Population-based Survey Research Articles

Prevalence of long COVID symptoms in Haryana, India: a cross-sectional follow-up study

Emerging research indicates growing concern over long COVID globally, although there have been limited studies that estimate population burden. We aimed to estimate the burden of long COVID in three districts of Haryana, India, using an opportunity to link a seroprevalence study to follow-up survey of symptoms associated with long COVID. We used a population-based seroprevalence survey for COVID-19 conducted in September 2021 across Haryana, India. Adults from three purposively selected districts (Rohtak, Gurugram, and Jhajjar) were eligible to participate; 2205 of 3213 consented to participate in a survey on health status. Trained investigators administered a structured questionnaire that included demographic characteristics, self-reported symptoms of illness in the last six months before the survey, mental health, and history of COVID-19. Unadjusted regression estimates indicated positive correlations between symptomatic complaints and COVID-19 exposure, suggesting lingering effects of COVID-19 in this population. The overall physical morbidity index was higher among those who tested positive for COVID-19, as was the incidence of new cases. However, both morbidity and incidence became statistically insignificant after adjustment for multiple comparisons. Cough emerged as the only statistically significant individual persistent symptom. Sex-stratified analyses indicated significant estimates only for physical morbidity in women. This study is one of the first from India that uses a large population-based sample to examine longer term repercussions of COVID infections. The burden of long COVID should primarily be addressed in clinical settings, where specialised treatment for individual cases continues to evolve. Our analyses also provide insight into the size and nature of studies required to assess the population-level burden of long COVID. This paper was produced under the auspices of the Lancet COVID 19 Commission India Task Force, which was supported financially by the Reliance Foundation. The Lancet COVID 19 Commission was set up in July 2020 and submitted its final report by October 2022. This report by the India Task Force was prepared during the same period.

Factors associated with poor adherence to medication in patients with diabetes and hypertension in Peru: findings from a pooled analysis of six years of population-based surveys

ObjectiveTo evaluate the factors associated with poor medication adherence in patients with DM and HTN in Peru. Study designA cross-sectional study. MethodsWe analyzed data from the Peruvian Demographic and Family Health Survey from 2014 to 2019. Adjusted prevalence ratios (aPR) and their respective 95% confidence intervals (CI) were estimated to determine the factors associated with poor medication adherence. ResultsWe included 15,184 participants with a known diagnosis of DM and HTN. The frequency of poor medication adherence was 37.1%, with 36.7% among individuals with HTN and 29.2% among individuals with DM. Those belonging to age groups above 30 years (aPR: 0.77; 95% CI: 0.74–0.80, for the group ≥ 60 years) had a lower frequency of poor medication adherence. Meanwhile, being male (aPR: 1.03; 95% CI: 1.01–1.05), lacking health insurance (aPR: 1.08; 95% CI: 1.05–1.10), belonging to lower wealth quintiles (aPR: 1.12; 95% CI: 1.08–1.17, for the first quintile), and living in the mountain region (aPR: 1.09; 95% CI: 1.06–1.12) were associated with a higher frequency of poor medication adherence. These findings were consistent when stratifying by the type of disease. ConclusionThis study showed that poor medication adherence is common in patients with HTN and DM in Peru and is associated with sociodemographic factors, highlighting the importance of public health approaches to improve adherence.

Access to Contraceptives among Venezuelan Migrant Women Residing in Peru: Analysis on a Population-Based Survey.

Introduction: The emigration of Venezuelans has seen a significant increase in recent years. The aim of this study was to identify factors associated with access to contraceptives in migrant women from Venezuela residing in Peru. Methods: An exploratory cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru. Access to contraceptives (yes/no) was established as the dependent variable. A Poisson regression model was performed for complex samples, and crude (PRc) and adjusted (PRa) prevalence ratios were reported. Results: A total of 3617 migrant women were analyzed, with 50.12% reporting access to contraceptives. Factors associated with greater access to contraceptives included being between 20 to 29 years old, having a university education, the entry period after the declaration of COVID-19 quarantine was associated with lower access to contraceptives. Conclusions: Access to contraceptives for Venezuelan migrants should be provided to all, as it is a free service in Peru. Additionally, education and family planning should be provided from the basic or middle school level to prevent unintended pregnancies in the future. Complete coverage should be provided regardless of the time of entry into Peru.

