Minor Risk Research Articles

Gastrointestinal infections and ethnicity in the UK: a systematic review and narrative synthesis

Abstract Background Gastrointestinal (GI) infections exert a significant public health burden on healthcare services in the United Kingdom (UK). The literature suggests an association between ethnicity and health; however, we do not know the extent of inequalities in GI infection/disease in the UK. This systematic review aimed to identify studies that ascertain differences in the incidence or prevalence of GI infections between UK ethnic groups and explore possible explanations for heterogeneity observed within the literature. Methods MEDLINE, CINAHL Plus, Web of Science (Science Social Science Citation Index), and grey literature were searched from 1980 to 21st June 2023 for studies reporting an association between ethnicity and GI infections in UK population samples. Two reviewers independently screened the studies and conducted quality appraisals; data extraction was undertaken by one reviewer and verified by another reviewer. A narrative synthesis was undertaken and a harvest plot supported the textual synthesis to investigate potential sources of heterogeneity in effect estimates by GI pathogen and ethnic group. Results The searches identified 10028 studies, of which 16 met the inclusion criteria. 15 out of 47 effect estimates from a total of 16 studies found that GI infection risk was greater in Black and Ethnic Minority Groups, mainly of Asian ethnicity, compared to the majority White population. 13 studies reported a higher risk in ethnic minorities of Asian ethnicity, while one study described a higher risk in the Non-White ethnic group. One single study on STEC reported a higher risk of GI infection in the White population compared to the Non-White population, while another single study on norovirus found no significant difference by ethnic group. Conclusions This systematic review demonstrates that ethnic minority groups in the UK have a higher risk of GI infections than the general or White population. Key messages • There is a clear need to elucidate further the high incidence of GI infections in UK Indian, Pakistani, and Bangladeshi communities. • Tackling ethnic inequalities requires a concerted approach and translating evidence into policy.

The Association of Antidepressants in Late Pregnancy with Postpartum Hemorrhage: Systematic Review of Controlled Observational Studies.

Introduction: Despite advances in obstetric care, postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Prior reviews of studies published through 2016 suggest an association of antidepressant use during late pregnancy and increased risk of PPH. However, a causal link between prenatal antidepressants and PPH remains controversial. Objectives: This systematic literature review aimed to synthesize the empirical evidence on the association of antidepressant exposure in late pregnancy with the risk of PPH, including studies published before and after 2016. Methods: A systematic literature search was conducted using PubMed, OVID Medline, EMBASE, SCOPUS, PsycINFO, and CINAHL from inception to September 9, 2023. Original, peer-reviewed studies (published in English) that reported on the frequency or risk of PPH in women with evidence of antidepressant use during pregnancy and included at least one control group were included. Results: Twenty studies (eight published after 2016) met inclusion criteria, most of which focused on the risks of PPH associated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). The main findings from the individual studies were mixed, but the majority documented statistically significant associations of PPH with late prenatal exposure, especially for exposures occurring within 30 days of delivery, compared with unexposed deliveries. Fourteen studies addressed underlying antidepressant indications or their correlates. Few studies focused on prenatal antidepressants and the risk of well-defined severe PPH or on antidepressant dose changes and general PPH risk. None examined competing risks of antidepressant discontinuation on mental health outcomes. Conclusions: Late pregnancy exposure to antidepressants may be a minor risk factor for PPH, but it is unclear to what extent reported associations are causal in nature, as opposed to correlational (effects related to nonpharmacological factors including maternal indication). For patients needing antidepressants during pregnancy, current evidence does not favor routinely discontinuing antidepressants specifically to reduce the risk of PPH.

