Odds Ratio Research Articles

Experiences of Pregnant and Parenting Adolescents and Young Women During COVID-19 Pandemic: A Mixed-Methods Study Among Girls and Women in Kenya

PurposeThis study examines the experiences of pregnant/parenting adolescents and young women during the first two years of the coronavirus disease 2019 (COVID-19) pandemic. MethodsThis explanatory sequential mixed-methods study leverages quantitative data collected among a cohort of adolescents and young people aged 15–22 years in three Kenyan counties; Nairobi, Kisumu, and Kilifi at three time points (2020, 2021, 2022), and two rounds of qualitative interviews in the same settings conducted in 2020 and 2022. ResultsAmong 2337 (2020), 1438 (2021), and 1669 (2022) respondents, pregnant/parenting adolescents and youth comprised 140 (6%), 101 (7%), and 83 (5%) individuals, respectively. Across the three time points, the experience of depressive symptoms was similar between pregnant/parenting adolescents and those not pregnant/parenting. Pregnancy and parenting was associated with twice the odds of skipping health services (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.43–3.35), in 2020, and 85% higher odds (aOR 1.85, 95% CI 1.14–3.02) in 2021, and 90% higher odds of skipping meals (aOR 1.90, 95% CI 1.19–3.03) in 2022. Qualitative findings indicated experiences of psychological distress, food insecurity, and inadequate access to health care services among pregnant/parenting young people during the pandemic. DiscussionThe pandemic increased pre-existing challenges associated with adolescent and young people's health, predisposing young pregnant/parenting women to greater adversity than their nonpregnant/parenting counterparts. Targeted and responsive approaches during emergencies and crises such as social protection, food security, and mental health programs for this group of vulnerable people are required and need to be integrated into disaster response plans.

"What Matters" in the Emergency Department: A Prospective Analysis of Older Adults' Concerns and Desired Outcomes.

To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes. As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED. We performed a secondary analysis of a multicenter prospective observational study. The study enrolled 1013 patients aged 65 and older during an ED encounter and performed 90-day follow-up interviews. The primary outcome was the quantification of "What Matters" (concerns and desired outcomes) to older adults during emergency care. As secondary outcomes, we assessed concerns at day 90, if desired outcomes were met at follow-up, and patient characteristics associated with outcome achievement by estimating multivariable logistic regression models. Older adults reported specific concerns at the time of the ED visit including: (1) symptom identification and/or persistence (31.4%), (2) ability to take care of oneself (19.4%), and (3) end-of-life (17.8%). Desired outcomes expressed by participants included: (1) getting well and symptom resolution (72.0%), (2) obtaining a diagnosis (25.7%), and (3) functional independence (19.5%). At day 90 follow-up, concerns remained similar to the initial ED visit, and the majority of participants (66.2%) achieved their desired outcome. Frailty (adjusted odds ratio = 0.56, 95% CI: 0.38-0.83, P < 0.01) was associated with older adults not meeting their desired outcomes. Older adults identified a variety of concerns during emergency care, and two-thirds reported that desired outcomes were met at longitudinal day 90 follow-up.

Unintended Pregnancy After Kidney Transplantation

OBJECTIVE: To define risk factors, obstetric morbidity, and allograft outcomes associated with an unintended pregnancy after kidney transplant. METHODS: This is a retrospective cohort study of pregnancies in women after kidney transplantation enrolled in the Transplant Pregnancy Registry International with births between 1967 and 2019, with cohorts categorized as intended pregnancies and unintended pregnancies. The primary outcome was acute kidney rejection during pregnancy or by 6 weeks postpartum. Secondary outcomes included allograft loss, severe maternal morbidity, and neonatal composite morbidity. Multivariable logistic regression, Kaplan–Meier curves, and Cox proportional hazards regression models were performed, with adjustment for covariates pertinent to allograft function. RESULTS: Among 1,723 pregnancies of kidney transplant recipients, 1,081 (62.7%) were intended and 642 (37.3%) were unintended pregnancies. Risk factors for unintended pregnancy included younger age, Black race, nulliparity, chronic hypertension, and transplant from a deceased donor. Exposure to mycophenolate products (16.0% vs 5.7%) and termination (4.7% vs 0.4%) were more common in unintended pregnancies (P&lt;.001). Unintended pregnancy was not associated with acute kidney rejection (2.3% vs 0.9%, adjusted odds ratio [AOR] 2.38, 95% CI, 0.91–6.30, P=.08). Unintended pregnancy was independently associated with allograft loss at 2 years from the end of pregnancy (8.1% vs 3.5%, AOR 2.27, 95% CI, 1.32–3.94, P=.003) but not allograft survival (adjusted hazard ratio 1.22, 95% CI, 1.00–1.49, P=.05). There were no differences in severe maternal morbidity (3.3% vs 3.6%) or neonatal composite morbidity (12.9% vs 14.3%) by pregnancy intention. CONCLUSION: Unintended pregnancy was not associated with acute kidney allograft rejection in the peripartum period, but it was associated with mycophenolate exposure and allograft loss at 2 years from pregnancy. The same social vulnerabilities that underlie difficulty in accessing reproductive care may be similarly important for transplant health. We recommend prepregnancy counseling and longitudinal follow-up of transplant recipients to reduce rates of unintended pregnancy and to optimize transplantation success over time.

