Odds Ration Research Articles

Pulmonary diffusing capacity among individuals recovering from mild to moderate COVID-19: a cross-sectional study

Impaired pulmonary diffusing capacity for carbon monoxide (DLCO) following COVID-19 has been consistently reported among individuals recovering from severe-critical infection. However, most long COVID cases follow non-severe COVID-19. We assessed DLCO among individuals with long COVID recovering from mild to moderate acute illness. A cross-sectional study of adults with long COVID, assessed at a COVID recovery clinic > 3 months following the onset of acute infection, during 2020–2021. Participants subjectively ranked their dyspnea severity based on its impact on their daily living and underwent comprehensive pulmonary function testing (PFT). Clinical correlates for impaired DLCO (defined as < 80%) were assessed using multivariable logistic regression models. A total of 458 individuals, their mean age 45 (SD 16) and 246 (54%) of whom are women, were evaluated at an average of ~ 4 months following acute COVID-19. The most frequent PFT impairment was reduced DLCO, identified among 67 (17%) of the cohort. Clinical correlates of impaired DLCO included women (odds ration [OR] 3.64, 95% confidence interval [CI] 1.78–7.45, p < 0.001), cigarette smoking (OR 2.25, 95% CI 1.14–4.43, p = 0.019), and moderate-severe dyspnea (OR 2.77, 95% CI 1.39–5.50, p = 0.004). BMI inversely correlated with DLCO (OR 0.90, 95% CI 0.85–0.96 per 1 unit, p = 0.002). Impaired DLCO was not uncommon among individuals recovering from mild to moderate COVID-19. Women are at a greater risk, and subjective dyspnea correlated with impaired DLCO. Clinicians can rely on self-reported significant dyspnea to guide further assessment.

Exploring the Association Between Oral Health Literacy and Oral Health-Related Quality of Life Among Young Women in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-Sectional Study.

One approach for improving oral health is focusing on oral health literacy (OHL). In this study, we aimed to investigate the association between OHL and oral health-related quality of life (OHRQoL) and to identify relevant OHL intervention targets that can be used to improve oral health. We performed a cross-sectional questionnaire study among 1889 10th grade female students in the Eastern Province of the Kingdom of Saudi Arabia (KSA). We then assessed OHL using the Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). OHRQoL was assessed using the 14-item oral health impact profile (OHIP-14). Information on socio-demographics and oral health-related behaviours (e.g., toothbrushing, sugary diet consumption and dental attendance) was also collected. The relationship between OHL and OHRQoL was investigated using binary logistic regression adjusted for sociodemographic information and oral health-related behaviours. In both the adjusted and unadjusted models, poor OHL was significantly associated with OHRQoL problems (odds ration [OR] = 2.90, p < 0.001). Having any OHL problem was significantly associated with having an OHRQoL problem (p < 0.001). The ORs were highest for the domains of financial barriers (OR = 2.49, p < 0.001) and receptivity (OR = 2.16, p < 0.001). Interventions targeted at individuals with low OHL are crucial to improving OHRQoL in the population. The most relevant interventions concern (a) dedicating time and attention to oral health and (b) financial barriers.

Following carpel tunnel release, what factors affect whether patients return to the same or different hand surgeon for a subsequent procedure?

Following carpal tunnel release (CTR), patients may be indicated for subsequent hand surgery (contralateral CTR and/or trigger finger release [TFR]). While surgeons typically take pride in patient loyalty, the rate of returning to the same hand surgeons has not been previously characterized. Patients undergoing CTR were isolated from 2010-2021 PearlDiver M151 dataset. Subsequent CTR or TFR were identified and characterized as being performed by the same or different surgeon, with patient factors associated with changing to a different surgeon determined by multivariable analyses. In total, 1,121,922 CTR patients were identified. Of these, subsequent surgery was identified for 307,385 (27.4%: CTR 289,455 [94.2%] and TFR 17,930 [5.8%]). Of the patients with a subsequent surgery, 257,027 (83.6%) returned to the same surgeon and 50,358 (16.4%) changed surgeons. Multivariable analysis found factors associated with changing surgeon (in order of decreasing odds ration [OR]) to be: TFR as the second procedure (OR 2.98), time between surgeries greater than 2-years (OR 2.30), Elixhauser-Comorbidity Index (OR 1.14 per 2-point increase), and male sex (OR 1.06), with less likely hood of changing for those with Medicare (OR 0.95 relative to commercial insurance) (p<0.001 for each). Pertinent negatives included: age, Medicaid, and having a 90-day adverse event after the index procedure. Over fifteen percent of patients who required a subsequent CTR or TFR following CTR did not return to the same surgeon. Understanding what factors lead to outmigration of patients form a practice may help direct efforts for patient retention.

