Years Of Age Research Articles

Digital health data security practices among health professionals in low-resource settings: cross-sectional study in Amhara Region, Ethiopia

IntroductionProtecting digital health data from unauthorized access, alteration, and destruction is a crucial aspect of healthcare digitalization. Currently, digital security breaches are becoming more common. Healthcare data breaches have compromised over 50 million medical records per year. In Ethiopia, health digitization has grown gradually. However, there is a limitation of study in digital health security. Studying digital health data security helps individuals protect digital data as a baseline and contributes to developing a digital health security policy.ObjectiveTo assess the practice of healthcare professionals in digital health data security among specialized teaching referral hospitals in Amhara Region, Ethiopia.MethodA cross-sectional study design supplemented by a qualitative purposive sampling method was used to measure the digital data security practices of health professionals. The sample size was determined via single population proportion formula. A simple random sampling technique was used for the study participants. Then, self-administered questionnaires were administered. Multivariable logistic analysis was used to identify associated factors using STATA software. For the qualitative study, key informant interviews were used and analyzed using thematic analysis approach via open-code software.ResultsOut of the 423 health professionals, 95.0% were involved in the survey. The finding indicates digital health data security practice of health professionals working at specialized teaching hospitals were 45.0%, CI: (40, 50). Health professionals 41–45-year age group (AOR = 0.107), master’s degree (AOR = 2.45), postmaster’s degree (AOR = 3.87), time to visit the internet for more than two hours (AOR = 2.46), basic computer training (AOR = 2.77), training in digital data security (AOR = 2.14), and knowledge (AOR = 1.76) were associated with the practice of digital health data security. For the qualitative study, three teams were prepared. The findings indicate digital health data security can be improved through training, advanced knowledge and working with digital security.ConclusionThe practice of digital health data security in specialized teaching hospitals in the Amhara region was inadequate. Therefore, it can be improved through enhancing education status, increasing the time needed to visit the internet, providing computer training, and updating health professionals’ knowledge toward digital health data security.

Inflammation and endothelial gene polymorphism are associated with ischemic stroke

AimEvaluate the correlation between ischemic stroke and genetic variations related to inflammation and endothelial function.MethodsThis was a multicenter cross-sectional research conducted in southwestern China. Residents aged ≥40 years voluntarily join in the face-to-face survey in 8 communities. 2,377 participants were at high risk of stroke, of which 429 had a previous history of ischemic stroke. We selected the 429 ischemic stroke patients as the research subjects, and adopted a 1:1 matching method to select 429 healthy people with a 2-year age difference and the same gender and hypertension as the control group. We detected genotypes of 19 variants in 10 genes related to inflammation and endothelial function. Analyze gene–gene interaction through generalized multifactor dimensionality reduction (GMDR).ResultsAnalysis found no statistically significant differences in age, gender, hypertension, BMI, and smoking history between ischemic stroke patients and healthy control group. Compared with the healthy group, ischemic stroke group has a higher proportion of diabetes, heart disease, dyslipidemia, stroke family history, and a higher proportion of lack of exercise. HABP2 rs7923349, NOS2A rs8081248, HABP2 rs932650 were related to stroke in univariate analysis. GMDR analysis showed significant gene–gene interactions between HABP2 rs7923349, HABP2 rs932650. After adjusting for covariates, high-risk interaction genotypes between these two variants were independently associated with higher stroke risk (OR, 3.578, 95% CI: 2.618–4.890, p < 0.001).ConclusionThis study found that specific variations in genes related to inflammation and endothelial function are associated with ischemic stroke. The high-risk interactive genotypes among HABP2 rs7923349, HABP2 rs932650 distinctly increased the risk of ischemic stroke.

Rhythms and shifts of chemokines and cytokines interplay in a decade lifespan: The longitudinal community-based Bambuí health and aging study.

Aging is associated with several physiological changes, including a remarkable remodeling of the immune system. Herein, the rhythms and shifts in serum immune mediators were characterized in a decade lifespan as a longitudinal community-based prospective investigation from Bambuí Health and Aging Study. The study population included paired samples from 713 subjects survivors from the original BHAS cohort and at 10-years Follow-up, categorized into 5-years age range intervals (60-64Yrs towards 90 + Yrs). Quantification of soluble mediators were carried out by Cytometric Bead Array. The results demonstrated a rhythmic increase in serum immune mediators, especially CXCL9, CXCL10, IL-1β, IL-6 and TNF following the aging process, particularly at age intervals 70-74Yrs and 85-89Yrs. More prominent fold change magnitudes were observed for TNF (27.64×), CXCL9 (2.40×), IL-1β (2.20×), IL-6 (1.47×) and CXCL10 (1.26×). On the other hand, analysis of integrative networks showed a waning in the correlation numbers between immune mediators in a decade lifespan and a shift of connectivity from chemokines at Enrollment towards cytokines at 10-years Follow-up. Cross-correlation approaches revealed that CXCL9, CXCL10, IL-1β, IL-6 and IL-10 were placed in the innermost position, underscoring the higher contribution of these mediators along aging. Overall, these findings re-emphasize the impact of aging in the dynamic profile of serum immune mediators, highlighting the shift of selective mediators and their rhythmic signatures across chronological aging.

