Study protocol to assess aflatoxin M1 health risks versus benefits of dairy consumption in Ethiopian children: an epidemiological trial and risk-benefit analysis

INTRODUCTION

In Sidama, Ethiopia, animal-source foods can be difficult to access. Milk has important nutrients for child growth, but carries the risk of aflatoxin M1 (AFM1) contamination. AFM1 is a metabolite of the mycotoxin aflatoxin B1 (AFB1) in dairy feed; cows secrete AFM1 in milk when their feed contains AFB1 produced by Aspergillus fungi in maize, nuts and oilseeds. It is unknown whether AFM1 compromises child growth and health.

METHODS AND ANALYSIS

This protocol paper describes our study in Sidama to determine the impact of milk consumption and AFM1 on child growth in the first 18 months of life. We will collect baseline and end-line data on dairy production, socioeconomic and nutritional factors of 1000 dairy-owning households with children ages 6-18 months at baseline; and gather samples of milk and dairy feed and child anthropometrics. We will conduct phone interviews every 6 months to ascertain changes in practices or child health. Dairy feed will be tested for AFB1; milk for AFM1, pathogens and nutrients. Controlling for herd size, socioeconomic, nutritional and behavioural factors, we will determine the association between child anthropometrics and milk consumption, as well as AFM1 exposure. We will examine whether AFM1 exposure affects child growth in the first 18 months of life, and weigh the benefits and risks of milk consumption.

ETHICS AND DISSEMINATION

The protocol is approved by the Institutional Review Boards of the Ethiopian Public Health Institute (EPHI-IRB-481-2022), Michigan State University (STUDY00007996) and International Food Policy Research Institute (DSGD-23-0102). Written informed consent will be obtained from all participants, who may withdraw from the study at any time. Confidentiality of collected data will be given high priority during each stage of data handling. The study's findings will be disseminated through stakeholder workshops, local and international conferences, journal articles and technical reports.

Quantification of low-level human cytomegalovirus and Epstein-Barr virus DNAemia by digital PCR

BACKGROUND

Digital PCR (dPCR) can quantify cell-free viral DNA (DNAemia), a biomarker of active viral infection. To accelerate epidemiologic investigation into low-level viral reactivation in chronic disease, we have evaluated the performance of dPCR to detect cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNAemia across platforms and blood matrices.

METHODS

The droplet-based (BioRad) dPCR platform performance was compared to chip-based (BioMark), and assay validation followed dMIQE guidelines. CMV and EBV DNA reference materials were spiked into known negative plasma and serum samples. In addition, two independent cohorts of ovarian cancer patients were evaluated for viral DNAemia (n = 65 serum and 79 plasma samples).

RESULTS

The limit of quantification (LOQ) was at or slightly above 100 copies/mL for both instruments: 105-135 copies/mL for droplet-based detection and 100 copies/mL for chip-based detection. DNAemia in serum had a slightly lower LOQ (105-110 copies/mL) compared to plasma (LOQ; 115-135 copies/mL). The variation (CV) coefficients for each assay and machine were less than 5 %. In patient samples, CVs ranged from 4.5 - 7.4 % and were similar for cell-free DNA derived from serum or plasma. There was good correlation between DNAemia measurements in patient samples across dPCR platforms (r > 0.90 for each assay and matrix).

CONCLUSION

dPCR can quantify low-level herpes virus DNAemia with CVs below 8 %. Our results indicate that using serum-derived cell-free DNA and droplet-based dPCR is optimal for quantitating low-level viral DNAemia; however, plasma and chip-based approaches are acceptable alternatives and suitable for epidemiologic investigation.

Prevalence of multiple long-term conditions (multimorbidity) in England: a whole population study of over 60 million people

OBJECTIVES

To determine the prevalence of multiple long-term conditions (MLTC) at whole English population level, stratifying by age, sex, socioeconomic status and ethnicity.

DESIGN

A whole population study.

SETTING

Individuals registered with a general practice in England and alive on 31 March 2020.

PARTICIPANTS

60,004,883 individuals.

MAIN OUTCOME MEASURES

MLTC prevalence, defined as two or more of 35 conditions derived from a number of national patient-level datasets. Multivariable logistic regression was used to assess the independent associations of age, sex, ethnicity and deprivation decile with odds of MLTC.

RESULTS

The overall prevalence of MLTC was 14.8% (8,878,231), varying from 0.9% (125,159) in those aged 0-19 years to 68.2% (1,905,979) in those aged 80 years and over. In multivariable regression analyses, compared with the 50-59 reference group, the odds ratio was 0.04 (95% confidence interval (CI): 0.04-0.04; p < 0.001) for those aged 0-19 years and 10.21 (10.18-10.24; p < 0.001) for those aged 80 years and over. Odds were higher for men compared with women, 1.02 (1.02-1.02; p < 0.001), for the most deprived decile compared with the least deprived, 2.26 (2.25-2.27; p < 0.001), and for Asian ethnicity compared with those of white ethnicity, 1.05 (1.04-1.05; p < 0.001). Odds were lower for black, mixed and other ethnicities (0.94 (0.94-0.95) p < 0.001, 0.87 (0.87-0.88) p < 0.001 and 0.57 (0.56-0.57) p < 0.001, respectively). MLTC for persons aged 0-19 years were dominated by asthma, autism and epilepsy, for persons aged 20-49 years by depression and asthma, for persons aged 50-59 years by hypertension and depression and for those aged 60 years and older, by cardiometabolic factors and osteoarthritis. There were large numbers of combinations of conditions in each age group ranging from 5936 in those aged 0-19 years to 205,534 in those aged 80 years and over.

CONCLUSIONS

While this study provides useful insight into the burden across the English population to assist health service delivery planning, the heterogeneity of MLTC presents challenges for delivery optimisation.

Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon

OBJECTIVE

The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator.

METHODS

This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet.

RESULTS

The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet.

CONCLUSIONS

Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.

Application of ventilator-associated events (VAE) in ventilator-associated pneumonia (VAP) notified in Brazil (IMPACTO MR-PAV): a protocol for a cohort study

INTRODUCTION

Certain criteria for ventilator-associated events (VAE) definition might influence the type of an event, its detection rate and consequently the resource expenditure in intensive care unit. The Impact of Infections by Antimicrobial-Resistant Microorganisms - Ventilator-Associated Pneumonia (IMPACTO MR-PAV) aims to evaluate the incidence and diagnostic accuracy of ventilator-associated pneumonia (VAP) using the current criteria for VAP surveillance in Brazil versus the VAE criteria defined by the US National Healthcare Safety Network-Center for Diseases Control and Prevention (CDC) criteria.

METHODS AND ANALYSIS

The study will be conducted in around 15 centres across Brazil from October 2022 to December 2023. Trained healthcare professionals will collect data and compare the incidence of VAP using both the current criteria for VAP surveillance in Brazil and the VAE criteria defined by the CDC. The accuracy of the two criteria for identifying VAP will also be analysed. It will also characterise other events associated with mechanical ventilation (ventilator-associated condition, infection-related ventilator-associated complication) and adjudicate VAP reported to the Brazilian Health Regulatory Agency (ANVISA) using current epidemiological diagnostic criteria.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board under the number 52354721.0.1001.0070. The study's primary outcome measure will be the incidence of VAP using the two different surveillance criteria, and the secondary outcome measures will be the accuracy of the two criteria for identifying VAP and the adjudication of VAP reported to ANVISA. The results will contribute to the improvement of VAP surveillance in Brazil and may have implications for other countries that use similar criteria.

TRIAL REGISTRATION NUMBER

NCT05589727; Clinicaltrials.gov.

Effect of Lifestyle Promotion in the PRECEDE-PROCEED model among pre-diabetic adults based on PERSIAN cohort study: a randomized controlled trial study

Background

Diabetes is a chronic disease caused by impaired glucose metabolism. This study aimed to design and evaluate the effect of a lifestyle promotion program based on the PRECEDE-PROCEED model among pre-diabetic individuals.

Methods

This randomized controlled trial evaluated the effect of a lifestyle promotion program using the PRECEDE-PROCEED model among pre-diabetic individuals in Hoveizeh city in 2019. The study collected information on the disease status and risk factors associated with non-communicable conditions from the website of Hoveizeh Cohort Study Center. The primary outcome of the study was the percentage of glycated hemoglobin (HbA1c) with a three-month follow-up.

Results

A total of 240 individuals participated in the study. There was no significant difference in anthropometric characteristics between the intervention and control groups (P < 0.05). Initially, there was no significant difference in the mean HbA1c between the intervention and control groups (P = 0.97). However, after three months of intervention, a statistically significant difference was observed (P > 0.001). The results indicated an increase in the mean quality of life in the intervention group, but no significant difference was found between the two groups or before and after the intervention within each group (P < 0.05).