Factors associated with unfavourable treatment outcomes among tuberculosis patients at health facilities of Maseru, Lesotho.

Tuberculosis (TB) treatment success rates (TSR) remain low in Lesotho. The country achieved TSR of 76% in 2020, which is far below the World Health Organization's 95% target set for 2030. This study determined the level of treatment success and factors associated with unfavourable treatment outcomes. This descriptive cross-sectional study used patient records to perform descriptive and logistic regression analyses. Sixty-one per cent of the 336 TB patients were male. Two hundred and eighty-nine had favourable outcomes, of which 10% died in the course of treatment. Patients ≤ 44 years old, and those with supported treatment, had lower odds of unfavourable treatment outcomes, respectively, adjusted odds ration [aOR] = 0.39 (95% CI: 0.19-0.78) and aOR = 0.22 (95% CI: 0.08-0.62),p 0.05.Contribution:The death of patients while on TB treatment needs to be addressed, including heightened advocacy for supported treatment.

Circulating Cell-Free Nuclear DNA Predicted an Improvement of Systolic Left Ventricular Function in Individuals with Chronic Heart Failure with Reduced Ejection Fraction

Background: Patients with heart failure (HF) with improved ejection fraction (HFimpEF) demonstrate better clinical outcomes when compared with individuals without restoration of cardiac function. The identification of predictors for HFimpEF may play a crucial role in the individual management of HF with reduced ejection fraction (HFrEF). Cell-free nuclear (cf-nDNA) DNA is released from damaged cells and contributes to impaired cardiac structure and function and inflammation. The purpose of the study was to elucidate whether cf-nDNA is associated with HFimpEF. Methods: The study prescreened 1416 patients with HF using a local database. Between October 2021 and August 2022, we included 452 patients with chronic HFrEF after prescription of optimal guideline-based therapy and identified 177 HFimpEF individuals. Circulating biomarkers were measured at baseline and after 6 months. Detection of cf-nDNA was executed with real-time quantitative PCR (qPCR) using NADH dehydrogenase, ND2, and beta-2-microglobulin. Results: We found that HFimpEF was associated with a significant decrease in the levels of cf-nDNA when compared with the patients from persistent HFrEF cohort. The presence of ischemia-induced cardiomyopathy (odds ration [OR] = 0.75; p = 0.044), type 2 diabetes mellitus (OR = 0.77; p = 0.042), and digoxin administration (OR = 0.85; p = 0.042) were negative factors for HFimpEF, whereas NT-proBNP ≤ 1940 pmol/mL (OR = 1.42, p = 0.001), relative decrease in NT-proBNP levels (&gt;35% vs. ≤35%) from baseline (OR = 1.52; p = 0.001), and cf-nDNA ≤ 7.5 μmol/L (OR = 1.56; p = 0.001) were positive predictors for HFimpEF. Conclusions: We established that the levels of cf-nDNA ≤ 7.5 μmol/L independently predicted HFimpEF and improved the discriminative ability of ischemia-induced cardiomyopathy, IV NYHA class, and single-measured NT-proBNP and led to a relative decrease in NT-proBNP levels ≤35% from baseline in individuals with HFrEF.

The causal association between epilepsy and amyotrophic lateral sclerosis: A two-sample Mendelian randomization study.

