Significant Increase In Odds Research Articles

The association between traffic noise and self-rated health within the German National Cohort (NAKO)

Abstract Objectives Traffic noise can cause stress and disturb sleep, impacting health in many ways. However, few large studies on this topic exist. We investigated the association between traffic noise and self-rated health (SRH) within the German National Cohort (NAKO). Methods NAKO enrolled >200,000 adults ages 20-74 at 18 sites in Germany. We used logistic regression to test whether 1) annual mean 24-hour ambient traffic noise levels at or above 55 dB(A) within a 10-meter residential buffer and 2) subjectively reported nighttime traffic noise annoyance were associated with higher odds of reporting fair/poor SRH. We calculated these associations within the full sample, stratified by sex, and stratified by age group (≤39 years, 40-59 years, ≥60 years). We adjusted for study site, age, sex, marital status, education level, and migration background. Results Among participants without missing data (n = 121,232), moderate annoyance was associated with 1.27 higher odds (95% CI 1.21-1.32) and strong annoyance with 1.75 higher odds (95% CI 1.65-1.84) of fair/poor SRH, while annual mean noise ≥55 dB(A) was associated with 1.07 higher odds (95% CI 1.03-1.12). Females who reported strong annoyance had especially high odds of fair/poor SRH (OR 1.81, 95% CI 1.69-1.95), as did those aged 40-59 years who reported high annoyance (OR 1.78, 95% CI 1.66-1.92). Those 39 and under had no significant increase in odds of fair/poor SRH if they reported moderate annoyance or if they were exposed to ≥ 55 dB(A) annual mean noise. In single exposure models, noise annoyance and objectively measured noise were both significantly associated with higher odds of reporting fair/poor SRH, but in combined models, the effect of objectively measured noise became insignificant while the effect of annoyance remained strongly significant. Conclusions These findings confirm that traffic noise is an important public health issue. Further analyses on most affected populations should inform noise protection policies. Key messages • Higher levels of traffic noise are associated with worse self-rated health. • Ambient noise is an important public health issue for which more research is needed.

The Learning Curve in Digital Replant Surgery: 46 Prospectively Collected Cases From a Single Surgeon Over a 10-Year Period.

Digital replantation is a technically difficult microsurgery requiring significant surgical skill.The aim of this study was to investigate postoperative outcomes associated with the surgical learning curve for microvascular digital replantation. A prospectively maintained surgical database of consecutive patients who underwentdigital replantation from 2002 to 2012 was reviewed.All cases were performed by a single surgeon and began immediately after the surgeon's fellowship.A total of 46 patients were identified.Outcomes of digital replantation were tested for association with time since fellowship, total microvascular operative experience, and location and type of injury. Overall, 38/46 (82.6%) of patients underwent a successful digital replantation.There was a significant difference between survival percentages over the years (p=0.04), with improvement seen over time.Total microvascular experience was significantly associated with successful outcomes (p<0.001).After 100 hours of microvascular experience, there was a significant increase in the survival odds ratio (OR 8.5, 95% CI 1.5-47.9).Crush and thumb injuries were more likely to have detrimental outcomes. There was marked improvement in replant survival over time, with a significant increase in odds of survival after 100 hours of microvascular experience.One hundred operating hours under the microscope occurred around 2 years in practice for this high-volume surgeon.There is strong evidence that a steep learning curve occurs in microvascular digit replantation surgery.

Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention.

HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates. To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan. We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022. We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent. Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities. The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community. Received an HIV test in the prior six months. There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city (AOR=1.08, 95% CI=1.05-1.12; p<.001). The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM. This trial is registered with clinicaltrials.gov (NCT02786615). National Institute on Drug Abuse (NIDA), grant number R01DA040513.

Impact of Society Guidelines on Trends in Use of Newer P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.

Over the past decade, major society guidelines have recommended the use of newer P2Y12 inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice. All percutaneous coronary intervention procedures (n=534 210) for acute coronary syndrome in England and Wales (April 1, 2010, to March 31, 2022) were retrospectively analyzed, stratified by choice of preprocedural P2Y12 inhibitor (clopidogrel, ticagrelor, and prasugrel). Multivariable logistic regression models were used to examine odds ratios of receipt of ticagrelor and prasugrel (versus clopidogrel) over time, and predictors of their receipt. Overall, there was a significant increase in receipt of newer P2Y12 inhibitors from 2010 to 2020 (2022 versus 2010: ticagrelor odds ratio, 8.12 [95% CI, 7.67-8.60]; prasugrel odds ratio, 6.14 [95% CI, 5.53-6.81]), more so in ST-segment-elevation myocardial infarction than non-ST-segment-elevation acute coronary syndrome indication. The most significant increase in odds of receipt of prasugrel was observed between 2020 and 2022 (P<0.001), following a decline/plateau in its use in earlier years (2011-2019). In contrast, the odds of receipt of ticagrelor significantly increased in earlier years (2012-2017, Ptrend<0.001), after which the trend was stable (Ptrend=0.093). Over a 13-year-period, there has been a significant increase in use of newer P2Y12 inhibitors, although uptake of prasugrel use remained significantly lower than ticagrelor. Earlier society guidelines (pre-2017) were associated with the highest rates of ticagrelor use for non-ST-segment-elevation acute coronary syndrome and ST-segment-elevation myocardial infarction cases while the ISAR-REACT 5 (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome) trial and later society guidelines were associated with higher prasugrel use, mainly for ST-segment-elevation myocardial infarction indication.

