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Background: Adult-led organized settings for children (eg, classrooms) provide opportunities for physical activity (PA). The structure of setting time may influence inequalities (ie, unequalness) in the distribution of PA. This study examined differences in PA inequality by setting and time-segment purpose in time-segmented organized group settings for children. Methods: PA and setting meetings were assessed using accelerometer and video observation data from school, before-/after-school, and youth club groups (n = 30) for third- through sixth-grade children (n = 699) in 2 rural US communities. Meetings (n = 130) were time-segmented into smaller units (sessions; n = 835). Each session was assigned a purpose code (eg, PA). Accelerometer data were paired with the meetings and sessions, and the Gini coefficient quantified inequality in activity counts and moderate to vigorous PA minutes for each segment. Beta generalized estimating equations examined differences in PA inequality by setting and session purpose. Results: Activity count inequality was lowest (P <.05) during youth club meetings (Gini = 0.17, 95% CI, 0.14–0.20), and inequality in moderate to vigorous PA minutes was greatest (P <.01) during school (Gini = 0.34, 95% CI, 0.30–0.38). Organized PA sessions (Gini = 0.20, 95% CI, 0.17–0.23) had lower activity count inequality (P <.0001) than academic (Gini = 0.30, 95% CI, 0.27–0.34), enrichment (Gini = 0.31, 95% CI, 0.27–0.36), and nonactive recreation (Gini = 0.30, 95% CI, 0.25–0.34) sessions. Inequality in moderate to vigorous PA minutes was lower (P <.05) in organized PA (Gini = 0.26, 95% CI, 0.20–0.32) and free play (Gini = 0.28, 95% CI, 0.19–0.39) than other sessions. Conclusions: PA inequality differed by setting time structure, with lower inequality during organized PA sessions. The Gini coefficient can illuminate PA inequalities in organized settings and may inform population PA improvement efforts in rural communities. [ABSTRACT FROM AUTHOR]

Background: Walking activity has been associated with reduction in the development of chronic disease, cognitive and physical function impairment, disability, and mortality. The objective of this study was to examine the relationship between walking activity and physical function over 9 years of follow-up among Mexican Americans aged 78 years and older. Methods: Participants (N = 998) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2007–2016). Measures included walking activity duration and frequency, socio-demographics, body mass index, medical conditions, pain, depressive symptoms, limitation in activities of daily living, and the Mini-Mental State Examination. Low physical function was defined as scoring <7 on the Short Physical Performance Battery. At baseline, participants were grouped into nonwalkers (n = 653), walked <150 minutes/week (n = 144), and walked 150 minutes/week or more (n = 201). A Generalized Estimating Equation model was used to estimate the odds ratio and 95% CI of low physical performance as a function of walking activity status. Results: Compared with nonwalkers, participants walking < 150 minutes/week had lower odds (odds ratio = 0.66, 95% CI, 0.51–0.86) of low physical function over time, after controlling for all covariates, as did those walking ≥ 150 minutes/week (odds ratio = 0.54, 95% CI, 0.41–0.71). Conclusions: Mexican American older adults who engage in any walking activity are at reduced risk of low physical function, even those with disability. Interventions at the individual and community level are recommended to reduce physical function impairment, even in those with preexisting medical conditions or disability. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of converting a conventional mandibular denture (CMD) into a single-implant mandibular overdenture (SIMO). Materials and Methods: Edentulous patients received a new CMD and were randomly assigned to the CMD or SIMO group. For SIMO patients, a midline early-loaded implant was inserted and incorporated into the CMD after 3 weeks. Patient satisfaction and oral health--related quality of life were assessed at baseline and up to 1 year. Regression models were constructed using Generalized Estimating Equation (GEE). Results: After 12 months, 32 patients were assessed (CMD: n = 17; SIMO: n = 15). Significant improvement was observed for the SIMO group compared to baseline measures. Conclusions: SIMO may be considered an effective alternative for patients unsatisfied with their CMDs. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Does an association exist between diminished ovarian reserve (DOR) and embryonic aneuploidy risk in young women of reproductive age?This retrospective cohort study included 854 participants treated in the Department of Reproductive Medicine, Women's Hospital of Nanjing Medicine University, Nanjing Maternity and Child Health Care Hospital, from May 2016 to September 2023 for a total of 894 cycles. The relationship between ovarian reserve and embryonic euploidy was evaluated using statistical methods such as generalized estimating equation (GEE) and propensity score matching (PSM).Despite the higher number of biopsied blastocysts in women with normal ovarian reserve, no significant difference in embryonic aneuploidy rates was observed between DOR women and the control group. In addition, there were no significant disparities observed in the rates of metaphase II (MII) oocytes, normal fertilization, transferable embryos, blastocyst formation, and high‐scoring blastocysts between the DOR and control groups after PSM.This study showed that DOR had no significant effect on the incidence of aneuploidy in embryos. Young women informed about DOR should be relatively confident about the quality of their eggs and the euploidy status of their embryos before conventional assisted reproduction, thereby mitigating concern regarding adverse maternal outcomes due to aneuploidy. [ABSTRACT FROM AUTHOR]

Difficulties may arise when analyzing longitudinal data using mixed-effects models if nonparametric functions are present in the linear predictor component. This study extends semiparametric mixed-effects modeling in cases when the response variable does not always follow a normal distribution and the nonparametric component is structured as an additive model. A novel approach is proposed to identify significant linear and non-linear components using a double-penalized generalized estimating equation with two penalty terms. Furthermore, the iterative approach intends to enhance the efficiency of estimating regression coefficients by incorporating the calculation of the working covariance matrix. The oracle properties of the resulting estimators are established under certain regularity conditions, where the dimensions of both the parametric and nonparametric components increase as the sample size grows. We perform numerical studies to demonstrate the efficacy of our proposal. [ABSTRACT FROM AUTHOR]

Super Skills for Life is a structured intervention rooted in cognitive-behavioral therapy and a transdiagnostic approach, aimed at preventing childhood emotional problems. Over the past decade, it has demonstrated positive outcomes in various formats and countries. This study evaluated the comparative effectiveness of two individual modalities: the computerized and the traditional version enriched with multimedia content, through a comparative randomized effectiveness trial. 109 children (55.24 % female) aged 8–12 years participated, randomly assigned to either the traditional (n = 54) or computerized (n = 51) groups. Pre- and post-intervention assessments involved emotional problem measures completed by children and parents. Both groups exhibited significant reductions in all outcomes according to parent reports, including depression, anxiety, and anxiety-related life interference. Children's self-reports indicated improvements across all general measures. Generalized Estimating Equations indicated marginally better improvements in the traditional group. Limitations included the absence of follow-up assessment, variability in participant regions across Spain, and input from other informants like teachers. This study pioneers the examination of short-term effects of the program in both a fully computerized format supervised by a specialized therapist and an enriched traditional individual format, and the promising results suggest their potential for indicated prevention of childhood emotional problems. • First study to evaluate short-term effects of fully computerized Super Skills intervention supervised by therapists. • Results show the fully computerized Super Skills format is as effective as the traditional one-to-one version. • Streamlined materials and shorter application times enhance cost-effectiveness of computerized format. • Promising results suggest transdiagnostic CBT interventions as effective tools for preventing children's emotional problems. [ABSTRACT FROM AUTHOR]

