As the impact of angiotensin receptor/neprilysin inhibitor (ARNI) on cardiac function in acute myocardial infarction (AMI) patients is unclear in clinical therapy, we conducted this research to investigate the actual effects of improving cardiac function with ARNI in AMI patients. Publications were checked up to June 2022. Standardised mean differences (SMD) and 95% confidence intervals (CI) were utilised for assessing the size of the effect of continuous variables. To assess the magnitude of the effect of dichotomous variables, a relative risk (RR) with 95% CI was used. ARNI could improve left ventricular ejection fraction (SMD = 0.40; 95% CI: 0.23 - 0.58), while lowering left ventricular end-diastolic volume (SMD = -0.43, 95% CI: -0.78 to -0.08), left ventricular end-systolic volume (SMD = -0.39, 95% CI: -0.66 to -0.11) and left ventricular enddiastolic diameter (SMD = -0.49; 95% CI: -0.65 to -0.33). Besides, it could decrease the rates of major adverse cardiac events (RR = 0.55; 95% CI: 0.43 - 0.69) and heart failure (RR = 0.42; 95% CI: 0.31 - 0.58). ARNI could greatly improve cardiac function in AMI patients.

Multiple studies of telecritical care (TCC) programs have demonstrated an association between TCC implementation and reduced mortality, as well as decreased hospital and ICU length of stay (LOS), but these effects have been heterogeneous. We evaluated the impact of implementing a TCC program on inpatient mortality and LOS and examined heterogeneity in outcomes by acute severity of illness and chronic comorbidity groups. Retrospective study of adult ICU patients with and without TCC program exposure between January 1, 2015, and April 30, 2024. Eighteen medical surgical units in an integrated healthcare system in Northern California before and after implementation of an overnight TCC program. A total of 172,878 patient encounters (137,457 pre-TCC and 35,421 post-TCC implementation). No intervention. We used generalized linear models to estimate adjusted relative risk (ARR) of inpatient mortality and differences in hospital and ICU LOS comparing TCC exposed and unexposed groups. We performed mortality-adjusted LOS analysis by setting decedents' LOS to the 99th percentile of non-TCC encounters' LOS. Unadjusted analyses showed that the TCC exposed group had higher inpatient mortality (17.8 vs. 14.3% TCC vs. non-TCC), mean acuity indices, rates of COVID-19, and mechanical ventilation despite lower mean Comorbidity Point Score, Version 2, at admission. After adjustment for patient demographics, acuity, and comorbidity, TCC exposure was associated with decreased inpatient mortality with an ARR of 0.93 (95% CI, 0.89-0.98). The mortality-adjusted ICU and hospital LOS were not statistically significant in the TCC exposed group, with a difference of -0.07 days ICU LOS (95% CI, -0.18 to 0.05 d) and -0.10 days hospital LOS (95% CI, -0.35 to 0.15 d). Multihospital implementation of night coverage by a TCC program was associated with a reduced adjusted risk of inpatient mortality with no significant differences in mortality-adjusted ICU or hospital LOS.

