Significant Association Research Articles

Long‐term implications of childhood and adolescent popularity for social behavior and status in emerging adulthood

AbstractPeer status is associated with social functioning throughout childhood and adolescence, but little is known about its’ long‐term implications. This study examined longitudinal associations of childhood and adolescent popularity with social behavior and status in emerging adulthood. In line with concurrent associations of popularity with social behavior, we hypothesized that childhood popularity would be associated with a positive, prosocial profile, and adolescent popularity would be associated with a powerful and forceful profile. As research has shown curvilinear associations of popularity with aggression in childhood and adolescence, we also examined whether longitudinal associations were curvilinear. Peer‐nominated popularity was measured at 9 and 16 years of age for 118 longitudinal participants. At age 24, they participated in a survey and an online video call session together with three unfamiliar peers, after which everyone in the session rated each other's social behavior. Results showed significant curvilinear associations of childhood and adolescent popularity with emerging adult social behavior and status. Childhood popularity was associated with positive, prosocial behavior and status indicators, showing that in addition to high childhood popularity, also low childhood popularity was associated with higher peer‐reported positive, prosocial behavior. High adolescent popularity was associated with both positive, prosocial, and powerful and forceful behavior and status indicators, with especially low adolescent popularity associated with lower levels of these behaviors and status in emerging adulthood. Childhood and adolescent popularity were thus uniquely and differentially associated with social behavior and status in emerging adulthood.

The cumulative prospect theory and fund flows in emerging markets

ABSTRACT This study is the first to examine the efficacy of the Cumulative Prospect Theory value of the past return (CPTV) to explain fund flow in emerging markets funds by considering the impact of fund managers’ characteristics and behavioural biases on fund investors’ investment decisions. Besides, this study also investigates the impact of fund investors’ ability to identify fund managers’ skills. The findings suggest that CPTV has a significant and positive association with subsequent fund flow and emerging market funds’ performance. Notably, the study documents a negative relationship between fund flow and fund size and also highlights that newer funds generate greater fund flows. Furthermore, the findings indicate that investors investing in emerging market funds tend to behave differently, allocate money for alpha, and avoid giving distorted income for factor-related returns to fund managers. The results demonstrate that managers’ skill and portfolio concentration decision affects fund flow and CPTV relationships. The findings illustrate that fund managers who concentrate their portfolio and invest in high CPTV stocks tend to generate higher fund flow than their diversified counterparts.

An Investigation into Demographic Disparities in Emergency Department Disposition Decisions

We investigate the presence of health disparities in emergency department (ED) disposition decisions and if crowding levels might have an exacerbating role. Using data from a large, academic ED, we find statistically significant associations between ED disposition decisions and patient sex, race, as well as ethnicity, with male, Caucasian, and non-Hispanic patients being more likely to be admitted to the hospital compared with, respectively, female, African-American, and Hispanic patients. In line with earlier findings in other studies, we find that longer waiting times, suggesting higher levels of ED crowding, is associated with higher rates of admission. Moreover, longer ED wait times modified sex differences, suggesting that the disposition disparity in female patients might be exacerbated when the ED is more crowded.

Serum betaine and dimethylglycine in mid-pregnancy and the risk of gestational diabetes mellitus: a case-control study.