Conclusion

The findings suggest that the PRECEDE-PROCEED model provides a suitable framework for training pre-diabetic individuals and patients with type 2 diabetes mellitus (T2DM) to promote self-care behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01273-7.

Outpatient orthognathic surgery: a prospective study of predictive factors for the length of hospital stays

OBJECTIVES

Transitioning from non-outpatient orthognathic surgery to outpatient surgery is a new challenge, and it is essential to target the eligible population as precisely as possible. Several authors describe series of outpatient orthognathic surgery but do not include the reasons for their success or failure. The main aim of this study was to identify the factors significantly associated with "successful" outpatient orthognathic treatment. The secondary objective was to determine the factors significantly associated with prolonged hospital stays (≥ 2 nights).

MATERIALS AND METHODS

A prospective cohort study including patients undergoing orthognathic surgery was conducted over a period of 1 year. We recorded the prognostic factors that contributed to successful outpatient treatment and prolonged hospital stays. These factors were evaluated by bivariate and multivariate analysis.

RESULTS

A total of 102 patients were included, and the success rate of treatment was 65%. The variables that were isolated by multivariate analysis were: patients over the age of 22, procedures ending before 1 pm, brief operations, the absence of both postoperative vomiting and the administration of morphine.

CONCLUSION

Patient selection, organisation of outpatient facilities and anaesthetic protocols contribute to the development of outpatient orthognathic surgery. These initial considerations provide a framework for our practice, but the considerations that predict the failure of outpatient surgery will need to be clarified.

CLINICAL RELEVANCE

Orthognathic surgery can be performed on outpatient basis in selected cases. Age, the operative time, procedure end time, postoperative vomiting and the administration of morphine are associated with the success of outpatient care.

How are children with medical complexity being identified in epidemiological studies? A systematic review

BACKGROUND

There are different definitions to identify/classify children with medical complexity (CMC). We aimed to investigate and describe the definitions used to classify CMC in epidemiological studies.

METHODS

PubMed, SciELO, LILACS, and EMBASE were searched from 2015 to 2020 (last updated September 15th, 2020) for original studies that presented the definition used to classify/identify CMC in the scientific research method. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. From the included studies, the following were identified: first author, year of publication, design, population, study period, the definition of CMC used, limitations, and strengths.

RESULTS

Nine hundred and sixty-seven records were identified in the searched databases, and 42 met the inclusion criteria. Of the 42 studies included, the four most frequent definitions used in the articles included in this review were classification of CMC into nine diagnostic categories based on the International Classification of Diseases, Ninth Revision (ICD-9) (35.7%, 15 articles); update of the previous classification for ICD-10 codes with the inclusion of other conditions in the definition (21.4%, nine articles); definition based on a medical complexity algorithm for classification (16.7%, seven articles); and a risk rating system (7.1%, three articles).

CONCLUSIONS

CMC definitions using diagnostic codes were more frequent. However, several limitations were found in its uses. Our research highlighted the need to improve health information systems to accurately characterize the CMC population and promote the provision of comprehensive care.

A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy

PURPOSE

To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system.

DESIGN

Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis.

SUBJECTS

We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses.

INTERVENTION

Pneumatic retinopexy was compared with PPV in all analyses.

MAIN OUTCOME MEASURES

The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications.

RESULTS

In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR.

CONCLUSIONS

Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Global Burden of Disease 2017 estimates for Major Depressive Disorder: a critical appraisal of the epidemiological evidence

Objectives

To critically appraise the quality of the studies underpinning the Global Burden of Disease (GBD) 2017 estimates for Major Depressive Disorder (MDD) with respect to i) the GBD 2017 inclusion criteria and ii) population coverage.

Design

Systematic critical appraisal.

Setting

Not applicable.

Participants

Not applicable.

Main outcome measures

Each study was critically appraised with respect to the four GBD 2017 inclusion criteria: representativeness, study method and sample, diagnostic criteria and publication from 1980 onwards. Population coverage was calculated.

Results

Less than half of studies (221/467, 47.3%) were nationally representative. Only 262/467 (56.1%) of studies reported specifically on MDD and more than a third did not use DSM or ICD diagnostic criteria: 94/467 (20.1%) did not specify any diagnostic criteria and 68/467 (14.6%) relied on self-reported depression for diagnosis. Only 62/467 (13.3%) of studies were conducted during the period 2011-2017. Only 107/195 (54.9%) of countries had one or more prevalence studies.

Conclusions

GBD 2017 estimates for MDD are based on incomplete country and population coverage. The inclusion of studies with non-representative populations, that do not use diagnostic criteria and the lack of specific data on MDD reduces the reliability of estimates and limits their value for policy making.

Quality of survey-based study reports in dentistry

BACKGROUND

Surveys are a widely used research method in dentistry in different specialities. The study aimed to determine the quality of survey-based research reports published in dentistry journals from 2015 to 2019.

METHODS

A cross-sectional descriptive research study was conducted. The report quality assessment was carried out through the SURGE guideline modified by Turk et al. Four journals indexed in the Web of Science were selected: BMC Oral Health, American Journal of Orthodontics and Dentofacial Orthopedics, Journal of Dental Education, and Journal of Applied Oral Science. The selection of articles was made using the PubMed database considering the following search words: questionnaire OR survey, two trained reviewers applied the guideline to the selected articles, and the controversies were solved by discussion and consensus.

RESULTS

A total of 881 articles were identified, of which 99 met the selection criteria and were included in the study. The best-reported items (n = 99) were four: the two that described the introduction of a study, the results reflecting and concerning the study objectives, and the review by an ethics committee. Five items were poorly reported: to declare the incentives to study participants (n = 93), three items on the description of statistical analyses (n = 99, 99, and 94), and information on how nonrespondents differed from respondents (n = 92).

CONCLUSIONS

There is a moderate quality of reporting of all aspects that should be considered in survey-based studies in dentistry journals. Poorly reported criteria were found mainly in the statistical analysis.

Differential Unmet Needs and Experience of Restorative Dental Care in Trajectories of Dental Caries Experience: A Birth Cohort Study

Dental caries is a chronic and cumulative disease but little has been reported on the continuity of the disease and its treatment through life. Group-based multi-trajectory modeling was used to identify developmental trajectories of untreated carious tooth surfaces (DS), restored tooth surfaces (FS), and teeth extracted due to caries (MT) from ages 9 to 45 years in a New Zealand longitudinal birth cohort, the Dunedin Multidisciplinary Health and Development Study (n = 975). Associations between early-life risk factors and trajectory group membership were examined by specifying the probability of group membership according to a multinomial logit model. Six trajectory groups were identified and labeled: "low caries rate"; "moderate caries rate, maintained"; "moderate caries rate, unmaintained"; "high caries rate, restored"; "high caries rate, tooth loss"; and "high caries rate, untreated caries". The two moderate-caries-rate groups differed in count of FS. The three high-caries-rate groups differed in the relative proportion of accumulated DS, FS, and MT. Early childhood risk factors associated with less favorable trajectories included higher dmfs scores at age 5, lack of exposure to community water fluoridation during the first 5 years of life, lower childhood IQ, and low childhood socioeconomic status. Parent self-ratings of their own or their child's oral health as "poor" were associated with less favorable caries experience trajectories. Children who had clinical signs of dental caries together with a parent rating of child's oral health as poor were more likely to follow a less favorable caries trajectory. Higher deciduous dentition caries experience at age 5 years was associated with less favorable caries trajectories, as were children whose parents gave "poor" ratings of their own or their child's oral health. These findings highlight the considerable intergenerational continuity in dental caries experience from early childhood to midlife. Subjective measures of child oral health are informative and might aid as predictors of adult caries experience in cases where childhood dental clinical data were not available.

Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A systematic review and dose-response meta-analysis with GRADE assessment

BACKGROUND

Several studies have explored the association between Mediterranean diet and frailty, but reported inconsistent results. This systematic review and dose-response meta-analysis summarized the existing evidence on the relationship between Mediterranean diet and risk of frailty and pre-frailty in elderly adults.

METHODS

A systematic search on MEDLINE (PubMed), Scopus, Institute for Scientific Information (ISI) Web of Science and Google Scholar was conducted up to January 2023. Study selection and data extraction were performed by two reviewers working in parallel. Epidemiologic studies reporting relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for frailty/pre-frailty in relation to Mediterranean diet (as a priori dietary pattern) were considered. The overall effect size was determined using a random effects model. The body of evidence was assessed by the GRADE approach.

