Region-specific Risk Research Articles

Significant risk factors for oral mucosa cancer in the Altai Krai population

Relevance. Squamous cell carcinoma of the head and neck, including oral and oropharyngeal cancer, ranks as the seventh most common cancer worldwide, contributing to over 660,000 new cases and 325,000 deaths annually. Understanding the interplay of adverse factors, their association with disease development, and the creation of mathematical risk prediction models can play a crucial role in enhancing screening efforts and advancing primary prevention of malignant neoplasms.Objective. This study aimed to identify significant risk factors for oral mucosa cancer in the Altai Krai population and to develop a mathematical model for disease risk assessment.Material and methods. The study included 184 patients diagnosed with oral mucosa cancer, along with a control group of 416 healthy volunteers with no history or current diagnosis of oncological diseases. A total of 39 potential risk factors were analyzed across all participants. Statistical analyses were conducted to identify region-specific risk factors for Altai Krai. Binary logistic regression and ROC analysis were used to construct the risk prediction model.Results. Comparative analysis between the patient group and the control group revealed differences in 19 of the 39 evaluated factors. However, the final risk prediction model identified five key factors significantly influencing disease development. Advanced age, smoking status, the number of cigarettes smoked, and alcohol consumption were found to substantially increase the risk of oral mucosa cancer, while engagement in intellectual work-related activities was associated with a reduced risk. The resulting formula demonstrated high predictive accuracy, with an Area Under the ROC Curve (AUC) of 0.91, a standard error of 0.024, and a 95% confidence interval of 0.856–0.955 (z-statistic: 17.50; significance level: P (area = 0.5) < 0.001). Both the sensitivity and specificity of the model were high.Conclusion. The developed risk assessment model shows great promise for helping screen and diagnose oral cancer in the Altai Krai population. This tool could give dentists and healthcare providers a simple, practical way to identify individuals at risk early by using well-established risk factors.

Regional Variations in the Prevalence of Risk Factors and Non-Communicable Diseases in Papua New Guinea: A Scoping Review.

Often referred to as 'the last unknown', Papua New Guinea's largely unexplored environments across its four distinct regions, the Highlands, New Guinea Islands, Momase, and Southern, exhibit remarkable diversity. Understanding this diversity is significant in contextualising the risk factors associated with developing non-communicable diseases. This review aims to map and summarise the literature to provide region-specific prevalence data for risk factors and non-communicable diseases. Four databases and grey literature were searched. Two reviewers completed the screening and data extraction. Twenty-one studies were included, with five reporting the data by region and the remaining reporting the data nationwide. Six studies reported on risk factors, thirteen reported on non-communicable diseases, and two reported on risk factors and non-communicable diseases. The Southern region, which includes the Capital, Port Moresby, reported the highest prevalence for most risk factors: anthropometric (overweight, obesity, and waist circumference), lifestyle (betel nut, alcohol, unhealthy diet, and stress), and biochemical (cholesterol, triglycerides, HbA1c, and metabolic syndrome). The findings of this review highlight the limited evidence base for region-specific risk factor data and the lack of objective diagnosis of non-communicable diseases. There were variations in the prevalence of specific risk factors by region; however, the Southern region stands out as requiring immediate attention for health promotion program interventions.

Paradigm Shift in Typhoon Forecasting for the Korean Peninsula: A Case Study on the Applicability of the Typhoon-Ready System

Climate change has significantly increased multi-hazard disasters caused by typhoons, exposing the limitations of conventional forecasting systems that often neglect regional socio-economic vulnerabilities. This study develops and validates the Typhoon-Ready System (TRS) as an effective disaster-management framework for the Korean Peninsula. The TRS integrates hazard data with socio-economic and environmental vulnerability factors to produce region-specific risk indices. The analysis of four representative typhoons—Lingling (2019), Rusa (2002), Maemi (2003), and Mitak (2019)—demonstrates TRS’s applicability in identifying high-risk zones and supporting disaster preparedness strategies. The TRS framework incorporates indices, such as the Strong Wind Index (SWI), Heavy Rainfall Index (HRI), Storm Surge Index (SSI), and Air Quality Index (AQI), effectively combining meteorological modeling with vulnerability analysis. Results demonstrate that the TRS outperforms traditional systems by accurately identifying high-risk zones and correlating them with observed damage patterns. For example, the TRS successfully pinpointed high wind risks in Seoul and Incheon during Typhoon Lingling and forecasted severe flooding in Gangneung and Samcheok during Typhoon Rusa. By integrating vulnerability factors, including population density, infrastructure aging, and urbanization levels, the TRS provides a more holistic and accurate risk assessment. This research highlights the necessity of a multi-dimensional forecasting approach for enhancing disaster preparedness and resilience against climate change-induced typhoon impacts.

