Propensity Score Matching Model Research Articles

The initial high-dose versus maintenance-dose anticoagulation therapy with direct oral anticoagulants for cancer-associated venous thromboembolism: from the COMMAND VTE Registry-2

Abstract Background/Introduction Initial high-dose anticoagulation therapy with rivaroxaban and apixaban has been a standard treatment for venous thromboembolism (VTE), although there could be concerns of an increased risk of bleeding events especially among high bleeding-risk patients including those with active cancer. Purpose The present study aimed to evaluate the clinical outcome of initial high-dose anticoagulation therapy comparing to maintenance-dose anticoagulation therapy in patients with cancer-associated VTE using propensity score-matching analysis. Methods The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. Among 1507 patients with cancer-associated VTE, we evaluated 180-day clinical outcomes before discontinuation of anticoagulation therapy using a 1:1 propensity score-matching model with 21 risk-adjusting variables Results After the propensity score-matching, we enrolled 324 patients with initial high-dose anticoagulation therapy and 324 patients with initial maintenance dose anticoagulation therapy. Of patients with initial high-dose anticoagulation therapy, rivaroxaban and apixaban were administered in 198 and 126 patients, respectively. Of those with initial maintenance-dose anticoagulation therapy, rivaroxaban, apixaban, and edoxaban were administered in 34, 46 and 244 patients, respectively. The median durations of initial high-dose anticoagulation therapy were 18 [IQR: 15-21] days for rivaroxaban and 7 [IQR: 7-7] days for apixaban. In the current study population, the mean age was 67±12 years, 346 were women, and the mean body weight was 58±12 kg. There was no significant difference in the distribution of gastrointestinal cancer such as stomach and colorectal cancer between the 2 groups (4.6% vs. 4.9%, P=1.0, 8.3% vs. 11.4%, P=0.22). The cumulative 180-day incidence of discontinuation of anticoagulation was not significantly different between the 2 groups (27.8% vs. 30.5%, P=0.50). There were no significant differences in the cumulative 180-day incidences of recurrent VTE (3.1% vs. 1.0%, P=0.08), nor major bleeding (8.1% vs. 7.0%, P=0.66), nor all-cause death (25.1% vs. 21.6%, P=0.33) between the 2 groups. There were also no significant differences in the cumulative 180-day incidences of all clinically relevant bleeding (14.9% vs. 13.3%, P=0.72), gastrointestinal bleeding (8.4% vs. 5.4%, P=0.15), nor major gastrointestinal bleeding (5.4% vs. 2.7%, P=0.10). Conclusions There was no signal of an increased risk of recurrent VTE in the initial maintenance-dose anticoagulation therapy. Considering a numerically slightly higher incidence of gastrointestinal bleeding in the initial high-dose anticoagulation therapy for cancer-associated VTE, the initial maintenance-dose anticoagulation therapy could be a potential treatment option for selected patients including patients at a high risk of gastrointestinal bleeding.Study flow chartResults

The effect of air pollution on hospitalizations with Parkinson’s disease among medicare beneficiaries nationwide

We examined the effect of annual exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), on the rate of first hospitalization with a PD-related diagnosis (hospitalization with PD) among Medicare Fee-for-Service beneficiaries (2001-2016). Machine learning-derived annual air pollution concentrations were linked to residential ZIP codes. For each exposure, we fitted four models: 1) traditional outcome stratification, 2) marginal structural, 3) doubly robust, and 4) generalized propensity score matching Poisson regression models, adjusted for sociodemographic and meteorological confounders and long-term trends. Among 49,121,026 beneficiaries, incidence rate ratios of 1.08 (95% CI: 1.07, 1.10), 1.07 (95% CI: 1.05, 1.08), and 1.03 (95% CI: 1.02, 1.05) for an interquartile range increase in PM2.5 (3.72 µg/m3), NO2 (13.84 ppb), and O3 (10.09 ppb), respectively, were estimated from doubly robust models. Results were similar across modeling approaches. In this nationwide study, higher air pollution exposure increased the rate of hospitalizations with PD.