RESULTS

A total of 19 studies (12 cohorts and 7 cross-sectionals) were included. In cohort studies (89,608 participants/ 12,866 cases), the highest versus lowest category of Mediterranean diet was inversely associated with frailty (RR: 0.66; 95%CI: 0.55, 0.78; I²:52.4%, P_Q-test=0.02). This association was also significant in cross-sectional studies with 1093 cases among 13,581 participants (OR: 0.44; 95%CI: 0.28, 0.70; I²:81.8%, P_Q-test<0.001). Moreover, each 2-point increase in Mediterranean diet score was related to decreased risk of frailty in cohort (RR: 0.86; 95%CI: 0.80, 0.93) and cross-sectional (OR: 0.79; 95%CI: 0.65, 0.95) studies. Nonlinear association showed a decreasing slope in curve, sharper at high scores for cohort studies and a steadily reduction for cross-sectional studies. The certainty of the evidence was graded as high in both cohort and cross-sectional studies. Combining 4 effect sizes of 4 studies (12,745 participants/ 4363 cases), the highest adherence to Mediterranean diet was linked to a lower risk of pre-frailty, as well (pooled OR: 0.73; 95%CI: 0.61, 0.86; I²:40.9%, P_Q-test=0.17).

CONCLUSION

Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and thus, has a considerable impact on health of this population.

Lessons learned: A look back at the performance of nine COVID-19 serologic assays and their proposed utility

BACKGROUND

Serologic assays for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been proposed to assist with the acute diagnosis of infection, support epidemiological studies, identify convalescent plasma donors, and evaluate vaccine response.

METHODS

We report an evaluation of nine serologic assays: Abbott (AB) and Epitope (EP) IgG and IgM, EUROIMMUN (EU) IgG and IgA, Roche anti-N (RN TOT) and anti-S (RS TOT) total antibody, and DiaSorin (DS) IgG. We evaluated 291 negative controls (NEG CTRL), 91 PCR positive (PCR POS) patients (179 samples), 126 convalescent plasma donors (CPD), 27 healthy vaccinated donors (VD), and 20 allogeneic hematopoietic stem cell transplant (HSCT) recipients (45 samples).

RESULTS

We observed good agreement with the method performance claims for specificity (93-100%) in NEG CTRL but only 85% for EU IgA. The sensitivity claims in the first 2 weeks of symptom onset was lower (26-61%) than performance claims based on > 2 weeks since PCR positivity. We observed high sensitivities (94-100%) in CPD except for AB IgM (77%), EP IgM (0%). Significantly higher RS TOT was observed for Moderna vaccine recipients then Pfizer (p-values < 0.0001). A sustained RS TOT response was observed for the five months following vaccination. HSCT recipients demonstrated significantly lower RS TOT than healthy VD (p < 0.0001) at dose 2 and 4 weeks after.

CONCLUSIONS

Our data suggests against the use of anti-SARS-CoV-2 assays to aid in acute diagnosis. RN TOT and RS TOT can readily identify past-resolved infection and vaccine response in the absence of native infection. We provide an estimate of expected antibody response in healthy VD over the time course of vaccination for which to compare antibody responses in immunosuppressed patients.

Are the different cut-off points for sitting time associated with excess weight in adults? A population based study in Latin America

BACKGROUND

Excess weight is increasing worldwide, and in Latin America more than half of the population is excess weight. One of the reasons for this increase has been excessive sitting time. Still, it remains to be seen whether there is an excessive amount of that time in Latin American adults. This study aimed to associate different sitting time cut-off points with the excess weight.

METHODS

Data from the Latin American Study of Nutrition and Health (ELANS), a cross-sectional population-based survey conducted in eight Latin American countries, were used. The excess weight indicators used were body mass index, and waist and neck circumferences. Sitting time was obtained using questionnaires and categorized at different cut-off points. Differences between sitting time categories (< 4 or ≥ 4; < 6 or ≥ 6; and < 8 or ≥ 8 hours/day) and excess weight were obtained by Student's t test for independent samples and the association between sitting time categories and different indicators of excess weight were obtained by logistic regression.

RESULTS

The median of the sitting time was 420 min/day (IQR: 240-600). There were no significant differences between body mass index (kg/m²) and waist circumference (cm) with categories of sitting time. The mean values of neck circumference (cm) were significantly higher in ≥4, ≥6 and ≥ 8 hours/day than < 4, < 6, and < 8 hours/day of sitting time in the pooled sample. Some distinct differences by country were observed. There were significant differences among excess weight by body mass index (63.2% versus 60.8) with < 8 vs ≥8 hours/day of sitting time. The proportion of excess weight by neck circumference was higher in participants who reported ≥4, ≥6, and ≥ 8 hours/day compared to < 4, < 6, and < 8 hours/day of sitting time. Considering ≥8 hours/day of sitting time, higher odds of excess weight were found evaluated by body mass index (OR: 1.10; 95% CI: 1.01, 1.20) and neck circumference (OR: 1.13; CI 95%: 1.03, 1.24) overall.

CONCLUSIONS

Sitting time above 8 hours/day was associated with higher odds of excess weight, even though there were no differences in waist circumference between sitting time categories.

TRIAL REGISTRATION

Clinical Trials NCT02226627. (27/08/2014).

Epidemiology of suicide in the Tri-City metropolitan area in Poland in 2010-2019

The paper, which is a continuation of our previous epidemiological studies on the phenomenon of suicide in the Tri-City metropolitan area, presents the results of statistical analyses of suicides in the autopsy material of the Department of Forensic Medicine of the Medical University of Gdańsk in the years 2010-2019. The purpose of the study was to analyse in detail demographic data of suicides (age, sex, place of death), as well as to assess suicide methods and the impact of alcohol on suicides in the study area. During the 10-year study period, 8495 autopsies were performed, of which 1261 were suicides (14.8%). Statistical analyses were conducted using the statistical data analysis software system STATISTICA, version 13 (StatSoft, Tulsa, Oklahoma, USA). The results of the study indicate a continuing downward trend in the number of suicides since the beginning of the 21th century, with the number of suicides in rural areas increasing over the same period. In the analysed cohort, suicides were committed in particular by middle-aged men and the number of suicides among older people (65 +) increased at the same time. The increase in suicide occurred in late autumn and early spring. The most common method of suicide was hanging. There was a high percentage of inebriated victims (45%), and a comparison of the present studies with previous ones indicates the increasing impact of alcohol on suicide.

Heterogeneous trends of premature mortalities in Japan: joinpoint regression analysis of years of life lost from 2011 to 2019

Purpose

To assess long-term premature mortalities in Japan for providing evidence of strategies for sustainable development in population health.

Methods

Descriptive study for observing the trends of premature mortalities due to 10 major causes and all-cause in Japan was conducted using governmental statistics taken between 2011 and 2019. Years of life lost (YLL) was calculated for each cause, and the trends of these were examined by joinpoint regression analysis.

Results

The means of YLL for all-cause through 2011 to 2019 were 8,121,565.1 in males and 6,743,198.4 in females. For each cause, the trends of age-standardized YLL were downward except for malignant neoplasm of pancreas and heart failure in males, and malignant neoplasm of pancreas, malignant neoplasm of breast, and age-related physical debility in females. One significant joinpoint for heart failure was found in males, and one significant joinpoint for each of malignant neoplasm of pancreas and age-related physical debility were found in females.

Conclusions

Premature mortalities due to malignant neoplasm of pancreas in both sexes, heart failure in males and malignant neoplasm of breast in females were issues to be prioritized for promoting population health in Japan.

Racial discrimination, low trust in the health system and COVID-19 vaccine uptake: a longitudinal observational study of 633 UK adults from ethnic minority groups

OBJECTIVES

To examine whether racial/ethnic discrimination predicts future COVID-19 vaccine refusal, and whether this association is explained by trust in government and the health system.

DESIGN

Longitudinal observational study of racial/ethnic discrimination occurring since the start of the first lockdown (measured in July 2020) and later COVID-19 vaccine status.

SETTING

UK (England, Scotland, Wales and Northern Ireland).

PARTICIPANTS

A total of 633 adults belonging to ethnic minority groups who took part in the UCL COVID-19 Social Study.

MAIN OUTCOME MEASURES

COVID-19 vaccine refusal (vs. accepted/waiting/had at least one dose) between 23 December 2020 and 14 June 2021.

RESULTS

Nearly 1 in 10 (6.69%) who had refused a COVID-19 vaccine had experienced racial/ethnic discrimination in a medical setting since the start of the pandemic and had experienced twice as many incidents of racial/ethnic discrimination than those who had accepted the vaccine. Structural equation modelling results indicated a nearly four fold (odds ratio = 3.91, 95% confidence interval = 1.40 to 10.92) total effect of racial/ethnic discrimination on refusing the vaccine which was mediated by low trust in the health system to handle the pandemic (odds ratio = 2.49, 95% confidence interval = 1.12 to 5.39). Analyses adjusted for a range of demographic and COVID-19 related factors.

CONCLUSIONS

Findings underscore the importance of addressing racial/ethnic discrimination and the role the National Health Service in regaining trust from ethnic minority groups to increase COVID-19 vaccine uptake among ethnic minority adults.