Background: The generalized estimating equation (GEE) method is widely used for analyzing longitudinal and clustered data. Although the GEE estimate for regression coefficients and sandwich covariance estimate are consistent regardless of the choice of covariance structure, they are generally biased for small sample sizes. Various researchers have proposed modified GEE methods and covariance estimators to handle small-sample bias. Results: We briefly present bias-corrected and penalized GEE methods, along with 11 bias-adjusted covariance estimators. In addition, we focus on analyzing longitudinal or clustered data with binary outcomes using the logit link function and introduce package geessbin in R to implement conventional and modified GEE methods with bias-adjusted covariance estimators. Finally, we illustrate the implementation and detail a usage example of the package. The package is available from the Comprehensive R Archive Network (CRAN) at https://cran.r-project.org/web/packages/geessbin/index.html. Conclusions: The geessbin package provides three GEE estimates with numerous covariance estimates. It is useful for analyzing correlated data such as longitudinal and clustered data. Additionally, the geessbin is designed to be user-friendly, making it accessible to non-statisticians. [ABSTRACT FROM AUTHOR]

The prevalence of AIDS and mortality rates among HIV-infected individuals in Guangxi remain relatively high, potentially due to impaired CD4 + cell recovery. This study aims to identify factors hindering CD4 + cell recovery in people living with HIV. We conducted a retrospective study on people living with HIV in Guangxi, China, with data collection extending to the end of 2023. CD4 + T cells were categorized into "immunological responders" and "non-responders" based on CD4 + cell recovery after treatment. Multivariate logistic regression was used to analyze factors associated with the development of immunological non-responders. Recovery of CD4 + T lymphocytes was assessed using the Generalized Additive Mixed Model (GAMM) and Generalized Estimating Equations (GEE). Additionally, multivariate Cox regression identified factors influencing survival rates. Our findings indicated a 52.44% incidence of immunological non-responders after two years of treatment. Factors such as age, sex, education, occupation, infection route, pre-treatment CD4 + T cell count, HIV subtype, and treatment regimen were linked to immunological non-response. Specifically, male gender, education up to high school, farming occupation, heterosexual transmission, CRF01_AE subtype, pre-treatment CD4 + T cell count < 200/µL, and the 3TC + EFV + TDF regimen were identified as significant risk factors. Statistically significant differences in CD4 + T lymphocyte recovery rates were observed among different HIV subtypes (P < 0.05). Beyond age, sex, ethnicity, occupation, subtype, and treatment regimen, being an immunological non-responder was found to be a risk factor for both mortality and accelerated disease progression. The study highlights the complexity of factors affecting CD4 + cell recovery post-HIV treatment in Guangxi and underscores the need for vigilant clinical monitoring of people living with HIV, particularly those with low pre-treatment CD4 + T cell levels. [ABSTRACT FROM AUTHOR]

Background: The geographic footprint of Lyme disease is expanding in the United States, which calls for novel methods to identify emerging endemic areas. The ubiquity of internet use coupled with the dominance of Google's search engine makes Google user search data a compelling data source for epidemiological research. Objective: We evaluated the potential of Google Health Trends to track spatiotemporal patterns in Lyme disease and identify the leading edge of disease risk in the United States. Materials and methods: We analyzed internet search rates for Lyme disease-related queries at the designated market area (DMA) level (n = 206) for the 2011–2019 and 2020–2021 (COVID-19 pandemic) periods. We used maps and other exploratory methods to characterize changes in search behavior. To assess statistical correlation between searches and Lyme disease cases reported to Centers for Disease Control and Prevention (CDC) between 2011 and 2019, we performed a longitudinal ecological analysis with modified Poisson generalized estimating equation regression models. Results: Mapping DMA-level changes in "Lyme disease" search rates revealed an expanding area of higher rates occurring along the edges of the northeastern focus of Lyme disease. Bivariate maps comparing search rates and CDC-reported incidence rates also showed a stronger than expected signal from Google Health Trends in some high-risk adjacent states such as Michigan, North Carolina, and Ohio, which may be further indication of a geographic leading edge of Lyme disease that is not fully apparent from routine surveillance. Searches for "Lyme disease" were a significant predictor of CDC-reported disease incidence. Each 100-unit increase in the search rate was significantly associated with a 10% increase in incidence rates (RR = 1.10, 95% CI: 1.07, 1.12) after adjusting for environmental covariates of Lyme disease identified in the literature. Conclusion: Google Health Trends data may help track the expansion of Lyme disease and inform the public and health care providers about emerging risks in their areas. [ABSTRACT FROM AUTHOR]

Aim: This pre-post intervention study aimed to assess the relationship between baseline dietary quality and the efficacy of a dietitian-guided weight reduction program, which has not been thoroughly documented to date. Methods: Ninety-two consecutive obese or overweight patients visiting a tertiary center clinic for weight reduction were enrolled in this study. Participants received a dietitian-guided weight reduction education program aimed at reducing daily caloric intake by 500 kcal and improving adherence to the Mediterranean diet for 3 months. Baseline dietary quality was assessed using the 14-item Taiwanese Mediterranean Diet Adherence Screener (T-MEDAS), where a higher T-MEDAS score reflects greater adherence to the Mediterranean diet. Additional covariates, including dietary behaviors, lifestyle factors, and comorbidities were also recorded. The primary outcome was the percentage of weight reduction at 3 months, analyzed using restricted cubic spline models and generalized estimating equations (GEE) to account for the correlation between weight change and the baseline T-MEDAS scores. Results: Thirty-nine participants were excluded due to major illnesses, use of anti-obesity medications, or loss to follow-up. Among the remaining 53 participants (mean age 41.2 ± 12.8 years, 56.6% female), the average weight reduction was 3.9 ± 3.3% from a baseline weight of 98.5 ± 12.8 kg. Participants who did not achieve a weight reduction of more than 5% had higher baseline T-MEDAS scores compared to those who did (5.4 ± 1.7 vs. 4.1 ± 1.8, p = 0.026). A restricted cubic spline model, adjusted for covariates including age, gender, diabetes mellitus (DM), dyslipidemia, and smoking, revealed a significant inverse relationship between higher baseline T-MEDAS scores and weight loss. After controlling for various confounders, GEE analysis demonstrated that higher baseline T-MEDAS scores were significantly associated with less weight loss (beta: -4.1, 95% CI: -5.6 to -2.6, p < 0.001). Conclusions: Higher baseline dietary quality was associated with reduced effectiveness of a dietitian-guided weight reduction program. This suggests that additional strategies may be required to improve the success of weight loss interventions in individuals with higher baseline dietary quality. [ABSTRACT FROM AUTHOR]

Purpose: To analyze and compare the physiological responses of women during singles and doubles beach tennis sessions. Methods: In this crossover trial, twenty-two women with previous participation in amateur beach tennis tournaments randomly performed two experimental sessions: singles and doubles beach tennis. The routine for both sessions consisted of 10-min of seated rest, followed by 45-min of beach tennis and 30-min of post-exercise recovery. Participants were matched against opponents of the same competition level, defined according to their local beach tennis ranking (advanced or intermediate level). They warmed up with basic techniques for 5-min and played 3 matches lasting 12-min, interspersed with 2-min recovery intervals. Heart rate (HR), energy expenditure (EE), number of steps (STEPS), handgrip strength (HS), rating of perceived exertion (RPE), and enjoyment were assessed throughout the sessions. Generalized estimating equations were employed to examine the main effects between experimental sessions over the time and in relation to competition level. Results: HRmean and HRmax (Δ: HRmean = 13 ± 3 bpm; HRmax = 11 ± 3 bpm) as well as EE and Steps (Δ: EE = 66 ± 22 kcal; RPE = 2 ± 0 A.U.; Steps = 250 ± 52 A.U.) were higher in singles than doubles (p < 0.05). The percentage of total time spent in the highest HR zone (91–100%HRmax) was significantly greater in singles than in doubles (39% ± 22% vs. 15% ± 18%; p < 0.05). Differences were found in the percentage of total time spent in each HR zone, recovery HR, and HS between competition levels (p < 0.05). Conclusion: Singles beach tennis resulted in higher physiological demands than doubles in women, and players' competition level partly affects the training responses. [ABSTRACT FROM AUTHOR]