Effect of postthaw change in embryo score on single euploid embryo transfer success rates

ObjectiveTo assess whether the change in embryo morphology from pre-cryopreservation to post-thaw is associated with embryo transfer success rates in single euploid embryo transfer cycles. DesignRetrospective cohort study SubjectsPatients who underwent a single euploid embryo transfer cycle from September 2016 – April 2022 were included. A decision support tool was used to assign each embryo a reproductive potential score based on the day of biopsy, expansion, and grade of trophectoderm and inner cell mass (ICM) at the time of cryopreservation and post-thaw.(1) Embryos were divided into 4 groups: Group 1 included embryos with the same score post-thaw (reference), Group 2 higher score, Group 3 lower score, and Group 4 embryos that did not re-expand post-thaw. Intervention(s)No interventions administered. Main Outcome MeasuresPrimary outcome was live birth rates per embryo transfer (LBR). Secondary outcomes included chemical pregnancy, clinical pregnancy, and clinical pregnancy loss rate. Comparative statistics and univariate analyses were performed using Kruskal-Wallis and chi-square tests. Multivariate logistic regression fitted with generalized estimating equation was performed to compare the odds of live birth between groups. ResultsA total of 7750 embryo transfers performed for 4613 patients met inclusion criteria: 5331 in Group 1, 486 in Group 2, 1726 in Group 3, and 207 in group 4. On univariate analysis, there was a statistically significant difference in LBR between groups 1, 2, 3, and 4 (55.8% vs 51.4%, 47.5%, 26.6%, p<0.0001). Logistic regression controlling for oocyte age, AMH, BMI, endometrial thickness, year of embryo transfer, time from thaw to final grading, and embryo score prior to cryopreservation showed significantly lower odds of LBR when the embryo was downgraded (OR 0.70, CI 0.62-0.79, p=<.0001) or did not re-expand (OR 0.36, CI 0.26-0.51 p=<.0001) compared with no change in score. When controlling for all variables, there was a significant increase in odds of live birth between embryos that had higher score post-thaw versus those without a change (OR 1.42, CI 1.14-1.76, p=0.002). There was no significant difference in clinical pregnancy loss rate among the 4 groups. ConclusionsThe change in quality of the embryo post-thaw is an important factor in embryo transfer success. In an adjusted analysis, the chemical pregnancy, clinical pregnancy, and LBR per embryo transfer are all significantly decreased in embryos that were downgraded or did not expand on the day of single euploid embryo transfer. Embryos that re-expand and improve their quality post-thaw have the highest odds of live birth.

Association between psychiatric disorders and glioma risk: evidence from Mendelian randomization analysis

BackgroundObservational studies have explored the association of psychiatric disorders and the risk of brain cancers. However, the causal effect of specific mental illness on glioma remains elusive due to the lack of solid evidence.MethodsWe performed a two-sample bidirectional Mendelian randomization (MR) analysis to explore the causal relationships between 5 common psychiatric disorders (schizophrenia, major depressive disorder, bipolar disorder, autism spectrum disorder, and panic disorder) and glioma. Summary statistics for psychiatric disorders and glioma were extracted from Psychiatric Genomics Consortium (PGC) and 8 genome-wide association study (GWAS) datasets respectively. We calculated the MR estimates for odds ratio of glioma associated with each psychiatric disorder by using inverse-variance weighting (IVW) method. Sensitivity analyses such as weighted median estimator, MR-Egger and MR-PRESSO were leveraged to assess the strength of causal inference.ResultsA total of 30,657 participants of European ancestry were included in this study. After correction for multiple testing, we found that genetically predicted schizophrenia was associated with a statistically significant increase in odds of non-glioblastoma multiforme (non-GBM) (OR = 1.13, 95% CI: 1.03–1.23, P = 0.0096). There is little evidence for the causal relationships between the other 4 psychiatric disorders with the risk of glioma.ConclusionsIn this MR analysis, we revealed an increased risk of non-GBM glioma in individuals with schizophrenia, which gives an insight into the etiology of glioma.