Understanding Whether Economic Instability and Food Insecurity During COVID-19 Moderate the Change in Emotional Abuse and Emotional Neglect Over Time: A Longitudinal Pre- and During COVID-19 Analysis From China, Democratic Republic of Congo, Indonesia, and Malawi

PurposeThis study explores whether economic instability or food insecurity moderates the changes in emotional abuse and neglect over time. MethodsWe used data from the Global Early Adolescent Study, a longitudinal study among adolescents ages 13–18 years (10–14 during pre–COVID-19 round) from poor urban communities in China (n = 387), the Democratic Republic of Congo (DRC) (n = 285), Indonesia (n = 400), and Malawi (n = 320). Data were collected before (2017 to March 2020) and during the pandemic (June to November 2020). Generalized estimating equations, using inverse probability weights evaluated changes in emotional abuse and neglect pre- and during COVID-19 and tested whether these changes varied by economic instability and food insecurity experiences during COVID-19. ResultsPre–COVID-19, emotional abuse ranged from 37.2% in DRC to 65.3% in Indonesia, and emotional neglect from 10.9% in DRC to 50.3% in Indonesia. The odds of emotional neglect increased in all sites during COVID-19 except Indonesia (adjusted odds ratio (aOR) ranging from 1.7 in China to 4.1 in Malawi). In Indonesia, odds of abuse and neglect decreased significantly during COVID-19 (aOR ranging from 0.4 to 0.7); however, emotional abuse and/or neglect declines was less pronounced for those who experienced economic instability and/or food insecurity. In Malawi, adolescents who experienced food insecurity had a significant increase in odds of emotional neglect during COVID-19. DiscussionThe COVID-19 pandemic exacerbated emotional neglect and emotional abuse among adolescents living in low- and middle-income countries, although this effect varies by place and population. In Malawi and Indonesia, adolescents who experienced economic instability and/or food insecurity had more unfavorable outcomes during COVID-19, highlighting the importance of social programs correcting inequities during pandemics.

Disparities in Utilization of Immune Checkpoint Inhibitor Therapy Among Older Patients With Advanced Non–Small Cell Lung Cancer: A SEER-Medicare Analysis

PURPOSE In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors. This study investigates the association between race/ethnicity and the utilization of immune checkpoint inhibitor (ICI) therapy among older patients with advanced NSCLC (aNSCLC). METHODS This retrospective study used data from the SEER-Medicare–linked database. The cohort included patients (age 66 years or older) diagnosed with aNSCLC (stage III/IV) between March 2015 and December 2017, and they were followed through December 2019. Race/ethnicity was categorized as non-Hispanic (NH)-White, NH-Black, Hispanic, and Other. ICI therapy utilization was determined by identifying any usage of ICI agents (nivolumab, pembrolizumab, atezolizumab, durvalumab, ipilimumab, and cemiplimab-rwlc) from the Medicare database. Multivariable logistic regression models assessed the association between race/ethnicity and ICI therapy utilization (yes, no). Effect measure modification analyses were conducted by sex, socioeconomic status, and comorbidity. RESULTS The final sample included 26,836 patients; 76.2% were NH-White, 10.1% NH-Black, 5.7% Hispanic, and 8.0% Other. The overall ICI therapy utilization proportion was 17.8%, varying across ethnicities: NH-Black 14.1%, Hispanic 16.3%, NH-White 18.4%, and Other 18.5%. In comparison with NH-White patients, NH-Black patients were 15% less likely to receive ICI therapy (adjusted odds ratio, 0.85 [95% CI, 0.75 to 0.96]). Furthermore, the association between race/ethnicity and utilization of ICI therapy was modified by comorbidity status, sex, and socioeconomic status. CONCLUSION NH-Black patients with aNSCLC were less likely to receive ICI therapy than their NH-White counterparts. Our findings indicate the racial/ethnic disparities in ICI therapy utilization and call for further interventions to optimize access to care.

