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Background: Longitudinal healthcare worker (HCW) cohorts throughout the COVID-19 pandemic provide a unique opportunity to study the relative contributions of various exposures to infection risk over time. This study aimed to examine how demographic, health, occupational, household and community factors influenced the SARS-CoV-2 infection risk in a cohort of HCWs in Southeastern Ontario, Canada, during the early pandemic and the Omicron waves. We compared the contribution of these factors to infection risk and explored the implications for future epidemic preparedness and the protection of HCWs. Methods: We conducted a longitudinal analysis using data from a cohort of HCWs recruited from one acute care hospital and four long-term care homes. The analysis was divided into two periods: the initial phase of the pandemic (period #1) and the first three Omicron waves (period #2). We employed Poisson regression for period #1 and Cox regression for period #2 to examine associations of demographic factors (age, sex, ethnicity, migration status, income insufficiency), health factors (chronic conditions, smoking history, SARS-CoV-2 vaccination status), household factors (exposure to COVID-19), occupational factors (work role, exposure to COVID-19 patients, personal protective equipment access, aerosol-generating procedures) and community exposures (use of masks, distance, hand-washing) with SARS-CoV-2 infection. Results: At period #1, 17/208 (8.2%) HCWs reported having had SARS-CoV-2 infection. At period #2, 65/167 (38.3%) reported at least one SARS-CoV-2 infection. In period #1, factors associated with increased risk of infection included working in a long-term care home, exposure to more COVID-19-positive patients, working as a nurse or therapist, and inadequate use of personal protective equipment. In period #2, the hazard of infection was higher among HCWs who had COVID-19-infected children at home, whereas the use of protective measures in the community (maintaining social distance, mask-wearing) and receiving a vaccine booster were associated with reduced risk. Providing care to COVID-19 patients was not associated with the risk of acquiring SARS-CoV-2 infection at period #2. Conclusions: During the Omicron wave, community and household exposures, but not occupational exposure to COVID-19 cases, were the primary factors contributing to infection risk in HCWs. This contrasts with the early waves of the pandemic where occupational exposures played a significant role. These findings may be explained by the effectiveness of institutional interventions in reducing the risk of SARS-CoV-2 transmission in healthcare settings, alongside the failure of community-level interventions to mitigate risk during the Omicron period. [ABSTRACT FROM AUTHOR]

Background: Sexual and gender minority (SGM) persons experience substantial mental health disparities throughout the life course, including increased vulnerability to depression and suicide. Few existing studies, however, have explored how pervasive experiences of SGM-related stigma, discrimination, and trauma (i.e., minority stress) contribute to adverse mental health outcomes among diverse sub-populations of SGM adults living in rural areas of the United States. This paper describes the protocol for a prospective cohort study, "Rural Exploration and Approaches for LGBTQ + Mental Health (REALM)," that will explore minority stress in relation to mental health conditions and suicidal behaviors among rural SGM adults. Methods: Online processes will be used to recruit and enroll a diverse sample of up to 2,500 SGM adults aged 18 + living in rural counties and small metropolitan areas in the United States to complete an online baseline survey. This will include: up to 1,000 cisgender sexual minority persons (up to n = 500 each cisgender women and cisgender men); and up to 1,500 gender minority persons (up to n = 500 persons who were assigned male at birth and identify as a woman, female, and/or transfeminine; up to n = 500 persons who were assigned female at birth and identify as a man, male, and/or transmasculine; and up to n = 500 persons who identify as some other gender, including non-binary, gender non-conforming, and/or agender regardless of sex assigned at birth). All enrolled participants will subsequently be followed over a 12-month period, with repeated surveys at three-month intervals. Included survey measures will focus on sociodemographic information, mental health, substance use, suicidal behaviors, minority stressors, psychological processes, and other related risk and protective factors. Discussion: This study presents a critical opportunity to better understand how minority stress contributes to adverse mental health outcomes among populations that remain underrepresented in research and programs in 2024. Results will be used to create more targeted, acceptable, and impactful intervention content and strategies that mitigate stigma, promote mental health, and prevent suicidal behaviors among rural SGM adults. [ABSTRACT FROM AUTHOR]

