Relative Risk Values Research Articles

A place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States

ObjectiveThe objective of this study was to identify place features associated with increased risk of drug-involved fatalities and generate a composite score measuring risk based on the combined effects of features of the built environment. MethodsWe conducted a geospatial analysis of overdose data from 2022 to 2023 provided by the St. Louis County Medical Examiner's Office to test whether drug-involved deaths were more likely to occur near 54 different place features using Risk Terrain Modeling (RTM). RTM was used to identify features of the built environment that create settings of heightened overdose risk. Risk was estimated using Relative Risk Values (RRVs) and a composite score measuring Relative Risk Scores (RRS) across the county was produced for drugs, opioids, and stimulants, as well as by Black and White decedents. ResultsIn the model including all drugs, deaths were more likely to occur in close proximity to hotels/motels (RRV=39.65, SE=0.34, t-value=10.81 p<.001), foreclosures (RRV=4.42, SE=0.12, t-value = 12.80, p<.001), police departments (RRV=3.13, SE=0.24, t-score=4.86, p<.001), and restaurants (RRV=2.33, SE=0.12, t-value=7.16, p<.001). For Black decedents, deaths were more likely to occur near foreclosures (RRV=9.01, SE=0.18, t-value =11.92, p<.001), and places of worship (RRV= 2.51, SE=0.18, t-value = 11.92, p<.001). For White decedents, deaths were more likely to occur in close proximity to hotels/motels (RRV=38.97, SE=0.39, t-value=9.30, p<.001) foreclosures (RRV=2.57, SE=0.16, t-value =5.84, p<.001), restaurants (RRV=2.52, SE=0.17, t-value=5.33, p<.001) and, auto painting/repair shops (RRV=0.04, SE=0.18, t-value =3.39, p<.001). ConclusionThese findings suggest that places of worship, the hospitality industry, and housing authorities may be physical features of the environment that reflect social conditions that are conducive to overdose. The scaling up of harm reduction strategies could be enhanced by targeting places where features are co-located.

The Fault Diagnosis Method for Photovoltaic Modules Based on Machine Learning

Based on the urban natural gas pipeline accident statistics and semi-quantitative risk evaluation index system, this paper applies Bayesian network to establish a network model between various types of risk factors and the risk of natural gas pipeline failure. The EM algorithm was used to learn from the statistical accident data to obtain the parameters of the model. Based on the principle of evidential reasoning in reverse, the probability of occurrence of all risk indicators can be obtained when the probability of occurrence of urban natural gas pipeline accidents is 100%, the index weight is obtained by normalizing the occurrence probability. On this basis, this paper develops an efficient urban natural gas pipeline integrity risk identification and management software. The software can realize the basic data management of urban natural gas pipeline system, pipeline relative risk value calculation, pipeline risk level calculation and other functions, and the results are visualized. Finally, the practicability and effectiveness of the model and software are verified by a case of natural gas pipeline evaluation in a block.

Independent and interactive effects of particulate matter and meteorological factors on hand, foot and mouth disease in Fuyang.

Previous research has demonstrated the influence of environmental factor on the occurrence of infectious diseases. However, there is insufficient and conflicting evidence regarding the association between Hand, foot and mouth disease (HFMD) and environmental variables, particularly the interaction of environmental variables. This study aims to investigate the individual and interactive effects of particulate matter (PM) and meteorological factors on HFMD incidence in Fuyang. The generalized additive models were combined with distributed lag non-linear models to assess the individual effects between PM and meteorological factor on HFMD incidence in Fuyang. Subsequently, a product term was incorporated into the model to investigate the interaction between PM and meteorological factors. Temperature and PM2.5 were identified as the two primary risk factors for HFMD, with relative risks (RR) of 1.586(1.493,1.685) and 1.349(1.325,1.373), respectively. Furthermore, PM exhibited a synergistic effect with meteorological factors. For instance, the RR values for PM2.5 in relation to HFMD were 1.029 (95% CI: 1.024-1.035) and 1 0.117 (95% CI: 1 0.108 - 11 0.127) under different temperature group categories. Notably, HFMD predominantly affects children under the age of five years old and infants aged between zero to one year old demonstrate heightened susceptibility to environmental variables. The results showed that both PM and meteorological factors were risk factors for HFMD, with evidence of an interaction between these variables. These findings have important implications for local HFMD incidence prediction and the development of effective prevention strategies.

