Risk Reduction Research Articles

Novel Comprehensive Unified Classification System Toward Smart Standardized Built Environment Knowledge and Low-Risk International Collaborations: UniCCC

The Construction Industry (CI) data is acknowledged to still be unstructured and high-dimensional. Efforts were undertaken to tackle this problem using regional Unified Classification Systems (UCSs). The study emphasizes the necessity for a comprehensive international UCS to manage the growing trend of international collaborations within the CI and associated data risks. Existing UCSs exhibit significant inconsistencies, such as regional omissions, terminological disparities, and diverse data structuring, underscoring the need for a unified approach. Accordingly, using a 3-stage mixed method, the novel UCS ‘Unified Classification of Construction Components_ UniCCC’ was developed, comprising 4 phyla, 9 divisions, and 54 classes, and was shown to have good adaptability/scalability, structure/breakdown, clarity, codifiability, and inclusivity of the 11 key CI aspects. By addressing inconsistencies and smartly structuring CI knowledge from North America, Europe, Africa, and the Middle East, using a faceted classification scheme aligned with ISO 12006, and being developed using a conventional modeling language, UniCCC represents a significant advancement in UCSs, with promising implications for global CI practices and research, paving the way for new avenues in CI performance, innovation, and sustainability. It demonstrated efficiency in various CI aspects, including risk reduction, automation, and sustainability enhancement. As evidence of its performance, using UniCCC for scheduling might decrease up to 58.17%, 66.85%, and 31.74% of the related time, request for information, and omissions, respectively. The study suggests future research perspectives to explore UniCCC's applicability in different regions, its integration with emerging technologies, its proficiency metrics for different purposes, and strategies for organizational implementation.

The Impact of Social Determinants of Health on Peripheral T cell Lymphoma Outcomes: Treatment center-type emerges as a powerful prognostic indicator

BackgroundPrognostic models in peripheral T cell lymphoma (PTCL) have identified biological factors including age, performance status, LDH, and bone marrow involvement as prognostic for survival. The association of nonbiological factors, termed social determinants of health (SDH), on PTCL outcomes remains unexplored. MethodsTo evaluate the impact of actionable SDH on PTCL mortality across race groups, we conducted a retrospective cohort study that included all White, Hispanic, Asian/Pacific Islander (PI) and Black adult patients with PTCL (AITL, ALCL, NKTCL and PTCL, NOS), diagnosed from 2000 to 2020, in California. We utilized Chi2 and Wilcoxon rank-sum tests for descriptive metrics and Kaplan-Meier statistics for mortality estimation. Regression models included patient- (age, sex, race, stage, Charlson Comorbidity Index, histology, treatment type, treatment at an academic center, payer), and neighborhood-level factors (socioeconomic (SES) quintile, proportion without a high school diploma, and rural/urban). Risk factors significant in univariate regression at a P-value < 0·10 were incorporated into the multivariable model. FindingsOur analysis included 6,158 patients: 51·8% White, 25·8% Hispanic, 14·7% Asians/PI, and 7·6% Black. Hispanics exhibited the longest median survival (33 months) followed by Whites, Blacks, and Asian/PI (25, 20, and 14 months, respectively; P = 0·011). Risk factors independently associated with inferior lymphoma-specific survival (LSS) included Asian/PI compared with NH White race (HR, 1·23; 95% CI, 1·10-1·34; P = 0·0002), AITL and ALCL compared with PTCL, NOS histology (AITL HR, 1·14; 95% CI, 1·02-1·25; P = 0·011; ALCL HR, 1·15; 95% CI 1·04-1·26; P = 0·004), academic compared to non-academic facility-type (HR 0·71; 95% CI, 0·64-0·77; P < 0·01), Medicare compared with uninsured status (HR 1·48, 95% CI 1·25-1·73; P < 0·01), and the lowest three education quartiles compared to the highest education quartile (Q2 HR 1·13; 95% CI 1·01-1·25; P = 0·021; Q3 HR 1·14; 95% CI 1·02- 1·26; P = 0·018; Q4 HR 1·22; 95% CI 1·08-1·36; P < 0·001). In the least resourced patients, histology, treatment, treatment facility-type, payer and education were independently prognostic for LSS. Treatment at an academic institution was associated with a striking improvement in LSS (academic institution: yes= 101 months, no = 17 months; P < 0·01) InterpretationThese data identify treatment facility-type, payer and education, as an independent actionable SDH for PTCL mortality. Treatment center-type had the strongest prognostic association with LSS in our PTCL cohort, conferring a risk reduction of PTCL mortality by nearly 30%. Interventions targeted at improving access to academic centers may improve outcomes for all PTCL patients.

