Population-based Prospective Cohort Research Articles

An epidemiological survey of visual impairment in rural populations aged 30 and above: the Handan Eye Study

Objective: To investigate the changes in prevalence and causes of blindness and visual impairment over six years among rural populations aged 30 and above in Yongnian County, Handan City, Hebei Province, a pilot area in northern China for blindness prevention and treatment, and to study the incidence of common blinding eye diseases. Methods: This population-based prospective cohort study included a baseline survey conducted from 2006 to 2007 using stratified cluster sampling, targeting 6 830 Han Chinese individuals aged 30 and above, with a response rate of 90.4%, and a follow-up survey conducted from 2012 to 2013 with 5 394 participants, maintaining a response rate of 85.3%. Visual impairment was defined according to World Health Organization standards as visual acuity<20/60 but ≥20/400, and blindness as visual acuity<20/400. Age-and gender-standardized prevalence rates of blindness and visual impairment, along with their 95% confidence intervals (CI), were estimated. The six-year incidence rates of primary glaucoma, age-related macular degeneration, and myopic maculopathy, along with their 95%CI, were reported. Results: At baseline, the standardized prevalence of bilateral blindness in individuals aged 30 and above was 0.6% (41/6 799) for presenting visual acuity and 0.5% (31/6 799) for best-corrected visual acuity. These rates were higher than those found in the follow-up survey, 0.5% (27/5 293) and 0.3% (17/5 276). Conversely, the standardized prevalence of bilateral visual impairment increased from 4.7% (361/6 799) and 1.0% (85/6 799) at baseline to 6.5% (355/5 293) and 1.4% (74/5 276) at follow-up, respectively. The leading cause of bilateral blindness was cataract in both baseline (13/31, 41.9%) and follow-up (7/17) surveys. Other major causes included myopic retinal degeneration (5/31, 16.1% at baseline; 2/17 at follow-up), glaucoma (3/31, 9.7% at baseline; 2/17 at follow-up), and corneal opacity (3/31, 9.7% at baseline; 2/17 at follow-up). Over six years, the incidence rates for primary glaucoma, early and late age-related macular degeneration, and myopic maculopathy in individuals aged 35 and above were 1.6% (95%CI: 1.2%-1.9%), 4.2% (95%CI: 3.8%-4.7%), 0.2% (95%CI: 0.2%-0.3%), and 0.1% (95%CI: 0.0%-0.2%), respectively. Conclusions: The prevalence of bilateral blindness in the rural population of Yongnian County, Handan City, Hebei Province, decreased over six years due to blindness prevention and treatment efforts but remained higher than in urban areas. Meanwhile, the prevalence of bilateral visual impairment increased since the baseline survey. Cataracts continued to be the primary cause of blindness, followed by myopic retinal degeneration, glaucoma, and corneal opacity.

SARS-CoV-2 memory response in non-hospitalised cases: immunology in the context of a population-based cohort study

Background The study of non-hospitalised COVID-19 cases provides a context for improved understanding of the immune response to existing and new infections. Population-based cohorts provide a unique opportunity to do this in relation to rich longitudinal pre- and pan-pandemic data. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective population-based cohort study which recruited pregnant women in 1990-1992 and has subsequently followed participants for over 30 years. Methods A study comprising three clinic visits was implemented, in response to the COVID-19 pandemic, amongst ALSPAC participants to measure SARS-CoV-2 specific humoral and cellular responses longitudinally. Here we present data from the first clinic in December 2020 before the start of the UK vaccination campaign and examine associations with a set of exemplar pre- and pan-pandemic health factors. Results We observed humoral and cellular memory immune responses to SARS-CoV-2 infection in mild cases of COVID-19 up to 9 months post-infection. Symptomatic infection elicited a memory immune response of greater magnitude, though there was variation in response in both asymptomatic and symptomatic individuals. We examined health factors associated with severe COVID-19 and found that cardio-metabolomic, respiratory and immune-related health factors associate with a memory immune response of higher magnitude. For example, in older participants (mean age 58 years), higher BMI was associated with an immune memory response of greater magnitude, particularly with anti-S and anti-N binding antibodies. Conclusions We set out to illustrate the use of cohort studies to deliver detailed immunological data and to provide example analyses of how life course health factors can be examined in relation to the immune response following a widespread and novel infection. We expanded this assessment to include longitudinally assessed traits, opening up the potential for the more common use of longitudinal population studies for the better understanding the aetiology of infection outcome.