BackgroundHearing loss is a significant public health concern, which we estimate in the Global Burden of Disease (GBD) study impacts over one billion or 65% of adults aged 55 and older. The Lancet Commission identified a link between hearing loss and increased risk of dementia, however, prior evidence synthesis have not considered non‐linear relationships nor have they incorporated between‐study variation into uncertainty estimates. We conducted a systematic review and meta‐analysis to quantify the relative risk of dementia associated with hearing loss, utilizing a novel meta‐analytic framework to address these prior limitations.MethodWe searched PubMed, Embase, and Web of Science for articles that estimated all‐cause dementia risk associated with adult hearing loss from January 1980 to October 2023. To summarize the evidence, we used the Burden of Proof (BoP) meta‐analytic framework developed for the GBD study. Unlike traditional meta‐analysis, the BoP methodology adjusts for systematic biases, allows for non‐linear fit, and incorporates between‐study variation in uncertainty estimates to provide a conservative interpretation of the evidence. We estimated dementia risks along continuous decibel thresholds in a dose‐response model among studies that use audiometry. Mean relative‐risks (RR) and 95% uncertainty intervals (UI) accounting for between‐study heterogeneity are presented.ResultWe screened 808 records and identified 38 studies for inclusion, covering 481,809 dementia cases. Hearing loss was measured by self‐report in 9 studies, administrative records in 12 studies, audiometry in 10 studies, and other methods of direct observation in 7 studies. Among studies that use audiometry, compared to a baseline threshold of 15 decibel, dementia risk is increased by 29% (95% UI: 23‐35%) for moderate hearing loss (35 decibel threshold) and 49% (95% UI: 39 – 61%) for severe hearing loss (65 decibel threshold). We also defined hearing loss as a binary variable to incorporate alternative hearing loss measurements and results yielded a non‐significant increase in risk of dementia: 31% (95% UI: ‐4 – 80%).ConclusionHearing loss in adults is associated with increased risk for dementia, with stronger evidence among studies that use objective audiometry measurements. Dementia risk reduction should prioritize preventing hearing loss and promoting hearing aid use and access.

IntroductionShock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, including Ethiopia, which hinders the provision of quality care for improved outcomes. Hence, this study aimed to determine the incidence of death and predictors among adult patients with shock managed at the Emergency Department of St. Paul’s Hospital Millennium Medical College in Ethiopia.MethodsA retrospective chart review study was conducted among eligible patients managed at the hospital between October 1, 2021 and May 20, 2022. Mortality was estimated with incidence density using person day (PD) of observation. To identify predictors of mortality, a generalized linear model using poisson regression model with robust standard errors fitted, where adjusted relative risk (ARR) with 95 % CI was used to interpret results.ResultDuring the study period, a total of 196 patients were identified for assessment, of which 18 with incomplete records were excluded, resulting in 178 eligible patients for inclusion. The majority of participants were 40 or older (69.7 %) and female (51.1 %), presenting with symptoms lasting less than one week (68.5 %) and had at least one comorbid illness (70.8 %). The incidence of death was 16.5 deaths per 100 PD (95 % CI = 13.1 to 20.9). While triage to orange was associated with a decreased risk of death, high shock index, septic shock diagnosis, vasopressor use, and organ failure were associated with increased risk of death.ConclusionThe incidence of mortality among shock patients was found to be considerable. To optimize patient care and improve outcomes, it is important to remain vigilant in the proper triage and early diagnosis of shock using more sensitive tools for prompt identification of high-risk cases, as well as to provide timely, prioritized and effective interventions.