Sex disparities in outcomes of transcatheter aortic valve implantation- a multi-year propensity-matched nationwide study

Transcatheter Aortic Valve Implantation (TAVI) has revolutionized the management of severe aortic stenosis (AS), but the impact of sex on TAVI outcomes remains unclear. In this study, we examined differences between men and women in the post-procedural outcomes of TAVI, including healthcare burden and readmission rates. The Nationwide Readmissions Database (2016–2020) was utilized to identify hospitalizations for TAVI. A propensity score matching (PSM) model was used to match males and females. Outcomes were examined using Pearson's chi-squared test. Among 320,324 hospitalizations for TAVI, 142,054 (44.3 %) procedures were performed in women. After propensity matching (N = 165,894 with 82,947 hospitalizations in each group), women had higher in-hospital mortality (2.48 % vs 2.11 %, p: 0.001), stroke (2.14 % vs 1.49 %, p < 0.001), post-procedural bleeding (2.34 % vs 1.72 %, p < 0.001), vascular complications (1.2 % vs 0.7 %, p < 0.001), pericardial complications (1.13 % vs 0.60 %, p < 0.001), acute respiratory failure (ARF) (5.10 % vs 4.63 %, p < 0.001), need for transfusion (7 % vs 5.56 %, p < 0.001), need for vasopressors (2.48 % vs 2.11 %, p < 0.001) and major adverse cardiac and cerebrovascular events (MACCE) (7.53 % vs 6.85 %, p < 0.001). Meanwhile, women had modestly lower incidence of acute kidney injury (AKI) (10.17 % vs 11.88 %, p < 0.001), sudden cardiac arrest (SCA) (0.96 % vs 1.06 %, p: 0.042), cardiogenic shock (1.69 % vs 2.05 %, p < 0.001) and mechanical circulatory support (MCS) requirement (0.69 % vs 0.84 %, p < 0.001). With regard to readmissions, men had higher readmission rates at 30 days (16.07 % vs 14.75 %, p < 0.001) and 90 days (23.8 % vs 21.9 %, p < 0.001). No significant difference was observed in 180-day readmission rates between men and women after TAVI. Notably, procedure-related mortality decreased for both sexes from 2016 to 2020, accompanied by faster recovery times and reduced hospitalization costs (p-trend <0.001). In conclusion, women had higher mortality and post-procedural complication rates, while men had higher readmission rates, cardiogenic shock, AKI and need for mechanical circulatory support. While procedure-related mortality and resource utilization for TAVI have improved over time from 2016 to 2020, irrespective of sex, our findings highlight that significant disparities exist in TAVI outcomes.

Unveiling the causal effects of China’s minimum living standard guarantee on household transportation expenditures: A causal forest analysis

We investigate the causal effects of China’s Minimum Living Standard Guarantee (MLSG, also called Dibao) subsidy on household transportation expenditures. Utilizing data from the Chinese Social Survey, we employ a combination of the propensity score matching (PSM), causal forest (CF) and marginal treatment effect model (MTE) methodologies to rigorously estimate the subsidy’s effects. The PSM allows us to mitigate selection bias by matching MLSG recipients with comparable non-recipients. While the causal forest captures the heterogeneity of treatment effects across various household profiles. The result of MTE indicate that observable and essential heterogeneity are present to influence the effect of their subsidies, which present the consistent with PSM and CF. The causal mediation analysis indicates the mediating mechanism that MLSG impacts on household transportation expenditures, while also revealing significant variations among different regions. The study not only refines our understanding of the MLSG’s effects on household spending but also offers novel insights into applicational advancements by incorporating machine-learning techniques for policy evaluation. These results have important implications for policy formulation and refinement, particularly in the urban-rural differences.

