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Purpose: To systematically review the characteristics of the available pharmacovigilance signal detection studies in pregnancy, and comprehensively assess the reliability, transparency, reporting, and interpretation of these studies., Methods: We searched five databases from inception to February 2024 to identify the available pharmacovigilance signal detection studies in pregnancy. We extracted three aspects of information (basic information, data processing modes, signal detection analyses) to assess the reliability, transparency, and reporting of each study. Moreover, we adopted the criteria of Mouffak et al.'s study to assess the misinterpretation of signal detection results in these studies., Results: A total of 33 pharmacovigilance signal detection studies in pregnancy were identified. Among them, there were great methodological heterogeneities in the data processing modes (restriction to the population, comparator, standardization of drug names and adverse event names, the assigned roles of drugs, counting unit, etc.) and signal detection analyses (signal detection method, sensitivity analysis, subgroup analysis, adjustment for confounding factors, etc.). Moreover, 13 (39%) studies had at least one type of inappropriate interpretation and/or extrapolation of signal detection results., Conclusion: Our results reveals that the quantity of pharmacovigilance signal detection studies in pregnancy is relatively limited. Furthermore, the reliability, transparency, reporting, and interpretation of the existing studies are less optimistic. The main issues existing in the available pharmacovigilance signal detection studies in pregnancy consist of two aspects: (1) great methodological heterogeneities exist in the data processing modes and signal detection analyses among different studies and (2) inappropriate interpretation and extrapolation of signal detection results are frequent., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Postacute sequelae of SARS-CoV-2 infection (PASC) are extensive. Also known as long COVID, primary outcomes reported are neurologic, cardiac and respiratory in nature. However, several studies have also reported an increase in gastrointestinal (GI) symptoms and syndromes following COVID-19. This study of PASC will include extensive analyses of GI symptoms, determine if people with pre-existing irritable bowel syndrome (IBS) are at higher risk of developing PASC generally or PASC-GI, and which biomarkers are impacted and to what degree. This R01 study is being funded by the National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK135483-01) from 2023 to 2028., Methods and Analyses: This study combines a longitudinal epidemiologic cohort study and in-depth, novel biologic analyses. In collaboration with a pre-existing study, the Arizona CoVID-19 Cohort (CoVHORT)-GI will recruit participants based on the history of COVID infection(s), new or ongoing GI symptoms 3-6 months postinfection, and pre-existing or incident IBS diagnosis to represent five study groups for comparison and analyses. A subset (n=1000) of those recruited will submit both stool and blood samples. Both samples will undergo a novel method to quantitate humoral and mucosal immune responses to host-derived faecal communities in conjunction with magnetic bead-based separation and high-depth shotgun microbial sequencing. Stool samples will also undergo traditional microbiome analyses (diversity and abundance) and faecal calprotectin assays. Additional serum analyses will aim to determine if a proteomics-based signature exists that differentiates a unique biomarker compositional signature discriminating PASC-GI versus no PASC. All laboratory data will be linked with in-depth epidemiologic data on demographics, symptoms and chronic conditions., Ethics and Dissemination: This study involves human participants and was approved by the University of Arizona Institutional Review Board (IRB (#00002332) and has been deemed minimal risk. Participants gave informed consent to participate in the study before taking part. All publications from the study will be shared back to participants along with alternative lay summaries and webinars to communicate key findings. The data management plan has been published and is publicly available online, including protocols for data requests., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: This study sheds light on the available global definitions, classifications, and criteria used for rare diseases (RDs), ultrarare diseases (URDs), orphan drugs (ODs) and ultraorphan drugs (UODs) and provides insights into the rationale behind these definitions., Design: A systematic literature review was conducted to identify existing definitions and the criteria used to define RDs, ODs and their subtypes., Data Sources: Searches were performed in the PubMed/Medline, Embase, Scopus and Web of Science (Science and Social Sciences Citation Index) databases covering articles published from 1985 to 2021., Eligibility Criteria for Selecting Studies: English-language studies on the general human population were included if they provided definitions or criteria for RDs, ODs and/or their subtypes without restrictions on publication year, country or jurisdiction., Data Extraction and Synthesis: Two independent reviewers conducted the search, screening and data extraction. Narrative synthesis, content analysis and descriptive analyses were conducted to extract and categorise definitions and criteria from these sources. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools., Results: Online searches identified 2712 published articles. Only 93 articles met the inclusion criteria, with 209 distinct definitions extracted. Specifically, 93 of these articles pertained to 119 RDs, 11 URDs, 67 ODs and 12 UODs. These definitions varied in their reliance on prevalence based and other contextual criteria., Conclusion: Prevalence-based criteria alone pose challenges, as disease frequencies differ by country. Establishing country-specific definitions can enhance understanding, support intercountry evaluations, improve healthcare efficiency and access to ODs, and strengthen equity and equality in healthcare. Such efforts would also promote research and development and support better outcomes for patients with complex and rare conditions., Prospero Registration Number: CRD42021252701., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Objectives: This study aims to estimate the impact of the co-occurrence of behavioural risk factors on mortality in the Spanish adult population., Design: Population-based cohort study based on data from the 2011-2012 Spanish National Health Survey and the 2014 European Health Survey (n=35 053 participants ≥15 years of age) both linked to mortality data as of December 2022. Risk factors included tobacco use, high-risk alcohol consumption, low adherence to the Mediterranean diet, leisure time sedentary lifestyle and body mass index outside the 18.5-24.9 kg/m 2 range. Deaths from any cause (n=2784), from diseases of the circulatory system (n=678) and from tumours (n=869) were identified. Standardised rate differences (SRD) and standardised rate ratios (SRR) were estimated using Poisson regression models adjusted for sociodemographic variables., Results: Compared with those with no unhealthy behaviours, overall mortality risk increased gradually as the co-occurrence of risk behaviours increased. Individuals with two factors had an SRD of 3.0 deaths per 1000 person-years (95% CI 1.8; 4.3) and an SRR of 1.88 (95% CI 1.35; 2.62). A coexistence of five risk factors increased SRD and SRR to 11.5 (95% CI 7.2; 15.8) and 4.34 (95% CI 2.84; 6.63), respectively. The association was stronger among individuals under 65 years of age, whereas it did not vary by sex and educational level. Those reporting five risk factors had SRRs of 6.35 (95% CI 2.91; 13.83) and 2.57 (95% CI 1.11; 5.98) for tumour-related and cardiovascular disease mortality, respectively., Conclusions: The co-occurrence of unhealthy behaviours increases the risk of overall and cause-specific mortality. Targeting multiple risk behaviours should be incorporated into the public health strategy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: Explore the nature and prevalence of long-term conditions in individuals with intellectual disability., Design: Retrospective longitudinal population-based study., Setting: Primary and secondary care data across the population of Wales with the Secure Anonymised Information Linkage (SAIL) Databank., Participants: 14 323 individuals were identified during the study date period 1 January 2000 to 31 December 2021 using the following inclusion criteria: 18 or older, alive at the cohort start date, a resident of Wales, with a primary care registration at a SAIL providing general practice with available records and a recorded diagnosis of intellectual disability. Once individuals were identified, health records were observed from birth., Results: 13 069 individuals had a recorded diagnosis of intellectual disability and at least one long-term condition, reflecting 91.25% of the population. Demographic data from the SAIL dataset reveal that the study population is predominantly White, with low levels of representation of non-White ethnic groups. In the cohort, a larger proportion of patients live in the most deprived areas of Wales (22.30%), with fewer individuals in less deprived categories. Mental illness was identified as the most prevalent of the identified long-term conditions, whereby 30.91% of the population had a recorded diagnosis of a mental illness which was chronic. For many common conditions, including epilepsy, thyroid disorders, upper gastrointestinal disorders, chronic kidney disease and diabetes, there was an overall trend of higher prevalence rates in the intellectual disability cohort when compared with the general population. The prevalence of hypertension was lower in individuals with intellectual disability. Chronic constipation, chronic diarrhoea and insomnia were examples of long-term conditions added as relevant to individuals with intellectual disability. Notable differences in the distribution of long-term conditions were observed when comparing across sex and age groups. The number of long-term conditions increases with age. Conditions which may usually be expected to emerge later in life are present in younger age groups, such as diabetes, hypertension and chronic arthritis. When hospital episodes were analysed, epilepsy, diabetes, chronic airway disease and mental illness were commonly treated conditions during hospital admission across both sexes. Conditions which were less prevalent in the intellectual disability cohort, but which were treated during ≥6% of total hospital admissions include cancer, cardiac arrhythmias and cerebral palsy., Conclusions: This study establishes a range of 40 relevant long-term conditions for people with intellectual disability through an iterative process, which included a review of the available literature and a series of discussions with a Professional Advisory Panel and Patient and Public Involvement groups of this research project. The findings of the study reinforce the high prevalence and early emergence of long-term conditions in the intellectual disability cohort. It also demonstrates the difference in the range of conditions when compared with the general population. There were differences in long-term conditions when separated by sex and age. Long-term conditions which commonly require treatment in hospitals were also revealed. Further work is required to translate the findings of this study into actionable insights. Clusters of multiple long-term conditions, trajectories, outcomes and risk factors should be explored to optimise the understanding and longitudinal care of individuals with intellectual disabilities and long-term conditions., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: Authors RK, EA, GC, GTJ, NK, AA and SG received financial support from the DECODE funding from UK National Institute for Health and Care Research (NIHR203981) for the submitted work; there are no other declared relationships or activities that could appear to have influenced the submitted work. All other authors do not have any competing interests to declare., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Purpose: Bangladesh has experienced a rapid epidemiological transition from communicable to non-communicable diseases (NCDs) in recent decades. There is, however, limited evidence about multidimensional determinants of NCDs in this population. The BangladEsh Longitudinal Investigation of Emerging Vascular and nonvascular Events (BELIEVE) study is a household-based prospective cohort study established to investigate biological, behavioural, environmental and broader determinants of NCDs., Participants: Between January 2016 and March 2020, 73 883 participants (aged 11 years or older) were recruited from 30 817 households across urban, urban-poor ('slum') and rural settings in Bangladesh. A structured questionnaire was administered by trained personnel recording participants' demographic, socioeconomic, behavioural, medical, environmental and other factors. Anthropometric measurements and blood pressure were recorded for each participant. Biological specimens were collected and aliquoted for long-term storage and analysis., Findings to Date: Of the 73 883 study participants (mean [SD] baseline age: 39 [15] years), 43 470 (59%) were females, and 38 848 (52%) had no or only primary-level education. Focusing only on the 65 822 adult participants aged 20-79 years at baseline, 15 411 (23%) reported being diagnosed with hypertension; 10 578 (16%) with type 2 diabetes and 7624 (12%) with hypercholesterolaemia. Age and sex-standardised prevalences of these conditions were much higher in urban than slum and rural settings. Overall, the mean (SD) body mass index (BMI) was 25 (5) kg/m 2 , with 10 442 (16%) participants aged 20-79, classified as obese (ie, BMI≥30 kg/m 2 ). Mean BMI was also higher in urban than slum and rural areas., Future Plans: The collection of information during the baseline visit was completed in 2020. Regular longitudinal follow-up is ongoing for ascertainment and adjudication of a range of fatal and non-fatal health outcomes among participants. This cohort will provide a powerful resource to investigate multidimensional determinants of incident NCDs across diverse settings in Bangladesh, helping to advance scientific discovery and public health action in an archetypal low-middle-income country with pressing public health needs., Competing Interests: Competing interests: AB reports institutional grants from AstraZeneca, Bayer, Biogen, BioMarin, Bioverativ, Novartis, Regeneron and Sanofi. JD holds a British Heart Foundation Professorship and an NIHR Emeritus Senior Investigator Award (*). JD serves on scientific advisory boards for AstraZeneca, Novartis, Our Future Health and UK Biobank and has received multiple grants from academic, charitable and industry sources outside of the submitted work. EDA holds an NIHR Senior Investigator Award (*). SG has received honoraria from Astra Zeneca and Eli Lilly for contributions to postgraduate education for health professionals in the UK. SS holds an Emeritus NIHR Senior Investigator Award (*). AW is part of the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement No 116074. *The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Background: Previous studies have suggested oxidative stress may play a key role in the pathogenesis of retinopathy, while evidence from observational studies directly linking oxidative biomarkers to clinically relevant outcomes has been limited. This study aims to investigate the association between oxidative balance score (OBS) and prevalence of retinopathy in a nationally representative sample of U.S. adults, including both those with and without diabetes., Methods: Data were obtained from the NHANES 2005-2008, including 3,287 participants. OBS was calculated from 16 dietary and 4 lifestyle components and categorized into tertiles. Weighted logistic regression was used to assess the association between OBS and retinopathy in the overall, diabetic, and non-diabetic populations, and Cox proportional hazards models evaluated the link between OBS and all-cause mortality in those with retinopathy. Restricted cubic spline (RCS) analysis explored the dose-response relationship between OBS and retinopathy. Subgroup analyses and interaction tests were conducted based on age, sex, race, BMI, education level, and diabetes status., Results: Participants in the highest OBS tertile had a 28% lower risk of retinopathy compared to those in the lowest tertile (OR 0.72, 95% CI 0.54-0.95, P = 0.023). RCS analysis showed a significant overall association between higher OBS and reduced retinopathy risk, without a nonlinear pattern. In participants with retinopathy, higher OBS was linked to a 60% reduction in all-cause mortality (HR 0.40, 95% CI 0.24-0.66, P < 0.001). Subgroup analysis revealed stronger inverse associations between OBS and retinopathy in younger individuals and those with higher education, with a significant interaction between OBS and age (P for interaction < 0.05)., Conclusion: Our study provides evidence that higher cumulative antioxidant exposure assessed by OBS is associated with a reduced risk and severity of retinopathy and lower all-cause mortality in U.S. adults with retinopathy, highlighting the importance of maintaining a favorable oxidative balance in retinal health., Competing Interests: Declarations. Ethics approval and consent to participate: The NHANES agreement has been reviewed and approved by the NCHS Research Ethics Committee. All participants provided written informed consent before participating. Consent for publication: All participants provided written informed consent before participation. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Background: In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement., Methods: MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD)., Results: We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were "more or less identical", 71.9% "similar but not identical" and 7.8% "broadly similar". Most RCTs were classified as "low risk of bias" (26.6%) or with "some concerns" (65.6%); cohort studies were mostly rated with "some concerns" (46.6%) or "high risk of bias" (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91-1.10, n = 54); and DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than "PI/ECO similarity" degree., Conclusions: Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Tooth loss among indigenous people in the Amazon emphasizes the need for culturally appropriate oral health interventions. The objective of this study was to analyze the incidence of tooth loss in two remote Amazon indigenous populations. This prospective cohort evaluated a total of 47 indigenous in the permanent dentition at T0 and thirteen years later (T1) from two villages, Arara-Laranjal (n = 28, mean age 16.1 and 29.9 years) and Assurini do Xingu (n = 19, mean age 15.9 and 29.5 years), of different ethnic groups. A multilevel Poisson regression model assessed the influence of village, sex, and age on tooth loss. At T0, the indigenous people had all their permanent teeth. Forty-two lost at least one tooth (89%), and a total of 172 teeth were lost at T1 at an incidence of 97% among females and 76% in males. There was no influence of ethnicity on tooth loss ( p = 1.000). A lower risk of tooth loss was associated with male subjects (β = -0.50, p < 0.05) but not with age. In females (22/46.8%) and males (11/23.4%), the highest incidence of tooth loss was the lower second molars. The risk was higher among females, and there was no influence on age, village, or ethnicity. The second and first molars were the most affected teeth. These findings suggest an increase in tooth loss caused by close contact between indigenous and urban populations.