Prevalence of Mental Health and Substance use Problems and Awareness of Need for Services in Lesotho: Results from a Population-Based Survey

AbstractWe conducted a household survey among 6061 adults in Lesotho to (1) assess the prevalence of moderate/severe mental health (MH) and substance use (SU) problems (2) describe the MH and SU service cascades, and (3) assess predictors of MH and SU problem awareness (i.e., awareness of having a MH/SU problem that requires treatment). Moderate/severe MH or SU problems was reported between 0.7% for anxiety in the past 2 weeks to 36.4% for alcohol use in the past 3 months. The awareness and treatment gaps were high for both MH (62% awareness gap; 82% treatment gap) and SU (89% awareness gap; 95% treatment gap). Individuals with higher than the median household wealth had lower MH and SU problem awareness and those living in urban settings had greater SU problem awareness. Research should investigate how to increase population awareness of MH/SU problems to reduce the burden of these conditions in this setting.

Challenges in assessing the immunization status of adults in Germany-lessons from a population-based VACCELERATE survey on polio vaccination.

Considering the re-emergence of poliomyelitis (PM) in non-endemic regions, it becomes apparent that vaccine preventable diseases can rapidly develop epi- or even pandemic potential. Evaluation of the current vaccination status is required to inform patients, health care providers and policy makers about vaccination gaps. Between October 28 2022 and November 23 2022, 5,989 adults from the VACCELEREATE Volunteer Registry completed an electronic case report form on their previous PM vaccine doses including number, types/-valencies and the time of administration based on their vaccination records. A uni-/multivariable regression analysis was performed to assess associations in participant characteristics and immunization status. Among German volunteers (n = 5,449), complete PM immunization schedule was found in 1,981 (36%) participants. Uncertain immunization, due to unknown previous PM vaccination (n = 313, 6%), number of doses (n = 497, 9%), types/-valencies (n = 1,233, 23%) or incoherent immunization schedule (n = 149, 3%) was found in 40% (n = 2,192). Out of 1,276 (23%) participants who reported an incomplete immunization schedule, 62 (1%) never received any PM vaccine. A total of 5,074 (93%) volunteers reported having been vaccinated at least once and 2,087 (38%) indicated that they received vaccination within the last ten years. Female sex, younger age, as well as availability of first vaccination record were characteristics significantly associated with complete immunization (p < 0.001). Full PM immunization schedule was low and status frequently classified as uncertain due to lack of details on administered doses. There is an obviousneed for improved recording to enable long-term access to detailed vaccination history in the absence of a centralized immunization register.

Colliding harms of gambling and gaming: A four-wave longitudinal population study of at-risk gambling and gaming in Finland

Aims: Both gambling and digital gaming are growing in popularity and there is ongoing discussion about their convergence. This population-based longitudinal survey study investigated how gambling and digital gaming types contribute to at-risk gambling and gaming. Methods: The study was based on a representative sample of 18–75-year-olds from mainland Finland. Survey data were collected at 6 -month intervals in 2021–2022, starting in April 2021. Of original T1 respondents, 58.95% took part in all four time points. In total, 3,608 observations from 902 individuals were analysed. Outcome measures were at-risk gambling and gaming based on the Problem Gambling Severity Index and the Internet Gaming Disorder Test. Various types of gambling and gaming were investigated. Results: Population-averaged models showed that different forms of gambling were associated with a higher risk of at-risk gaming. Online casino games were associated with the highest likelihood of at-risk gambling and gaming. Prevalence of digital gaming problems was low. Hybrid models were used to investigate the longitudinal within-person and between-person effects of gambling and gaming activities. Online casino games and offline slot machines increased at-risk gambling. Microtransactions within digital games increased at-risk gambling and gaming over time, but the amount of money spent on digital gaming was small compared to gambling. Conclusions: Our results underline the risks of EGMs and online gambling for the participants. Although gambling and gaming are converging, harm is mostly based on gambling.

CalScope: methodology and lessons learned for conducting a remote statewide SARS-CoV-2 seroprevalence study in California using an at-home dried blood spot collection kit and online survey.