Cannabidiol exerts antipyretic effects by downmodulating inflammatory mediators in LPS-induced fever

Contrasting to tetrahydrocannabinol (THC), cannabidiol (CBD) has virtually no psychoactive effects and thus presents a minor risk for abuse. Furthermore, emerging preclinical and clinical evidence indicates that CBD exerts several beneficial pharmacological effects, including anti-inflammatory and antioxidant properties. Even though fever is one of the responses associated with systemic inflammation, no previous study assessed the putative impact of CBD on lipopolysaccharide (LPS)-induced fever. The present study aimed to evaluate whether CBD exerts effects on febrile responses, by modulating the hypothalamic-pituitary-adrenal (HPA) axis, and the inflammatory reflex, in this response. CBD caused no change in euthermic mice, indicating that it does not alter euthermia. Conversely, CBD blunted all the assessed systemic inflammation parameters including fever (a hallmark of infection), plasma pro-inflammatory cytokines and prostaglandin E2 (PGE2) surges, and hypothalamic PGE2 (the proximal mediator of fever) synthesis. Moreover, CBD also reduced LPS-induced increase in plasma corticosterone levels and spleen TNF-α. These data are consistent with the notion that CBD has antipyretic effects, reducing peripheral febrigenic signaling (plasma pro-inflammatory cytokines levels), and eventually down-modulating hypothalamic PGE2 production, possibly in a corticosterone- and inflammatory reflex-dependent manner.

Incidence and Correlates of Husband-Perpetrated Rape Among Currently Married Women in Nigeria.

Husband-perpetrated rape (HPR), which implies every form of unwilling sex with a husband as a result of force, threat or drug, is rarely discussed or reported, and it has been quite understudied in Nigeria. Hence, this study answers two questions: What is the incidence of HPR, and what are the correlates among currently married women in Nigeria? Descriptive and multi-level logistic regression tools are used to analyze data from a sub-sample of 1,583 currently married women (16 years and above) surveyed in a larger survey conducted in mid-2022. The results suggest that the national incidence rate of HPR among currently married women in Nigeria is 20%. Although any married woman could experience HPR anywhere, the main correlates that are likely to elevate the risk in Nigeria are childhood sexual abuse experience (OR = 3.9, p < .001, 95% CI [2.9, 5.2]), membership in Yoruba ethnic group (OR = 2.7, p < .001, [1.7, 4.3]), and having husbands who smoke (OR = 2.4, p < .001, [1.7, 3.4]). Other minor risk factors are minority ethnic groups membership (OR = 2.1, p < .01, [1.4, 3.3]), husband's substance use (OR = 1.7, p < .001, [1.3, 2.2]), childhood family situation wherein parents separated/divorced (OR = 1.8, p < .01, [1.3, 2.6]) and membership of the Igbo ethnic group (OR = 1.7, p < .05, [1.1, 2.8]). Therefore, to reduce HPR experience in Nigeria, appropriate organs should design and implement an invigorated child protection law targeting childhood sexual abuse reduction. An aggressive campaign against smoking and substance consumption among married men is also imperative. Also, a sustained campaign against HPR using multiple media all over Nigeria is crucial.

Spatial variability, source identification, and partitioning of groundwater constituents in a typical lakeside plain on Yungui Plateau

The fragile ecological balance of lakeside plains on plateau makes groundwater hydrochemical composition highly susceptible to human disturbances. This research investigates a typical plain on Yunnan Plateau to quantitatively identify the potential sources of groundwater pollution in lakeside plains on plateau by combining receptor models with risk assessment models. Receptor models show there are three potential pollution sources for groundwater including water-rock interactions, agricultural pollution, and domestic sewage/manure discharge. Groundwater hydrochemical composition is predominantly shaped by natural water-rock interactions, accounting for an average of 50.12 % of the influence. This is followed by agricultural non-point source pollution, which contributes 10.79 %, and the discharge of domestic sewage and manure, which accounts for 10.61 %. Groundwater in the current plain could pose a minor non-carcinogenic risk for long-term drinking, with the total hazard index (THI) for adults varying between 0.015 and 1.089, and for children between 0.024 and 1.737. Notably, 4.35 % of groundwater samples have a THI exceeding the safe threshold of 1. NO3- (72 %) is the primary contributor to non-carcinogenic risks, accounting for 72 %, trailed by Mn (13 %), NH4+ (9 %), Fe (6 %) and NO2- (1 %). The non-carcinogenic risks are predominantly attributed to agricultural non-point source pollution (71.6 %) and the discharge of domestic sewage and manure (26.9 %). A conceptual model has been developed to encapsulate the dynamics of groundwater quality formation in lakeside plains on plateau. This research will aid residents in safeguarding against groundwater contamination and enhancing agricultural practices in present plain and similar lakeside plain worldwide.

