Population-based Case-control Study Research Articles

A UK population-based case-control study of blood tests before cancer diagnosis in patients with non-specific abdominal symptoms.

Abnormal results in commonly used primary care blood tests could be early markers of cancer in patients presenting with non-specific abdominal symptoms. Using linked data from the UK Clinical Practice Research Datalink (CPRD) and national cancer registry we compared blood test use and abnormal results from the 24-months pre-diagnosis in 10,575 cancer patients (any site), and 52,875 matched-controls aged ≥30 presenting, with abdominal pain or bloating to primary care. Cancer patients had two-fold increased odds of having a blood test (odds ratio(OR):1.51-2.29) and 2-3-fold increased odds of having an abnormal blood test result (OR:2.42-3.30) in the year pre-diagnosis compared to controls. Raised inflammatory markers were the most common abnormality (74-79% of tested cases). Rates of blood test use and abnormal results progressively increased from 7 months pre-diagnosis in cancer patients, with relatively small corresponding increases in symptomatic controls. In cancer patients, the largest increases from baseline were raised platelets in males with abdominal pain (increased 33-fold), raised white blood cell count in males with abdominal bloating (increased 37-fold) and low albumin in females with either symptom (increased 22-41 fold). Common blood test abnormalities are early signals of cancer in some individuals with non-specific abdominal symptoms and could support expedited cancer diagnosis.

Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study

Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study

Early-Life Exposures and Odds of Adenomyosis: A Population-Based Case-Control Study.

Adenomyosis can confer life-altering symptoms such as pelvic pain. Yet, the epidemiologic study of this uterine condition lags other gynaecologic conditions. This includes the investigation of intrauterine exposures that could disrupt foetal development and contribute to the presence of adenomyosis in adulthood. We investigated nine early-life factors and the odds of adenomyosis using data from a population-based case-control study of enrollees of an integrated healthcare system in Washington State ages 18-59. Cases (n = 386) had incident, pathology-confirmed adenomyosis diagnosed between 2001 and 2006. Two control groups were employed: hysterectomy controls (n = 233) and randomly selected age-matched enrollees with an intact uterus ('population controls', n = 323). The primary study activity was a structured in-person interview; participants were also mailed a family history questionnaire that included questions on early-life factors. We conducted logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the associations between early-life factors and adenomyosis. Comparing cases to population controls, our data suggested an 80% increased odds of adenomyosis with younger maternal age at participant's birth (≤ 19 vs. ages 25-29) (aOR 1.81, 95% CI 0.94, 3.50) and a 50% increased odds of adenomyosis for participants who were the fourth or later live birth (vs. firstborn) (aOR 1.51, 95% CI 0.88, 2.59). Among never-smoking participants, our data suggested a 50% increased odds of adenomyosis with intrauterine exposure to cigarette smoking (aOR 1.50, 95% CI 0.92, 2.46). In analyses using hysterectomy controls, these associations were attenuated. These data suggested that several intrauterine exposures were associated with increased odds of adenomyosis in adulthood. The intrauterine period may be a susceptible window for subsequent development of adenomyosis and warrants further investigation.

Kidney and gallbladder stones and the risk of prostate cancer: Results from the EPICAP study.

Prostate cancer remains the most frequent cancer among men, representing a significant health burden. Despite its high morbidity and mortality rates, the etiology of prostate cancer remains relatively unknown, with only non-modifiable established risk factors. Chronic inflammation has emerged as a potential factor in prostate carcinogenesis. We investigated the role of kidney and gallbladder stones and the risk of prostate cancer. We used data from EPICAP, a population-based case-control study. A total of 819 diagnosed prostate cancer cases and 879 controls were face-to-face interviewed using a standardized questionnaire that collected information on personal medical history, including history of kidney and gallbladder stones. Odds Ratios (OR) and their 95% confidence interval (CI) were estimated using multivariate unconditional logistic regression. Our study revealed intriguing patterns regarding kidney and gallbladder stones in relation to prostate cancer risk. The analysis indicated significant potential associations between kidney stones and the risk of prostate cancer (OR: 1.46 95% CI: 1.13-1.90), particularly in men with a history of kidney infection. Additionally, our data suggested a possible relationship between gallbladder stones and prostate cancer when considering triglyceride (OR: 2.27, 95% CI: 0.99-5.28), although further research is needed for a conclusive understanding. Our results suggest an association between calculi and the risk of prostate cancer. Findings from this study underscore the need for a more comprehensive investigation to understand the role of chronic inflammation or metabolism and delineate the mechanisms underlying these potential associations in order to guide the development of targeted preventive strategies for aggressive prostate cancer.