To describe the methodology for conducting the CalScope study, a remote, population-based survey launched by the California Department of Public Health (CDPH) to estimate SARS-CoV-2 seroprevalence and understand COVID-19 disease burden in California. Between April 2021 and August 2022, 666,857 randomly selected households were invited by mail to complete an online survey and at-home test kit for up to one adult and one child. A gift card was given for each completed survey and test kit. Multiple customized REDCap databases were used to create a data system which provided task automation and scalable data management through API integrations. Support infrastructure was developed to manage follow-up for participant questions and a communications plan was used for outreach through local partners. Across 3 waves, 32,671 out of 666,857 (4.9%) households registered, 6.3% by phone using an interactive voice response (IVR) system and 95.7% in English. Overall, 25,488 (78.0%) households completed surveys, while 23,396 (71.6%) households returned blood samples for testing. Support requests (n = 5,807) received through the web-based form (36.3%), by email (34.1%), and voicemail (29.7%) were mostly concerned with the test kit (31.6%), test result (26.8%), and gift card (21.3%). Ensuring a well-integrated and scalable data system, responsive support infrastructure for participant follow-up, and appropriate academic and local health department partnerships for study management and communication allowed for successful rollout of a large population-based survey. Remote data collection utilizing online surveys and at-home test kits can complement routine surveillance data for a state health department.

Association between alcohol consumption and chronic kidney disease: a population-based survey.

Alcohol consumption is associated with both beneficial and harmful effects, and the role of alcohol consumption in chronic kidney disease (CKD) remains inconclusive. This study aimed to investigate the relationship between alcohol consumption and CKD or estimated glomerular filtration rate (eGFR). This study enrolled adults from the second Taiwanese Survey on Prevalences of Hypertension, Hyperglycemia, and Hyperlipidemia, conducted in 2007. Participants were categorized into frequent drinkers, occasional drinkers, and nondrinkers. The amount of alcohol consumption was assessed by standard drinks per week. The primary outcome was the presence of CKD, and the secondary outcome was the eGFR. Among 3967 participants with a mean age of 47.9years and a CKD prevalence of 11.7%, 13.8% were frequent drinkers, and 23.1% were occasional drinkers. The average amount of alcohol consumed was 3.3 drinks per week. Frequent drinkers (odds ratio [OR] 0.622, 95% confidence interval [CI] 0.443-0.874) and occasional drinkers (OR 0.597 95% CI 0.434-0.821) showed a lower prevalence of CKD than nondrinkers. Consumption of a larger number of standard drinks was associated with a lower prevalence of CKD (OR 0.872, 95% CI 0.781-0.975). Frequent drinkers and those who consumed a larger number of standard drinks per week showed higher eGFRs. Within the range of moderate alcohol intake, those who consumed more alcohol had a higher eGFR and reduced prevalence of CKD. The potentially harmful effects of heavy drinking should be taken into consideration, and alcohol intake should be limited to less than light to moderate levels.

Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS).

In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.

Age-dependent association of cannabis use with risk of psychotic disorder.

Epidemiologic research suggests that youth cannabis use is associated with psychotic disorders. However, current evidence is based heavily on 20th-century data when cannabis was substantially less potent than today. We linked population-based survey data from 2009 to 2012 with records of health services covered under universal healthcare in Ontario, Canada, up to 2018. The cohort included respondents aged 12-24 years at baseline with no prior psychotic disorder (N = 11 363). The primary outcome was days to first hospitalization, ED visit, or outpatient visit related to a psychotic disorder according to validated diagnostic codes. Due to non-proportional hazards, we estimated age-specific hazard ratios during adolescence (12-19 years) and young adulthood (20-33 years). Sensitivity analyses explored alternative model conditions including restricting the outcome to hospitalizations and ED visits to increase specificity. Compared to no cannabis use, cannabis use was significantly associated with psychotic disorders during adolescence (aHR = 11.2; 95% CI 4.6-27.3), but not during young adulthood (aHR = 1.3; 95% CI 0.6-2.6). When we restricted the outcome to hospitalizations and ED visits only, the strength of association increased markedly during adolescence (aHR = 26.7; 95% CI 7.7-92.8) but did not change meaningfully during young adulthood (aHR = 1.8; 95% CI 0.6-5.4). This study provides new evidence of a strong but age-dependent association between cannabis use and risk of psychotic disorder, consistent with the neurodevelopmental theory that adolescence is a vulnerable time to use cannabis. The strength of association during adolescence was notably greater than in previous studies, possibly reflecting the recent rise in cannabis potency.