Epilepsy and amyotrophic lateral sclerosis (ALS) are common neurological disorders. The association between the two disorders has been raised in observational studies. However, it is uncertain to what extent they have mutual causal effects. In this study, we aimed to investigate their causal association using a two-sample Mendelian randomization (MR) method. We performed a two-sample bidirectional MR analysis to evaluate the causal association of epilepsy with the risk of ALS. Publicly published genome-wide association study statistics for epilepsy and ALS were used in the study. The primary analysis included genetic variants with a p value of less than 1 × 10-5 as instrumental variables. We applied several alternative methods, including inverse variance weighting, weighted median, simple mode, weighted mode, MR-Egger regression and MR pleiotropy residual sum and outlier, and statistical graphs to assess the associations of epilepsy and its subtype with the risk of ALS. Reverse MR analyses were also performed to examine the association of ALS with the risk of epilepsy. The primary MR analysis found no causal effect of epilepsy on risk of ALS (odds ration [OR]: 1.133, 95% confidence interval [CI]: 0.964-1.332, p=.130). Among subtypes of epilepsy, it also failed to observe any causal association between general epilepsy and ALS (OR: 1.036, 95% CI: 0.969-1.108, P=.300). However, focal epilepsy contributed to an increase in the risk of ALS (OR: 1.177, 95% CI: 1.027-1.348, p=.019). Moreover, the investigation of reverse causalities did not reveal significant results. The current study supports a causal influence of focal epilepsy on ALS risk. Future studies are needed to explore its potential role in ALS.

Acculturation, Perceptions about Seeking Mental Health Care, and Utilization of Mental Health Services among US-based South Asians.

To examine the relationship between acculturation, cultural perceptions surrounding mental health (MH) burden and utilization of MH services among South Asian (SA) adults in the United States. Cross-sectional study. Online survey. Four hundred five SA adults (≥18 years old) residing in the United States. Cross-sectional study of acculturation, attitudes toward MH burden, and MH service utilization was conducted via online survey. Multivariate logistic regression models were employed to understand how these factors were associated with MH service utilization. Utilization of MH services. Among the 405 participants, 49.0% identified as immigrants (75.1% Indian, 8% Bangladeshi, 5.5% Pakistani, and 3.8% from other SA countries). Current utilization of MH services was associated with comfort conversing in English (odds ration [OR]=5.99; 95% confidence interval [CI]=1.63, 27.02), having English-speaking peers (OR=3.80; 95% CI=1.12, 12.93), and having family (OR=2.37; 95% CI=1.21, 4.64) and peers (OR=5.64; 95% CI=1.71, 18.66) who used MH services. Participants with mostly SA peers (OR=0.48; 95% CI=0.23, 0.97) reported lower lifetime MH service utilization, and those with positive perceptions about MH burden reported higher lifetime utilization (OR=1.04; 95% CI=1.01, 1.09). Comfort expressing emotions in English, knowledge of family/peer MH service use, and type of social connections were associated with MH service utilization among SA immigrants. Interventions should aim to increase SA languages in which MH services are offered and to engage with SA communities to increase acceptance of MH service utilization.

High Postreperfusion Pulmonary Artery Pressure Is Associated With Increased 30-Day Mortality in Liver Transplantation

Objective: Mean pulmonary artery pressure (mPAP) is frequently elevated after graft reperfusion during liver transplantation (LT), but its influence on clinical outcomes remains unclear. In this retrospective study, we aimed to explore the incidence, risk factors, and impact of elevated mPAP on 30-day mortality in LT. Design: A retrospective study. SettingUniversity tertiary medical center. ParticipantsAdult patients who underwent LT from 2013 to 2023. InterventionNo intervention. Measurements and Main ResultsData of consecutive adults who underwent LT (n=1243) between 2013 and 2023 were extracted from our institutional Discovery Data Repository. Elevated mPAP was defined as ≥40 mmHg or a ≥20% increase from baseline during the first hour following reperfusion. The 30-day mortality rate was recorded. Risk factors were identified using multivariable logistic regression. Patients were 55.2±11.9 years old and had a mean MELD-Na score of 34.8±6.1. Ninety-one patients (7.3%) developed an elevated postreperfusion mPAP. Multivariate logistic regression revealed that preoperative elevated PAP estimated by echocardiogram, preoperative creatinine, and the use of epinephrine during LT were significant risk factors. Thirty-two patients (1.9%) died within 30 days after LT. Elevated postreperfusion mPAP was significantly associated with 30-day mortality (odds ration: 6.056, 95% confidence interval: 2.349–15.611, p<0.001). Conclusions: In this retrospective study, we observed a rate of 7.3% occurrence of high PAP following reperfusion in LT and high postreperfusion PAP was associated with 30-day mortality.

Lnsights into Adjuvant Systemic Treatment Selection for Patients with Stage III Melanoma: Data from the Dutch Cancer Registry.

