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Importance: Evidence regarding associations of blood donor sex with mortality among red blood cell transfusion recipients is conflicting.Objective: To study associations of donor sex and prior pregnancy with mortality of transfusion recipients.Design, Setting, and Participants: Data from 3 retrospective cohorts of transfusion recipients (the Kaiser Permanente Northern California [KPNC] and Recipient Epidemiology and Donor Evaluation Study-III [REDS-III] databases of data from January 2013 to December 2016 and the Scandinavian Donations and Transfusions [SCANDAT] database with data from January 2003 to December 2012) were analyzed. Final dates of follow-up were December 31, 2016, for the KPNC and REDS-III cohorts and December 31, 2012, for the SCANDAT cohort. Stratified Cox regression models were used to estimate associations between donor exposure groups with risk of mortality, adjusting for the number of red blood cell unit transfusions.Exposures: The number of transfused red blood cell units from female donors, previously pregnant donors, and sex-discordant donors (male donor and female recipient or female donor and male recipient).Main Outcomes and Measures: In-hospital mortality.Results: The study population included 34 662 patients (mean age, 69 years; 18 652 [54%] women) from the KPNC cohort, 93 724 patients (mean age, 61 years; 48 348 [52%] women) from the REDS-III cohort, and 918 996 patients (mean age, 72 years; 522 239 [57%] women) from the SCANDAT cohort. The median number of red blood cell transfusions per patient was 3 in the KPNC cohort, 2 in the REDS-III cohort, and 3 in the SCANDAT cohort. The percentage of transfusions from previously pregnant or parous donors was 9% in the KPNC cohort, 18% in the REDS-III cohort, and 25% in the SCANDAT cohort. The percentage of transfusions in the 3 cohorts from female donors ranged from 39% to 43%, from previously pregnant or parous donors ranged from 9% to 25%, and from sex-discordant donors ranged from 44% to 50%. There were 3217 in-hospital deaths in the KPNC cohort, 8519 in the REDS-III cohort, and 198 537 in the SCANDAT cohort. There were no statistically significant associations between any of the 3 donor exposures and in-hospital mortality in the 3 cohorts. Hazard ratios for in-hospital mortality per transfused unit from female donors were 0.99 (95% CI, 0.96-1.03) for the KPNC cohort, 1.00 (95% CI, 0.99-1.01) for the REDS-III cohort, and 1.00 (95% CI, 0.99-1.00) for the SCANDAT cohort. For units from previously pregnant or parous female donors, hazard ratios were 1.00 (95% CI, 1.00-1.01) for the KPNC cohort, 1.01 (95% CI, 0.98-1.03) for the REDS-III cohort, and 1.00 (95% CI, 1.00-1.01) for the SCANDAT cohort. For units from sex-discordant transfusions, hazard ratios were 1.02 (95% CI, 0.99-1.05) for the KPNC cohort, 0.99 (95% CI, 0.98-1.00) for the REDS-III cohort, and 1.00 (95% CI, 0.99-1.00) for the SCANDAT cohort.Conclusions and Relevance: Among red blood cell transfusion recipients, transfusions from female, previously pregnant, or sex-discordant donors were not significantly associated with increased mortality. [ABSTRACT FROM AUTHOR]

PURPOSE One of the most common sexually transmitted diseases in the United States, human papillomavirus (HPV), infects about 14 million people each year. About 80% of sexually active males and females are infected with HPV at some point in their lives. In addition to causing genital warts, HPV has carcinogenic variants known to cause cancer of the cervix, anus, vagina, vulva, penis, head, and neck. Medical and professional associations, including the FDA, CDC, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Society of Clinical Oncology, and American Cancer Society, have endorsed strong recommendations and guidelines for males and females to start the HPV vaccination at age 11 years. Despite the substantially high HPV rates, significant hesitancy continues among college students about receiving the HPV vaccine. This study evaluated whether education level or having a primary care provider (PCP) were associated with HPV vaccination rates and perceived knowledge of the HPV vaccine. METHODS We used a nonexperimental survey-based research design to evaluate our participants' responses. Our population consisted of students ages 18 to 26 years who had completed at least one semester of college. Qualtrics survey software was used to administer the 27-item questionnaire, which provided information on inclusion criteria, demographic descriptors, and knowledge score of the HPV vaccine. The survey was anonymous and distributed through email and social media. Analysis of the data via chi-square and logistic regression was performed using SPSS software. RESULTS A chi-square test for association was conducted between sex and HPV vaccination rates. A significant relationship was found between sex and HPV vaccination rates, chisquare (2, N = 356) = 12.385, P < .05, with females more likely to receive the HPV vaccine. Nearly 80% of females and nearly 61% of males had received the vaccine. A chisquare test for association was conducted between health/ biologic science majors and HPV vaccination rates, chisquare (1, N = 356) = 6.592, P < .05. Of students studying health/biologic sciences, 82.1% had received the HPV vaccine, compared with 70.6% of students in other majors. Logistic regression was used to analyze the relationship between being offered the vaccine by a PCP and the probability of receiving the vaccine. In this study, students were 24 times more likely to get the HPV vaccine if they were offered it. The relationship between survey score and the probability of receiving the vaccine also was analyzed via logistic regression. In this study, for every 25% increase in knowledge score, students were about 8.4 times more likely to receive the HPV vaccine. CONCLUSIONS Our results suggest that HPV vaccination rates would increase if PCPs recommended the vaccine more often and if people were more knowledgeable about HPV and the vaccine. The next possible research questions can be identifying barriers to recommending the vaccine or considering ways to increase knowledge of HPV among the population that would benefit from the vaccine. [ABSTRACT FROM AUTHOR]

