoimmune vasculitis before the index date during the 30‐year period. Among the cases, the prevalence of any autoimmune vasculitis was 2.3%, whereas the frequency of autoimmune vasculitis in controls was 1.5% (P<0.001). After adjusting for potential confounders, the odds of autoimmune vasculitis in AF cases was 1.5 times higher than in controls (odds ratio, 1.47; 95% CI, 1.04–2.01; P=0.03). Patients with AF and autoimmune vasculitis had worse 5‐year survival than those without autoimmune vasculitis or AF (44.7% versus 77.2%; log‐rank P<0.001).ConclusionsAutoimmune vasculitis is significantly associated with AF and independently confers worse survival. These observations may represent one mechanism linking autoimmunity and inflammation to the pathogenesis and prognosis of AF.

Nested matched case control study for the Japan Fukushima Health Management Survey's first full-scale (second-round) thyroid examination.

Since Fukushima nuclear accident in 2011, thyroid ultrasound examinations have been conducted. The first full-scale examination detected 71 thyroid-cancer cases. This study examined whether radiation exposure was associated with thyroid-cancer incidence.Subjects were participants in the baseline screening and newborns during the 2011 fiscal year. Under nested matched case-control study design, 10 controls per each case were selected by matching the age, sex, baseline screening results, and interval between examinations. With 3 dose levels of external radiation: 1.3 + mSv (upper), 0.8 to 1.3 (middle), and 0.0 to 0.8 (reference), we applied 2 logistic models adjusting for 3 participation-proportions (primary, secondary, and fine-needle aspiratory cytology), overweight, and the B-result of baseline screening (Model 1), and past medical history, family history of thyroid cancer, and frequencies of eating seafood and seaweed in addition to the parameters in Model 1 (Model 2). We examined each model in 3 ways: (a) excluding subjects with a missing radiation exposure dose; and substituting (b1) median or (b2) mean dose of the municipality with missing dose.Odds ratios (ORs) of middle-dose exposure were (a) 1.35 (0.46-3.94), (b1) 1.55 (0.61-3.96), and (b2) 1.23 (0.50-3.03) for Model 1, and (a) 1.18 (0.39-3.57), (b1) 1.31 (0.49-3.49), and (b2) 1.02 (0.40-2.59) for Model 2. For upper-dose exposure, similar results were obtained. Past medical history was significantly associated (odds ratio  = 2.04-2.08) with both (b1) and (b2) in Model 2.No significant associations were obtained between the external radiation exposure and thyroid-cancer incidence.

Active Tobacco Smoking Impairs Cardiac Systolic Function

Tobacco smoking is a well-established risk factor for cardiovascular disease, but its direct effect on myocardial structure and function remains unclear. This study investigated the effects of smoking using a nested matched case-control study design. 5,668 participants of the UK Biobank study who underwent cardiovascular magnetic resonance imaging were screened for inclusion. 102 smokers (56 males) with a median age of 56 years were matched to non-smokers based on sex, age, and body surface area. Manual post-processing and feature tracking analyses were performed to determine left ventricular (LV) and right ventricular (RV) structure and function measures. Linear regression analyses were performed to determine the effect of tobacco smoking on imaging measures. Tobacco smoking was associated with increased LV and RV end-systolic volume (4.98 ± 2.08 mL, 5.19 ± 2.62 mL, P = 0.018, 0.049 respectively), reduced LV and RV ejection fraction (β: −2.21 ± 0.82%, −2.06 ± 0.87%, P = 0.007, 0.019 respectively), and reduced absolute measures of LV peak global longitudinal, radial, and circumferential strain (β: 0.86 ± 0.30%, −2.52 ± 0.99%, 1.05 ± 0.32%, P = 0.004, 0.011, 0.001 respectively). Effect sizes were larger in daily smokers compared to occasional smokers. In a general Caucasian population without known clinical cardiovascular disease, active tobacco smoking was dose dependently associated with impaired cardiac systolic function.

Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia.