Patient demographics and shared decision making might influence the choice of adjuvant therapy for stage III melanoma. To identify factors for treatment selection of patients diagnosed with stage III melanoma to better understand current treatment decisions and improve further treatment counseling. Data from 2007 patients diagnosed with stage III melanoma, between December 2018 and 2021, sourced from the Dutch Cancer Registry, were analyzed. Among the cohort, 48.7% received no therapy, 45.8% received checkpoint inhibition, and 5.5% received targeted therapy (TT). Patients foregoing therapy were significantly older [67.0 years (range 53.0-77.0) vs. 62.0 year (range 52.0-72.0)], had poorer performance scores (PS), and higher Charlson Comorbidity Index scores compared to those receiving therapy (p<0.001). Patients undergoing therapy had significantly higher median Breslow thickness (3.3mm vs. 2.2mm) and higher prevalence of ulceration (49.9% vs. 38.1%). Those with connective tissue disease and/or congestive heart disease were more likely to receive TT [odds ration (OR) 8.1; 95% confidence interval (CI) 1.7-37.6 and OR 9.3; 95% CI 1.2-72.2, respectively]. Median treatment time among strata for disease recurrence was 4.26months (3.69-4.82) for immunotherapy and 3.1months (0.85-5.36) for TT (p=0.298). Patients who developed recurrent disease were equal across treatment types (p=0.656). The number of patients with grade 3 complications was different for each treatment type [immunotherapy: 17.8% vs. TT: 37.3% (p<0.001)]. Age, PS, and Breslow thickness seem to influence adjuvant treatment decisions. Clinicians' preference for immunotherapy might play a role in counseling BRAF-positive patients for adjuvant therapy, this however, cannot be confirmed in this dataset. Overall, only a small proportion of patients completed adjuvant treatment.

Brain Imaging in New-Onset Seizure of Children Living With Human Immunodeficiency Virus in Zambia

BackgroundThere are an estimated 1.5 million children living with human immunodeficiency virus (CLHIV), most residing in sub-Saharan Africa. A common hospital presentation of CLHIV is new-onset seizure, for which imaging is helpful but not routinely performed due to scarce resources. We present imaging findings and their association with clinical risk factors and outcomes in a cohort of Zambian CLHIV presenting with new-onset seizure. MethodsIn this prospective cohort study, participants were recruited at the University Teaching Hospital in Lusaka, Zambia. Various clinical and demographic characteristics were obtained. Computed tomography (CT), magnetic resonance imaging (MRI), or both were obtained during admission or shortly after discharge. If both studies were available, MRI data was used. Two neuroradiologists interpreted images using REDCap-based NeuroInterp, a tool that quantifies brain imaging findings. Age-dependent neuropsychologic assessments were administered. ResultsNineteen of 39 (49%) children had a brain MRI, 16 of 39 (41%) had CT, and four of 39 (10%) had both. Mean age was 6.8 years (S.D. = 4.8). Children with advanced HIV disease had higher odds of atrophy (odds ration [OR] 7.2, 95% confidence interval [CI] 1.1 to 48.3). Focal abnormalities were less likely in children receiving antiretroviral therapy (ART) (OR 0.22, 95% CI 0.05 to 1.0). Children with neurocognitive impairment were more likely to have atrophy (OR 8.4, 95% CI 1.3 to 55.4) and less likely to have focal abnormalities (OR 0.2, 95% CI 0.03 to 0.9). ConclusionsFocal brain abnormalities on MRI were less likely in CLHIV on ART. Brain atrophy was the most common imaging abnormality, which was linked to severe neurocognitive impairment.

Safety and Effectiveness of Debulking for the Treatment of Infrainguinal Peripheral Artery Disease. Data From the Recording Courses of vascular Diseases Registry in 2910 Patients.