Background: Prediabetes, impacting a third of the adult Chinese population, is linked to a variety of detrimental health outcomes. However, scant research has delved into the factors that affect a regression from prediabetes to normal glucose regulation (NGR) in middle-aged and elderly Chinese adults. Methods: We conducted a longitudinal analysis of 2,655 adults, aged 45 years and above, drawing data from wave 1 and wave 3 of the China Health and Retirement Longitudinal Study (CHARLS). We employed a stepwise logistic regression model to identify factors associated with the regression to NGR. Restricted Cubic Spline (RCS) analysis was used to evaluate the dose-response relationships between baseline fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) levels and the likelihood of regression to NGR. Attribution fraction (AF) analysis was conducted to measure the impact of modifiable factors on the regression of prediabetes. We further examined how changes in these factors were associated with regression to NGR. Results: During the 4-year follow-up, 570 of 2,655 prediabetes participants regressed to NGR. The stepwise logistic regression model identified older age, female sex, abdominal obesity (OR 0.70, 95% CI 0.57–0.86), elevated LDL-C (OR 0.69, 95% CI 0.48–0.97), higher FPG (OR 0.68, 95% CI 0.52–0.90), and higher HbA1c (OR 0.23, 95% CI 0.18–0.30) as factors associated with regression to NGR. AF analysis showed that a lower initial HbA1c was the most influential factor for regression to NGR. Additionally, evaluated blood lipid profiles reduced the odds of regression to NGR. Conclusion: This study underscores the influence of age, gender, abdominal obesity, LDL-C levels, FPG, HbA1c, and blood lipid profiles on the likelihood of regressing from prediabetes to NGR. It suggests that adopting a healthy lifestyle and preemptively mitigating these risks may be more beneficial than addressing them after they have been identified in clinical settings. [ABSTRACT FROM AUTHOR]

Objectives The potential impact of ankylosing spondylitis (AS) on cancer risk remains unclear. This study seeks to investigate the relationship between AS and different types of cancers. Methods A literature search on PubMed, EMBASE and Cochrane Library up to 10 July 2023 was conducted. Two investigators selected eligible studies and extracted relevant data. The study used the random-effects model to explore the causality between AS and cancer, utilizing relative risk (RR) as a measure for the study. Results A total of 20 cohorts with >330 000 participants were included. The pooling analysis shows AS being associated with a higher risk of cancers (RR = 1.16, 95% CI: 1.07–1.26, P  = 0.001, I 2 = 70.60%). In the subgroup analysis, AS has a higher cancer risk in Asia, but this association is not significant in Europe. Individual investigations indicate that AS is associated with an increased risk of bone cancer (RR = 3.41, 95% CI: 1.45–7.99, P =  0.005, I 2 = 0.00%), thyroid gland cancer (RR = 1.76, 95% CI: 1.29–2.40, P  < 0.001, I 2 = 13.70%), multiple myeloma (RR = 1.74, 95% CI: 1.42–2.15, P <  0.001, I 2 = 27.20%), leukaemia (RR = 1.52, 95% CI: 1.27–1.82, P <  0.001, I 2 = 0.00%), kidney cancer (RR = 1.45, 95% CI: 1.08–1.94, P =  0.014, I 2 = 0.00%), prostate cancer (RR = 1.43, 95% CI: 1.17–1.74, P <  0.001, I 2 = 82.80%) and non-Hodgkin's lymphoma (RR = 1.42, 95% CI: 1.17–1.73, P <  0.001, I 2 = 0.00%). However, there is no significant correlation with connective tissue cancer, brain cancer, testicular and other male cancers, bladder cancer, female cancers, skin cancer, and cancers of the digestive system and respiratory system. Conclusion AS appears to be related to cancer development. The results highlighted the necessity for large-scale studies, considering influencing factors such as AS course, medication histories and potential biases when examining cancer risk. [ABSTRACT FROM AUTHOR]