Cancer mortality risk in the Urals Cohort of Exposed Population Offspring

The objective of the study is to analyze solid cancer mortality and estimate the risk value of solid cancer mortality in the offspring of parents irradiated in the Southern Urals, depending on the dose to the parents' gonads as well as to conduct a preliminary assessment of the mortality risk from cancer of individual locations depending on the gonadal dose. The issue of the transgenerational effects of the human gonad exposure is still very important. There exists conclusive evidence of the presence of such effects in experimental animals. However, there is no proof of the existence of these effects in humans despite a great number of research on this subject. International scientific community and international organizations, UNSCEAR and ICRP being among them, regard this issue as the one that has not been solved yet and requires further studies. Urals Cohort of offspring of the population exposed on the Techa River and on the territory of the East Ural radioactive trace was established in the Urals research Center for Radiation medicine in 2022. The key feature of the cohort is the exclusion of the offspring with postnatal exposure. The size of the cohort as of September 2023 is 31,154 persons. The number of person-years over the whole follow-up period from 1950 through 2020 is 1 226 380. Mean dose to the gonads of mothers of all the cohort members is 41 mGy, to those of the fathers' — 35 mGy, mean combined gonad dose is 76 mGy. Over the whole follow-up period 3,774 deaths from all causes including 284 deaths from solid cancers were registered in the cohort. The mean age of the cohort members at the end of the follow-up period was 42 years. The risk of death was analyzed using Poisson regression by the programs of the EPICURE statistical software package. Three models of dose dependence were tested: linear, quadratic, and linear-quadratic models of paternal gonadal dose, maternal gonadal dose, and total gonadal dose. Mortality risk analysis of all solid cancers in the offspring cohort showed no statistically significant effect with parental gonadal dose (we have obtained positive although statistically insignificant values of solid cancers mortality risk) which is consistent with the results of other studies in human populations. At the same time, the analysis for the first time obtained a statistically significant linear dependence of the solid cancer mortality risk in offspring with father's age over 45 years depending on the dose to the father's gonads. The excess relative risk of death was 8.09/Gy, (0.51-22.93), p &lt; 0.05. Also, for the first time, evidence of dose dependence of the mortality risk of lung cancer in male offspring on maternal gonadal dose, paternal gonadal dose, and combined gonadal dose was obtained. The values of excess relative risk of lung cancer and 95% confidence intervals according to the linear model were 5.39/Gy (0.46; 15.56) from paternal gonad dose, 4.36/Gy (0.15; 13.48) from maternal gonad dose, and - 3.95/Gy (0.55; 12.14) from combined gonad dose. Point risk estimates of lung cancer at this stage are characterized by wide confidence intervals and require additional studies to assess the influence of possible effect modifiers, but with a high degree of probability indicate the presence of dose dependence of this effect. Increasing the follow-up period and attained age, will increase the number of cancers in the future and will reduce dose response uncertainties and provide more accurate estimates of the risk of death in the offspring cohort.

Heatwave and upper urinary tract stones morbidity: effect modification by heatwave definitions, disease subtypes, and vulnerable populations.

As heatwave occurs with increased frequency and intensity, the disease burden for urolithiasis, a heat-specific disease, will increase. However, heatwave effect on urolithiasis subtypes morbidity and optimal heatwave definition for urolithiasis remain unclear. Distributed lagged linear models were used to assess the associations between 32 defined heatwave and upper urinary tract stones morbidity. Relative risk (RR) and attributable fraction (AF) of upper urinary tract stone morbidity associated with heatwave of different intensities (low, middle, and high) were pooled by meta-analysis. Optimal heatwave definition was selected based on the combined score of AF, RR, and quasi-Akaike Information Criterion (QAIC) value. Stratified analyses were conducted to investigate the modification effects of gender, age, and disease subtypes. Association between heatwave and upper urinary tract stones morbidity was mainly for ureteral calculus, and AF was highest for low-intensity heatwave. This study's optimal heatwave was defined as average temperature > 93rd percentile for ≥ 2 consecutive days, with AF of 7.40% (95% CI:2.02%, 11.27%). Heatwave was associated with ureteral calculus morbidity in males and middle-aged adults. While heatwave effect was statistically insignificant in females and other age groups. Managers should develop appropriate definitions to address heatwave based on regional characteristics and focus on heatwave effects on urolithiasis.