Multisociety consensus recommendations on hepatitis delta virus infection.

Hepatitis D virus (HDV) prevalence data and country-specific HDV guidelines are not widely available in the Gulf Cooperation Council (GCC) states. We developed consensus recommendations to guide healthcare professionals, policymakers, and researchers in improving HDV management and patient health outcomes in three GCC states: Kuwait, Saudi Arabia, and the United Arab Emirates. A consensus panel comprising hepatology experts (n = 6) from the three GCC societies was formed. The panel identified two broader areas related to clinical practice (screening and diagnosis, and treatment and management), addressed critical questions, and developed draft recommendations in February 2024. The strength of the final set of recommendations was subjected to consensus voting in March 2024. A majority was defined a priori with a two-thirds vote (67%). The paper outlines those recommendations alongside showcasing the current epidemiology of HDV in the GCC states, emphasizing the variability in prevalence, demographic patterns, and region-specific risk factors. It also highlights the current state of screening and diagnosis practices, identifying key obstacles, such as access to advanced screening protocols and diagnostic tools. Furthermore, HDV treatment landscape and preventative strategies are outlined, focusing on vaccination, public health initiatives, and the crucial role of public awareness and education. Ethical and sociocultural considerations are discussed, underscoring the importance of culturally sensitive healthcare practices. These recommendations present a comprehensive overview of the challenges and strategies for managing HDV in these states. Policy recommendations are provided to support HDV management, including standardizing care protocols and promoting public health measures.

A systematic review and meta-analysis on the epidemiology of early childhood caries in Nigeria

BackgroundEarly childhood caries (ECC) is a significant oral health issue affecting children under six years old. This study aimed to determine the prevalence and distribution of ECC in Nigeria through a systematic review and meta-analysis.MethodsA systematic search was conducted across multiple databases for studies on ECC prevalence in Nigeria. The Joanna Briggs Institute (JBI) checklist was used to assess study quality. A random-effects model was employed to calculate pooled prevalence estimates and mean dmft scores. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.ResultsTwenty-three studies met the inclusion criteria, comprising 7,362 participants. The pooled ECC prevalence in Nigeria was 17% (95% CI 11–24%), with significant heterogeneity (I2 = 97%). Subgroup analyses revealed variations across geopolitical zones and study settings. The pooled mean dmft score was 0.44 (95% CI 0.24–0.74). Age group and gender showed minimal impact on ECC prevalence.ConclusionWith a 17% prevalence rate, ECC remains a significant public health concern in Nigeria. The study highlights the need for targeted interventions, standardized national surveys, and further research into region-specific risk factors to address ECC effectively.

Burden of ischemic stroke in sub-Saharan African countries based on DALYs index - trend analysis and identification of risk factors.