Impact of Smoking on Cervical Histopathological Changes in High-Risk HPV-Positive Women: A Matched Case–Control Study

Background and Objectives: The aims of this study were to assess the impact of smoking on cervical histopathology in women with high-risk HPV types 16 and 18 (the most common types) utilizing comprehensive clinical data and to conduct a risk analysis based on smoking pack-years. Materials and Methods: Between 2022 and 2024, 1048 high-risk HPV-positive women aged 25 to 65 years were categorized into two groups: smokers and non-smokers. Data acquired from a histopathological examination of samples collected during a colposcopic evaluation of these women were compared individually regarding clinical and demographic factors, specifically age, gravida, parity, and alcohol consumption. Subsequently, the impact of prolonged and excessive smoking on histopathological cellular changes was assessed in women with the same characteristics. A case–control study was performed on 312 smokers and 312 non-smokers following mutual matching. Results: The women were matched one-to-one regarding gravida, parity, and alcohol consumption. Subsequently, they were paired within a ±2-year age range. The mean age of the smoker group was 47.1 ± 8.8, while that of the non-smoker group was 47.2 ± 8.5 (p: 0.904). In all cases of high-risk HPV positivity, the rate of normal cervical cytological results was 14% in women who smoked and 29% in women who did not smoke. The LGSIL, HGSIL, ASC-H, and AGC-NOS rates were elevated in the smoker group, and a statistically significant difference was observed between the two groups in terms of abnormal cervical cytological results (p < 0.001). After a colposcopic biopsy, the smoker group exhibited higher rates of HGSILs, LGSILs, AGC-NOS, and CIS pathological lesions (28% vs. 23%), whereas the non-smoker group exhibited higher rates of chronic cervicitis (23% vs. 16%). However, no statistically significant difference was found between the two groups (p: 0.092). In a comparison of endocervical curettage (ECC) samples, it was observed that the HGSIL, CIS, and AGC-FN rates in the smoker group were almost the same as those in the non-smoker group. However, the LGSIL histopathology results (32% vs. 18%) were higher, and the rate of negativity with no pathology was higher in the non-smoker group (72% vs. 59%). A statistically significant difference in ECC histopathology was noted between the two groups (p < 0.001). An ROC analysis conducted between smoking pack-years and the colposcopic and endocervical curettage biopsy results revealed that the cutoff value for the colposcopic abnormal histopathological results increased, with 40% sensitivity and 76% specificity above 20 pack-years (AUC: 0.592 and p: 0.025). Additionally, the abnormal histopathology rates for endocervical curettage exhibited 81% sensitivity and 32% specificity above 13 pack-years (AUC: 0.586 and p: 0.008). The rate of abnormalities in the colposcopic biopsy results was 2.19 times higher for individuals with over 20 pack-years, and the rate of abnormalities in the ECC results was 2.08 times higher for those with over 13 pack-years; additionally, statistically significant results were obtained (p-values of 0.027 and 0.008, respectively). Conclusions: The most important cause of neoplastic changes in the cervix uteri is high-risk HPV infection, with evidence indicating that prolonged excessive smoking significantly exacerbates the persistence and progression of HPV infection, thereby influencing neoplastic changes in the cervix uteri. It is crucial for women to cease smoking in order to eradicate HPV infection from the body.

Dynamic Importance of Genomic and Clinical Risk for Coronary Artery Disease Over the Life Course.