Assessing Exposure to Unconventional Oil and Gas Development: Strengths, Challenges, and Implications for Epidemiologic Research

PURPOSE OF REVIEW

Epidemiologic studies have observed elevated health risks in populations living near unconventional oil and gas development (UOGD). In this narrative review, we discuss strengths and limitations of UOG exposure assessment approaches used in or available for epidemiologic studies, emphasizing studies of children's health outcomes.

RECENT FINDINGS

Exposure assessment challenges include (1) numerous potential stressors with distinct spatiotemporal patterns, (2) critical exposure windows that cover long periods and occur in the past, and (3) limited existing monitoring data coupled with the resource-intensiveness of collecting new exposure measurements to capture spatiotemporal variation. All epidemiologic studies used proximity-based models for exposure assessment as opposed to surveys, biomonitoring, or environmental measurements. Nearly all studies used aggregate (rather than pathway-specific) models, which are useful surrogates for the complex mix of potential hazards. Simple and less-specific exposure assessment approaches have benefits in terms of scalability, interpretability, and relevance to specific policy initiatives such as set-back distances. More detailed and specific models and metrics, including dispersion methods and stressor-specific models, could reduce exposure misclassification, illuminate underlying exposure pathways, and inform emission control and exposure mitigation strategies. While less practical in a large population, collection of multi-media environmental and biological exposure measurements would be feasible in cohort subsets. Such assessments are well-suited to provide insights into the presence and magnitude of exposures to UOG-related stressors in relation to spatial surrogates and to better elucidate the plausibility of observed effects in both children and adults.

Sexual attraction to men as a risk factor for eating disorders: the role of mating expectancies and drive for thinness

BACKGROUND

Men tend to give more importance than women to physical aspects when selecting a partner; thus, the internalization of beauty standards and the ideal of thinness may be greater in populations attracted to men, placing them at a higher risk of eating disorders.

METHODS

In a sample (n = 398) of heterosexual and gay men and women, we evaluated the drive for thinness, body dissatisfaction, and bulimic symptomatology. Using ANCOVAs, we analyzed the differences in symptoms score according to sex, sexual orientation and relational status including body mass index (BMI) as covariate; we also evaluated the mediating role of drive for thinness in the relationship between sexual orientation and body dissatisfaction.

RESULTS

We found an increased drive for thinness and body dissatisfaction in men-attracted compared with women-attracted participants; also, body dissatisfaction was greater in women than in men. Heterosexual women presented higher bulimia scores than lesbian women. Gay men open to relationships presented higher drive for thinness and body dissatisfaction scores than those not-open to relationships. Finally, differences in body dissatisfaction between gay and heterosexual men were fully explained by drive for thinness, while, in the case of women, drive for thinness only partially explained these differences.

CONCLUSIONS

Attraction to men seems to be a risk factor for EDs in the case of gay men and heterosexual women. In addition, in the case of heterosexual women, other factors independent of the desire to attract men seem to be important.

Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis

BACKGROUND

Several studies have assessed the relationship between type 2 diabetes (T2D) and tooth loss; however, results have been inconsistent. Therefore, the present systematic review and meta-analysis of observational studies was designed to examine the association between T2D and tooth loss.

METHODS

This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We searched all the relevant studies in international databases of Scopus, PubMed, ProQuest, Web of Science, Cochrane Library, and Google scholar search engine until February 2022. The heterogeneity of the studies was calculated using the I² index. Measure of effect and 95% confidence interval (CI) were extracted from each study. The results of the study were analyzed using the random effects model.

RESULTS

In the present study, 22 eligible studies were included. Meta-analysis of unadjusted and adjusted results showed that T2D significantly increased the risk of tooth loss, and Odds Ratio (OR) unadjusted was 1.87 (95% CI: 1.62-2.13, p < 0.001), and OR adjusted was 1.20 (95% CI: 1.10-1.30, p < 0.001), respectively. Subgroup analysis based on study design for adjusted OR indicated that in the cohort study (OR: 1.29, 95% CI: 1.07-1.51), in the cross-sectional study (OR: 1.15, 95% CI: 1.06-1.23), and in the case-control study (OR: 5.10, 95% CI: 1.01-9.18) there was a significant association between T2D and tooth loss. Other subgroups analyses showed consistent results and no publication bias existed.

CONCLUSIONS

The findings suggest that T2D is associated with increased risk of tooth loss. This conclusion may provide useful evidence for correlated clinical researches.

Evaluating the impact of the COVID-19 pandemic on cancer screening in a central Canadian province

We evaluated the impact of COVID-19 on cancer screening in Manitoba, Canada using an interrupted time series (ITS) design and data from Manitoba's population-based, organized cancer screening programs from April 2020 to August 2021. In June 2020 (breast screening was suspended during April and May 2020), there was a 54% decrease between the predicted (i.e., observed data produced from regression models) and expected (i.e., counterfactual values produced for the COVID-19 period by assuming COVID-19 did not occur) number of screening mammograms (ratio = 0.46, 95% Confidence Interval (CI) 0.28-0.64). By December 2020, there was no significant difference between predicted and expected number of screening mammograms (ratio = 0.95, 95% CI 0.80-1.10). In April 2020, there was an 83% decrease in the number of Pap tests (ratio = 0.17, 95% CI 0.04-0.30). By January 2021, there was no significant difference between predicted and expected number of Pap tests (ratio = 0.93, 95% CI 0.81-1.06). In April 2020, there was an 81% decrease in the number of screening program fecal occult blood tests (FOBTs) (ratio = 0.19, 95% CI 0.0-0.44). By September 2020, there was no significant difference between predicted and expected number of FOBTs (ratio = 0.95, 95% CI 0.65-1.24). The estimated cumulative deficit (i.e., backlog) from April 2020 to August 2021 was 17,370 screening mammograms, 22,086 Pap tests, and 5253 screening program FOBTs. Overall, screening programs adapted quickly to the COVID-19 pandemic. Additional strategies may be needed to address remaining backlogs.

[Help-seeking efficacy and the intention of social assistance among medical care personnel during the major public health events]

Objective: To explore the help seeking efficacy and social assistance willingness of medical staff during major public health events, so as to provide basis for improving the psychological resources and service quality of medical staff and further optimizing the prevention and treatment policies. Methods: In February 2020, a convenient sampling method was used to conduct an online questionnaire survey on medical staff in Henan Province, and a total of 2136 questionnaires were collected. Among them, there were 1940 valid questionnaires, and the effective recovery rate was 90.82%. The questionnaire of help seeking efficacy and willingness to social assistance under epidemic situation was used to investigate the help seeking efficacy and willingness of medical staff. The frequency and rate (%) were used to analyze the overall situation of medical staff's help seeking efficacy and social assistance willingness. The differences among different demographic variables were tested by χ(2) test. Results: Among the 1940 medical and nursing staff, 18.81% (365/1940) did not know how to obtain appropriate psychological assistance. Compared with the low age group, the medical staff in the high age group had the ability of information query, the ability to occupy knowledge resources, the ability to distinguish rumors and facts and the sense of efficacy of obtaining appropriate medical help, and the difference was statistically significant (P<0.05) . The willingness of medical and nursing staff to actively cooperate with the government, maintain social stability and volunteer work were 99.43% (1929/1940) , 98.81% (1917/1940) and 97.11% (1884/1940) . Conclusion: The medical staff had a higher sense of help seeking efficacy and willingness to social assistance. It is necessary to further strengthen the resource support of psychological, social and humanistic care for medical staff.

[Analysis on the incidence of occupational diseases in Bao'an District of Shenzhen city from 2006 to 2019]

Objective: To analyze the characteristics of occupational diseases in Bao'an District of Shenzhen from 2006 to 2019, so as to provide scientific basis for formulating occupational disease prevention policies and measures. Methods: In September 2020, the information of new occupational disease cases in Bao'an District of Shenzhen from 2006 to 2019 was collected through the national occupational disease and occupational health information monitoring system, and the classification, disease type distribution, population distribution and industry and enterprise scale distribution of new occupational disease cases were analyzed. Results: From 2006 to 2019, a total of 762 new occupational diseases were reported in Bao'an District of Shenzhen, of which the top three were occupational ear, nose, throat and oral diseases (233 cases, accounting for 30.58%) , occupational chemical poisoning diseases (219 cases, accounting for 28.74%) , occupational pneumoconiosis and other respiratory diseases (127 cases, accounting for 16.67%) . The classification composition of occupational diseases was different in different years, and the difference was statistically significant (P<0.05) . New occupational diseases are mainly distributed in the manufacturing industry (394 Eaterprises, caccouling 93.59%) , concentrated in (346 cases, accounting for 47.66%) and medium-sized enterprises (199 cases, accounting for 27.4%) small enterprises. Conclusion: New occupational diseases in Bao'an District of Shenzhen should focus on small and medium-sized manufacturing enterprises, carry out risk assessment of occupational hazards, implement classified and hierarchical supervision of occupational health, and implement occupational health protection.