Poverty Dynamics and Caries Status in Young Adolescents.

To investigate whether timing, accumulation and trajectories of poverty are associated with dental caries in young adolescents. The study was conducted within the Generation R Study, which is an ongoing population-based prospective cohort study conducted in Rotterdam, the Netherlands. This study included 2653 children. Information about household income and number of children and adults living in a household at six time points from pregnancy to 13 years old was retrieved from parental questionnaires to construct the poverty variable. Dental caries was assessed with the decayed, missing and filled teeth index through intraoral photographs at the age of 13 years. Sociodemographic and oral health-related characteristics were included as possible confounders. The association between poverty and dental caries was analysed on the basis of the three lifecourse theories, that is, critical period, cumulative risk and social mobility model. For the latter, we used latent class growth analysis (LCGA) to identify poverty trajectories over time. Next, the associations were studied with Hurdle Negative Binomial Models. Poverty at birth and intermittent poverty up to the age of 13 were significantly associated with dental caries at 13 years of age (OR 1.41, 95% CI 1.01-1.99; OR 1.36, 95% CI 1.01-1.83 respectively) and with an increased mean number of decayed teeth by 34% (95% CI 1.02-1.76; 95% CI 1.05-1.71, respectively). LCGA showed four trajectories for the probabilities of poverty. All trajectories were significantly associated with dental caries at 13 years of age, with the 'downward mobility' trajectory showing the strongest association with dental caries (OR 1.55, 95% CI 1.05-2.29) and an increasing mean number of decayed teeth by 58% (95% CI 1.18-2.12) than the 'stable absent' trajectory. Poverty at birth, intermittent poverty and downward poverty trajectory were associated with higher odds and higher mean number of decayed teeth at 13 years of age. The three lifecourse models influenced dental caries status during adolescence, hence strategies and policies targeted to improve socioeconomic conditions on deprived children should be implemented.

Association of RAAS inhibitors on osteoporosis and fracture risk in the hypertensive population–A prospective population-based cohort study in Lanzhou, China

BackgroundRenin-angiotensin-aldosterone system (RAAS) inhibitors appear to benefit bone tissue in antihypertensive treatment. However, the association between RAAS inhibitors and bone metabolism was inconsistent.Methods and study designBased on the study of Risk Evaluation of Cancers in Chinese Diabetic Individuals(REACTION) conducted in 2011, We followed 6,252 Lanzhou residents aged 40–75 years from 2014 to 2016. Finally, 1,625 hypertension cases with complete data were included in the analysis. The study subjects were divided into four groups according to the type of antihypertensive drugs. We employed logistic or multivariate Cox proportional hazards regression to estimate the association between different antihypertensive drug use and osteoporosis, the risk of fracture, and the change in bone mineral density (BMD) level. The association of osteoporosis or the fracture risk by cumulative duration of use of these medications (< 3 years.) and (> 3 years.) was also estimated.ResultsThe cross-sectional study showed that there was no significant association between baseline antihypertensive drugs (angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB)) use and osteoporosis and fracture. During a mean follow-up of 3.4 years in the longitudinal study, there were 478 new osteoporosis cases and 76 fractures. Compared with patients without antihypertensive drug use, the hazard ratios (HRs) [95% confidence interval (CI)] for the risk of osteoporosis were 1.005(0.651,1.552) and 1.077(0.793,1.462) in ACEI or ARB use (p > 0.05). ACEI or ARB use was also not significantly associated with fracture risk (HR 1.102(0.326,3.726), 0.735(0.251,2.148), p > 0.05). Further analysis showed that the use of ACEI (HR 1.078(0.146,7.950)) or ARB (HR 1.169(0.347,3.939)) was not significantly associated with the improvement of osteoporosis (p > 0.05). In addition, the duration of RAAS inhibitors used showed no apparent correlation with the risk of osteoporosis (≤ 3 years: HR 0.872 (0.516, 1.474), > 3 years: HR 1.151 (0.574, 2.308)), nor with the improvement of osteoporosis and the risk of fracture. Meanwhile, the association mentioned above did not change compared to different RAAS inhibitors.ConclusionsThe use of RAAS inhibitors, including ACEIs and ARBs, was not significantly associated with osteoporosis, risk of fracture, or BMD change.