Dynamic trends of ischemic heart disease mortality attributable to high low-density lipoprotein cholesterol: a joinpoint analysis and age-period-cohort analysis with predictions

AimsThe purpose of this study was to analyze the dynamic trends of ischemic heart disease (IHD) mortality attributable to high low-density lipoprotein cholesterol (LDL-C).MethodsData on IHD mortality attributable to high LDL-C from 1990 to 2021 were extracted from the global disease burden database. Joinpoint software was used to estimate the average annual percentage change (AAPC) in the age-standardized mortality rate (ASMR). An age‒period‒cohort model was used to analyze the impacts of age, period, and cohort on these changes. The Bayesian framework was used to predict IHD mortality attributable to high LDL-C from 2022 to 2040.ResultsThe overall ASMR of IHD attributable to high LDL-C decreased from 50. 479 per 100,000 people in 1990 to 32.286 per 100,000 people in 2021, and ASMR of IHD attributable to high LDL-C was higher in males than in females. The longitudinal age curves of the overall IHD mortality attributable to high LDL-C showed a monotonic upward trend, especially after 65 years of age. The period and cohort effect relative risk (RR) values of overall IHD mortality attributable to high LDL-C showed a downward trend. The overall ASMR of IHD attributable to high LDL-C is predicted to show a downward trend, and male IHD mortality attributable to high LDL-C is expected to be higher than that of females.ConclusionThis study revealed a sustained decrease in IHD mortality attributable to high LDL-C over three decades, with a continued decline expected. Despite this, gender disparities persist, with males experiencing higher mortality rates and elderly individuals remaining a vulnerable group.

Efficacy and safety of mesenchymal stem cell therapy for acute respiratory distress syndrome-a systematic review and meta-analysis.

Mesenchymal stem cells (MSC) therapy for acute respiratory distress syndrome (ARDS) represents a burgeoning treatment approach, supported by numerous preclinical studies confirming its efficacy. Our study aims to provide a comprehensive evaluation of both the safety and effectiveness of MSC. We conducted searches across three databases (PubMed, Embase, Cochrane) for randomized controlled studies up to June 23, 2024. A meta-analysis was performed on variables including adverse events, mortality, changes in the PaO2/FiO2 ratio, intensive care unit (ICU), length of stay, ventilation-free days, and changes in pro-inflammatory and anti-inflammatory cytokines. Relative risk (RR) values were employed for dichotomous variables, while mean difference (MD) and standard mean difference (SMD) were used for continuous variables. Risk bias was assessed using risk of bias 2 (ROB2). The meta-analysis encompassed 17 experiments involving 796 patients, with 410 undergoing MSC treatment and 386 in the control group. Primary outcomes indicated that MSC treatment did not escalate adverse events [RR =1.04; 95% confidence interval (CI): 0.90, 1.19; P=0.59; I2=0%]. On the contrary, it significantly diminishes the mortality (RR =0.79; 95% CI: 0.64, 0.97; P=0.02; I2=0%). Regarding secondary outcomes, MSCs led to a significant improvement in the PaO2/FiO2 ratio for ARDS patients (SMD =0.53; 95% CI: 0.15, 0.92; P=0.007; I2=0%). However, there were no significant differences in ICU length of stay (MD =-1.77; 95% CI: -6.97, 3.43; P=0.50; I2=63%) and ventilation-free days (MD =-1.29; 95% CI: -4.09, 1.51; P=0.37; I2=0%). MSCs significantly lowered C-reactive protein (CRP) (SMD =-0.65; 95% CI: -1.18, -0.13; P=0.01; I2=56%) and interleukin-6 (IL-6) levels compared to the control group (SMD =-0.76; 95% CI: -1.34, -0.17; P=0.01; I2=74%). However, changes in interleukin-10 (AIL-10) (SMD =-0.46; 95% CI: -1.51, 0.58; P=0.38; I2=77%), and changes in tumor necrosis factor-alpha (ATNF-α) (SMD =-1.5; 95% CI: -3.39, 0.40; P=0.12; I2=92%) levels showed no significant changes. MSC therapy demonstrates reliable safety, with a significant impact on reducing mortality and improving certain clinical symptoms. Moreover, in certain aspects, it may alleviate the inflammatory response in ARDS. Nonetheless, these findings necessitate validation through additional high-quality randomized controlled trials.