Genome-wide association study of periodontal pocketing in Finnish adults

Background

A genome‐wide association study is an analytical approach that investigates whether genetic variants across the whole genome contribute to disease progression. The aim of this study was to investigate genome-wide associations of periodontal condition measured as deepened periodontal pockets (≥ 4 mm) in Finnish adults.

Methods

This study was based on the data of the national Health 2000 Survey (BRIF8901) in Finland and the Northern Finland Birth Cohort 1966 Study totalling 3,245 individuals. The genotype data were analyzed using the SNPTEST v.2.4.1. The number of teeth with deepened periodontal pockets (≥ 4 mm deep) was employed as a continuous response variable in additive regression analyses performed separately for the two studies and the results were combined in a meta-analysis applying a fixed effects model.

Results

Genome-wide significant associations with the number of teeth with ≥ 4 mm deep pockets were not found at the p-level of < 5 × 10⁻⁸, while in total 17 loci reached the p-level of 5 × 10⁻⁶. Of the top hits, SNP rs4444613 in chromosome 20 showed the strongest association (p = 1.35 × 10⁻⁷).

Conclusion

No statistically significant genome-wide associations with deepened periodontal pockets were found in this study.

The BRAIN-Q, a tool for assessing self-reported sport-related concussions for epidemiological studies

OBJECTIVES

The BRAIN-Q is a tool aimed at maximising the accuracy and minimising measurement error for retrospectively assessing concussions. This paper reports the agreement of the BRAIN-Q tool when compared to extant questionnaire questions, and its reproducibility when compared with its telephonic version (tBRAIN-Q).

METHODS

The BRAIN-Q entails a 3-stage process: defining a concussion, creating a visual timeline with life events, and establishing detailed characteristics for each reported concussion. It was designed to be administered in-person by trained personnel, and was used in the BRAIN study. Its performance was compared with the MSK study, which previously collected a few questions in a broader self-administered questionnaire, and with the tBRAIN-Q Recall, its telephonic version.

RESULTS

In total, 101 participants were included, of whom 9 were re-assessed with the tBRAIN-Q. The agreement of the BRAIN-Q with the muscle skeletal-questionnaire for rugby-related concussion was 86.7% (κ=0.6). Rugby-related concussion with loss of consciousness showed lower agreement (82.0%; κ=0.6). The comparison between the BRAIN-Q and the tBRAIN-Q showed good reproducibility.

CONCLUSIONS

The BRAIN-Q is a relatively easy tool to administer in face-to-face assessments, and it showed optimal reproducibility. It includes a well-established definition of concussion, and is used to collect detailed information on each concussion, allowing for a number of subgroup analyses (e.g., by severity, age, or context). The BRAIN-Q is easily adaptable to other sporting settings.

The association between erosive tooth wear and diet, hygiene habits and health awareness in adolescents aged 15 in Poland

Purpose

The aim of the study was to assess the prevalence of erosive tooth wear (ETW) and risk indicators in the population of adolescents aged 15 in Poland.

Methods

Erosive tooth wear in 2639 participants was determined by calibrated examiners according to the BEWE scoring system, and the prevalence of risk factors was assessed on the basis of a survey.

Results

Erosive tooth wear was reported in 24.3% of participants. Initial loss of surface (BEWE 1) was the predominant finding, observed in 21.3% of participants. Hard tissue loss (BEWE 2 and 3) occurred very rarely, only in 3% of participants. Acidic diet, masculine gender and lower socio-economic status were associated with higher prevalence and severity of erosive lesions in the examined population.

Conclusion

Two modifiable factors—acidic diet and low health awareness—were found to be highly unsatisfactory in the adolescents aged 15 in Poland. Accordingly, to prevent the deterioration of the functionality and aesthetics of the teeth in young people, certain measures, such as routine clinical examination, education, dietary consulting and prophylaxis, should be implemented as early as possible, focusing predominantly on families with lower socio-economic status.

Head and Face Injuries in Brazilian Homicide Victims - A Retrospective Study

Introduction:

Violence is a serious problem in view of its magnitude and impact on the health of the population in several countries. The aim of the study was to evaluate the occurrence of head and face injuries among homicide victims in a municipality in the Northeastern region of Brazil.

Materials and Methods:

A cross-sectional study carried out at the Police Station for Crimes against Persons of the Civil Police, which evaluated 168 police inquiries of homicide victims notified from January 2015 to December 2018. Variables analyzed were related to the Victim's sociodemographic profile, homicide characteristics and body region involved. Descriptive data analysis and Pearson's Chi-square test (P < 0.05) were performed.

Results:

There was greater involvement of men (92.9%) aged 20–29 years (36.3%), drug users (70.7%) and with a criminal record (65.9%). There was a predominance of simple homicides (92.3%), with greater occurrence on Sundays (16.7%), in the night shift (40.1%), revenge was the main reason for the crime (32%), and firearms as the main means used (89.2%). Regarding the number of body regions affected, victims were more frequently affected in 2 regions (36.5%). Head injuries were identified in 68.3% of victims, while face injuries represented 35.3%. There was an association between the presence of head injuries and number of injuries (P < 0.05).

Discussion:

The prevalence of head and face injuries resulting from homicide was high and victims are predominantly young men, drug users and those with a criminal record. The association was found between the presence of head injuries and number of injuries.

Epidemiologic study of rhegmatogenous retinal detachment in Japan from the Diagnosis Procedure Combination database over a 2-year period (2014-2015)

PURPOSE

To determine the incidence of rhegmatogenous retinal detachments (RRDs) and proliferative vitreoretinopathies (PVRs) and their distribution by age and sex in hospitalized patients in Japan.

STUDY DESIGN

Retrospective nationwide observational study.

METHODS

Information on the number of inpatients primarily diagnosed with RRD or PVR and their age and sex were collected from the Diagnosis Procedure Combination (DPC) database for 2014 and 2015. The incidence was determined using the Japanese population report published by the Public Management Ministry's Statistics Bureau.

RESULTS

The incidence of RRD in these hospitalized patients was 10.9/100,000, with 15.0/100,000 in men and 7.1/100,000 in women, and that of PVR was 2.1/100,000, with 2.9/100,000 in men and 1.3/100,000 in women. The incidence in men was twice that in women for both RRD and PVR. The distribution of RRD by age was monophasic, with a peak at 50 years for both sexes, and that of PVR was at peak in the 60 s for men and in the 70 s for women. PVR was more common than RRD in children aged younger than 10 years, but the incidence of RRD was higher in the other age groups.

CONCLUSION

A study of the DPC database can provide useful information on the incidences of RRD and PVR in hospitalized patients in Japan.

Patient experience and self-perceived biopsychosocial burden of people living with multiple sclerosis: An epidemiological survey (BPS-MuScle study) in Spain

BACKGROUND

Updated information on the self-perceived biopsychosocial burden and the healthcare experience among people living with multiple sclerosis in Spain is scarce.We aim to describe the self-reported disease experience of patients diagnosed with MS in Spain and to estimate their biopsychosocial burden.

METHODS

Multicentre epidemiological study based on a cross-sectional nationwide survey completed by a geographically stratified sample of MS patients in Spain.

RESULTS

A total of 490 surveys completed at 61 neurology units across Spain were analysed. Mean age was 43.7 ± 10.0 years (range:21-72), 71.4% were women. Most patients identified themselves as having relapsing-remitting MS (77.1%), 81.9% retained independent mobility. Most patients considered their health condition to be good (39.4%) or very good (13.1%). Mean EuroQoL questionnaire score was 69.2 ± 21.5. Most patients expressed high level of satisfaction with access to and quality of health care. However, 53.7% considered that sadness or depression interfered with their daily life. Concerns about social support were also mentioned.

CONCLUSION

Most people living with MS in Spain consider that their health condition is at least good but more psychological support and social protection measures are needed. Insights obtained from this study may help to better manage the condition in the future.

[Epidemiological characteristics of infectious diseases of group A, B and C among Chinese students' population]

OBJECTIVE

To analyze the secular trend, ranking change, age- and regional- characteristics of leading infectious diseases among Chinese students population aged 6 to 22 years from 2008 to 2017.

METHODS

Data were drawn from the national surveillance from 2008 to 2017, and the participants were students aged from 6 to 22 years who were diagnosed with notifiable infectious diseases. A total of 40 infectious diseases were classified into three groups based on national notifiable infectious diseases classification of A, B and C. The morbidity and mortality rates from infectious diseases were calculated using the numbers of students published by the ministry of education as the denominator. The age- and province-specific infectious diseases with the highest incidence were selected as the leading infectious diseases for analysis.