OBSTRUCTIVE SLEEP APNEA RISK AND LONGITUDINAL TRAJECTORY OF FUNCTIONAL HEARING LOSS OVER EIGHT YEARS OF FOLLOW-UP

Abstract Hearing loss prevention is important for physical, cognitive and psychosocial health among older adults. Obstructive sleep apnea (OSA) might cause functional hearing loss through ischemic damages to the cochlea or central auditory processing, but there is a lack of longitudinal evidence. The National Health and Aging Trends Study (NHATS) is a longitudinal panel survey of Medicare beneficiaries aged 65+ years. STOP-Bang is a validated screening tool for OSA risk and a subsample of NHATS round 3 participants responded to a modified version (age&amp;gt;50, male, high blood pressure, body mass index &amp;gt;35 kg/m2, snore loudly, observed apnea, tiredness; range 0-7, elevated risk if ≥3). Functional hearing loss at follow-up (rounds 3-11) was defined as self-reported deafness, hearing aid use, or inability to hear well enough to use the telephone or have conversations in a room with the television or radio on. We used generalized estimating equations logistic regression with inverse probability attrition weighting, adjusting for demographics and comorbidities. Among 1,433 participants, elevated OSA (58%) was associated with higher odds of hearing loss at baseline (odds ratio:1.50, 95% confidence interval[CI]:1.08, 2.10). Both OSA groups had significant annual increases in odds of functional hearing loss (Low:1.07, 95% CI:1.01, 1.13; Elevated:1.12, 95% CI:1.07, 1.18) during the first 4 years. Afterwards, the low OSA risk group continued to have significant increase in odds of functional hearing loss but not the elevated OSA risk group. OSA might be a novel risk factor for hearing loss. Screening and treating OSA might be important for hearing loss prevention.

Prevalence rate trends of borderline personality disorder symptoms and self-injurious behaviors in college students from 2017 to 2021

The current study examines the prevalence rates of borderline personality disorder (BPD) symptoms and nonsuicidal self-injury (NSSI) behaviors amongst college students over a five-year period, including pre- and during the COVID pandemic. Online prescreener surveys were completed by undergraduate students (n = 12,756) attending a large Southern Plains University every semester from Spring of 2017 to Spring of 2021. The percentage of students with NSSI history and significant BPD symptoms were visualized by semester to examine trends over time. A series of logistic regressions and negative binomial regressions were conducted on NSSI history and BPD symptoms to examine whether the endorsement rates have been increasing over time and to compare before and during COVID pandemic. There was an increasing trend of NSSI rates and significant BPD symptoms over time for all sexes. Furthermore, there was a steeper increase in BPD symptoms specifically in female students over the last five years. Additionally, there was a significant increase in odds of elevated BPD symptoms and NSSI behaviors in the college students enrolled during the COVID pandemic compared with pre-COVID. Overall, there has been an increasing trend in BPD symptoms and NSSI rates over the last few years, including during the COVID pandemic.

Acute Health Effects of Wildfire Smoke Exposure During a Compound Event: A Case-Crossover Study of the 2016 Great Smoky Mountain Wildfires.

In 2016, unprecedented intense wildfires burned over 150,000 acres in the southern Appalachian Mountains in the United States. Smoke from these fires greatly impacted the region and exposure to this smoke was significant. A bidirectional case-crossover design was applied to assess the relationship between PM2.5 (a surrogate for wildfire smoke) exposure and respiratory- and cardiovascular-related emergency department (ED) visits in Western North Carolina during these events. For 0-, 3-, and 7-day lags, findings indicated a significant increase in the odds of being admitted to the ED for a respiratory (ORs: 1.055, 95% CI: 1.048-1.063; 1.083, 1.074-1.092; 1.066, 1.058-1.074; respectively) or cardiovascular event (ORs: 1.052, 95% CI: 1.045-1.060; 1.074, 1.066-1.081; 1.067, 1.060-1.075; respectively) for every 5μg/m3 increase in PM2.5 over a chosen cutpoint of 20.4μg/m3. For all endpoints assessed except for emphysema, there were statistically significant increases in odds from 5.1% to 8.3%. In general, this increase was most pronounced 3days after exposure. Additionally, individuals aged 55+ generally experience higher odds of heart disease at the 3- and 7-day lag points, and Black/African Americans generally experience higher odds of asthma at the 3-day lag point. In general, larger fires and increased numbers of fires within counties resulted in higher health burden at same day exposure. In a secondary analysis, the odds of an ED visit increased by over 40% in several cases among people exposed to days above the Environmental Protection Agency 24-hr PM2.5 standard of 35μg/m3. Our findings provide new understanding on the health impacts of wildfires on rural populations in the southeastern US.