Objective: Frontotemporal dementia (FTD) is a progressive neurodegenerative disorder that affects the frontal and temporal lobes of the brain, leading to cognitive decline and personality changes. The objective of this cross-sectional study was to characterize angioarchitectural changes in the retina and choroid of individuals with FTD compared to cognitively normal controls using optical coherence tomography (OCT) and OCT angiography (OCTA). Methods: Cross-sectional comparison of patients with FTD and controls with normal cognition. All participants underwent Mini-Mental State Examination (MMSE) at the time of imaging. Outcome measures included OCT parameters: retinal nerve fiber layer (RNFL) thickness, ganglion cell layer-inner plexiform layer (GC-IPL) thickness, central subfield thickness (CST), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI); and OCTA superficial capillary plexus parameters: foveal avascular zone (FAZ) area, 3x3mm and 6x6mm macular perfusion density (PD) and vessel density (VD), 4.5x4.5mm peripapillary capillary perfusion density (CPD) and capillary flux index (CFI). Generalized estimating equation analysis was used to account for the inclusion of 2 eyes from the same participant. Results: 29 eyes of 19 patients with FTD and 85 eyes of 48 controls were analyzed. In FTD, 3x3mm macular PD (p = 0.02) and VD (p = 0.02) and CFI (p = 0.01) were reduced compared to controls. There was no difference in average 4.5x4.5mm CPD, RNFL thickness, GC-IPL thickness, CST, SFCT, CVI, FAZ, or 6x6mm VD or PD between FTD and controls (all p > 0.05); however, there was a trend toward lower macular 6x6mm PD and VD in patients with FTD. Conclusion: Decline of peripapillary and macular OCT and OCTA parameters merit further investigation as potential biomarkers for FTD detection. Noninvasive retinal and choroidal imaging may hold promise for earlier detection, and future longitudinal studies will clarify their role in monitoring of FTD. [ABSTRACT FROM AUTHOR]

Many clinical trials involve partially clustered data, where some observations belong to a cluster and others can be considered independent. For example, neonatal trials may include infants from single or multiple births. Sample size and analysis methods for these trials have received limited attention. A simulation study was conducted to (1) assess whether existing power formulas based on generalized estimating equations (GEEs) provide an adequate approximation to the power achieved by mixed effects models, and (2) compare the performance of mixed models vs GEEs in estimating the effect of treatment on a continuous outcome. We considered clusters that exist prior to randomization with a maximum cluster size of 2, three methods of randomizing the clustered observations, and simulated datasets with uninformative cluster size and the sample size required to achieve 80% power according to GEE‐based formulas with an independence or exchangeable working correlation structure. The empirical power of the mixed model approach was close to the nominal level when sample size was calculated using the exchangeable GEE formula, but was often too high when the sample size was based on the independence GEE formula. The independence GEE always converged and performed well in all scenarios. Performance of the exchangeable GEE and mixed model was also acceptable under cluster randomization, though under‐coverage and inflated type I error rates could occur with other methods of randomization. Analysis of partially clustered trials using GEEs with an independence working correlation structure may be preferred to avoid the limitations of mixed models and exchangeable GEEs. [ABSTRACT FROM AUTHOR]

Background and objectives: Preterm birth (PTB) affects ~10% of births worldwide; however, most literature focused on short-term clinical outcomes, with much less focus on long-term socioeconomic outcomes after PTB. We examined associations between PTB and individuals' income, employment, and educational outcomes during early adulthood. Methods: We conducted a population-level matched cohort study including all live births in Canada between 1990 and 1996, followed until 2018. Outcomes included Employment income per year in 2018 CAD and employment between ages 18 and 28 years, postsecondary education enrollment (18–22 years), and maximum educational attainment at age 22–27 years. Mean differences and risk ratios (RR) and differences (RD) were estimated using generalized estimating equation regression models for economic outcomes and multinomial logistic regression models for educational outcomes. Results: Of 2.4 million births, 7% were born preterm (0.3%, 0.6%, 0.8%, and 5.4% born extremely preterm (24–27 weeks), very preterm (28–31 weeks), moderately preterm (32–33 weeks), and late preterm (34–36 weeks) respectively). After matching on baseline characteristics (e.g., sex, province of birth, and parental demographics) and adjusting for age and period effects, preterm-born individuals, on average, had $958 CAD less employment income per year (95% CI: $854-$1062), 6% lower income per year, than term-born individuals, and were 2.13% less likely to be employed (1.98–2.29%). PTB was also negatively associated with university enrollment (RR 0.93 (0.91–0.94) and graduation with a university degree (RR 0.95 (0.94–0.97)). Mean income differences for those born 24–27 weeks were -$5,463 CAD per year (17% lower), and adjusted RR were 0.55 for university enrollment and graduation. Conclusion: In this population-based study, preterm birth was associated with lower economic and educational achievements at least until the late twenties. The associations were stronger with decreasing GA at birth. Policymakers, clinicians, and parents should be aware that the socioeconomic impact of PTB is not limited to the early neonatal period but extends into adulthood. [ABSTRACT FROM AUTHOR]

Background: The psychological well-being of medical students has often been studied in relation to various factors and typically exhibits poorer scores than comparable student groups. This diminished well-being can have far-reaching implications, like impact on career or academic engagement. While there are some studies on specialty choice or academic performance few studies have examined the effects of stress at the beginning of medical school on career ambitions and the associated interest in research. Given the anticipated future shortage of healthcare professionals and the goal of gender equality in higher positions, it is crucial to examine this relationship as early as medical education. The question arises whether medical education and the demands of studying influence the career ambitions of different student groups. Method: As part of a longitudinal survey, students from a medical cohort are surveyed over three consecutive years. A total of 297 students participated in the surveys, of which 66.4% were women. Stress experiences during medical school and career aspirations are assessed and analyzed using Generalized Estimating Equation (GEE) modeling. Results: The results indicate that early academic stress is a negative predictor of the career ambitions of medical students (B = 1.637; p = 0.009). Also, female students report lower career goals than male students (B = 1.168; p = 0.018). In addition, gender moderates the impact of stress on career ambitions (p = 0.046). Finally, stress levels are highest when starting the medical program (p = 0.022) and decrease over time. Discussion: Stress during the initial medical training impedes students to pursue higher career ambitions. Future research as well as medical programs need to elaborate more on and consider structural stress prevention interventions in order to promote well-being and strengthen also scientific career goals at an early stage, specifically for female students. [ABSTRACT FROM AUTHOR]