To investigate the associations of choline, betaine, dimethylglycine (DMG), L-carnitine, and Trimethylamine-N-oxide (TMAO) with the risk of Gestational diabetes mellitus (GDM) as well as the markers of glucose homeostasis. We performed a case-control study including 200 diagnosed GDM cases and 200 controls matched by maternal age (±2 years) and gestational age (±2 weeks). Concentrations of serum metabolites were measured by the high-performance liquid chromatography - tandem mass spectrometry (HPLC-MS/MS). Compared to the control group, GDM group had significantly lower serum betaine concentration and betaine/choline ratio, and higher DMG concentration. Furthermore, decreased betaine concentration and betaine/choline ratio, increased DMG concentration showed significant association with the risk of GDM. In addition, serum betaine concentrations were negatively associated with blood glucose levels at 1-h post-glucose load (OGTT-1h), and both betaine and L-carnitine concentrations were positively associated with 1,5-anhydroglucitol levels. Betaine/choline ratio was negatively associated with OGTT-1h and blood glucose levels at 2-h post-glucose load (OGTT-2h) and serum choline concentrations were negatively associated with fasting blood glucose and positively associated with OGTT-2h. Decreased serum betaine concentrations and betaine/choline ratio, and elevated DMG concentrations could be significant risk factors for GDM. Furthermore, betaine may be associated with blood glucose regulation and short-term glycemic fluctuations.

A comparison of Bayesian and frequentist approaches to incorporating clinical and biological information for the prediction of response to standardized pediatric colitis therapy.

The prospective cohort study PROTECT is the largest study in pediatric ulcerative colitis (UC) with standardized treatments, providing valuable data for predicting clinical outcomes. PROTECT and previous studies have identified characteristics associated with clinical outcomes. In this study, we aimed to compare predictive modeling between Bayesian analysis including machine learning and frequentist analysis. The key outcomes for this analysis were week 4, 12 and 52 corticosteroid (CS)-free remission following standardized treatment from diagnosis. We developed predictive modeling with multivariable Bayesian logistic regression (BLR), Bayesian additive regression trees (BART) and frequentist logistic regression (FLR). The effect estimate of each risk factor was estimated and compared between the BLR and FLR models. The predictive performance of the models was assessed including area under curve (AUC) of the receiver operating characteristic (ROC) curve. Ten-fold cross-validation was performed for internal validation of the models. The estimation contained 95% credible (or confidence) interval (CI). The statistically significant associations between the risk factors and early or late outcomes were consistent between all BLR and FLR models. The model performance was similar while BLR and BART models had narrower credible intervals of AUCs. To predict week 4 CS-free remission, the BLR model had AUC of 0.69 (95% CI 0.67-0.70), the BART model had AUC of 0.70 (0.67-0.72), and the FLR had AUC of 0.70 (0.65-0.76). To predict week 12 CS-free remission, the BLR model had AUC of 0.78 (0.77-0.79), the BART model had AUC of 0.78 (0.77-0.79), and the FLR model had AUC of 0.79 (0.74-0.83). To predict week 52 CS-free remission, the BLR model had AUC of 0.69 (0.68-0.70), the BART model had AUC of 0.69 (0.67-0.70), and the FLR model had AUC of 0.69 (0.64-0.74). The BART model identified nonlinear associations. BLR and BART models had intuitive interpretation on interval estimation, better precision in estimating the AUC and can be alternatives for predicting clinical outcomes in pediatric patients with UC. BART model can estimate nonlinear nonparametric association.

Determinants of public health expenditure in the EU.

Public health expenditure is one of the fastest-growing spending items in EU member states. As the population ages and wealth increases, governments allocate more resources to their health systems. In view of this, the aim of this study is to identify the key determinants of public health expenditure in the EU member states. This study is based on macro-level EU panel data covering the period from 2000 to 2018. The association between explanatory variables and public health expenditure is analyzed by applying both static and dynamic econometric modeling. Although GDP and out-of-pocket health expenditure are identified as the key drivers of public health expenditure, there are other variables, such as health system characteristics, with a statistically significant association with expenditure. Other variables, such as election year and the level of public debt, result to exert only a modest influence on the level of public health expenditure. Results also indicate that the aging of the population, political ideologies of governments and citizens' expectations, appear to be statistically insignificant. Since increases in public health expenditure in EU member states are mainly triggered by GDP increases, it is expected that differences in PHE per capita across member states will persist and, consequently, making it more difficult to attain the health equity sustainable development goal. Thus, measures to reduce EU economic inequalities, will ultimately result in reducing disparities in public health expenditures across member states.