Objectives: To elucidate the incidence of myopia, progression of refractive error, axial length (AL) elongation and factors associated with myopia in secondary school students in Vietnam., Design: Prospective cohort study., Settings: Hue Healthy Adolescent Cohort Study, Hue City, Vietnam., Participants: 3-year longitudinal data were available for 355 secondary school students (mean age 11.60±0.36, 46.8% girls). Noncycloplegic refraction and AL measurements were performed at baseline and the 3-year follow-up examinations., Primary and Secondary Outcome Measures: The primary outcomes were myopia incidence and progression. Myopia, emmetropia and hyperopia were defined as spherical equivalent (SE)≤-1.0 diopters (D), -0.5 D

Objective: This study analysed the spatial and temporal patterns of cervical cancer incidence in Addis Ababa from 2012 to 2021., Design: An ecological study was conducted from 1 September to 30 November 2023 to examine the spatiotemporal trends of cervical cancer incidence., Setting: The research was conducted in Addis Ababa, the capital city of Ethiopia., Participants: Included were all patients with clinically and/or histopathologically confirmed diagnoses of cervical cancer., Data Analysis: The study employed advanced analytical tools including R programming, Quantum Geographic Information System V.3.36.0, GeoDa V.1.2.2 and System for Automated Geoscientific Analyses GIS V.9.3.2. Techniques such as Bayesian empirical testing with a block weighting matrix for hotspot identification, Global Moran's I for spatial autocorrelation, nearest neighbour imputation and universal Kriging interpolation were used to manage data gaps. Joinpoint trend analysis and direct age-standardised incidence rate (ASIR) using the Segi's World standard population was applied to compare trends across subcities. A statistical significance threshold was set at p<0.05., Results: Between 2012 and 2021, a total of 2435 new cervical cancer cases were recorded in the Addis Ababa City Population-based Cancer Registry, with significant spatial clustering observed in Nifas Silk Lafto, Bole, Kirkos as well as parts of Gulele and Yeka sub cities (z score>1.96) in 2018. The citywide age-standardised incidence rate varied from 19 to 26 cases per 100 000 women-years during 2013 and 2016, respectively. Subcity trends varied significantly, with increases and decreases noted in Akaki Kality and Kolfe Keraniyo over different periods while Bole subcity showed modest increase at 4.2% APC (95% CI: 0.6% to 7.9%; p=0.026)., Conclusion: The study highlights substantial fluctuations in ASIR and significant geographic disparities in cervical cancer throughout Addis Ababa. To address these challenges, the implementation of school-based human papillomavirus vaccination programmes, alongside targeted interventions, active campaigns and sustained surveillance, is critical. These strategies are essential to effectively reduce the cervical cancer burden and improve health outcomes in the community., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: When Cox regression models are used to analyse time-to-event data, the proportional hazard assumption (PHA) must be reassured to obtain valid results. Transparent reporting of the statistics used is therefore essential to interpret research. This study aimed to assess the quality of statistical reporting and testing of the PHA in subgroup analysis of surgical randomised controlled trials (RCTs)., Methods: All published articles (see appendix 1) in the top quartile (25%) of surgical journals from 2019 to 2021 were screened in a literature review according to the ClarivateTM journal citation report impact factor. Subgroup analyses of surgical RCT data that used Cox models were identified. Statistical reporting was rated using a previously established 12-item PHA Reporting Score as our primary endpoint. For original surgical publications, the PHA was formally tested on reconstructed time-to-event data from Kaplan-Meier estimators. Methodological reporting quality was rated according to the CONSORT statement. Digitalisation was only possible in studies where a Kaplan-Meier estimator including numbers at risk per time interval was published. All results from the subgroup analyses were compared to primary surgical RCT reports and benchmark RCTs using Cox models published in the New England Journal of Medicine and The Lancet., Results: Thirty-two studies reporting secondary subgroup analyses on surgical RCT data using Cox models were identified. Statistical reporting of surgical subgroup publications was significantly inferior compared to original benchmark publications: median PHA Reporting Score 50% (interquartile range [IQR]: 39 to 58) vs 58% (IQR: 42 to 67), p <0.001. The subgroups did not differ in comparison to primary surgical RCTs: median PHA Reporting Score 50% (IQR: 39 to 58) vs 42% (IQR: 33 to 58), p = 0.286. Adherence to the CONSORT reporting standards did significantly differ between subgroup studies and benchmark publications (p <0.001) as well as between subgroup studies and primary surgical RCT reports: 13 (12.5 to 14) vs 13 (IQR: 11 to 13), p = 0.042., Conclusion: Statistical methodological reporting of secondary subgroup analyses from surgical RCTs was inferior to benchmark publications but not worse than primary surgical RCT reports. A comprehensive statistical review process and statistical reporting guidelines might help improve the reporting quality.