The association of HIV status with triple-negative breast cancer in patients with breast cancer in South Africa: a cross-sectional analysis of case-only data from a prospective cohort study

Breast cancer is the most common malignancy diagnosed among women in South Africa, with the aggressive triple-negative subtype comprising approximately 15% of breast cancers in this population. South Africa has the largest population of people with HIV in the world. This study aims to evaluate the association between HIV status and the proportion of patients with breast cancer with the triple-negative subtype. We did a cross-sectional analysis of case-only data from the South African Breast Cancer and HIV Outcomes (SABCHO) study, a prospective cohort study recruiting patients with newly diagnosed breast cancer at six public hospitals in South Africa. We analysed data from patients who enrolled in SABCHO between Jan 1, 2015, and Jan 18, 2022. Women aged 18 years or older with newly diagnosed and histologically confirmed invasive breast cancer were eligible. Participants were classified as HIV-positive or HIV-negative by use of an ELISA-based HIV test done at the time of enrolment. We developed multivariable logistic regression models to test for an association between HIV status and the proportion of triple-negative relative to non-triple-negative breast cancers while adjusting for demographic and reproductive risk factors. Of the 4122 patients enrolled in the SABCHO cohort within our study timeframe, 239 patients were excluded due to unknown breast cancer subtype (n=141), HIV status (n=97), or race (n=1). 3883 women with breast cancer were included in the study, of whom 637 (16·4%) had triple-negative breast cancer, 894 (23·0%) were HIV-positive, and 186 (4·8%) had triple-negative breast cancer and HIV. Triple-negative breast cancer accounted for 186 (20·8%) of 894 breast cancers among women who were HIV-positive and 451 (15·1%) of 2989 breast cancers among women who were HIV-negative (p<0·0001). In the fully adjusted logistic regression model, HIV-positive status was associated with an increased proportion of triple-negative breast cancer (adjusted odds ratio [OR] 1·39, 95% CI 1·12-1·74, compared with women who were HIV-negative). When compared with women who were HIV-negative, the association between HIV-positive status and the proportion of triple-negative breast cancer was strongest among the subgroup of women with a duration of HIV infection of 2 years or longer (1·57, 1·23-2·00) and those on antiretroviral therapy (ART; 1·47, 1·16-1·87). Patients with breast cancer and chronic HIV who are on ART are more likely to have triple-negative breast cancer than patients with breast cancer without HIV. This association is independent of age, race, and reproductive factors. US National Institutes of Health, University of the Witwatersrand, South Africa Medical Research Council Common Epithelial Cancers Research Center, Conquer Cancer Foundation, and Varmus Global Scholars Fund.

Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage

OBJECTIVE: To evaluate whether individuals who have a placenta previa or low-lying placenta that resolves before delivery are at increased risk of postpartum hemorrhage and postpartum hemorrhage–related morbidity. METHODS: This was a prospective, multicenter, 1:3 matched cohort study of pregnant individuals with singleton gestations diagnosed with low placentation by transvaginal scan at 19 to 23 weeks of gestation between January 2021 and December 2023 at nine academic maternity centers (exposed participants). Unexposed participants were those with a normally located placenta, matched in a 1:3 ratio according to parity. Resolution of low placentation was diagnosed when placenta was at 20 mm or more from the internal os. Individuals with fetal anomalies, hematologic disorders, therapeutic anticoagulation, placenta accreta spectrum disorder, vasa previa, persistent low placentation at birth, and delivery at a nonenrolling center were excluded. Primary outcome was postpartum hemorrhage of 1,000 mL or more. Secondary outcomes included postpartum hemorrhage of 1,500 mL or more, use of second-line uterotonic drugs, blood transfusions, additional procedures to control bleeding, intensive care unit admission, and hospital stay for more than 7 days. Multivariable logistic regression adjusted for confounders was used to estimate independent associations with outcomes. RESULTS: The study population included 182 exposed and 589 unexposed participants. Individuals with resolved low placentation had higher rates of smoking (P=.024), prior dilation and curettage (P=.012), posterior placenta (P&lt;.001), and induction of labor (P=.038). Multivariate logistic regression analysis adjusted for confounders showed that exposed people had higher odds of postpartum hemorrhage of 1,000 mL or more (13.2% vs 4.1%, adjusted odds ratio [aOR] 3.1) compared with unexposed people and of use of second-line uterotonic drugs (28.0% vs 12.4%, aOR 2.69) and tranexamic acid (16.5% vs 7.5%, aOR 2.19), as well as hospital stay longer than 7 days (11.5% vs 3.4%, aOR 2.63). CONCLUSION: Individuals with resolved low placentation are at increased risk of postpartum hemorrhage and related complications compared with those who always had a normally located placenta.

Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort study

Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. We conducted a population-based national retrospective cohort study of children (0-9 years) and adolescents (10-17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9-3.1) and did not receive DOT (2.3, 1.9-2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2-2.0), illicit drug use (4.2, 3.4-5.1), tobacco use (1.6, 1.3-2.1), HIV infection (2.7, 2.2-3.4), and not receiving DOT (2.6, 2.3-2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3-0.9). In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals.

There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births. To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset. Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02-1.70); 0.95 (0.88-1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54-1.74); 0.85 (0.76-0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53-1.11), 0.90 (0.82-0.98)], neonatal intensive care unit admission [0.54 (0.28-1.00), 0.97 (0.86-1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68-1.67; only calculated once because of small numbers of events). Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.

Influence of behavioral and genetic variables on the prevalence of type 2 diabetes mellitus in middle-aged monks of Thailand

Diabetes mellitus (DM) and its associated complications present a major health problem for the Thai people, including Buddhist monks. This study aimed to identify the influence of behavioural and genetic variables on the prevalence of type 2 diabetes mellitus in middle-aged monks of Thailand. The study analyzed data from the health data centre of the Department of Public Health, Thailand, focusing on middle-aged monks in 76 provinces across 12 regions. The study recruited 6,408 Thai monks who met inclusion and exclusion criteria between October 2015-November 2019. Multivariable analysis was performed using a generalized linear mixed model, with adjusted odds ratios and 95% confidence intervals reported at a significance level of 0.05. Our study found that among the middle-aged monks of Thailand, 7.12% (95% CI: 6.49-7.78) had diabetes mellitus out of a total of 6,408. The results of our multivariable analysis showed that the following factors were associated with diabetes mellitus in monks of Thailand: respondents’ body mass index (BMI) ≥30 kg/m2 (AOR=4.26, 95% CI: 3.08-5.90, p-value &amp;lt;0.001), respondents with a family history of DM (AOR=3.37, 95% CI: 2.52-4.81, p-value&amp;lt;0.001), and respondent’s age ranges of 55-59 (AOR=2.87, 95% CI: 2.26-3.84, p-value&amp;lt;0.001), respectively. Diabetes millatus is significantly associated with the respondents who were obese, aged, and had a family history of DM. Therefore, a regular DM screening program as well as a timely health monitoring system for monks will enhance the diabetes control program in reducing the DM burden in Thailand.

The Roles of Cytoplasmic Polyadenylation Element Binding Protein 1 in Tumorigenesis.

CPEB1 is an alternative polyadenylation binding protein that promotes or suppresses the expression of related mRNAs and proteins by binding to a highly conserved Cytoplasmic Polyadenylation Element (CPE) in the mRNAs 3'UTR. It is found to express abnormally in multiple tumors and affect tumorigenesis through many pathways. This review summarizes the functions and mechanisms of CPEB1 in a variety of cancers and suggests new directions for future related treatments. A total of 95 articles were eligible for inclusion based on the year, quality of the research, and the strength of association with CPEB1. In this review, current research about how CPEB1 affects the initiation and progression of glioblastoma, breast cancer, hepatocellular carcinoma, gastric cancer, colorectal cancer, non-small cell lung cancer, prostate cancer, and melanoma are dissected, and the biomedical functions and mechanisms are summarized. CPEB1 mostly presents as a tumor suppressor for breast cancer, endometrial carcinoma, hepatocellular carcinoma, non-small cell lung cancer, prostate cancer, and melanoma. However, for glioblastoma, gastric cancer, and colorectal cancer, CPEB1 exhibts two opposing properties of tumorigenesis, either promoting or inhibiting it. CPEB1 is likely to serve as a target and dynamic detection index or prognostic indicator for its function of apoptosis, activity, proliferation, migration, invasion, stemness, drug resistance, and even ferroptosis in various cancers.