Background: Problem-solving interventions with workplace involvement (PSI-WPI) have been shown to reduce sick leave and increase return to work in an occupational health services context. However, many employees struggle with reduced work functioning, anxiety-, and depressive symptoms up to 12 months after a sick leave episode, and it is unclear if the intervention affects outcomes other than sick leave. The aim of this study is to investigate if a PSI-WPI added to care as usual (CAU) is superior to CAU with respect to self-reported sick leave, psychological symptoms, work ability, work performance, and health after RTW when provided in primary care. Methods: Employed individuals aged 18–59 years on sick leave (2 to 12 weeks) diagnosed by a physician at a primary care center with mild to moderate depression, anxiety, or adjustment disorder were enrolled in a two-armed cluster-randomised trial evaluating the effectiveness of a PSI-WPI. Multiple outcomes were recorded at baseline, six months, 12 months, and every fourth week during the study period. Outcomes were categorised into psychological symptoms, health, work ability, work performance, and self-reported sick leave. Data were analysed using MANOVA, GEE (Generalized Estimating Equations), and cox regression. Results: One hundred ninety-nine individuals responded to the invitation to participate; one participant withdrew, one was excluded as the employment ended, nine did not answer the baseline survey, and three were removed from the analysis due to missing data. The analysis included 81 subjects who received the intervention and 104 subjects who received the control. Baseline characteristics were similar across both groups. No differences between the groups were found among either variables except one. There was a significant difference between the groups in self-rated health (EQ5D) in favour of the CAU group from baseline to six-month follow-up, with a mean difference of -8.44 (-14.84, -2.04). Conclusions: A problem-solving intervention with workplace involvement added to CAU did not result in statistically significant reductions in outcomes. Further research is needed to understand why problem-solving interventions appear to have an effect on sick leave in an occupational health services context and not in a primary care context. Trial registration: NCT3346395, registration date 2017–11-17. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease pandemic has worsened psychological distress in people experiencing homelessness (PEH). This study evaluates the impact of learning the Bhagavad Gita versus engaging in Kuchipudi dance on reducing psychological distress in PEH in Chennai and Dhanbad, India. Methods and analysis: Participants will be allocated into Bhagavad Gita, Kuchipudi dance, Both interventions, or Control groups. The Kessler scale (K10) score, representing the primary outcome, will be measured at four time points: one day before intervention, one day after intervention completion, 40 days post-intervention, and 1 year post-intervention. The K10 scores will be analyzed using the Generalized Estimating Equation framework. Additionally, subgroup analysis based on participant demographics (e.g., age, education, religion, employment) will be conducted to explore potential differential effects using analysis of covariance. Statistical significance will be determined at p < 0.05 (two-tailed). Dissemination: After study completion, findings will be shared at conferences, in peer-reviewed journals, and with stakeholders and community groups. Authorship will be granted to contributing researchers, with acknowledgment for others. The dataset will be publicly available upon publication. Efforts will be made to communicate results through infographics, plain language summaries, and tailored strategies, including community meetings and digital platforms, to engage and empower PEH in decision-making. Trial registration: The trial has been registered with the Clinical Trials Registry of India (registration number: CTRI/2022/12/048416). [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo analyze the clinical and economic consequences of the progression to castration-resistant status for patients with metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC) in South Korea.This retrospective cohort study was conducted using National Health Insurance claims data from 2013 to 2021. Patients defined as newly diagnosed with mHSPC had an index date of first claim for metastatic PC between 2015 and 2016 and no exposure to CRPC medicines during the washout period. All-cause monthly medical and end-of-life costs were described for mHSPC and mCRPC. Descriptive statistics were used to analyze medical costs, and generalized estimating equations were used to evaluate the correlation between medical costs and significant variables, including disease progression, death, and clinical characteristics.Of the 3,739 patients with mHSPC included (mean 72.9 years), 779 progressed to mCRPC. The overall study population underwent a median 60.48-month follow-up period. The average monthly medical cost depending on CRPC progression was 1.5 times higher in the mCRPC than in the mHSPC group ($1,734.2 vs. $1,185.4). Monthly medical costs for those who progressed to mCRPC were 2.4 times higher one year after progression than one year before. In all groups, the average total medical costs gradually increased near mortality. Disease progression and death had a significant correlation with medical costs, by 1.7 times and 2.46 times, respectively.This study highlights the economic and health benefits of preventing progression to castration resistance in patients with mHSPC based on real-world data. [ABSTRACT FROM AUTHOR]

Although positive attitudes toward own aging (ATOA) have been shown to be associated with higher levels of quality of life (QoL) among older adults, the potential interrelationship between ATOA and QoL has not been fully explored. A sample of 2129 older adults aged 60 and above who participated in the three waves of the Chinese longitudinal healthy longevity survey was used. QoL was measured using three indicators, including self‐rated health, loneliness, and life satisfaction. The cross‐lagged analysis results showed that the bidirectional association between ATOA and QoL was not significant, while positive ATOA predicted better self‐rated health, higher life satisfaction, and less loneliness. And there are no gender or age differences in the above relationships. In addition, economic status, sleep quality, and activity participation were common influences on self‐rated health, life satisfaction, and loneliness, as well as important factors affecting ATOA. Several variables, such as demographic characteristics, health behaviors, and health status, also influenced QoL and ATOA. Measures to promote positive ATOA can help improve QoL. In addition, emphasis should be placed on improving economic status, sleep quality, and activity participation levels to enhance QoL and ATOA in older adults, with appropriate interventions targeting other factors affecting QoL and ATOA. [ABSTRACT FROM AUTHOR]