Prenatal maternal infections and early childhood development outcomes: An analysis of Scottish linked administrative health data

ObjectivesPrevious research suggests that prenatal maternal infections may be linked to later childhood neurodevelopmental outcomes and socioemotional difficulties. We exploited a large linked administrative health dataset to examine relationships between prenatal infections and early childhood development outcomes in Greater Glasgow &amp; Clyde (GGC), Scotland.&#x0D; MethodsWe used population data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in GGC, 2011-2015, and their mothers. Logistic regression models were used to examine the relationship between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and having adverse childhood development outcomes identified by health visitors during 6-8 weeks/27-30 months routine child health reviews. Secondary analysis examined whether results varied by (a) specific development outcome types (i.e. gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention, and speech-language-communication development), and (b) the trimester(s) in which infections occurred.&#x0D; ResultsAfter adjusting for confounders/covariates, hospital-diagnosed infections were associated with increased odds of having at least one adverse development outcome identified during child health reviews (OR: 1.30; 95% CI: 1.19-1.42). This relationship was consistent across almost all development outcome types, and appeared to be specifically linked to infections occurring in trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), i.e. the trimesters in which fetal brain myelination occurs. Infection-related prescriptions were not associated with a significant increase in odds of having at least one adverse development outcome after adjusting for confounders/covariates (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of adverse outcomes specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development.&#x0D; ConclusionPrenatal infections, particularly those which are hospital-diagnosed and therefore likely to be more severe, are associated with early childhood development outcomes. Our study highlights the usefulness of Scotland’s administrative health data in measuring childhood development. Future research will examine the impact of COVID-19 prenatal infections and lockdown measures.

Clinical outcomes in neovascular age-related macular degeneration: a cohort study of patients with care delay due to the COVID-19 pandemic

The COVID-19 pandemic has led to both intentional and unintentional care delay among age-related neovascular macular degeneration (nvAMD) patients. Prior studies have demonstrated that patients who discontinue nvAMD treatment for prolonged intervals are at high risk for vision loss, but less is known regarding shorter-term delay, such as during the height of the pandemic. Previous studies have looked at COVID-19 related delay in care and have shown a loss of visual acuity (VA) among these patients, but studies are limited by short follow-up or insufficient comparisons. This was an observational cohort study of nvAMD patients from March 1, 2019, through July 1, 2021, who experienced care delay. VA was modeled using a linear longitudinal mixed-effects model comparing historic data pre-lockdown to data post-lockdown. Covariates included baseline anatomic variables, demographic variables, and time intervals (treatment interval, delay interval). Secondary anatomic and treatment outcomes were modeled using a multilevel binary logistic regression model. 163 eyes among 116 patients were included. Initial longitudinal mixed-effects models found that although overall VA decreased at a yearly rate, when comparing pre-lockdown and post-lockdown time periods, VA slopes were not statistically different. Single-covariate longitudinal models showed that age, sex, and delay interval significantly affected VA slope. The multivariate longitudinal model found that a longer delay interval significantly decreased rate of VA loss. Multilevel binary logistic regression models showed a significant increase in odds of anti-VEGF treatment, presence of subretinal fluid, and macular hemorrhages in the post-lockdown period. Overall, when compared to historic data, rate of VA loss among our cohort did not vary significantly in pre-versus post-lockdown time periods, although treatment and anatomic variables did worsen post-lockdown suggesting that patients may be appropriately delayed but this comes at the risk of increased need for treatment.

School-Based Mental Health Service Utilization Through the COVID-19 Pandemic and Beyond.

We examined trends in mental health service utilization before, during, and in the immediate return to in-person learning throughout the COVID-19 pandemic. Retrospective chart review was assessed for changes in odds of any visit being a mental health encounter from five school-based health centers from the 2018-2019 to the 2021-2022 school years. Data are limited to the in-person school year from mid-August to early June. Data were assessed from 1239 students seen through 2256 visits over the 4 school years (Mage = 12.93). The odds of any visit being related to a mental health encounter increased each school year, with the 2020 to 2021 and 2021 to 2022 school years having significant increases in odds (both compared to the first and to the antecedent school year). In addition, during the 2019 to 2020 and 2020 to 2021 school years, the odds of a repeated mental health encounter significantly increased from year to year. Findings indicate a steadily increasing number of mental health service utilization needs among adolescent students that was significantly exponentiated throughout the COVID-19 pandemic.