Obesity Affects Disease Activity and Progression, Cognitive Functioning, and Quality of Life in People With Multiple Sclerosis.

While obesity is a known risk factor of the development of multiple sclerosis (MS), its impact on MS disease progression remains unclear. We aimed to investigate the influence of body mass index (BMI) on disease activity and progression, cognitive performance, and health-related quality of life in patients with MS. Patients from an incident population-based case-control study (n = 3,249) were categorized based on BMI status at diagnosis and followed up after diagnosis through the Swedish MS registry. Outcomes included changes in the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale 29, and Symbol Digit Modalities Test. The mean follow-up time was 10.6 years (SD 6.1). Linear mixed models were used to analyze long-term changes while Cox regression models assessed the risk of 24-week confirmed disability worsening, time to reach EDSS score 3 and EDSS score 4, the appearance of new lesions on MRI, patient-reported physical and psychological worsening, and processing speed worsening. Obesity, compared with healthy weight, was associated with a 0.02-point faster annual increase in the EDSS score (β for EDSS score x time 0.02, 95% CI 0.00-0.04). In addition, obesity was linked to a higher risk of reaching EDSS score 3 (HR 1.43, 95% CI 1.17-1.75) and EDSS score 4 (HR 1.40, 95% CI 1.07-1.73) and an increased risk of physical and psychological worsening. New lesions on MRI were more frequent among those with overweight and obesity, compared with those with healthy weight (HR 1.21, 95% CI 1.02-1.44 and HR 1.29, 95% CI 1.03-1.62, respectively). Among those who had not changed BMI group during follow-up, the associations between obesity and unfavorable outcomes became more pronounced, and the HR of cognitive disability worsening was 1.51 (95% CI 1.09-2.09) among those with obesity, compared with nonobese participants. In participants with MS, obesity was associated with faster disease progression, poorer health-related quality of life, and more rapid cognitive decline. Both overweight and obesity were associated with higher MRI activity.

Breast Cancer Susceptibility Gene Sequence Variations and Development of Contralateral Breast Cancer

Heterogeneity in development of estrogen receptor (ER)-specific first primary breast cancer exists due to deleterious germline variants in moderate- to high-penetrance breast cancer susceptibility genes, but it is unknown if these associations occur in ER-specific CBC. To determine the association of deleterious germline variants in breast cancer susceptibility genes with ER-specific CBC development and whether ER status of the first primary breast cancer modifies these associations. This case-control study included CBC cases and matched unilateral breast cancer controls from The Women's Environment, Cancer, and Radiation Epidemiology (WECARE) Study, a population-based case-control study. Eligible women were diagnosed between 1985 and 2000 with data and biospecimens collected from 2001 to 2004. Eligible participants were women younger than 55 years at first invasive breast cancer diagnosis. Participants were matched on age, diagnosis year, cancer registry region, and race and ethnicity, and countermatched on radiation treatment. For cases, CBC occurred 1 year or more following first breast cancer diagnosis. Analyses were performed from May to October 2024. CHEK2 1100delC and deleterious variants in ATM, BRCA1, and BRCA2. Development of CBC, measured as a rate ratio (RR). A total of 1290 women were included in analysis (median [IQR] age at first diagnosis, 47 [42-51] years). The ER-positive CBC rate for women with deleterious ATM variants was 4 times higher than for women without deleterious ATM variants (RR, 4.84; 95% CI, 1.11-21.08; P = .04); no women with ER-negative CBC carried deleterious ATM variants. The ER-positive CBC rates for women with deleterious variants in BRCA2 or CHEK2 1100delC were 5 to 6 times higher than for women without deleterious variants in BRCA2 or CHEK2 1100delC, respectively (BRCA2: RR, 5.88; 95% CI, 2.61-13.26, P < .001; CHEK2 1100delC: RR, 6.06; 95% CI, 1.26-29.04; P = .02). The ER-negative CBC rate for women with deleterious BRCA1 variants was 26 times higher than for women without deleterious BRCA1 variants (RR, 26.16; 95% CI, 8.01-85.44; P < .001). First primary breast cancer ER status did not modify associations between deleterious variants and ER-specific CBC development. In this case-control study of CBC, deleterious variants in breast cancer susceptibility genes were differentially associated with ER-specific CBC development. Germline variation profile may inform estimates of outcomes for ER-specific CBC subtypes.