Association of Zinc Intake, Tobacco Smoke Exposure, With Metabolic Syndrome: Evidence from NHANES 2007-2018.

The objective was to explore the effect modification of zinc (Zn) intake levels on the relationship of tobacco smoke exposure and risk of metabolic syndrome (MetS) in children and adolescents. We used data from 2007-2018 National Health and Nutrition Examination Survey (N = 3701). MetS was considered as main endpoint. Weighted multivariable logistic regression models showed that high cotinine level (≥ 0.05ng/mL) was associated with increased odds of MetS [odds ratio = 1.54, 95% confidence interval: 1.01, 2.36], and the association between Zn intake levels and MetS did not demonstrate statistical significance. Importantly, the multiplicative interaction term between low Zn intake (≤ 4.89mg/1000kcal) and high cotinine level was related to higher odds of MetS (p-value for interaction 0.018). For the group with low Zn intake, high cotinine level was associated with increased odds of MetS. However, there was no significant relationship between cotinine levels and MetS risk in the group with high Zn intake. The effect modification by Zn intake on the relationship of tobacco smoke exposure and risk of MetS is significant in individuals who had a sedentary time of ≥ 6h, identified as non-Hispanic White, or resided in households with smokers. In short, low Zn intake may potentiate the association of tobacco smoke exposure and MetS risk in children and adolescents.

Composition of the neutralising antibody response predicts risk of BK virus DNAaemia in recipients of kidney transplants

BK polyomavirus (BKV) DNAaemia occurs in 10% of recipients of kidney transplants, contributing to premature allograft failure. Evidence suggests disease is donor derived. Hypothetically, recipient infection with a different BKV serotype increases risk due to poorer immunological control. Thus, understanding the composition and activity of the humoral anti-BKV responses in donor/recipient (D/R) pairs is critical. Using 224 paired pre-transplant D/R samples, BKV VP1 genotype-specific pseudoviruses were employed to define the breadth of the antibody response against different serotypes (ELISA) and, to characterise specific neutralising activity (nAb) using the 50% inhibitory concentration (LogIC50). Mismatch (MM) ratios were calculated using the ratio of recipient ELISA or nAb reactive BKV serotypes relative to the number of donor reactive serotypes. BKV DNAaemia was observed in 28/224 recipients of kidney transplants. These recipients had lower nAb titres against all the serotypes, with median logIC50 values of 1.19-2.91, compared to non-viraemic recipients' median logIC50 values of 2.13-3.30. nAb D/R MM ratios >0.67 associated with significantly higher risk of BKV viraemia, with an adjusted odds ratio of 5.12 (95% CI 2.07 to 13.04; p<0.001). Notably, a mismatch against donor serotype Ic and II associated with adjusted odds ratios of 8.12 (95% CI 2.10 to 35.61; p=0.002) and 4.52 (95% CI 1.19 to 19.23; p=0.03) respectively. 21 recipients demonstrated broadly neutralising responses against all the serotypes, none of whom developed BKV DNAaemia post-transplant. In contrast, there was poor concordance with PsV-specific ELISA data that quantified the total antibody response against different serotypes. BKV nAb mismatch predicts post-transplant BKV DNAaemia. Specific mismatches in nAb, rather than total seroreactivity, are key indicators of BKV risk post-transplant. This has the potential to risk-stratify individuals and improve clinical outcomes by influencing the frequency of monitoring and individualised tailoring of immunosuppression. Furthermore, detailed examination of individuals with broadly neutralising responses may provide future therapeutic strategies. The research was funded by St. Peters Trust, Royal Free Hospital Charity and Wellcome Trust (grant numbers RFCG1718/05, SPT97 and 204870/Z/WT_/Wellcome Trust/United Kingdom).

Features Associated With Different Inflammatory Phenotypes of Calcium Pyrophosphate Deposition Disease: A Study Using Data From the International American College of Rheumatology/EULAR Calcium Pyrophosphate Deposition Classification Criteria Cohort.