Stroke burden, measured by DALYs, reveals a growing concern in sub-Saharan Africa. Ischemic stroke, exacerbated by modifiable risk factors like hypertension and household air pollution, poses a significant health challenge. Regional disparities, economic development, and healthcare inefficiencies underscore the need for targeted interventions and further research. This study aims to analyze trends in the burden of ischemic stroke across specific regions in sub-Saharan Africa from 2000 to 2019. The objective is to identify key changes in stroke burden progression and highlight modifiable risk factors. Utilizing World Health Organization (WHO) data from 2000 and 2019, national estimates of ischemic stroke DALYs in 49 sub-Saharan African countries were collected. DALYs were calculated per 100,000 population to reduce the impact of population size. Statistical analyses and visual representations using MapChart were employed to interpret the trends. The study reveals wide variations in ischemic stroke DALYs changes across sub-Saharan African countries from 2000 to 2019. Predominantly, countries in the Eastern and Southern regions experienced adverse increases, while those in the Central and West regions mostly exhibited declines in DALYs. Countries such as Lesotho, Zimbabwe, and Mauritius, saw the most significant DALYs increases, whereas Rwanda, Malawi, and Equatorial Guinea experienced the most favorable changes. Stroke is a pressing health concern in sub-Saharan Africa. Modifiable risk factors like hypertension and household air pollution necessitate targeted interventions. Tailored healthcare policies, reinforced health systems and comprehensive research into region-specific risk factors are crucial to alleviate stroke-related morbidity and mortality in the region. Addressing these challenges is vital to mitigate the increasing burden of stroke in the particular regions of sub-Saharan Africa.

Climate damage projections beyond annual temperature

Estimates of global economic damage from climate change assess the effect of annual temperature changes. However, the roles of precipitation, temperature variability and extreme events are not yet known. Here, by combining projections of climate models with empirical dose–response functions translating shifts in temperature means and variability, rainfall patterns and extreme precipitation into economic damage, we show that at +3 °C global average losses reach 10% of gross domestic product, with worst effects (up to 17%) in poorer, low-latitude countries. Relative to annual temperature damage, the additional impacts of projecting variability and extremes are smaller and dominated by interannual variability, especially at lower latitudes. However, accounting for variability and extremes when estimating the temperature dose–response function raises global economic losses by nearly two percentage points and exacerbates economic tail risks. These results call for region-specific risk assessments and the integration of other climate variables for a better understanding of climate change impacts.

Stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region, Cameroon, from 2018 to 2022: a case control study

BackgroundStillbirth is a common adverse pregnancy outcome worldwide, with an estimated 2.6 million stillbirths yearly. In Cameroon, the reported rate in 2015 was 19.6 per 1000 live births. Several risk factors have been described, but region-specific risk factors are not known in the northwest region of Cameroon. This study aims to determine the stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region of Cameroon.Materials and methodsA Hospital-based case‒control study conducted from December 2022 to June 2023 on medical files from 2018 to 2022 at the Bamenda Regional Hospital. Cases were women with stillbirths that occurred at a gestational age of ≥ 28 weeks, while controls were women with livebirths matched in a 1:2 (1 case for 2 controls) ratio using maternal age. Sociodemographic, obstetric, medical, and neonatal factors were used as exposure variables. Multivariable logistic regression was used to determine adjusted odds ratios of exposure variables with 95% confidence intervals and a p value of < 0.05.ResultsA total of 12,980 births including 116 stillbirths giving a stillbirth rate of 8.9 per 1000 live births. A hundred cases and 200 controls were included. Factors associated with stillbirths after multivariable analysis include nulliparity (aOR = 3.89; 95% CI: 1.19–12.71; p = 0.025), not attending antenatal care (aOR = 104; 95% CI: 3.17–3472; p = 0.009), history of stillbirth (aOR = 44; 95% CI: 7-270; p < 0.0001), placenta abruption (aOR = 14; 95% CI: 2.4–84; p = 0.003), hypertensive disorder in pregnancy (aOR = 18; 95% CI: 3.4–98; p = 0.001), malaria (aOR = 8; 95% CI: 1.51-42; p = 0.015), alcohol consumption (aOR = 9; 95% CI: 1.72-50; p = 0.01), birth weight less than 2500 g (aOR = 16; 95% CI: 3.0–89; p = 0.001), and congenital malformations (aOR = 12.6; 95% CI: 1.06–149.7;p = 0.045).ConclusionThe stillbirth rate in BRH is 8.9 per 1000 live births. Associated factors for stillbirth include nulliparity, not attending antenatal care, history of stillbirth, placental abruption, hypertensive disorder in pregnancy, malaria, alcohol consumption, birth weight less than 2500 g, and congenital malformations. Close antenatal care follow-up of women with such associated factors is recommended.

Treatment adherence and the contemporary approach to treating type 2 diabetes mellitus.