COVID-19 and prevalence of venous thromboembolism among cancer patients: A nationwide inpatient sample analysis.

e18839 Background: Cancer, as well as immunosuppression from chemotherapy, aggravates thromboembolism risk. The risk is likely amplified in an additive fashion with COVID-19 infection, which confers a higher risk of VTE risk with viral sepsis, endothelial inflammation, and microthrombi formation. Numerous studies have shown the heightened risk of pulmonary embolism among severe COVID-19 patients. We sought to evaluate further the extent of COVID-19-associated coagulopathy and associated outcomes. Methods: National Inpatient Sample 2020 was used to identify non-elective hospitalizations of patients with a secondary diagnosis of any cancer. These were stratified into two cohorts based on the presence of the primary diagnosis of COVID-19. Primary outcomes include venous thromboembolism, PE, and VTE without PE in cancer patients with and without Covid-19 infection. The secondary outcomes examined were in-patient mortality, the average length of stay (LOS), and total hospital charge (THC). Multivariate analysis was performed to obtain the odds ratio. All weighted analysis was conducted through STATA 17. Results: Out of 1,734,735 non-elective admissions of patients with cancer, 36,295 (2%) were admitted for COVID-19. Our analysis showed statistically non-significant increased odds of venous thromboembolism(aOR:1.09 CI 0.99-1.20) in cancer patients with COVID. There was, however, a significant increase in the odds of pulmonary embolism(aOR 1.7, CI: 1.51- 1.91) among cancer patients with Covid-19. There were decreased odds of VTE without PE(aOR: 0.67 CI: 0.57-0.78). There was a statistically significant increase in odds of mortality (aOR: 2.8 CI: 2.63-3.0), length of stay(aOR:1.85 CI: 1.65- 2.05), total hospital charges($83,201 vs. $78,869 p: &lt; 0.01) in cancer patients with COVID-19 compared to cancer patients without COVID-19. Conclusions: This study shows that COVID-19 in cancer patients has deleterious effects, including an increased risk of pulmonary embolism and poor in-hospital outcomes. The finding of a lower incidence of non-PE VTE in patients with cancer is likely related to limitations with coding in NIS, in which lower complexity codes might be omitted in patients with multiple diagnoses. With significantly increased mortality and economic burden, these findings emphasize the significance of thrombotic prophylaxis and vaccination in cancer patients. [Table: see text]

Virtues of Academic Exploration:

As many as 75% of college students change their major at least once during their undergraduate career (Gordon &amp; Steele, 2015). This study examined the impact of academic major changes on bachelor’s degree attainment within six years. Using data from the 2012/17 Beginning Postsecondary Students Longitudinal Study (n = 13,800), we found a significant increase in odds of degree attainment for students who changed their major one or more times. Accompanying our analyses and results, we offer implications for early advising and transition programming including the role of meta-majors, and consideration for student backgrounds as they seek advising and choose majors.

33. Obesity as a Risk Factor in Cosmetic Abdominoplasty: A Systematic Review and Meta-Analysis

PURPOSE: The incidence of obesity is on the rise around the globe. Outside the massive weight loss patient population, knowledge of risk factors associated with abdominoplasty is limited. This systematic review and meta-analysis assesses the impact obesity has on cosmetic abdominoplasty outcomes. METHODS: A systematic review was conducted in accordance with PRISMA. PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases were reviewed using syntax “obesity”, “abdominoplasty”, “panniculectomy”, and “body contouring” for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of massive weight loss. Obesity was defined as BMI ≥ 30 kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving massive weight loss patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis. RESULTS: Of 3,088 initial studies, 16 met inclusion criteria. Of which, 9 studies included patient-reported outcomes that were used for pooled and meta-analysis. Six studies utilized national databases and were excluded from our data analysis. Meta-analysis demonstrated obesity was associated with more seromas (OR 1.45, 1.06-1.98, p=0.02), hematomas (OR 2.21, 1.07-4.57, p=0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p=0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class revealed no significant increase in odds in seromas or wound dehiscence. CONCLUSION: This review demonstrates obesity increased the odds of postoperative complications following cosmetic abdominoplasty. However, risk of complications does not continue to increase with higher obesity class. Additional research in cosmetic abdominoplasty is encouraged to further assess the impact of obesity on complications.

Traumatic Brain Injury Under Triage Risk: A Rural Trauma System Experience.