Earlier identification of high coronary artery disease (CAD) risk individuals may enable more effective prevention strategies. However, existing 10-year risk frameworks are ineffective at earlier identification. We sought to understand how the variable importance of genomic and clinical factors across life stages may significantly improve lifelong CAD event prediction. A longitudinal study was performed using data from 2 cohort studies: the FOS (Framingham Offspring Study) with 3588 participants aged 19 to 57 years and the UKB (UK Biobank) with 327 837 participants aged 40 years to 70 years. A total of 134 765 and 3 831 734 person-time years were observed in FOS and UKB, respectively. Hazard ratios for CAD were calculated for polygenic risk score (PRS) and clinical risk factors at each age of enrollment. The relative importance of PRS and pooled cohort equations in predicting CAD events was also evaluated by age groups. The importance of CAD PRS diminished over the life course, with a hazard ratio of 3.58 (95% CI, 1.39-9.19) at the age of 19 years in FOS and a hazard ratio of 1.51 (95% CI, 1.48-1.54) by the age of 70 years in UKB. Clinical risk factors exhibited similar age-dependent trends. PRS significantly outperformed pooled cohort equations in identifying subsequent CAD events in the 40- to 45-year age group, with 3.2-fold more appropriately identified events. Overall, adding PRS improved the area under the receiving operating curve of the pooled cohort equations by an average of +5.1% (95% CI, 4.9%-5.2%) across all age groups; among individuals <55 years, PRS augmented the area under the curve-ROC of the pooled cohort equations by 6.5% (95% CI, 5.5%-7.5%; P<0.001). Genomic and clinical risk factors for CAD display time-varying importance across the lifespan. The study underscores the added value of CAD PRS, particularly among individuals younger than 55 years, for enhancing early risk prediction and prevention strategies. All results are available at https://surbut.github.io/dynamicHRpaper/index.html.

P0932 The Impact of Crohn’s Disease on Fertility in Chinese Women: A Comparative Study with the General Population

Abstract Background This study aims to clarify the uncertain impact of Crohn’s disease on fertility among Chinese female by comparing their fertility rates with those of the general female population. Methods From January 2012 to December 2022, Crohn’s disease patients at Sixth Affiliated Hospital of Sun Yat-sen University were identified through hospital records. Female patients aged 15 to 44 were included. Demographic and fertility data were collected through structured questionnaires. Comparative data for the general population aged 15 to 44 were obtained from the National Bureau of Statistics of China. Age-adjusted overall fertility rate and adjusted fertility rate ratio (AFRR) were calculated using poisson regression, along with fertility rate ratios for 5-year age groups stratified by disease onset, surgery, and perianal disease. Results A total of 564 valid questionnaires were collected. The overall fertility rate among females with Crohn’s disease was 43.41 live births per 1000 person-years (95%CI [39.30-48.11.]), significantly lower than the general population(52.80, 95%CI[52.72-52.97], AFRR 0.82, p&amp;lt; 0.001). Pre-onset rates showed no significant difference, but there was a significantly decline post-onset(35.84, 95%CI[30.32-42.31], AFRR 0.55, 95%CI[0.46-0.65], p&amp;lt;0.001). Fertility rates decreased in patients aged 20 to 29 post-onset. Those who underwent bowel surgery had reduced fertility rates post-surgery(31.44, 95%CI[21.05-92.49] vs 49.92, 95% CI [45.35-54.91], AFRR 0.63, 95% CI [0.45-0.89], p=0.008). Patients with perianal disease was 47% of that of the general population (25.05, 95% CI [8.94-40.97] vs. 48.61, 95% CI [43.57-52.97], AFRR 0.47, 95% CI [0.43-0.52], p&amp;lt;0.001). Conclusion Female Crohn’s disease patients show lower fertility rates than the general population, particularly among those aged 20-29 age post-disease onset, with further reductions after surgery and perianal disease.

The global, regional, and national disease burden of colorectal cancer attributable to low physical activity from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021

ObjectivesThis study aims to estimate the spatiotemporal variation in the burden of colorectal cancer (CRC) attributable to low physical activity (LPA) at global, regional, and national levels from 1990 to 2021.Study designCross-sectional study.MethodsAnnual data on deaths of CRC related to LPA, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and the age-standardized DALYs rate (ASDR) for 204 countries and territories from 1990 to 2021 was extracted from the Global Health Data Exchange website. They were retrieved by age (5-year age groups from 25 to 94 years, and 95+ years), gender (male and female), and Socio-demographic Index (SDI). The association between age-standardized rates and SDI values was assessed by Spearman’s correlation.ResultsBetween 1990 and 2021, there was nearly a twofold increase in DALYs and mortality globally for CRC related to LPA, despite decreases in ASMR and ASDR (EAPC: −0.82% and −0.83%, respectively). However, on a national scale, ASMR and ASDR increased in more than half of the world’s countries and territories. Moreover, a greater burden of CRC related to LPA was observed in older populations, females, and those residing in regions with an SDI near 0.77.ConclusionThese findings indicate the critical need to raise awareness about the preventive role of physical activity in CRC. Policymakers should prioritize developing and implementing strategies that ensure equitable access to sports resources, enabling more people to meet the World Health Organization guidelines.

How many people in the Netherlands live with a hip, knee, or shoulder replacement?