The quality of life and work productivity are affected by the presence of nausea/vomiting in patients taking iron preparations for heavy menstrual bleeding or anemia: a population-based cross-sectional survey in Japan

BackgroundPatients with iron deficiency anemia are treated with iron preparations, but gastrointestinal symptoms such as nausea and vomiting occur frequently. These symptoms may negatively affect the quality of life and work productivity in patients with iron deficiency anemia. This study assessed the impact of nausea and vomiting on the quality of life and work productivity of patients taking iron preparations for heavy menstrual bleeding or anemia.MethodsAn online survey was conducted among patients taking iron preparations for heavy menstrual bleeding or anemia. Demographic data and information about medication use and the health condition were collected. The patients were asked to answer the 5-level EQ-5D version, and work productivity and activity impairment questionnaires. The outcomes were reported by patients in the presences of nausea, vomiting, and nausea or vomiting. The association with the 5-level EQ-5D version utility score for the severity and frequency of the symptoms were also assessed.ResultsA total of 385 patients were enrolled, and 96 were patients with nausea or vomiting, of which 94 were with nausea and 27 were with vomiting. The 5-level EQ-5D version utility scores for the patients with nausea, vomiting, and nausea or vomiting were significantly lower than those of the patients without these symptoms (p < 0.001 for each). The 5-level EQ-5D version utility score was correlated with the severity of nausea and the frequency of vomiting per day (p < 0.001 for each). As for the work productivity and activity impairment, the presenteeism, the overall work impairment, and the activity impairment of the patients with nausea, vomiting, and nausea or vomiting were significantly higher than those without these symptoms (p < 0.001 for each). The absenteeism was slightly higher trend was observed, but not significant.ConclusionPatients taking iron preparations who have nausea or vomiting experience a significant burden in terms of poorer quality of life and higher work productivity impairment.Trial registrationUMIN000045700 (http://www.umin.ac.jp/ctr/). Registered on October 11, 2021.

Urban-Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18).

Diabetes is a multifactorial disease with far-reaching consequences. Environmental factors, such as urban or rural residence, influence its prevalence and associated comorbidities. Haryana-a north Indian state-has undergone rapid urbanisation, and part of it is included in the National Capital Region (NCR). The primary aim of the study is to estimate the prevalence of diabetes in Haryana with urban-rural, NCR and non-NCR regional stratification and assess the factors affecting the likelihood of having diabetes among adults. This sub-group analysis of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study (a nationally representative cross-sectional population-based survey) was done for Haryana using data from 3722 participants. The dependent variable was diabetes, while residence in NCR/non-NCR and urban-rural areas were prime independent variables. Weighted prevalence was estimated using state-specific sampling weights and standardized using National Family Health Survey-5 (NFHS-5) study weights. Associations were depicted using bivariate analysis, and factors describing the likelihood of living with diabetes were explored using a multivariable binary logistic regression analysis approach. Overall, the weighted prevalence of diabetes in Haryana was higher than the national average (12.4% vs. 11.4%). The prevalence was higher in urban (17.9%) than in rural areas (9.5%). The prevalence of diabetes in rural areas was higher in the NCR region, while that of prediabetes was higher in rural non-NCR region. Urban-rural participants' anthropometric measurements and biochemical profiles depicted non-significant differences. Urban-rural status, age and physical activity levels were the most significant factors that affected the likelihood of living with diabetes. The current analysis provides robust prevalence estimates highlighting the urban-rural disparities. Urban areas continue to have a high prevalence of diabetes and prediabetes; rural areas depict a much higher prevalence of prediabetes than diabetes. With the economic transition rapidly bridging the gap between urban and rural populations, health policymakers should plan efficient strategies to tackle the diabetes epidemic.

Filling the EU information deficit mitigates negative EU attitudes among the least knowledgeable. Evidence from a population-based survey experiment

ABSTRACT The cognitive mobilisation thesis suggests that increasing knowledge on the European Union (EU) would lead to increased support for the institution. We test this with a strategic case whereby we provide information on the EU’s subsidiarity principle to the citizenry of a small member state and examine whether it mitigates negative EU attitudes. In an original, pre-registered, population-based survey experiment conducted with members of a panel representative of the Dutch population, respondents were assigned randomly to a control group or a treatment: a professionally produced information video mimicking EU communications. Along with estimating the overall treatment effects, based on extant literature we assess whether these effects are moderated by the respondents’ prior EU knowledge and level of populist attitudes. Consistent with the information deficit theory, we find that information provision decreases negative attitudes among the least knowledgeable. We discuss the implications of our findings and provide suggestions for further research.

