Risk Factors For Formation Research Articles

To evaluate the predisposing factors of uterovaginal prolapse in women admitted in gynaecology ward

: Uterovaginal prolapse is an abnormal protrusion or herniation of pelvic organs from its normal position in the pelvis, due to failure of anatomical support. The prevalence of uterovaginal prolapse is difficult to be determined because many women are asymptomatic and many are hesitant to discuss with family. It can be considered a silent epidemic. The cause of uterovaginal prolapse is multifactorial. The parity, mode of delivery, postmenopausal status, obesity are some of the factors affecting the severity. The condition is preventive and by counseling and care during antenatal and postnatal period, the prevalence of this condition can be curtailed and quality of life can be improved.To evaluate the predisposing factors of uterovaginal prolapse in women admitted to the gynaecology ward.: A retrospective study was done for a period of 2 years from January 2019 to January 2021 at Integral Institute of Medical Sciences and Research, a tertiary care hospital and medical college, Kursi Road, Dasauli, Lucknow. The women admitted in gynaecology ward with symptoms of mass per vagina were included in the study. The data was retrieved from medical records of the department. The case file as per inclusion and exclusion criteria was identified and included in the study. The information of risk factors was collected using patient proforma. The pelvic organ prolapse quantification system (POPQ) approved by international continence society was used for categorizing uterovaginal prolapse. Data was analysed using SPSS version 20. Frequencies, percentage and mean computed to describe the variables of the study. The Chi-square test was used to compare variables. The statistical significance P<0.05 was considered significant.: The period of study was from January 2019 to January 2021. During this period 11256 patients were seen at the gynaecological clinic, out of which 206 patients had uterovaginal prolapse. The prevalence was 1.8%. The multiparity, prolonged and difficult deliveries, delivery by untrained personnel, mismanaged third stage of labour involving injury to sphincters and vaginal tears are determinants of prolapse uterus. Further postmenopausal condition causing hypoestrogenic state causes weaking of ligaments, collagen and aggravates the condition. Hence, preventive measures like institutional delivery, delivery by trained personnel, menopausal clinics may help the target population.

Spatiotemporal Drivers of the African Swine Fever Epidemic in Lao PDR

African swine fever (ASF) is a devastating transboundary disease of swine. Following the first report of ASF in China in August 2018, ASF spread through South-East Asian nations in 2019. Without control and containment measures, ASF can decimate smallholder pig holdings and disrupt value chains. This study aimed to describe the spatiotemporal spread of the 2019 Lao PDR ASF epidemic in domestic pigs, identify environmental (protected areas and forests), production (pig ownership), transportation (roads), and social (poverty and ethnicity) risk factors, and recommend measures that could reduce ASF spread. A retrospective spatiotemporal study was conducted at the village level. Information on the date that ASF was first reported from each case location was collected, and the outcome variable of interest “epidemic day” was created. Risk factor information from different sources was extracted for each case location. The association or correlation between epidemic day and risk factors for the spread of ASF was investigated using Kruskal–Wallis tests and Spearman rank correlation statistics. The epidemic started on June 16 and lasted for 190 days, displaying a right-skewed epidemic curve. The directional distribution was rotated approximately 305°, from Southeast to Northwest Laos. Significant risk factors for ASF associated with epidemic day were location in terms of distance from the closest protected natural area P = 0.020 , pig ownership P = 0.005 , road networks P = 0.003 , and poverty indices P < 0.001 . Cases were reported earlier in this epidemic at locations that were closer to protected natural areas, of higher pig ownership, more connected via the national road network, and which experienced elevated poverty. The spatiotemporal pattern described suggests that ASF was introduced via infected pigs from Vietnam. Based on study findings, recommendations for smallholder pig production in Southeast Asia include improving knowledge of swine value chains to inform disease risk and control, monitoring pig transportation, implementing stricter biosecurity measures on the domestic pig population, and providing biosecurity support and education to smallholder pig farmers in poverty.