We estimated the prevalence of people living with at least one hip, knee, or shoulder arthroplasty in the Netherlands. We included the first hip (n = 416,333), knee (n = 314,569), or shoulder (n = 23,751) arthroplasty of each patient aged ≥ 40 years between 2007 and 2022 (hip/knee) or 2014 and 2022 (shoulder) from the Dutch Arthroplasty Register (LROI). Data on the size of the Dutch population were obtained from Statistics Netherlands. Annual incidences and deaths from hip and knee arthroplasty since 2010, and shoulder arthroplasty since 2015, were observed from the LROI. Annual incidences and deaths before those years were estimated using Poisson regression analyses and parametric survival models based on a Gompertz distribution. Non-parametric percentile bootstrapping with resampling was used to estimate 95% CIs. Annual incidences per 100,000 Dutch inhabitants aged ≥ 40 years increased for hip arthroplasties from 221 (95% CI 214 to 229) in 1990 to 360 in 2022, for knee arthroplasties from 181 (95% CI 174 to 188) to 272, and for shoulder arthroplasties from 11 (95% CI 8.0 to 16) to 34. In 2022, 791,000 (95% CI 787,000 to 794,000) people in the Netherlands were living with at least one joint replacement, representing 8.4% (95% CI 8.4 to 8.5) of the Dutch population aged ≥ 40 years. For hip, knee, and shoulder arthroplasties, these were 436,000 (95% CI 433,000 to 438,000), 383,000 (95% CI 380,000 to 386,000), and 34,000 (95% CI 33,000 to 36,000) people, corresponding to 4.7% (95% CI 4.6 to 4.7), 4.1% (95% CI 4.1 to 4.1), and 0.4% (95% CI 0.3 to 0.4) of the Dutch population, respectively. The most common age group living with at least one joint replacement was the ≥ 80-year age group, representing 38% (95% CI 37 to 38) of the Dutch population aged ≥ 80 years. Approximately 800,000 people in the Netherlands were living with at least one hip, knee, or shoulder replacement in 2022, representing one in 12 Dutch inhabitants aged ≥ 40 years.

Trends in childhood asthma in Denmark, Finland, Norway and Sweden.

Estimate the incidence of asthma among children aged 0 to 15 years in Denmark, Finland, Norway and Sweden during 2000-2017. Cases of preschool asthma (up to 6 years) and school-age asthma (from 6 years) were identified through national registers using an algorithm including hospital diagnoses and prescription medicines. The respective cumulative incidence (CI) was estimated in 1-year age intervals for each country and birth year. The CI of algorithm-based preschool asthma peaked for the birth cohorts 2008 or 2009 at 14.8% in Denmark, 11.0% in Finland, 15.1% in Norway and 13.7% in Sweden. For later birth cohorts, a slight decrease was observed. The CI of school-age asthma was 7.1% in Denmark, 10.5% in Finland, 9.7% in Norway and 10.2% in Sweden (children born in 2002). A slight decline over time was seen in Denmark and Norway, and a slight increase in Sweden and Finland. Finland had a markedly lower CI of preschool asthma and Denmark lower CI of school-age asthma as estimated by prescriptions and hospital diagnoses. Preschool asthma may have plateaued in the Nordic countries. For school-age asthma trends over time varied by country. Differences in diagnostic and prescription practices may have influenced the results.

Sex-, age- and season-specific variations in accidental deaths from stumbling falls, bathtub drowning, food choking and traffic injuries among older adults in Japan.

The aim of this study was to identify opportunities for more effective measures. We analyzed sex-, age- and season-specific trends in unintentional accidental deaths from stumbling falls, bathtub drowning, food choking and traffic injuries among older adults in Japan. Death rates from major unintentional accidents were analyzed by sex, month and 5-year age groups (aged ≥50 years) based on a custom-made aggregation of data from the Vital Statistics survey (2008-2022) in compliance with the Statistics Act. From 2008 to 2022, death rates from the 4 major unintentional accidental causes (11 354 and 11 374 deaths in 19 408 000 men and 24 272 000 women aged ≥60 in 2022) were obviously higher among older men than older women, except for notably high death rates from bathtub drowning among women aged 75-84 years. Significant increases in death rates from stumbling falls were observed in men and women aged ≥85 years, with significant decreases among men aged 60-74 years and women aged 65-74 years. Significant increases in bathtub drowning death rates were observed among men aged 90-94 and ≥100 years, as well as among women aged 90-99 years. Bathtub drowning death rates rose with age but peaked in women aged 85-89 years. Both bathtub drowning and food choking deaths were more frequent during the winter season. Accidental deaths from stumbling falls and bathtub drowning continue to rise among older Japanese adults in some age groups. Notably, deaths from bathtub drowning were distinctively higher among women aged in their 70s and 80s, possibly including apparently healthy women, during the winter season. Geriatr Gerontol Int 2025; ••: ••-••.