Potential of Tambo Dam implementation as a flood control measure

AbstractRecent climate change has resulted in severe and frequent natural disasters globally, prompting the need for adaptation to these events. As an adaptation measure, disaster prevention and mitigation using natural processes and mechanisms (or ‘green infrastructure’) have become widely recognized in many countries. Ecosystem‐based disaster risk reduction has been promoted in Japan since 2015. The ‘Tambo Dam’, a flood mitigation project using paddy fields in which the authors have participated, has the potential to become one of the most extensive forms of green infrastructure in Japan. This study outlines the runoff control mechanisms of Tambo Dams, demonstrates their effectiveness in reducing flood damage at the watershed scale, and discusses two key factors for successful sustainable efforts: the design of appropriate runoff control equipment and administrative schemes that support incentives for the efforts of farmers. The results indicated that Tambo Dam implementation represented a crucial strategy for managing agricultural resources. The functionality of paddy fields could be preserved by managing them as Tambo Dams. This approach not only contributes to flood control but also ensures a swift return to rice cultivation during emergencies. Moreover, establishing a system akin to the Tambo Dam initiative of Mitsuke City, supported by the ‘Direct Payment Scheme for Multifunctional Activities’ for maintenance and management, could ensure the feasibility of Tambo Dam implementation.

Lichen planopilaris is associated with cardiovascular risk reduction: a retrospective cohort review.

Lichen planopilaris is associated with cardiovascular risk reduction: a retrospective cohort review.

Association of ambient air pollution with cognitive functioning and markers of structural brain damage: The Maastricht study

IntroductionGiven the absence of curative interventions and the rising global incidence of dementia, research is increasingly focusing on lifestyle factors for prevention. However, identifying shared environmental risk for dementia, next to individual factors, is crucial for optimal risk reduction strategies. Therefore, in the present study we investigated the association between air pollution, cognitive functioning, and markers of structural brain damage. MethodsWe used cross-sectional data from 4,002 participants of The Maastricht Study on volumetric markers of brain integrity (white and grey matter volume, cerebrospinal fluid volume, white matter hyperintensities volume, presence of cerebral small vessel disease) and cognitive functioning (memory, executive functioning and attention, processing speed, overall cognition). Individuals were matched by postal code of residence to nationwide data on air pollution exposure (particulate matter < 2.5 μm (PM2.5), particulate matter <10 μm (PM10), nitrogen dioxide (NO2), soot). Potentia linear and non-linear associations were investigated with linear, logistic, and restricted cubic splines regression. All analyses were adjusted for demographic characteristics and a compound score of modifiable dementia risk and protective factors. ResultsExposure to air pollutants was not related to cognitive functioning and most brain markers. We found curvilinear relationships between high PM2.5 exposures and grey matter and cerebrospinal fluid volume. Participants in the low and high range of exposure had lower grey matter volume. Higher cerebrospinal fluid volumes were only associated with high range of exposure, independent of demographic and individual modifiable dementia risk factors. After additional post hoc analyses, controlling for urbanicity, the associations for grey matter volume became non-significant. In men only, higher exposure to all air pollutants was associated with lower white matter volumes. No significant associations with white matter hyperintensities volume or cerebral small vessel disease were observed. DiscussionOur findings suggest that higher PM2.5 exposure is associated with more brain atrophy.