Diarrhea is one of the leading causes of child morbidity and mortality in low- and middle-income countries like Ethiopia. The use of safe drinking water and improved sanitation are important practices to prevent diarrhea. However, limited research has been done to link water supply, sanitation and hygiene practices and childhood diarrhea. Therefore, this study aimed at assessing the association between microbial quality of drinking water, sanitation and hygiene practices and childhood diarrhea. Community-based matched case-control study design was applied on 198 paired children from June to July 2019 in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. Cases are children < 5 years of age with diarrhea during the two weeks before the survey. The controls are children without diarrhea during the two weeks before the survey. Twenty-five percent matched pair samples of water were taken from households of cases and controls. Data were collected using structured questionnaire by interviewing mothers/caregivers. A sample of water was collected in nonreactive borosilicate glass bottles and analyzed by the membrane filtration method to count fecal indicator bacteria. A conditional logistic regression model was used; variables with p-value less than 0.05 were considered as significantly associated with childhood diarrhea. A total of 396 (each case matched with control) under-five children with their mothers/caregivers were included in this study. In the analysis, variables like presence of under-five child in their home (AOR = 2.76; 95% CI: 1.33-5.71), wealth status (AOR = 5.39; 95% CI: 1.99-14.55), main sources of drinking water (AOR = 4.01; 95% CI: 1.40-11.44), hand washing practice before water collection (AOR = 4.28; 95% CI: 1.46-12.56), treating water at household level (AOR = 1.22; 95% CI: 0.48-3.09), latrine use all the times of the day and night (AOR = 0.22; 95% CI: 0.06-0.78), using pit as method of waste disposal (AOR = 4.91; 95% CI: 1.39-13.29) and use of soap for hand washing (AOR = 2.89; 95% CI: 1.35-6.15) were significantly associated with childhood diarrhea. Moreover, 30% of sampled water from cases and 26% of sampled water from controls families were free from Escherichia coli whereas all sampled water analyzed for Total coliforms were positive. We conclude that the main sources of drinking water, hand washing before water drawing from a storage container, domestic waste disposal place and use of soap for hand washing were the most important factors for the prevention of childhood diarrhea.

Hubungan Status ASI Eksklusif dan Pemberian Kolostrum dengan Kejadian Autisme pada Anak di Bawah 10 tahun

Background: The cause of autism until now is still not exactly known. One of the efforts in preventing the occurrence of autism is intervention early with giving colostrum and exclusive breastfeeding. The number of autism in Indonesia according to data released by the Central Bureau of Statistics in 2010 was estimated at 2.4 million people. Based on data from autism special school Bina Anggita Yogyakarta, recorded increase in the number of students from the beginning of the school in 2001 were 15 students, in 2009 the number increased to 32 students and in 2013 were 45 students.Objective: To determine the relationship between the status of exclusive breastfeeding and giving colostrum to the incidence of autism in children under 10 years.Methods: This research is a quantitative study with a matched case control study design. Subjects were children aged under 10 years who consisted of children with autism were 19 cases and 19 controls for normal children in Yogyakarta. The independent variable in this study in the provision of colostrum and exclusive breastfeeding, and dependent variable was autism. The counfounding variables are gastrointestinal infections, low birth weight and maternal age. Retrieval of data collected using a questionnaire. Univariable data analysis using frequency distribution, bivariate statistics using the McNemar test, multivariable analysis was not performed because the bivariate analysis, all variables are not significantly.Results: Of the five variables that were related to the occurrence of autism, five variables are not statistically significant and two variables that increase the risk of autism gastrointestinal infection (p=0,09 OR 3,5 CI 95%; 0,66-34,53) and low birth weight (p=0,17 OR 4 CI 95%; 0,39-196,9).Conclusions: There was no significant relationship between the giving of colostrum, exclusive breastfeeding and maternal age, but clinical gastrointestinal infection and low birth weight were risk factor  of autism. Keywords: Colostrum, exclusive breastfeeding, autism.