Evaluation of Brain CT Findings in Patients with Head Trauma Visiting Khatam Al-Anbia Hospital in Zahedan in 2022

Background: Traumatic brain injury (TBI) remains a leading cause of mortality and long-term disability. This study aims to evaluate brain CT scan findings in patients with head trauma admitted to Khatam al-Anbia Hospital in Zahedan during 2022. Methods: This cross-sectional, descriptive-analytical study focused on patients presenting with head trauma at Khatam al-Anbia Hospital in Zahedan throughout 2022 who underwent brain CT scans. A census-based sampling method was employed, and data were collected using a structured checklist. The analysis was conducted using SPSS software. Results: The study included patients with a mean age of 51.78 ± 26.75 years, ranging from 1 to 99 years. Among the 100 participants, 25 (25%) were women and 75 (75%) were men. The highest incidence of TBI was observed in the 70 to 80-year age group, with 15 patients, whereas the lowest incidence was found in the 50 to 60-year and over 90-year age groups, with 6 patients each. Car accidents were identified as the leading cause of head trauma, accounting for 32 cases (32%), followed by physical altercations, which contributed to 10 cases (10%). CT scan results indicated that 10% of the scans were normal, while 90% were abnormal. Notable abnormal findings included subdural hemorrhage (6 cases), frontal bone fractures (16 cases), and cytotoxic edema (6 cases). The most frequent location and type of skull fractures were in the temporal region (8 cases, 29.6%) and linear fractures (16 cases, 59.3%), respectively. The majority of TBIs were classified as mild (54 cases), with moderate TBIs being the least common (16 cases). Additionally, significant associations were found between injury type, gender, and the nature of the trauma. Conclusions: This study highlights that road traffic accidents are a predominant cause of traumatic brain injuries, consistent with findings from various studies. The most frequently affected age group was 70 to 80 years, with a predominance of men. Abnormal CT findings commonly included subdural hemorrhage, frontal bone fractures, and cytotoxic edema. These results indicate potential regional differences in TBI patterns and emphasize the importance of targeted diagnostic and treatment strategies. The findings underscore the need for early and precise CT imaging in managing head trauma to improve patient outcomes. Further research is essential to refine management approaches and address regional variations in TBI.

Trends and ethnic disparity in endometrial cancer mortality in South Africa (1999-2018): A population-based Age-period-cohort and Join point regression analyses.

Endometrial cancer is the sixth leading cause of cancer among females and about 97,000 global deaths of endometrial cancer. The changes in the trends of obesity, fertility rates and other risk factors in South Africa (SA) may impact the endometrial cancer trends. The aim of this study was to utilise the age period cohort and join point regression modelling to evaluate the national and ethnic trends in endometrial cancer mortality in South Africa over a 20year period (1999-2018). Data from Statistics South Africa was obtained to calculate the annual number of deaths, and annual crude and age standardised mortality rates (ASMR) of endometrial cancer from 1999-2018. The overall and ethnic trends of endometrial cancer mortality was assessed using the Join point regression model, while Age-period-cohort (APC) regression modelling was conducted to estimate the effect of age, calendar period and birth cohort. During the period 1999-2018, 4,877 deaths were due to endometrial cancer which constituted about 3.6% of breast and gynecological cancer deaths (3.62%, 95% CI: 3.52%-3.72%) in South Africa. The ASMR of endometrial cancer doubled from 0.76 deaths per 100,000 women in 1999 to 1.5 deaths per 100,000 women in 2018, with an average annual rise of 3.6% per annum. (Average Annual Percentage change (AAPC): 3.6%, 95%CI:2.7-4.4, P-value < 0.001). In 2018, the overall mean age at death for endometrial cancer was was 67.40 ± 11.04 years and, the ASMR of endometrial cancer among Indian/Asians (1.69 per 100,000 women), Blacks (1.63 per 100,000 women) and Coloreds (1.39 per 100,000 women) was more than doubled the rates among Whites (0.66 deaths per 100,000 women). Indian/Asians had stable rates while other ethnic groups had increased rates. The Cohort mortality risk ratio (RR) of endometrial cancer increased with successive birth cohort from 1924 to 1963 (RR increased from 0.2 to 1.00), and subsequently declined among successive cohorts from 1963 to 1998 (1.00 to 0.09). There was strong age and cohort but not period effect among the South African women. Ethnic disparity showed that there was age effect among all the ethnic groups; Cohort effect among Blacks and Coloureds only, while Period effect occurred only among Blacks. The mortality rates of endometrial cancer doubled over a twenty-year period in South Africa from 1999-2018. There was strong ethnic disparity, with age and cohort effect on endometrial cancer trends. Thus, targeted efforts geared towards prevention and prompt treatment of endometrial cancer among the high-risk groups should be pursued by stake holders.