Advanced imaging to diagnose pulmonary embolism (PE) during pregnancy increases costs, ionizing radiation exposure, and the risk of overdiagnosis. D-dimer testing can exclude PE and compression ultrasonography can diagnose deep vein thrombosis (DVT), both reducing advanced imaging needs. How these 2 strategies are used in community PE diagnostics is unknown. To analyze the use and efficiencies of D-dimer and ultrasonography for the diagnosis of antenatal PE. This retrospective cohort study was performed in 21 US community hospitals from October 1, 2021, to March 31, 2023. Participants included pregnant patients who underwent D-dimer testing, compression ultrasonography, or advanced imaging for suspected PE. D-dimer testing or ultrasonography. The main outcome was avoidance of advanced imaging, measured by the number needed to test (NNT) to avoid 1 advanced imaging study using low to intermediate D-dimer values or a positive ultrasonography finding. Variables associated with D-dimer and ultrasonography were evaluated using quasi-Poisson regression reported as adjusted relative risks (ARRs). A total of 720 outpatient encounters in 699 patients were included in the analysis (median age, 30.2 [IQR, 24.3-36.1] years). D-dimer testing was obtained in 524 patients (72.8%). Advanced imaging was not pursued in 149 of 155 patients (96.1%) with low (<0.5 mg/L) and 82 of 179 (45.8%) with intermediate (0.5 to <1.0 mg/L) D-dimer values, yielding an NNT to avoid 1 advanced imaging study of 2.3 (95% CI, 2.0-2.6). No 90-day venous thromboembolism or death occurred following rule-outs. D-dimer testing was less commonly used in third (vs first) trimester (ARR, 0.85; 95% CI, 0.75-0.97); with unilateral signs or symptoms of DVT (vs none) (ARR, 0.67; 95% CI, 0.54-0.82), and during labor and delivery unit (vs emergency department) evaluation (ARR, 0.27; 95% CI, 0.20-0.35). Compression ultrasonography was performed in 229 patients (31.8%), with DVT diagnosed in 3 (1.3%). Advanced imaging was not pursued in 2 of these patients, yielding an NNT to avoid 1 advanced imaging study of 115 (95% CI, 32-417). Ultrasonography use and results varied by DVT symptoms. Among 55 patients with DVT symptoms, 46 (83.6%) underwent ultrasonography, with positive findings in 3 (yield of 6.5%). Among 665 patients without symptoms, 183 (27.5%) underwent ultrasonography, with negative findings in all (yield of 0). In this cohort study, use of D-dimer testing was efficient and safe with opportunities for expansion across settings and patients. These findings suggest that ultrasonography efficiency was low but could be improved with symptom-driven use in antenatal PE diagnostics.

Long-acting nitrate use before and after revascularization to evaluate angina in chronic coronary syndrome: a case-crossover study from SCAAR

Military personnel are routinely involved in pandemic relief efforts, placing them at risk of increased exposure to pandemic-related stressors. Although ample research suggests exposure to pandemic-related stressors contributed to decrements in mental health among civilians during the COVID-19 pandemic, limited work has examined whether these patterns were also salient in military populations. The Army Study to Assess Risk and Resilience in Servicemembers (STARRS) Longitudinal Study screened for 30-day prevalence of major depressive episode, generalized anxiety disorder, post-traumatic stress disorder, and panic attack among n=10,206 US Army soldiers and veterans before (2018-2019) and then again during (2020-2022) the COVID-19 pandemic. Statistically significant increases were found in prevalence, with relative-risk (RR) comparable to those observed in civilian samples (RR=1.28-1.40). Greatest increases occurred among women, Blacks, Hispanics, those of lower socio-economic status, and Regular Army soldiers relative to reservists and those separated from service. Exposures to pandemic-related stressors, although associated with significantly increased mental health difficulty (RR=1.06-1.17), did not explain associations of socio-demographics and Army career characteristics with difficulty RR. No significant interactions were found between pandemic-related stressors and either baseline difficulty prevalence, socio-demographics or Army career characteristics predicting difficulty RR. Results suggest military personnel may experience pandemic-related decrements in mental health comparable to those observed in civilian samples, with largest changes among personnel with greater socioeconomic vulnerability and/or greatest exposure to pandemic-related stress. Findings emphasize the importance of ensuring accessibility of appropriate supports for military personnel during pandemic conditions.