Life’s Simple 7 and the Risk of Dementia among Women (P2-5.030)

<h3>Objective:</h3> To determine if higher scores on the American Heart Association (AHA) Life’s Simple 7 in midlife are associated with a decreased risk of dementia among women. <h3>Background:</h3> A growing body of research underscores the need to examine midlife risk factors for dementia, as dementia pathology often begins decades before diagnosis. <h3>Design/Methods:</h3> The study population included women enrolled in the Women’s Health Study who had available risk factor information needed to calculate the AHA Life’s Simple 7 at baseline (1992–1994) and approximately ten years later (2004) and were fully covered by fee-for-service Medicare for all eligible person-months. Women received one point for each component of the AHA Life’s Simple 7 (smoking status, diet, physical activity, body mass index, diabetes, blood cholesterol, and blood pressure) for which they had ideal cardiovascular health. We used fee-for-service Medicare data (available from 2011 through 2018) and validated lists of ICD-9 and ICD-10 codes to identify dementia diagnoses. We used logistic regression to examine the association between the score, modeled as a continuous variable, and dementia diagnosis adjusted for age and socioeconomic status at baseline. <h3>Results:</h3> 13,720 women were eligible for these analyses and 1771 (12.9%) dementia cases were observed. The mean age (standard deviation (SD)) was 54.2 (6.6) years at baseline. The average AHA Life’s Simple 7 score at baseline was 4.3 (SD=1.3) and after ten years of follow-up was 4.2 (SD=1.3). Higher AHA Life’s Simple 7 score as measured at baseline (odds ratio per one unit change in score=0.94, 95% CI: 0.90–0.98) was associated with a decreased risk of dementia. This effect was similar for the AHA Life’s Simple 7 score as measured after ten years of follow-up (OR=0.95, 95% CI: 0.91–1.00). <h3>Conclusions:</h3> Better cardiovascular health in midlife was associated with a decreased risk of dementia in late life among women. <b>Disclosure:</b> Dr. Rist has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Rist has received research support from National Institutes of Health. The institution of Dr. Rist has received research support from Biogen, Inc. The institution of Dr. Rist has received research support from Brigham and Women’s Hospital. Melinda Power, PhD has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. I-Min Lee has nothing to disclose. Julie E. Buring has nothing to disclose.

Consensus-based failure mode and effect analysis in group decision-making with incomplete weights of risk factors: Case study of stereotactic body radiation therapy for lung cancer

Failure mode and effect analysis (FMEA) is a widely used management technique to identify potential failure modes in products, processes, systems, and services to assign limited resources for implementing improvement efforts. For the FMEA with a number of experts, the experts may take different influences on the decision-making process due to the difference between individual rationality and cognition and the influence of social relations. Besides, incomplete weights of risk factors are vital to capturing the fuzziness of experts’ evaluation. Therefore, this paper proposes a consensus-based FMEA method to explore that how cooperative relationship network of experts, the consensus process, and incomplete weight information of risk factors in FMEA influence the decision-making process. First, a consensus reaching process considering cooperative relationships between experts, the self-confidence of experts, and minimum adjustment of expert opinion is proposed to derive a collective evaluation of group. Afterward, the stochastic multicriteria acceptability analysis method is integrated with the gained and lost dominance score method to deal with incomplete weights of risk factors in the FMEA. The proposed method is employed in a case study about ranking the failure modes of stereotactic body radiation therapy for lung cancer patients. The robustness and feasibility of the proposed method are validated by comparative analysis.

Association of Overweight, Obesity, and Recent Weight Loss With Colorectal Cancer Risk