Late-life social activity and subsequent risk of dementia and mild cognitive impairment.

Social activity is associated with better cognitive health in old age. To better translate epidemiological research for public health communication, we estimated relations of levels of social activity to average age at dementia onset. In the Rush Memory and Aging Project (MAP), we followed 1923 dementia-free older adults and conducted annual clinical evaluations of dementia/mild cognitive impairment (MCI). During a mean follow-up of 6.7 (SD=4.7) years, 545 participants developed dementia, and 695 developed MCI. Using Accelerated Failure Time models adjusted for age, sex, education, race/ethnicity, and marital status, we found predicted mean age of dementia onset for the least socially active was 87.7 years, approximately 5 years earlier than the most socially active (mean age=92.2, p <.01); we found a similar 5-year difference in age at MCI onset by social activity. Our findings highlight the value of social activity as a possible community-level intervention for reducing dementia. Accelerated failure time models estimated age at dementia onset by social activity level to aid interpretation. Higher social activity was associated with a 5-year older age at dementia onset. Economic research shows a 5-year delay translates to US$500,000 of healthcare savings per capita. Our findings help understand the public health significance of social activity.

Optimizing Travel Insurance Purchase Detection using Predictive Models

What traveler features should be considered when designing airline travel insurance policies, and can predictive modeling enhance the accuracy of purchase predictions? Motivated by the increased need to safeguard investments due to frequent flight interruptions and cancellations during the COVID-19 pandemic and its travel restrictions, we investigate the uptake of flight travel insurance using predictive models. This study applies various machine learning techniques to a dataset consisting of 1,987 travelers, examining whether they purchased travel insurance (a binary classification problem). Performance metrics such as misclassification rate, precision, recall, F-score, and the area under the receiver operating characteristic curve (AUC) are used to assess model effectiveness. The models were optimized using cross-validation on the training data. Among the models tested, eXtreme Gradient Boosting Machine (XGBoost) achieved the highest accuracy rate of 86%, along with the best AUC, precision, recall, and specificity, indicating a 98% accuracy in predicting who will purchase travel insurance. Other robust models, such as ensemble methods and neural networks, also demonstrated strong performance, with similar AUC and precision scores. Features such as annual income, age, travel history, and education history were found to be the most significant predictors, while chronic disease history had little impact. Parsimonious predictive models, using only the most important variables, yielded better performance. Our findings highlight the critical role of predictive accuracy in helping insurers mitigate the financial risk due to travel interruptions.

High Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study.

High altitude may induce physiological changes that can predispose patients to venous thromboembolism (VTE), a relatively uncommon, but potentially fatal complication following total knee arthroplasty (TKA). The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA. A large claims database was queried for patients who underwent TKA at high-altitude (≥ 1,219-meters) and low-altitude (≤ 30-meters) using Current Procedural Terminology codes, International Classification of Disease codes, and zip codes. High- and low-altitude cohorts were matched 1:3 by 5-year age range, sex, Charlson comorbidity index (CCI), diabetes mellitus, obesity (body mass index ≥ 30), hypertension, and tobacco use. There were 57,135 patients included in the high-altitude group and 171,322 in the low-altitude group. Outcome measures included 30- and 90-day incidence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). Chi-square was used to determine differences in demographics. Binomial logistic regression was used to determine postoperative rates of VTE, DVT, and PE. The incidence of VTE was significantly greater in the high-altitude versus the low-altitude group at 30-days (OR [odds ratio] 1.15 [95% CI (confidence interval) 1.02 to 1.30], P = 0.022) and 90-days (OR 1.20 [95% CI 1.08 to 1.34], P = 0.0007). The incidence of DVT was significantly higher for the high-altitude cohort at both 30- (OR 1.30 [95% CI 1.10 to 1.54], P = 0.002) and 90-days (OR 1.36 [95% CI 1.18 to 1.57], P < 0.0001). The incidence of PE within 30- and 90-days was not significantly different between groups. High altitude (> 1,219-meters) is an independent risk factor for VTE following TKA. Patients who undergo TKA at surgical centers greater than 1,219-meters in elevation are more likely to develop VTE and DVT within 30- and 90-days postoperatively. Surgeons may account for high altitude as a risk factor and determine the most suitable postoperative prophylaxis method for their patients.