Introduction: Delirium is a neuropathological syndrome that is associated with several negative outcomes. Nursing home residents are vulnerable to developing delirium. Valid prevalence data and associated factors are not yet available for Germany. Therefore, the aim of the prevalence study of the DeliA project (Delirium in Nursing Homes) is to assess the prevalence of delirium and its associated factors in 750 nursing home residents., Methods and Analysis: Trained registered nurses from each participating nursing home will collect the data in a multicentre cross-sectional study. The inclusion criteria for residents are valid informed consent, age ≥65 years and sufficient language skills. The exclusion criteria are aphasia, coma, deafness or end-of-life status. The 4 'A's Test will be used as the primary measurement. Delirium motor subtypes will be determined using the Delirium Motor Subtype Scale. Covariables for associated factors, including functional impairments, pain, cognitive status and nutritional status, are assessed through standardised measurements. Moreover, data such as prescribed drugs or medical diagnosis, hearing impairment or falls will be assessed from the nursing records. Furthermore, the Drug Burden Index will be calculated, and associated factors will be determined using a logistic regression model. The period for data collection in participating nursing homes is planned for 2 consecutive weeks in April 2024., Ethics and Dissemination: This study was approved by the Ethics Committee of Witten/Herdecke University (no. 82/2023). Findings will be published in peer-reviewed journals and presented at conferences., Registration: https://osf.io/xkfvh/ (DOI 10.17605/OSF.IO/XKFVH)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Depression is a significant public health concern, with severe adolescent morbidity and mortality. Promoting adolescents' mental health is increasingly recognized, and schools are proposed as screening and preventive intervention sites. This cross-sectional study aimed to screen self-reported elevated depressive symptom prevalence among secondary school students in Istanbul, Turkey. The secondary objectives were determining behavioral problems, resilience, positive attitudes, and risk factors associated with depressive symptoms., Methods: Data collection was conducted between April-June 2022. Six thousand one hundred ten students from nine randomly selected schools from different city districts were approached. Depression was screened by the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems and positive attitudes. Resilience was evaluated by the Child and Youth Resilience Measure (CYRM)., Results: The final study sample comprised 2780 participants (response rate 47.7 %) with a mean age of 12.4 ± 1.1 years (females:52.7 %). Elevated depressive symptoms were detected in 31.2 % of the students. Female students exhibited higher scores in CES-DC and total difficulties but lower resilience scores in CYRM than male students. In a multiple regression analysis, female gender, higher total difficulties score, lower resilience score, and lower perceived academic performance significantly predicted CES-DC [F(6,2279) = 421, p < 0.01]., Discussion: Our findings showed high rates of elevated self-reported depressive symptoms in a city sample among Turkish adolescents at middle schools, in addition to coexisting behavioral difficulties and decreased resilience indicating poor psychosocial functioning. Given the prevalent depressive symptoms, screening and intervention programs involving resilience promotion may involve school systems to prevent adolescent depression., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: This study evaluates the prevalence and correlates of opioid agonist therapy (OAT) discontinuation across British Columbia (BC), using a sample of individuals who used substances and accessed harm reduction sites., Design: This study uses data from the 2019 cross-sectional Harm Reduction Client Survey (HRCS)., Setting: The 2019 survey was administered from October to December at 22 harm reduction supply distribution sites across the 5 Regional Health Authorities of BC., Participants: The 2019 HRCS was administered among individuals who used illicit substances in the past 6 months and were aged 19 years and above., Primary and Secondary Outcome Measures: The primary outcome was defined as self-reported discontinuation of OAT in the past 6 months. Measures of association (χ 2 and Fisher's exact tests) and logistic regression models were used to assess the strength of association between OAT discontinuation and demographic, socioeconomic, accessibility, drug use and harm reduction correlates., Results: Of the 194 participants included, 59.8% self-identified as cis man, 37.6% self-identified as Indigenous, 38.1% were aged 30-39 years and 43.8% had discontinued OAT in the past 6 months. Multivariable logistic regression analyses identified that those aged ≥50 years (AOR=0.12, 95% CI (0.03 to 0.45)) and those who took the survey in medium/large urban areas (AOR=0.27, 95% CI (0.07 to 0.98)) were significantly less likely to discontinue OAT, while those who experienced an overdose in the past 6 months were significantly more likely (AOR=3.77, 95% CI (1.57 to 9.03)) to have discontinued OAT in the past 6 months. Substance use, including opioids and stimulants, was similar among those who continued and discontinued OAT. Of the 73 participants who discontinued OAT and provided a reason, one-third reported discontinuing OAT because treatment was not effective, 27.4% could not get to the pharmacy during open hours, 23.3% could not make their clinic appointment and 15.1% reported challenges with transportation/travel., Conclusions: OAT discontinuation prevention efforts for individuals using substances in BC need to address disparities in healthcare accessibility, especially in rural areas and among younger individuals. Continued access to harm reduction services can allow for safer consumption of substances for individuals enrolled in OAT programs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Current care plans for stroke survivors typically focus on acute management, resulting in many stroke survivors being discharged to their communities without adequate follow-up, despite their often experiencing significant post-stroke complications, such as post-stroke spasticity (PSS). While studies have explored the incidence and prevalence of PSS, little is known about how early PSS develops and how many stroke survivors develop 'problematic' PSS that would benefit from pharmacological treatment., Methods and Analysis: EPITOME is a prospective, international, observational, epidemiological study of participants (aged 18-90 years) who develop paresis within days 3-14 of a first-ever stroke that occurred within the past 4 weeks. Participants at sites across seven different countries are monitored remotely at 2 weeks and 1, 2, 3, 6, 9 and 12 months post-stroke to detect the possible onset of PSS using the Post-stroke Spasticity Monitoring Questionnaire (PSMQ). If the PSMQ indicates the possible presence of PSS, participants undergo a full in-clinic assessment to confirm the presence of PSS. For participants with confirmed PSS, the severity and distribution of spasticity is documented, and the investigator assesses whether the participant has spasticity that could benefit from pharmacological therapy. Participants without clinically confirmed PSS return to remote monitoring., Ethics and Dissemination: Ethics approval was obtained in all seven participating countries. Results will be published at international meetings and in an international peer-reviewed journal. Lay summaries will be prepared to accompany the primary paper and will also be provided to study participants., Trial Registration Number: ClinicalTrials.gov NCT06055725., Competing Interests: Competing interests: RDZ, LSB, SB, SG, DHH, RP and AP are investigators in the EPITOME study and either they or their institutions receive payment for participation from Ipsen. In addition, RDZ reports research funding from Ipsen and AbbVie, consulting fees from Ipsen, royalties from Demos Medical for the Textbook of Stroke Recovery and Rehabilitation, and participation in a data safety monitoring board for SPR Therapeutics. SG reports research funding from Bundesministerium fur Bildung und Forschung (BMBF), Disabled Facilities Grants (DFG), Universitätsmedizin Mainz, Abbott, Boston Scientific, Böhringer Foundation, Magventure, Precisis, Innovationsfond GBA and lecture fees from Abbott, AbbVie, Bial, BVDN, Ipsen, and UCB. SS is a patient representative of Different Strokes and has no financial disclosures to report. SM, SP and PM are employed by Ipsen. AP reports consultancy for Ipsen, Merz and AbbVie., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: This study planned to analyse the association between ondansetron use within 24 hours before intensive care unit (ICU) admission to within 48 hours after ICU admission and the risk of sepsis in ICU patients., Design: A cohort study., Setting and Participants: Data of 65 366 participants in Medical Information Mart for Intensive Care IV from ICU in the Beth Israel Deaconess Medical Center., Primary and Secondary Outcome Measures: Sepsis was the primary outcome, which indicated patients with documented or suspected infection and acute change in total Sequential Organ Failure Assessment (SOFA) score ≥2 points. In-hospital mortality was the secondary outcome., Results: There were 6737 patients with early ondansetron use. In total, 1646 patients suffered sepsis. According to the data from multivariate cox regression model, compared with participants without early ondansetron use, the risk of sepsis was reduced in participants with early ondansetron use relative to those without HR (HR=0.84, 95% CI: 0.76 to 0.93). The risk of in-hospital mortality was reduced in those with early ondansetron use (HR=0.63, 95% CI: 0.55 to 0.72). Subgroup analysis revealed that the association between early ondansetron use and decreased risk of sepsis was significant in participants aged <65 years, men, not complicated with trauma, no surgery, systemic inflammatory response syndrome ≥2, Charlson Comorbidity Index ≥2, with ventilation use, without antibiotics use or without insulin use. In both patients with SOFA <3 or SOFA ≥3, early ondansetron use was correlated with a reduced risk of sepsis., Conclusion: Patients with early ondansetron use had lower odds of experiencing sepsis than patients without early ondansetron use, which might provide a reference for the management of sepsis in ICU patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: This study aimed to assess the impact of the COVID-19 pandemic on the characteristics and outcomes of patients with burns in a burn centre situated in Northwest China., Design: A retrospective descriptive study., Setting: This study was conducted in Tangdu Hospital, a major regional burn centre in Xi'an, Shaanxi Province of China., Participants: A total of 1413 patients with burns were included in the study, with the admission period spanning from 2017 to 2019 (before the pandemic) and 2020 to 2022 (during the pandemic)., Results: Burn hospitalisations decreased during the pandemic for both children (9.80%) and adults (24.68%). The pandemic was associated with a decrease in work-related burns and a corresponding increase in the risk of domestic burns (both p<0.001). The proportions of burns due to scald and flame increased, while electrical injury cases and proportions decreased significantly (both p=0.001). The estimated range of % total body surface area (TBSA) for children increased from 8% (IQR: 5-12%) to 10% (IQR: 8-15%) in children (p<0.001) and from 8% (IQR: 4-18%) to 11% (IQR: 6-25%) in adults (p<0.001). In children, the number of burn cases transferred from other hospitals decreased (p=0.011). Among adults, the number of female patients with burns rose (p=0.013), and the number of patients with inhalation injury also rose (p=0.009)., Conclusion: During the COVID-19 pandemic, the number of inpatients with burns declined. Domestic burns became more common, and scald and flame burns as well as the average burn area (% TBSA) increased. These findings might highlight the significance of implementing specific public health strategies and safety measures to improve family safety both during and after the pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: The aim of this study was to assess the prevalence of diabetic retinopathy (DR) and retina screening coverage among people with diabetes in the catchment area of a high-volume eye care organisation in north India., Design: A population-based cross-sectional study using Rapid Assessment of Avoidable Blindness survey, including the DR module., Setting: A customised rural district in the catchment of Dr Shroff's Charity Eye Hospital in Uttar Pradesh in north India., Participants: 4095 people of age 50 years and above were enrolled using a two-staged cluster sampling, 3867 (94.4%) participated; 2167 (52.9%) were women. 