RESULTS

From 2008 to 2017, the incidence rate, the number of cases and the number of deaths of infectious diseases among the boys aged 6-22 years in China were higher than that of the girls, and the overall trend was downward during the study period. The incidence rates in the boys and girls decreased from 2008 to 2015 with decrease of 43.4% and 40.1%, respectively. However, by 2017, the increase rate rebounded with the increases of 47.1% and 53.8%. The rebound trend was mainly caused by the increase of group C of infectious diseases. During the past decade, the top leading three diseases of groups A and B of infectious diseases were viral hepatitis, tuberculosis and dysentery in 2018, respectively, which changed to tuberculosis, scarlet fever and viral hepatitis in 2017. The top leading three infectious diseases in terms of mortality were rabies, tuberculosis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in 2008, which were transformed into HIV/AIDS, rabies, and tuberculosis in 2017. There was no significantly obvious change in the incidence and mortality order of group C of infectious diseases during the decade. In the analysis of age groups and regions, the leading infectious diseases in groups A and B transferred from viral hepatitis to scarlet fever and tuberculosis, while in group C, mumps and infectious diarrhoea almost always dominated the leading infectious diseases. But in recent years, influenza and hand-foot-and-mouth disease increased significantly in the eastern region.

CONCLUSION

During the past decade, China has got remarkable achievements in the prevention and control of children infectious disease. However, the change patterns and characteristics of notifiable infectious diseases among children and adolescents show the urgent need for prevention and control of respiratory tract infectious diseases, HIV/AIDS and other sexually transmitted diseases as well as new emerging infectious diseases in China in the future. This study provides important basis for policy making of Chinese national school-based infectious disease prevention and control mechanism.

[Epidemiological characteristics of infectious diseases of group A, B and C among Chinese students' population]

OBJECTIVE

To analyze the secular trend, ranking change, age- and regional- characteristics of leading infectious diseases among Chinese students population aged 6 to 22 years from 2008 to 2017.

METHODS

Data were drawn from the national surveillance from 2008 to 2017, and the participants were students aged from 6 to 22 years who were diagnosed with notifiable infectious diseases. A total of 40 infectious diseases were classified into three groups based on national notifiable infectious diseases classification of A, B and C. The morbidity and mortality rates from infectious diseases were calculated using the numbers of students published by the ministry of education as the denominator. The age- and province-specific infectious diseases with the highest incidence were selected as the leading infectious diseases for analysis.

RESULTS

From 2008 to 2017, the incidence rate, the number of cases and the number of deaths of infectious diseases among the boys aged 6-22 years in China were higher than that of the girls, and the overall trend was downward during the study period. The incidence rates in the boys and girls decreased from 2008 to 2015 with decrease of 43.4% and 40.1%, respectively. However, by 2017, the increase rate rebounded with the increases of 47.1% and 53.8%. The rebound trend was mainly caused by the increase of group C of infectious diseases. During the past decade, the top leading three diseases of groups A and B of infectious diseases were viral hepatitis, tuberculosis and dysentery in 2018, respectively, which changed to tuberculosis, scarlet fever and viral hepatitis in 2017. The top leading three infectious diseases in terms of mortality were rabies, tuberculosis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in 2008, which were transformed into HIV/AIDS, rabies, and tuberculosis in 2017. There was no significantly obvious change in the incidence and mortality order of group C of infectious diseases during the decade. In the analysis of age groups and regions, the leading infectious diseases in groups A and B transferred from viral hepatitis to scarlet fever and tuberculosis, while in group C, mumps and infectious diarrhoea almost always dominated the leading infectious diseases. But in recent years, influenza and hand-foot-and-mouth disease increased significantly in the eastern region.

CONCLUSION

During the past decade, China has got remarkable achievements in the prevention and control of children infectious disease. However, the change patterns and characteristics of notifiable infectious diseases among children and adolescents show the urgent need for prevention and control of respiratory tract infectious diseases, HIV/AIDS and other sexually transmitted diseases as well as new emerging infectious diseases in China in the future. This study provides important basis for policy making of Chinese national school-based infectious disease prevention and control mechanism.

Incidence and risk factors of congenital heart disease in Qingdao: a prospective cohort study

Background

Many studies have been conducted to assess the incidence of congenital heart disease (CHD). However, results were greatly inconsistent among these studies with a broad range of findings.

Methods

A prospective census-based cohort study was conducted in Qingdao, China, from August 1, 2018 to April 30, 2019. All of the local registered pregnant women were continuously investigated and followed from 15 to 20 weeks of gestation to delivery, tracking the CHD cases in both the fetal and neonatal stages. A logistic regression model was applied to assess the association between CHD and possible risk factors.

Results

The positive rate of prenatal CHD screening was 14.36 per 1000 fetuses and the incidence of CHD was 9.38 per 1000 live births. Results from logistic regression indicated that, living in the countryside (odds ratio, (OR): 0.771; 95% confidence interval, (CI): 0.628–0.946) and having a childbearing history (OR: 0.802; 95%CI: 0.676–0.951) were negatively associated with CHD. However, twin pregnancy (OR: 1.957, 95% CI: 1.245–3.076), illness in the first trimester (OR: 1.306; 95% CI: 1.048–1.628), a family history of CHD (OR: 7.156; 95% CI: 3.293–15.552), and having a child with a birth defect (OR: 2.086; 95% CI: 1.167–3.731) were positively associated with CHD.

Conclusion

CHD is a serious health problem in Qingdao. The CHD incidence found in this study was similar to existing research. The positive rate of prenatal CHD screening was higher than the incidence of neonatal CHD. Moreover, CHD risk factors were identified in our study, and our findings may have great implications for formation CHD intervention strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11034-x.

[A cross-sectional study on informatization construction about occupational health in China]

Objective: To understand the current situation of the construction of occupational health information system in China and put forward countermeasures and suggestions for the construction of occupational health information system. Methods: In November 2019 and April 2020, a cross-sectional survey was conducted on the occupational health information systems of national, provincial and some central enterprises. A total of 57 occupational health information systems were investigated, including 4 national systems, 44 provincial systems and 9 industrial systems. The terminal type, main function, construction type, user classification and main authority, computer terminal structure, data collection mode, data transmission mode, data docking are analyzed. Results: The four national level systems all adopt B/S structure, and all transmit network data through computer terminals. The main data acquisition mode is online acquisition and external system docking. Among the 44 provincial-level systems, 41 (93.18%) were self built systems, 75.00% (33/44) were computer terminals, and 90.91% (40/44) were B/s structures; 17 (38.64%) systems used multiple data acquisition methods; 13.64% (6/44) systems used multiple data transmission methodsand the main way of data transmission method is network report (88.64%, 39/44) ; 84.09% (37/44) of the system network access mode was Internet mode. Among the nine industry systems, 66.67% (6/9) of them deployed servers in the form of self built computer rooms, 77.78% (7/9) of them supported docking and reserved ports; 66.67% (6/9) of them used computer terminals, and 100.00% (9/9) of them used B/S structure; 77.78% (7/9) of them used manual filling for data collection. Conclusion: The construction of occupational health information system in China has many problems, such as scattered and separate construction, and lack of effective data sharing between related systems, it＇s urgent to unify the standard and plan as a whole.

[COVID-19 and functional dependence: cohort study of an outbreak in a nursing home for elderly.]

OBJECTIVE

Older people have been severely affected by the COVID-19 pandemic. The aim of this study was to describe the main epidemiological findings of a COVID-19 outbreak occurred in March 2020 at a nursing home for elderly in Granada. Risk factors associated with the spread of the virus in the center were investigated.

METHODS

A retrospective cohort study was conducted, collecting the most relevant clinical and epidemiological findings, occurred during the outbreak follow-up period (from 03/13/2020 to 06/20/2020). The association between the residents' health conditions (underlying diseases, level of physical dependence, level of cognitive impairment) and the risk of infection was estimated using multivariate Cox regression.

RESULTS

52 PCR-confirmed COVID-19 cases were identified among the residents and 50 cases among the employees of the nursing home. The epidemic curve was characteristic of a person to person transmission. Among residents with a higher level of physical dependence, according to the Barthel index score, a higher incidence of infection was detected, adjusting for age, sex and health conditions. At 55 days of exposure, moderately (RR 2.82), severely (RR 4.71) and completely (RR 3.49) dependent residents had between 2-4 times greater risk of infection than the minimally dependent residents (p<0.05).

CONCLUSIONS

The epidemic curve supports the hypothesis of a cross-transmission of infections between residents and staff members of the nursing home. In the context of sustained transmission of the virus, physical dependence of the residents increases the risk of exposure to the virus, facilitating its spreading.

Residential traffic noise exposure and headaches: Results from the population-based heinz nixdorf recall study

Context and aim

The link between headaches and exposure to loud noise in occupational settings has been established. However, the effect of less intense but chronic residential traffic noise exposure on headache occurrence is less clear.

Settings and design

We included 3,025 participants from the Heinz Nixdorf Recall study in Germany for this cross-sectional analysis.