The study objective was to examine the disease, demographic, and imaging features associated with different inflammatory phenotypes of calcium pyrophosphate deposition (CPPD) disease, ie, recurrent acute calcium pyrophosphate (CPP) crystal arthritis, chronic CPP crystal inflammatory arthritis, and crowned dens syndrome (CDS). Data from an international cohort (assembled from 25 sites in 7 countries for the development and validation of the 2023 CPPD classification criteria from the American College of Rheumatology/EULAR) that met the criteria were included. Three cross-sectional studies were conducted to determine the phenotypic characteristics of recurrent acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and CDS. Multivariable logistic regression analysis was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI) to examine the association between potential risk factors and the inflammatory phenotype. Among the 618 people included (56% female; mean age [standard deviation] 74.0 [11.9] years), 602 (97.4%) had experienced acute CPP crystal arthritis, 332 (53.7%) had recurrent acute arthritis, 158 (25.6%) had persistent inflammatory arthritis, and 45 (7.3%) had had CDS. Recurrent acute CPP crystal arthritis associated with longer disease duration (aOR 2.88 [95% CI 2.00-4.14]). Chronic CPP crystal inflammatory arthritis was associated with acute wrist arthritis (aOR 2.92 [95% CI 1.81-4.73]), metacarpophalangeal joint osteoarthritis (aOR 1.87 [95% CI 1.17-2.97]), and scapho-trapezo-trapezoid (STT) joint osteoarthritis (aOR 1.83 [95% CI 1.15-2.91]), and it was negatively associated with either metabolic or familial risk for CPPD (aOR 0.60 [95% CI 0.37-0.96]). CDS was associated with male sex (aOR 2.35 [95% CI 1.21-4.59]), STT joint osteoarthritis (aOR 2.71 [95% CI 1.22-6.05]), and more joints affected with chondrocalcinosis (aOR 1.46 [95% CI 1.15-1.85]). CPPD disease encompasses acute and chronic inflammatory phenotypes, each with specific clinical and imaging features that need to be considered in the diagnostic workup.

A novel resident physician examination using clinical simulation video to assess clinical competence in Japan: a cross-sectional study

BackgroundThe general medicine in-training examination (GM-ITE) assesses physicians’ clinical knowledge. This study expanded on findings from a previous pilot study to assess the relationship between general medicine in-training examination (GM-ITE) scores and the diagnostic skills of resident physicians in Japan by employing an innovative clinical simulation video (CSV-IE).MethodsThis multicenter cross-sectional study included 4,677 resident physicians who took the GMITE between January 17 and 30, 2023. Participants watched the CSV-IE, depicting an emergency room scenario, and provided a diagnosis. The CSV-IE depicts an emergency case and provides a diagnosis. Discrimination indices were used to assess the CSV-IE’s effectiveness across clinical competence domains, and multilevel logistic regression was used to analyze physician- and hospital-level factors associated with correct diagnoses.ResultsCorrect diagnoses were provided by 470 participants (10.0%). The CSV-IE demonstrated high discriminatory power across all assessed domains, including basic clinical knowledge (DI = 0.44), symptomatology and clinical reasoning (DI = 0.31), physical examination and clinical procedure (DI = 0.35), and knowledge about the disease (DI = 0.25), supporting its utility as an effective assessment tool. In the multivariable analysis, factors associated with a higher likelihood of providing a correct CSV-IE diagnosis included a higher annual number of emergency outpatients (adjusted odds ratio: 1.025; 95% confidence interval [CI]: 1.003–1.047; P = .0230) and being in a higher postgraduate year (adjusted odds ratio: 1.387; 95% CI: 1.104–1.742; P = .005). Conversely, resident physicians at university hospitals were less likely to provide a correct CSV-IE response (adjusted odds ratio: 0.624; 95% CI: 0.435–0.896; P = .0107).ConclusionsCSV-IE modules may provide an integrative and realistic evaluation of clinical competence, addressing limitations of traditional MCQ-based assessments by offering contextualized, real-world scenarios that require dynamic decision-making and diagnostic reasoning.