The process of interfacility transfer may cause a delay in the necessary medical treatment, which could lead to poor outcomes and increased mortality rates. The ACS-COT considers an acceptable under triage rate of <5%. The aim of this research was to identify the likelihood of under triage among transferred-in traumatic brain injury (TBI) patients. This is a single-center study of Trauma Registry data, from July 1, 2016, to October 31, 2021. The inclusion criteria were based upon age (≥40years), ICD10 diagnosis of TBI, and interfacility transfer. Under triage using the Cribari matrix method was the dependent variable. A logistic regression was performed to identify additional predictor variables on the likelihood that an adult TBI trauma patient experienced under triage. 878 patients were included in the analysis; 168 (19%) experienced an under triage. The logistic regression model was statistically significant (N = 837, P < .01). In addition, several significant increases in odds for under triage were identified, which included increasing injury severity score (ISS; OR 1.40, P < .01), increasing AIS head region (OR 6.19, P < .01), and personality disorders (OR 3.61, P = .02). In addition, a reduction in odds in TBI adult trauma under triage is the comorbidity of anticoagulant therapy (OR .25, P < .01). The likelihood of under triage in the adult TBI trauma population is associated with increasing AIS head injuries and increasing ISS and among those with mental health comorbidities. This evidence and additional protective factors, such as patients on anticoagulant therapy, may aid in education and outreach efforts to reduce under triage among the regional referring centers.

Assessing the Relationship between Thrombosis and Immune-Related Adverse Events in Patients with Lung Cancer Treated with Immune Checkpoint Inhibitors

Introduction: Venous thromboembolisms (VTE) frequently occur in cancer patients, and the role of immune checkpoint inhibitors on thrombotic risk has been a rising concern for clinicians. Identifying pro-thrombotic risk factors could guide primary prophylaxis strategies in patients receiving immunotherapy. Immune checkpoint blockade can induce inflammatory side effects known as immune-related Adverse Events (irAE). Inflammatory states are known to be associated with a hypercoagulable state. It is not established whether patients treated with immunotherapy experience a higher risk of thrombotic events during periods of increased inflammation surrounding irAE occurrence. Similarly, while immune checkpoint inhibitors have been shown to be associated with increased bleeding events, it is not clear whether irAE occurrence affects incidence of hemorrhage. Our primary objective was to determine the association between irAE and thrombosis in patients with non-small cell lung cancer treated with immune checkpoint inhibitors in order to better elucidate potential risk factors for thrombosis in patients on immunotherapy. Our secondary objective was to evaluate the association between irAE and clinically significant bleeding events. Methods: We identified all patients with non-small cell lung cancer treated with pembrolizumab at an academic medical center between 2016 and 2021. Outcomes of interest were VTE and clinically relevant bleeding (a composite of major bleeding and clinically-relevant non-major bleeds). We collected information regarding concurrent chemotherapy use with immunotherapy, frequency and type of irAE, steroid use for treatment for irAE, and use of anticoagulation or antiplatelet agents. We used logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) of VTE and clinically-relevant bleeding among patients who had an irAE prior to the outcome of interest compared to those who did not. We calculated the odds of VTE associated with use of concurrent chemotherapy (vs. no concurrent chemotherapy). Results: Of 102 patients included, 46.1% were female, and average age at diagnosis was 66.8 ± 10.5 years. Thirty-four patients were treated with pembrolizumab alone, with the remainder receiving concurrent chemotherapy and/or targeted therapy with pembrolizumab. Overall, 21 patients experienced thrombotic events (20.6%), 7 (6.9%) experienced clinically-relevant bleeding events, and 28 (27%) experienced an irAE. (Table 1). Overall, occurrence of irAE was not associated with increased odds of VTE (OR: 1.07, 95% CI: 0.37-3.11, P=0.90). (Figure 1). Similarly, among those with an irAE, steroid treatment was not associated with increased odds of VTE (OR: 1.14, 95% CI: 0.17-7.69, P=0.89). The combination of chemotherapy with pembrolizumab did not result in a statistically significant increase in odds of VTE (OR: 1.37, 95% CI: 0.52-3.60, P=0.53). The odds of clinically-relevant bleeding was not statistically higher among those with an irAE (OR: 2.10, 95% CI: 0.44-10.0, P=0.35). Conclusions: The development of irAE in patients with NSCLC treated with pembrolizumab does not appear to predict the development of VTE. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

International Society for Cutaneous Lymphomas Pandemic Section (ICLYPS) analysis of cutaneous T-cell lymphoma outcomes during the COVID-19 pandemic: A retrospective cohort study