Background: Orthostatic hypotension (OH) is a common condition in Parkinson's disease (PD) with a possible link to cognitive decline. Objective: The aim was to explore the association between OH and PD‐associated mild cognitive impairment (PD‐MCI) and dementia (PDD) over 9 years in a population‐based incident PD cohort. Methods: We prospectively followed up patients from PD diagnosis with serial blood pressure measurements, clinical examinations, and neuropsychological assessments. We defined OH using (1) consensus‐based criteria and (2) clinically significant OH by mean arterial pressure (MAP) in standing position ≤75 mmHg. PD‐MCI and PDD were diagnosed according to acknowledged criteria. We applied generalized estimating equations models to investigate associations between OH measurements and cognitive impairment over time. Weibull accelerated failure time regression models were used to study if early OH (≤3 years of PD diagnosis) accelerates the time to incident PD‐MCI and PDD. Results: Of 186 enrolled patients, consensus‐based OH affected 68.8%, clinically significant OH 33.9%, PD‐MCI 60.8%, and PDD 31.2%. Consensus‐based OH was associated with PD‐MCI (odds ratio [OR]: 2.04, 95% confidence interval: 1.44–2.90, P < 0.001), whereas clinically significant OH was associated with both PD‐MCI (OR: 1.95, 1.11–3.43, P = 0.020) and PDD (OR: 3.66, 1.95–6.86, P < 0.001). Early clinically significant OH, but not early consensus–based OH, reduced time to incident PD‐MCI by 54% (P = 0.021) and time to PDD by 44% (P = 0.003) independently of potential confounders, including supine hypertension and cardiovascular disease. Conclusions: MAP in standing position emerged as a stronger predictor of cognitive decline than OH determined using consensus‐based criteria. These findings have implications for both research and clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This exploratory analysis sought to determine whether decreases in cannabis use are associated with improvements in cannabis-related problems and functional outcomes, and if so, what percentage decrease is associated with improvement. Methods: Data were aggregated from seven cannabis use disorder treatment trials conducted in the United States (N=920; ages 13 years and older; mean age, 25 years; 30% female, 7% Black, 11% Hispanic/Latinx). Outcome measures included the patient-reported Marijuana Problems Scale (MPS), Health-Related Quality of Life scale (HRQOL), and Pittsburgh Sleep Quality Index and the clinician-rated Clinical Global Impressions (CGI) severity and improvement scales (CGI-S and CGI-I). Generalized estimating equations tested the association between changes in 4-week cannabis use and improvements in functional outcomes. Classification and regression tree (CART) models were developed to determine what reductions in cannabis use could be used as classifiers of improvement. Results: Decreases in the amount and frequency of cannabis use were significantly associated with improvements in MPS severity and total scores as well as improvements on the CGI-I and in sleep quality, but not improvements on the HRQOL. CART models performed best for CGI-I scores (72%–75% correct classification), while other outcome measures did not perform as well (40%–62% correct classification). CART models showed improvements on the CGI at 74% reduction in use amounts and 47% reduction in use days. Conclusions: Reductions in cannabis use (∼50% reduction in use days and ∼75% reduction in use amounts) were associated with clinician-assessed improvement, which suggests that cannabis use reduction may yield benefit among individuals with cannabis use disorder. These exploratory results extract a data-driven metric to inform future studies, clinicians, patients, and policy recommendations. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the endothelialization process and assess the potential association between endothelialization and peri-device leak (PDL) following Watchman implantation via a quantitative method. Methods: This is a single-center retrospective study of consecutive patients undergoing LAAO between December 2015 and November 2021. Device endothelialization, compared between PDL and non-PDL group, were quantitatively analyzed based on hypoattenuated thickening in cardiac computed tomography angiography (CCTA). Advancement in endothelialization over time were explored using the Cochran-Armitage test and generalized estimating equation approach. Potential risk factors of delayed endothelialization were analyzed using the Cox proportional-hazards model. Results: A total of 172 patients (mean age, 68 years ± 10 [standard deviation], 114 men) were finally included. The average endothelialization ratio of the study population was 89.8 ± 7.2 percent. In the follow-up period of postprocedural 3 months to more than 12 months, an incremental trend of endothelialization over time was observed with the ratio of 85.8 ± 8.0, 89.6 ± 7.6, 92.2 ± 4.5, 94.3 ± 2.9 percent, respectively (p < 0.0001). Notably, patients without PDL exhibited a swifter advancement in endothelialization compared to those with PDL, irrespective of device size. The multivariable Cox regression model showed that PDL (HR = 2.113, 95%CI: 1.300–3.435, p = 0.003), DSP (HR = 1.717, 95%CI: 1.113–2.647, p = 0.014) were independent risk factors of delayed endothelialization. Conclusion: CCTA holds promise as an effective means of quantitatively assessing device endothelialization. Endothelialization advanced gradually over time, with PDL potentially impeding device endothelialization. Clinical relevance statement: A comprehensive understanding of the correlation between endothelialization ratio, time, and residual shunt can establish a more dependable foundation for determining the appropriate anticoagulation treatment following left atrial appendage closure. Key Points: Current recommendations for postleft atrial appendage occlusion anti-platelet and anticoagulation therapy are based on animal studies. Cardiac computed tomography angiography (CCTA) combined with the UNet neural network model enables the quantitative assessment of device endothelialization. This technique will allow for additional studies to better understand device endothelialization to optimize treatments in this population. [ABSTRACT FROM AUTHOR]

Introduction The COVID-19 pandemic dramatically altered patterns of healthcare delivery. Smoking remains an important risk factor for multiple chronic conditions and may exacerbate more severe symptoms of COVID-19. Thus, it is important to understand how pandemic-induced changes in primary care practice patterns affected smoking assessment and cessation assistance. Aims and Methods Electronic health record data from eight community health centers were examined from March 1, 2019 to February 28, 2022. Data include both telehealth (phone and video) and in-person office visits and represent 310 388 visits by adult patients. Rates of smoking assessment, provision of referral to counseling, and orders for smoking cessation medications were calculated. Comparisons by visit mode and time period were examined using generalized estimating equations and logistic regression. Results The proportion of telehealth visits was < 0.1% 1 year prior to COVID-19 onset and, 54.5% and 34.1% 1 and 2 years after. The odds of asking about smoking status and offering a referral to smoking cessation counseling were significantly higher during in-person versus telehealth visits; adjusted odds ratios (AOR) (95% CI) = 15.0 (14.7 to 15.4) and AOR (95% CI) = 6.5 (3.0 to 13.9), respectively. The interaction effect of visit type * time period was significant for ordering smoking cessation medications. Conclusions Telehealth visits were significantly less likely to include smoking status assessment and referral to smoking cessation counseling compared to in-person visits. Given that smoking assessment and cessation assistance do not require face-to-face interactions with health care providers, continued efforts are needed to ensure provision at all visits, regardless of modality. Implications The COVID-19 pandemic dramatically altered patterns of healthcare-seeking and delivery with a considerable rise in telehealth visits. This study examined 1 year prior to the onset of COVID-19 and 2 years after to evaluate the assessment of tobacco use and assistance with tobacco cessation and differences during in-person versus telehealth visits. Tobacco assessment was 15 times more likely during in-person versus telehealth visits in the 2 years post onset of COVID-19. Given that telehealth visits are likely to continue, ensuring that patients are regularly assessed for tobacco regardless of visit modality is an important concern for health systems. [ABSTRACT FROM AUTHOR]

Background: Despite the need to increase engagement of underrepresented groups (URG) in Alzheimer's disease and related dementias (ADRD) studies, enrollment remains low. Objective: Compare referral sources across racial and ethnic groups among participants enrolled in ADRC studies. Methods: Data for this cross-sectional secondary analysis were extracted from the National Alzheimer's Coordinating Center Uniform Data Set. We performed mixed effects logistic regression models using generalized estimating equations for professional referral versus non-professional referral by racial and ethnic group, adjusted for age, gender, education, visit year, and Clinical Dementia Rating scale (CDR) with a random effect for study site. Results: Included in the analysis were 48,330 participants across 46 ADRCs (mean [SD] age, 71.3 [10.5] years; 20,767 female [57%]; 4,138 Hispanic [8.6%]; 1,392 non-Hispanic Asian [2.9%]; 6,766 non-Hispanic Black [14%] individuals; and 676 individuals [1.4%] of other races. Non-Hispanic Black and Asian participants had lower odds of being referred by a professional contact compared to non-Hispanic White participants (Black: adjusted OR = 0.61, 95% CI = 0.44–0.86, p = 0.005; Asian: adjusted OR = 0.65, 95% CI, p = 0.004). In participants who had completed an MRI, there was no significant difference in referral source across ethnic and racial groups. Conclusions: Further studies are needed to better understand the systemic and structural factors that contribute to differences in referral sources and disparities in recruitment of URG into ADRD studies. [ABSTRACT FROM AUTHOR]

Dental age assessment based on evaluating dental mineralization status is one of the most common methods used in forensic practice. The aim of this study is to enhance the accuracy of age diagnostics and provide reference data from the Syrian population for forensic application. After several selection steps, a total of 280 orthopantomograms (OPGs) from 140 males and 140 females from the Syrian population divided into 14 age groups between 12 and 25 years were analysed. Based on Demirjian's classification system, the mineralization stages of third molars (18, 28, 38 and 48) as well as lower second molars (37 and 47) were evaluated. Statistical investigations and evaluations were carried out to estimate the marginal probabilities of the subjects having attained ages 14 and 18 by generalized estimating equation models. Our results show that no significant differences can be revealed in the mineralization status with respect to jaw side and sex. In the Syrian population, third molars showing mineralization stage G provide evidence of reaching the age of 14 years with the highest standard of proof ("beyond reasonable doubt"). A completed mineralization in lower second molars (stage H) provides very high marginal probabilities (more than 90%) of the subjects having attained age 14 years. Nevertheless, this cannot exclude an age under 14 years. For the age threshold of 18 years, third molars showing incomplete root development (G dental stage or lower) are associated with a low probability (less than 40%) of the subject having reached 18 years of age. A person's probability of having attained 18 years of age is very high (82– 95%) when the roots of third molars are fully developed (stage H). Nevertheless, third molars at stage H do not conclusively exclude an age under 18 years. [ABSTRACT FROM AUTHOR]