Ivermectin-based mass drug administration for scabies in northern India: a single-arm community intervention trial

Abstract Background Scabies and impetigo cause direct health effects and contribute to severe infectious and immune-mediated complications. Ivermectin-based mass drug administration can reduce scabies and impetigo prevalence in island settings with high prevalence but the effectiveness in moderate prevalence settings is not known. Methods We conducted a single-arm, before-after community intervention trial. Mass drug administration was offered to the entire population of four villages in Uttarakhand, India. The treatment consisted of two doses, given seven days apart, of oral ivermectin (approximately 200 μg/kg) or topical 5% permethrin if ivermectin was contraindicated. The primary outcome was the prevalence of scabies at 12 months compared to baseline, as diagnosed using clinical assessment and the 2020 International Alliance for the Control of Scabies criteria. Secondary outcomes included the prevalence of impetigo at each timepoint. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12619001712190). Results In January 2020, 1211 participants were enrolled (100% of the estimated village population). Treatment coverage was high - 1204 (99.4%) and 1177 (97.2%) received one and two doses, respectively. Scabies was diagnosed in 91 participants (7.5%) and impetigo in 15 (1.2%). In February 2021, 1190 (98.3% of baseline) participants re-enrolled, and of these 11 had scabies (0.9%, relative risk reduction 87.7%, 95% CI 77.1-93.4) and five had impetigo (0.4%, relative risk reduction 66.1%, 95% CI 7.0-87.6). Conclusions A single round of ivermectin-based mass drug administration substantially reduced the prevalence of scabies and impetigo in this setting with moderate scabies prevalence in northern India.

Vietnamese migrants’ engagement in disaster risk reduction: The relevance of social capital

Researchers commonly employ the concept of social capital to examine how people engage with disaster risk reduction. This approach has generated useful knowledge to improve the effectiveness of disaster risk reduction for the general population. However, disaster risk reduction knowledge and practices designed for the general population might not speak to Vietnamese migrants because they do not reflect Vietnamese cultural practices and norms. This paper contributes to the literature by presenting findings from a narrative inquiry into Vietnamese migrants’ experiences of disaster risk reduction in the Wellington Region, Aotearoa New Zealand. The participants’ narratives suggest that Vietnamese migrants employ bonding and bridging social capital to gain knowledge about natural hazards and disaster risk reduction. Their disaster risk reduction reflects certain socio-cultural norms and values as well as family and gender dynamics among Vietnamese migrants. The findings also indicate that, for Vietnamese migrants who do not have well-established social networks, social capital-based disaster risk reduction might be less effective.

ENHANCED GIS-BASED MULTI-CRITERIA DECISION ANALYSIS FOR OPTIMAL FLOOD SHELTER SITE SELECTION: A CASE STUDY OF KUANTAN, MALAYSIA

Floods significantly impact lives, infrastructure, and economies, especially in disaster-prone regions such as Kuantan, Malaysia. This study aims to develop a suitability map for flood shelters in Kuantan, Pahang, by employing the Analytic Hierarchy Process (AHP) and Weighted Overlay Analysis (WOA) within ArcGIS software. Geospatial criteria such as elevation, slope, proximity to disaster-prone areas, landslides, floods, and land use were used as parameters. The results indicated that 21% of flood shelters were in unsuitable locations, 32% were in moderately suitable areas, 39% were in very suitable areas, and 8% were in extremely suitable sites. This study highlighted the critical role of geospatial criteria in selecting flood shelter sites and advocated for continuous reassessment to optimise their effectiveness and safety. The research provides valuable insights for urban planning and disaster risk reduction, emphasising the necessity for strategic, data-driven decision-making to enhance urban resilience against floods.

Status of uterine cervix cancer mortality and incidence disparities in Appalachian eastern Kentucky.