Effects of depression and cognitive impairment on increased risks of incident dementia: a prospective study from three elderly cohorts

Depression is usually accompanied with cognitive impairment and increases risk of incident dementia. However, evidence has been limited on the effect size of depression with cognitive impairment and their synergistic effect on future dementia. To explore this, we examined three large cross-country population-based prospective cohorts. Depressive symptoms were assessed by epidemiologic scale, while cognitive impairment was defined by subjective cognitive tests. Dementia was ascertained by self-reported physician-diagnosed conditions. Cox proportional hazard models were employed to determine the hazard ratio (HR) and 95% confidence interval (95% CI), with adjustments of potential confounding variables. Addictive and multiplicative interactions were calculated to evaluate the synergistic effect. A total of 64,706 participants were included at baseline (mean age: 63.9, female: 55.2%), where 4197 (6.5%) individuals had depressive symptoms only, 28,175 (43.5%) individuals had cognitive impairment only, 11,564 (17.9%) individuals had both, and 20,770 (32.1%) individuals had neither. Compared with the neither group, all the other three groups had higher risks of subsequent dementia (depression only: HR 1.65, 95% CI 1.26–2.17; cognitive impairment only: HR 2.71, 95% CI 2.33–3.14; depression with cognitive impairment: HR 3.51, 95% CI 2.95–4.17). There was insignificant additive (RERI, 0.15, 95% CI −0.45–0.75; AP, 0.042, 95% CI −0.13–0.21; SI, 1.06, 95% CI 0.83–1.37) and multiplicative (0.78, 95% CI 0.58–1.06) interaction between depression and cognitive impairment on subsequent dementia. We found depression with cognitive impairment has higher risks of dementia than either condition alone and no significant synergistic effect exists between these two factors.

Adverse childhood experiences, economic challenges and suicide risk under COVID-19 pandemic: results from U-CORONA study

Purpose The purpose of this study is to examine the synergistic effect of adverse childhood experiences (ACEs) and economic challenges on suicide risk, under the coronavirus disease 2019 (COVID-19) pandemic, using a prospective population-based cohort study. Design/methodology/approach Participants included 435 adults (aged from 18 to 92 years, mean = 53.8) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, a population-based longitudinal study in Utsunomiya city, Japan. The baseline survey was conducted in June 2020, between the first and the second wave of the COVID-19 pandemic in Japan. ACEs were assessed using 13 items, and economic challenges due to the COVID-19 were assessed using one item. In the follow-up study, conducted in October 2020 between the second and the third wave of the COVID-19 pandemic in Japan, suicide risk was assessed using six items from the Mini-International Neuropsychiatric Interview via a self-reported questionnaire. Findings This study found positive independent association between ACEs and economic challenges due to COVID-19 and suicide risk. Synergistic effects were also found: the participants with one ACE and economic challenges and those with 2+ ACEs and economic challenges were more likely to be at higher risk of suicide compared to those without ACEs and economic challenges. Originality/value The findings suggest that adults with a higher number of ACEs, in addition to severe economic challenges, were more likely to be at risk for suicide during the COVID-19 pandemic.

Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon

The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03–1.23), 1.47 (95% CI 1.07–2.03), 1.96 (95% CI 1.40–2.74), 1.05 (95% CI 1.03–1.08) for each unit increase, and 1.62 (95% CI 1.16–2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29–3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14–1.43) for each 10-year increase, 1.64 (95% CI 1.07–2.52), 2.35 (95% CI 1.14–4.83), 1.88 (95% CI 1.03–3.44), 6.73 (95% CI 4.08–11.09), 2.31 (95% CI 1.52–3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31–180 days after ICU discharge were 3.13 (95% CI 1.84–5.31) and 1.69 (95% CI 0.99–2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.

Association of Hyperandrogenaemia With Hypertension and Cardiovascular Events in Pre-menopausal Women- A Prospective Population-Based Cohort Study.