Towards a sustainable decision analysis approach for moisture-safe building envelope design

Energy-efficient building designs, notably through adding insulation, can reduce energy consumption and greenhouse gas emissions by over 40 %, but may also increase risk of condensation. Therefore, a comprehensive decision analysis approach is essential for selecting optimal building envelope assemblies while considering their hygrothermal, economic, and environmental implications. This study introduces a novel decision analysis method based on the inutility decision analysis (IDA) concept, in which the building envelope with the lowest inutility is considered the optimal choice. Initially, different building envelope assemblies were assessed through probabilistic hygrothermal analysis combined with a machine learning metamodel. Subsequently, the environmental and economic consequences associated with each assembly were quantified by integrating moisture-related damage into these assessments. Combining these outputs yielded inutility indices for the case studies, guiding the selection of the most optimal alternative. The results indicated that an external wall, with a minor risk of moisture-related failure, may outperform other alternatives when considering economic and environmental metrics. However, the final decision on the acceptability of such risk should rest with the customers or owners. Balancing the trade-off between performance longevity, cost, and occupants’ health is crucial.

PERCUTANEOUS AXILLARY ACCESS IN THE ENDOVASCULAR ERA: A VIABLE ALTERNATIVE?

The common femoral artery is the most commonly used vascular access due to its low complication rate and high technical success rate. However, this approach may be less suitable in patients with certain factors such as obesity, the need to treat both lower limbs, and the inability to access the lesion via crossover. In this context, endovascular approaches using percutaneous puncture or upper arm access have emerged. Therefore, we evaluated the feasibility of percutaneous access to the axillary artery in routine endovascular procedures. This single-center observational study included consecutive patients requiring percutaneous access to the axillary artery for endovascular procedures from January 2020 to December 2023. Demographic and procedural characteristics were collected. The primary endpoint was efficacy (technical success rate) and safety (complications rate) at 30 days. Secondary endpoints were minor complications and risk factors of complications. 85 patients were included. Axillary approach was used to treat peripheral artery disease (PAD) in 77.6% (n=66), complex aortic aneurysm in 17.7% (n=15), and acute type B aortic dissection in 4.7% (n=4) of patients. This approach was used due to bilateral PAD treatment (n=20), obesity (n=18), prior EVAR (n=12), prior common femoral artery stenting (n=9), major iliac tortuosity (n=9), prior kissing stent (n=8), favorable angulation (n=5) and true lumen positioning in type B aortic dissection (n=4). The left axillary approach was used in 97.6% (n=83) of cases. The efficacy was 100%. At 30 days, safety was 85.6% with a major complication rate of 14.2% (n=12), including 10.6% (n=9) surgical conversion for hemostasis, 2.4% (n=2) covered stenting, and 1.2% (n=1) stroke. Body mass index was associated with a higher rate of complications (25.2 ± 6.17 vs. 29.0 ± 6.04, OR: 1.2 [1.05; 1.37] p=0.006). Axillary arteries are an effective alternative access route for patients with unsuitable iliofemoral arteries. Randomized clinical trials are needed to confirm our findings and to assess the best approach for the upper arm.