Impacts of Irrigated Water Use on Household’s Income in South Wollo Zone, Amhara Regional State, Ethiopia

Agriculture is the backbone of the Sub-Saharan African economy. Ethiopia&amp;apos;s GDP is also shared by 45 from the agriculture sectors. However, it is confronted and challenged by variable rainfall and climate changes. Particularly, in South Wollo zone, agriculture is not exceptional in facing such daunting challenges and effects of variable rainfall and climate change despite there are abundant alternative irrigated water resources. River and groundwater sources have not yet been used as alternative uses for agricultural production. As a result, rural households&amp;apos; income couldn’t meet their minimum food and nonfood requirements. This study, thus, attempted to evaluate the impact of irrigated water use on rural household&amp;apos;s income in South Wollo Zone, Amhara regional state, Ethiopia. In pursuit of this, it employed a descriptive type of research design and triangulated research approach that consists of both quantitative and qualitative techniques. Primary and secondary data were collected from small scale irrigated households and secondary sources. Binary logistic regression was used to determine major significant factors that affect households&amp;apos; irrigated water use for agricultural production. A propensity core matching model was employed to evaluate irrigated water use and agriculture on household’s income. This study result (binary logistic regression result) showed that the household’s family size, land size and willingness were significant factors that determined irrigated water use for agricultural production at 95 percent level of significance. The propensity score matching model result also shows that irrigated water use significantly created significant impact on household’s income. It is, thus, keenly important to change and improve the smallholder farmer’s land size, extension services, rural credit, technology, education level, awareness about family size, and willingness to use irrigated water sources, such as, ground and river water for agriculture agricultural production that increase their level of income.

Prognostic value of the geriatric nutritional risk index in patients with non-metastatic clear cell renal cell carcinoma: a propensity score matching analysis

BackgroundThis study aimed to investigate the prognostic value of the geriatric nutritional risk index (GNRI) in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) who underwent nephrectomy.MethodsPatients with non-metastatic ccRCC who underwent nephrectomy between 2013 and 2021 were analyzed retrospectively. The GNRI was calculated within one week before surgery. The optimal cut-off value of GNRI was determined using X-tile software, and the patients were divided into a low GNRI group and a high GNRI group. The Kaplan-Meier method was used to compare the overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) between the two groups. Univariate and multivariate Cox proportional hazard models were used to determine prognostic factors. In addition, propensity score matching (PSM) was performed with a matching ratio of 1:3 to minimize the influence of confounding factors. Variables entered into the PSM model were as follows: sex, age, history of hypertension, history of diabetes, smoking history, BMI, tumor sidedness, pT stage, Fuhrman grade, surgical method, surgical approach, and tumor size.ResultsA total of 645 patients were included in the final analysis, with a median follow-up period of 37 months (range: 1-112 months). The optimal cut-off value of GNRI was 98, based on which patients were divided into two groups: a low GNRI group (≤ 98) and a high GNRI group (> 98). Kaplan-Meier analysis showed that OS (P < 0.001), CSS (P < 0.001) and RFS (P < 0.001) in the low GNRI group were significantly worse than those in the high GNRI group. Univariate and multivariate Cox analysis showed that GNRI was an independent prognostic factor of OS, CSS and RFS. Even after PSM, OS (P < 0.05), CSS (P < 0.05) and RFS (P < 0.05) in the low GNRI group were still worse than those in the high GNRI group. In addition, we observed that a low GNRI was associated with poor clinical outcomes in elderly subgroup (> 65) and young subgroup (≤ 65), as well as in patients with early (pT1-T2) and low-grade (Fuhrman I-II) ccRCC.ConclusionAs a simple and practical tool for nutrition screening, the preoperative GNRI can be used as an independent prognostic indicator for postoperative patients with non-metastatic ccRCC. However, larger prospective studies are necessary to validate these findings.