Psychiatrists’ Engagement in Research as a Pathway towards the Expansion of Distributed Medical Education (DME): A Regional Analysis across Two Provinces in Atlantic Canada

In the context of Canadian medical education, Distributed Medical Education (DME) plays a crucial role in addressing healthcare disparities, particularly in rural areas. This study focuses on the Department of Psychiatry at Dalhousie University, analyzing psychiatrists’ engagement and willingness to participate in research at DME sites in Nova Scotia (NS) and New Brunswick (NB). The cross-sectional study, encompassing data from an environmental scan, surveyed 60 psychiatrists involved in medical education across seven health zones. Results revealed significant associations between gender, type of graduates, and specialist training. A majority of psychiatrists (68.3%) do not currently engage in mental health or translational research, citing barriers such as a lack of protected time and financial incentives. Notably, participants expressed interest in future research areas, including health services/quality improvement and addiction research. Geriatric psychiatry, predominantly female-dominated, lacked current research activities. The study emphasizes the need to address barriers and promote motivators, both intrinsic and extrinsic, to enhance psychiatrists’ research engagement. This strategic approach is essential for fostering active participation in research, thereby contributing to the expansion of DME sites in Atlantic Canada and beyond.

Prevalence and patterns of cerebral venous sinus thrombosis following vestibular schwannoma surgery: a systematic review and meta-analysis.

Cerebral venous sinus thrombosis (CVST) is a potentially serious complication following surgical treatment of vestibular schwannoma, a benign tumor originating from Schwann cells of the vestibulocochlear nerve. This study aimed to determine the prevalence of CVST following surgical treatment of vestibular schwannoma and the factors contributing to its occurrence. Two independent researchers searched the global databases of PubMed, Web of Science, Scopus, and the Cochrane Library up to September 01, 2023. We employed a random-effects model for data analysis. Heterogeneity was evaluated using the I2 test. To assess the quality of the studies meeting our inclusion criteria, we employed the Joanna Briggs Institute Critical Appraisal Checklist. We included 23 articles in this meta-analysis. The pooled prevalence of CVST after vestibular schwannoma surgery was 6.4% (95%CI 3.4-11.5%). The pooled prevalence of CVST following the retrosigmoid (RS), translabyrinthine (TL), and middle cranial fossa (MCF) approaches was 4.8% (95%CI 2.0-11.0%), 9.6% (95%CI 4.3-20.3%) and 9.9% (95%CI 1.6-42.2%), respectively, revealing a significant difference between the TL and the RS approaches (Odds ratio=2.10, 95%CI 1.45-3.04, P< 0.001).The sigmoid sinus exhibited the highest post-operative thrombosis rate (7.9%), surpassing the transverse sinus (3.7%) and involvement of both sigmoid and transverse sinuses (1.6%), respectively. No significant associations were found with demographic or surgical factors. In the current meta-analysis, we identified a 6.4% CVST prevalence following vestibular schwannoma surgery, with varying rates depending on the surgical approach. No significant associations with patient or surgical factors were found, emphasizing the need for heightened clinical vigilance and further research in this context. PROSPERO ID: CRD42023453513.

Body composition, physical activity, and menopause symptoms: how do they relate?

This study characterized the impact of physical activity (light, moderate, and vigorous [VIG] active minutes per day) and body composition (percent body fat [%BF] and fat-free mass index) on total menopausal symptoms (TMSs) in 72 premenopausal, perimenopausal (PERI), or postmenopausal women. Activity minutes were collected from wearable fitness trackers. Body composition was evaluated using a whole-body dual-energy x-ray absorptiometry scan. TMSs were quantified using The North American Menopause Society Questionnaire. Significant associations were observed between TMSs and %BF ( r = 0.464, P < 0.001) and VIG ( r = -0.245, P = 0.038). %BF and VIG were significant predictors for TMSs across groups ( R2 = 0.146 and R2 = 0.092, respectively), but only %BF maintained for PERI ( R2 = 0.421, P < 0.001). %BF predicted nearly half of the variance in PERI TMSs, whereas VIG predicted 9% of the sample variance, demonstrating an important influence of body fat accumulation and intense physical activity in the menopause transition. High-intensity exercise interventions to alleviate body composition changes may also reduce menopausal-related symptoms for PERI women.