We investigated the safety and efficacy of debulking infrainguinal lesions in patients with peripheral artery disease (PAD) undergoing endovascular revascularization (EVR) as part of the RECording Courses of vascular Diseases (RECCORD) registry. Patient and lesion specific characteristics, including the lesion complexity score (LCS) were analyzed. The primary endpoint encompassed: (i) clinical improvement in Rutherford categories, (ii) index limb re-interventions, and (iii) major amputations during follow-up. The secondary endpoint included the need for bail-out stenting. Overall, 2910 patients were analyzed; 2552 without and 358 with debulking-assisted EVR. Patients were 72 (interquartile range (IQR) = 15) years old and 1027 (35.3%) had diabetes. Overall complication rates were similarly low in the debulking vs the non-debulking group (4.7 vs 3.2%, P = .18). However, peripheral embolizations rates were low but more frequent with debulking vs. non-debulking procedures (3.9 vs 1.1%, P < .001). After adjustment for clinical and lesion-specific parameters, including LCS, no differences were noted for the primary endpoint (odds ration (OR) = 0.99, 95%CI = 0.69-1.41, P = .94). Bail-out stenting was less frequently performed in patients with debulking-assisted EVR (OR = 0.5, 95%CI = 0.38-0.65, P < .0001). Debulking-assisted EVR is currently used in ∼12% of EVR with infrainguinal lesions and is associated with lower bail-out stent rates but higher peripheral embolization rates; no differences were found regarding index limb re-intervention and amputation rates.

Detection of Toxoplasma gondii in wild bivalves from the Kerguelen and Galapagos archipelagos: influence of proximity to cat populations, exposure to marine currents and kelp density

Oocysts of the protozoan Toxoplasma gondii are found in felid feces and can be washed into coastal waters, where they persist for months, attaching to algae and accumulating in invertebrates. We used wild bivalves to assess contamination of coastal waters of the Kerguelen and Galapagos archipelagos by this zoonotic parasite. Additionally, we leveraged the contrasting situations of these archipelagos to identify some potential drivers of contamination. In the Galapagos, with a cat density reaching 142 per km2, 15.38% of the sampled oysters (Saccostrea palmula) tested positive for T. gondii by quantitative real-time PCR (qPCR) (n = 260), and positive samples were found in all eight sampling sites. In Kerguelen, with 1-3 cats per km2, 40.83% of 120 tested mussels (Mytilus edulis platensis) were positive, and positive samples were found in four out of the five sampling sites. These findings provide evidence of T. gondii contamination in the coastal waters of these archipelagos. Furthermore, T. gondii-positive bivalves were found on islands located 20 km away (Galapagos) and 5 km away (Kerguelen) from the nearest cat population, indicating that T. gondii oocysts can disperse through waterborne mechanisms over several kilometers from their initial deposition site. In the Galapagos, where runoff is infrequent and all sites are exposed to currents, the prevalence of qPCR-positive bivalves did not show significant variations between sites (p = 0.107). In Kerguelen where runoff is frequent and site exposure variable, the prevalence varied significantly (p < 0.001). The detection of T. gondii in Kerguelen mussels was significantly correlated with the site exposure to currents (odds ratio (OR) 60.2, p < 0.001) and the on-site density of giant kelp forests (OR 2.624, p < 0.001). This suggests that bivalves can be contaminated not only by oocysts transported by currents but also by consuming marine aggregates containing oocysts that tend to form in kelp forests.

Prevalence of Musculoskeletal Pain in Amateur Golfers in the State of São Paulo: A Cross-sectional Study.

Objective To verify the prevalence of musculoskeletal pain in amateur golfers in the State of São Paulo, Brazil. Methods The present is a cross-sectional study performed from September 2019 to March 2020 in golf clubs affiliated to Federação Paulista de Golfe (São Paulo Golf Federation). Federation players were evaluated regarding data on golf practice and sport routine by a main investigator, though an assessment form with multiple-choice questions, to determine sample characteristics and recent pain intensity by the Visual Analogue Scale. Results Approximately 359 amateur golfers were analyzed. The prevalence of pain was of 55.15% (95% confidence interval [95%CI]: 50.0% to 60.3%); the average pain intensity according to the VAS was moderate (mean ± standard deviation: 5.21 ± 2.04; odds ration [OR]: 47,98%). The golfer's age range was significantly associated with the presence of pain ( p < 0.05). The highest prevalence estimate of pain was of 68.80% in the age group between 30 and 39 years (OR: 7,33; 95%CI: 2,26 to 23,85; p = 0,0009). The segments most affected by pain were the upper limbs (65.66%), followed by the spine (59.09%) and the lower limbs (32.83%). Conclusion There is a high prevalence rate of pain in Brazilian amateur golfers, especially in younger players in the age group between 30 and 39 years.