Supply chain chronic losses and risk interdependencies: a Bayesian Belief Network approach

ABSTRACT Supply Chain Risk Management (SCRM) has become integral to firm governance, and risk interdependencies, despite limited attention, significantly impact risk analysis and mitigation. Recurrent risks, resulting from consistent disturbances, generate chronic losses and are critically affected by other related risks. This work enhances the assessment of chronic losses with interdependent risks, building upon an existing Bayesian Belief Network (BBN) approach for risk interdependencies in SCRM, combining expected utility theory to address the complex, interconnected nature of risks. This work advocates a change in existing approaches to properly evaluate chronic losses often underestimated due to decision makers’ expectations. The research shows that the impact of recurrent risks may be underestimated by other approaches based on their frequency, undermining confidence in mitigation strategies. This work not only presents a novel approach to risk assessment but also highlights the importance of studying causal interdependencies, and emphasises the need to consider low-probability and high-impact risks but also recurrent, seemingly minor risks in SCRM processes.

Mars 2020 Descent Stage Integrated Propulsion Subsystem: Changes and Flight Performance

On February 18, 2021, NASA’s Mars 2020 mission successfully landed the Perseverance rover in Jezero Crater, the heaviest interplanetary rover ever built, on the surface of Mars. Following up on the successful entry, descent, and landing of the Curiosity rover of the Mars Science Laboratory mission in August 2012, the Mars 2020 mission Descent Stage Propulsion System was a build-to-print sequel. The Mars 2020 Descent Stage Propulsion System had a few minor low risk changes based on the flight performance of the Mars Science Laboratory System to improve performance. The in-flight performance of the Descent Stage Propulsion System was consistent with expectations with the exception of apparent higher than expected delivered thrust from the Mars Lander Engines, which occurred on both the Mars 2020 and the Mars Science Laboratory missions. The Descent Stage Propulsion System completed its mission with significant capability margin with respect to thruster life, maximum delivered thrust, and available propellant at touchdown.

Research on Construction Risk Assessment of Long-Span Cantilever Casting Concrete Arch Bridges Based on Triangular Fuzzy Theory and Bayesian Networks

Considering the complex construction processes involved, there are significant risks during the construction of long-span cantilever casting arch bridges. In this study, a risk assessment method for the construction process of cantilever casting concrete arch bridges was developed. The compositional elements and characteristics of safety risks in the construction of cantilever casting concrete arch bridges were clarified, and a safety risk source list that includes seven major risk sources and thirty-three minor risk sources was formed. Then, a Bayesian model for the risk analysis of cantilever casting concrete arch bridge construction was established, and a method was proposed to determine the prior and posterior probabilities of the Bayesian network using triangular fuzzy numbers. This method fully utilizes the experience of experts while avoiding the subjectivity of expert opinions. A cantilever casting concrete open spandrel arch bridge (Bridge A) with a total span length of 287 m was taken as an example, and a safety risk assessment was conducted during its construction process. The calculation results show that the construction safety risk level of Bridge A was level III. This engineering application verified the feasibility of determining key node parameters of the Bayesian network using triangular fuzzy numbers.

Hepatitis B reactivation in PsA patients: an SLR and meta-analysis for IL-17, IL-23 and JAK inhibitors.

Hepatitis B reactivation (HBVr) constitutes a side effect of the treatment of autoimmune rheumatic diseases. Even though HBVr risk of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) and anti-tumor necrosis factor (anti-TNF) agents has long been established, the risk of targeted synthetic (ts)DMARDs and anti-interleukin (anti-IL) agents remains largely unknown. We conducted a SLR (PubMed, Scopus and EMBASE) and metanalysis to examine the HBVr risk for the following: anti-IL17, anti-IL12/23, anti-IL23 and JAK-inhibitors in patients with chronic HBV infection (HBsAg presence or detectable HBV-DNA) and in patients with prior HBV infection (HBcAb-positive and HBsAg-negative). Meta-analysis was performed using both the fixed and random effects method and was conducted using the R computing language. Overall, our study revealed a low HBVr risk of < 6% in all agents; the risk was significantly higher for people having chronic compared with those with resolved HBV (14,4% vs 5.1%, respectively p< 0.01). There was no difference among different drugs in the HBVr rates [anti-IL-17: 4% (95% CI: 1-9%), anti-IL-12/IL-23: 2% (95% CI: 0-5%), JAK-inhibitors: 4% (95% CI: 1-8%), anti-IL23: 0%]. Of note, HBVr rate reached 28% in patients with chronic HBV who did not receive anti-viral treatment. For patients with resolved hepatitis the respective percentage was 4.7%. Overall, our meta-analysis shows that patients with chronic HBV receiving anti-IL-17, anti-IL-12/23, anti-IL-23 and JAK-inhibitors have significant risk for HBVr, especially if they are not under anti-viral treatment. In contrast, resolved HBV seems to offer minor risk for HBVr even without anti-viral treatment.