To the Editor: Outcomes of patients with cutaneous T-cell lymphoma (CTCL), a diverse group of non-Hodgkin lymphomas, during the COVID-19 pandemic are unknown. Patients with CTCL require active management and rely on various local and systemic therapies administered in-hospital or in-office, representing an increased risk for contracting COVID-19. There are no established maintenance protocols for cutaneous lymphomas. The COVID-19 pandemic served as an “experiment of nature” to understand the effects of reduced regimens and maintenance therapy. The professional societies developed emergency guidelines for the management of patients with cutaneous lymphomas during the pandemic to ensure patient safety.1Zic J.A. Ai W. Akilov O.E. et al.United States Cutaneous Lymphoma Consortium recommendations for treatment of cutaneous lymphomas during the COVID-19 pandemic.J Am Acad Dermatol. 2020; 83: 703-704Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar,2Papadavid E. Scarisbrick J. Ortiz Romero P. et al.Management of primary cutaneous lymphoma patients during COVID-19 pandemic: EORTC CLTF guidelines.J Eur Acad Dermatol Venereol. 2020; 34: 1633-1636Crossref PubMed Scopus (11) Google Scholar The International Society for Cutaneous Lymphomas created an International Cutaneous Lymphomas Pandemic Section to collect data to assess the impact of these guidelines. Using these data, we can determine if these measures were effective in preventing COVID-19 infection, what the impact was of maintenance therapy, and how delays in treatment affected disease outcomes in CTCL patients. We performed a retrospective analysis of data from the electronic medical records at 9 international academic medical centers in 7 countries from March to October 2020, including 149 patients, actively managed with an established diagnosis of cutaneous lymphoma. Patient demographics, date of diagnosis, staging details, treatment details, delays or changes to treatment regimens, disease outcomes, and COVID-19 disease history including the source of transmission were recorded (Fig 1). Treatment was delayed for 53.0% of patients for a mean of 3.2 months (range: 10 days-10 months). Adjusting for age, race, biological sex, COVID-19 status, and disease stage, treatment delay was associated with a significant risk of disease relapse or progression across all stages (odds ratio 5.00; 95% confidence interval [2.38, 11.0], P value < .001) and, for each additional month that a patient experienced treatment delay, the odds of disease progression increased by 37.0% (odds ratio 1.37; 95% confidence interval [1.14, 1.70], P value < .001) (Table I). A total of 28 (18.8%) patients with CTCL were diagnosed with COVID-19, none acquired from outpatient office visits. Patients who contracted COVID-19 did not have a statistically significant increase in odds of disease progression compared to COVID-19–negative patients (odds ratio 0.41; 95% confidence interval [0.15, 1.08], P value = .07).Table IDemographic and outcomes by treatment delay statusTreatment delay (n = 79) N (%)No treatment delay (n = 70) N (%)Total (N = 149) N (%)Age Mean6459 Median (IQR)65 (53, 78)62 (48, 72) Range28, 9522, 88Biological sex Male43 (54.4)40 (57.1)83 (55.7) Female36 (45.6)30 (42.9)66 (44.3)Race White60 (75.9)44 (62.9)104 (69.8) Black/African American8 (10.1)19 (27.1)27 (18.1) Other/unknown/declined11 (13.9)7 (10.0)18 (12.1)Stage IA-IIA40 (50.6)37 (52.9)77 (51.6) IIB11 (13.9)12 (17.1)23 (15.4) IIIA-IIIB4 (5.1)2 (2.8)6 (4.0) IVA1 (SS)19 (24.1)16 (22.9)35 (23.5) IVA2-IVB3 (3.8)3 (4.3)6 (4.0) PC CD30+ LPD2 (2.5)0 (0.0)2 (1.3)COVID-19 status Positive18 (22.8)10 (14.3)28 (18.8) Negative61 (77.2)60 (85.7)121 (81.2)Length of treatment delay (mo) Mean3.200.00 Median (IQR)3.00 [1.05, 4.00]0.00 [0.00, 0.00] Range0.30, 10.000.00, 0.00 Unknown20Outcomes Improvement of disease5 (6.3)10 (14.3)15 (10.1) Stable disease15 (19.0)36 (51.4)51 (34.2) Disease progression/relapse52 (65.8)22 (31.4)74 (49.7) Deceased7 (8.9)2 (2.9)9 (6.0) Open table in a new tab Based on the results of this study, we conclude the following:1.Adequate safety measures and protocols can prevent transmission of COVID-19 at physicians' offices as no outpatient office-acquired infections were reported.2.Patients with cutaneous lymphomas who develop COVID-19 do not have worse outcomes than expected according to their risk factors.3.As the pandemic continues, our data reveals the need to re-evaluate the initial recommendations made by the USCLC and EORTC-CLTG, and it provides reassurance that our current COVID-19–conscious management practices are safe and effective.4.Delays in therapy lead to adverse clinical outcomes and should be avoided, as the risk of contracting COVID-19 in the outpatient setting did not outweigh the risk of morbidity and mortality due to disease progression.5.Ensuring continuity of treatment and maintenance therapy appears critical to avoiding disease progression, underscoring the importance of maintenance therapy for CTCL. None disclosed.