The Association between the Dietary Antioxidant Index and Weight Status in Primary School Students: An Epidemiological Study.

Obesity is an emerging threat and a current challenge for children and adolescents worldwide. The aim of the present work was to evaluate the relationship between the Dietary Antioxidant Index (DAI) and the weight status of students in early adolescence. A sample of 1580 students aged 10-12 years from 47 primary schools in Greece were enrolled. Anthropometric characteristics were assessed, and calculation of the Body Mass Index (BMI) was used to categorize students into two weight-status groups. Dietary habits and physical activity were evaluated using a self-completed questionnaire, and the DAI was calculated through derived micronutrients' content, along with energy, macro-, and micro-nutrient intake. Crude and adjusted regression analysis showed a significant inverse association of the DAI and body weight status (Odds Ratio (OR): 0.719, 95% Confidence Interval (CI): 0.576; 0.897, and adjusted Odds Ration (aOR): 0.667, 95% CI: 0.489; 0.907). An antioxidant diet seems to play a protective role against increased body weight among students in early adolescence. Thus, dietary patterns rich in antioxidants should be promoted to facilitate healthy habits early in life, and to fight the obesity threat.

The Association of Dyslipidemias with Cholelithiasis: A Case-Control Study Conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad

Objective: To find the association of lipid profile with early sign of cholecystitis (gall stones formation). Study Design: Case control study. Place and Duration of Study Methodology: The study recruited cholecystitis patients from 1st April 2022 to 30th September 2022 at Pathology Department, Pakistan Institute of Medical Sciences, Islamabad. Those patients having an age above 40 years and clinically diagnosed with gall bladder stone, went under ultrasonography examination, were included in the study. A total of 100 cases were compared with 100 controls in a case control study design. The lipid profile included serum concentrations of HDL cholesterol, Total Cholesterol, triglyceride, LDL cholesterol levels. Other tests as fasting blood glucose (FBG), total bilirubin (T-bil), alanine transaminase (ALT), aspartate transaminase (AST), creatinine (Cr), uric acid (UA), and urea nitrogen (UN) were also conducted. Results: The mean age of the gall stone patients and of normal controls was 51.71±13.48 and 42.00±13.14 years respectively. There was no variance in the BMI of both groups. The incidence of kidney stones was higher in the cases than controls while hypertension was more commonly reported in the 36% of the cases in comparison to the 19% of the controls. The logistic regression analysis presented a data where significant difference within lipid profile values of cases and controls could be seen having high values reported in cases than controls. The multivariant analysis of the lipid profile analyzed values presented a significant variance in the odds ration of high-density lipoprotein cholesterol levels and triglycerides of cases and controls. Conclusion: Low levels of high-density lipoprotein cholesterol and high levels of triglycerides are associated with the risk of gall bladder formation.