The present study aimed to clarify the conflicting association of premenopausal hyperandrogenaemia (HA) with the development of hypertension and CVDs in women. A population-based cohort study including 5889 women. The association of serum testosterone (T), sex hormone-binding globulin (SHBG), and free androgen index (FAI) at age 31 with blood pressure (BP) and hypertension (BP ≥140/90 mmHg and/or use of antihypertensive medication) at ages 31 and 46 and with CVDs (angina pectoris [AP] and/or acute myocardial infarction [AMI] n=74, transitory cerebral ischemia [TIA] and/or stroke n=150) and combined CVD events (AP, AMI, stroke, heart failure, or CVD mortality n=160) by age 53 was investigated. T and FAI were positively associated with systolic and diastolic BP at ages 31 and 46 in the multivariable model. Compared to their lowest quartile, the highest quartiles of T and FAI were positively associated with hypertension at age 31 in the multivariable model. During the 22-year follow-up, FAI was positively associated with increased risk of AP/AMI (hazard ratio [HR]:2.02, 95%CI:1.06-3.85) and overall CVD events or mortality (HR:1.54, 95%CI:1.02-2.33) in the unadjusted models. However, the significance disappeared after adjusting for BMI. Women with HA at premenopausal age had an elevated risk of hypertension, and together with BMI, increased risk of CVD events and CVD mortality during the 22-year follow-up. However, because of several study limitations regarding ethnicity and BMI characteristics, a longer follow-up of this cohort and future studies in ethnically diverse populations are needed to verify the results.

Examining associations between brain morphology in late childhood and early alcohol or tobacco use initiation in adolescence: findings from a large prospective cohort

A prominent challenge in understanding neural consequences of substance use involves disentangling predispositional risk factors from resulting consequences of substance use. Existing literature has identified pre-existing brain variations as vulnerability markers for substance use throughout adolescence. As early initiation of use is an important predictor for later substance use problems, we examined whether pre-existing brain variations are associated with early initiation of use.In the Generation R Study, a prospective population-based cohort, brain morphology (gray matter volume, cortical thickness and surface area) was assessed at ages 10 and 14 using neuroimaging. In the second wave, participants reported on alcohol and tobacco use initiation. From a base study population (N = 3019), we examined the longitudinal (N = 2218) and cross-sectional (N = 1817) association between brain morphology of frontolimbic regions of interest known to be associated with substance use risk, and very early (age < 13) alcohol/tobacco use initiation. Additionally, longitudinal and cross-sectional associations were examined with a brain surface-based approach. Models were adjusted for age at neuroimaging, sex and relevant sociodemographic factors.No associations were found between brain morphology (ages 10 and 14) and early alcohol/tobacco use initiation (<13 years). Sex-specific analyses suggested a cross-sectional association between smaller brain volume and early initiated tobacco use in girls. Our findings are important for interpreting studies examining neural consequences of substance use in the general population. Future longitudinal studies are needed to specify whether these findings can be extended to initiation and continuation of alcohol/tobacco use in later stages of adolescence.

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery

IntroductionBoth twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery. MethodsWe conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n=8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage. ResultsAmong the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p=0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group. ConclusionIn women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

Sex disparities in gallstone disease: insights from the MAUCO prospective population-based cohort study

ObjectiveTo investigate factors associated with the prevalence and incidence of gallstone disease (GSD) in women and men of the MAUCO population-based prospective cohort.Design8948 MAUCO participants (aged 38–74 years) underwent abdominal...

Association of maternal thyroglobulin with gestational thyroid function and offspring IQ and brain morphology.

Low maternal urinary iodine concentration (UIC) during pregnancy is associated with adverse offspring neurodevelopment. Thyroglobulin (Tg) has been suggested as a more sensitive biomarker than UIC of long-term iodine status, but associations of Tg with neurodevelopment and the possible mediating role of thyroid function remain unknown. To study whether maternal Tg is associated with i) maternal and newborn thyroid function and ii) offspring IQ and brain morphology. Participants were selected from two population-based prospective cohorts: Generation R (the Netherlands, iodine-sufficient) and INfancia y Medio Ambiente (Spain, mildly iodine-deficient) with maternal Tg and thyroid function data in the first half of pregnancy or in cord blood, early childhood IQ (age 4.5 and 6 years), late childhood IQ (age 9 and 13), or brain morphology at 10 years. Associations of Tg with TSH, FT4, IQ and brain morphology were studied with multivariable linear regression. i) Tg was associated with lower TSH (-0.12[-0.16; -0.08]) and higher FT4 (0.08[0.05;0.12]) in pregnancy (N=4,367), but not with cord blood TSH or FT4 (N=2,008). ii) Tg was associated with lower IQ in early childhood (β[95% CI]:-0.06 [-0.10; -0.01], N=2,919), but not with IQ (N=2,503) or brain morphology (N=1,180) in later childhood. None of the associations of Tg with the studied outcomes differed by the iodine-to-creatinine ratio (i.e. effect modification) or changed when adjusted for thyroid function. Higher Tg is associated with lower IQ in early childhood and higher thyroid function during pregnancy, but not with IQ or brain morphology in later childhood. Further research should determine the value of Tg in addition to UIC for defining iodine status.