Ethnic-racial disparities in poisoning cases: analysis of drugs of abuse, medicines and pesticides in Brazil

ABSTRACT In Brazil, ethnic-racial inequalities exist in all fields, obstructing access to goods, services, and opportunities, including healthcare services. However, there are no apparent studies that assess, at a national level, ethnic-racial disparities in poisoning cases, emphasizing skin color as a determining factor. The study aimed to examine the relationship between race/ethnicity and general poisoning cases, by medications, pesticides, and drug of abuse in Brazilian states. Poisoning cases data were extracted for the years 2017, 2018, and 2019. Notification data for general poisoning cases and toxic agents were collected: medications, pesticides, and drugs of abuse. Data were categorized between whites and non-whites (blacks, browns, and indigenous) and without information on skin color/ethnicity. Rates of poisonings amongst ethnic-racial groups and cases of not declared skin color as well as relative risk (RR) of poisoning among non-whites were calculated. All states in the North, Northeast (states with the worst Human Development Index), Midwest, and 2 states in the Southeast exhibited higher rates of poisoning cases per 100,000 inhabitants among non-whites. The RR values for nonwhite individuals were higher in the North and Northeast regions for all types of poisonings. The type of poisoning cases that presented the highest RR for non-whites over the 3 years was drugs of abuse (2–2.44), when compared to other types of poisonings from pesticides (2–2.33) and medications (1.5–1.91). The spatial distribution of poisoning cases rates and RR of nonwhite population support public policies to reduce socioeconomic and environmental inequalities.

Risk Evaluation and Software Development of Urban Natural Gas Pipelines Based on Bayesian Networks

Based on the urban natural gas pipeline accident statistics and semi-quantitative risk evaluation index system, this paper applies Bayesian network to establish a network model between various types of risk factors and the risk of natural gas pipeline failure. The EM algorithm was used to learn from the statistical accident data to obtain the parameters of the model. Based on the principle of evidential reasoning in reverse, the probability of occurrence of all risk indicators can be obtained when the probability of occurrence of urban natural gas pipeline accidents is 100%, the index weight is obtained by normalizing the occurrence probability. On this basis, this paper develops an efficient urban natural gas pipeline integrity risk identification and management software. The software can realize the basic data management of urban natural gas pipeline system, pipeline relative risk value calculation, pipeline risk level calculation and other functions, and the results are visualized. Finally, the practicability and effectiveness of the model and software are verified by a case of natural gas pipeline evaluation in a block.

Identifying the pollution risk pattern from industrial production to rural settlements and its countermeasures in China

Impacted by large-scale and rapid rural industrialization in the past few decades, China's rural settlements are confronted with the risk of heavy metal pollution stemming from industrial production, which might pose a significant threat to the rural habitat and the well-beings. This study devised a relative risk model for industrial heavy metal pollution to the rural settlements based on the source-pathway-receptor risk theory. Using this model, we assessed the risk magnitudes of heavy metal pollution from industrial production at a 10 km × 10 km grid scale and identified the characteristics of the risk pattern in China. Our finding reveals: (1) the relative risk values of wastewater, waste gas and total heavy metal pollution are notably concentrated within a confined spectrum, with only a small number of units are characterized by high-risk level; (2) Approximately 21.57 % of China's rural settlements contend with heavy metal pollution, with 4.17 %, 9.84 % and 7.55 % being subjected to high, medium and low risks, respectively; (3) The high-risk units mainly is concentrated in the developed areas such as Yangtze River Delta, Pearl River Delta, and the Beijing-Tianjin metropolitan area, also dispersed in the plain areas with high rural population density. Guided by these insights, this study puts forth regionally tailored prevention and control strategies, as well as distinct process prevention and control strategies.

Daylight Saving Time Transitions and Risk of Heart Attack—a Systematic Review and Meta-Analysis.

The health risks of daylight saving time transitions are intensely debated. Disturbed circadian rhythms and lack of sleep after transitions might increase the risk of acute myocardial infarction (AMI). The only meta-analysis on the risk of AMI has now been considerably expanded. In this systematic review and meta-analysis (including meta-regressions and sensitivity analyses), we examine the frequency of AMI in the first few weeks after daylight saving time transitions (OSF registration www.doi.org/10.17605/OSF.IO/7CFKS). Eight databases were searched for pertinent literature up to September 2023. Authors were contacted for additional information. Study quality was rated using the Newcastle-Ottawa Scale. Twelve studies from ten countries were included in the meta-analysis. Nine were of adequate quality, and three were of good quality. The pooled relative risk (RR) of AMI after daylight saving time onset (spring) was 1.04 (95% confidence interval [1.02; 1.07], I2: 57.3%), and 1.02 ([0.99; 1.05], I2: 51.6%) after daylight saving time offset (autumn). Recalculation after the exclusion of one study with inconsistencies yielded pooled RR values of 1.04 [1.01; 1.06] and 1.00 [0.99; 1.02], with the spring results being heterogeneous (I2: 56.9%) and the autumn results homogeneous (I2: 17.1%). Current evidence suggests that there may be an increased risk of AMI after the spring transition, although there is moderate to marked heterogeneity among the studies that support this conclusion. More easily interpretable studies, such as those already conducted in the field of economics, should clarify associations with the aid of discontinuity regression and placebo tests. To this end, comparative risk analyses using years or places wherein daylight saving time was not practiced would be suitable.