Abstract PO2-09-11: Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program

Abstract Background. Currently, sexual orientation data is not collected, nor is the language to study sexual orientation data defined by any national cancer database. Due to this limitation, little is known about breast cancer (BC) disparities in sexual minority women (SMW) despite several studies showing increased lifestyle risk factors. Our objective was to study this question in the All of Us database. Methods. We analyzed data from the All of Us research program, a national open enrollment database that registers diverse subjects through associated healthcare electronic medical records and collects survey data. We aimed to compare risk factors, as well as preventative and procedural healthcare utilization differences between SMW and straight women (StW) as they relate to BC care. Results were expressed as odds ratios (OR) with a 95% confidence interval [CI]. Results. Of 229,917 cisgender women who answered the sexual orientation question, 27,302 (11.9%) selected “non-straight orientation, prefer not to answer, or skipped” and thus were defined as SMW. In total, 6,905 (3.0%) women had received a BC diagnosis, including 423 (6.1%) SMW. SMW were less likely to have a BC diagnosis than StW (OR 0.48 [0.43-0.53]). Among all women, there were significant differences in frequency and types of visits and procedures performed. SMW women were less likely to undergo annual history and physical examination (0.79 [0.73-0.85]), mammography (0.61 [0.53-0.69]), and breast biopsy (0.55 [0.41-0.72]), as well as being less likely to undergo breast surgeries (mastectomy 0.53 [0.30-0.93]; lumpectomy 0.53 [0.38-0.74]). Survey data revealed differences in several lifestyle factors that relate to BC risk development. While StW were more likely to answer yes to being an “alcohol participant” (0.79 [0.77-0.82]), SMW reported higher rates of alcohol intake on a daily, weekly, and monthly basis, as well as being more likely to consume 6 or more drinks in one sitting. SMW also showed significantly increased history of smoking/nicotine usage. There were also significant differences in healthcare access and utilization: StW were more likely to receive health advice from a primary care provider (0.65 [0.65-0.69]), while SMW were more likely to utilize urgent and emergency care (1.44 [1.34-1.54]). SMW were also more likely to report being unable to afford care (1.82 [1.72-1.93]), medication (1.69 [1.61-1.76]), specialty care (1.98 [1.89-2.08]), and follow-up care (1.85 [1.75-1.95]), as well as to delay care due to cost concerns about the copay (2.13 [2.02-2.23]), deductible (1.64 [1.56-1.73]), paying out of pocket (1.70 [1.63-1.77]) or because they were nervous (2.80 [2.69-2.91]). SMW reported being more likely to experience healthcare discrimination based on questions about healthcare provider interactions (Table 1). Conclusions.Although likelihood of a breast cancer diagnosis in the All of Us database is significantly higher in StW than SMW, discrimination, lack of access, and underutilization of preventative and screening services by SMW likely creates an underrepresentation of the true number of SMW with BC. Further studies on characteristics at diagnosis, treatments, and survival are needed to address how these disparities affect BC outcomes in SMW. Table 1: Survey answers among sexual minority women (SMW) compared to straight women (StW) reporting on discrimination from healthcare provider interactions in the All of Us database. SMW: sexual minority women; StW: straight women; OR: odds ration; Lower 95 CI: lower 95% confidence interval; Upper 95 CI: upper 95% confidence interval; Sig. *: statistically significant with p &amp;lt; 0.05; OR&amp;gt;1: SMW most likely to answer; OR &amp;lt;1 StW most likely to answer. Citation Format: Lucas Houser, Collin Dougherty, Sean Figy, Jessica Maxwell, Juan Santamaria-Barria. Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-11.

Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study

Pregnancies with large for gestational age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options including expectant management, induction of labour and caesarean birth. For women to be able to make an informed decision about birth, antenatal detection of large for gestational age is essential. To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth. In this retrospective cohort study, we analysed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication, as well as a subgroup where the reason for scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW centile, for estimated fetal weight as well as for neonatal weight. We also tested performance of an uncustomized standard, with Hadlock fetal weight >90th centile and neonatal weight >4kg. We calculated diagnostic characteristics for the whole population as well as groups with different maternal body mass indices. The study cohort consisted of 26,527 pregnancies which on average had a scan at 256 days gestation and delivered 20 days later at a median of 276 days (interquartile range 15). In total 2241 (8.4%) of neonates were large for gestational age by customized centiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th centile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with sensitivity of 77.1% and false positive rate 36.0%. When comparing subgroups from low (<18.5kg/m2) to high body mass index (>30kg/m2), sensitivity increased from 55.6 to 67.8%, false positive rate from 5.2 to 11.5% and positive predictive value from 32.1 to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4kg), and of these 1058 (40.9%) were large for gestational age (>90th centile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized compared to uncustomized standards for low body mass index (<18.5; diagnostic odds ratio 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ration 16.2 vs 8.8). Late third trimester ultrasound estimation of fetal weight for any indication has good ability to identify and predict large for gestational age at birth, and improves with the use of a customised standard. Detection rate is better when ultrasound is performed for a suspected large fetus, however at the risk of higher false positive diagnosis. Our results provide information for women and clinicians to aid antenatal decision making about birth of a fetus suspected of being large for gestational age.