Preconception and Early-Pregnancy Body Mass Index in Women and Men, Time to Pregnancy, and Risk of Miscarriage

Obesity in women is associated with reduced fertility and an increased risk of miscarriage. These associations might also be present across the full range of body mass index (BMI) categories as well as among men. To investigate the associations of preconception BMI in both partners with time to pregnancy and miscarriage. This population-based prospective cohort study was conducted in Rotterdam, the Netherlands, between August 9, 2017, and July 1, 2021. A total of 3604 women and their partners were included from the preconception period onward with follow-up until birth. The date of analysis was July 12, 2024. Body mass index (calculated as weight in kilograms divided by height in meters squared) measured in preconception or early pregnancy. Fecundability, defined as the probability of conceiving within 1 month; subfertility, defined as time to pregnancy or duration of actively pursuing pregnancy of more than 12 months or use of assisted reproductive technology; and miscarriage, defined as pregnancy loss before 22 weeks of gestation. These measures were assessed using questionnaires and via the obstetric caregiver. The study population for time-to-pregnancy analyses consisted of 3033 episodes among women (median age, 31.6 years [IQR, 29.2-34.5 years]; median BMI, 23.5 [IQR, 21.2-26.5]) and 2288 episodes among men (median age, 33.4 years [IQR, 30.5-36.8 years]; median BMI, 24.9 [IQR, 23.0-27.4]). The study population for miscarriage analyses consisted of 2770 pregnancy episodes among women (median age, 31.5 years [IQR, 28.9-34.3 years]; median BMI, 23.5 [IQR, 21.3-26.7]) and 2189 pregnancy episodes among men (median age, 33.5 years [IQR, 30.4-36.8 years]; median BMI, 25.0 [IQR, 23.0-27.5]). Higher BMI in women and men was associated with lower fecundability: for every unit increase in BMI, fecundability decreased (fecundability ratio [FR]: women, 0.98 [95% CI, 0.97-0.99]; men, 0.99 [95% CI, 0.98-1.00]). Women with overweight (FR, 0.88 [95% CI, 0.80-0.98]) and obesity (FR, 0.72 [95% CI, 0.63-0.82]) had lower fecundability compared with women with normal weight. Compared with normal weight in women, underweight (odds ratio [OR], 1.88 [95% CI, 1.22-2.88]), overweight (OR, 1.35 [95% CI, 1.11-1.63]), and obesity (OR, 1.67 [95% CI, 1.30-2.13]) were associated with increased odds of subfertility. In men, obesity was associated with increased odds of subfertility (OR, 1.69 [95% CI, 1.24-2.31]). Compared with normal weight in women, overweight (OR, 1.49 [95% CI, 1.12-1.98]) and obesity (OR, 1.44 [95% CI, 1.00-2.08]) were associated with increased odds of miscarriage. In this cohort study, BMI outside of the normal category in women and men during the preconception or early-pregnancy periods was associated with time to pregnancy and miscarriage. Optimizing BMI in women and men from the preconception period onward might be an important strategy to improve fertility outcomes.

Population-based age- and type-specific prevalence of human papillomavirus among non-vaccinated women aged 30 years and above in Germany