Background/Objectives: The impact of daily variations in habitual maternal intake on human milk (HM) composition has been poorly studied. We aimed to investigate the associations between day-to-day fluctuation in the micronutrient concentration in HM and daily maternal diet. Methods: To this end, an observational longitudinal study was carried out. A total of 143 lactating women each compiled a five-day weighed dietary record and concomitantly expressed milk for four successive days. Maternal daily intakes of micronutrients and food groups were analyzed. Free thiamine, free riboflavin, nicotinamide, pantothenic acid, pyridoxal, folic acid, cobalamin, ascorbic and dehydroascorbic acids, retinol, alpha- and gamma-tocopherol, cholecalciferol, and calcidiol in HM were determined for each of the four investigated days. A longitudinal data analysis with generalized estimating equation models was performed. Results: For each daily serving of meat, fish, and eggs, total vitamin D3 levels increased by 243.2 pg/mL (p = 0.027) and selenium levels increased by 0.16 ppb (p = 0.031) in HM. For every 1 mg/day of riboflavin supplementation, free riboflavin levels in HM increased by 28.6 mcg/L (p = 0.019). Pyridoxal levels in HM increased by 6.3 mcg/L per 1 mg/day of vitamin B6 supplementation (p = 0.001), and by 2 mcg/L per daily fruit ration (p = 0.016). Conclusions: In conclusion, we were able to quantify the impact of the usual day-to-day variations in the diet and in the intake of commonly used supplements on the fluctuation of vitamin D, free riboflavin, pyridoxal, and selenium concentration in the milk of lactating women. [ABSTRACT FROM AUTHOR]

We study partially linear models in settings where observations are arranged in independent groups but may exhibit within-group dependence. Existing approaches estimate linear model parameters through weighted least squares, with optimal weights (given by the inverse covariance of the response, conditional on the covariates) typically estimated by maximizing a (restricted) likelihood from random effects modelling or by using generalized estimating equations. We introduce a new 'sandwich loss' whose population minimizer coincides with the weights of these approaches when the parametric forms for the conditional covariance are well-specified, but can yield arbitrarily large improvements in linear parameter estimation accuracy when they are not. Under relatively mild conditions, our estimated coefficients are asymptotically Gaussian and enjoy minimal variance among estimators with weights restricted to a given class of functions, when user-chosen regression methods are used to estimate nuisance functions. We further expand the class of functional forms for the weights that may be fitted beyond parametric models by leveraging the flexibility of modern machine learning methods within a new gradient boosting scheme for minimizing the sandwich loss. We demonstrate the effectiveness of both the sandwich loss and what we call 'sandwich boosting' in a variety of settings with simulated and real-world data. [ABSTRACT FROM AUTHOR]

Background: Anxiety symptoms are factors that directly affect eating habits, but this interference can be heterogeneous depending on the nutritional status of the individuals. Objectives: To analyze whether the presence of anxiety symptoms at the beginning of the pandemic influenced the change in food consumption according to its purpose and extent of processing during a one-year follow-up and whether this association occurs equally with excess weight and without excess weight university students. Methods: This longitudinal study was carried out with 583 university students from a public Higher Education Institution (HEI) in Brazil. The Generalized Estimating Equation (GEE) was used to verify whether anxiety symptoms were associated with changes in food consumption over time. Results: The results showed that previous moderate/severe anxiety symptoms were associated with an increased frequency of consumption of both fresh or minimally processed foods (β: 0.2 95%CI: 0.1; 0.7 p = 0.013) and ultra-processed foods (β: 5.6 95%CI: 1.8; 17.7 p = 0.003), but with different magnitudes. In university students who were not excess weight, previous moderate/severe anxiety symptoms were associated with a reduction in the frequency of consumption of fresh or minimally processed foods (β: −2.0 95%CI: −3.5; −0.5 p = 0.008), while in those who were excess weight, there was an increase in consumption of ultra-processed foods (β: 4.5 95%CI: 2.2; 6.8 p < 0.001). Conclusion: This study confirms the influence of anxiety symptoms on food consumption according to the extent and purpose of processing. In addition, these results emphasize the role of psychological distress in the university population, and that this factor can affect excess weight and without excess weight individuals differently. [ABSTRACT FROM AUTHOR]

Squared 2 × 2 tables with binary data from matched pairs are typically analyzed using Cochran-Mantel-Haenszel methodology, conditional logistic regression, or random intercepts logistic regression. These are all "pair-specific" type of approaches. However, many more methods and models for clustered binary data, including marginal models and marginalizable pair-specific models, can be applied. We provide a comprehensive overview of methods and apply them all to two well-known example datasets, the prime minister's performance and the myocardial infarction datasets. The simple setting of matched binary data allows us to compare and relate different models, methods and their estimates. A technical explanation is given for why in some settings boundary estimates are obtained. for this article are available online. [ABSTRACT FROM AUTHOR]

Purpose We aimed to investigate the association between maternal fasting plasma glucose (FPG) trajectories during pregnancy and children's refractive errors at 6 years of age. Design Based on the Ma'anshan Birth Cohort (MABC) in China, a total of 1987 mother-child pairs were included in this study. Methods Using the group-based trajectory model, trajectory fitting was performed on FPG levels during the first, second, and third trimesters of pregnancy. Children's vision was measured at 6 years of age using the standard logarithmic visual acuity E-chart and cycloplegic refraction examination. Logistic regression models and multi-informant generalized estimating equations were used to analyze the association between maternal blood glucose level and 6-year-old children's visual acuity. Results Children born of mothers with high level FPG trajectory had a higher risk of developing refractive error (odds ratio [OR] = 1.46 [95% CI: 1.08, 1.97]), hypermetropia (OR = 1.64 [95% CI: 1.09, 2.46]), and astigmatism (OR = 1.60 [95% CI: 1.06, 2.41]) at age 6 compared to those with low level trajectory. Maternal blood glucose level in the first (β = −.012 [95% CI: −.024, −.001]) and the second (β = −.016 [95% CI: −.025, −.006]) trimesters was associated with 6-year-old children's distance vision value. Conclusion High level of FPG trajectories during pregnancy has been observed to be associated with 6-year-old children's refractive error, hypermetropia, and astigmatism. The first and the second trimesters may be critical periods for the effects of maternal blood glucose on children's vision. The long-term effect of maternal glucose metabolism on children's visual development deserves further study. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a significant public health concern, particularly in the elderly population. Absolute handgrip strength (HGS) serves to quantify muscle strength. It is recommended that the risk of low muscle strength and increased body mass index be concurrently evaluated using relative HGS. There are currently insufficient evidence regarding the relationship between relative HGS and DM in the elderly Korean population. Therefore, the association between relative HGS and the development of DM in Korean elderly was investigated. Methods: Data from the Korean Longitudinal Study of Ageing were used to determine the odds ratio (OR) between relative HGS and DM during the follow-up period from 2006–2020 among Korean men and women aged ≥65 years without DM when they first participated in this survey. Analysis was conducted using the Generalized Estimating Equation method. Trend analysis was performed for DM development based on relative HGS. Results: Among elderly males, higher relative HGS groups had reduced odds of developing DM (Middle tertile: OR 0.87, 95% CI 0.61–1.23, p = 0.419.) (Upper tertile: OR 0.82, 95% CI 0.56–1.18, p = 0.281.) Among elderly females, the reductions were similar. (Middle tertile: OR 0.82, 95% CI 0.66–1.03, p = 0.087.) (Upper tertile: OR 0.79, 95% CI 0.50–1.25, p = 0.306.) However, these differences were not statistically significant. Significant predictors of new-onset DM included age, BMI (overweight/obese), household income, alcohol consumption, hypertension, and chronic liver disease. Trend tests indicated a substantial decrease in the OR as the relative HGS increased for male and total groups (p for trend < 0.05). Conclusion: Relative HGS did not achieve statistical significance. Our findings indicate that BMI, particularly overweight and obesity, significantly predicts new-onset DM. However, trend tests indicated a substantial decrease in the OR as the relative HGS increased for male and total groups (p for trend < 0.05), even after adjusting for BMI categories. Despite the lack of statistical significance in some cases, the trend suggests that promoting resistance exercises to enhance HGS could be beneficial in DM prevention. Comprehensive DM prevention strategies should include managing obesity and chronic conditions for elderly. [ABSTRACT FROM AUTHOR]