The rising burden of type 2 diabetes mellitus (T2D) poses a significant healthcare challenge on a global scale. The economic impact is also substantial and continually increasing. In Serbia, even though the prevalence is officially around 12 percent, nearly 40 percent of the adult population is estimated to be living with undiagnosed diabetes and more than half the population is obese or overweight. This review comprehensively addresses the present approach to treating T2D, emphasizing the critical role of treatment adherence. We review the various components of T2D treatment, underlining the significance of lifestyle modifications. The pros and cons of medications used in treatment are discussed and factors influencing adherence are analysed. A healthy lifestyle remains the foundation of the treatment, and if not sufficient, early pharmacotherapy is initiated. Medications have been developed to lower blood sugar levels with cardiorenal protection, however, due to their still high cost, metformin remains the drug of first choice for most patients. Adherence to the treatment regimen is often poor. Factors associated with this are diverse and often multiple in a particular patient. Poor adherence is associated with poor glycaemic control, increased risk of disease complications, higher cardiovascular risk, increased mortality, hospitalizations, and healthcare costs. In addition to reducing the complexity of drug therapy and better informing the patient, improved education and motivation could lead to greater adherence. Enhanced communication between the patient and the physician and reduced treatment costs could also have a positive impact. The review concludes that addressing factors affecting adherence can significantly improve T2D outcomes and reduce costs. Further research is needed to identify region-specific risk factors for poor adherence.

Investigating climate change effects on bridges and tunnels

The earth's climate is changing, partly from continued natural warming since the last ice age and partly man made. The changing climate with resulting more extreme weather events is likely to impact bridges and other long-life infrastructure assets. This research considers the broad effects of climate change on load effects, load combinations and material properties of bridges and tunnels. Effects such as temperature, fire, storminess, precipitation, snow, ice, wind, sea levels and acidity as they affect bridges are discussed. The uncertainty of the data in its probability and the magnitude of extreme events on these climate effects is noted and discussed in relation to resilience. Specific examples of where climate change may affect bridges and tunnels are considered, and where further research is required. A risk assessment of the likelihood and impact of climate change is presented to quantify the effects on bridges and tunnels, to support design or asset management decisions. The work is primarily based on British and north European data, but data from other parts of the world are also considered. Current code and standard provisions for design and assessment are reviewed in relation to climate change and resilience, and recommendations are outlined. Conducting asset- or region-specific risk assessments using the methods of this research is recommended.

Recalibration of Framingham risk for a local population of Sri Lanka

BackgroundCardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka.MethodA cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations.ResultsOriginal and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively.ConclusionThese findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.

Impact of advanced maternal age on perinatal outcomes in Tanzania: Insights from Kilimanjaro Christian Medical Center Birth Registry

The increasing prevalence of advanced maternal age (AMA) births necessitates the exploration of associated pregnancy outcomes within the healthcare-limited context of northern Tanzania to elucidate potential region-specific risks and implications. This study explored the influence of AMA on pregnancy outcomes in northern Tanzania, where healthcare resources and infrastructure are constrained in comparison to developed countries. This cross-sectional hospital-based study utilized maternally linked data from the Kilimanjaro Christian Medical Center (KCMC) Medical Registry and included 32,798 women who delivered single infants between 2004 and 2013. Multiple logistic regression models were used to determine adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AMA-associated adverse pregnancy outcomes. A total of 16 % of mothers belonged to AMA with increased odds of undergoing a cesarean section (aOR: 1.32; 95%CI [1.24–1.41]; P < 0.001), gestational diabetes (aOR: 13.16; 95%CI [3.28–52.86]; P < 0.001) or pregestational diabetes (aOR: 3.15; 95%CI [1.87–5.31]; P < 0.000), and developing pre-eclampsia (aOR: 1.63; 95%CI [1.41–1.89]; P < 0.000). More women with AMA reported alcohol use during pregnancy and had preexisting conditions before conception than did younger women. Maternal education level, employment status, urban residency, and Christianity were statistically significant. This study establishes a connection between AMA and higher odds of cesarean section, gestational diabetes, pregestational diabetes, and pre-eclampsia. Women with AMA were more inclined to consume alcohol during pregnancy and exhibited preexisting conditions before conception. Moreover, AMA was linked to increased odds of low birth weight, stillbirths, and NICU transfers.