Overweight and obesity, conditions with rising prevalence in many countries, are associated with increased colorectal cancer (CRC) risk. However, many patients with CRC lose weight before diagnosis, which may lead the association to be underestimated. To evaluate the association of body mass index (BMI) and weight change with CRC risk when considering BMI at different time frames, with the intention to account for prediagnostic weight loss. This population-based case-control study was conducted in southwestern Germany between 2003 and 2021. Cases with a first diagnosis of CRC and controls (frequency matched by age, sex, and county) with comprehensive risk factor information and self-reported weight at different time points were included. Data were analyzed between October 2022 and March 2023. BMI and weight change at different time frames before the time of diagnosis (cases) or recruitment (controls). Association of BMI and weight change at various points in time before and up to diagnosis with CRC, assessed by multivariable logistic regression with comprehensive confounder adjustment. A total of 11 887 participants (6434 CRC cases, 5453 controls; median [IQR] age, 69 [61-77] years; 7173 male [60.3%]) were included. At the time of diagnosis, 3998 cases (62.1%) and 3601 controls (66.0%) were overweight or obese, suggesting an inverse association between excess weight and CRC risk. Conversely, we found significant positive associations of overweight (adjusted odds ratio [aOR], 1.27; 95% CI, 1.03-1.56), obesity (aOR, 2.09; 95% CI, 1.61-2.70), and a 5-unit increase in BMI (aOR, 1.35; 95% CI, 1.21-1.50) with CRC risk when using BMI measured 8 to 10 years before diagnosis. High BMI as a risk factor for CRC was increased as earlier periods before diagnosis were examined, with the association being particularly pronounced using BMI at least 8 years before diagnosis. An opposite trend was found for the association of weight loss (at or exceeding 2 kg) with CRC, with the greatest effect sizes occurring for weight loss within 2 years before diagnosis (aOR, 7.52; 95% CI, 5.61-10.09), and gradually decreased for earlier intervals. In this population-based case-control study, accounting for substantial prediagnostic weight loss further highlighted the association of overweight and obesity with CRC risk.

Exploring the barriers to and facilitators of implementing CanRisk in primary care: a qualitative thematic framework analysis.

The CanRisk tool enables the collection of risk factor information and calculation of estimated future breast cancer risks based on the multifactorial Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model. Despite BOADICEA being recommended in National Institute for Health and Care Excellence (NICE) guidelines and CanRisk being freely available for use, the CanRisk tool has not yet been widely implemented in primary care. To explore the barriers to and facilitators of the implementation of the CanRisk tool in primary care. A multi-methods study was conducted with primary care practitioners (PCPs) in the East of England. Participants used the CanRisk tool to complete two vignette-based case studies; semi-structured interviews gained feedback about the tool; and questionnaires collected demographic details and information about the structural characteristics of the practices. Sixteen PCPs (eight GPs and eight nurses) completed the study. The main barriers to implementation included: time needed to complete the tool; competing priorities; IT infrastructure; and PCPs' lack of confidence and knowledge to use the tool. Main facilitators included: easy navigation of the tool; its potential clinical impact; and the increasing availability of and expectation to use risk prediction tools. There is now a greater understanding of the barriers and facilitators that exist when using CanRisk in primary care. The study has highlighted that future implementation activities should focus on reducing the time needed to complete a CanRisk calculation, integrating the CanRisk tool into existing IT infrastructure, and identifying appropriate contexts in which to conduct a CanRisk calculation. PCPs may also benefit from information about cancer risk assessment and CanRisk-specific training.

Quantifying the effects of risk-stratified breast cancer screening when delivered in real time as routine practice versus usual screening: the BC-Predict non-randomised controlled study (NCT04359420)

BackgroundRisk stratification as a routine part of the NHS Breast Screening Programme (NHSBSP) could provide a better balance of benefits and harms. We developed BC-Predict, to offer women when invited to the NHSBSP, which collects standard risk factor information; mammographic density; and in a sub-sample, a Polygenic Risk Score (PRS).MethodsRisk prediction was estimated primarily from self-reported questionnaires and mammographic density using the Tyrer–Cuzick risk model. Women eligible for NHSBSP were recruited. BC-Predict produced risk feedback letters, inviting women at high risk (≥8% 10-year) or moderate risk (≥5–<8% 10-year) to have appointments to discuss prevention and additional screening.ResultsOverall uptake of BC-Predict in screening attendees was 16.9% with 2472 consenting to the study; 76.8% of those received risk feedback within the 8-week timeframe. Recruitment was 63.2% with an onsite recruiter and paper questionnaire compared to <10% with BC-Predict only (P < 0.0001). Risk appointment attendance was highest for those at high risk (40.6%); 77.5% of those opted for preventive medication.DiscussionWe have shown that a real-time offer of breast cancer risk information (including both mammographic density and PRS) is feasible and can be delivered in reasonable time, although uptake requires personal contact. Preventive medication uptake in women newly identified at high risk is high and could improve the cost-effectiveness of risk stratification.Trial registrationRetrospectively registered with clinicaltrials.gov (NCT04359420).