Insomnia and obstructive sleep apnea (OSA) are associated with pregnancy complications. To evaluate the association of insomnia and OSA during pregnancy with the risk of ischemic placental disease (IPD) and severe morbidity (SM) and to compare these risks between the 2 sleep disorders. This cross-sectional study included a statewide population-based sample of liveborn singleton births with linked birth certificates for birthing people and their infants in California from January 1, 2011, through December 31, 2020. The analysis was performed on July 22, 2024. Insomnia and OSA. The main outcomes were IPD, defined as preeclampsia, placental abruption, and birth of a neonate small for gestational age (SGA), and SM, defined according to the Centers for Disease Control and Prevention definition. During the study period, there were 4 145 096 singleton live births among birthing people aged 13 to 55 years; 4783 (0.1%) had insomnia, 5642 (0.1%) had OSA, and 4 134 671 (99.7%) had neither condition. The prevalence of insomnia and OSA was 116 and 136 cases per 1000 live births, respectively. Compared with patients without insomnia or OSA (738 660 [17.9%]), the adjusted relative risk (ARR) of any IPD was 1.42 (95% CI, 1.35-1.50) for those with insomnia (1406 patients [29.4%]) and 1.57 (95% CI, 1.50-1.64) for those with OSA (1848 [32.8%]). Compared with patients with neither disorder, the ARR of birth of an SGA neonate was higher for those with insomnia (1.23; 95% CI, 1.13-1.35) than for those with OSA. The ARR of preterm birth was 1.81 (95% CI, 1.68-1.95) for insomnia (711 patients [14.9%]) and 1.73 (95% CI, 1.62-1.85) for OSA (870 [15.4%]) vs neither disorder (279 364 [6.8%]). The ARR of SM was 2.26 (95% CI, 2.03-2.50) for insomnia (366 patients [7.7%]) and 2.81 (95% CI, 2.58-3.06) for OSA (545 [9.7%]) vs neither disorder (93 857 [2.3%]). In this cross-sectional study of singleton live births, pregnant individuals with insomnia or OSA were at increased risk for IPD, SM, and preterm birth compared with those without these sleep disorders. Further study is needed to determine the biological mechanisms for these risks and whether early identification and targeted preventive interventions may improve pregnancy outcomes.

Etomidate as well as ketamine are hemodynamically stable induction agents for rapid sequence intubation (RSI) in critically ill patients. Despite, their relative stability in terms of hemodynamics, the impact of choice of agent, on mortality and success of the procedure, is debatable and has not yet been explored via systematic review and meta-analysis. The objective of this systematic review is to compare the efficacy of ketamine versus etomidate for RSI in terms of mortality, hemodynamic parameters, and success rate. A comprehensive search was conducted throughout PubMed, Embase, and Web of Science from starting date of database until April 2024. Randomized controlled trials, comparing safety and efficacy of ketamine against etomidate as induction drugs for critically ill patients undergoing RSI were included. Primary outcome was risk of 28-day mortality, while secondary outcome included success rate, and post-induction hypotension. Pooled relative-risks (RR) with 95% confidence intervals (CI) were calculated using random-effects meta-analysis. Four studies (n= 1663) were meta-analyzed. There was no statistically significant difference between the two drugs for: 28-day mortality RR 0.95 (95% CI: 0.72-1.25), (heterogeneity- I2 39%, level of certainty of evidence per GRADE: moderate); first pass success rate 1.00, (0.97- 1.03); post induction cardiac arrest 1.10 (0.62- 1.96). Post induction hypotension was higher in the ketamine group 1.30 (1.03- 1.64), although result was not statistically significant. There is no difference in mortality outcomes for ketamine vs etomidate, when used for RSI in critically ill patients. ketamine, however, is associated with higher risk of post induction hypotension.