BackgroundA persisting high-risk human papillomavirus (HR-HPV) infection is causal for cervical cancer; however, there is limited population-based data on the prevalence of HPV infections in Germany. We assessed the age and type-specific HPV prevalence, and associated risk factors in HPV unvaccinated women aged 30 and above.MethodsThe MARZY prospective population-based cohort study was conducted between 2005 and 2012 in Mainz and Mainz-Bingen, Germany. Eligible women were randomly recruited from population registries and invited for cervical cancer screening (n = 5,275). A study swab (liquid-based cytology) was taken and HPV testing was performed with GP5+/6 + polymerase chain reaction (PCR) followed by genotyping. We assessed HPV types as HR-HPV, ‘moderate’ risk and low-risk (LR-HPV). Logistic regression was performed to identify factors associated with HPV infection, stratified by HPV types.Results2,520 women were screened with a valid PCR result. Overall HPV prevalence was 10.6% (n = 266), with 6.5% HR-HPV positive (n = 165), 1.5% ’moderate’ risk type (n = 38) and 3.3% LR-HPV type (n = 84) positive. 8.9% had a single infection (n = 225) and 1.6% had multiple types (n = 41). The most common HR-HPV types were 16, 56, 52 and 31 and LR-HPV 90 and 42. Of 187 HR-HPV infections detected (among 165 women), 55.1% (n = 103) were with HPV types not covered by available bivalent or quadrivalent HPV vaccines. About 23% (n = 43) were of types not covered by the nonavalent vaccine (HPV 35, 39, 51, 56, 59). The HR and LR-HPV prevalence were highest in the age group 30–34 years (HR 9.8%, ‘moderate’ risk 3.0% and LR 5.6%), decreasing with increasing age. HR-HPV prevalence in women with normal cytology was 5.5%. In women with a high-grade squamous intraepithelial lesion (HSIL), prevalence was 66.7%. Women currently not living with a partner and current smokers had increased chances of an HR-HPV infection.ConclusionThe overall population-based HPV prevalence was relatively high. An important share of prevalent HR-HPV infections constituted types not covered by current HPV vaccines. With the advent of HPV screening and younger vaccinated cohorts joining screening, HPV types should be monitored closely, also in older women who were not eligible for HPV vaccination.

Neighborhood Safety Concerns and the Onset of Depressive Symptoms Among Women: A Population-based Prospective Cohort Study in South Korea.

Neighborhood safety is crucial for the well-being of residents; however, longitudinal evidence is scarce. This study explored the association between neighborhood safety concerns and depressive symptoms among women. A nationally representative sample of 10,008 women was surveyed in 2016. Six dimensions of neighborhood safety concerns were assessed: crime, food, safety at night, traffic accidents, building and facility, and general safety. The total score for neighborhood safety concerns ranged from 6 to 24, with higher scores indicating greater concerns. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression. For cross-sectional analyses, we explored how neighborhood safety concerns were associated with concurrent depressive symptoms at baseline. For the longitudinal analyses, we explored how they were associated with depressive symptom onset at the 2-year follow-up (2018) among women without depressive symptoms at baseline (n = 7,643). Logistic regressions were employed. The mean (standard deviation [SD]) of the neighborhood safety concern score was 12.7 (3.3). In the cross-sectional analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.23-fold (95% CI: 1.13-1.35) increase in the odds of concurrent depressive symptoms at the baseline year. In the longitudinal analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.15-fold (95% CI: 1.03-1.29) increase in the odds of experiencing the onset of depressive symptoms at the follow-up year. This study suggests that neighborhood safety concerns are risk factors for the development of depressive symptoms of female residents. Policy efforts are necessary to ensure community safety.

Traumatic Brain Injury and Risk of Incident Dementia: Forensic Applications of Current Research

Abstract Objective Traumatic Brain Injury (TBI) has been purported to increase risk for later developing neurodegenerative disorders (ND). Forensic neuropsychologists are frequently asked to opine on risk for ND after an alleged TBI. We provide an evidence-based foundation to aid forensic practice by summarizing the: role of the neuropsychologist in TBI-related litigation, complexities associated with identifying TBIs in forensic cases, science of TBI in relation to incident dementia, and current scientific evidence for chronic traumatic encephalopathy. Data Selection The most applicable studies to forensic settings are large prospective cohort and population-based cohort studies given their wider generalizability and long periods of follow-up/tracking for outcomes. Data Synthesis Developing ND after TBI is the exception rather than the rule. Only a small subset (&amp;lt; 5%) of individuals with moderate-to-severe TBI, and even fewer (&amp;lt; 1%) with mild TBI, appear to develop ND, and the characteristics that place some at risk remain unclear. Positive evidence for risk of ND after mild TBI is weak and mostly consists of observational studies characterized by methodological limitations. Conclusions Forensic methods used to establish the likely occurrence of TBI are typically more extensive than those used in clinical evaluations, while TBI definitions used in current research are even more rudimentary and inconsistent. Applying clinical research findings regarding TBI and dementia outcomes to forensic cases at an individual level carries significant limitations. Estimating the contribution of remote TBI/concussion in a causal manner to ND risk is a challenge forensic experts sometimes face, yet at present, the task is impossible beyond correlations and speculation.