Abstract P503: Association Between Life’s Simple 7 and the Risk of Dementia Among Women

Introduction: Given the higher burden of dementia, it is particularly important to identify risk factors for dementia among women. A growing body of research underscores the need to examine midlife risk factors for dementia, as dementia pathology often begins decades before diagnosis. Hypothesis: We hypothesized that higher scores on the AHA Life’s Simple 7 in midlife, indicating better cardiovascular health in midlife, would be associated with a decreased risk of dementia among women followed from middle age into older age. Methods: The study population included women enrolled in the Women’s Health Study who had available risk factor information needed to calculate the AHA Life’s Simple 7 at baseline (1992-1994) and approximately ten years later (2004) and were fully covered by fee-for-service Medicare for all eligible person-months. Women received one point for each component of the Life’s Simple 7 (smoking status, diet, physical activity, body mass index, diabetes, blood cholesterol, and blood pressure) for which they had ideal cardiovascular health. We used fee-for-service Medicare data (available from 2011 through 2018) and validated lists of ICD-9 and ICD-10 codes to identify dementia diagnoses. We used logistic regression to examine the association between the score, modeled as a continuous variable, and dementia diagnosis adjusted for age and socioeconomic status at baseline. Results: A total of 13,720 women were eligible for these analyses and 1771 (12.9%) dementia cases were observed. The mean age (standard deviation (SD)) was 54.2 (6.6) years at baseline. The average Life’s Simple 7 score at baseline was 4.3 (SD=1.3) and after ten years of follow-up was 4.2 (SD=1.3). Higher Life’s Simple 7 score as measured at baseline (odds ratio per one unit change in score=0.94, 95% CI: 0.90-0.98) was associated with a decreased risk of dementia. This effect was similar for the Life’s Simple 7 score as measured after ten years of follow-up (OR=0.95, 95% CI: 0.91-1.00). Conclusions: In this large cohort of women, better cardiovascular health in midlife was associated with a decreased risk of dementia in late life.

Prevalence of Hepatitis B Virus Infection among Inmates at the Monrovia Central Prison, Liberia.

Determination of hepatitis B virus (HBV) infections in key populations including prison inmates is crucial for formulating appropriate intervention approaches. However, in many low-income countries, such as Liberia, there is hardly any documentation on HBV prevalence among inmates. This study determined and evaluated the prevalence of HBV infections among incarcerated persons in the Monrovia Central Prison, Liberia. One hundred participants comprising 76 males and 24 females were studied. Participants' demographic and potential risk factors information were obtained using a semi-structured questionnaire, and blood samples were collected for the analysis. Plasma was tested for five HBV serological markers, namely, HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. The seroreactivity of actively infected persons was confirmed by nucleic acid detection. Results of the serological assay showed that 34% of the participants had been exposed to the virus and 14% were actively infected. qPCR confirmed HBV DNA in seven actively infected samples. Statistical analysis indicated that a low level of education, a history of blood transfusion, and intravenous drug use, were significant predictors of active HBV infection and HBV exposure, respectively. These findings might make the testing and vaccination of convicts against HBV infection prior to their admission into prison facilities imperative.

Primary school mobile dental program in New South Wales, Australia: protocol for the evaluation of a state government oral health initiative

BackgroundSocioeconomically disadvantaged children are disproportionately affected by oral disease. Mobile dental services help underserved communities overcome barriers to accessing health care, including time, geography, and trust. The NSW Health Primary School Mobile Dental Program (PSMDP) is designed to provide diagnostic and preventive dental services to children at their schools. The PSMDP is mainly targeted toward high-risk children and priority populations. This study aims to evaluate the program’s performance across five local health districts (LHDs) where the program is being implemented.MethodsThe evaluation will use routinely collected administrative data, along with other program-specific data sources, from the district public oral health services to conduct a statistical analysis that determines the reach and uptake of the program, its effectiveness, and the associated costs and cost-consequences. The PSMDP evaluation program utilises data from Electronic Dental Records (EDRs) and other data sources, including patient demographics, service mix, general health, oral health clinical data and risk factor information. The overall design includes cross-sectional and longitudinal components. The design combines comprehensive output monitoring across the five participating LHDs and investigates the associations between socio-demographic factors, service patterns and health outcomes. Time series analysis using difference-in-difference estimation will be conducted across the four years of the program, involving services, risk factors, and health outcomes. Comparison groups will be identified via propensity matching across the five participating LHDs. An economic analysis will estimate the costs and cost-consequences for children who participate in the program versus the comparison group.DiscussionThe use of EDRs for oral health services evaluation research is a relatively new approach, and the evaluation works within the limitations and strengths of utilising administrative datasets. The study will also provide avenues to improve the quality of data collected and system-level improvements to better enable future services to be aligned with disease prevalence and population needs.