Methods and material

Residential road traffic noise exposure at the 2006-2008 address was modelled in A-weighted decibels (dB(A)) according to the European Noise Directive (2002/49/EC) for 24-hour (L_den) and night-time noise (22-6 h, L_night). Indoor traffic noise exposure was obtained by modifying L_den and L_night based on residence orientation, window type, and personal window opening habits. Traffic noise exposure below 55, 45 dB(A), 35 and 25 dB(A) were set as the reference for L_den, L_night, L_den,indoor and L_night,indoor, respectively. Average number of days with headache per month over the past three months was ascertained during the follow-up (2011-2015) medical interview.

Statistical analysis used

Prevalence Odds Ratios (POR) of having eight or more headaches per month per 5 dB(A) increase in traffic noise exposure were calculated using logistic regression, adjusting for age, sex, sport, number of chronic conditions, years of education and smoking status.

Results

The mean age of participants was 58.3. Mean L_den was 54 dB(A). Median monthly headache days was one. No association was seen between traffic noise exposure and having ≥8 headaches/month for all the examined traffic noise indicators. However, traffic noise was positively associated with traffic noise-annoyance and insomnia; and night-time traffic noise-annoyance and insomnia were positively associated with headache.

Conclusion

In conclusion, our data did not provide any evidence for an association between chronic traffic noise exposure and prevalence of headaches at this population's exposure levels. This should be explored in different populations given that this is the first study of its type and that noise exposure was generally low in our population.

A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer

PURPOSE

We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC).

METHODS

We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I-III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs.

RESULTS

Overall, 4535 patients with stage I-III and 354 with stage IV HER2+ BC were identified. Most patients with stage I-III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I-III HER2+ BC.

CONCLUSION

Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC.

The prevalence of behavioral problems among school-aged children in home quarantine during the COVID-19 pandemic in china

BACKGROUND

To prevent spreading of the COVID-19 infection, many countries have implemented a nationwide school closure. We aimed to assess the prevalence of behavioral problems in school-aged children during home confinement.

METHODS

We conducted an internet-based survey involving 1264 children (grades 2-6) and their parents from two primary schools between February 25 and March 8, 2020, in Hubei province, China. Behavioral problems were evaluated using the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The prevalence of prosocial behaviors among children was 10.3%, followed by total difficulty (8.2%), conduct problems (7.0%), peer problems (6.6%), hyperactivity-inattention (6.3%) and emotional problems (4.7%). Compared with children who did not exercise, children with psychical activity had a lower hyperactivity-inattention risk (Odds Ratio (OR): 0.44 for 1-2 days/week; OR: 0.56 for more than 2 days/week) and less prosocial behaviors problems (OR: 0.65 for 1-2 days/week; OR: 0.55 for more than 2 days/week). Children of parents with anxious symptoms were associated with increased risks of emotional symptoms and total difficulty (OR: 5.64 and 3.78, respectively).

LIMITATIONS

We adopted self-report questionnaires and did not collect baseline information before COVID-19 outbreak. The potential self-selection bias inherent in the study should be noted.

CONCLUSION

The prevalence of behavioral problems among school-aged children varied from 4.7% to 10.3% in home quarantine during the COVID-19 outbreak. Taking physical exercise may be an efficient measure to reduce behavioral problems for school-aged children in home confinement.

[Situation of coal dust hazards and its damage of pulmonary function of a large-scale coal mine enterprise of Shanxi province]

Objective: To investigate the status of coal dust hazard classification and lung function damage in a large coal mine in Shanxi Province. Methods: From January to June in 2019, 51 coal dust posts and 598 workers exposed to coal dust were selected from a large coal mine enterprise in Shanxi Province. The coal dust (exhaled dust) samples were collected and tested, and the hazard classification index of coal dust (exhaled dust) was calculated. The jobs exposed to coal dust (exhaled dust) were divided into relatively harmless, mild, moderate and severe hazard posts, and the corresponding workers were divided into relatively harmless group, mild, moderate and severe hazard groups. The forced expiratory volume (FEV1) , forced vital capacity (FVC) and forced expiratory volume/forced vital capacity (FEV1/FVC) in the first second were measured. Spearman rank correlation method was used to analyze the relationship between the hazard grade of coal dust and lung function. Results: Among 51 coal dust (exhalation) posts, 13 coal dust (exhalation dust) exceeded the standard (25.5%) . 168 cases (34.78%) had abnormal pulmonary function. Compared with the relatively harmless group, the proportion of abnormal pulmonary function of workers in mild, moderate and severe hazard groups were higher, FEV1, FVC, FEV1/FVC values were lower, the differences were statistically significant (P<0.05) . The rank of coal dust (exhaled dust) was negatively correlated with FEV1, FVC and FEV1/FVC (P<0.01) . Conclusion: Attention should be paid to the supervision and management of relatively harmless and slightly harmful coal dust posts. FVC may be one of the lung function indexes sensitive to coal dust exposure.

Prevalence, distribution, characteristics and associated factors of molar-incisor hypo-mineralisation among Libyan schoolchildren: a cross-sectional survey

BACKGROUND AND AIM

This study aimed to assess the prevalence and clinical status of molar incisor hypomineralisation (MIH) and other enamel defects and associated factors in Libyan children.

METHODS

A cross-sectional survey of a randomly selected sample of 8- to 10-year-old Libyan school children was conducted in the city of Benghazi, Libya in 2019. The children were assessed for the presence of MIH and enamel defects according to EAPD evaluation criteria. The survey was supplemented by a questionnaire, completed by parents, about potential associated factors occurring before, around and after birth. Association with risk indicators was assessed using chi-square and Mann-Whitney U tests.

RESULTS

One thousand forty-seven children returned complete questionnaires and attended the clinical examination, with 87% response rate. MIH was the most common form of enamel defects, affecting 162 (15.5%) children. The average number of MIH affected teeth was 3.54 (SD = 1.82). There were no statistically significant associations between the prevalence of MIH and health or demographic characteristics except for the history of early childhood health problems (P = 0.047).

CONCLUSIONS

In Libyan children, MIH appeared to be the most prevalent type of enamel defects affecting 15.5% of the participants. Although not statistically significant, MIH appeared to be associated with prenatal, perinatal and post-natal challenges.

Cervical Cancer in Women with Normal Papanicolaou Tests: A Korean Nationwide Cohort Study

Purpose

This study aimed to evaluate the risk of cervical cancer diagnosed within 1 year after the last of multiple consecutive normal Papanicolau (Pap) tests.

Materials and Methods

The database of the National Health Insurance Service was used. We obtained Pap test data for 11,052,116 women aged 30–79 between 2007–2012. The cumulative incidence rates and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last normal Pap test were compared between women with one (N1), two (N2), and three consecutive normal Pap tests (N3). Women who did not receive a Pap test during the study period were assigned in the N0 group.

Results

The 1-year cumulative incidence rates of cervical cancer were 58.9, 24.6, 20.3, and 14.2 per 10⁵ in the N0, N1, N2, and N3 groups, respectively. Compared to the N1 group, the risk of cervical cancer diagnosed within 1 year of the last normal Pap test decreased by 17% (relative risk [RR], 0.825; 95% confidence interval [CI], 0.716 to 0.951) in the N2 group and 42% (RR, 0.578; 95% CI, 0.480 to 0.695) in the N3 group. However, the 5-year survival rate in women diagnosed with cervical cancer within 1 year of the last normal Pap test in the N3 group was not higher than that of the N1 group (79.6% vs. 81.3%, p=0.706).

Conclusion

As normal Pap tests are consecutively repeated, cervical cancer risk significantly decreases. However, previous consecutive normal Pap tests are not associated with improving survival outcomes in women shortly diagnosed with cervical cancer after the last normal Pap test.

Validation of a Three-Item Short Form of the Modified Weight Bias Internalization Scale (WBIS-3) in the German Population

INTRODUCTION

Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect).

OBJECTIVE

Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated.

METHODS

A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (n = 1,092). This new short form was validated in a second representative population sample (n = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided.

RESULTS

The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample.

CONCLUSIONS

The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.

Editorial Perspective: Why I am now convinced that emotional disorders are increasingly common among young people in many countries

This editorial perspective comments on the evidence that mental health is deteriorating among children and young people at the same time as the impact of poor mental health is more impairing. It discusses the methodological difficulties in detecting a 'true' change in prevalence. There are particular gaps in the evidence from low- and middle-income countries and also in relation to autism spectrum disorders. The evidence in high-income countries points to recent increases in anxiety, depression and self-harm in teenagers, particularly young women. We need more longitudinal data to disentangle the potential explanations for these changes.