Discharge Against Medical Advice from Neonatal Intensive Care Unit and Some Influencing Factors in an Academic Center

Background: Early discharge from the hospital against medical advice poses a significant threat to the health of patients, particularly neonates, who are a vulnerable population. Objectives: This study aimed to determine the frequency of neonatal discharge with personal consent and identify the most influential factors. Methods: This retrospective cross-sectional study was conducted at Alzahra Hospital in Rasht from 2020 to 2021. Using a census method, information on all infants discharged against medical advice was extracted from the hospital's clinical records available in the information system. Data on the reason for neonatal hospitalization and discharge against medical advice, neonatal age, weight, maternal education, and insurance status were recorded. Results: Among 2327 neonates, 581 (24.96%) were discharged from the hospital against medical advice. The primary cause of early discharge was related to family problems (64.4%), followed by dissatisfaction with the hospital and treatment process (15.3%), prolonged hospitalization (11%), and financial problems (9.3%). A significant association was found between neonatal age, weight, type of delivery, maternal education, insurance status, and the reason for hospitalization with the reason for discharge against medical advice (all P &lt; 0.001). Conclusions: The rate of discharge against medical advice in this study was notably higher compared to other studies, possibly due to the timing of the study coinciding with the peak of COVID-19 and the different reasons for hospitalization, such as icterus versus sepsis. Family problems were identified as the main cause of discharge against medical advice, while financial problems were the least common. Therefore, practical and preventive solutions should be provided to families whenever possible.

Prevalence of Hypogonadism and Associated Risk Factors among Newly Diagnosed ART Naïve HIV-Infected Males in Mwanza, Tanzania.

Hypogonadism is frequent among HIV-infected males and might have significant clinical impact leading to sexual impairment and metabolic derangement. There is limited information about the magnitude of hypogonadism and its associated factors among people living with HIV in Tanzania. We aimed to determine the prevalence of hypogonadism and associated risk factors among newly diagnosed ART naïve HIV-infected men in Mwanza, Tanzania. Newly diagnosed ART naïve HIV-infected men were enrolled at Voluntary Counseling and Testing Centres of four selected hospitals in the Mwanza region and subjected to thorough clinical and general physical examination including anthropometric measurements. A prestructured questionnaire was used to collect sociodemographic characteristics and clinical data. Serum total testosterone, follicle-stimulating hormone, luteinizing hormone, and estradiol were estimated. Serum total testosterone <300 ng/dl or testosterone >300 ng/dl with high LH and FSH (compensatory hypogonadism) was taken as markers of hypogonadism. Data were analyzed using STATA version 15. Of the 388 enrolled participants, hypogonadism was found in 47.9%, with secondary hypogonadism (83.9%, 156/186) being the most frequent form. Logistic regression analysis showed a significant association between hypogonadism and CD4+ count (OR 2.0; 95% CI 1.1-3.6; p=0.022), decreased libido (OR 1.6; 95% CI 1.1-2.4; p=0.024), age of above 46 years (OR 2.3; 95% CI 1.1-4.6; p=0.023), herbal medicine use (OR 2.4; 95% CI 1.5-3.9; p < 0.001), WHO clinical stage 3 (OR 2.7; 95% CI 1.4-5.2; p=0.003), and weight loss (OR 1.8; 95% CI 1.1-3.0; p=0.016). Hypogonadism was found in nearly half (47.9%) of ART naïve HIV-infected men. The majority (83.9%) had secondary hypogonadism. There was a significant association of hypogonadism with older age, herbal medicine use, weight loss, advanced clinical stage, CD4+ count, and decreased libido.