Daylight Saving Time Transitions and Risk of Heart Attack.

The health risks of daylight saving time transitions are intensely debated. Disturbed circadian rhythms and lack of sleep after transitions might increase the risk of acute myocardial infarction (AMI). The only meta-analysis on the risk of AMI has now been considerably expanded. In this systematic review and meta-analysis (including meta-regressions and sensitivity analyses), we examine the frequency of AMI in the first few weeks after daylight saving time transitions (OSF registration www.doi.org/10.17605/OSF.IO/7CFKS). Eight databases were searched for pertinent literature up to September 2023. Authors were contacted for additional information. Study quality was rated using the Newcastle-Ottawa Scale. Twelve studies from ten countries were included in the meta-analysis. Nine were of adequate quality, and three were of good quality. The pooled relative risk (RR) of AMI after daylight saving time onset (spring) was 1.04 (95% confidence interval [1.02; 1.07], I2: 57.3%), and 1.02 ([0.99; 1.05], I2: 51.6%) after daylight saving time offset (autumn). Recalculation after the exclusion of one study with inconsistencies yielded pooled RR values of 1.04 [1.01; 1.06] and 1.00 [0.99; 1.02], with the spring results being heterogeneous (I2: 56.9%) and the autumn results homogeneous (I2: 17.1%). Current evidence suggests that there may be an increased risk of AMI after the spring transition, although there is moderate to marked heterogeneity among the studies that support this conclusion. More easily interpretable studies, such as those already conducted in the field of economics, should clarify associations with the aid of discontinuity regression and placebo tests. To this end, comparative risk analyses using years or places wherein daylight saving time was not practiced would be suitable.

Association between ambient fine particular matter components and subsequent cognitive impairment in community-dwelling older people: a prospective cohort study from eastern China

BackgroundFine particular matter (PM2.5) has been associated with dementia, but limited information is available regarding the association between PM2.5 components and dementia.AimsWe aimed to identify the major components of PM2.5 that affect cognitive function to further investigate its mechanism of action, and develop a prevention strategy for dementia.MethodsIn this study, we included 7804 participants aged ≥ 60 years recruited from seven counties in Zhejiang province, eastern China. The participants completed the baseline survey between 2014 and 2015, and were followed up until the end of 2020. We adopted single-component robust Poisson regression models for analyses, and estimated relative risks and 95% confidence intervals describing associations between the chemical constituents of PM2.5 exposure and incident cognitive impairment in those who were free from cognitive impairment at baseline.ResultsSignificantly positive associations were observed between sulfate, nitrate, ammonium, and organic matter in PM2.5 and incident cognitive impairment across different exposure periods; the relative risks of 10-year exposure before enrollment ranged from 1.01 to 1.02. However, we did not find a significant association between black carbon and cognitive impairment. The point estimates of the relative risk values did not change substantially after performing the sensitivity analyses.ConclusionsOur findings strengthen the idea that long-term exposure to PM2.5 mass and its chemical components is associated with an elevated risk of incident cognitive impairment among older adults.

The risk of developing cancer of the digestive organs (excluding intestines) in the South Urals Population Exposed to Radiation Cohort