The Impact and Perception of England's Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study.

It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously. This study aimed to understand who accesses England's heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services. There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis. Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24%), those from White ethnic background (3,972,293/4,898,532, 81.09%), and those living in the least deprived 20% of areas (707,747/4,898,532, 14.45%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior. England's web-based HAT has engaged large number of people in their heart health. Improvements to England's HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the test on behavioral outcomes are warranted.

A framework for assessing confidence in freedom from infection in animal disease control programmes.

In the Surveillance Tool for Outcome-based Comparison of FREEdom from infection (STOC free) project (https://www.stocfree.eu), a data collection tool was constructed to facilitate standardised collection of input data, and a model was developed to allow a standardised and harmonised comparison of the outputs of different control programmes (CPs) for cattle diseases. The STOC free model can be used to evaluate the probability of freedom from infection for herds in CPs and to determine whether these CPs comply with the European Union's pre-defined output-based standards. Bovine viral diarrhoea virus (BVDV) was chosen as the case disease for this project because of the diversity in CPs in the six participating countries. Detailed BVDV CP and risk factor information was collected using the data collection tool. For inclusion of the data in the STOC free model, key aspects and default values were quantified. A Bayesian hidden Markov model was deemed appropriate, and a model was developed for BVDV CPs. The model was tested and validated using real BVDV CP data from partner countries, and corresponding computer code was made publicly available. The STOC free model focuses on herd-level data, although that animal-level data can be included after aggregation to herd level. The STOC free model is applicable to diseases that are endemic, given that it needs the presence of some infection to estimate parameters and enable convergence. In countries where infection-free status has been achieved, a scenario tree model could be a better suited tool. Further work is recommended to generalise the STOC free model to other diseases.

Lifestyle and cardiometabolic risk factors in the ethnic and non-ethnic population > 15 years of age: results from the National Chilean Health Survey 2016-2017.

Background: lifestyle and cardiometabolic risk factors information is scarce regarding youth and adults of Latin-American ethnics. Objective: the primary aim was to describe the lifestyle and cardiometabolic risk factors for arterial hypertension (HTN) and diabetes in ethnic Latin-American groups (Mapuche and Aymara) and other non-ethnics > 15 years of age in the Chilean population. A secondary aim was to determine the association between physical activity 'intensity' with HTN and diabetes markers. Material and methods: a representative sample from the National Chilean Health Survey 2016-2017, included Mapuche (EG-Map; women n = 166, men n = 300; total n = 466), Aymara (EG-Aym; women n = 96, men n = 55; total n = 151), and a non-ethnic population group (No-EG; women n = 2057, men n = 3445; total n = 5502). The main outcomes were; systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (GL), and secondary outcomes were other anthropometric, lipid profile, and lifestyle parameters. Results: GL was significantly associated with nutrition (0.9 %, p < 0.0001), tobacco and alcohol habits (0.6 %, p < 0.0001). SBP was significantly associated with nutrition (whole-grains 0.04, p = 0.001; water consumption 0.07, p < 0.0001), sleep hygiene (week 0.04, p = 0.030; on weekends -0.04, p = 0.026), and alcohol consumption (-0.06, p < 0.0001). Conclusion: in conclusion, lifestyle differences among Mapuche and Aymara ethnic groups in comparison with non-ethnic Chilean peers > 15 years are significantly associated with blood pressure and glycemia.