Risk of Esophageal and Gastric Cancer in Patients with Type 2 Diabetes Receiving Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs): A National Analysis.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are becoming more popular in managing type 2 diabetes mellitus (T2DM). Concerns linger over potential links to malignancies like pancreatic and thyroid cancers, requiring more research to clarify their safety profiles. Additionally, evidence suggests GLP-1 RAs may lower colorectal and pancreatic cancer risk, especially in obese and overweight individuals, indicating a protective effect beyond weight loss. Current studies leave a gap in comprehensively understanding cancer risks associated with GLP-1 RAs, which prompts further research to enhance our understanding of their overall safety. We queried the US Collaborative Network (63 health care organizations) of the TriNetX research database. Patients with T2DM were identified and divided into two cohorts: patients on GLP-1 RAs and patients not on GLP-1 RAs. We excluded tobacco use and alcohol use disorders, obese patients with a body mass index (BMI) of >25 kg/m2, and those with a family history of gastrointestinal malignancy, infectious mononucleosis, chronic gastritis, pernicious anemia, helicobacter pylori infection, or gastroesophageal reflux disease (GERD). We used a 1:1 propensity score matching (PSM) model using patients' baseline characteristics, medications, labs, and genetics. We compared the rate of gastric cancer and esophageal cancer at the seven-year mark. A total of 2,748,431 patients with T2DM were identified. Of those, 6% (n = 167,077) were on a GLP-1 RA and 94% (n = 2,581,354) were not on a GLP-1 RA. After PSM, both cohorts included 146,277 patients. Patients with T2DM who were on a GLP-1 RA, compared to those who were not, had a statistically significant lower risk of both gastric cancer (0.05% vs. 0.13%, p < 0.0001) and esophageal cancer (0.04% vs. 0.13%, p < 0.0001) at the seven-year mark. The use of GLP-1 RAs in patients with T2DM does not significantly increase the risk of gastric or esophageal cancer. This finding supports the continued use of GLP-1 analogues as a therapeutic option in managing T2DM, considering their well-established benefits and low risk of complications. Based on the study results, these medications may even have a protective effect against these malignancies.

Racial Disparities in Nasopharyngeal Carcinoma Characteristics and Survival

Objective: To investigate and compare the distribution of histological subtypes, stage at presentation, and survival outcomes among Chinese American, Non-Hispanic White, and African American patients with nasopharyngeal carcinoma (NPC). Materials and methods: We identified Chinese American, Non-Hispanic White, and African American patients with NPC who were diagnosed between 2010 and 2017. Statistical analyses were conducted using the chi-square test, propensity score matching, Kaplan-Meier analysis, and multivariate Cox proportional hazards models. Results: A total of 1646 eligible patients with NPC were included. Non-Hispanic White accounted for 1049 (63.7%), African Americans for 265 (16.1%), and Chinese Americans for 332 (20.2%), and their median age at diagnosis was 59, 55, and 53 years, respectively ( P &lt; .001). Chinese Americans most frequently harbored undifferentiated non-keratinizing squamous cell carcinoma subtype (n = 134, 40.4%) than Non-Hispanic White (n = 164, 15.6%) or African American patients (n = 44, 16.7%) ( P &lt; .001). Histological subtype distribution was similar between Non-Hispanic White and African American patients ( P = .338). African American patients had the highest rate of stage III to IV disease (n = 206, 77.7%) compared to Non-Hispanic White (n = 704, 67.1%) and Chinese American patients (n = 210, 63.2%) ( P = .009). No significant difference in stage distribution was observed between Chinese American and Non-Hispanic White patients ( P = .494). Non-Hispanic White patients [hazard ratio (HR) 1.344, 95% confidence interval (CI) 1.007-1.479, P = .045] and African American patients (HR 2.314, 95% CI 1.405-3.813, P &lt; .001) had significantly worse overall survival compared to Chinese American patients. However, race was not associated with NPC-specific survival in the multivariate analysis. Similar results were found after propensity score matching. Conclusions: Race influences the distribution of histological subtypes, stage at presentation, and survival outcomes in NPC.

Peer effects affect the adaptation behaviour of rural residents to geohazards in China: a new policy pathway