Antepartum hemorrhage (APH) complicates 2-5% of all pregnancies and is the main cause of fetal and maternal death. However, little is known about the adverse maternal and perinatal outcomes of antepartum hemorrhage in the Tigray region. Therefore, this study assessed the effects of antepartum hemorrhage on maternal and perinatal adverse outcomes at Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia, in 2024. An institutional-based retrospective cohort study was conducted among 539 mothers who gave birth between September 2019 and August 2021 at Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia. Mothers who gave birth with and without antepartum hemorrhage were categorized as exposed and nonexposed groups, respectively. A systematic sampling method was used to select participants from medical records. Data were collected through a retrospective review of medical records. A modified Poison regression model with robust standard errors was used to estimate relative risk (RR). An adjusted relative risk (ARR) with 95% confidence interval (CI) and a p-value < 0.05 were considered statistically significant. The incidence of adverse maternal outcomes among mothers with antepartum hemorrhage was 46.1%, compared to 14.2% among mothers without APH. Approximately 57.2% of mothers with APH and 18.9% of those without APH experienced adverse perinatal outcomes. Mothers with antepartum hemorrhage were more likely to experience postpartum hemorrhage (ARR = 3.9, 95% CI: 1.8, 8.8), emergency cesarean section (ARR = 2.9, 95% CI: 2.1, 3.9), preterm birth (ARR = 3.9, 95%CI: 2.8, 5.6), low birth weight baby (ARR = 4.5, 95%CI: 3.0, 6.6), stillbirth (ARR = 3.8, 95%CI: 1.9, 7.4), perinatal death (ARR = 3.7, 95%CI: 2.0, 6.9), admission to the NICU (ARR = 6.7, 95% CI: 3.1, 14.9), low Apgar score at the first minute (ARR = 2.8, 95%CI: 1.8, 4.3), and low Apgar score at the fifth minute (ARR = 3.7, 95% CI: 2.0, 6.8) compared to mothers without APH. Antepartum hemorrhage is associated with an increased risk of adverse maternal and perinatal outcomes; -including postpartum hemorrhage, emergency cesarean section, preterm birth, low birth weight, stillbirth, perinatal death, a low Apgar score and admission to the NICU. Improving access to emergency obstetric care in areas with a high burden of APH should be critical to ensure timely intervention and reduce adverse maternal and perinatal outcomes.

BackgroundPrevious evidence on sex differences in stroke care and outcomes was limited in sample representativeness and coverage of care indicators. We aim to investigate various indicators of stroke care quality, survival, and functional outcome at discharge between men and women, using a national stroke registry.MethodsTen key indicators, representative from across stroke care pathway, were compared between men and women using the Sentinel Stroke National Audit Programme, a national quality register for England, Wales, and Northern Ireland (2013–2023, n=844 970). Multivariable Poisson regression models with robust variance were constructed to estimated adjusted relative risks (ARR). The 1‐year adjusted hazard ratios (AHR) of mortality were conducted using adjusted restricted mean survival time. Favorable functional outcomes at discharge were measured using modified Rankin Scale (0–2).ResultsWomen comprised 48% of the study population, mean age 77 years (SD: 13.4) compared with 72 years (13.3) for men. Compared with men, women tend to have severe strokes (19% versus 12%), lower prevalence of diabetes (20% versus 24%), and higher prevalence of atrial fibrillation (21% versus 18%) but similar stroke types (ischemic: 87% versus 88%). Women were less likely to have thrombolysis of arrival <1 hour, brain scan <1 hour, thrombolysis of stroke onset <4 hours, swallowing screen <4 hours, admission to stroke unit <4 hours, assessed by trained nurses <24 hours, assessed by occupational therapist <72 hours, and communication speech and language therapy <72 hours. Women tended to have poorer functional outcome at discharge (ARR, 1.06 [95% CI, 1.05–1.06]) but better 1‐year survival (AHR, 0.99 [95% CI, 0.98–0.99]).ConclusionsWomen were less likely to receive several indicators of evidence‐based stroke care compared with men. Although they had better survival, functional outcome was poorer in women.