3803 of 4095 (92.9%) participants were assessed for diabetes. People with already diagnosed diabetes and anyone with a random blood glucose ≥200 mg/dL were offered dilated fundus examination., Primary and Secondary Outcomes: Primary and secondary outcomes were the prevalence of DR and screening coverage for DR, respectively., Results: The prevalence of diabetes was 7.0% (95% CI 5.9% to 8.0%). 50.2% of all people with diabetes were newly detected. The prevalence of any DR among people with diabetes who consented to dilated pupillary examination was 22.8% (51 of 224), (95% CI 18.2% to 27.3%). 5.8% (13/224) of people with diabetes were found to have sight-threatening DR and only 15.4% (2/13) had received treatment. 84.8% of people with previously diagnosed diabetes had never had their eyes tested for DR; this was significantly higher in women (90.2% vs 76.0%, respectively, p<0.001). 76% of people with previously diagnosed diabetes had poorly controlled diabetes; this was significantly higher for those on non-allopathic treatment (p<0.01). The odds of DR were higher with duration of diabetes >10 years and poor glycaemic control (OR of 1.8 and 1.6, respectively), but this was not found to be statistically significant., Conclusion: The prevalence of DR in this predominantly rural setting was found to be higher than the national average. Coverage of retinal screening and treatment was found to be very low. Working with general health providers to increase detection of people with diabetes and leveraging vision centres to improve DR screening coverage is needed in this region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: The Swedish Families of the 1990s (SWIFT90) is a population-based national register cohort that follows everyone born between 1990 and 1999, their parents and siblings. The cohort was set up primarily to investigate factors associated with biological parents' involvement with child welfare services and their outcomes following child(ren) placement in out-of-home care (OHC) under the research project 'Drivers of inequalities of families involved in child welfare services (DRIVERS)'., Participants: This cohort is defined as families consisting of parents and their children, of which at least one was born between 1990 and 1999 in Sweden, which totals 1 075 037 children. The children are linked to both (adoptive or biological) parents and their siblings, so the total number of individuals in the SWIFT90 yields a total sample of n=3 292 417. These families are followed through multiple national registers including information on income, education, inpatient care, mortality and criminal offences. SWIFT90 compiles administrative data spanning from 1960 to 2022, which reflects the most recent data available at the time of the data request., Findings to Date: SWIFT90 provides information on 61 982 parents (fathers=31 028; mothers=30 954) with children placed in OHC and their respective children (38,084). Several covariates could be assessed for the parental generation, therefore, providing a comprehensive picture of socioeconomic and health-related aspects of families with children born in the 1990s and placed in OHC in Sweden., Future Plans: SWIFT90 will be used to investigate the socioeconomic and health trajectories of families involved with the child welfare system. With this cohort study ia possible to examine whether the inclusion of certain covariates alters the association between parental characteristics and child welfare outcomes. Future studies could also guide initiatives to prevent vulnerable circumstances among biological parents from escalating to the point where child placement into OHC becomes necessary. Additionally, they could help enhance the conditions of biological families and support opportunities for reunification after placement has occurred., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Objective: Adaptive coping mechanisms (ACMs) are effective ways to cope with stress and anxiety in patients with chronic illnesses, such as glaucoma. This study aimed to assess the proportion of ACM and associated factors among adult glaucoma patients enrolled at the tertiary eye care and training centre in Northwest Ethiopia., Design: An institution-based cross-sectional study., Setting: This study was conducted at a tertiary eye care and training centre in Northwest Ethiopia from 15 May 2022 to 30 June 2022., Participants: The study included a sample of 398 adult glaucoma patients selected using a systematic random sampling technique., Primary and Secondary Outcome Measures: The participants were diagnosed with glaucoma by ophthalmologists. Optometrists conducted interviews, reviewed medical records and administered a pretested, structured questionnaire based on the Brief Coping Orientation to Problems Experienced inventory. Binary logistic regression was performed to identify associated factors, with significance considered at a p<0.05 and 95% CI., Results: The prevalence of ACM use among glaucoma patients was 45.7% (95% CI 41.2% to 50.3%). Factors significantly associated with ACM included urban residence (adjusted OR, AOR 2.57, 95% CI 1.25 to 5.28), higher average family monthly income (AOR 3.83, 95% CI 1.37 to 10.70), moderate to severe visual impairment (AOR 2.24, 95% CI 1.06 to 4.74), duration of diagnosis between 11 and 16 months (AOR 3.94, 95% CI 1.84 to 8.44) and more than 24 months (AOR 3.75, 95% CI 1.59 to 8.81) and the presence of ocular comorbidities (AOR 4.28, 95% CI 2.28 to 8.05)., Conclusions: About half of adult glaucoma patients used ACM to manage their condition. Older age, urban residence, higher average family monthly income, moderate to severe visual impairment and the presence of ocular comorbidities were significantly associated with ACM. Implementing an integrated approach that incorporates biopsychosocial strategies aimed at reducing ACM and promoting the adaptive one is essential., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: The childhood hand, foot and mouth disease (HFMD) sequelae cohort study (HNHFMDCS) is an ambispective cohort study of patients with HFMD based in Henan Province, China, consisting of patients treated in a key hospital for the diagnosis and treatment of HFMD in Henan Province. The study aims to investigate the long-term sequelae of HFMD survivors and to provide a comprehensive understanding of the potential harm caused by this infectious disease., Participants: In the retrospective phase of the cohort study, children diagnosed with HFMD from January 2014 to January 2023 were included, and clinical and demographic information about the patients was collected through a self-developed questionnaire. Patients hospitalised with HFMD since January 2023 were enrolled in the prospective cohort phase of the study, and long-term follow-up will be performed after completion of the baseline investigation (interview and comprehensive physical examination), clinical laboratory examination and biospecimen collection., Findings to Date: For the retrospective analysis of the cohort, a total of 18 705 HFMD cases (11 834 males and 6871 females) were observed between 2014 and 2022, of which 17 202 were mild cases (10 839 males and 6363 females) and 1503 were severe cases (995 males and 508 females). Statistical analysis was performed on the collected clinical examination data, and descriptive statistical methods, including mean value, SD and t-test, were used to compare the intergroup data. All tests were bilateral, and p<0.05 was considered statistically significant. There were significant differences in the hospitalisation duration and clinical examination indicators, such as platelets (PLT), C reactive protein (CRP), aspartate amino transferase (AST), alanine amino transferase (ALT), T lymphocyte subsets (CD3+ and CD3+CD4+) and B lymphocytes (CD19+) between mild and severe patients. The differences in these clinical examination indicators also help to detect changes in the disease in time so as to deeply understand the potential harm and social burden of the disease, and provide strong support for the rehabilitation of patients., Future Plans: Prospective cohort studies are currently underway, primarily enrolling hospitalised patients with HFMD to participate in our study. After the baseline investigation is completed, we will conduct long-term follow-up of the enrolled cases. In the coming year, we expect to obtain preliminary data on the incidence of sequelae in patients with HFMD 1-10 years after discharge, as well as information on the occurrence of sequelae. This dataset will be updated and expanded on an annual basis to support the continuous monitoring of patient health and disease progression. From HNHFMDCS, the study will provide a comprehensive overview of the potential harm caused by this common infectious disease, assess the social burden caused by this disease and make recommendations for the rehabilitation of survivors and prevention of further disability., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: This study assessed whether patients with potentially preventable emergency admissions had limited access to outpatient care immediately before admission and whether they received appropriate outpatient care during their outpatient visits., Design: Retrospective observational study., Setting: Linked outpatient and inpatient care records obtained from a nationwide claims database in Japan., Participants: Patients who experienced emergency admissions for ambulatory care-sensitive conditions between April 2005 and March 2020. Patient and regional characteristics were examined to assess the types of patients who faced difficulties with outpatient visits and receiving outpatient care related to the disease that resulted in admissions (hereafter referred to as admission-related outpatient care)., Main Outcome Measures: (1) Whether patients had an outpatient visit during the 2 weeks preceding admission and (2) whether patients received admission-related outpatient care during the 2 weeks before admission., Results: This study included 18 449 emergency admissions for ambulatory care-sensitive conditions, representing 16.3% (18 449/113 669) of all emergency admissions in our data. Among patients with emergency admissions for ambulatory care-sensitive conditions, 37.4% did not have an outpatient visit within the 2 weeks preceding admission and 29.9% did not receive admission-related outpatient care despite having an outpatient visit. In total, 67.4% did not receive admission-related outpatient care during the 2 weeks preceding admission. Patients in their 40s and 50s were less likely to have outpatient visits and receive admission-related outpatient care before admission. No evidence associates regional characteristics with outpatient visits and receiving admission-related outpatient care before admission., Conclusion: Most patients who underwent emergency admissions for ambulatory care-sensitive conditions did not have an outpatient visit or receive admission-related outpatient care, despite having an outpatient visit immediately before admission. Our findings suggest that emergency admissions may be prevented by improving access to timely and effective outpatient care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: To investigate the association between social support and depressive symptoms among internal migrant workers with a focus on the mediating role of a healthy lifestyle., Design: Cross-sectional study., Setting: The research was conducted among internal migrant workers in Henan Province, China, in August 2023., Participants: Internal migrant workers are defined as individuals residing outside their registered household location (excluding mobility within the municipal district) and participating in various social and economic activities, including employment, entrepreneurship and social services., Primary Outcome Measures and Analyses: Social support was measured using the Chinese version of the social support rating scale. The severity of depression among the study participants was evaluated using the Patient Health Questionnaire-9. A healthy lifestyle was assessed based on the questionnaire we developed based on the American Medical Association Healthy Lifestyle Scale. Statistical analyses, including logistic regression, Spearman's correlation and mediation analysis, were deployed to explore the associations between social support, healthy lifestyle and depressive symptoms., Results: Among 19 326 participants, 21.45% exhibited depressive symptoms, with a higher prevalence observed among males. Social support levels among internal migrant workers were found to be lower than those in the general population, and higher social support was significantly associated with a decreased risk of depressive symptoms (OR=0.102, 95% CI: 0.086 to 0.121). Mediation analysis revealed that a healthy lifestyle partially mediated the relationship between social support and depressive symptoms among internal migrant workers, with a mediation effect of -0.063, accounting for 18.75% of the total effect., Conclusion: This study provides insights into the complex interplay between social support, healthy lifestyle and depressive symptoms among internal migrant workers in China. Implementing interventions aimed at enhancing social support and promoting healthy lifestyle behaviours can significantly improve the mental health and overall well-being of internal migrant workers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