Incidence, Mortality, and Epidemiology of Leukemia in South Asia: An Ecological Study

Background: Nowadays cancer is a buzzword in every corner of the world. Back a few decades, cancer was not that much known to the people of South Asia let alone known of Leukemia. Many countries in the South Asian region are designated as developing countries. Hence, the deficiency of diagnosis system, treatment, management, and lack of knowledge about leukemia in this region are major problems. Therefore, the incidence rate, mortality rate, and several deaths are increasing day by day. Methods: This cross-sectional study is aimed to investigate the incidence and mortality of leukemia in South Asian Countries for the year 2020 by acquiring data from the global cancer project (GLOBOCAN2020) accessible at https://gco.iarc.fr. Results: In South Asia, 1,733,573 cancer cases were documented in 2020 where 62,163 cases were leukemia related. The highest incidence rate was reported in Pakistan (4.3 in 1,000,000) and Sri Lanka (4.1 in 1,000,000) and the lowest in Bangladesh (1.8 in 1,000,000) and Nepal (2.0 in 1,000,000). On the other hand, 1,124,875 death had been reported in 2020, where 45,707 (4.1%) death was associated with leukemia. Pakistan (3.4 in 1,000,000) and Maldives (3.1 in 1,000,000) had the highest death and lowest in Bangladesh (1.4 in 1,000,000) and Nepal (1.5 in 1,000,000). Adults aged from 60 - 85 years old have the highest rate of incidence and mortality rate in all countries except Nepal. Conclusions: Leukemia is one of the major concerning cancer of all ages people in South Asia, the situation and related risk factors information can be helpful to reduce death through proper treatment.

Survey of nosocomial gastrointestinal protozoa infections among hospitalized patients of a tertiary and a secondary hospital in Awka, Anambra state, Nigeria

The hospital environment often become contaminated by infectious agents either through patients or hospital sources. This cross-sectional hospital-based study was conducted to survey the epidemiology of nosocomial gastrointestinal protozoa infections among hospitalized patients in a tertiary and a secondary hospital, Awka, Anambra state. Stool samples were collected from 210 admitted patients and analyzed using direct wet mount and formol ether concentration technique. Demographic and risk factor information were gathered using a structured questionnaire. Data was analyzed using Pearson chi-square test and Probability values ≤ 0.05 were considered significant. From the 210 patients examined, 31(14.8%) contracted nosocomial gastrointestinal protozoa infections. Nosocomial gastrointestinal protozoa infection was recorded in all two hospitals with the tertiary hospital (COOUTH) having the highest infection prevalence of 15.7% at an occurrence rate of 80.6%. Female gender, 10-19years of age, patients with longer admission duration had more prevalent rates of 16.2%, 28.6% and 89.5% respectively. Also, patients admitted in the paediatric ward, those with only primary education and those who don’t always wash their hands before introducing any substance into the mouth had higher prevalence of 20.0%, 25.0% and 20.7% respectively. Nosocomial gastrointestinal protozoa infection was strongly associated with duration of hospital stay and hand washing habits P˂0.05. Among the five protozoa parasites seen, Entamoeba histolytica was the most prevalent 18(58.1%). There is an urgent need for improved patients and health workers personal hygiene, hospital sanitation, and the use of safer medical practices to stop the spread of nosocomial infection.

Assessment of Body Mass Index, Polygenic Risk Score, and Development of Colorectal Cancer

Excess weight, the prevalence of which is high and increasing in many countries, is linked to multiple adverse health outcomes, including increased colorectal cancer (CRC) risk. Better communication of health risks associated with excess weight might support efforts of prevention. To evaluate the individual and joint associations of body mass index (BMI) and polygenic risk with CRC, to assess potential interactions among them, and to quantify by how much increased polygenic risk for CRC can be offset by having a BMI within reference range. This population-based case-control study was conducted in the Rhine-Neckar region of southwest Germany, with recruitment from 2003 to 2017. Participants with both risk factor and genetic information were included for analysis. Data analysis was conducted from December 8, 2021, to February 17, 2022. BMI was calculated as self-reported weight in kilograms approximately 10 years before diagnosis or interview and current height in meters squared. A polygenic risk score (PRS) was built based on 140 CRC-related risk loci. Individual and joint associations of BMI and PRS with CRC were estimated using multiple logistic regression. Associations of excess weight with CRC were quantified by adjusted odds ratios (aORs) and genetic risk equivalents (GREs), the equivalent outcomes conveyed by defined differences in PRS percentiles. Among 9169 participants (median [IQR] age, 69 [62-76] years; 5589 [61.0%] male participants) included, 5053 had CRC and 4116 did not. BMI of 30 or greater was associated with higher odds of having CRC compared with BMI less than 25 (aOR, 1.71; 95% CI, 1.49-1.97), independent of PRS levels (P for interaction = .45). Participants with BMI of 30 or greater and a PRS in the highest tertile had higher odds of CRC compared with participants with BMI less than 25 and a PRS in the lowest tertile (aOR, 3.82; 95% CI, 3.03-4.82). The estimated association of BMI greater than 30 with CRC risk was equivalent to that of having a 41 (95% CI, 29-53)-percentile higher PRS. BMI of 30 or greater was particularly associated with stage IV CRC (aOR, 2.21; 95% CI, 1.71-2.84). These findings suggest that excess weight was associated with CRC regardless of PRS levels. The association of having a BMI within reference range may be similar to that of having a substantially lower polygenic risk for CRC.