ABSTRACT Disaster prevention and mitigation (DPM) is one of the responses to extreme climate change impacts and depends on the adoption of risk adaptation behaviour by rural residents. While residents exhibit a high willingness to adapt, they also show low behaviour with reference to DPM. While adaptation behaviour of individuals has been studied extensively, the mutual impact of adaptation behaviour among residents has so far been neglected in the literature. Evaluating this interaction could serve as an important foundation for refining disaster reduction policies. Drawing on social cognitive theory, we propose a novel theoretical framework to analyze peer effects on individual decision-making in DPM. Using data gathered from 536 respondents in Sichuan Province, China, this paper adopts the Bayes Markov chain Monte Carlo estimation method to perform a regression of the spatial probit model. Further, the propensity score matching model was used to explore peer effects on the transformation between residents’ willingness to actual behaviour. Results indicate significant and robust peer effects on DPM behaviour among residents. A heterogeneity test indicated that peer effects are predominantly observed among residents with low and medium social status perception and not in those with high social status perception. Peer effects have a significant and positive influence on the transformation from residents’ willingness to their behaviour. Residents are not completely independent in their decision-making, and complex social mechanisms dictate rational and irrational choices of behaviour. Therefore, it is necessary to fully consider positive peer effects on residents in the formulation of policies. Key policy insights Focusing on the adaptation behaviours and peer effects of rural residents is conducive to improving the public's acceptance of disaster reduction policies. It is difficult for homogenization policies to accurately meet the needs of rural residents in China, and the response to geohazard events requires diversified local policies. Through peer effect, the government can create a kind of environmental soft pressure and promote the transformation of residents’ willingness into behaviour. Due to peer effects, the government can utilize the leading role of a small number of target groups to reduce the cost of implementing disaster reduction policies.

Does Central Bank Transparency Matter for Inflation: Role of Inflation Targeting

This paper examines the relationship between central bank transparency and inflation for six inflation targeting (IT) and ten non-inflation targeting (non-IT) Asian economies. The propensity score matching and panel regression model are employed in the study. The empirical analysis shows that IT enhances central bank transparency. Further, we find that central bank transparency in IT significantly lowers inflation, suggesting that countries promoting greater monetary policy transparency can have a better advantage of experiencing low inflation. Our findings have policy implications for central banks in developing economies that are grappling with low transparency.

Can socialised agricultural services balance equity and efficiency? Analysis from the perspective of government-market relationships

ABSTRACT Socialized agricultural services (SASs) are becoming increasingly popular in developing countries to address future farming challenges. In China, there is an ongoing debate in the academic community regarding the equity and efficiency issues arising from whether SASs have a ‘smallholder crowding out’ effect. By using data from the 2018 China Labour Force Dynamics Survey, we first investigate the equity problem of SASs using a Logit model and then analyse the efficiency problem of SASs using the propensity score matching model. Specifically, we examine whether smallholder farmers have equal access to SASs when different entities provide services and whether SASs can effectively increase farmer cultivation returns. We find that smallholder farmers have equal access to SASs and that SASs can significantly improve farmer returns on grain production, meaning SASs can balance efficiency and equity. Furthermore, SASs can enhance the efficiency of land resource allocation by accelerating land transfer, leading to increased returns. These findings indicate that China should accelerate the construction of SAS system, improve relevant rules for the SAS market, and support smallholder farmers in adopting SASs.

Gender disparities in outcomes of cardiogenic shock secondary to Takotsubo cardiomyopathy

BackgroundTakotsubo cardiomyopathy (TTC) has a preponderance for females, particularly postmenopausal. However, recent data from multicenter registries identified a worse prognosis in male patients, particularly with cardiogenic shock. We aim to investigate gender disparities in outcomes of TTC-associated cardiogenic shock (TTC-CS). MethodsThe National Readmission Database (2016–2020) was utilized to identify TTC-CS hospitalizations. Cohorts were stratified by gender. A Propensity Score Matching (PSM) model, which utilized complete Mahalanobis Distance Matching within the Propensity Score Caliper following multivariate regression, successfully matched males and females. Pearson's χ2 test was applied to the propensity-matched cohorts to compare outcomes. ResultsAmong 12,803 TTC-CS hospitalizations, the majority (74.1 %) were females (N: 9490), and 25.9 % were males (N: 3313). On propensity-matched cohorts (2609), males were found to have higher in-hospital mortality (31 % vs. 26 %, p < 0.001), higher incidence of sudden cardiac arrest (14 % vs. 10.8 %, p < 0.001), endotracheal intubation (52.1 % vs. 48.8 %, p: 0.001), acute liver injury (18 % vs. 15.9 %, p: 0.004), acute stroke (7.2 % vs. 5.8 %, p: 0.004), cardiac arrhythmias (55.1 % vs. 49.3 %, p < 0.001) and acute kidney injury (63.1 % vs. 49 %, p < 0.001); while female patients were found to have higher utilization of mechanical circulatory support (MCS) modalities (16.1 % vs 13.2 %, p < 0.001).Males had a higher adjusted cost of hospitalization ($54,537 vs. $42,805, p < 0.001) with a higher median length of hospital stay (10 vs. 9 days, p < 0.001). The two groups had no significant difference in 30, 90, and 180-day readmission rates (p > 0.05). From 2016 to 2020; mortality has not changed significantly for TTC-CS, while the use of percutaneous coronary angiogram (PCA) and MCS has down-trended (p-trend < 0.05). ConclusionFor TTC-CS hospitalization, males have higher in-hospital mortality and complication rates, along with higher LOS and cost of hospitalization. Despite advances in the management of CS, there was no significant difference in mortality from 2016 to 2020.