A Systematic Review of Drink Specials, Drink Special Laws, and Alcohol-Related Outcomes

Purpose of Review

The adverse health and safety consequences of heavy alcohol consumption are a leading problem around the world. While many risk factors have been extensively studied and presented in comprehensive summaries, not all questions regarding risk factors for problematic drinking behaviors have been answered and presented in systematic reviews. As of March 2020, no review has summarized studies assessing the role of promotional price practices at on-premises alcohol outlets, known as drink specials. Also missing was systematic information of policies that regulated these promotional practices. We aimed to synthesize the available research evidence of the effects that drink specials and drink special laws have on different alcohol-related outcomes.

Recent Findings

Twelve studies examined the effect of drink specials in seven countries between 1978 and 2018. Of these, 11 found a consistent positive association between drink specials and increased alcohol consumption, heavy drinking, and alcohol intoxication. Drink specials also increased reports of driving under the influence, fighting, and unprotected sex. Drink specials were also associated with expectations of higher consumption and modified attitudes and behaviors towards favorable views of drink specials. Effect sizes ranged from 1.80 to 4.43 increased odds for the examined alcohol-related outcomes. The only study examining the effects of a drink special law revealed mixed findings between prohibiting happy hours and three alcohol-related outcomes.

Summary

Drink specials were consistently associated with alcohol-related adverse outcomes, but almost nothing is known about the effects of laws restricting drink specials.

Screening Effects of the National Health Screening Program on Developmental Disorders

As the prevalence of developmental disorders (DDs) has increased, many OECD countries provide a national screening examination for early detection and intervention for DDs. This study examined effects of the National Health Screening Program in Korea. 65,334 children (39%) were DD-screened and 35,466 children (21%) received a false negative among the 167,050 study subjects. The DD-screened rate had increased from 3208 (27.2%) in 2008 to 8471 (47.3%) in 2012, then decreased to 5544 (29.8%) in 2017. Changes in the false negative rates increased from 2.7% in 2008 to 23.8% in 2017 were one of the most influential factors in these fluctuations. The DD-screened rate was influenced by demo-geographic and economic factors as well as by age-related characteristics of the subconditions.

Confounding due to pre-existing diseases in epidemiologic studies on sedentary behavior and all-cause mortality: a meta-epidemiologic study

PURPOSE

We examined the influence of confounding due to pre-existing diseases in prospective studies on sedentary behavior and all-cause mortality.

METHODS

We analyzed 25 studies included in systematic reviews. The risk of confounding due to pre-existing diseases was assessed by five methodologic characteristics.

RESULTS

Sedentary behavior was associated with higher all-cause mortality. Studies with short average follow-up length had stronger magnitudes of association: 1 to less than 5 years (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.28-1.94), 5 to 9 years (HR, 1.24; 95% CI, 1.16-1.31), and 10 years or more of follow-up (HR, 1.20; 95% CI, 1.10-1.31). Studies that did not adjust for diseases at baseline, did not exclude deaths in the first years of follow-up, and did not exclude participants with diseases/conditions showed stronger associations. Studies with higher risk of confounding because of pre-existing diseases (HR, 1.40; 95% CI, 1.27-1.54) showed stronger association than lower risk studies (HR, 1.18; 95% CI, 1.10-1.27). Studies excluding participants with diseases at baseline had weaker associations compared with studies adjusting for diseases in models.

CONCLUSIONS

Sedentary behavior was associated with increased all-cause mortality, although confounding due to pre-existing diseases may bias the magnitude of the association.

[Follow-up and retrospective investigation of patients with pneumoconiosis in Jiangsu Province, China]

Objective: To investigate the features, changing trend, and rules of pneumoconiosis in Jiangsu Province, China, as well as the health status of patients with pneumoconiosis. Methods: From July to October 2019, the patients with pneumoconiosis, reported up to the end of 2018 in Jiangsu Province, were enrolled as respondents, and follow-up and retrospective investigation were performed. A total of 24405 patients with pneumoconiosis were investigated, and related data were collected from the monitoring system of cause of death for residents, pneumoconiosis network reporting system, occupational disease diagnosis institution, management institutions for the reporting of occupational diseases, and related residents' committee or village committee. The patients with pneumoconiosis, who had been reported, were followed up by telephone or on-site visit to obtain the information on their conditions. A descriptive analysis was performed for age of onset, working years, sex, category of industry, type of pneumoconiosis, annual disease onset, geographic distribution, and medical security. Results: Among the 24405 patients, a male/female ratio was 16.81∶1. Of all 24405 patients, 15948 (65.35%) had stage 1 pneumoconiosis, 5289 (21.67%) had stage 2 pneumoconiosis, and 1637 (6.71%) had stage 3 pneumoconiosis. The mean working years for dust exposure was 16.25±9.95 years for all patients, and the mean working years for dust exposure was 15.80±9.95 years for patients with stage 1 pneumoconiosis, 17.82±9.80 years for patients with stage 2 pneumoconiosis, and 16.31±9.90 years for patients with stage 3 pneumoconiosis. The highest number of cases of pneumoconiosis was reported in Wuxi (5744 cases, accounting for 23.54%) , followed by Zhenjiang (4160 cases, accounting for 17.05%) , Xuzhou (3851 cases, accounting for 15.78%) , Yancheng (3340 cases, accounting for 13.69%) , and Suzhou (2948 cases, accounting for 12.08%) . Major types of pneumoconiosis included silicosis (15392 cases, accounting for 63.07%) and coal workers' pneumoconiosis (5253 cases, accounting for 21.52%) . In this survey, 21115 completed follow-up, among whom 15924 survived and 5191 died, 15924 patients with pneumoconiosis survived, among whom 7461 (46.85%) had an age of ≥70 years and 2515 (15.79%) were exposed to dust for 5-9 years. The industries involved were mainly coal mining and washing industry (5687 cases, accounting for 35.71%) and public management, social security, and social organization (3349 cases, accounting for 21.03%) ; in terms of security, 7999 patients (50.23%) were covered by occupational injury insurance, 946 (5.94%) were compensated by employers, 4537 (28.49%) were covered by basic medical insurance for urban and rural residents, 1590 (9.98%) were covered by critical illness insurance, and 5458 (34.28%) were covered by other types of social security, such as medical assistance and poverty relief. Conclusion: Silicosis and coal worker's pneumoconiosis are the key points for the prevention and treatment of pneumoconiosis in Jiangsu Province, and supervision should be strengthened for industries and regions with serious dust hazards.

Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study

BACKGROUND

Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use.

METHODS

We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0&lt; DDDs ≤45), intermediate users (45&lt; DDDs ≤90), and high users (90&lt; DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures.

RESULTS

Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users.

CONCLUSION

As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.

Risk of sexual dysfunction with progestin-based contraceptives in women of child-bearing age

PURPOSE

To examine whether there is a positive association between sexual dysfunction (SD) and different types of progestin-based contraceptives.

METHODS

Nested case-control study in women of child-bearing age (15-45 years) from the IQVIA® Ambulatory electronic medical record database from 2008 to 2018. Cases defined by diagnosis of sexual dysfunction identified by international classification for disease clinical modification code 9th and 10th. Each case was matched to four controls and rates of prescriptions of the following were compared: levonorgestrel intra-uterine device (IUD), progestin, and ethinyl estradiol (EE) combined oral contraceptive (COC) formulations including levonorgestrel, norgestimate, drospirenone, desogestrel, norethindrone, and norgestrel; etonogestrel vaginal ring; and medroxyprogesterone injection.

RESULTS

Overall, 6689 cases of patients with SD were matched to 26,756 matched controls. Compared with matched controls, more subjects with SD used levonorgestrel IUD (OR 1.24, 95% CI 1.08-1.44), EE-levonorgestrel COC (OR 1.18, 95% CI 1.00-1.41), EE-drospirenone (OR 1.28, 95% CI 1.00-1.67), and medroxyprogesterone (OR 1.38, 95% CI 1.12-1.70). The use of norgestrel exhibited a protective effect (OR 0.83, 95% CI 0.73-0.95). When using the EE-levonorgestrel COC as a comparator, norgestrel users exhibited a protective effect (OR 0.70, 95% CI 0.57-0.87) while no other contraceptives showed a statistically significant difference in association with SD.

CONCLUSION

Our study found an increase in the use of levonorgestrel (COC and IUD), drospirenone, and medroxyprogesterone in subjects with SD. The risk of contraceptives did not differ when compared with oral levonorgestrel. The small association size and lack of difference between drug formulations suggest a minimal impact of progestin-based contraceptives on sexual dysfunction.

[Prevention of blindness and ophthalmic epidemiology in China over the past 70 years]

Prevention of blindness is of paramount importance for eye care and health care in China. In the past 70 years, we have embraced a lot of advancements in practice, manpower and landmark studies for the prevention of blindness and development of ophthalmic epidemiology. This summary is dedicated to our predecessors and successors for their contributions to the progress of ophthalmology in China, particularly workers in the field of prevention of blindness and ophthalmic epidemiology. Congratulations on the 70th anniversary of Chinese Journal of Ophthalmology. (Chin J Ophthalmol, 2020, 56: 561-566).