Prevalence of Obstructive Sleep Apnea Among Veterans and Nonveterans.

Understanding disease prevalence can inform treatment and resource needs across populations. This study aimed to identify the prevalence of sleep apnea (OSA) among veterans and nonveterans. The national Comparative Health Assessment Interview Study, cross-sectional survey using probability-based sampling frames. Surveys completed by Internet or phone. 15,166 veterans (40% response rate) and 4,654 nonveterans (57% response rate). Self-report of healthcare provider-based diagnosis of OSA. Calculation of prevalence of OSA using statistical weighting to allow for direct comparison between veterans and nonveterans. Secondary analyses evaluated OSA by deployment status among veterans and compared average age of OSA diagnosis and differences in OSA prevalence among veterans and nonveterans stratified by gender, marital status, race/ethnicity, and posttraumatic stress disorder diagnosis. OSA diagnosis was more than twice as prevalent among veterans (21%, 95% CI 20%-22%) than nonveterans (9%, 95% CI 8%-10%; aOR: 2.56, 95% CI 2.22-2.95, P < .001). Deployment was associated with higher odds of OSA among veterans (aOR: 1.64, 95% CI 1.43-18.7, P < 001.) Veterans were diagnosed with OSA on average 5 years earlier than nonveterans. Veterans have a high prevalence rate of OSA, highlighting the importance of veterans' access to treatment. OSA is likely underdiagnosed in nonveterans, particularly among racial/ethnic minoritized groups. Future research should investigate disparities in access to diagnostic testing for racial/ethnic minority nonveterans and/or risk factors for OSA among racial/ethnic minority veterans. The increased odds of OSA among those with PTSD highlights in the importance of early referral for OSA testing by providers as well as development of trauma-informed strategies to promote OSA treatment adherence. Limitations include a bias toward underestimation of true disease prevalence due to self-report of diagnosis.

Spatial variation, emissions, transport, and risk assessment of organophosphate esters in two large petrochemical complexes in southern China

Organophosphate esters (OPEs) serve as significant flame retardants and plasticizers in various petrochemical downstream products. The petrochemical industry could be a potential source of atmospheric OPEs, but their emissions from this industry are poorly understood. The present study revealed the spatial variation, emission, and atmospheric transport of traditional and novel OPEs (TOPEs and NOPEs, respectively) in atmospheric particulate matter (PM) across Hainan and Guangdong petrochemical complexes (HNPC and GDPC, respectively) in southern China. The total concentrations of TOPEs ranged from 232 to 46,002 pg/m3 and from 200 to 20,347 pg/m3 in the HNPC and GDPC, respectively, which were substantially higher than those of NOPEs (HNPC: 23.5−147 pg/m3, GDPC: 13.9−465 pg/m3). Enterprises involved in the production of downstream petrochemical products presented relatively high concentrations of OPEs, indicating evident emissions of these pollutants in the petrochemical industry. The correlations of PM-bound OPEs in the atmosphere are determined mainly by their coaddition to industrial products or their coexistence in technical mixtures. The annual emissions of TOPEs and NOPEs in the HNPC were 42.6 kg and 0.34 kg, respectively, and those in the GDPC were 116 kg and 1.85 kg, respectively. OPEs from the HNPC can reach Vietnam, Cambodia, and Guangxi Province, China, and those from the GDPC can reach Guangxi Province and Hunan Province via atmospheric transmission after 24 h of emission. The OPE concentrations reaching the receptor regions were generally less than 3.20 pg/m3. Risk assessment revealed that OPE inhalation exposure on two petrochemical complexes likely poses minor risks for people living in the study areas, but the risk resulting from two chlorinated OPEs should be noted since they are close to the threshold values. This study has implications for enhancing control measures for OPE emissions to reduce health risks related to the petrochemical industry.