Clinical profile and outcome of acute kidney injury in children admitted to paediatric intensive care unit: A prospective observational study

Introduction: Acute kidney injury (AKI) is a commonly encountered problem in the paediatric intensive care unit (PICU). There are limited reports on paediatric AKI from the Indian subcontinent. Objective: To determine the incidence, aetiology and outcome in paediatric AKI using Acute Kidney Injury Network (AKIN) criteria. Method: This prospective observational study was conducted in the PICU of a teaching hospital in Western Maharashtra, India, from July 2016 to June 2017 on patients aged 1 month to 17 years. Results: The incidence of AKI was 18.8% (80/426). The mean age was 70 ± 60 months. Most (66.3%) cases had stage I AKI and 54% developed AKI within 72 hours. Sepsis (35%), pneumonia (25%) and tropical febrile illnesses (18.7%) were the common aetiologies. Complete recovery (CR) was seen in 79% and partial recovery (PR) in 21%. CR was highest in stage I (91%) as compared to stages II and III (p=0.005). Mortality was 22% (18/80). Mortality significantly increased with the stage of AKI (p=0.003). Mechanical ventilation, inotrope support, shock and the stage of AKI had a significant association with mortality on bivariate analysis. Mechanical ventilation was found to be a significant independent predictor of mortality (p= 0.011). Renal replacement therapy was needed in 6 (8%) cases. Conclusions: About one-fifth of children admitted to ICU developed AKI and most experienced mild transient AKI. Moderate to severe AKI carried high mortality suggesting a dose-response effect. Infections remain the commonest cause and mechanical ventilation was an independent predictor of mortality.

Association between fetal fraction of cell-free DNA and adverse pregnancy outcomes.

To determine the association between fetal fraction (FF) levels in cell-free fetal DNA (cffDNA) testing and adverse pregnancy outcomes. This retrospective cohort study, conducted at a single center, involved 2063 pregnant women with normal 1st and 2nd trimester non-invasive prenatal test (NIPT) results between 2016 and 2021. Pregnancy outcomes were examined by determining the < 4% and < 5th percentile (3.6%) cut-off values for low fetal fraction (LFF). Pregnancy outcomes were also examined by dividing the FF into population-based quartiles. Adverse pregnancy outcomes were pregnancy-induced hypertensive diseases (PIHD), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), intrahepatic cholestasis of pregnancy (ICP), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, and 1st and 5th minutes low APGAR scores (< 7). PIHD was significantly higher in LFF (< 4% and < 5th percentile) cases (p = 0.015 and p < 0.001, respectively). However, in population-based quartiles of FF, PIHD did not differ significantly between groups. Composite adverse maternal outcomes were significantly higher in the FF < 4% group (p = 0.042). When analyzes were adjusted for maternal age, BMI, and gestational age at NIPT, significance was maintained at < 4%, < 5th percentile LFF for PIHD, and < 4% LFF for composite adverse maternal outcomes. However, there was no significant relationship between LFF with GDM, ICP and PTB. Additionally, there was no significant association between low APGAR scores, SGA, LGA, LBW, macrosomia, and LFF concerning neonatal outcomes. Our study showed that LFF in pregnant women with normal NIPT results may be a predictor of subsequent PIHD.

Clinical Outreach Training and Supportive Supervision Quality-of-Care Analysis: Impact of Readiness Factors on Health Worker Competencies in Malaria Case Management in Cameroon, Mali, and Niger.

Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.