Air pollution and risk of 32 health conditions: outcome-wide analyses in a population-based prospective cohort in Southwest China

BackgroundUncertainty remains about the long-term effects of air pollutants (AP) on multiple diseases, especially subtypes of cardiovascular disease (CVD). We aimed to assess the individual and joint associations of fine particulate matter (PM2.5), along with its chemical components, nitrogen dioxide (NO2) and ozone (O3), with risks of 32 health conditions.MethodsA total of 17,566 participants in Sichuan Province, China, were included in 2018 and followed until 2022, with an average follow-up period of 4.2 years. The concentrations of AP were measured using a machine-learning approach. The Cox proportional hazards model and quantile g-computation were applied to assess the associations between AP and CVD.ResultsPer interquartile range (IQR) increase in PM2.5 mass, NO2, O3, nitrate, ammonium, organic matter (OM), black carbon (BC), chloride, and sulfate were significantly associated with increased risks of various conditions, with hazard ratios (HRs) ranging from 1.06 to 2.48. Exposure to multiple air pollutants was associated with total cardiovascular disease (HR 1.75, 95% confidence intervals (CIs) 1.62–1.89), hypertensive diseases (1.49, 1.38–1.62), cardiac arrests (1.52, 1.30–1.77), arrhythmia (1.76, 1.44–2.15), cerebrovascular diseases (1.86, 1.65–2.10), stroke (1.77, 1.54–2.03), ischemic stroke (1.85, 1.61–2.12), atherosclerosis (1.77, 1.57–1.99), diseases of veins, lymphatic vessels, and lymph nodes (1.32, 1.15–1.51), pneumonia (1.37, 1.16–1.61), inflammatory bowel diseases (1.34, 1.16–1.55), liver diseases (1.59, 1.43–1.77), type 2 diabetes (1.48, 1.26–1.73), lipoprotein metabolism disorders (2.20, 1.96–2.47), purine metabolism disorders (1.61, 1.38–1.88), anemia (1.29, 1.15–1.45), sleep disorders (1.54, 1.33–1.78), renal failure (1.44, 1.21–1.72), kidney stone (1.27, 1.13–1.43), osteoarthritis (2.18, 2.00–2.39), osteoporosis (1.36, 1.14–1.61). OM had max weights for joint effects of AP on many conditions.ConclusionsLong-term exposure to increased levels of multiple air pollutants was associated with risks of multiple health conditions. OM accounted for substantial weight for these increased risks, suggesting it may play an important role in these associations.

Correlation of anogenital distance from childhood to age 9 years-a prospective population-based birth cohort-the Odense Child Cohort.

Does anogenital distance (AGD) - distance from the anus to the genitals - correlate from infancy (3 months) to the age of 9 years in boys and girls? In boys, AGD correlated from infancy to 9 years of age, whereas in girls, correlations were weaker, especially between infancy and later childhood. AGD is considered a marker for prenatal androgen action. In males, reduced AGD is associated with testicular cancer, infertility, and lower sperm count. In females, AGD is associated with endometriosis and polycystic ovary syndrome. In the Odense Child Cohort, a prospective population-based birth cohort, pregnant women were enrolled in early pregnancy. AGD and BMI were measured repeatedly in children at ages 3 and 18 months, as well as at 3, 5, 7, and 9 years. AGD was measured from the anus to the scrotum (AGDas) and to the penis (AGDap) in 1022 boys, and to the posterior fourchette and the clitoris in 887 girls repeatedly between the age of 3 months to 9 years. In total, 7706 assessments were made. AGD was adjusted for body weight, and SD scores (the difference between individual AGD and the mean of AGD in the population divided by SD of AGD) were calculated for each child. Pearson correlation coefficient (r) of each measurement was performed to investigate whether individual AGD was stable during childhood. Short predictive values at 3 months (20th percentile) to 9 years were investigated using the AUC produced by the receiver operating characteristic curve. In boys, AGD/body size-index SD score correlated significantly between infancy and 9 years, strongest for AGDas (r = 0.540 P > 0.001). In girls, weaker significant correlation coefficients were found between AGD at infancy and 9 years; higher correlation coefficients were found between AGD from 3 to 9 years (P > 0.001). Short AGDas in infancy predicted short AGDas in boys aged 9 years (AUC: 0.767, sensitivity 0.71, specificity 0.71). The predictive values of short infant AGDap, penile width (in boys), and AGD (in girls) concerning short outcomes at 9 years were low. The AGD measurements are less precisely measurable in girls compared to boys, especially in infancy, resulting in less reproducible measurements. Additionally, because AGD is shorter in girls, the same absolute measurement error is relatively more significant, potentially contributing to greater variability and lower reproducibility in girls. This may contribute to the weaker correlations in girls compared to boys. In boys, AGDas, relative to body size, correlated from infancy to 9 years, suggesting that AGD in infancy can be considered a non-invasive marker of later reproductive health. Further follow-up studies are needed to evaluate long-term individual tracking of AGD as well as assessment of childhood AGD as early marker of adult reproductive health. This study was supported by Odense University Hospital, Denmark, the Region of Southern Denmark, the Municipality of Odense, Denmark, the University of Southern Denmark, Odense Patient data Exploratory Network (OPEN), Denmark, the Danish Research Council (4004-00352B_FSS), Novo Nordisk Foundation, Denmark (grant no. NNF19OC0058266 and NNF17OC0029404), Sygeforsikring Danmark (journalnr. 2021-0173), the Collaborative Foundation between Odense University Hospital and Rigshospitalet, and Helsefonden. There is no conflict of interest of any author that could be perceived as prejudicing the impartiality of the research reported. N/A.