Comparative effectiveness and safety of direct oral anticoagulants and warfarin in atrial fibrillation patients with dementia.

Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia. We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC. There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome. Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.

Graft choice to decrease the revision rate of anterior cruciate ligament reconstruction: a nationwide retrospective cohort study

There are many graft choices for anterior cruciate ligament (ACL) reconstruction, including autografts and allografts. The choice of graft has been identified as a significant factor affecting the outcome of ACL reconstruction. This study aimed to determine whether allograft or autograft is better for avoiding revisional ACL reconstruction. The National Health Insurance Service-Health screening database analyzed 146,122 patients who underwent ACL reconstruction surgery from Jan. 1, 2002, to Dec. 31, 2021. The study was conducted in two groups, autograft or allograft, and the rates of revision ACL reconstruction between the two groups were compared. Propensity score matching and multivariable Cox Proportional Hazard model analysis were used. The significant predictors for complications (p < 0.05) were as follows. The total of patients with ACL reconstruction was 146,122. Allograft was used in 121,148 patients, and autograft was used in 24,974 patients. 9.2% of the allograft group and 8.7% of the autograft group underwent revision ACL reconstruction. (P < .0001) 70.0% & 63.6% of patients underwent revision surgery within 1 year in the allograft & autograft groups, respectively. In summary, using autograft in primary ACL reconstruction is helpful in lowering the rate of revision surgery.

Serum trace elements show association with thyroperoxidase autoantibodies in Thyroid Imaging Reporting and Data System (TI-RADS) 4 nodules

Thyroid nodule (TN) has been becoming a great concern worldwide due to its high incidence. Although some studies have reported associations between trace elements exposure and the risk of TNs, the linkage was not inconclusive. The present study aimed to identify the association of selected serum trace elements (Ca, Mg, V, Fe, Co, Cu, Zn, Se, Mn and Mo) with TNs among general adults. A cross-sectional study was conducted in January 2021 in Chengdu, China. 1282 subjects completed the questionnaire and gave at least one human biological material after an overnight fast, venous blood, and urine, including 377 TN participants defined through ultrasound. Various trace elements in serum specimens were determined by inductively coupled plasma mass spectrometry. Thyroid functions were tested by chemiluminescent microparticle immunoassay (CMIA). The associations between trace elements levels and the risk of TNs were examined by restricted cubic splines (RCS) regression and bayesian kernel machine regression (BKMR) models. TNs were more common in females (P < 0.001) and in the elderly (P < 0.001) and that they were also frequently associated with fertility, marital status, annual household income, drinking, anxiety, vitamin supplement, tea consumption, hypertension and hyperlipidemia. After adjusting for confounders by a propensity score matching model, the association between trace elements concentrations and TNs risk was found to be statistically insignificant in the RCS (P for nonlinear > 0.05) and BKMR models. FT3 or T4 (total or free) increased significantly with increasing total trace elements mixture levels. In TI-RADS-4 TN subjects, TPO-Ab level increased significantly with increasing total trace elements mixture levels in the high-dose range. Ca, Zn, Mo at their 75th percentile showed positive individual effects on TPO-Ab, which was examined to be interactive. The detection of trace elements for TNs in general adults may be of no significance, but once individuals classified as TI-RADS-4 TNs are detected with abnormal TPO-Ab, Ca, Zn and Mo level are recommended to measure. The substantive association on it still needs to be continuously explored in the future.