In observational studies, identifying and adjusting for a sufficient set of confounders is crucial for accurately estimating the causal effect of the exposure on the outcome. Even in studies with large sample sizes, which typically benefit from small variances in estimates, there is a risk of producing estimates that are precisely inaccurate if the study suffers from systematic errors or biases, including confounding bias. To date, several approaches have been developed for selecting confounders. In this article, we first summarize the epidemiological and statistical approaches to identifying a sufficient set of confounders. Particularly, we introduce the modified disjunctive cause criterion as one of the most useful approaches, which involves controlling for any pre-exposure covariate that affects the exposure, outcome, or both. It then excludes instrumental variables but includes proxies for the shared common cause of exposure and outcome. Statistical confounder selection is also useful when dealing with a large number of covariates, even in studies with small sample sizes. After introducing several approaches, we discuss some pitfalls and considerations in confounder selection, such as the adjustment for instrumental variables, intermediate variables, and baseline outcome variables. Lastly, as it is often difficult to comprehensively measure key confounders, we introduce two statistics, E-value and robustness value, for assessing sensitivity to unmeasured confounders. Illustrated examples are provided using the National Health and Nutritional Examination Survey Epidemiologic Follow-up Study. Integrating these principles and approaches will enhance our understanding of confounder selection and facilitate better reporting and interpretation of future epidemiological studies.