ABSTRACT In observational health services research, researchers often use clustered data to estimate the independent association between individual outcomes and several cluster‐level covariates after adjusting for individual‐level characteristics. Generalized estimating equations are a popular method for estimating generalized linear models using clustered data. The conventional Liang–Zeger variance estimator is known to result in estimated standard errors that are biased low when the number of clusters in small. Alternative variance estimators have been proposed for use when the number of clusters is low. Previous studies focused on these alternative variance estimators in the context of cluster randomized trials, which are often characterized by a small number of clusters and by an outcomes regression model that often consists of a single cluster‐level variable (the treatment/exposure variable). We addressed the following questions: (i) which estimator is preferred for estimating the standard errors of cluster‐level covariates for logistic regression models with multiple binary and continuous cluster‐level variables in addition to subject‐level variables; (ii) in such settings, how many clusters are required for the Liang–Zeger variance estimator to have acceptable performance for estimating the standard errors of cluster‐level covariates. We suggest that when estimating standard errors: (i) when the number of clusters is < 15 use the Kauermann–Carroll estimator; (ii) when the number of clusters is between 15 and 40 use the Fay–Graubard estimator; (iii) when the number of clusters exceeds 40, use the Liang–Zeger estimator or the Fay–Graubard estimator. When estimating confidence intervals, we suggest using the Mancl–DeRouen estimator with a t‐distribution. [ABSTRACT FROM AUTHOR]

Background: The present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents. Methods: Cross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents' highest education, household financial situation) with HRQoL, psychosocial (parent–child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL. Results: Of 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96–7.36 and aOR: 3.66; 95%CI: 2.06–6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5–70%) and 40% (95%CI: 18–63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL. Conclusions: These findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic led to dramatic changes in the lives of children that impact cardiometabolic health. Cities and counties had varying policies with respect to school closure, recreational programs, and efforts to mitigate food insecurity and economic distress. Our objective was to evaluate changes in BMI-z score and prevalence of overweight/obesity prior to and during the pandemic among children in San Francisco, CA, where public schools were closed for 18-months. Methods: This was an electronic medical record-based retrospective cohort study. We included 15,401 children, 4–17 years of age at study onset. Our exposure was time into each of three time periods: (1) March 2018-February 2019; (2) March 2019-February 2020; (3) March 2020-August 2021 (the pandemic period of school closure). Generalized estimating equations (GEE) were used to assess changes in BMI-z score and overweight/obesity across the three time periods. We assessed for effect modification by age-category, insurance status, and race/ethnicity. Results: Mean BMI-z score increased by 0.06 per year in time period 2, the year prior to the pandemic (p < 0.001, 95% CI: 0.04, 0.09), and by 0.12 per year during time period 3, the first 18 months of the pandemic (p < 0.001, 95% CI 0.10, 0.13). The proportion of children with overweight/obesity increased by 1.4% points per year during time period 2 (p = 0.012, 95% CI: 0.03, 2.46) and by 4.9% points per year during the first 18 months of the pandemic (p < 0.001, 95% CI: 4.11, 5.67). The effect modification analysis demonstrated that the youngest age group, publicly insured children (versus privately insured), and Black, Latino, and Asian children (versus White children) experienced greater increases in BMI-z score during the pandemic (p < 0.01 for all comparisons). The youngest age group (p = 0.022) and publicly insured children (versus privately insured children) (p < 0.001) also experienced greater increases in the proportion of children with overweight/obesity during the pandemic. Conclusions: Among children in San Francisco, increases in BMI-z score and overweight/obesity were greater during the pandemic compared to prior changes, with the most pronounced increases among younger and publicly insured children. These findings support the need for more targeted and effective policies for addressing childhood overweight/obesity, especially among these high-risk populations. [ABSTRACT FROM AUTHOR]

Guideline concordant opioid therapy is a key part of the concerted effort to address the opioid crisis in the United States. The study aimed to compare the rates of guideline concordant care between veterans who solely used VA services (mono users) and veterans who used both VA services and community care (dual-system users). We used electronic health record data from the Washington DC and Baltimore VA Medical Centers from 2015 to 2019. We provided descriptive statistics as well as generalized estimating equations models to find associations between mono vs. dual-system users and each guideline outcome, controlling for demographic factors and comorbid conditions. The study found that overall rates of guideline concordant care were high in both mono and dual-system users with over 90% adherence rates for the majority of recommendations. However, there were variations in adherence to specific guidelines, with urine drug screening at initiation being the least commonly followed recommendation (8.9% of mono-user opioid initiators and 11.2% of dual-user initiators). This study also found that there was no consistent pattern of higher guideline adherence in mono vs. dual-system users but did show that through the course of this study (2015–2019) overall rates of guideline concordance increased. Future research will explore additional guideline recommendations and potential coordination issues among dual-system users. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To compare conservative management and appendectomy for acute appendicitis during pregnancy by trimester.This retrospective cohort study used data from a national inpatient database from July 2010 to March 2022. Pregnant women diagnosed with acute appendicitis were included. Multivariable analysis using generalized estimating equations was performed to compare outcomes between conservative management and appendectomy across trimesters. The main outcomes were preterm labor, preterm delivery, or abortion; antepartum hemorrhage; duration of hospitalization; and duration of antibiotic use.A total of 3158 individuals from 632 acute‐care hospitals were eligible. The proportion of conservative management versus appendectomy by trimester were 507 (49.1%) versus 525 (50.9%) in the first, 690 (44.6%) versus 856 (55.4%) in the second, and 337 (58.1%) versus 243 (41.9%) in the third. In the second trimester, appendectomy was associated with a higher rate of preterm delivery, preterm labor, or abortion (odds ratio [OR], 2.91 [95% confidence interval (CI), 1.62–5.25]). Antepartum hemorrhage occurred more frequently for appendectomy in the first (OR, 2.12 [95% CI, 1.31–3.43]) and third (OR, 2.43 [95% CI, 1.79–3.31]) trimesters. Appendectomy was associated with a longer duration of hospitalization in the second (2.15 days; 95% CI, 1.14–3.17 days) and third (3.97 days; 95% CI, 2.22–5.71 days) trimesters. Antibiotic use duration was shorter for appendectomy in the first (−1.20 days [95% CI −1.51 to −0.90 days]) and second (−0.61 days [95% CI −0.90 to −0.32 days]) trimesters.Clinical outcomes of acute appendicitis during pregnancy vary by trimester. Considering the appendectomy risks, conservative management may be viable depending on the clinical context and trimester. [ABSTRACT FROM AUTHOR]