Risk of acute myocardial infarction associated with anti-rheumatic agents in patients with rheumatoid arthritis: a nationwide population-based case-control study

Risk of acute myocardial infarction associated with anti-rheumatic agents in patients with rheumatoid arthritis: a nationwide population-based case-control study

Comorbid diseases in bullous pemphigoid: A population-based case-control study.

Bullous pemphigoid (BP) is the most prevalent autoimmune blistering disorder, triggered by autoantibodies targeting hemidesmosome components. It is associated with substantial morbidity and increased mortality. No studies comprehensively evaluate all comorbidities before and after diagnosing patients with BP. We aimed to investigate all BP-associated comorbid diseases and their patterns of associations. This nationwide population-based study included 5066 patients with BP and 10 132 controls between 2011 and 2021. We performed an automated mass screening of 546 diagnostic codes to identify BP-associated comorbidities 5 years before and after BP diagnosis, and analyzed associations patterns of comorbidities. Patients with BP had increased odds of having pressure ulcers, intracerebral hemorrhage, scabies, neuropsychiatric disorders, psoriasis, drug eruption, and acute renal failure before BP diagnosis. After BP diagnosis, they had increased odds pneumonia, sepsis, chronic renal disease, and cardiac arrest. Strong interrelationships were observed between five neuropsychiatric conditions before BP diagnosis and a strong bidirectional association between Alzheimer's dementia and pneumonia after BP diagnosis. This large case-control study of patients with BP thoroughly identified all relevant comorbidities before and after BP diagnosis, highlighting their clinical significance as predisposing and prognostic factors in patients with BP.

Increased Rates of Infectious Diseases in Fibromyalgia Patients: A Population-Based Case-Control Study.

Introduction: Fibromyalgia (FM) patients are known to have medical comorbidities. This study characterized the rates of infectious diseases in FM patients compared to the general population. Methods: A nationwide population-based case-control study was conducted, including all patients diagnosed with FM by a rheumatologist compared to a matched 5:1 control group within a large health maintenance organization in Israel (January 2002 to December 2023). Demographic, anthropometric, and health habit data were extracted from medical records as well as the ICD-9 codes of diagnoses related to infectious diseases in 9232 FM patients and 46,160 controls. Infection rates in the FM patients were compared to the controls over a mean follow-up of 6.7 years. Results: The FM patients had a significantly higher incidence of viral, bacterial, fungal, and parasitic diseases compared to the controls. The FM patients had significantly higher odds ratios (ORs) for respiratory/sinopulmonary infections, including upper respiratory tract infections (OR = 1.49), influenza (OR = 1.80), tonsillitis (OR = 1.40), sinusitis (OR = 1.98), otitis media (OR = 1.84), otitis externa (OR = 1.48), and pneumonia (OR = 1.60), all p < 0.01. They also experienced more gastrointestinal infections, including gastroenteritis (OR = 1.40), Helicobacter pylori (OR = 2.05), candidal esophagitis (OR = 7.88), and giardiasis (OR = 3.41), all p < 0.01. They had a higher prevalence of genitourinary infections, including urinary tract infections (OR = 1.79) and pelvic inflammatory disease (OR = 3.17), p < 0.01 as well as skin infections such as abscess (OR = 1.74) and cellulitis (OR = 1.64) and systemic infections such as symptomatic COVID-19 (OR = 1.76) and Cytomegalovirus (CMV) (OR = 1.85), all p < 0.01. Conclusions: The FM patients had a significantly higher incidence of infectious diseases than the general population. Further research is needed to better understand the underlying mechanisms and develop targeted interventions to address infection risks in FM patients.