Purpose: Although (poly)phenols have shown potential in anti-cancer activities, their impact on improving ovarian cancer (OC) survival remains unknown. Therefore, we aim to first investigate the association between dietary polyphenol intake and OC survival, providing valuable insights into potential interventions. Methods: The prospective cohort recruited 560 patients with OC to assess the associations of polyphenol intake, not only pre- and post-diagnosis but also the change from pre- to post-diagnosis with OC survival. Dietary intakes of total (poly)phenols and their five classes (flavonoids, phenolic acids, lignans, stilbenes, and other polyphenols) were assessed using a validated 111-item food frequency questionnaire. Overall survival (OS) was tracked through active follow-up and medical records until February 16th, 2023. Cox proportional hazard regression models were applied to calculate the hazard ratios (HR) and 95% confidence intervals (CI). Results: During a median follow-up of 44.4 months, 211 all-cause deaths were identified. We observed significant associations between higher polyphenol intake with lower risk of mortality among patients with OC ((HR T3 vs. T1 = 0.55, 95%CI = 0.35–0.87 for pre-diagnosis; and HR T3 vs. T1 = 0.59, 95%CI = 0.39–0.90 for post-diagnosis). Consistently, an evident linear trend was observed for polyphenol and flavonoid intake with OC survival. Of note, compared to the stable group (change within 10%), the decreased intake (change of more than 10%) of total (poly)phenols and five polyphenol classes was significantly associated with worse OS. Conclusion: Dietary (poly)phenols, as well as its five classes, have an inverse association with OC survival. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence of potential associations between body mass index (BMI) and risk of vulvar and vaginal cancer. We explored these associations in a large cohort of Norwegian women. Methods: The analytical dataset included 889,441 women aged 16–75 years at baseline in 1963–1975. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between BMI and vulvar and vaginal cancer incidence. Results: During 30.1 million person-years of follow-up, 1748 incident vulvar and 408 incident vaginal cancer cases occurred. The HRs (95% CIs) for vulvar cancer for a BMI of 15- < 18.5, 18.5- < 25, 25- < 30, 30- < 35, ≥ 35 were 0.62 (0.38–1.01), 1.00 (reference), 1.23 (1.10–1.40), 1.43 (1.23–1.66) and 1.72 (1.35–2.20, ptrend < 0.001), and per 5 kg/m2 increment was 1.20 (1.13–1.26). The corresponding HRs (95% CIs) for vaginal cancer were 1.05 (0.52–2.15), 1.00, 0.89 (0.71–1.12), 0.95 (0.68–1.34), and 2.01 (1.29–3.13, ptrend < 0.001), respectively, and per 5 kg/m2 was 1.11 (0.99–1.25). The HR (95% CI) per 5 kg/m2 increase in BMI at ages 16–29 was 1.28 (1.07–1.54, n = 250 cases) for vulvar and 1.53 (1.11–2.11, n = 66 cases) for vaginal cancers. The HR (95% CI) per 5 kg/m2 for early-onset (< 50 years age at diagnosis) vulvar cancer was 0.92 (0.66–1.28, n = 87 cases) and 1.70 (1.05–2.76, n = 21 cases) for vaginal cancer. Conclusion: These results further support the associations between higher BMI and increased risk of vulvar and vaginal cancers, with suggestive stronger associations between BMI in early adulthood for both cancers and for early-onset vaginal cancer. Further studies are needed to elucidate these findings and investigate the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Predicted nursing deficits and low nursing student retention rates highlighted the need to investigate cultivation of grit, a malleable trait involving perseverance and passion to achieve long-term goals amidst challenges and difficulties. Objective: The objective of this study was to identify how cultivation of grit and additional academic and non-academic strategies aided gritty second-year associate degree-seeking nursing students in addressing nursing program challenges and completing their nursing program. Methods: Twenty-two second-year associate degree-seeking nursing students in rural central Arizona completed demographic and Grit-O Scale questions using Survey Monkey™ and participated in semi-structured interviews or focus group discussions held from September through December 2022. Research questions provided study foundation: RQ1: How do second-year nursing students with high levels of self-perceived grit of greater than 3.5 out of 5 as measured on the Grit-O Scale describe how grit was cultivated during their associate degree-seeking nursing program? RQ2: How do second-year nursing students with high levels of self-perceived grit describe how additional academic and non-academic strategies added to them in dealing with the challenges of their associate degree-seeking nursing program? Design: Qualitative Descriptive Research Results: Inductive thematic analysis revealed six themes: importance of perseverance and passion, facets of grit; identification of program challenges and strategies used to deal with challenges; and the significance of support from nursing cohort, family, and friends, and nursing instructors. Conclusions: Effective strategies for participating nursing student retention and program completion involved cultivation of grit and its facets of perseverance and passion and additional academic and non-academic strategies of nursing cohort and instructor support aided students in dealing with challenges faced during their associate degree-seeking nursing program at a rural, central Arizonan community college. [ABSTRACT FROM AUTHOR]

Objective: To determine the change in English emergency postnatal maternal readmissions 2007–2017 (pre‐COVID‐19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS). Design: National cohort study. Setting: All English National Health Service hospitals. Population: A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017. Methods: Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database. Main Outcome Measures: Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS. Results: A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28–1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31–1.39); age < 20 years (aOR 1.09, 95% CI 1.05–1.12); 40+ years (aOR 1.07, 95% CI 1.03–1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91–0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82–1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53–1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06–2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83–2.21). Conclusions: The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those < 20 and ≥ 40 years old; primiparous women; and those with specified obstetric risk factors. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the prevalence and risk factors associated with depression symptoms at 10 years after traumatic brain injury (TBI) and compare with results at 10 weeks and 1 year. Methods: A large cohort of prospective admissions with TBI were followed up for 10 years. Depression using HADS (Hospital Anxiety and Depression Scale) score > 8 was measured. Several injury and demographic features were examined for association with depression. Results: Over 4 years, 1130 individuals were recruited of whom 916 attended at 1 year; after 10 years, 552 attended and 210 had died. 154 (17%) of the cohort was lost to follow-up. The prevalence of depression at 10 weeks was 56.3% [95%CI 52.2–60.5], at 1 year was 42.4% [95%CI 38.3–46.5] and 10 years 38.4% [95%CI 34.3–42.5]. There was considerable change in individual scores over time in both directions. A multivariable analysis identified the independent predictors of 10-year depression score as lower GCS, social deprivation, female gender, past psychiatric history, alcohol intoxication and unemployment. Age, ethnicity, social support, TBI etiology, CT abnormality and medical comorbidity were insignificant. Conclusions: While the overall level of symptoms at 10-year post-TBI remains high, there is considerable change in individual depression status over time. The predictors identified may allow the targeting of vulnerable sub-populations. [ABSTRACT FROM AUTHOR]