Waterpipe smoking is associated with presence and severity of coronary artery disease: a propensity score-matched study

BackgroundThe prevalence of waterpipe smoking (WPS) has been increasing worldwide. This trend is alarming as WPS can negatively impact cardiovascular health. In the present study, we explored the association between WPS and the presence and severity of CAD.MethodsThis study was a retrospective analysis of patients who underwent diagnostic coronary angiography at Tehran Heart Center between April 2021 and May 2022. Patients with a previous history of percutaneous coronary intervention and coronary surgery were excluded. Waterpipe smokers were matched with non-smokers based on age, gender, and cigarette smoking using a 1:4 propensity score matching model. Stenosis ≥ 50% in any coronary artery was considered a CAD diagnosis. Gensini score was also calculated to measure the severity of the CAD.ResultsWe reviewed the medical records of 8699 patients, including 380 waterpipe smokers. After matching, 1520 non-smokers with similar propensity scores to the waterpipe smokers were selected. Waterpipe smokers were more likely to have CAD than non-smokers (OR: 1.29; 95% CI: 1.04–1.60, P = 0.021). In addition, WPS increased the natural logarithm of the Gensini score by 1.24 (95% CI: 1.04–1.48, P = 0.014) in patients with atherosclerotic coronary disease.ConclusionWPS may increase the risk of CAD independent of age, gender, and cigarette smoking. In addition, among patients with any degree of atherosclerosis in coronary arteries (GS > 0), WPS may lead to higher average GS, suggesting more severe atherosclerosis.Graphical

Sustainable potato farming in Shandong Province, China: a comprehensive analysis of organic fertilizer applications

IntroductionThe potato holds the distinction of being the world’s largest non-cereal food crop and ensuring its sustainable production is imperative for global food security. Notably, China leads in both the planting area and output of potatoes globally, cementing its crucial role in the nation’s agricultural economy. A scientific assessment of the effectiveness of organic fertilizers on potato cultivation can significantly contribute to the promotion of sustainable agriculture.MethodsThis study utilizes a Propensity Score Matching (PSM) model and introduces a novel cost-efficiency approach to analyze and evaluate the production efficiency and economic impact of organic fertilizer application among 546 potato growers in Shandong.ResultsThe research findings reveal the following: Firstly, compared to the control group without organic fertilizer application, it is evident that the use of organic fertilizers enhances production technology efficiency, labor productivity, land productivity, and net profit per unit by 3.6%, 1588.47 kg/person, 16346.77 kg/ha, and 16135.32 yuan/ha, respectively. Secondly, an examination of cost efficiency among growers with different production scales indicates that those with a planting scale of 0.667-1.333 hectares demonstrate relatively high production efficiency across multiple factors. Additionally, there is an observable inverted U-shaped trend in the relationship between planting scale and production efficiency. Thirdly, the continuous application of organic fertilizers proves advantageous in mitigating inefficiencies in investment techniques, leading to cost savings and efficiency improvements in potato cultivation.DiscussionConsequently, it is recommended that the government and relevant departments enhance technical support, elevate professional training programs, and optimize the allocation of input factors. These measures aim to encourage farmers to adopt organic fertilizers, thereby promoting sustainable agricultural practices.

Axillary lymph node removal in de novo metastatic breast cancer.