Paper‐like 100% Si Nanowires Electrodes Integrated with Argyrodite Li6PS5Cl Solid Electrolyte

Silicon anodes are a promising solution in all‐solid‐state batteries (ASSBs) due to minor lithium dendrite risk, high capacity, and low potential. Research on Si integration in ASSBs is still nascent, requiring a deep understanding of the interplay between electrode composition, structure, and performance. Here, we present the first study on 100% Si nanowires integrated with Li6PS5Cl solid electrolyte (SE). The anodes are paper‐like networks of aggregated Si nanowires produced by a slurry‐free method without carbon/binders. Despite the lack of any conductor, the Si anodes provide &gt;2.5 Ah/g capacity at a high mass loading of 1.7 mg/cm2(~5 mAh/cm2), demonstrating sufficient electric and ionic conductivities. Electro‐chemo‐mechanical properties of the electrodes over (de)lithiation were probed through electrochemical impedance spectroscopy, ex‐situ microscopy, and in‐operando pressure regulation measurements. The lithiated electrode/SE interface was found to be electrochemically stable. Cross‐sectional microscopy at various states‐of‐charge confirmed the buffering effect of the anode porosity, resulting in the preservation of the electrode’s thickness after the first lithiation but a considerable shrinkage during delithiation, producing cracking and formation of the new interface. Capacity remains constant for five cycles, then decreases linearly up to 40 cycles. This is attributed to repeated fracture of the anode/electrolyte interface and the corresponding impedance increase

Ultrasound Guided Subscapularis and Subomohyoid Plane Blocks versus Interscalene Block with Levobupivacaine for Analgesia in Shoulder Surgery

Abstract Background Now Shoulder surgery is a common procedure, particularly as it is associated with reduced hospitalization times, even though the technique may lead to moderate and severe postoperative pain. In recent years, various studies have been carried out that demonstrated the need for valid anaesthetic techniques that allow adequate control of postoperative pain and also favour early mobilization and rehabilitation. Subscabularis and subomohyoid plane blocks allow pain control after shoulder surgery while decreasing the need of opioids and pain medication after surgery. In contrast to interscalene brachial plexus block, subscabularis and subomohyoid plane blocks carry minor risks of intrathecal injection or post operative respiratory distress. Aim of the Work to compare analgesic efficacy of ultrasound guided subomohyoid and subscapularis plane blocks versus interscalene block using levobupivacaine in both techniques for pain control after shoulder surgery. Patients and Methods This exploratory randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent shoulder surgery under general anesthesia were included in the study their ages range between 21 and 65 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization and opaque sealed envelopes into two groups 30 patients in each (n = 30). Results In this study we find that combined subscapularis plane and sub-omohyoid injections may serve as an alternative to interscalene block for shoulder analgesia, with less complications. The present study shows no difference in the demographic data between the two groups (p-value &amp;gt;0.05). Also there was no statistically significant difference in the surgery duration between the two groups. But the duration of subomohyoid and subscapularis plane block was longer than the duration of interscalene block, the Mean± SD is (10.80±2.64 minutes) for subomohyoid and subscapularis plane blocks while interscalene block duration is (5.33±1.56 minutes) so there was astatically significant difference P-value &amp;lt;0.001. Conclusion Subscapularis plane and subomohyoid plane blocks can be used as an alternative shoulder analgesia with minor risks.

Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial

Uncertainty exists about whether lowering systolic blood pressure to less than 120 mm Hg is superior to that of less than 140 mm Hg, particularly in patients with diabetes and patients with previous stroke. In this open-label, blinded-outcome, randomised controlled trial, participants with high cardiovascular risk were enrolled from 116 hospitals or communities in China. We used minimised randomisation to assign participants to intensive treatment targeting standard office systolic blood pressure of less than 120 mm Hg or standard treatment targeting less than 140 mm Hg. The primary outcome was a composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes, assessed by the intention-to-treat principle. This trial was registered with ClinicalTrials.gov, NCT04030234. Between Sept 17, 2019, and July 13, 2020, 11 255 participants (4359 with diabetes and 3022 with previous stroke) were assigned to intensive treatment (n=5624) or standard treatment (n=5631). Their mean age was 64·6 years (SD 7·1). The mean systolic blood pressure throughout the follow-up (except the first 3 months of titration) was 119·1 mm Hg (SD 11·1) in the intensive treatment group and 134·8 mm Hg (10·5) in the standard treatment group. During a median of 3·4 years of follow-up, the primary outcome event occurred in 547 (9·7%) participants in the intensive treatment group and 623 (11·1%) in the standard treatment group (hazard ratio [HR] 0·88, 95% CI 0·78-0·99; p=0·028). There was no heterogeneity of effects by diabetes status, duration of diabetes, or history of stroke. Serious adverse events of syncope occurred more frequently in the intensive treatment group (24 [0·4%] of 5624) than in standard treatment group (eight [0·1%] of 5631; HR 3·00, 95% CI 1·35-6·68). There was no significant between-group difference in the serious adverse events of hypotension, electrolyte abnormality, injurious fall, or acute kidney injury. For hypertensive patients at high cardiovascular risk, regardless of the status of diabetes or history of stroke, the treatment strategy of targeting systolic blood pressure of less than 120 mm Hg, as compared with that of less than 140 mm Hg, prevents major vascular events, with minor excess risk. The Ministry of Science and Technology of China and Fuwai Hospital. For the Mandarin translation of the abstract see Supplementary Materials section.

Religious minority status and risk of hypertension in women: Evidence from Bangladesh

Discrimination based on religion and communal violence against religious minorities have been on the rise worldwide. Despite growing incidences of violence against religious minorities, little is known on the relationship between minority status and population health outcomes in the low-and-middle income countries (LMICs). This study intends to fill this gap by assessing the prevalence of hypertension among religious minority women in Bangladesh, a South Asian country with high levels of social hostilities involving religion. Using data from the Bangladesh Demographic and Health Survey (BDHS) 2017–18, we examined whether religious minority women had a differential risk of having hypertension. We estimated logistic regression models to obtain the odds in favor of being hypertensive among women aged 18–49 years and compared the odds for religious minority women with that of their non-minority counterparts. We then estimated linear regression models to examine how average systolic- and diastolic-blood pressure measures differ across minority and non-minority women. We found that the odds of being hypertensive for minority women were 1.43 (95 % CI: 1.14–1.79) times that of their non-minority counterparts. The adjusted odds ratio was very similar, 1.45 (95 % CI: 1.14–1.84), when various sociodemographic and other risk factors were accounted for. The conditional average SBP and DBP levels were respectively 3.42 mmHg (95 % CI: 1.64–5.20) and 1.44 mmHg (95 % CI: 0.37–2.51) higher among minority women. Thus, we found evidence that religious minority women in Bangladesh had a disproportionately higher risk of having hypertension compared to their non-minority peers. These results call for further research on psychological distress from systematic discrimination and collective trauma among religious minorities in Bangladesh.

Risk of recurrent venous thromboembolism and major bleeding according to risk factor profiles in Asian patients: a subgroup analysis EINSTEIN-Extension and EINSTEIN-CHOICE