Objectives: To assess the prevalence and associated factors of hearing loss in Ethiopia, considering socioeconomic conditions, regional variations and age-related impacts., Design: Nationwide cross-sectional survey., Setting: Data were collected from 2 February to 10 June 2023, covering all regions of Ethiopia except Tigray (due to security concerns)., Participants: A sample of 3000 households and 7061 individuals aged 5 years and above was selected using a multistage sampling procedure. Eligible participants had resided in the area for at least 6 months. Exclusions included visitors, critically ill individuals and those with communication difficulties., Outcome Measures: Hearing loss was defined as an average hearing threshold >20 dB in the better ear at frequencies of 0.5 kHz, 1 kHz, 2 kHz and 4 kHz, measured using pure-tone audiometry. Logistic regression analysis was performed to determine factors associated with hearing loss., Results: The overall prevalence of hearing loss among individuals aged 5+ years was 18.4%. The prevalence was 8.1% among children aged 5-14 years and 73.7% among adults aged 60+ years. Factors significantly associated with hearing loss included being over 60 years old (adjusted OR (AOR)=51.41; 95% CI 36.95, 71.53), having no formal education (AOR=2.12; 95% CI 1.47, 3.08), ear discharge (AOR=3.01; 95% CI 2.07, 4.38), wax presence (AOR=1.92; 95% CI 1.53, 2.40), and tympanic membrane abnormality (AOR=17.17; 95% CI 12.27, 24.02). Participants from the Harari (AOR=3.25; 95% CI 1.85, 5.72) and Somali (AOR=2.37; 95% CI 1.49, 3.77) regions were more likely to experience hearing loss compared with those from other regions., Conclusions: Hearing loss is highly prevalent in Ethiopia, influenced by both modifiable and non-modifiable factors. Regional disparities in hearing loss suggest a need for targeted interventions. Evidence-based policies and strategies are essential to reduce ear diseases, improve hearing care services, and address disparities in hearing health across regions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Dental trauma is common in all age groups, although, epidemiologically, it is more common in children with studies that indicate that 15% of preschoolers and 20-25% of school-age children experience it. These injuries, which frequently call for immediate attention, can affect the hard tissues and supporting components of the teeth, and, because dental damage in deciduous teeth occurs frequently and affects speech, nutrition, and oral development, it is particularly worrying. After searching three databases, Scopus, Web of Science (WoS), and PubMed, and removing duplicates, 3,630 articles were screened, and 12 publications were included in the qualitative analysis. Due to their busy lifestyles, children are particularly susceptible to oral trauma and in certain areas and lower socioeconomic groups, the incidence is higher. From little fractures in the enamel to serious dislocations and avulsions, injuries vary and must be treated promptly in order to avoid consequences and to prevent long-term issues. Furthermore, a conservative treatment strategy is recommended to preserve tooth vitality and prevent extractions. Reducing the occurrence of dental injuries requires the implementation of preventive measures including mouthguard use and educational campaigns. In summary, this review emphasizes the importance of early diagnosis, immediate management, and long-term care, by synthesizing existing knowledge on the prevalence, types, management, complications, and prevention of dental trauma in deciduous teeth. Finally, it's important to underscore the need for continued research to refine treatment approaches., Competing Interests: Declarations. Ethics approval and consent to participate: All patients gave written informed consent to participate. Consent for publication: All parents/legal guardians gave Written Informed consent to publish pictures. Competing interests: The authors declare no competing interests. Disclaimer: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content., (© 2024. The Author(s).)

This chapter summarizes the epidemiological study design of natural immune epidemiology studies based on recent COVID-19-related research. The epidemiological studies on antiviral innate immunity have mainly included randomized controlled trials (RCTs) and observational studies. Importantly, this chapter will discuss how to use these methodologies to answer an epidemiological question of natural immunity in the viral infection process based on previous studies. An observational case- or cohort-based study of antiviral innate immunity may support this theoretical hypothesis but is not appropriate for clinical practice or treatment. RCTs are the gold standard for epidemiological studies and occupy a greater role in the hierarchy of evidence., (© 2025. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: To our knowledge, no agreed-upon best practices exist for joining U.S. Census ZIP Code Tabulation Areas (ZCTAs) and U.S. Postal Service ZIP Codes (ZIPs). One-to-one linkage using 5-digit ZCTA identifiers excludes ZIPs without direct matches. "Crosswalk" linkage may match a ZCTA to multiple ZIPs, avoiding losses., Methods: We compared noncrosswalk and crosswalk linkages nationally and for mortality and health insurance in California. To elucidate selection implications, generalized additive models related sociodemographics to whether ZCTAs contained nonmatching ZIPs., Results: Nationwide, 15% of ZCTAs had nonmatching ZIPs, i.e., ZIPs dropped under noncrosswalk linkage. ZCTAs with nonmatching ZIPs were positively associated with metropolitan core location, lower socioeconomics, and non-White population. In California, 34% of ZIPs in the mortality and 25% in the health insurance data had ZCTAs with nonmatching ZIPs; however, these ZIPs constitute only 0.03% of total mortality and 0.44% of total insurance enrollees., Conclusions: Our study findings support the use of crosswalk linkages and ZCTAs as a unit of analysis. One-to-one linkage may cause bias by differentially excluding ZIPs with more disadvantaged populations, although affected population sizes seem small., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objective: Randomized clinical trials (RCTs) provide the most reliable estimates of treatment effectiveness for therapeutic interventions. However, flaws in their design and conduct may bias treatment effect estimates, leading to overestimation or underestimation of the true intervention effect. This is especially relevant for complex interventions, such as those in rehabilitation, which are multifaceted and tailored for individual patients or providers, leading to variations in delivery and treatment effects. To assess whether poor intervention fidelity, the faithfulness of the intervention delivered in an RCT to what was intended in the trial protocol, influences (biases) estimates of treatment effects derived from meta-analysis of rehabilitation RCTs., Methods: In this metaepidemiological study of 19 meta-analyses and 204 RCTs published between 2010 and 2020, we evaluated the difference in intervention effects between RCTs in which intervention fidelity was monitored and those in which it was absent. We also conducted random-effects metaregression to measure associations between intervention fidelity, risk of bias, study sample size, and treatment effect estimates., Results: There was a linear relationship between fidelity and treatment effect sizes across RCTs, even after adjusting for risk of bias and study sample size. Higher degrees of fidelity were associated with smaller but more precise treatment effect estimates (d = -0.23 95% CI: -0.38, -0.74). Lower or absent fidelity was associated with larger, less precise estimates. Adjusting for fidelity reduced pooled treatment effect estimates in 4 meta-analyses from moderate to small or from small to no negligible or no effect, highlighting how poor fidelity can bias meta-analyses' results., Conclusion: Poor or absent intervention fidelity in RCTs may lead to overestimation of observed treatment effects, skewing the conclusions from individuals studies and systematic reviews with meta-analyses when pooled. Caution is needed when interpreting the results of complex intervention RCTs when fidelity is not monitored or is monitored but not reported., Plain Language Summary: Patients, the public, and health-care providers rely on clinical trials for information about how effective treatments are when making decisions about health care. However, the way that clinical trials are conducted may alter the evidence that clinical trials provide about how effective interventions truly are. In this study, we investigated whether how closely health-care providers monitor how they deliver rehabilitation treatments to patients in clinical studies, and how closely those treatments match the treatment that the researchers had planned, influences the results of those studies. We found that when researchers or health-care providers don't closely monitor how they deliver treatments during a study, those studies may provide exaggerated estimates of the effectiveness of the treatments studies. This is important, because it may mean that some health-care providers and patients may opt for treatments that are less effective than they appeared in clinical studies, or may overlook treatments that are more effective than they appeared in other studies., Competing Interests: Declaration of competing interest D.N. reports a relationship with University of Oxford that includes employment. P.M.C reports a relationship with University of Oxford that includes employment. D.B. reports a relationship with University of Oxford that includes employment. A.P. reports a relationship with Northeastern University that includes employment., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Epidemiological studies show a high prevalence of "insomnia" in adolescents. However, insomnia symptoms are not specific for insomnia disorder. Puberty is associated with circadian delay, which may cause insomnia symptoms such as problems falling asleep and daytime impairments, but also difficulties rising in the morning which is not a hallmark of insomnia disorder. The aim of this study was to investigate the extent to which adolescent insomnia symptoms may be attributed to circadian delay. The sample comprised 3,867 high-school-students. Survey instruments included the Bergen Insomnia Scale (BIS), the Munich ChronoType Questionnaire (MCTQ), the reduced Morningness-Eveningness Questionnaire (r-MEQ), and items on subjective sleep problems and sleep-related behaviors. Symptoms of circadian delay (CD) were defined as i) trouble waking on school days, ii) ability to sleep long into the day, iii) waking ≥10:00 on free days and/or iv) oversleeping for school. A total of 34.5% reported insomnia according to BIS. Among these, 88.4% reported ≥1 CD-symptom and 15.5% reported all CD-symptoms. Adolescents with insomnia and ≥1 CD-symptom were often evening-types (56.9%), had long social jetlag (2:55 h) and large school-/free day discrepancy in sleep duration (6:04 vs. 8:34 h). Results suggest circadian delay as a plausible explanation for insomnia symptoms in many adolescents.