Overcoming underestimation of the share of colorectal cancer cases attributable to excess weight: a population-based study.

Previous research may have underestimated the relationship between overweight/obesity and colorectal cancer (CRC) risk by overlooking important potential sources of bias. We used data from a large, population-based case-control study encompassing 7098 CRC cases and 5757 age- and sex-matched controls with comprehensive information on risk factors, including self-reported body weight. Multivariate logistic regression was used to assess the associations of BMI with CRC risk before and after considering prediagnostic weight loss, history of lower gastrointestinal endoscopy, and potentially increased CRC risk beneath the overweight threshold (BMI 25 kg/m2). Subsequently, population attributable fractions were calculated. In the standard analysis evaluating the BMI-CRC association, in which none of the three aforementioned factors wasconsidered, the fraction of CRC cases attributable to overweight and obesity was estimated to be 11.5%. This finding is consistent with estimates from previous studies, which mostly did not consider any of the three factors. However, when all three factors were considered in the analysis, a higher BMI was estimated to account for 23.4% of all CRC cases. Careful consideration of important sources of bias suggests that a substantially larger share of the CRC burden may be attributable to excess weight than previously thought.

Association of Scoliosis and Severe Knee Osteoarthritis: A Case-Control Study.

Background/Objectives: Scoliosis has been linked to pelvic position and tilt angle, but few studies have explored its relationship with knee pathology, which can be a significant burden for the elderly. Our aim is to investigate the relationship between scoliosis and knee osteoarthritis (OA). Methods: This population-based case-control study using data from the National Health Insurance Database of Taiwan included patients diagnosed with OA who underwent total knee replacement (TKR) for the first time between 2014 and 2019. Propensity score matching was employed to select controls who did not undergo TKR. Scoliotic cases were identified if they had been diagnosed before knee OA and TKR. The study samples included 10,021 patients with OA/TKR and 30,063 patients without OA/TKR. We then utilized logistic regression analysis to calculate the odds ratio (OR) and 95% confidence interval (CI) for the diagnosis of scoliosis prior to the index date. Results: The findings indicate that patients with pre-existing scoliosis have a 1.627 times greater likelihood of undergoing TKR, with significantly higher odds ratios observed across both female (OR = 1.583) and male (OR = 1.909) and younger (OR = 2.102) and older (OR = 1.575) patients. However, a notable limitation of this study is the absence of data on scoliosis curve side, which prevented us from analyzing the relationship between curve direction and knee arthritis laterality. Furthermore, while we included diagnostic codes indicating left or right TKR, the lack of precise measurements for variables such as lower limb length discrepancies may introduce residual confounding. Conclusions: Our research suggests a significant association between scoliosis and the development of knee OA.

Association Between Incense Burning and the Risk of Lung Cancer in Asian Population: Meta-Analysis of Nine Case-Control Studies.

Various studies have explored the potential association between incense burning and the risk of lung cancer. However, the findings from these studies have been inconsistent. This study aimed to provide a more comprehensive understanding of the relationship between incense burning and lung cancer risk in the Asian population through a meta-analysis. This meta-analysis, which includes nine case-control studies conducted in Asia and identified through Google Scholar, PubMed, and ScienceDirect up to January 7, 2024, was performed to evaluate the relevant literature. Using a fixed-effects model, the pooled odds ratio (OR) was calculated to determine the overall association between incense burning and lung cancer. The results of the meta-analysis revealed a significant association between incense burning and the development of lung cancer (pooled OR = 1.33, 95% confidence interval [CI]: 1.20-1.48). Furthermore, a subgroup analysis was conducted based on smoking status. It was found that ever-smokers had a significantly higher risk of developing lung cancer when exposed to incense burning (pooled OR = 1.34, 95% CI: 1.09-1.65). Both hospital-based case-control studies (pooled OR = 1.28, 95% CI: 1.10-1.48) and population-based case-control studies (pooled OR = 1.39, 95% CI: 1.21-1.60) yielded significant associations between incense burning and lung cancer. Limitations of this study include the lack of detailed histologic information in most of the selected studies, highlighting the need for future research to include cohort studies that can more accurately assess the association between incense smoke inhalation and specific lung cancer subtypes. In conclusion, the findings of this meta-analysis, based on nine case-control studies, suggest that the risk of developing lung cancer among Asians may increase with exposure to incense burning.