Tropical infections as occupational diseases among young volunteers in social projects.

The trend of volunteering overseas has increased tremendously over the last decade. Volunteers often go to regions where they are exposed to the risk of tropical infections like malaria, dengue, typhoid fever and schistosomiasis. Health assessments have shown a high occurrence of tropical infections among young volunteers. Such tropical infections are notifiable in Germany, as they are covered by a separate branch of the social insurance system. However, there is still limited data on systematical improvement of medical prevention and health care for volunteers. This retrospective study included 457 cases with a diagnosis for a tropical infection or typhoid fever from January 2016 to December 2019. Data sets were anonymised and then analysed with descriptive statistics first. Cases of volunteers sent abroad by "Weltwärts" were compared to cases of aid workers sent to non-industrial countries. A high occurrence of tropical infections as occupational diseases has been shown for volunteers compared to other (mostly older) aid workers being sent to tropical regions. The risk of acquiring a tropical infection was significantly higher in Africa compared to other tropical regions. Cases of malaria were reported significantly more often among the group of volunteers than among aid workers during the period under review. Medical check-ups after travel were rare among volunteers. Data imply a disproportionate risk for malaria in Africa with a higher risk of acquiring malaria tropica in Sub-Saharan regions. Region-specific risks need to be addressed in training seminars in order to raise awareness among young volunteers before travel. Medical examinations after travel should be mandatory and specific to a particular region.

Validation of the Nigerian Breast Cancer Study Model for Predicting Individual Breast Cancer Risk in Cameroon and Uganda.

The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed for predicting risk of invasive breast cancer in Nigeria. Its applicability outside of Nigeria remains uncertain as it has not been validated in other sub-Saharan Africa populations. We conducted a case-control study among women with breast cancer and controls ascertained in Cameroon and Uganda from 2011 to 2016. Structured questionnaire interviews were performed to collect risk factor characteristics. The NBCS model, the Gail model, the Gail model for Black population, and the Black Women's Health Study model were applied to the Cameroon and Uganda samples separately. Nigerian as well as local incidence rates were incorporated into the models. Receiver-Operating Characteristic analyses were performed to indicate discriminating capacity. The study included 550 cases (mean age 46.8 ± 11.9) and 509 controls (mean age 46.3 ± 11.7). Compared with the other three models, the NBCS model performed best in both countries. The discriminating accuracy of the NBCS model in Cameroon (age-adjusted C-index = 0.602; 95% CI, 0.542-0.661) was better than in Uganda (age-adjusted C-index = 0.531; 95% CI, 0.459-0.603). These findings demonstrate the potential clinical utility of the NBCS model for risk assessment in Cameroon. All currently available models performed poorly in Uganda, which suggests that the NBCS model may need further calibration before use in other regions of Africa. Differences in risk profiles across the African diaspora underscores the need for larger studies and may require development of region-specific risk assessment tools for breast cancer.

PB2212: VARIANT HAEMOGLOBIN ASSESSMENT AND CORRELATION WITH PHENOTYPIC PRESENTATION AT DIAGNOSIS IN SICKLE CELL DISEASE: A SINGLE CENTRE RETROSPECTIVE ANALYSIS OF CENTRAL GUJARAT COHORT