The morphology of proximal tibiofibular joint (PTFJ) predicts incident radiographic osteoarthritis: data from Osteoarthritis Initiative

To determine whether the morphology of proximal tibiofibular joint (PTFJ) is associated with increased risk of incident radiographic osteoarthritis (iROA) over 4 years in the OA Initiative (OAI) study. A nested matched case-control study design was used to select participants from OAI study. Case knees were defined as those with iROA. Control knees were matched one-to-one by sex, age and radiographic status with case knees. T2-weighted MR images were assessed at P0 (the visit when incident ROA was found on radiograph), P1 (1 year prior to P0) and at OAI baseline. The contacting area of PTFJ (S) and its projection areas onto the horizontal (load-bearing area, Sτ), sagittal (lateral stress-bolstering area, Sφ) and coronal plane (posterior stress-bolstering area, Sυ) were assessed, respectively. 354 case knees and 354 matched control knees were included, with a mean age of 60 and a mean body mass index (BMI) of 28kg/m2. Baseline PTFJ morphological parameters (S, Sτ and Sυ) were significantly associated with iROA over 4 years, and these associations remained unchanged after adjustment for BMI, number of knee bending activities, self-reported knee injury and surgery. S, Sτ and Sυ were also significantly associated with iROA at P1 and P0. In subgroup analysed, S, Sτ and Sυ were associated with risks of incident joint space narrowing in the medial, but not the lateral tibiofemoral compartment. Greater contacting area, load-bearing area and posterior stress-bolstering area of PTFJ were associated with increased risks of iROA, largely in the medial tibiofemoral compartment.

Healthcare expenditures among community-dwelling adults with thyroid cancer in the United States: A propensity score matched analysis

ObjectiveThis study assessed the excess healthcare expenditures and factors associated with it among community-dwelling adults with thyroid cancer compared to non-cancer controls in the United States. MethodA retrospective, cross-sectional, matched case-control study design was used by pooling multiple years of Medical Expenditure Panel Survey (MEPS) data (2002–2012). The eligible study sample comprised of adults (age ≥18 years), who were alive during the calendar year and reported positive healthcare expenditure. The case group consisted of adults with thyroid cancer only while the control group consisted of adults who did not have any form of cancer. Total and subtypes of mean annual healthcare expenditures comprised the main study outcome. We also calculated the total and subtypes of out-of-pocket (OOP) expenditures as well as OOP as a percentage of household income. Ordinary Least Square (OLS) regressions on log-transformed expenditures were conducted to elucidate the influence of different factors on healthcare expenditures among adults with thyroid cancer. ResultsThe yearly average total healthcare expenditures among adults with thyroid cancer was significantly higher compared to propensity score matched controls ($9,585 vs. $5,830, p < 0.001). Similar observations were found in terms of inpatient, and outpatient expenditures. Functional status as well as comorbid conditions were significantly associated with excess expenditures. The yearly average total OOP expenditure for adults with thyroid cancer was significantly higher compared to matched controls ($1,425 vs. $974, p < 0.001), with major differences observed in inpatient OOP ($178 vs. $24, p = 0.003), outpatient OOP ($435vs. $256, p < 0.001), and prescription OOP ($554 vs. $423, p < 0.001) expenditures. There was a significant (p < 0.001) difference between the average OOP as a percentage of household income between adults with thyroid cancer (Mean: 7.54%, S.E: 1.52%) and matched controls (Mean: 5.80%, S.E: 0.47%). ConclusionsOur findings suggest that holistic care approach could be helpful to significantly reduce the economic burden in this population. Viable strategies such as limits on OOP costs are required to minimize this high OOP burden among cancer survivors and their families.

Family Structure and Early Marriage on Women in Indramayu Regency

Early marriage in Indramayu Regency in the past two years had increased to three times. The purpose of this research was to identify the age of marriage and the factors which caused early marriage by looking at the variables of family structure, education and economic status of the household. This research used matched case control study design. The data were collected using questionnaires and interview guidelines. The samples were taken using simple random sampling technique. The subject consisted of 94 people. The data were analysed using McNemar test and conditional logistic regression. The variables which had significant relationship with early marriage were father’s education, education of the respondents, and economic status of the household. Meanwhile, family structure and mother’s education had no significant relationship with early marriage. It can be concluded that women with low father’s education and came from poor families had greater chance of getting married early.