BackgroundRisks of recurrence and major bleeding with extended anticoagulation in Asian patients with venous thromboembolism (VTE) are similar to those in non-Asian patients but risks according to baseline risk factor profiles is not well documented.MethodsSubgroup analysis of two randomized trials, which compared once-daily rivaroxaban (20 mg or 10 mg) with placebo or aspirin (100 mg) for extended treatment in Asian patients with VTE who had completed 6–12 months of anticoagulation. Index events were classified as unprovoked, provoked by major persistent risk factors, minor persistent risk factors, minor transient risk factors, or major transient risk factors. One-year cumulative risks of recurrent VTE were calculated for these risk factor profiles.Results367 patients received rivaroxaban, 159 aspirin, and 48 placebo. For patients with unprovoked VTE, one-year cumulative incidences of recurrence in the 202 patients given rivaroxaban, the 89 given aspirin and the 28 given placebo were 1.6%, 5.8%, and 14.8%, respectively. For patients with VTE provoked by minor persistent risk factors, these incidences were 0% in the 74 patients given rivaroxaban, 9.3% in the 36 given aspirin, and 0% in the 12 given placebo. No recurrent VTE occurred in patients with VTE provoked by major persistent or transient risk factors or minor transient risk factors. Rivaroxaban was not associated with a significant increase in major bleeding.ConclusionsRivaroxaban seems to be an effective and safe option for extended treatment in Asian patients, especially those presenting with unprovoked VTE. Subgroups of patients with provoked risk factors were too small to draw meaningful conclusions.Trial registrationNCT00439725 and NCT02064439.

Identifying and Evaluating Occupational Hazards of Infectious Waste Landfill Workers by the JHA Method

Background: In waste management, neglecting and mismanaging harmful biological factors can result in adverse consequences for both organizations and employees. Methods: This study aimed to identify and assess the health and safety risks faced by workers at an infectious waste site using the job hazard analysis (JHA) method. This cross-sectional descriptive study was conducted in 1401 at the waste disposal center "Halgheh Dareh" in Karaj. The JHA method involved dividing the job into tasks, identifying safety and health risks associated with each task, determining the probability and severity of the risks, and finally classifying them using a matrix based on the MIL-STD-882B standard. Control measures were also presented. All calculations were performed using Excel 2010. Results: The results revealed that out of the 20 risks analyzed, 40% were classified as unacceptable risks, 25% as undesirable risks, 30% as acceptable risks but in need of revision, and 5% as minor risks. Conclusion: Through the application of the JHA method, we were able to evaluate and classify health and safety risks according to their level of severity. By implementing control measures such as the use of personal protective equipment, periodic medical examinations, administration of the Hepatitis vaccine, and adherence to safety protocols, it is possible to reduce the risks and prevent the occurrence of occupational diseases and accidents that can lead to harm.

Evaluating the protective capacity of soil heavy metals regulation limits on human health: A critical analysis concerning risk assessment - Importance of localization

Heavy metal pollution of agricultural soil is a major global concern, prompting the establishment of maximum allowable limits (MALs) to ensure food safety and protect human health. This study collected and compared MALs for six heavy metals (As, Cd, Hg, Pb, Zn, and Cu) in agricultural soils from representative countries and organizations (EU and WHO/FAO). The research evaluated the critical health risks and efficacy of these MALs under the hypothetical scenario of metals concentrations reaching the maximum allowable level. Safe thresholds for heavy metals were then derived based on maximum acceptable health risk levels. The comparative analysis revealed significant variations in the specific limit values and terms of MALs across countries and organizations, even for the same metal. This suggests that there is no consensus among countries and organizations regarding the level of metal-related health risks. Furthermore, the risk analysis of metal concentrations reaching the maximum level accentuated heightened risks associated with As, suggesting that the current risk of soil As exposure was underestimated, particularly for children. However, soil Cu, Cd, and Zn limits generally resulted in low health risks, implying that the current limits may overestimate their hazard. Overall, the results highlight that the current MALs for soil heavy metals may not fully safeguard human health. There is a critical need to optimize current soil MALs based on localized risks and the actual impact of these metals on human health. It is suggested to appropriately lower the limits of metals (such as As) whose impact on health risks is underestimated, and cautiously increase the limits of metals (such as Cu, Cd, and Zn) that currently pose minor health risks. This approach aims to reduce both over and insufficient protection problems of soil heavy metal MALs, emphasizing the importance of considering the locality in setting these limits.