132 Background: Cervical cancer continues to affect the Appalachian population to a higher degree than the rest of the American population. Researchers believe the increased prevalence of cervical cancer in the Appalachian area is due to health disparities across the area. Methods: We queried the Kentucky Cancer Registries online public Cancer Incidence and Mortality Inquiry System to determine changes in age adjusted invasive cervical cancer incidence and mortality rates in Appalachian (AK) and Non-Appalachian Kentucky (NAK) counties over time. Incidence rate ratios were used to analyze the difference in cervical cancer incidence and mortality between Appalachian KY and non-Appalachian KY populations across several time periods. Results: In 1995-1999, there was a statistically significant difference in cervical cancer incidence between AK and NAK 14.8 vs. 12.7/100,000 people (p= 0.0035) and mortality 4.6 vs. 4.0/100,000 (p=0.0471). The cervical cancer incidence was 16.9% higher in AK versus NAK and mortality was 18.4% higher in AK versus NAK. In 2016-2020, there was a statistically significant difference in cervical cancer incidence between AK and NAK 12.1 vs. 8.9/100,000 people (p≤ 0.0001) and mortality between AK and NAK 3.6 vs. 2.3/100,000 people (p= 0.0001). The cervical cancer incidence was 36% higher in AK versus NAK and mortality was 55.7% higher in AK versus NAK. Conclusions: Disparities between in Appalachian Kentucky and Non-Appalachian Kentucky in cervical cancer incidence and mortality not only have persisted since the 1990’s, but they have widened proportionally over time as survival gains have lagged in Appalachia. The observed cervical cancer outcome disparities are likely contributed to by not only the lack of general health education in the region, but more importantly barriers to care access contributing to a lower use of Pap testing in the area. Higher rates of poverty, increased rates of smoking and HPV infection also likely play a role. Research has been conducted to observe identified opportunities for intervention and begin collaborative efforts in the region engineered towards a cervical cancer risk reduction program, but the need for improvement clearly remains. Cervical cancer mortality rates in Appalachian Kentucky vs. non-Appalachian Kentucky, 1995-2020. Appalachia Non-Appalachia Population at Risk Deaths Crude Rate/100,000 Age-Adjusted Rate 95% Confidence Interval Population at risk Deaths Crude Rate/100,000 Age-Adjusted Rate 95% Confidence Interval 1995-1999 2928468 145 5 4.6 [3.9-5.4] 7209127 301 4.2 4 [3.6-4.5] 2000-2004 2962204 102 3.4 3.2 [2.6-3.9] 7485965 214 2.9 2.7 [2.3-3.1] 2005-2009 2986284 117 3.9 3.5 [2.9-4.2] 7833348 225 2.9 2.6 [2.3-3.0] 2010-2015 3577269 141 3.9 3.4 [2.8-4.0] 9803897 277 2.8 2.5 [2.2-2.9] 2016-2020 2941022 121 4.1 3.6 [3.0-4.4] 8378683 221 2.6 2.3 [2.0-2.7]

Teaching Cancer CALM: Culinary and Lifestyle Medicine (CALM) Education for Cancer Risk Reduction (CRR)

Teaching Cancer CALM: Culinary and Lifestyle Medicine (CALM) Education for Cancer Risk Reduction (CRR)

Integrated hydrological modelling and streamflow characterization of Gangotri Glacier meltwater

Runoff from glaciated catchments is an integrated process that includes glacier melt, snowmelt, rainfall and surface and subsurface runoff of meltwater from glacierized and non-glacierized areas. Monitoring and quantifying the contribution of the hydrologic components (snow, ice and rain) to river discharge in the Himalayan basins is essential for decision-making in the water sector, particularly in water resources management and flood risk reduction in the region. An attempt has been made to characterize and hydrologically model streamflow (Bhagirathi River) for the Gangotri Glacier (Central Himalaya, India). A semi-distributed conceptual hydrological model is used for the streamflow modelling and assessing the major streamflow components (snow melt, glacier melt and rainfall runoff). Initially, the model was calibrated using the available in situ hydro-meteorological records for the ablation seasons of 2013–14 to 2015–16 (3 years), and further validated for the ablation seasons of 2016–17 to 2018–19 (3 years). The model performed well for all the studied years except for some months, where abrupt changes in the contrasting weather parameters (precipitation and temperature) were recorded. In the Gangotri Glacier Valley (upper Bhagirathi River catchment), snowmelt contributed the largest portion (55.5%) to total streamflow followed by glacier melt (29.7%) and rainfall runoff components (14.7%).