Background: Sickle cell disease (SCD) is caused by heritable point mutation at codon 6 of the human beta-globin gene widely distributed around the world. According to 2011 census, in India, there is a large tribal community of about 180 million. Among them18 million people carry the sickle cell trait and ~140,000 suffer from SCD. Gujarat State of India has a population of about 62 million, there are ~8.9 million tribal populations, among whom ~9, 00,000 people with Sickle cell Trait and ~70,000 people with SCD are expected. Though phenotypic heterogeneity of SCD is well known across the India, there is limited data on phenotypic presentation with variant haemoglobin correlation on large cohort from Central Gujarat. Aims: To correlate variant haemoglobin pattern with phenotypic presentation at diagnosis in SCD. Identify laboratory and clinical parameters to predict risk of complications in SCD. Methods: Five Hundred and seventy three patients registered at Haemato Oncology Care Centre (HOCC), Vadodara, Gujarat between August 2012 to December 2021, and diagnosed to have SCD were included in this study. This cohort represents tribal belt covering Bharuch,Narmada,Vadodara,Panchmahal,Dahod,Sabarkantha and Banaskantha districts of Central Gujarat. Diagnosis was based on clinical profile, complete blood counts (CBC) and peripheral smear evaluation along with variant haemoglobin assessment by High Performance Liquid chromatography / Capillary electrophoresis. Relevant Biochemistry investigations were done along with radiological assessment of hip joints in patients with specific symptoms.Osteonecrosis of Femur head (ONFH) was diagnosed according to Ficat and Arlet classification for ONFH. Recurrent Vaso occlusive episode(R-VOE) was labelled if there are >3 VOE/yr. Occasional VOE (O-VOE) labelled if <3 VOE/yr.Blood transfusion dependency was labelled if > 3 transfusion /yr required to maintain HB > 7 gm%.Splenomegaly was noted as palpable spleen below costal margin. Results: A total 573 SCD patients were evaluated. The median age was 20 years (range: 1-74) with 328 (57%) males and 245 (43%) females.HB was < 10 gm% in 378 (66%),HB <7 gm% in 78(14%),between7gm% to 10 gm% in 300(52.4%).315/378 (83%) had HBA <5%,Only 5/378 (1.32%)had Ferritin <20ng/ml.None had high indirect bilirubin with low HB. Transfusion dependency was found in 28(5%),HBA was 0%,<5%,6 to 10%,>10% in 12/28 (43%),7/28 (25%),6/28(21%),3/28(11%) respectively. R-VOE observed in 207 (36%),O-VOE in 259(45%),No VOE in 107(19%).Splenomegaly was found in 268(47%).HBF <10% in 86 (15%),10 to 20% in 258(45%)>20% in 229(40%).All Patients with no VOE 107(19%) had HBF >10% with palpable splenomegaly.ONFH was diagnosed on imaging in 108 (19%).101/108(93.5%) had HBF >10%.,25/108 (23%)had palpable splenomegaly. Summary/Conclusion: In our cohort High HBF with Splenomegaly was associated with no VOE. No protection for ONFH seen with high HBF or palpable spleen Regional increased prevalence of coinheritance of Thalassemia in SCD play important role in influencing clinical presentation and progression of complication like transfusion dependency and ONFH. In LMIC, Variant haemoglobin assessment with CBC, Retic count values can be used to predict probable coinheritance of Thalassemia; however DNA Mutation analysis on larger cohort can be done for validation. Region specific risk adapted optimization of treatment can modify natural history of disease

The Incidence and Etiology of 3rd, 4th, 6th, and Multiple Cranial Nerve Palsies in South India: A 6-Month Retrospective Prevalence Study

Cranial nerve palsies may occur secondary to various etiologies including vasculopathic risk factors, trauma, cerebrovascular accident, neoplasms, inflammation, pituitary apoplexy, aneurysm and giant cell arteritis [1-6]. Studies have compared various etiologies in the West, Korea, and North India but data aimed at the South Indian population is limited. Geographic specific data can help in better understanding region specific risk factors.

Elevated loading at the posterior acetabular edge of dysplastic hips during double-legged squat.

Hips with developmental dysplasia (DDH) are at a heightened risk of premature hip osteoarthritis, which is often expedited by mechanically induced articular tissue damage. A prevalent form of damage in DDH is labral tears caused by abnormal loading at the shallow acetabular edge. Although the majority of reported DDH-related labral tears occur in the antero-superior acetabulum, posterior labral tears are prevalent in individuals whose lifestyle involves frequent high hip flexion tasks such as squatting. To better understand region-specific risks for chondrolabral damage during high hip flexion, we used image-based musculoskeletal models to compare acetabular edge loading (AEL) during double-legged squat between hips with symptomatic DDH (n = 10) and healthy controls (n = 10). Compared to controls, hips with DDH had higher instantaneous posterior AEL at the lowest point of squat (2.6 vs. 1.8 ×BW, p ≤ 0.04), and higher accumulative loading across the duration of the squatting motion (2.6 vs. 1.9 ×BW*s, p ≤ 0.04). Elevated posterior AEL coincided with increased net hip extension moments and posterior joint reaction forces, and was correlated with the severity of DDH acetabular deformity. Our findings suggest that posterior AEL is elevated in hips with symptomatic DDH during double-legged squat, which may contribute to chondrolabral damage in individuals who often perform such high hip flexion tasks. Clinical evaluation of DDH should consider patient-specific anatomy and lifestyle factors when establishing diagnoses and planning personalized treatment.