Evaluation of the low dose effect on population health is still a relevant issue. It requires further studies to improve our understanding of these effects. To solve this problem, it is important to conduct studies of the late effects of radiation exposure with direct risk estimation in the population that combines all strata of the society: people of different sex, age, initial health status, social and economic status. Moreover, this population should be sizeable and has been followed up for a long-term period. This manuscript is the first to present the findings of the analysis of the incidence risk of cancer of all the digestive organs, excluding intestines, and stomach cancer taken separately in members of the Southern Urals Population Exposed to Radiation Cohort depending on the dose accumulated in the stomach over the period from 1956 through 2018. This cohort is comprised of individuals exposed in the Southern Urals in two radiation accidents (on the Techa River and in the East-Urals Radioactive Trace) over the period from 01.01.1950 through 31.12.1960. The cohort also includes those who were born during this period; they could have additional in utero exposure or have exposed parents. The population was affected by long-term combined exposure (external and internal) at the low-to-medium soft tissue dose range (up to 1.1 Gy). The size of the incidence cohort was 47,282 people. Over the follow-up period 01.01.1956-31.12.2018, the number of person-years made up 1 292 930; mean dose to the stomach was 47 mGy, maximum – 1,132 mGy. Excess relative risk of the cancer incidence of the digestive organs was assessed using the Poisson regression analysis. Calculations were performed using the EPICURE Statistical software package. Excess relative risk for stomach cancer with a 2-year minimal, was 0.98/Gy (р=0.026), for all cancers of the digestive organs, excluding intestines, – 0.58/Gy, р=0.06. There was no significant modification of the effect by non-radiation factors. These values of excess relative risk do not disagree with the results of similar studies in the Japanese cohort of the atomic bomb survivors who were compatible in terms of age but had acute exposure at higher doses. No significant dose dependence of the cancer incidence of the oral cavity, esophagus, liver, or pancreas was detected at this stage.

Adverse events following immunization of co- and separate administration of DTaP-IPV/Hib vaccines: A real-world comparative study

ABSTRACT To fully understand the safety of DTaP-IPV/Hib vaccination, we evaluated the differences between DTaP-IPV/Hib co-administration and separate administration of the DTaP, IPV and Hib vaccines (DTaP+IPV+Hib) based on adverse events following immunization (AEFI). All AEFI reported in Hebei Province, China, between 2020 and 2022 were included in this study. The risk difference (RD%), relative risk (RR), and Chi-square value were used to compare the differences in reported rates of AEFI between the DTaP-IPV/Hib and DTaP+IPV+Hib groups. From 2020 to 2022, 130 AEFI cases were reported in Hebei Province after DTaP-IPV/Hib vaccination, corresponding to an AEFI reported rate of 66.9/million doses, which was significantly lower than that for DTaP+IPV+Hib (9836 AEFI with a reported rate of 637.8/million doses). The overall reported rate of non-severe AEFI for DTaP+IPV+Hib vaccines was 9.5 times that of DTaP-IPV/Hib vaccination [95% confidence interval (CI): 8.0, 11.3]. Meanwhile, the reported rate of AEFI among infants aged 0–1 y was 9.8 times higher for DTaP+IPV+Hib than for DTaP-IPV/Hib (95% CI: 8.2, 11.7). DTaP+IPV+Hib vaccination also resulted in higher risks of high fever, localized redness and swelling, localized induration, and allergic rash compared with DTaP-IPV/Hib vaccination. The risk of AEFI, which were mostly mild reaction, was higher after vaccination with DTaP+IPV+Hib than after DTaP-IPV/Hib vaccination.

Assessing the modification impact of vaccination on the relationship of the Discomfort Index with hand, foot, and mouth disease in Guizhou: A multicounty study.

Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and humidity are well-documented predictors. However, evidence on the combined effect of temperature and humidity is still limited. It also remains unclear whether such an effect could be modified by the enterovirus 71 (EV71) vaccination. Based on 320,042 reported HFMD cases during the summer months between 2012 and 2019, we conducted a study utilizing Distributed Lag Non-Linear Models (DLNM) and time-varying DLNM to examine how China's HFMD EV71 vaccine strategy would affect the correlation between meteorological conditions and HFMD risk. The incidence of HFMD changed with the Discomfort Index in an arm-shaped form. The 14-day cumulative risk of HFMD exhibited a statistically significant increase during the period of 2017-2019 (following the implementation of the EV71 vaccine policy) compared to 2012-2016 (prior to the vaccine implementation). For the total population, the range of relative risk (RR) values for HFMD at the 75th, 90th, and 99th percentiles increased from 1.082-1.303 in 2012-2016 to 1.836-2.022 in 2017-2019. In the stratified analyses, Han Chinese areas show stronger relative growth, with RR values at the 75th, 90th, and 99th percentiles increased by 14.3%, 39.1%, and 134.4% post-vaccination, compared to increases of 22.7%, 41.6%, and 38.8% in minority areas. Similarly, boys showed greater increases (24.4%, 47.7%, 121.5%) compared to girls (8.1%, 28.1%, 58.3%). Additionally, the central Guizhou urban agglomeration displayed a tendency for stronger relative growth compared to other counties. Although the EV71 vaccine policy has been implemented, it hasn't effectively controlled the overall risk of HFMD. There's been a shift in the main viral subtypes, potentially altering population susceptibility and influencing HFMD occurrences. The modulating effects of vaccine intervention may also be influenced by factors such as race, sex, and economic level.