Explainable ensemble learning model improves identification of candidates for oral cancer screening

ObjectivesArtificial intelligence could enhance the use of disparate risk factors (crude method) for better stratification of patients to be screened for oral cancer. This study aims to construct a meta-classifier that considers diverse risk factors to identify patients at risk of oral cancer and other suspicious oral diseases for targeted screening. Materials and MethodsA retrospective dataset from a community oral cancer screening program was used to construct and train the novel voting meta-classifier. Comprehensive risk factor information from this dataset was used as input features for eleven supervised learning algorithms which served as base learners and provided predicted probabilities that are weighted and aggregated by the meta-classifier. Training dataset was augmented using SMOTE-ENN. Additionally, Shapley additive explanations (SHAP) values were generated to implement the explainability of the model and display the important risk factors. ResultsOur meta-classifier had an internal validation recall, specificity, and AUROC of 0.83, 0.86, and 0.85 for identifying the risk of oral cancer and 0.92, 0.60, and 0.76 for identifying suspicious oral mucosal disease respectively. Upon external validation, the meta-classifier had a significantly higher AUROC than the crude/current method used for identifying the risk of oral cancer (0.78 vs 0.46; p = 0.001) Also, the meta-classifier had better recall than the crude method for predicting the risk of suspicious oral mucosal diseases (0.78 vs 0.47). ConclusionOverall, these findings showcase that our approach optimizes the use of risk factors in identifying patients for oral screening which suggests potential clinical application.

Predictive capacity of COVID-19-related risk beliefs on weight management behaviors on a commercial weight loss program and speed of COVID-19 vaccination uptake: prospective cohort study

BackgroundRecent work has shown that obesity may be a risk factor for severe COVID-19. However, it is unclear to what extent individuals have heard or believe this risk factor information, and how these beliefs may predict their preventive behaviors (e.g., weight management behaviors or COVID-19 preventive behaviors). Previous work has primarily looked at overall risk likelihood perceptions (i.e., not about obesity as a risk factor) within general populations of varying weight and concentrated on COVID-19-related preventive behaviors. Therefore, this prospective cohort study explored whether beliefs about obesity as a risk factor and overall risk likelihood perceptions predicted weight management and COVID-19 preventive behaviors over the next 16 weeks in individuals with obesity or overweight.MethodsParticipants were 393 individuals in the US who joined a commercial weight management program in January, 2021. We leveraged the mobile program’s automatic measurement of real-time engagement in weight management behaviors (e.g., steps taken), while surveys measured risk beliefs at baseline as well as when individuals received COVID-19 vaccination doses (asked monthly) over the next 16 weeks. Mixed effects models predicted engagement and weight loss each week for 16 weeks, while ordinal logistic regression models predicted the month that individuals got vaccinated against COVID-19.ResultsWe found that belief in obesity as a risk factor at baseline significantly predicted greater engagement (e.g., steps taken, foods logged) in program-measured weight management behaviors over the next 16 weeks in models adjusted for baseline BMI, age, gender, and local vaccination rates (minimally adjusted) and in models additionally adjusted for demographic factors. Belief in obesity as a risk factor at baseline also significantly predicted speed of COVID-19 vaccination uptake in minimally adjusted models but not when demographic factors were taken into account. Exposure to obesity risk factor information at baseline predicted greater engagement over 16 weeks in minimally adjusted models.ConclusionsThe results highlight the potential utility of effective education to increase individuals’ belief in obesity risk factor information and ultimately promote engagement or faster vaccination. Future research should investigate to what extent the results generalize to other populations.