Cutaneous toxicities of mitogen-activated protein kinase inhibitors in children and young adults with neurofibromatosis-1.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder which commonly causes neoplasms leading to disfigurement or dysfunction. Mitogen-activated protein kinase inhibitors (MEKi) are generally well-tolerated treatments which target neural tumor progression in patients with NF1. However, cutaneous adverse events (CAEs) are common and may hinder patients' abilities to remain on treatment, particularly in children. We aim to characterize CAEs secondary to MEKi treatment in pediatric and young adult patients with NF1. We reviewed institutional medical records of patients under 30 years with a diagnosis of "NF1," "NF2," or "other neurofibromatoses" on MEKi therapy between January 1, 2019 and June 1, 2022. We recorded the time-to-onset, type, and distribution of CAEs, non-cutaneous adverse events (AEs), AE management, and tumor response. Our cohort consisted of 40 patients with NF1 (median age, 14 years). Tumor types included low-grade gliomas (51%) and plexiform neurofibromas (38%). MEKi used included selumetinib (69%), trametinib (25%), and mirdametinib (6%). A total of 74 CAEs occurred, with 28 cases of acneiform rash (38%). Other common CAEs were paronychia, seborrheic dermatitis, eczema, xerosis, and oral mucositis. The most common treatments included oral antibiotics and topical corticosteroids. Most patients had clinical (stable or improved) tumor response (71%) while 29% had tumor progression while on a MEKi. There was no significant association between CAE presence and tumor response (p = 0.39). Improvement in characterization of MEKi toxicities and their management is important to develop treatment guidelines for pediatric and young adult patients with NF1 on MEKi therapy.

Exploring associations between pregnancy cravings and sociodemographic, lifestyle and health factors: insights from a cross-sectional population study in Jordan

ObjectiveTo explore the potential associations between pregnancy cravings and various sociodemographic, lifestyle and health factors.DesignCross-sectional study.SettingPopulation-based study in Jordan.ParticipantsA total of 500 women who had children and experienced pregnancy cravings...

Age-specific comparisons in the rate of force development of toe pressure strength and its association with the timed up and go test.

It has recently been recommended that Rate of Force Development (RFD) be evaluated in addition to maximal muscle strength. There are no studies on RFD of toe pressure strength, and its importance in older adults and the extent to which it is associated with aging needs to be clarified. This study purpose was to examine the association between the RFD of toe pressure strength and timed up and go test (TUG) in an age-specific study. This study is a cross-sectional study. Participants in the study included 159 younger adults (26.3 ± 13.1years, 52% male) and 88 older adults (75.0 ± 6.2years, 26% male). The RFD of toe pressure strength was determined from the force-time curve obtained during the toe pressure strength assessment, and the ability to exert maximum muscle force in the shortest possible time was assessed. Regression analysis was performed for each group to test the association between RFD of toe pressure strength and TUG by age. Younger adults showed no association between TUG and RFD of toe pressure strength, and significant association between TUG and RFD of toe pressure strength was found only in the older adults (standard regression coefficient = - 0.19, p = 0.048). This study showed a significant association between TUG and RFD of toe pressure strength in older adults. These findings show that RFD is one of the functions that should be assessed, particularly in older adults. Furthermore, it was suggested that approaching RFD could improve gait, standing, and sitting movements.

Progranulin and neuropathological features of Alzheimer’s disease: longitudinal study