Associations Between Maternal Periconceptional Alcohol Consumption and Risk of Craniosynostosis Among Offspring, National Birth Defects Prevention Study, 1997-2011.

Previous studies of maternal alcohol consumption and craniosynostosis have reported null or inverse associations. We updated a previous analysis of National Birth Defects Prevention Study (NBDPS) data to further examine associations between maternal alcohol consumption and craniosynostosis. NBDPS was a multi-site, population-based case-control study. Mothers of craniosynostosis cases and randomly selected liveborn controls delivered during 1997-2011 completed a telephone interview about pregnancy exposures. We examined associations for self-reported periconceptional maternal alcohol consumption (during the month before conception through the third gestational month) and odds of craniosynostosis in offspring. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between any alcohol consumption and binge consumption and craniosynostosis, overall and by affected suture. Finally, we performed a probabilistic bias analysis using a range of assumptions about the sensitivity and specificity of self-reported consumption by case/control status. We analyzed interview data from 1435 mothers of craniosynostosis cases and 11,216 mothers of controls. Periconceptional alcohol consumption prevalence was similar among case (36.9%) and control (38.2%) mothers. We observed point estimates near or below 1.0 for alcohol consumption (any and binge) and all suture subtypes of craniosynostosis, with all CIs including the null. Our bias-adjusted estimates for periconceptional alcohol consumption were higher than our conventional estimates but supported the null findings. We observed primarily null associations between maternal periconceptional alcohol consumption and craniosynostosis. However, our findings do not diminish the prevailing clinical guidance in the United States that pregnant people should abstain from alcohol consumption.

Multidimensional Approach of Genotype and Phenotype in Stroke Etiology: The MAGPIE Study.

Stroke is a leading cause of mortality and morbidity in Bangladesh. It is estimated that genetic determinants account for around 40%-60% of its etiology, similar to environmental factors. This study aimed to provide a better understanding of the genetic, environmental, and clinical risk factors in stroke patients from Bangladesh. The MAGPIE (Multidimensional Approach of Genotype and Phenotype In Stroke Etiology) study is a population-based case-control study that will allow a hypothesis-free genome-wide association study (GWAS) to identify genetic risk factors associated with adult stroke (age ≥ 18 years) in Bangladesh. This study will collect detailed phenotypic data as well as blood samples from stroke patients and control subjects. High-molecular-weight genomic DNA will be isolated and archived using Qiagen DNA isolation kits. We will utilize SPSS v28.0, vR-4.3.2 and gPLINK v2.0 software to analyse the study variables, as appropriate. Further, appropriate statistical tests will be applied to test the significance level between study groups. As applicable, data will be presented in tables and graphs, such as Manhattan plots and Quantile-Quantile (QQ) plots. A p < 0.05 will be considered as statistical significance. This will be the first large-scale carefully phenotyped biobank of Bangladeshi stroke patients which will enable a GWAS enabling an understanding of the association between gene-phenotype risk factors which has the potential to revise and refine national stroke guidelines.

Effectiveness of influenza vaccination in preventing confirmed influenza cases and hospitalizations in Northern Spain, 2023/24 season: A population-based test-negative case-control study.