Characteristics of Diagnosed and Death Cases of Pneumoconiosis in Hubei Province, China, 1949-2019.

This study aims to summarize the characteristics of diagnosed pneumoconiosis and pneumoconiosis death in the Hubei Province of China, between the years 1949 and 2019, and provide clues for the scientific prevention of pneumoconiosis. We recruited 23,069 pneumoconiosis cases in Hubei Province, China, from 1949 to 2019. Basic information and occupational surveillance information were obtained from the Hubei Occupational Diseases and Health Risk Factors Information Surveillance System. The annually diagnosed pneumoconiosis cases showed an overall increasing trend from 1949 to 2019 in Hubei Province. The major types of pneumoconiosis were coal workers' pneumoconiosis (CWP, 49.91%) and silicosis (43.39%). Pneumoconiosis cases were mainly engaged in mining (75.32%) and manufacturing (12.72%), and were distributed in Huangshi (35.48%), Yichang (16.16%), and Jingzhou (7.97%). CWP (47.50%) and silicosis (44.65%) accounted for most of the deaths. The number of pneumoconiosis cases and deaths in Hubei increased in the period of 1949 to 2019. Silicosis and CWP contributed to the predominant types of pneumoconiosis. Prevention and control measures should continue to be taken to reduce the morbidity and mortality of pneumoconiosis.

Identifying Risk Factors, Patient-Reported Experience and Outcome Measures, and Data Capture Tools for an Individualized Pain Prediction Tool in Pediatrics: Focus Group Study.

The perioperative period is a data-rich environment with potential for innovation through digital health tools and predictive analytics to optimize patients' health with targeted prehabilitation. Although some risk factors for postoperative pain following pediatric surgery are already known, the systematic use of preoperative information to guide personalized interventions is not yet widespread in clinical practice. Our long-term goal is to reduce the incidence of persistent postsurgical pain (PPSP) and long-term opioid use in children by developing personalized pain risk prediction models that can guide clinicians and families to identify targeted prehabilitation strategies. To develop such a system, our first objective was to identify risk factors, outcomes, and relevant experience measures, as well as data collection tools, for a future data collection and risk modeling study. This study used a patient-oriented research methodology, leveraging parental/caregiver and clinician expertise. We conducted virtual focus groups with participants recruited at a tertiary pediatric hospital; each session lasted approximately 1 hour and was composed of clinicians or family members (people with lived surgical experience and parents of children who had recently undergone a procedure requiring general anesthesia) or both. Data were analyzed thematically to identify potential risk factors for pain, as well as relevant patient-reported experience and outcome measures (PREMs and PROMs, respectively) that can be used to evaluate the progress of postoperative recovery at home. This guidance was combined with a targeted literature review to select tools to collect risk factor and outcome information for implementation in a future study. In total, 22 participants (n=12, 55%, clinicians and n=10, 45%, family members) attended 10 focus group sessions; participants included 12 (55%) of 22 persons identifying as female, and 12 (55%) were under 50 years of age. Thematic analysis identified 5 key domains: (1) demographic risk factors, including both child and family characteristics; (2) psychosocial risk factors, including anxiety, depression, and medical phobias; (3) clinical risk factors, including length of hospital stay, procedure type, medications, and pre-existing conditions; (4) PREMs, including patient and family satisfaction with care; and (5) PROMs, including nausea and vomiting, functional recovery, and return to normal activities of daily living. Participants further suggested desirable functional requirements, including use of standardized and validated tools, and longitudinal data collection, as well as delivery modes, including electronic, parent proxy, and self-reporting, that can be used to capture these metrics, both in the hospital and following discharge. Established PREM/PROM questionnaires, pain-catastrophizing scales (PCSs), and substance use questionnaires for adolescents were subsequently selected for our proposed data collection platform. This study established 5 key data domains for identifying pain risk factors and evaluating postoperative recovery at home, as well as the functional requirements and delivery modes of selected tools with which to capture these metrics both in the hospital and after discharge. These tools have been implemented to generate data for the development of personalized pain risk prediction models.