Positive results from cancer screenings, like a cancer diagnosis, can increase the risk of cardiovascular disease (CVD) mortality due to heightened psychological stress. However, positive screening results may also serve as a teachable moment to encourage the adoption of a healthier lifestyle. Consequently, the overall association between positive screenings and CVD mortality risk remains unclear. Based on PLCO data, the risk of CVD mortality associated with the number and types of positive screens was evaluated using Cox regression models among 149,258 eligible participants enrolled between 1993 and 2001. Additional analyses explored these associations stratified by prior CVD history. Exploratory analyses were also conducted to investigate whether positive screens were linked to the potential adoption of a healthier lifestyle. After a median follow-up of 19 years, significantly decreased risk of CVD mortality was observed for individuals with occasional positive screening (≤ 2 positive screens) [adjusted hazard ratio (HR, 95%CIs): 0.931 (0.897–0.968), P < 0.001] compared to the control arm. This effect was particularly notable for flexible sigmoidoscopy [0.842 (0.802–0.884), P < 0.001] and transvaginal ultrasound [0.855 (0.776–0.942), P = 0.002]. However, when the number of positive screens increased to more than two, the reduced risk of CVD mortality became non-significant [0.977 (0.941–1.014), P = 0.220]. Subgroup analyses revealed a greater reduction in CVD mortality risk among participants without a history of CVD [0.917 (0.864–0.973)] compared to those with a history of CVD [0.944 (0.898–0.993)]. Sensitivity analyses excluding screening-detected cancers showed similar association in the overall population [0.933 (0.897–0.970)], as well as in both subgroups with [0.945 (0.898–0.995)] and without previous CVD [0.919 (0.865–0.976)]. Exploratory analyses indicated a significantly higher proportion of any body mass index (BMI) reduction among those with a baseline BMI ≥ 25 kg/m2 who had positive screens compared to the control arm, particularly for individuals with occasional positive screens (48.07% vs. 47.04%, P value = 0.037). Occasional positive cancer screening are associated with reduced risk of CVD mortality, regardless of prior CVD history, cancer diagnosis, and other competitive risks. [ABSTRACT FROM AUTHOR]

Background: Urine is an attractive biospecimen for nutritional status and population health surveys. It is an excellent non-invasive alternative to blood for appropriate biomarkers in young children and is suitable for home-based collection, enabling representative collections across a population. However, the bulk of literature in this population is restricted to collection in primary care settings. Feasibility of home-based collection at scale has not been tested. Here, we describe a mixed method approach to collect urine samples in a large cohort study with children under 5 years. Methods: The ORIGINS Project is an ongoing birth cohort investigating early life influences on child health outcomes in Perth, Australia. Recruitment began in 2017, with 3713 children consented by December 2022. Urine is collected longitudinally from children between 2 months and 5 years of age. Mixed methods for sample collection and return accommodates requirements across various ages and study timepoints. Uniquely, courier collection and postal kit deliveries were established in response to participant feedback regarding difficulty with in-person sample drop-offs with young children. Results: Over half of all eligible caregivers (1929/3713, 52%) returned a sample, 91% meeting quality standards. A third of all samples were returned by courier, with the highest uptake at 2–6 months of age, and increased uptake across all ages during COVID lockdowns. Caregivers cited being time-poor as the greatest barrier to sample completion and very few participants indicated difficulty with study methods. Conclusion: Our data suggests that home-based urine collection using a mixed method approach is acceptable to caregivers at a large scale, supporting the use of urine for biomarker studies and population surveys with young children. Key messages: • Urine from young children is an attractive non-invasive sample that has great potential for use in population-based health surveys and biomarker research. • Most researchers using child urine have performed the collections in a primary care setting, however, suitable methods for home collection must be developed to enable more widely representative sample collections across a population. • The ORIGINS Project has incorporated participant feedback to develop a mixed-methods strategy for urine collection and sample return in a large cohort of young children aged 2 months to 5 years. • More than half of all eligible children in The ORIGINS Project had caregivers return at least one child urine sample between 2017 and 2022. • To enable large scale urine home collections, particularly from children aged under 6 months, The ORIGINS Project recommends offering mixed methods and a courier service to increase compliance and allow continuity during periods of public health restrictions such as COVID lockdowns. [ABSTRACT FROM AUTHOR]