Coded health care data from patients' health records are used in epidemiological research, especially on incidence or prevalence of disease; for drug safety monitoring or long-term cohort tracking; and to inform policy making. This article briefly summarizes the evolution of internationally recognized coding ontologies and nomenclature and describes applications of coded electronic health record (EHR) data in day-to-day health care operations, research, auditing, and policy development. This article also illuminates how errors can occur when EHR information is coded, considers errors' consequences, and suggests strategies for mitigating errors and improving overall use of coded EHR data., (Copyright 2025 American Medical Association. All Rights Reserved.)

BackgroundCervical cancer is the most common cancer threatening women's health that calls for strengthened dynamic monitoring and early warning.ObjectiveTo perform a spatiotemporal analysis of cervical cancer prevalence in Guangdong from 2015 to 2019, providing a decision-making basis for relevant government departments to take targeted prevention and treatment measures for cervical cancer.MethodsIn May 2021, data of 5-year (2015—2019) cervical cancer prevalence in 20-64-year-old female Guangdongers living in Guangdong's 21 cities were collected for analysis at the provincial and municipal levels. Average annual growth rate for descriptive analysis. ArcGIS 10.6 was used for spatial visualization, spatial autocorrelation analysis and hot spot analysis (Getis-Ord Gi) .ResultsDuring 2015—2019, cervical cancer prevalence in Guangdong declined from 50.28/100 000 to 49.84/100 000. The highest average annual growth rate of cervical cancer prevalence was in Meizhou (76.05%), and the lowest was in Chaozhou (-52.81%). In 2019, Jieyang (210.40/100 000) was found to have the highest cervical cancer prevalence, followed by Maoming (127.34/100 000) and Yangjiang (108.05/100 000). In 2018, global spatial correlation (Global Moran's I value=0.364, P

INTRODUCTION: Ophidism is a neglected public health problem in many tropical countries. In Brazil, about 27,000 snakebites are recorded per year. The objective of this study is to describe the epidemiological profile of snakebite in Minas Gerais, Brazil, mapping risk areas, and correlating the incidence of accidents with urbanization and agricultural work. METHODS: Ecological study that analised the 853 municipalities of Minas Gerais (2007-2019), using data from Notifiable Diseases Information System: municipality of occurrence, age, sex, education, race, time to care, snake, severity, clinical evolution. The degree of municipal urbanization and the percentage of agricultural workers were obtained on IBGE. We assessed and mapped risk areas for snakebite in the state. RESULTS: The 41,725 reported cases affected mostly men (75.1%), young (40.5%), and brown (43.97%). The high-risk regions were Leste do Sul, Leste, Vale do Aço, and Nordeste. The incidence of snakebites was negatively correlated with level of urbanization (r=-0.22/p

Findings of observational studies that investigated the relationship between vitamin D deficiency and abnormal glucose homeostasis were contradictory. This meta-analysis of epidemiologic studies evaluated the association of vitamin D status and risk of type-2 diabetes (T2D) and prediabetes in adults. A systematic search was conducted on all published articles in five electronic databases (including MEDLINE/PubMed, EMBASE, Institute for Scientific Information, Scopus and Google scholar), up to August 2020. Twenty-eight prospective cohort and nested case-control studies and 83 cross-sectional and case-control investigations that reported relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for abnormal glucose homeostasis in relation to serum vitamin D levels in adults were included in the analysis. In prospective studies, high versus low level of vitamin D was respectively associated with significant 35%, 30% and 51% decrease in risk of T2D (RR:0.65; 95%CI: 0.55–0.76; 27 effect sizes), combined T2D and pre-diabetes (RR:0.70; 95%CI: 0.52–0.95; 9 effect sizes) and pre-diabetes (RR:0.49; 95%CI: 0.26–0.93; 2 effect sizes). These inverse associations were significant in almost all subgroups. Dose–response analysis in prospective studies showed that each 10 ng/ml increase in serum vitamin D levels resulted in 12% and 11% reduced risk of T2D (RR:0.88; 95%CI: 0.83–0.94) and combined T2D and prediabetes (RR:0.89; 95%CI: 0.87–0.92), respectively. In cross-sectional and case-control studies, highest versus lowest level of serum vitamin D was linked to reduced odds of T2D (OR:0.64; 95%CI: 0.57–0.72; 42 effect sizes) and combined T2D and pre-diabetes (OR:0.79; 95%CI: 0.74–0.85; 59 effect sizes); but not pre-diabetes (OR:0.64; 95%CI: 0.17–2.37; 11 effect sizes). This meta-analysis of epidemiologic studies disclosed that serum vitamin D level was reversely associated with the risk of T2D and combined T2D and prediabetes in adults, in a dose–response manner. However, the association was not remarkable for pre-diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The characteristics that predict the onset of psoriatic arthritis (PsA) among patients with psoriasis (PsO) may inform diagnosis and treatment.Objective: To develop a model to predict the 2-year risk of developing PsA among patients with PsO.Methods: This was a prospective cohort study of patients in the CorEvitas Psoriasis Registry without PsA at enrollment and with 24-month follow-up. Unregularized and regularized logistic regression models were developed and tested using descriptive variables to predict dermatologist-identified PsA at 24 months. Model performance was compared using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.Results: A total of 1489 patients were included. Nine unique predictive models were developed and tested. The optimal model, including Psoriasis Epidemiology Screening Tool (PEST), body mass index (BMI), modified Rheumatic Disease Comorbidity Index, work status, alcohol use, and patient-reported fatigue, predicted the onset of PsA within 24 months (AUC = 68.9%, sensitivity = 82.9%, specificity = 48.8%). A parsimonious model including PEST and BMI had similar performance (AUC = 68.8%; sensitivity = 92.7%, specificity = 36.5%).Limitations: PsA misclassification bias by dermatologists.Conclusion: PEST and BMI were important factors in predicting the development of PsA in patients with PsO over 2 years and thereby foundational for future PsA risk model development. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The merit of using baseline cognitive assessments in mid-life to help interpret cross-sectional cognitive tests scores in later life is uncertain.Objective: Evaluate how accuracy for diagnosing dementia is enhanced by comparing cross-sectional results to a midlife measure.Methods: Cohort study of 2,512 men with repeated measures of Mini-Mental State Examination (MMSE) over approximately 10 years. Index test MMSE at threshold of 24 indicating normal, as a cross-sectional measure and in combination with decline in MMSE score from mid-life. Reference standard consensus clinical diagnosis of dementia by two clinicians according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).Results: 1,150 men participated at phase 4 of whom 75 had dementia. A cross-sectional MMSE alone produced a sensitivity of 60% (50% to 70%) and specificity 95% (94% to 97%) with a threshold of≥24 points indicating normal. For lower-scoring men in late life, with cross sectional scores of < 22, combining cross-sectional AND a three-point or more decline over time had a sensitivity of 52% (39% to 64%) and specificity 99% (99% to 100%). For higher-scoring men in later life, with cross sectional scores < 26 combining cross-sectional OR decline of at least three points had a sensitivity of 98% (92% to 100%) and specificity 38% (32% to 44%).Conclusion: It may be helpful in practice to formally evaluate cognition in mid-life as a baseline to compare with if problems develop in future, as this may enhance diagnostic accuracy and classification of people in later life. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated unspecified or idiopathic pain associated with COIVD-19. This study aimed to provide the incidence rates of unspecified pain and idiopathic pain in patients with COVID-19 for 90 days after COVID-19 diagnosis. Methods: A propensity score matched cohort was used, including all patients with COVID-19 in South Korea, and analyzed their electronic medical records. The control group consisted of those who had not had tests for COVID-19 at all. Unspecified pain diagnoses consisted of diagnoses related to pain included in the ICD-10 Chapter XVIII. Idiopathic pain disorders included fibromyalgia, temporomandibular joint disorders, headaches, chronic prostatitis, complex regional pain syndrome, atypical facial pain, irritable bowel syndrome, and interstitial cystitis. Results: After matching, the number of participants in each group was 7,911. For most unspecified pain, the incidences were higher in the COVID-19 group (11.7%; 95% confidence interval [CI], 11.0-12.5) than in the control group (6.5%; 95% CI, 6.0-7.1). For idiopathic pain, only the headaches had a significantly higher incidence in the COVID-19 group (6.6%; 95% CI, 6.1-7.2) than in the control group (3.7%; 95% CI, 3.3-4.1). However, using a different control group that included only patients who visited a hospital at least once for any reasons, the incidences of most unspecified and idiopathic pain were higher in the control group than in the COVID-19 group. Conclusions: Patients with COVID-19 might be at a higher risk of experiencing unspecified pain in the acute phase or after recovery compared with individuals who had not had tests for COVID-19. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the prevalence of mild cognitive impairment (MCI) among the elderly in rural communities in Hangzhou, Zhejiang, and to explore the screening accuracy of Screening Scale for Mild Cognitive Impairment (sMCI) in the elderly with low education. Methods From April 2010 to September 2010, 360 elderly people in Sijiqing street, Jianggan district (now Shangcheng district), Hangzhou, Zhejiang were recruited. Dementia and MCI were judged by Mini⁃Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), sMCI and Clinical Dementia Rating Scale (CDR). Draw receiver operating characteristic (ROC) curve and calculate the area under the curve (AUC), and compare the accuracy of sMCI, MoCA and CDR scores in screening MCI. Results Finally, 171 cases completed all investigations. 1) 55 cases (32.16%) were diagnosed as MCI, including 25 cases (14.62%) of amnestic MCI (aMCI) and 30 cases of non⁃aMCI, 11 cases (6.43%) of dementia, 10 cases (5.85%) of depression, 4 cases (2.34%) of anxiety disorder, one case (0.58%) of bipolar disorder, one case (0.58%) of schizophrenia and one case (0.58%) of mental retardation. Among 154 patients with cognitive impairment, 25 cases (16.23%) were screened for dementia by MMSE, 8 cases (5.19%) were screened for dementia by CDR, and 11 cases (7.14%) were clinically confirmed; 138 cases (89.61%) of MCI were screened by MoCA, 117 cases (75.97%) by sMCI, 70 cases (45.45%) by CDR, and 55 cases (32.16%) were clinically confirmed. 2) Taking clinical diagnosis as reference standard, the ROC curve showed CDR score had the highest accuracy in screening MCI, and the AUC was 0.90 ± 0.03 (95%CI: 0.844-0.957, P=0.000); the AUC of MoCA score was 0.53 ± 0.05 (95%CI: 0.430-0.621, P=0.603); when the cut⁃off value of sMCI score was 23, the AUC was 1.00 ± 0.00 (95%CI: 1.000-1.000, P=0.000). The cut⁃off value of subjects with education level of 0-3 years was adjusted to 22, and the AUC was 0.67 ± 0.05 (95%CI: 0.578-0.756, P=0.001). 3) According to education level, they were divided into 0-3 years group (113 cases) and 4-6 years group (47 cases). Taking CDR score as the reference standard, ROC curve showed the AUC of MoCA score in screening MCI in 4-6 years group was 0.49 ± 0.17 (95%CI: 0.157-0.824, P=0.955), the cut⁃off value of sMCI score was 23, the AUC of sMCI score was 0.50 ± 0.17 (95%CI: 0.161-0.839, P=1.000); the AUC of MoCA score in the 0-3 years group was 0.51 ± 0.06 (95%CI: 0.402-0.617, P=0.858), and the cut⁃off value of sMCI score was adjusted to 22, and the AUC was 0.64 ± 0.05 (95%CI: 0.535-0.744, P=0.011). Conclusions It is more common for the elderly in the rural communities with low education to have MCI, the accuracy of sMCI in screening MCI is higher than MoCA, and the cut⁃off value is 23 (education level 4-6 years) and 22 (education level 0-3 years), which is worthy of clinical application.