Several prospective studies have found that local surgical resection did not improve the survival of patients with de novo metastatic breast cancer (dnMBC). However, a significant portion of dnMBC patients still undergo local surgery, and the role of axillary lymph node dissection (ALND) in dnMBC patients remains unclear. This study aimed to investigate the effect of ALND in patients with dnMBC. We included patients diagnosed with dnMBC between 2010 and 2020 using the data from the Surveillance, Epidemiology, and End Results program. The Chi-square test, binomial logistic regression, propensity score matching (PSM), Kaplan-Meier method, and multivariate Cox proportional models were employed for statistical analysis. A total of 6,838 patients were identified, with 5,562 (81.3%) in the ALND group and 1,276 (18.7%) in the non-ALND group. Being diagnosed in later years emerged as an independent predictive factor related to the receipt of ALND (P=0.003). Before PSM, the 5-year breast cancer-specific survival (BCSS) was 51.1% and 38.2% in those with and without ALND, respectively (P<0.001). The 5-year overall survival (OS) was 45.9% and 32.3% in those with and without ALND, respectively (P<0.001). ALND was identified as an independent prognostic factor related to better BCSS (P<0.001) and OS (P<0.001) compared to the non-ALND group. Similar findings were observed after PSM. The outcomes were significantly better in the ALND group than in the non-ALND group in most subgroups. However, the number of removed lymph nodes did not show a significant association with BCSS (P=0.27) and OS (P=0.29). Our study suggests that ALND is associated with improved survival outcomes in dnMBC patients. These findings advocate for a re-evaluation of the role of surgical interventions in dnMBC, emphasizing the need for personalized treatment strategies that consider the potential benefits of ALND.

Determinants of adoption of urban agriculture (UA) as climate-smart agriculture (CSA) practices and its impact on food security: evidence from Wolaita Sodo city, South Ethiopia

BackgroundClimate change is one of humanity's biggest problems. CSA offers a once-in-a-lifetime chance to adapt to global climate change and reduce greenhouse gas emissions. UA can improve food security by providing affordable, nutritious alternatives to commercially produced food, especially for economically disadvantaged people. This study examined the factors influencing the adoption of UA as CSA practices, as well as their effects on food security in Wolaita Sodo City, South Ethiopia.MethodsData was collected from primary and secondary sources, both qualitative and quantitative form. A structured and semi-structured questionnaire was used to gather data from 384 randomly chosen urban households through surveys/interviews, focus group conversations, and observation. The percentage and mean differences between UA adopters and non-adopters were calculated using the chi-square test and t-test. A propensity score matching (PSM) model assessed UA's impact on food security. A binary logistic regression model was used to determine factors influencing adoption of UA as CSA practice in the study area.ResultsThe descriptive analysis showed that 53.53% of respondents used UA. Statistics showed the existence of a significant mean differences between adopters and non-adopters in employment level, UA attitudes, and household size. Logit model computations showed that family size, home ownership, the household head's occupation, perceptions of UA, market demand, and access to training and support influenced UA adoption as a climate-smart farming practice.ConclusionsAs per the study's findings, there could be a correlation between specific factors and the adoption of UA as CSA in the studied area. The PSM study confirmed that UA deployment significantly improves food security. UA adoption increased food security by 0.685-fold. The report recommends that municipal education offices, UA offices, and cooperative offices create an integrated functional adult education programme for urbanites. Since UA is vital to fighting food insecurity, it suggests increasing support for cooperative entities.

Promoting sustainable agrifood production under climate change: adaptation, returns, and food security implications

ABSTRACT Climate change is challenging sustainable agrifood production and food security, and encouraging farmers’ climate change adaptation can help promote sustainable agrifood production and ensure food security. This study investigates farmers’ climate change adaptation and its impact on agrifood production. We employ the propensity score matching (PSM) model to address the selection bias issue of climate change adaptation and estimate the survey data collected from 415 rice-producing households in rural China. We also estimate the inverse probability weighted regression adjustment (IPWRA) model for robustness check. The empirical results show that farmers’ decisions on climate change adaptation are influenced by household heads’ age, education level, life satisfaction, temperature perception, and transportation conditions. The treatment effect estimations of the PSM model reveal that climate change adaptation significantly increases land productivity by 41.24–44.29% and labor productivity by 55.06–63.72% in rice production. The IPWRA model estimation largely confirms the robustness of the PSM model estimation. We also find that climate change adaptation significantly increases the net returns of rice production. These findings have significant global implications. By understanding the factors influencing farmers’ decisions to adapt to climate change, policymakers worldwide can design targeted interventions to encourage similar practices in other regions. Promoting farmers’ climate change adaptation to increase farm productivity is crucial for ensuring global food security in the face of ongoing climate challenges.