Enhancing gender-responsive resilience: The critical role of women in disaster risk reduction in Oman

Successful disaster risk reduction (DRR) and preparedness require the active participation of all genders and age groups. However, gender roles and relations are often overlooked in disaster management. This study explores the critical role of women in enhancing gender-responsive resilience within DRR in Oman. It highlights existing gender disparities in DRR strategies and emphasizes the need for inclusive policies that leverage women's knowledge, leadership, and adaptive capacities. By examining Oman's experience with natural disasters (cyclones) and COVID-19, the research underscores the importance of integrating gender perspectives in DRR for more effective outcomes. Utilizing a quantitative survey and statistical analysis, the study investigates variables shaping women's participation in DRR, including knowledge, communication, experience, social protection, and voluntarism. Findings demonstrate the crucial role of women in enhancing disaster resilience and their potential in mitigating disaster risks effectively. Policy recommendations advocate for empowering women and promoting their active participation in DRR to strengthen community resilience and contribute to broader socio-economic development goals in Oman. This study calls on policymakers, practitioners, and stakeholders to support the pivotal role of women in building resilient societies and to adopt a more equitable approach to disaster management.

Traditional Eye Cosmetics and Cultural Powders as a Source of Lead Exposure.

We aimed to describe the characteristics of traditional eye cosmetics and cultural powders, including the types, lead concentrations, origin, and regional variation in product names, and assess the differences in blood lead levels (BLLs) between product users and non-users. We analyzed 220 samples of traditional eye cosmetics and cultural powders collected in New York City between 2013 and 2022 during lead poisoning investigations and store surveys. We compared the BLLs of children who used these products with those of non-users. Lead levels in traditional eye cosmetics surma and kohl were much higher than levels in kajal and other cultural powders. Although the terminologies surma, kohl, and kajal are often used interchangeably, findings suggest regional variations in the product names. The majority of the surma in this study were from Pakistan, kohl was from Morocco, and kajal was from India. The results also show that these products can contribute to elevated BLLs in children. Our study reveals that traditional eye cosmetics and cultural powders are used among children as young as newborns, and exposure to these products can significantly add to their lead body burden. The study findings also reveal that lead concentrations in these products can vary by product type and product names can vary by region. Public health officials must be cognizant of these unique variations and use culturally appropriate terminologies for these types of products because such distinctions can be critical when conducting risk assessments, risk communication, and risk reduction activities.

Geriatric Pharmacotherapy Case Series: Medications for Diabetes-A Focus on Secondary Stroke Prevention.

This report addresses evidence for efficacy of diabetes medications with a focus on stroke risk reduction. The cardiovascular benefits of SGLT-2 inhibitors and GLP-1 receptor agonists have been well-established; however, clinical trials to date have examined composite cardiovascular endpoints that include, but do not specifically focus on, stroke. The purpose of this case review is to examine the evidence for the various diabetes medications in reducing the risk for stroke. This literature review was inspired by a patient seen in a geriatric day hospital program with diabetes and a history of multiple strokes. Our goal was to select a diabetes management regimen that would provide both glycemic control and stroke risk reduction. As diabetes and cerebrovascular disease commonly coexist and are important contributors to morbidity and mortality in older individuals, appropriate management must incorporate both current evidence as well as consideration for patient-specific factors that may influence the treatment plan. This patient case illustrates the importance of both.