Comparison of Management and Outcomes of Hip Fractures Among Low- and High-Income Patients in Six High-Income Countries.

There is a perception that income-based disparities are present in most countries but may differ in magnitude. However, there are few international comparisons that describe income-based disparities across countries and none that focus on hip fractures. To compare treatment patterns and outcomes of high- and low-income older adults hospitalized with hip fracture across six high-income countries. Retrospective serial cross-sectional cohort study. Adults aged ≥ 66years hospitalized with hip fracture from 2013 to 2019 in Canada, England, Israel, the Netherlands, Taiwan, and the USA using population-representative patient-level administrative data. Older adults in the top and bottom income quintiles within countries were compared on 30-day and 1-year mortality, treatment approaches, hospital length of stay (LOS), 30-day readmission rates, time to surgery, and discharge disposition. Annual age- and sex-standardized incidence rates of hip fracture were higher for low- than for high-income populations in all countries except in the USA. In all countries, adjusted 1-year mortality was lower for high-income than low-income patients, with the largest difference in Israel (- 10.0 percentage points [95% confidence interval [CI], - 15.2 to - 4.8 percentage points]). Across countries, utilization of total hip arthroplasty was 0.1 (95% CI, 0.0-0.2 percentage points) to 6.9 percentage points (95% CI, 4.6-9.2 percentage points) higher among high- vs. low-income populations. With few exceptions, LOS, adjusted 30-day readmission rate, and time to surgery were shorter and lower for high-income patients. Income-based disparities in treatments and outcomes for older adults hospitalized for hip fractures differed in magnitude, but were present in all six high-income countries. Defying our expectations, the USA did not have consistently larger disparities than other countries suggesting that the impacts of poverty exist in vastly different healthcare systems and transcend geopolitical borders.

Asymptomatic Plasmodium falciparum infections and determinants of carriage in a seasonal malaria chemoprevention setting in Northern Cameroon and south Senegal (Kedougou)

BackgroundAmong the several strategies recommended for the fight against malaria, seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine combination (SPAQ) targets children 3 months to 5 years in Sahel regions of Africa to reduce mortality and mortality. Since SMC with SPAQ is administered to symptoms-free children for prevention of malaria, it is anticipated that a proportion of asymptomatic parasitaemic children will also be treated and may result in a drop in both the overall population prevalence of asymptomatic malaria infections, subsequent risk of symptomatic malaria infections and transmission. Age-specific carriage of asymptomatic Plasmodium spp. infections (API) was evaluated in target children and adults in Cameroon and Senegal, prior to the 2018 SMC campaign in both countries.MethodsA baseline household survey was carried out in August 2018 in two areas in Cameroon and one in Senegal just before the beginning of distribution of SPAQ for SMC. The survey included collection of fingerpick blood for malaria rapid diagnostic testing (RDT) and administration of a pre-tested questionnaire on demographics and malaria risk factors to participants. The age-specific prevalence of API in all study sites was analysed, first as a distribution of RDT-positives in 5-year age categories and secondly, with age as a continuous variable in the whole sample, using the Wilcoxon rank sum test. Risk factors for carriage of asymptomatic infections were examined using logistic regression analysis in STATA v.16 and Rv4.1.2.ResultsIn total, 6098 participants were surveyed. In Cameroon, overall prevalence of API was 34.0% (32.1–36.0%) in Adamaoua, and 43.5% (41.0–45.7%) in the North. The median age of RDT positivity was higher in Senegal: 11 years (IQR 7–16) than in Cameroon—Adamaoua: 8 years (4–17) and North: 8 years (4–12) and significantly different between the three study regions. In all three study sites, asymptomatic carriage was significantly higher in the older age group (5–10 in Cameroon, and 7–14 in Senegal), compared to the younger age group, although the median age of participants was lower among RDT-negatives in the North compared to RDT-positives. Health area, gender and last infection within past year significantly confounded the relationship between age and parasite carriage in Adamaoua and Senegal but not in North Cameroon. Absence of bed net and previous infection within one month of the survey all independently predicted carriage of asymptomatic parasites in multivariate regression analysis.ConclusionUnder five years asymptomatic Plasmodium infection in northern Cameroon prior to SMC season remained high in 2018, irrespective of history of SMC implementation in the study areas in Cameroon. Compared to Adamaoua, peak asymptomatic malaria parasite rate was observed in children 5–10 years, which is out of the SMC target age-range. Health area, last infection within the past month and to a lesser extent gender affected the association between age and asymptomatic carriage in all sites except the North region of Cameroon, indicating wide heterogeneity in risk of malaria among the general population in that geography. Follow-up studies designed to measure SMC effects in Cameroon are warranted as it may become necessary to extend age of SMC eligibility to 10 years, as is practiced in Senegal.