BackgroundPediatric acute respiratory distress syndrome (PARDS) causes significant morbidity and mortality, especially in resource-limited settings. This study assessed national hospital and PICU admission rates, regional disparities, and factors associated with mortality in Thai children with PARDS.MethodsA nationwide retrospective study was conducted using National Health Security Office (NHSO) data from 2015 to 2022. Children aged 1 month to < 18 years with a diagnosis of PARDS (ICD-10-TM code J80) were included. Multivariable logistic regression was used to identify factors associated with mortality, reported as adjusted relative risk (ARR) with 95% confidence intervals (CI).ResultsAmong 4,241 patients, the prevalence of PARDS ranged from 29.8 to 37.2 per 100,000 hospital admissions, while PICU admission rates ranged from 13.5 to 18.6 per 1,000. Bangkok had the highest rate in 2022 (27.0 per 1,000) but the lowest mortality at 25.6%. The overall mortality rate declined from 53.7% in 2015 to 37.7% in 2022 but remained high in resource-limited regions. Malignancy (ARR 1.29, 95% CI 1.17–1.43 p < 0.001), drowning (ARR 1.43, 95% CI 1.29–1.60, p < 0.001), sepsis and septic shock (ARR 1.19, 95% CI 1.12–1.27, p < 0.001), non-major pulmonary trauma (ARR 1.43, 95% CI 1.16–1.77, p = 0.001), and cardiovascular dysfunction (ARR 1.41, 95% CI 1.32–1.51, p < 0.001) were strongly associated with mortality. Intubation was significantly associated with increased mortality (ARR 2.52, 95% CI 2.12–3.00, p < 0.001), whereas extracorporeal life support was associated with lower mortality (ARR 0.46, 95% CI 0.35–0.61, p < 0.001).ConclusionsPARDS remains a substantial burden in Thailand, with marked regional differences in access to critical care. Efforts to strengthen healthcare infrastructure and early respiratory support are needed to reduce preventable deaths.

BackgroundNeonatal mortality rate is high in sub-Saharan Africa than high-income countries in relation to the growing wealth disparity. Different factors are linked with neonatal mortality in Ethiopia. Identification of the causes of death is the first step in reducing mortality rates. Thus, the aim of this study was to assess the magnitude of neonatal mortality and associated factors among neonates admitted in Neonatal Intensive Care Unit (NICU) in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.MethodsA retrospective cohort study was conducted among 1,598 neonates admitted in Neonatal intensive care unit of Dessie Comprehensive Specialized Hospital from 28/06/2022 to 30/03/2023. Demographic and clinical data were abstracted from admission/discharge registration books; perinatal facility-based data abstraction form and patient medical records using data extraction checklist. Bivariable and multivariable analyses were conducted to determine the factors associated with neonatal mortality and variables with an adjusted relative risk (ARR) and its P-value < 0.05 were considered statistically significant. Model fitness was computed using Hosme-Lemeshow Goodness of fitness (P = 0.847).ResultsAmong 1,598 neonates who were admitted in NICU were included in this study of which 914 (57.2%) were males. The magnitude of neonatal mortality was 10.2%. Prematurity (ARR = 2.58, 95% CI: 1.39–4.87, P < 0.009), sepsis (ARR = 1.47 95% CI: 1.02–2.11, P < 0.036), birth asphyxia (3.59 = 4.36, 95% CI: 2.40–6.87, P < 0.008), and respiratory distress syndrome (ARR = 2.93, CI: 1.47–5.30, P = 0.011) were independent predictors of neonatal mortality.ConclusionThe magnitude of neonatal mortality was 10.2% which alarms the need of immediate collaborative actions for reduction of the burden particularly tackling on the causal factors such as prematurity, sepsis and birth asphyxia which leads adverse birth outcomes. Therefore, maternal counseling, giving focused ante natal care as well as behavior change communications might be considered to promote positive behaviors are recommended to avoid the leading causes of neonatal mortality.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study.

Randomized controlled trials (RCTs) are the gold standard for causal inference and are widely used. However, valid analyses of RCTs are often complicated by non-compliance, which can lead to confounding bias and biased causal effect estimation. The main challenge comes from compliance datasets in both the treatment and control groups both following two-component mixture models. The maximum nonparametric likelihood estimator is inconsistent in a two-component mixture model even if the mixture proportion and one of the components are completely known, but the other component is unknown. In this paper, we instead assume parametric models for the ratios of risks among compliers assigned treatment, never-takers and always-takers, and leave the baseline compliers not assigned treatment unspecified. We develop a novel two-step maximum likelihood estimation procedure by making full use of the observed covariates and latent compliance classes, which theoretically can produce asymptotic root consistent estimators. In particular, our proposed estimator for the conditional local risk ratio always lies within the range of the parameter. Our numerical results show that the proposed method is generally more reliable than existing alternatives.