Progress and Challenges Toward Coherence Among Disaster Risk Reduction, Climate Change Adaptation, and Sustainable Development

In 2023, which marked the midpoint of the post-2015 global agendas, the findings of midterm review process of the Sendai Framework (MTR SF) were presented. Various data demonstrate that hydro-meteorological disasters, presumably exacerbated by climate change, are increasing in frequency and intensity and causing widespread adverse impacts and associated losses, which calls for coherence among disaster risk reduction (DRR), climate change adaptation, and sustainable development. This article provides findings and recommendations through an analysis of publicly available data and reports, including monitoring for the Sendai Framework and Sustainable Development Goals as well as the MTR SF. The main findings in the MTR SF are that countries focus primarily on short- to mid-term adjustments rather than on long-term structural transformation and that policies and measures to reduce exposure are less well described. Recommendations include (i) the development of a national disaster loss database to collect data on both large- and small-scale and slow-onset disasters; (ii) the implementation of “custom indicators” to supplement the Sendai Framework Monitoring (SFM) by utilizing available loss data collection and exceptional governance measures in the case of high-impact disasters; (iii) the employment of common metrics with the SFM at the national level for climate change statistics and indicators to promote integrated data collection and coherence; (iv) the introduction of new indicators to measure and verify implementation; and (v) formulation and elaboration of a long-term comprehensive national strategy that goes beyond national DRR strategies to integrate DRR-related sectoral policies in support of relevant stakeholders, underpinned by secured resources and adaptive governance with monitoring and evaluation to enable a transformation toward more resilient and sustainable future.

Integrating Climate Change Adaptation, Disaster Risk Reduction, and Social Protection for Enhanced Resilience: Evidence from the Somali Region, Ethiopia

Integrating climate change adaptation, disaster risk reduction, and social protection is crucial for enhancing resilience in vulnerable communities. This study aims to assess the level of integration among these three approaches in the Somali Region, Ethiopia. A qualitative methodology, involving a meta-analysis of 122 projects and program documents was conducted to evaluate the integration levels of the approaches. Key informant interviews and focus group discussions were also used to gather qualitative insights from stakeholders. The findings reveal that the integration of the three approaches, in the form of adaptive social protection, is limited. While social protection and disaster risk reduction are combined more effectively, the inclusion of climate change adaptation remains insufficient. Duplication of activities is common in programs and projects, wasting resources. The study recommends implementing an adaptive social protection approach with clear institutional arrangements and stakeholder coordination to enhance resilience and resource efficiency.

Flaxseed extract: A potential therapeutic intervention for type-2 diabetes mellitus and cardiovascular risk reduction in Wistar rats

Introduction: Type 2 diabetes mellitus (T2DM) affects millions of people worldwide, highlighting the importance of dietary interventions. Flaxseed (Linum usitatissimum L.) has shown promise in treating chronic metabolic diseases. This study investigates the therapeutic potential of flaxseed as an antidiabetic agent and its protective effect on cardiovascular diseases. Methods: Rats were randomly divided into five groups: normal fed with drug carrier group (N), diabetes with drug carrier group (D), diabetes with metformin (M) group (D+M), and diabetes with flaxseed extract doses of 100 and 200 mg/kg (D+F1 and D+F2) groups. The diabetic rat model was established by administration of drinking water containing 25% fructose and a single intraperitoneal injection of 100 mg/kg alloxan. After a six-week intervention, the rats were sacrificed to assess the antidiabetic and cardiovascular effects. Results: The doses of 100 and 200 mg/kg flaxseed extract significantly reduced body weight and fasting glucose levels and increased insulin sensitivity index (KITT) compared to the diabetes group (P&lt;0.05). In addition, histological analysis showed a significant improvement and increase in pancreatic beta cells in the treatment group compared to the diabetes group (P&lt;0.05). Flaxseed extract doses of 100 and 200 mg/kg significantly reduced weight gain and insulin resistance, contributing to decreased arterial stiffness and atherogenic index compared to the diabetic group (P&lt;0.05). The hypoglycemic effect suggested a dose-dependent response. Conclusion: Flaxseed extract regulates blood glucose levels probably by enhancing insulin sensitivity and revitalizing damaged pancreatic beta cells. It mitigates cardiovascular risk, by reducing arterial stiffness and atherogenicity.