We estimated the influenza vaccination effectiveness (IVE) in preventing medical consultations and hospitalizations due to influenza during the 2023/24 season. Two test-negative case-control studies analyzed patients who consulted primary healthcare or were hospitalized for respiratory symptoms and were tested for influenza by PCR in the 2023/24 season in Navarre, Spain. Influenza vaccination status in the current and previous seasons was compared between confirmed influenza cases and test-negative controls. IVE was calculated as (1-adjusted odds ratio)x100. Of 3133 hospitalized patients, 529 (17%) were positive for influenza: 71% A/H1N1, 23% A/H3N2, and 7% A non-subtyped. IVE to prevent hospitalizations was 43% (95%CI: 26-56%) overall, 61% (95%CI: 32-77%) in people younger than 65 years old and 35% (95%CI: 10-53%) in older people. IVE was 48% (95%CI: 30-61%) against influenza A/H1N1, and 15% (95%CI: -42-49%) against influenza A/H3N2. IVE in people vaccinated only in the previous season was 28% (95%CI: -5-51%). Among 417 outpatients, 146 (35%) were confirmed for influenza. IVE to prevent outpatient cases was 49% (95%CI: -9-76%) overall and 42% (95%CI: -33-74%) against influenza A/H1N1. IVE was moderate against influenza A/H1N1 and low against influenza A/H3N2 in the 2023/24 season.

Seroprevalence of Helicobacter pylori and incident myocardial infarction - A population-based Swedish nested case-control study.

Helicobacter pylori (H. pylori) and its Cytotoxin associated gene A (CagA) have been associated with myocardial infarction (MI), but existing data are conflicting possibly due to limitations in study designs and lack of data on important confounders. The aim of this study was to determine whether H. pylori or CagA seropositivity are associated with incident MI, including MI phenotypes, and to describe temporal trends. We used the Northern Sweden Health and Disease study, a prospective biobank with data from residents enrolled in a population-based cohort from health examinations between 1986 and 2006. A total of 826 first time MI cases with available blood samples from their index health examination were identified up to 2006. Each case was 1:2 matched with controls by age, sex, sample date and geographical area. Blood samples were analysed using ELISA to determine seroprevalence of H. pylori and CagA, which were then used to study the association with incident MI. The median age at baseline was 50 years, and 71% of participants were male. Seroprevalence of H. pylori and CagA was 46.5% and 32.1% in cases, respectively, compared to 43.7% and 30.6% in controls. Overall, H. pylori prevalence decreased over the study period. After multivariable adjustments, no significant association was observed between H. pylori seropositivity and incident MI (odds ratio 1.15, 95% CI 0.94-1.42) nor between CagA-positive H. pylori and incident MI. In a Swedish population-based cohort, no significant association was observed between H. pylori or CagA seropositivity and incidence of MI.

Expert-based assessment of chemical and physical exposures, and organizational factors, in past agricultural jobs

BackgroundLimited data document the spectrum of exposures in the agricultural environment. We describe here the wide range of chemical and physical agents, and organizational factors, encountered in agricultural jobs held in the past in Canada and abroad. MethodsWe used data from a population-based case-control study of prostate cancer including 3,925 male participants residing in Montreal, Canada in 2005-2012. Lifetime occupational histories and detailed job descriptions were collected in-person. Industrial hygienists and an agronomist conducted semi-quantitative evaluations of exposure, including intensity and reliability, to some 300 chemical and physical agents in each job held. Analyses focused on the 156 agricultural jobs ever held in the study population. Clusters of agricultural co-exposures were derived. ResultsAgricultural jobs had taken place in 1946-2012, 53% ending in 1970 or after. Jobs were often (43%) held in Quebec, Canada; 22% in Italy, Portugal or Greece, and 10% in Haiti. Jobs entailed exposure to an average of 10 chemical agents (± 7) and most were characterized by long working hours, high physical activity levels, and did not provoke stress or anxiety. Few involved early morning shifts. Exposure to 78 agents was assigned with probable or definite certainty. The most common definite or probable carcinogens were ultraviolet radiation (92% of jobs), environmental tobacco smoke (39%), diesel engine exhaust (23%), wood dust (20%), lubricating oils and greases (20%) and lead (15%). Pesticide exposure (as a group) occurred in 31% of jobs. Fifty-four percent of jobs entailed exposure to ≥ 2 recognized carcinogens. Exposure clusters varied according to countries and type of agricultural activities (general, animal, crops, horticulture, vineyards, etc.). ConclusionsFindings highlight the heterogeneity of exposure patterns in past agricultural environments based on their setting and activities involved. Studies on health-related effects of farming should account for numerous potential exposures, beyond their typical focus on pesticides.