Abstract We analyze data from a survey we administered during the COVID-19 pandemic to investigate the relationship between people’s subjective beliefs about risks and their private protective behaviors. On average, people substantially overestimate the absolute level of risk associated with economic activity, but have directionally correct signals about their relative risk based on their demographic characteristics. Subjective risk beliefs are predictive of changes in economic activities independent of government policies. Government mandates restricting economic behavior, in turn, attenuate the relationship between subjective risk beliefs and protective behaviors.

BackgroundThe EXAcerbations of COPD and their OutcomeS on CardioVascular disease (EXACOS-CV) multi-database studies have consistently shown an increased risk of serious cardiovascular event following COPD exacerbations, but with some risk temporality variations. EXACOS-CV results were meta-analysed to increase their generalisability and improve precision.MethodsStudies conducted in Canada, the United States, Germany, the Netherlands, Spain, Italy, Japan and England were meta-analysed, amounting to 1 030 875 individuals. Generally, each study included individuals aged ≥40 years with a COPD diagnosis in 2014–2019; primary outcome was the composite of non-fatal acute coronary syndrome, decompensated heart failure, ischaemic stroke, arrhythmias and all-cause death. Pooled hazard ratios (HRp) of risks in post-exacerbation periods (versus periods outside exacerbations) were obtained through random effects meta-analysis.ResultsTime periods following an exacerbation (any severity) were associated with increased and sustained risks of the composite outcome: HRp 10.22 (95% CI 5.34–19.57) in days 1–7 and HRp 1.24 (95% CI 1.09–1.40) in days 181–365. Risks were elevated for 6 months (HRp 1.25, 95% CI 1.01–1.55 in days 31–180) and 1 year (HRp 1.48, 95% CI 1.11–1.96 in days 181–365) following a moderate or a severe exacerbation, respectively. In newly diagnosed individuals, risks were increased until days 31–180: HRp 1.66 (95% CI 1.14–2.42) and HRp 1.61 (95% CI 1.28–2.02) following the first and the second post-diagnosis exacerbation, respectively.ConclusionRisk of severe cardiovascular events is sustainably increased following an exacerbation of COPD, even early and moderate ones. Cardiopulmonary risk reduction should be a global core target of COPD management.

ABSTRACTBackground and AimsSexually Transmitted Infections (STIs) remain a significant public health concern, particularly among women of reproductive age (WRA) who face heightened vulnerability. Despite remarkable advancements in medicine, 1 million new cases of STIs are recorded daily. In Tanzania, however, data on STIs remains limited. This study seeks to bridge that gap by determining prevalence and factors associated with STIs among WRA in Tanzania.MethodsThis was analytical cross‐sectional study among WRA in Tanzania, using data from the current Demographic and Health Surveys (DHS) 2022. 15,254 weighed sample was analyzed using STATA version 18. Analysis considered the complex survey design through application of weights, clustering and strata. Modified Poisson regression models estimated the factors associated with STIs among WRA in Tanzania. Results were presented using adjusted relative risk (ARR) with a 95% confidence interval.ResultsThe prevalence of STIs among WRA in Tanzania was 4.7%. After adjusting for other variables, the following factors remained significantly associated with STIs among WRA: women aged 25–34 (ARR = 1.55, 95% CI:1.22–1.95), women from rich household (ARR = 1.39, 95% CI: 1.02–1.89), marriage (ARR = 0.81, 95% CI:0.65–0.99) and multiple sexual partners (ARR = 1.80, 95% CI:1.24–2.63).ConclusionAlthough STIs have a relatively low prevalence (4.7%) among Tanzanian WRA, behavioral change campaigns, young adult‐friendly health services, routine screening and tailored preventive education are crucial to achieving universal health goals, reducing new infections, and fostering the overall well‐being of this vulnerable group.