Abstract 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

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.

Individuals with cancer are vulnerable to infection with SARS-CoV-2, the virus causing COVID-19. Physical distancing, the reallocation of health care resources, and the implementation of procedures to reduce the spread of COVID-19 may also have serious consequences for people with cancer. We evaluated the impact of COVID-19 on new cancer diagnoses and oncology care in Manitoba, Canada using an interrupted time series design and data from the Manitoba Cancer Registry and CancerCare Manitoba’s (CCMB) electronic medical record. In April 2020, there was a 23% decrease in new cancer diagnoses, a 21% decrease in pathology reports, and a 43% reduction in surgical resections. There was no difference in new cancer diagnoses by August 2020, surgery by July 2020, and pathology reports by September 2020. From April 2020 to June 2021, there was a 13% decrease in radiotherapy (RT) fractions, an 18% decrease in UCC visits, and a 52% decrease in in-person visits. There was no change in intravenous chemotherapy visits per month, first RT visits, or overall patient visits. The impact of COVID-19 on shifts in the stage at diagnosis and survival will be assessed in future analyses.

Background  Brachial plexus injuries (BPI) cause severe physical disability and major psycho-socioeconomic burden. Although various countries have reported BPI incidence, the data from Indonesia as the fourth most populated country in the world remains unknown. We aim to assess the distribution of traumatic BPI, patients' characteristics, and treatment modalities in Indonesia. Methods  A retrospective investigation was performed comprising 491 BPI patients at a tertiary referral hospital in Indonesia from January 2003 to October 2019. Demographic and outcomes data were retrieved from medical records. Results  The average BPI patients' age was 27.3 ± 11.6 years old, with a male/female ratio of 4.6:1. Motorcycle accidents caused the majority (76.1%) of all BPI cases. Concomitant injuries were present in 62.3% of patients, dominated by fractures (57.1%) and brain injuries (25.4%). BPI lesion type was classified into complete (C5-T1, observed in 70% patients), upper (C5-C6, in 15% patients), extended upper (C5-C7, in 14% patients), and lower type (C8-T1, in 1% patients). The average time to surgery was 16.8 months (range 1–120 months), with the majority (76.6%) of the patients was operated on six months after the trauma. Free functional muscle transfer (FFMT) was the most common procedure performed (37%). We also analyzed the functional outcomes (active range of motion (AROM) and muscle power), DASH (Disabilities of the Arm, Shoulder, and Hand) score, and VAS (Visual Analogue Scale) across four most frequent procedures involving nerve reconstruction (FFMT, nerve transfer, external neurolysis, and nerve grafting). We found that FFMT was significantly better than nerve transfer in terms of DASH score and VAS (p  = 0.000 and p  = 0.016, respectively) in complete BPI (C5-T1). Moreover, we also found that nerve grafting resulted in a significantly better shoulder abduction AROM than nerve transfer and external neurolysis in extended upper BPI (C5-C7) (p  = 0.033 and p  = 0.033, respectively). Interestingly, no significant differences were observed in other measurements. Conclusion  This study provides an overview of traumatic BPI patients in a single tertiary trauma center in Indonesia, expressing the profile of their characteristics and functional outcomes after surgical procedures. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Previous studies involving injury surveillance in badminton players have used nonstandardized injury definitions and data collection methodologies. The purpose of this study was to apply a Delphi method to (1) reach a consensus on an injury definition in badminton and (2) develop a standardized badminton injury report form. An Injury Consensus Group was established under the auspices of the Badminton World Federation, and initial injury definitions and injury report form were developed. An internal panel was formed from the Injury Consensus Group, and an external panel was selected based on a combination of profession, experience in the field, sport-specific knowledge/expertise, and geographical location to obtain a widely representative sample. Through 2 rounds of voting by the external panel, consensus was reached on both the definition of an injury in badminton and a standardized injury report form. The agreed injury definition was "Any physical injury sustained by a player during a match or training regardless if further diagnostic tests were done or if playing time was lost" and the injury report form contained the following 7 sections: Injury record, Diagnosis, Injury mechanism, Regarding pain, Pain and return to play/training after injury, Grade of severity, and Recurrence. We recommend the use of the definitions and methods presented in this consensus statement for the reporting of injury in all international and domestic badminton players. This should make future injury surveillance reports directly comparable and hence more informative in recognizing trends over time and differences between countries. [ABSTRACT FROM AUTHOR]

We aimed to estimate the household secondary infection attack rate (hSAR) of SARS‐CoV‐2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta‐analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity‐aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta‐analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta‐analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%–71%; I2 = 99.7%); I2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence‐based pandemic preparedness and response efforts for SARS‐CoV‐2, influenza and future novel respiratory viruses. [ABSTRACT FROM AUTHOR]