Background Detailed information regarding plasma use in the United States is needed to identify opportunities for practice improvement and design of clinical trials of plasma therapy. Study Design and Methods Ten US hospitals collected detailed medical information from the electronic health records for 1 year (2010-2011) for all adult patients transfused with plasma. Results A total of 72,167 units of plasma were transfused in 19,596 doses to 9269 patients. The median dose of plasma was 2 units (interquartile range, 2-4; range 1-72); 15% of doses were 1 unit, and 45% were 2 units. When adjusted by patient body weight (kg), the median dose was 7.3 mL/kg (interquartile range, 5.5-12.0). The median pretransfusion international normalized ratio ( INR) was 1.9 (25%-75% interquartile range, 1.6-2.6). A total of 22.5% of plasma transfusions were given to patients with an INR of less than 1.6 and 48.5% for an INR of 2.0 or more. The median posttransfusion INR was 1.6 (interquartile range, 1.4-2.0). Only 42% of plasma transfusions resulted in a posttransfusion INR of less than 1.6. Correction of INR increased as the plasma dose increased from 1 to 4 units (p < 0.001). There was no difference in the INR response to different types of plasma. The most common issue locations were general ward (38%) and intensive care unit ( ICU; 42%). Conclusion This large database describing plasma utilization in the United States provides evidence for both inadequate dosing and unnecessary transfusion. Measures to improve plasma transfusion practice and clinical trials should be directed at patients on medical and surgical wards and in the ICU where plasma is most commonly used. [ABSTRACT FROM AUTHOR]

Reviewing recent methodological developments, the advantages of mixed mode approaches in facilitating study participation are emphasized. Clearly the population of the United States is aging at an unprecedented rate the rapid increase in the number of so-called oldest old is of particular note. Because of this phenomenon, there is a need for data concerning the health and effective functioning of these older people and their use of services. Such information obviously must be valid, reliable and inferentially sound in order to inform social policies affecting this burgeoning demographic category. These requirements, however, put into question our current data-gathering techniques because they have generally been derived from studies of younger populations, or from convenience samples. Studies of predominantly sick populations or the users of particular health services are likely to emphasize the distinctiveness of those populations. Not surprisingly, research based on representative community-based samples uncovers their similarity and continuity with other population groups.

Background: The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment.Methods: In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol.Findings: Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48·7%] women; median age 51·0 years [IQR 40·7-59·7]). 199 415 individuals were included in the derivation cohort (91 786 [48·4%] women) and 199 431 (92 269 [49·1%] women) in the validation cohort. During a maximum follow-up of 43·6 years (median 13·5 years, IQR 7·0-20·1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease event-rates for increasing non-HDL cholesterol categories (from 7·7% for non-HDL cholesterol <2·6 mmol/L to 33·7% for ≥5·7 mmol/L in women and from 12·8% to 43·6% in men; p<0·0001). Multivariable adjusted Cox models with non-HDL cholesterol lower than 2·6 mmol/L as reference showed an increase in the association between non-HDL cholesterol concentration and cardiovascular disease for both sexes (from hazard ratio 1·1, 95% CI 1·0-1·3 for non-HDL cholesterol 2·6 to <3·7 mmol/L to 1·9, 1·6-2·2 for ≥5·7 mmol/L in women and from 1·1, 1·0-1·3 to 2·3, 2·0-2·5 in men). The derived tool allowed the estimation of cardiovascular disease event probabilities specific for non-HDL cholesterol with high comparability between the derivation and validation cohorts as reflected by smooth calibration curves analyses and a root mean square error lower than 1% for the estimated probabilities of cardiovascular disease. A 50% reduction of non-HDL cholesterol concentrations was associated with reduced risk of a cardiovascular disease event by the age of 75 years, and this risk reduction was greater the earlier cholesterol concentrations were reduced.Interpretation: Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician-patient communication about primary prevention strategies.Funding: EU Framework Programme, UK Medical Research Council, and German Centre for Cardiovascular Research. [ABSTRACT FROM AUTHOR]