HIV estimation using population-based surveys with non-response: A partial identification approach.

HIV estimation using data from the demographic and health surveys (DHS) is limited by the presence of non-response and test refusals. Conventional adjustments such as imputation require the data to be missing at random. Methods that use instrumental variables allow the possibility that prevalence is different between the respondents and non-respondents, but their performance depends critically on the validity of the instrument. Using Manski's partial identification approach, we form instrumental variable bounds for HIV prevalence from a pool of candidate instruments. Our method does not require all candidate instruments to be valid. We use a simulation study to evaluate and compare our method against its competitors. We illustrate the proposed method using DHS data from Zambia, Malawi and Kenya. Our simulations show that imputation leads to seriously biased results even under mild violations of non-random missingness. Using worst case identification bounds that do not make assumptions about the non-response mechanism is robust but not informative. By taking the union of instrumental variable bounds balances informativeness of the bounds and robustness to inclusion of some invalid instruments. Non-response and refusals are ubiquitous in population based HIV data such as those collected under the DHS. Partial identification bounds provide a robust solution to HIV prevalence estimation without strong assumptions. Union bounds are significantly more informative than the worst case bounds without sacrificing credibility.

Prevalence of hepatitis B and C viruses among migrant workers in Qatar.

Limited data exist on viral hepatitis among migrant populations. This study investigated the prevalence of current hepatitis B virus (HBV) infection and lifetime hepatitis C virus (HCV) infection among Qatar's migrant craft and manual workers (CMWs), constituting 60% of the country's population. Sera collected during a nationwide COVID-19 population-based cross-sectional survey on CMWs between July 26 and September 9, 2020, underwent testing for HBsAg and HCV antibodies. Reactive samples underwent confirmatory testing, and logistic regression analyses were employed to explore associations with HBV and HCV infections. Among 2528 specimens tested for HBV infection, 15 were reactive, with 8 subsequently confirmed positive. Three samples lacked sufficient sera for confirmatory testing but were included in the analysis through multiple imputations. Prevalence of current HBV infection was 0.4% (95% CI 0.2-0.7%). Educational attainment and occupation were significantly associated with current HBV infection. For HCV infection, out of 2607 specimens tested, 46 were reactive, and 23 were subsequently confirmed positive. Prevalence of lifetime HCV infection was 0.8% (95% CI 0.5-1.2%). Egyptians exhibited the highest prevalence at 6.5% (95% CI 3.1-13.1%), followed by Pakistanis at 3.1% (95% CI 1.1-8.0%). Nationality, geographic location, and occupation were significantly associated with lifetime HCV infection. HBV infection is relatively low among CMWs, while HCV infection falls within the intermediate range, both compared to global and regional levels.

Introduction: IJCAR – 2023 Issue

Dear readers, I am pleased to introduce the 2023 Issue of the International Journal of Child and Adolescent Resilience (IJCAR). This issue includes: two regular articles on trauma and maltreatment and associated impacts; three brief reports on varying aspects of hardships and resilience in different populations; and one theoretical paper about a narrative shelter model to give youth who experienced violence a voice and choice. In particular, the regular articles shed light on hardships and resilience experienced by differing populations. Bégin and colleagues examined the effects of using the internet survey method compared to a population-based telephone survey method on the profile of women with a history of child sexual abuse, in terms of socio-demographic data, victimization experiences, and mental health symptoms in adulthood. Jamison and colleagues aimed to gain insights on youth of color in the United States who have experienced violence regarding the associations between resilience and psychological health, social support, and school engagement. Furthermore, the 2023 issue of IJCAR also includes three brief reports on different topics associated to experiences of trauma, maltreatment, and resilience in various populations. Firstly, Brend et al. compared a sample of Finnish social workers serving children and families or social workers in other domains, in terms of the associations between moral distress and burnout amongst these groups. Secondly, Frederickson et al. investigated whether child maltreatment predicted the severity of posttraumatic stress disorder symptoms and symptom clusters for Canadian women during pregnancy, as well as changes in symptoms from pregnancy to three months postpartum. Finally, Souza et al. aimed to determine if social media in Brazil is a viable outlet for the dissemination of empirically supported information surrounding the topics of child abuse, adverse childhood events, and resilience. Finally, the issue ends with a theoretical paper by Nyirinkwaya and Jenney, regarding a shelter narrative model for research and practice on childhood experiences of intimate partner violence in young people, in order to integrate storytelling and storylistening to help youth exercise their voice and choice. Thus, we encourage you to read these various articles to obtain rich information about ongoing research in the field of resilience. I wish to also take this opportunity to sincerely thank all the members of the IJCAR team for their continuous and dedicated work in the editing and publishing process. Particularly, I wish to thank our associate editors, Dr. Tara Black, Dr. Delphine Collin-Vézina, Dr. Isabelle Daigneault, Dr. Rachel Langevin, and Dr. Nicole Racine; layout editor, Manon Robichaud; and managing editor and senior copyeditor, Teresa Pirro, all of which have done a fantastic job in their varying roles. I also want to take this opportunity to welcome Dr. Roxanne Guyon as a new associate editor. We hope you enjoy reading the current issue! This is also a friendly reminder to prepare your manuscripts for the next issue. Please submit your manuscripts in English, or in French, and feel free to forward this information to colleagues and students who may be interested. We look forward to your manuscripts and to the next issue of IJCAR. Happy reading! Martine Hébert, Editor-in-Chief