BackgroundWhile acute appendicitis poses a significant disease burden worldwide, its etiology is not completely known. Previous studies have separately demonstrated its associations with ambient temperature and seasonal influenza, but there was no study that examined two exposures concurrently, leaving room for confounding and failing to isolate the effects of these two factors. This study aims to quantify such associations under a unified model, using population-level data in Hong Kong from 1998 to 2019.MethodsThe study outcome of weekly acute appendicitis admissions was analyzed with a number of covariates. The major covariates of interest included weekly mean temperature and three strain-specific influenza-like illness-positive (ILI+) rates, which were proxies for the activities of the respective influenza strains. Other covariates including weekly mean relative humidity, total rainfall and a composite index for air pollution were used for confounder control. A generalized additive model under the framework of distributed-lag non-linear model and quasi-Poisson distribution was used for multivariate analysis.ResultsA significant positive association between ambient temperature and acute appendicitis admission was found, with a cumulative adjusted relative risk (ARR) of 1.082 (95% CI: 1.065–1.099) comparing the 95th percentile to the median temperature. ILI + rates for influenza A/H1N1 and A/H3N2 were found to significantly and negatively associate with acute appendicitis admission, with cumulative ARRs of 0.961 (95% CI: 0.934–0.989) and 0.961 (95% CI: 0.929–0.993) respectively, comparing the 95th percentiles to zero. No significant association was found between ILI + rate for influenza B and acute appendicitis admission.ConclusionsWhile high temperature was associated with acute appendicitis admission, a negative association of influenza infection was showed. The mechanisms underlying the above associations should be investigated in future studies, with the aim of formulating preventive strategies against acute appendicitis that take environmental exposures into consideration.

An adverse maternal outcome, such as anemia, postpartum hemorrhage, and postpartum eclampsia, poses a significant risk to women. While studies on the burden of adverse maternal outcomes have been conducted in various countries, including Ethiopia, many predictors beyond obstetric factors have not been fully explored. This study aimed to determine the magnitude and factors associated with adverse maternal outcomes among women who gave birth at selected public hospitals in eastern Ethiopia. A hospital-based cross-sectional study was conducted among 2,608 randomly selected women who gave birth in six public hospitals in eastern Ethiopia from November 2023 to March 2024. Data were collected through face-to-face interviews and clinical chart reviews. Factors associated with adverse maternal outcomes were identified using bivariable and multivariable robust Poisson regression analyses. Adjusted relative risk (ARR) with a 95% confidence interval (CI) was used to report the strength of the association. The variables with a p-value of <0.05 were considered statistically significant. The magnitude of adverse maternal outcomes was 15.68% (95% CI: 14.70%-16.66%). A poor wealth index (ARR = 4.41; 95% CI: 3.46-5.62), having danger signs at admission (ARR = 1.86; 95% CI: 1.18-2.91), alcohol use during pregnancy (ARR = 1.86; 95% CI: 1.32-2.62), duration of labor ≥24 h (ARR = 1.69; 95% CI: 1.00-2.85), and maternal age greater than 35 years (ARR = 1.39; 95% CI: 1.03-1.86) increased the risk of adverse maternal outcomes. In contrast, folic acid intake during pregnancy (ARR = 0.47; 95% CI: 0.38-0.57), having partner support (ARR = 0.70; 95% CI: 0.59-0.83), and spontaneous vaginal delivery (ARR = 0.58; 95% CI: 0.49-0.68) reduced the risk of adverse maternal outcomes. One in six women who gave birth in eastern Ethiopia experienced adverse maternal outcomes. This rate was determined to be moderate when compared to the WHO projections for lower- and middle-income countries and better than the higher averages reported by the WHO. Targeted intervention programs, such as targeted education and empowerment programs, and the strengthening of the community health worker program would help address socioeconomic disparities and improve early detection and management of danger signs during pregnancy, which would aid in averting the occurrence of adverse outcomes.