Gender Differences in Anxiety-Induced Sleep Disturbance: A Survey Among In-School Adolescents in the Republic of Benin

Anxiety-induced sleep disturbance is a common phenomenon that affects the overall well-being and quality of life of school-going adolescents. Nonetheless, evidence on anxiety-induced sleep disturbance among adolescents in Benin is scarce. This study examined the gender differences in the prevalence and correlates of anxiety-induced sleep disturbance among in-school adolescents in the Republic of Benin. We conducted a secondary analysis of Benin’s 2016 Global School-Based Health Survey dataset involving 2496 in-school adolescents aged 13 years and above. The proportion of male and female students who reported anxiety-induced sleep disturbance was computed. The multivariable binary logistic regression analysis was conducted to determine the factors associated with anxiety-induced sleep disturbance. Adjusted odds ratios (aOR) were estimated with corresponding confidence intervals at a 0.05 significance level. The overall prevalence of anxiety-induced sleep disturbance among adolescents was 21.3%. The prevalence of anxiety-induced sleep disturbance was 22.4% and 19.9% among the male and female participants, respectively. Among male in-school adolescents, hunger (aOR = 0.51, 95% CI = 0.37–0.71), loneliness (aOR = 0.29, 95% CI = 0.20–0.41), suicide ideation (aOR = 0.37, 95% CI = 0.22–0.61), suicide attempt (aOR = 1.79, 95% CI = 1.12–2.87), ever having sex (aOR = 0.66, 95% CI = 0.48–0.91), and having understanding parents (aOR = 0.64, 95% CI = 0.47–0.87) were significantly associated with anxiety-induced sleep disturbance. On the other hand, hunger (aOR = 0.63, 95% CI = 0.42–0.94), loneliness (aOR = 0.42, 95% CI = 0.28–0.61), and suicide ideation (aOR = 0.52, 95% CI = 0.33–0.83) were significantly associated with anxiety-induced sleep disturbance among the female in-school adolescents. The prevalence of anxiety-induced sleep disturbance among in-school adolescents in Benin poses a great concern for their mental health and well-being. Collaborative efforts between schools, parents, and healthcare professionals should focus on culturally appropriate, gender-specific factors that may contribute to a reduction in anxiety-induced sleep disturbance among in-school adolescents in Benin.

Impact of regional medical self-sufficiency on mortality from cancer, stroke and myocardial infarction

ObjectivesThis study aimed to explore the impact of regional medical self-sufficiency on mortality from cancer, stroke and myocardial infarction (MI), and make policy suggestions to address regional health disparities and promote national health outcomes. Study designA multilevel analysis of nationwide data. MethodsThis study employed the Korean National Health Insurance Service-National Sample Cohort database at the individual level and the Korean Medical Utilization Statistics at the regional level. The study population included 31,862 individuals who were newly diagnosed with cancer, 16,793 with stroke and 2936 with MI between 2011 and 2019. Multilevel logistic regression was used to address the clustered structure of regional-level data with individual-level data on demographics and health details nested within it. ResultsRegional medical self-sufficiency did not significantly impact 1-year mortality in cancer patients. For patients with stroke and MI, a low level of medical self-sufficiency in the residential area was associated with a notably increased likelihood of dying within 1 month by 1.03 (95 % confidence interval [CI]: 1.02–1.07) and 1.44 (95 % CI: 1.08–2.01) times, respectively. Stratified analysis by region of residence showed that even if cancer patients lived in Seoul and metropolitan areas, they had an increased risk of death within 1 year if the medical self-sufficiency of their treatment areas was low (adjusted odds ratio [aOR]: 1.19, 95 % CI: 1.03–1.38). Moreover, for patients with MI living in medically underserved areas, the risk of death tended to increase with lower income. ConclusionsThe findings demonstrated that for acute stroke or MI patients, living in areas with low self-sufficiency of medical care had a higher likelihood of dying within 1 month. To improve national health outcomes and address regional medical disparities, it is crucial to prioritise policies such as establishing specialised centres dedicated to managing acute cardio-cerebrovascular conditions in each region.

Risk factors of acute urinary retention after spine surgery.