Two Decades of Air Pollution Health Risk Assessment: Insights From the Use of WHO's AirQ and AirQ+ Tools.

We evaluated studies that used the World Health Organization's (WHO) AirQ and AirQ+ tools for air pollution (AP) health risk assessment (HRA) and provided best practice suggestions for future assessments. We performed a comprehensive review of studies using WHO's AirQ and AirQ+ tools, searching several databases for relevant articles, reports, and theses from inception to Dec 31, 2022. We identified 286 studies that met our criteria. The studies were conducted in 69 countries, with most (57%) in Iran, followed by Italy and India (∼8% each). We found that many studies inadequately report air pollution exposure data, its quality, and validity. The decisions concerning the analysed population size, health outcomes of interest, baseline incidence, concentration-response functions, relative risk values, and counterfactual values are often not justified, sufficiently. Many studies lack an uncertainty assessment. Our review found a number of common shortcomings in the published assessments. We suggest better practices and urge future studies to focus on the quality of input data, its reporting, and associated uncertainties.

(125) INTRAPARTUM AND 30-DAY POSTPARTUM COMPLICATIONS IN PREGNANCIES WITH ANTENATAL SARS-COV-2 INFECTION

Abstract Introduction While COVID-19 has been associated with adverse pregnancy outcomes, data regarding intrapartum and postpartum maternal complications after antenatal COVID-19 infection is limited and variable. Objective This study compares the intrapartum and postpartum complication rates between pregnant patients with and without an antenatal COVID-19 diagnosis in a national dataset. Methods This is a retrospective cohort study of patients who gave birth between January 2020 and May 2023 utilizing the TriNetx Analytics Research Network, an aggregated electronic health record platform. Our data searches were performed on May 1, 2023. ICD-10 codes were used to identify the encounter for delivery (ICD-10 code O80-O82) and pregnant individuals with a COVID-19 diagnosis (ICD-10 code U70.1) during their gestational period. The control group was defined as those with one encounter for delivery between January 2020 and May 2023 and without a diagnosis of COVID-19 during the gestational period. Complications included obstetric, cardiovascular, neurovascular, and pulmonary outcomes diagnosed from the day of delivery to 30 days postpartum. The cohort was propensity matched by age, race, and ethnicity. The relative risk values and 95% confidence intervals for the outcomes were calculated and compared. Results Of the 368,923 patients who had an encounter for delivery between January 2020 and May 2023, 26,974 (7%) had an antenatal COVID-19 diagnosis. Compared to our matched control cohort, patients with antenatal COVID-19 were at an increased risk of postpartum hemorrhage (RR 1.24, 95% CI 1.16-1.33), gestational hypertension without significant proteinuria (1.27 [1.21-1.34]), pre-eclampsia (1.25 [1.18-1.32]), eclampsia (1.66 [1.29-2.23]), and preterm labor (1.21 [1.12-1.31]). Patients with antenatal COVID-19 infections were also at an increased risk of postpartum complications, including cerebral infarction (1.74 [1.04-2.90]), pulmonary embolism (2.68 [1.74-4.13]), acute embolism and thrombosis of deep veins of lower extremity (2.32 [1.45-3.71]), sepsis (2.21 [1.54-3.19]), heart failure (1.55 [1.04-2.31]), and cardiomyopathy (2.08 [1.30-3.32]). There was no elevated risk of HELLP syndrome (1.18 [0.96-1.44]), placental abruption (1.14 [0.94-1.37]), and myocardial infarction (1.4 [0.62-3.15]). Conclusions Pregnant individuals with antenatal COVID-19 diagnosis were more likely to have intrapartum and postpartum encounter diagnoses for obstetric, cardiovascular, neurovascular, and pulmonary complications. This data allows providers to identify antenatal COVID-19 infection as a risk factor and monitor patients for complications. Disclosure No.

Diagnostic value of MR and CT enterography in post-operative recurrence of Crohn's disease: a systematic review and meta-analysis.