Epidemiology and region-specific risk factors for low Apgar scores in China: a nationwide study.

Neonatal asphyxia is a serious public health issue. This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores, an important proxy for neonatal asphyxia, in China from 2015 to 2016. The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24 (out of 34) provinces. Logistic regression analysis was performed to examine the risk factors for a low Apgar score (< 7). Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions. The population attributable risk percentage (PAR%) was calculated for each region-specific risk factor. A total of 72,073 live births, including 320 births with low Apgar scores, were used for the analysis, giving a weighted rate of 3.9/1000 live births. There was a substantial difference in the incidence of low Apgar scores by geographic region, from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China. Maternal and obstetric factors are the major region-specific risk factors. In Southwest China, hypertensive disorders in pregnancy were more important contributors, with PAR% being 74.47%; in North and Northwest China, pre-pregnancy underweight was a more significant factor, with PAR% of 62.92%; in East China, infants born between 0:00 a.m. and 7:59 a.m. were a key factor, with PAR% of 80.44%. Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.

45. COVID-19 Vulnerability and Data Reporting in Africa: Reflections from Cameroon

Abstract Background At the beginning of the COVID-19 pandemic there were many questions about vulnerability and data reporting among African countries. We previously found that policymakers in Cameroon value region-specific risk maps for emerging diseases. Therefore, we created regional vulnerability indices for COVID-19 in Cameroon. As the pandemic grew, we aimed to compare how these predictions related to reported COVID-19 cases in Cameroon and whether additional African countries had available data to assess vulnerability for COVID-19. Methods Using data from the Cameroon 2018 Demographic and Health Survey (DHS), we had constructed an epidemiological vulnerability index based on comorbidities potentially associated with COVID-19 severity. Similarly, we had created a healthcare access index. We then compared these indices with regional COVID-19 cases per population from weekly situation reports in Cameroon. Finally, we identified the availability of DHS data and COVID-19 reporting systems in other African countries. Vulnerability Indices for COVID-19 in Cameroon The epidemiological and healthcare access vulnerability indices constructed for Cameroon are shown along with COVID-19 cases per population. Results Adjusting for data reporting limitations, regions in Cameroon that scored higher on the epidemiological vulnerability index were associated with greater COVID-19 cases per population. We also identified regions with mismatches between high epidemiological vulnerability and low healthcare access. COVID-19 data reporting systems varied among African countries. 29/54 (53.7%) of African countries had recurrent situation reports or online dashboards with subnational COVID-19 data in 2020. Meanwhile, 36/54 (66.7%) of African countries had DHS data reported in the last decade. Conclusion We found that vulnerability indices could be a rapid way of identifying populations at risk for emerging diseases such as COVID-19. This method could be used in other countries that have both recent health surveys from programs such as the DHS and subnational reporting of COVID-19 cases. Indices could be useful for decision-making, but they will need to be refined with national expert input. National situation reports and online dashboards provided subnational COVID-19 data in approximately half of African countries. Therefore, increased baseline health surveys as well as expanded reporting of COVID-19 case data could inform future vulnerability assessments in other countries. Disclosures All Authors: No reported disclosures

Malaysian Heart Failure (MYHF) Registry substantiates high burden of comorbidities across the continuum of ejection fraction in Malaysian HF patients

Data on heart failure in Malaysia is limited. It's known that patients from the South East Asian region suffer from a higher burden of heart failure and have poorer outcomes. Region specific gaps and risk factors need to be identified and addressed in order to better understand and improve outcomes.