Acute postoperative urinary retention (APOUR) is 1 of the most common complications of spinal surgery, impacting both postoperative care and the patients' quality of life. This study is designed to investigate the risk factors and the incidence of APOUR after spinal surgery in Taiwan. We conducted a retrospective analysis using the Taiwanese National Health Insurance Research Database (NHIRD), a nationwide cohort of patients who underwent spinal surgery from the year 2000 to 2013. Patients suffering from APOUR were collected and perioperative parameters were recorded. The risk factors related to APOUR after spinal surgery were examined using multivariate logistic regression analysis. A total of 16,160 patients who underwent spinal surgery were retrieved from NHIRD. Among them, 432 (2.67%) suffered from acute urinary retention after surgery. Multivariate logistic regression analysis revealed that age (adjusted odds ratio [OR] = 1.02, 95% CI = 1.01-1.02), male gender (adjusted OR = 1.35, 95% CI = 1.10-1.60) and undergoing spinal surgery more than 2 times (adjusted OR = 4.78, 95% CI = 2.49-9.20) were statistically significant risk factors for APOUR after spinal surgery. The results of this retrospective cohort study suggest that patients undergoing spinal surgery more than 2 times, male gender and advanced age are significantly associated with an increased risk of APOUR after spinal surgery. This information may assist surgeons to identify patients who have a high risk of APOUR after spinal surgery and proactively provide them with early intervention.

The correlation between rapid eye movement sleep and nocturnal hypertension in patients with obstructive sleep apnea: A retrospective study.

Obstructive sleep apnea (OSA) is a respiratory disease closely associated with hypertension and heart disease. This study aimed to evaluate the diagnostic value of rapid eye movement (REM) sleep during nocturnal hypertension in OSA patients. We selected 194 patients who underwent polysomnography (PSG) at the Respiratory and Critical Care Medicine Department of Jiading District Central Hospital in Shanghai between January 2021 and August 2023. All patients were assigned to the hypertension and normal blood pressure groups, and the differences between the 2 groups were compared. This study included 194 patients (137 with nocturnal hypertension and 57 with normal nocturnal blood pressure). The proportion of male sex, body mass index, apnea-hypopnea index (AHI), REM sleep duration, percentage of REM sleep duration to total sleep duration, REM-AHI, nonrapid eye movement-AHI, oxygen desaturation index (ODI), REM-ODI, nonrapid eye movement-ODI, and average nighttime heart rate during sleep were higher in the hypertension group than in the normal blood pressure group, and the lowest oxygen saturation was lower than that in the normal blood pressure group (P < .05). Logistic regression analysis showed that REM-AHI was an independent risk factor for nocturnal hypertension (adjusted odds ratio, 1.048; 95% confidence interval, 1.011-1.086; P = .01). Receiver operating characteristic curve analysis showed that the REM-AHI had an area under the curve of 0.721 (95% confidence interval, 0.641-0.801; P < .001) for diagnosing nocturnal hypertension in patients with OSA, with a maximum Youden index of 0.379. The optimal critical value of the REM-AHI was 23.6 times/h, with a sensitivity of 64.2% and specificity of 73.7%. REM sleep is closely related to nocturnal hypertension, and patients with OSA are more prone to cardiovascular events.

Maternal and neonatal outcomes of occiput posterior vaginal delivery.

The occiput posterior (OP) position is the most common fetal malposition associated with poorer maternal outcomes compared to the occiput anterior (OA) position. However, there are no equivalent reports for women in Japan. This study aimed to investigate the maternal and neonatal outcomes of OP delivery in Japan. This retrospective study was conducted at a tertiary hospital in Japan. Singleton pregnant women who delivered vaginally at and after 37 weeks of gestation between January 2000 and May 2023 were included. Participants were divided into OA and OP groups and pregnancy outcomes were compared. Multivariable analysis was performed to adjust for background. In total, 13 852 eligible participants were divided into OA (13 633, 98.4%) and OP (218, 1.6%) groups. Maternal weights were significantly higher in the OP group than in the OA group, but there were no significant differences in maternal age, height, BMI, and parity. The incidence of assisted vaginal delivery (6.0% vs. 25.2%, adjusted odds ratios [aOR] 6.97), third- or fourth-degree perineal laceration (0.9% vs. 2.8%, aOR 3.52), postpartum hemorrhage (4.3% vs. 8.7%, aOR 2.17), and prolonged second stage of labor (11.3% vs. 29.4%, aOR 4.75) were significantly higher in the OP group. On the other hand, there were no significant differences in neonatal outcomes. The present study showed that OP vaginal deliveries require more time, and the increased number of assisted vaginal deliveries resulted in more maternal lacerations and hemorrhage. Maternal complications should be noted in the management of OP deliveries.