A Bayesian approach for the continuous monitoring of the prediction of the physiological evolution of a crisis victim: a Decision Support System

Catastrophic events like earthquakes demand innovative tools for crisis management. Mathematical modeling and decision support systems (DSSs) have proved crucial for understanding, predicting and mitigating disaster impact. The quantification of complex phenomena through probabilistic models, to estimate the likelihood of events, provides actionable insights that are essential for disaster risk reduction (DRR).The present work stems from research conducted within the framework of the Search & Rescue (S&R) project (H2020-SU-SEC-2019), in particular from the development of the PHYSIO DSS module, the medical component of the S&R Decision Support System (DSS). The PHYSIO DSS focuses on predicting the physiological evolution of crisis victims: using a Bayesian approach, it incorporates real-time field observations to forecast patient conditions. This enables the prediction of the evolution of physiological compensation, allowing efficient resource allocation and timely interventions. By providing real-time insights into victim severity, PHYSIO DSS empowers medical personnel to prioritize treatment, potentially saving lives. Its adaptability allows integration into different platforms, from crisis management systems to apps to personal health devices.This tool has the potential to substantially enhance emergency response capability and overall disaster resilience by offering real-time, data-driven decision support.

Validation Assessment of Privacy-Preserving Synthetic Electronic Health Record Data: Comparison of Original Versus Synthetic Data on Real-World COVID-19 Vaccine Effectiveness.

To assess the validity of privacy-preserving synthetic data by comparing results from synthetic versus original EHR data analysis. A published retrospective cohort study on real-world effectiveness of COVID-19 vaccines by Maccabi Healthcare Services in Israel was replicated using synthetic data generated from the same source, and the results were compared between synthetic versus original datasets. The endpoints included COVID-19 infection, symptomatic COVID-19 infection and hospitalization due to infection and were also assessed in several demographic and clinical subgroups. In comparing synthetic versus original data estimates, several metrices were utilized: standardized mean differences (SMD), decision agreement, estimate agreement, confidence interval overlap, and Wald test. Synthetic data were generated five times to assess the stability of results. The distribution of demographic and clinical characteristics demonstrated very small difference (< 0.01 SMD). In the comparison of vaccine effectiveness assessed in relative risk reduction between synthetic versus original data, there was a 100% decision agreement, 100% estimate agreement, and a high level of confidence interval overlap (88.7%-99.7%) in all five replicates across all subgroups. Similar findings were achieved in the assessment of vaccine effectiveness against symptomatic COVID-19 Infection. In the comparison of hazard ratios for COVID 19-related hospitalization and odds ratio for symptomatic COVID-19 Infection, the Wald tests suggested no significant difference between respective effect estimates in all five replicates for all patient subgroups but there were disagreements in estimate and decision metrices in some subgroups and replicates. Overall, comparison of synthetic versus original real-world data demonstrated good validity and reliability. Transparency on the process to generate high fidelity synthetic data and assurances of patient privacy are warranted.

Individuals with a fragility fracture and a prescription for bone active medication have a positive perception of the medication but do not associate it with fracture risk reduction.

Our purpose was to examine perceptions about bone active medication from individuals with a fragility fracture and a prescription for bone active medication. In this qualitative description study, eligible participants were those who attended an Osteoporosis Canada education session, and reported sustaining a previous fragility fracture and receiving a prescription for bone active medication. We conducted one-on-one interviews and analyzed the data using the analytic hierarchy approach. We interviewed 32 female participants (age range 58-89years). Based on our analysis, two themes were developed: (1) most participants spoke positively about bone active medication, indicating they were willing to start, or continue to take, their medication. Positive perceptions were held by participants who sustained a fracture while taking bone active medication, participants whose healthcare provider had stopped the prescription, and participants who reported side effects from the medication; (2) most participants did not discuss bone activemedication in relation to their fracture and did not appear to connect the medication to the concept of fracture risk. Instead, participants talked about themedication in relation to bone health in general, or to bone density. Participants appeared to have positive perceptions of bone active medication, despite sustaining a fracture while taking the medication, reporting medication side effects, or having a healthcare provider stop the prescription. Participants did not connect bone active medication to the concept of fracture risk, illustrating the need for healthcare providers to emphasize the connection between fracture risk and bone active medication.