BMI trajectory of 8,155,894 Japanese adults from exhaustive health checkup data: the contributions of age-related changes in height and weight.

This study aimed to clarify the trajectory of BMI alongside age-related changes in height and weight among Japanese adults. Data from annual health checkups between 2015 and 2020 by the Japan Health Insurance Association were retrospectively analyzed. A total of 4,777,891 men and 3,378,003 women (age 35-69 years) were stratified into 14 subgroups based on sex and 5-year age categories. We used linear mixed-effects model to estimate values for each outcome, with six-time points (2015-2020) as the independent variable. Mean BMI changes were positive across all subgroups, indicating a trend of increasing BMI (men, 0.02 to 0.14 kg/m2/year; women, 0.05 to 0.16 kg/m2/year). In younger subgroups, the changed were relatively large, with the weight transitions mirroring those of BMI. However, the mean changes were negative (men, -0.06 kg/year; women, -0.01 kg/year) in the oldest subgroups. Height reduction increased with age across subgroups (men, -0.14 to -0.03 cm/year; women, -0.18 to -0.01 cm/year). In conclusion, BMI tended to increase with age in both sexes across all age groups of Japanese adults. The increase in BMI appeared to be influenced by weight gain in young to middle age, whereas height reduction influenced increased BMI in older age groups.

Evaluation of the Impact of Enteral Nutrition Support on Anthropometric Measurements and Micronutrient Levels in Malnourished Children.

Malnutrition is a critical clinical condition that requires early intervention due to its potential for causing preventable fatalities and complications. This study aims to assess the impact of outpatient enteral nutrition support (ENS) as a therapeutic intervention on anthropometric measurements, intolerance, and micronutrient values in malnourished children. This observational study included 344 patients in ages 1 to 18 treated with standard enteral nutrition (1.5 kcal/mL energy with fiber). Patient data recorded at admission, in 3 and 6 months, including weight, height, body mass index (BMI), intolerance symptoms, and micronutrient levels. Data were also compared by age groups (1-2, 3-5, 6-12, and 13-18 years of age). Malnutrition was prevalent in the 1- to 5-year age group (63.6%). Age-based analysis showed significant height and BMI z-score improvement in all age groups (P = .009 and P < .001, for all age groups, respectively), except the 13- to 18-year age group (P = .102 and P = .091, respectively). Micronutrient values remained within healthy ranges with minimal fluctuations. The ENS was well tolerated by 62.5% of patients, and the most common intolerance symptoms were constipation (15.4%), vomiting (8.1%), and nausea (7.3%). This study demonstrates that outpatient ENS therapy for 6 months significantly improved anthropometric measurements in malnourished children and was well tolerated. The 1 to 2 age group exhibited the most substantial response to treatment, whereas the 1 to 5 age group required at least 6 months of nutritional therapy to prevent stunting. However, the effect of ENS therapy on height and BMI z-scores in the 13 to 18 age group appeared insufficient after 3 months.

Age- and sex-related reference values for central blood pressure parameters in middle-aged and older Japanese adults: the Wakayama study.

Central blood pressure (BP) is more strongly associated with cardiovascular events than brachial BP. Few studies have described age-related changes in central BP in the general Japanese population. This study aimed to provide reference values for central BP parameters according to the age and sex, using data from 2964 participants aged 40-89 years (mean age: 60 years) who had no history of overt cardiovascular or chronic kidney disease and had not received antihypertensive, lipid-lowering, or hypoglycemic treatments. The central aortic pressure waveform was measured noninvasively by pulse wave analysis using the SphygmoCor XCEL operating system. Central systolic BP (cSBP), pulse pressure (cPP), and augmentation pressure (AP) exhibited a curvilinear relationship with age, with men having significantly higher cSBP but lower cPP and AP than women (cSBP: 132 mmHg vs. 123 mmHg, P < 0.001; cPP, 50 mmHg vs. 55 mmHg, P = 0.001; and AP: 24 mmHg vs. 32 mmHg, P = 0.002). Reference percentiles for cSBP, cPP, and AP were determined for each 5-year age group using the LMS method. Multiple regression analyses showed that age-standardized z-scores for cSBP, cPP, and AP were significantly associated with hypertension, dyslipidemia, diabetes mellitus, abdominal obesity, and heavy smoking, after adjusting for potential confounders. In conclusion, this study provides age- and sex-specific percentiles of central BP parameters in middle-aged and older Japanese adults. These reference values allow a more accurate interpretation of results and may be useful for diagnosis and management of hypertension in clinical practice and for risk stratification in population studies.