Prevalence and risk factors of gastro-oesophageal reflux symptoms among adolescents, the HUNT study

Background Gastro-oesophageal reflux disease (GORD) is recognized by symptoms of heartburn and acid regurgitation. These gastro-oesophageal reflux symptoms (GORS) are common in adults, but data from adolescents are sparse. This study aimed to assess the prevalence and risk factors of GORS among adolescents in a large and unselected population. Methods This study was based on the Trøndelag Health Study (HUNT), a longitudinal series of population-based health surveys conducted in Nord-Trøndelag County, Norway. This study included data from Young-HUNT4 performed in 2017–2019, where all inhabitants aged 13–19 years were invited and 8066 (76.0%) participated. The presence of GORS (any or frequent) during the past 12 months and tobacco smoking status were reported through self-administrated questionnaires, whereas body mass index (BMI) was objectively measured. Results Among 7620 participating adolescents reporting on the presence of GORS, the prevalence of any GORS and frequent GORS was 33.2% (95% confidence interval [CI] 32.2 − 34.3%) and 3.6% (95% CI 3.2 − 4.0%), respectively. The risk of frequent GORS was lower among boys compared to girls (OR 0.61; 95% CI 0.46 − 0.79), higher in current smokers compared to never smokers (OR 1.80; 95% CI 1.10 − 2.93) and higher among obese compared to underweight/normal weight adolescents (OR 2.50; 95% CI 1.70 − 3.66). Conclusion A considerable proportion of adolescents had GORS in this population-based study, particularly girls, tobacco smokers, and individuals with obesity, but frequent GORS was relatively uncommon. Measures to avoid tobacco smoking and obesity in adolescents may prevent GORS.

Association between breastfeeding duration and diabetes mellitus in menopausal women: a machine-learning analysis using population-based retrospective study

BackgroundBreastfeeding resets insulin resistance caused by pregnancy however, studies on the association between breastfeeding and diabetes mellitus (DM) have reported inconsistent results. Therefore, we aimed to investigate the risk of DM according to breastfeeding duration in large-scale population-based retrospective study. In addition, machine-learning prediction models for DM and hemoglobin A1c (HbA1c) were developed to further evaluate this association.MethodsWe used the Korean National Health and Nutrition Examination Surveys database, a nationwide and population-based health survey from 2010 to 2020. We included 15,946 postmenopausal women with a history of delivery, whom we divided into three groups according to the average breastfeeding duration: (1) no breastfeeding, (2) < 12 months breastfeeding, and (3) ≥ 12 months breastfeeding. Prediction models for DM and HbA1c were developed using an artificial neural network, decision tree, logistic regression, Naïve Bayes, random forest, and support vector machine.ResultsIn total, 2248 (14.1%) women had DM and 14,402 (90.3%) had a history of breastfeeding. The prevalence of DM was the lowest in the < 12 breastfeeding group (no breastfeeding vs. < 12 months breastfeeding vs. ≥ 12 months breastfeeding; 161 [10.4%] vs. 362 [9.0%] vs. 1,725 [16.7%], p < 0.001). HbA1c levels were also the lowest in the < 12 breastfeeding group (HbA1c: no breastfeeding vs. < 12 months breastfeeding vs. ≥ 12 months breastfeeding; 5.9% vs. 5.9% vs. 6.1%, respectively, p < 0.001). After adjustment for covariates, the risk of DM was significantly increased in both, the no breastfeeding (adjusted odds ratio [aOR] 1.29; 95% CI 1.29, 1.62]) and ≥ 12 months of breastfeeding groups (aOR 1.18; 95% CI 1.01, 1.37) compared to that in the < 12 months breastfeeding group. The accuracy and the area under the receiver-operating-characteristic curve of the DM prediction model were 0.93 and 0.95, respectively. The average breastfeeding duration was ranked among the top 15 determinants of DM, which supported the strong association between breastfeeding duration and DM. This association was also observed in a prediction model for HbA1c.ConclusionsWomen who did not breasted had a higher risk of developing DM than those who breastfed for up to 12 months.