Current epidemiology of infectious encephalitis: a narrative review.

Infectious encephalitis poses a global health challenge with a high mortality and severe neurological consequences in survivors. Emerging pathogens and outbreaks are reshaping the patterns of the disease. To understand the current epidemiology for improving prevention, diagnosis, and treatment. MEDLINE/PubMed was searched using "encephalitis" and related MeSH terms from 2020 to September 2024. Population-based and case-control studies on encephalitis were searched for without time restrictions. Other studies known by the authors were also included. The incidence of infectious encephalitis ranged from 1.4 to 13.8 cases per 100,000 per year with a bimodal peak in infants and older adults. Herpes viruses remain the most common causes of sporadic encephalitis with Herpes simplex virus type 1 and Varicella Zoster virus reported most frequently. In endemic regions, arboviruses such as Japanese encephalitis virus and West Nile virus contribute significantly to the disease burden. Climate change is adding to the spread of these vector-borne viruses and thereby both altering the geographic distribution of causative agents and increasing the frequency of outbreaks. Evidence on risk factors associated to encephalitis is scarce and hampered by the absence of population-based case-control studies. The prognosis of infectious encephalitis remains unchanged during recent decades with high case-fatality rates and may vary according to e.g. aetiology, age, and presence of immuno-compromising conditions or other comorbidities. Importantly, a substantial proportion of survivors are left with disabling neurological sequalae. The findings underscore the importance of public health surveillance and prevention strategies to address the changing epidemiology of encephalitis. This can be pursued through vaccination programs and vector control efforts. Future research should focus on identifying risk factors, improving diagnostic tools, optimizing current treatment as well as exploring novel therapies for patients with encephalitis. Timely treatment and specialised post-hospital rehabilitation remain essential for patient management.

Associations of Diabetes, Mental Health, and Asthma with Hypertensive Disorders of Pregnancy: A Population-based Case-Control Study in Alberta, Canada

ObjectiveTo explore direct and indirect associations of diabetes, mental health, and asthma diagnosed before or during pregnancy with gestational hypertension (GH) or preeclampsia (PE). Study designThis population-based case-control study conducted in Alberta, Canada, analyzed perinatal registry data from primiparous pregnant women aged 16 years and above, with no prior hypertension history, during the period 2010 to 2013. Cases of GH and PE were matched on gestational age with a random sample of controls at a 1:3 ratio. Main outcome measuresWe examined the presence of type 2 diabetes mellitus (T2DM) or gestational diabetes, depression, anxiety, and asthma diagnoses within five years before and during pregnancy. To estimate direct and indirect associations between these diagnoses and GH and PE, we used multivariable logistic and mediation models, adjusting for covariates. ResultsThe analysis included 18,381 women (3,443 GH cases, 1,152 PE cases, and 13,786 controls). We found a direct association between anxiety during pregnancy and GH (adjusted Odds Ratio [aOR] 2.18, 95 % confidence interval (CI) 1.43–3.31). Depression before pregnancy increased the odds of anxiety during pregnancy (aOR 4.78, 95 % CI 2.89–7.92) resulting in an indirect effect on GH (aOR 3.63, 95 % CI 1.67––7.87). For PE, we observed direct associations with pre-pregnancy T2DM (aOR 1.58, 95 % CI 1.12–2.24), gestational diabetes (aOR 1.28, 95 % CI 1.04–1.56), and asthma during pregnancy (aOR 2.23, 95 % CI 1.41–3.51). ConclusionThese findings highlight the interplay of mental health factors in influencing GH and underscore the clinical importance of diabetes and asthma in the pathogenesis of PE.

Association between triglyceride-glucose index and risk of kidney stone: a Chinese population-based case–control study

ObjectiveTo investigate the association between the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance and the risk of kidney stones (KSs) in a Chinese population.DesignCase–control study.SettingThree Physical Examination Centers...