S141 Long-Term Risk of Colorectal Cancer in Patients With Prediabetes : A Systematic Review and Meta-Analysis

Introduction: Prediabetes is often underdiagnosed and underreported due to its asymptomatic state in over 80% of individuals. Considering its role in promoting cancer incidence and limited evidence linking prediabetes and colorectal cancer (CRC), we conducted a meta-analysis to evaluate the incidence of colorectal cancer in people with prediabetes. (Figure) Methods: A comprehensive search through PubMed/Medline, Embase, Scopus, and Google Scholar was performed until June 1, 2022, to screen for studies reporting colorectal cancer incidence/risk in prediabetics. Binary random-effects models were used to perform meta-analysis and subgroup analyses. Sensitivity analysis was done using leave-one-out method. Results: Seven prospective and one retrospective study comprising 15 cohorts and a pooled number of 854876 cases and 2190511 controls were included in the analysis (2 Japan, 2 Korea, 1 Sweden, 1 UK, 1 China, and 1 USA). After combining all the studies the forest plots for adjusted analysis shows a significant increase in odds of having CRC with prediabetes - (OR 1.16; 1.08–1.25, p< 0.01) (fig 1b) and unadjusted analysis also shows a significant increase in odds of having CRC with prediabetes (OR 1.62; 1.35–1.95, p< 0.01) (fig 1a). Sensitivity analysis using the Leave-one-out method did confirm equivalent results (fig 1c). Heterogeneity analysis for adjusted OR had moderate heterogeneity with an overall I^2 of 56.06% with a p value < 0.01 and for unadjusted OR had considerable heterogeneity with an overall I^2 of 85.72% with a p value less than 0.01. Subgroup analysis based on type of study, the odds of developing colorectal cancer was higher in prospective studies (OR 1.175; 1.065-1.298)(p 0.001) than retrospective studies(OR 1.162; 1.033- 1.306)(p 0.012) .The odds of developing cancer was not significantly higher in ages >60(OR 1.446; 0.887-2.356)(p 0.139) compared to less than 60 years. The strongest association b/w Prediabetes and CRC was found on a median 5-10 years(aOR 1.257; 1.029-1.534)(p 0.025) follow-up compared to < 5 years and 10 years and higher. Conclusion: This study showed nearly 16% higher long-term risk of colorectal cancer in patients with prediabetes. Lifestyle modifications like weight loss, proper diet, and exercise are essential to control prediabetes. This study further warrants a specific prediabetes screening for patients already at high risk of colorectal cancer with other risk factors. These strides would help subsequently lower the disease burden, and associated morbidity/mortality.Figure 1.: Forest Plot: Long-term Risk of Colorectal Cancer in Patients with Prediabetes vs Normoglycemia

Predicting disability retirement among Abu Dhabi police using multiple measure of sickness absence

BackgroundDisability retirement has been investigated in the last two decades using predictors such as measures of sickness absence, psychological, social, and organizational work factors. The impact of various health-related and sickness measures on disability retirement across various occupational group reveal a significant relation. However, current literature lacks understanding in police personnel.MethodsThis study examines the roles of demographic and measures of sickness absence on disability retirement among police personnel in Abu Dhabi, UAE. The case–control design was used to predict disability retirement wherein controls were matched with cases according to age and gender from those who worked in the same administration as the case at baseline, to reduce the possible confounding influence of these variables. Conditional logistic regression models were used determine the odds-ratio of various measures of sickness absence in predicting disability retirement.ResultsResults indicate that increased number of spells, and number of days of sickness absence can predict disability retirements among police personnel in the UAE. Results indicate that odds ratios for disability retirement for the total exposure period increased from 1.76 (95% CI = 1.42-2.20) for spells of 4-7d to 2.47 (95%CI = 1.79-3.40) for spells of > 4 weeks. When compared with their married counterparts, non-married police employees had a statistically significant increase in odds of disability retirement of almost three fold (OR = 2.93, 95% CI = 1.55-5.56). Non-field and field police officers, on the other hand, had significantly reduced odds of disability retirement compared with admin/supportive staff (OR = 0.43 and 0.28 with 95% CI = 0.19-0.96 and 0.13-0.61 respectively). Odds ratios of disability retirement at end of the exposure period for the matching variables with those obtained after additionally adjusting for all demographic variables (model b), namely, marital status, occupation, employment grade and type, and educational level. The odds ratios of disability retirement remained significantly raised for the total number of days of sickness absence and for the number of spells of sickness absence for all spell types.ConclusionsRecommendation to reduce the number of future disability retirements among Abu Dhabi Police include structured problem-solving process addressed through stepwise meetings between the line-managers and the employee.