Survey of awareness and beliefs about cancer (ABC) in Tehran Province, Iran

IntroductionKnowledge, attitudes, and practices are essential measures for planning and evaluating cancer control programs. Little is known about these in Iran.MethodsWe conducted a population-based interview survey of adults aged 30–70 using the Farsi version of the Awareness and Beliefs about Cancer questionnaire in the capital province of Tehran, Iran, 2019. We calculated weighted estimates of levels of cancer knowledge, attitudes, and practices to allow for different selection probabilities and nonresponse. We used multivariate logistic regression to understand demographic factors associated with bowel, cervix, and breast screening practices.ResultsWe interviewed 736 men and 744 women. The mean number of recalled cancer warning signs was less than one; 57.7% could not recall any cancer warning signs. Participants recognized 5.6 out of 11 early cancer warning signs and 8.8 of 13 cancer risk factors. Most (82.7%) did not know that HPV infection was a cancer risk factor. Approximately, half had negative attitudes towards cancer treatment, but over 80% had positive attitudes towards the effectiveness of screening for improving survival. Colorectal, breast, and cervical screening rates were 24%, 42%, and 49%, respectively. Higher socioeconomic status increased the odds of taking up screening for cancer. Women aged 60–70 were less likely to report taking up breast and cervical screening than younger women.DiscussionThe Iranian population has poor awareness and negative attitudes about cancer, and participation in screening programs is low. Public awareness and early detection of cancer should be promoted in Iran.

Youth who acquired HIV perinatally have poorer viral suppression than those who acquired HIV later in life: findings from a population survey in Zimbabwe

Background: Perinatally acquired HIV may lead to worse health outcomes compared to later acquisition. We compared the demographic and clinical characteristics of youth diagnosed with HIV in childhood and adulthood, as a proxy for acquisition route (perinatal vs horizontal). Setting: Youth aged 18-24 years in 3 provinces in Zimbabwe Methods: In a representative population-based survey, participants were asked their HIV status, date of HIV diagnosis if positive, and whether they were diagnosed in childhood. A dried blood spot was taken to measure viral load. Multilevel mixed-effects generalized linear modelling was used to estimate the association between HIV acquisition time and viral non-suppression (≥1000 copies/ml). Results: 17,682 participants (60.8% female) were enrolled, 17553 (99.3%) gave a DBS sample, 1200 (6.8%) tested HIV antibody positive (7 indeterminate results) and 26 reported being HIV positive without confirmation. Of the 1226 participants living with HIV, 435 (35.5%) self-reported they were HIV-positive, of whom 196 (45.1%) were diagnosed in childhood (median age 7 years). A higher proportion of adult-diagnosed than child-diagnosed participants were female (91.2% vs 76.5%), had ever had sex (93.3% vs 61.5%), been married/cohabiting (59.4% vs 19.4%) and been pregnant (78.9% of women vs 40.0%). A lower proportion had viral suppression (39.3% vs 52.5%). Adjusting for sex, age, marital status and education, those diagnosed as children had higher odds of viral non-suppression (adjusted odds ratio=1.83, 95%CI 1.17-2.85, p=0.008). Conclusion: Youth who acquired HIV perinatally have differentiated care needs and greater risk of viral non-suppression compared to those who acquired HIV later.