Infant and Maternal Morbidity Symptoms as Predictors for the Interruption of Exclusive Breastfeeding in Lima, Peru: A Prospective Study

The global prevalence of exclusive breastfeeding for 6 months is 48%. This analysis examined the relationship between infant and maternal morbidity symptoms and the interruption of exclusive breastfeeding. Data from a cohort study among women living in a peri-urban community in Peru were used. Data were collected during pregnancy, birth, and the first 6 months postpartum among 179 dyads... After the first month, interruption of exclusive breastfeeding was almost twofold (adjusted odds ration [aOR] = 1.99, 95% confidence interval [CI]: 1.14, 3.45) more likely among infants with symptoms (e.g., diarrhea, cough) than those without. Maternal morbidity symptoms (e.g., gastrointestinal, respiratory) and breast problems were positively associated with interruption of exclusive breastfeeding throughout the first 6 months (aOR = 1.77, 95% CI: 1.11, 2.82 and aOR = 3.23, 95% CI: 1.84, 5.69, respectively). Mother-infant dyads often experience illness symptoms that are not contraindications to breastfeeding. Health professionals need to reinforce that exclusive breastfeeding should continue during illness.

First use of tissue exudate serology to identify Toxocara spp. infection in food animals

Toxocara canis and Toxocara cati are globally distributed, zoonotic roundworm parasites. Human infection can have serious clinical consequences including blindness and brain disorders. In addition to ingesting environmental eggs, humans can become infected by eating infective larvae in raw or undercooked meat products. To date, no studies have assessed the prevalence of Toxocara spp. larvae in meat from animals consumed as food in the UK or assessed tissue exudates for the presence of anti-Toxocara antibodies. This study aimed to assess the potential risk to consumers eating meat products from animals infected with Toxocara spp. Tissue samples were obtained from 155 different food producing animals in the south, southwest and east of England, UK. Tissue samples (n = 226), either muscle or liver, were processed by artificial digestion followed by microscopic sediment evaluation for Toxocara spp. larvae, and tissue exudate samples (n = 141) were tested for the presence of anti-Toxocara antibodies using a commercial ELISA kit. A logistic regression model was used to compare anti-Toxocara antibody prevalence by host species, tissue type and source. While no larvae were found by microscopic examination after tissue digestion, the overall prevalence of anti-Toxocara antibodies in tissue exudates was 27.7%. By species, 35.3% of cattle (n = 34), 15.0% of sheep (n = 60), 54.6% of goats (n = 11) and 61.1% of pigs (n = 18) had anti-Toxocara antibodies. Logistic regression analysis found pigs were more likely to be positive for anti-Toxocara antibodies (odds ration (OR) = 2.89, P = 0.0786) compared with the other species sampled but only at a 10% significance level. The high prevalence of anti-Toxocara antibodies in tissue exudates suggests that exposure of food animals to this parasite is common in England. Tissue exudate serology on meat products within the human food chain could be applied in support of food safety and to identify practices that increase risks of foodborne transmission of zoonotic toxocariasis.

Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study

BackgroundIn some cases of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR), negative pupillary light reflex (PLR) and mydriasis upon hospital arrival serve as common early indicator of poor prognosis. However, in certain patients with poor prognoses inferred by pupil findings upon hospital arrival, pupillary findings improve before and after the establishment of ECPR. The association between these changes in pupillary findings and prognosis remains unclear. This study aimed to clarify the association of pupillary examinations before and after the establishment of ECPR in patients with OHCA showing poor pupillary findings upon hospital arrival with their outcomes. To this end, we analysed retrospective multicentre registry data involving 36 institutions in Japan, including all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. We selected patients with poor prognosis inferred by pupillary examinations, negative pupillary light reflex (PLR) and pupil mydriasis, upon hospital arrival. The primary outcome was favourable neurological outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Multivariable logistic regression analysis was performed to evaluate the association between favourable neurological outcome and pupillary examination after establishing ECPR.ResultsOut of the 2,157 patients enrolled in the SAVE-J II study, 723 were analysed. Among the patients analysed, 74 (10.2%) demonstrated favourable neurological outcome at hospital discharge. Multivariable analysis revealed that a positive PLR at ICU admission (odds ration [OR] = 11.3, 95% confidence intervals [CI] = 5.17–24.7) was significantly associated with favourable neurological outcome. However, normal pupil diameter at ICU admission (OR = 1.10, 95%CI = 0.52–2.32) was not significantly associated with favourable neurological outcome.ConclusionAmong the patients with OHCA who underwent ECPR and showed poor pupillary examination findings upon hospital arrival, 10.2% had favourable neurological outcome at hospital discharge. A positive PLR after the establishment of ECPR was significantly associated with favourable neurological outcome.