Telomere Length Is Associated with Increased Risk of Cardiovascular Events in Patients with End-Stage Kidney Disease on Hemodialysis.

Patients with chronic kidney disease, especially those with end-stage kidney disease (ESKD) on hemodialysis (HD), are at increased risk for cardiovascular disease (CVD), including myocardial infarction and ischemic stroke. A shortening in telomere length, as a parameter for accelerated vascular aging, is an established biomarker for CVD in the general population. We aimed to elucidate the role of telomere length in ESKD patient on HD and its association with cardiovascular outcomes. Telomere length was measured in a prospective population-based cohort study of prevalent HD patients. DNA was isolated from whole blood, sampled at baseline, and analyzed for telomere length via a qPCR-based approach. The risk for the occurrence of the independently adjudicated three-point major adverse cardiovascular event outcome (myocardial infarction, ischemic stroke, and cardiovascular death) was statistically analyzed considering the competing risk of non-cardiovascular death. In the cohort of 308 patients with ESKD (115 [37.3%] women, median [25th-75th percentile] age: 67.0 [56.8-76.0]), the median telomere length was 1.51 kb (25th-75th percentile 0.6-3.2 kb). The 3P-MACE outcome occurred with an incidence rate of 9.4 per 100 patient-years. Patients with longer telomere length more frequently had vascular nephropathy compared to patients with shorter telomere length. Interestingly, patients in the highest quartile of telomere length had a 1.8-fold increased risk for 3P-MACE (95% CI: 1.051-3.201, p = 0.033), after multivariable adjustment for age, history of stroke, myocardial infarction, venous thromboembolism, presence of heart valve replacement, atrial fibrillation, smoking, anticoagulation, or immunosuppressive use. Surprisingly, in this high-risk cohort of patients with ESKD on HD, longer telomere lengths were associated with increased risk of cardiovascular events.

Effectiveness of malaria chemoprevention in the first two years of life in Cameroon and Côte d’Ivoire compared to standard of care: study protocol for a population-based prospective cohort impact evaluation study

BackgroundPerennial malaria chemoprevention (PMC) is a chemoprevention strategy endorsed by the World Health Organization (WHO) and is increasingly being adopted by National Malaria Programmes. PMC aims to reduce morbidity and mortality caused by malaria and anaemia in in young children through provision of antimalarial drugs at routine contact points with the local health system. This study aims to evaluate the impact of the programmatically-implemented country-tailored PMC programmes targeting children up to two years of age using sulfadoxine-pyrimethamine (SP) on the incidence of malaria and anaemia in children in Cameroon and Côte d’Ivoire.MethodsWe will assess the impact of PMC using passive and active monitoring of a prospective observational cohort of children up to 36 months of age at recruitment in selected study sites in Cameroon and Côte d’Ivoire. The primary and secondary outcomes include malaria, anaemia and malnutrition incidence. We will also conduct a time-series analysis of passively detected malaria and anaemia cases comparing the periods before and after PMC introduction. This study is powered to detect a 30% and 40% reduction of malaria incidence compared to the standard of care in Cameroon and Côte d’Ivoire, respectively.DiscussionThis multi-country study aims to provide evidence of the effectiveness of PMC targeting children in the first two years of life on malaria and anaemia and will provide important information to inform optimal operationalization and evaluation of this strategy.Trial RegistrationCameroon - NCT05889052; Côte d’Ivoire - NCT05856357.