BackgroundProgranulin is an anti-inflammatory protein that plays an essential role in the synapse function and the maintenance of neurons in the central nervous system (CNS). It has been shown that the CSF level of progranulin increases in Alzheimer’s disease (AD) patients and is associated with the deposition of amyloid-beta (Aβ) and tau in the brain tissue. In this study, we aimed to assess the longitudinal changes in cerebrospinal fluid (CSF) progranulin levels during different pathophysiological stages of AD and investigate associated AD pathologic features.MethodsWe obtained the CSF and neuroimaging data of 1001 subjects from the ADNI database. The participants were classified into four groups based on the A/T/N framework: A + /TN + , A + /TN−, A−/TN + , and A−/TN−.ResultsBased on our analysis there was a significant difference in CSF progranulin (P = 0.001) between ATN groups. Further ANOVA analysis revealed that there was no significant difference in the rate of change of CSF-progranulin ATN groups. We found that the rate of change of CSF progranulin was associated with baseline Aβ-PET only in the A−/TN + group. A significant association was found between the rate of change of CSF progranulin and the Aβ-PET rate of change only in A−/TN + ConclusionOur findings revealed that an increase in CSF progranulin over time is associated with faster formation of Aβ plaques in patients with only tau pathology based on the A/T/N classification (suspected non-Alzheimer’s pathology). Together, our findings showed that the role of progranulin-related microglial activity on AD pathology can be stage-dependent, complicated, and more prominent in non-AD pathologic changes. Thus, there is a need for further studies to consider progranulin-based therapies for AD treatment.

Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study

BackgroundFew Australian studies have examined the incidence of prescribed opioid use prior to primary total knee or total hip arthroplasty (TKA, THA) and whether it predicts post-surgery outcomes. A recent Australian study demonstrated that the prevalence of pre-arthroplasty opioid use was approximately 16%. In the United States, approximately 24% of people undergoing TKA or THA are chronic opioid users preoperatively.PurposeThis study aimed to determine (i) the proportion of TKA and THA patients who use prescribed opioids regularly (daily) before surgery (i.e., opioid use reported between the time of waitlisting and any time up to 3 months before surgery), (ii) if opioid use before surgery predicts (a) complication/readmission rates to 6-months post-surgery, and (b) patient-reported outcomes to 6-months post-surgery.MethodsA retrospective cohort study of patients who underwent TKA or THA between January 2013 and June 2018 from two Australian public hospitals was undertaken utilizing linked individual patient-level data from two prospectively collected independent databases comprising approximately 3,500 and 9,500 people (database contained known opioid usage data within the 5-year time frame). Inclusion criteria included (i) primary diagnosis of osteoarthritis of the index joint, (ii) primary elective THA or TKA, and (iii) age ≥ 18 years. Exclusion criteria included (i) revision arthroplasty, (ii) non-elective arthroplasty, (iii) hip hemiarthroplasty, (iv) uni-compartmental knee arthroplasty, and (v) previous unilateral high tibial osteotomy.ResultsAnalysis was completed on 1,187 study participants (64% female, 69% TKA, mean (SD) age 67 [9.9]). 30% were using regular opioids preoperatively. Adjusted regression analyses controlling for multiple co-variates indicated no significant association between preoperative opioid use and complications/readmission rates or patient-reported outcomes to 6 months post-surgery. Model diagnostics produced poor discrimination for area under the curves and non-significant goodness of fit tests. Pre-arthroplasty opioid use was associated with lower health-related quality of life (EuroQol-Visual Analogue Scale) compared to non-opioid users undergoing primary THA (mean difference -5.04 [-9.87, -0.22], P = 0.04, Adjusted R2 = 0.06)ConclusionIn this study, 30% of patients were using prescribed opioids daily prior to primary TKA or THA. Pre-arthroplasty opioid use was not associated with postoperative adverse events or patient-reported pain, function, or global perceived improvement up to six months post-surgery.

Stock Prices and COVID-19 Stimulus Policies: Evidence From Tourism and Hospitality Industry

This study examines the impact of economic stimulus policies on tourism-related firms’ stock prices, after movement restriction announcements, and differences in the relationships between economic policy responses and stock prices for large firms vis-à-vis small firms. Using a cross-section data of 888 firms from 56 countries listed on several stock exchanges, we find a positive and significant association between the COVID-19 economic stimulus index and 1- and 2-week average changes in tourism firms’ stock prices after movement restriction announcements. Tourism firms’ stock prices responded favorably to the introduction of macrofinancial packages and monetary policies. This study complements the literature on stock market reactions during the pandemic and contributes to the growing body of literature examining its overall effect.