Post-operative recurrence is a critical issue in the surveillance of Crohn's disease after ileocecal resection. This meta-analysis aims to assess the diagnostic yield of enterography techniques in post-operative recurrence of Crohn's disease. A systematic electronic bibliographic databases search was conducted. The inclusion criteria of original articles were: Utilized MR enterography or CT enterography after ileocolonic resection; Documented recurrence by ileo-colonoscopy (Rutgeerts' score ≥ i2); Provided crude data of diagnostic performance. A random-effect method was used for analysis. Relative risk and diagnostic value of each imaging feature were calculated. Eleven studies (11 populations and 589 patients) were included (4 CTE and 7 MRE with 248 and 341 patients, respectively). The pooled sensitivity and specificity of the enterography were 91% (95% CI: 0.85-0.95) and 75% (95% CI: 0.56-0.87), respectively. The pooled sensitivity and specificity of CTE were 93% (95% CI: 0.87-0.96) and 67% (95% CI: 0.35-0.90), respectively. MRE revealed pooled sensitivity and specificity of 90% (95% CI: 0.78-0.96) and 78% (95% CI: 0.57-0.90), respectively. The inter-study heterogeneity was low for sensitivity (I2 = 29%, p-value = 0.17) and high for specificity (I2 = 85%, p-value < 0.01). Wall enhancement, anastomosis wall thickening, anastomosis stenosis, pre-anastomotic dilatation, penetrating lesion, comb sign, and perivisceral edema were significantly higher in POR patients. Wall thickening and penetrating lesion were the most sensitive (81%) and specific (97%) findings, respectively. MRE and CTE exhibit high sensitivity and acceptable specificity (especially MRE) for detection of recurrence in Crohn's disease which makes them an effective initial screening tool and reserves ileo-colonoscopy for those patients with inconclusive enterography results.

MACE prediction in patients with STEMI and NSTEMI: from classic to novel markers in the estimation of coronary microcirculation disorder

Evaluation of classic and novel markers of coronary microcirculatory disorder (CMD) which have a predictive value on the risk of major cardiovascular event (MACE) in patients with STEMI and NSTEMI. Material and methods. The research included the retrospective analysis of a prospective observational study carried out on 600 patients, of which have been formed equal 4 groups of 80 patients (STEMI+MACE; STEMI-MACE; NSTEMI+MACE; NSTEMI-MACE) in which the collected blood on the 5-th day after angioplasty, the circulating level of 16 markers referring to CMD in the field of estimating endothelial dysfunction and hemostasis was determined: 8 classic markers (hsCRP, IL-6, TNF-α, IL-10, myeloperoxidase, NO , angiopoietin 2, fibrin monomers) and 8 new markers (neopteirn, endocan, syndecan 1, L-Arginine/ADMA, Ang 1-7/Ang II, endothelial microparticles, platelet microparticles, von Willebrand/ADAMTS13). In order to assess the prediction of MACE (cardiac death, re-infarction, stroke) at 1-st year, the relative risk of markers that had significant differences in patients with MACE versus without MACE in both groups (STEMI and NSTEMI) was assessed. The control group consisted of 40 apparently healthy people. Results. The MACE rate in STEMI and NSTEMI patients at 1 year was similar, 29% and 28%, respectively. All markers of endothelial dysfunction explored had significant deviations from control. Of these, however, only 4 markers had significant different values in patients (STEMI and NSTEMI) with MACE vs without MACE: neopterin, endocan, L-Arginine/ADMA and Ang 1-7/Ang II. Remarkably, all 3 markers of hemostasis explored had circulating levels in patients who developed MACE significantly higher than patients without MACE, which significantly exceeded the control marker. The assessment of the relative risk value has allowed the delineation of markers regarding the prediction of MACE such as: von Willebrand/ADAMTS13, platelet microparticles, fibrin monomers, endocan, neopterin, Ang 1-7/ Ang II, L-Arginine/ADAMTS13. Conclusions. 1. Endothelial dysfunction and compromised hemostasis are pathophysiological pillars of CMD which influences the MACE risk, and thus new markers such as von Willebrand/ADAMTS13 ratio, platelet microparticles, endocan, the ratio Ang 1-7/Ang II and L/Arginine/ ADMAs have notable predictive value on MACE.2. Since CMD may be a key mechanism of cardiac ischemia in chronic non-obstructive coronary artery disease (&lt;50%) its evaluation, including through the identified predictors, has a conclusive diagnostic and prognostic relevance.