Sport-related concussions (SRCs) are prevalent in high school (HS) sports, though the determinants of, and relationships between concussion symptoms in this population remain relatively unknown. We analysed SRC data captured within the HS RIO injury surveillance system during 2014/15-2018/19. We used Generalized Estimating Equations to simultaneously assess covariate predictors of symptom presentations and identify pairwise symptom associations and employed multivariable ordinal logistic regressions to determine symptom resolution time (SRT) predictors. Among the 8,969 concussions assessed, headaches (94.3%) and dizziness (73.3%) were the most prevalently reported symptoms. In 5,953 boys’ concussion assessed, class year, event type and injury mechanism emerged as determinants of various concussion symptoms, while in 3,016 girls’ concussions assessed, class year, event type, injury mechanism, and sport type emerged as significant symptom determinants. In both groups, difficulty concentrating, sensitivity to light, sensitivity to noise, and disorientation were symptoms with the strongest associations with other symptoms. Odds of longer SRT were higher with greater endorsement (i.e. counts) of the subset of symptoms with strongest cross-domain associations (ORadj. = 1.35; 95% CI = [1.30, 1.40]). Our findings provide valuable information for informing sideline and follow-up clinical concussion assessment algorithms in high school athletes. [ABSTRACT FROM AUTHOR]

Abstract.We study the estimation of nonlinear models with cross-sectional data using two-step generalized estimating equations within the quasi-maximum likelihood estimation framework. To improve efficiency, we propose a grouped estimator that accounts for potential spatial correlation in the underlying innovations of nonlinear models. Under mild weak dependence assumptions, we provide results on estimation consistency and asymptotic normality. Monte Carlo simulations demonstrate the efficiency gain of our approach compared to various estimation methods. Finally, we apply the proposed approach to examine the role of cultural distance in an extended gravity equation using international trade data from China. Compared to existing methods, our approach yields estimates with smaller standard errors and reinforces the hypothesis that both cultural and geographical distances significantly negatively influence international trade. [ABSTRACT FROM AUTHOR]

Introduction: The impact of deceased donor characteristics on kidney transplant outcomes is controversial. Correspondingly, the predictive performance of deceased donor scores remains moderate, and many transplant centers lack validated criteria for graft acceptance decisions. To better dissect donor-related risk from recipient and periprocedural variables, we analyzed outcomes of kidney donor pairs transplanted in different individuals. Methods: This study explored (a)symmetry of early outcomes of 328 cadaveric kidney transplant recipients from 164 donor pairs transplanted at three Eurotransplant centers. The primary discriminatory factor was (a)symmetry of partner graft function, defined as early graft loss or impaired graft function [estimated glomerular filtration rate (eGFR) <30 mL/min] 3 months after transplantation. We reasoned that a relevant impact of donor factors would result in a high concordance rate of limited graft function or failure. Results: The observed number of symmetric graft failure after transplantation was less than statistically expected (3 months: 1 versus 2, p = 0.89; and 12 months: 3 versus 5, p = 0.26). However, we found a trend toward an impaired 5-year graft survival of grafts with good function 3 months after transplantation but a failed or impaired partner graft compared to symmetrically well-functioning grafts (p = 0.09). Subsequently, we explored the impact of individual donor and recipient variables on early transplant outcomes. Generalized estimating equations after feature selection with LassoGEE bootstrap selected donor age, donor body mass index, and donor eGFR as the relevant risk factors. Discussion: Our findings indicate that donor factors impact early outcomes in kidney transplantation but may have a limited role in long-term graft survival, once a graft has been accepted for transplantation. Utilizing donor-based clinical scores has the potential to aid clinicians in acceptance decisions, giving them an estimate of individual posttransplant outcomes. However, the ultimate decision for acceptance should rest with clinicians, who must consider the complex interplay of donor factors, as well as recipient and periprocedural characteristics. [ABSTRACT FROM AUTHOR]

Background: Inadequacy of antenatal care (ANC) utilization is a prominent public health problem, causing poor pregnancy outcomes. In developing countries, including Ethiopia, having ANC coverage, many pregnant women do not achieve the first ANC visits in the first trimester and receive at least four ANC visits. Therefore, this study aimed to examine the magnitude and identify determinants of inadequacy of antenatal care attendance amongst pregnant women in Ethiopia. Methods: Inadequate ANC attendance was defined as combining starting ANC visits after the first trimester and having fewer than four visits together. The study used secondary data from the 2019 mini-demographic and health survey. A weighted sample of 3927 pregnant women was included in this study. Data management and further analysis were performed using STATA 14 software. A multivariable generalized estimating equation analysis was used to identify determinants associated with inadequacy of antenatal care attendance. The Adjusted odds ratio with a 95% confidence interval was used to identify significant variables for inadequate antenatal care visits. Result: Overall, 78.5% of pregnant women did not attend adequate antenatal care visits during pregnancy. In multivariable generalized estimating equation analysis, women aged 25 to 34 years (AOR = 0.77, 95% CI: 0.61–0.95), being educated (AOR = 0.31; 95% CI: 0.22–0.45), and being wealthier index (AOR = 0.67, 95% CI: 0.51–0.88) were less likely to inadequate antenatal care attendance. Whereas being rural residents (AOR = 1.49; 95% CI:1.08–2.07), no television exposure (AOR = 1.51; 95% CI:1.1–2.06), having more family members in the household (AOR = 1.81; 95% CI: 1.11–2.95), and women from semi-peripheral region (AOR = 1.92; 95% CI: 1.42–2.59) were higher odds of being associated with inadequacy of antenatal care attendance. Conclusions: The prevalence of Inadequate antenatal care attendance amongst pregnant women in Ethiopia is still High. The study identifies significant variables that could be positively and negatively associated with inadequate antenatal care visits. Health education interventions should target uneducated, poorer, and rural women to attend early antenatal care and use at least four antenatal care utilization for early detection of complications during pregnancy and delivery. [ABSTRACT FROM AUTHOR]

Background: This study investigated the image quality and detectability of double low-dose hepatic multiphase CT (DLDCT, which targeted about 30% reductions of both the radiation and iodine concentration) using a vendor-agnostic deep-learning-based contrast-boosting model (DL-CB) compared to those of standard-dose CT (SDCT) using hybrid iterative reconstruction. Methods: The CT images of 73 patients with chronic liver disease who underwent DLDCT between June 2023 and October 2023 and had SDCT were analyzed. Qualitative analysis of the overall image quality, artificial sensation, and liver contour sharpness on the arterial and portal phase, along with the hepatic artery clarity was conducted by two radiologists using a 5-point scale. For quantitative analysis, the image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured. The lesion conspicuity was analyzed using generalized estimating equation analysis. Lesion detection was evaluated using the jackknife free-response receiver operating characteristic figures-of-merit. Results: Compared with SDCT, a significantly lower effective dose (16.4 ± 7.2 mSv vs. 10.4 ± 6.0 mSv, 36.6% reduction) and iodine amount (350 mg iodine/mL vs. 270 mg iodine/mL, 22.9% reduction) were utilized in DLDCT. The mean overall arterial and portal phase image quality scores of DLDCT were significantly higher than SDCT (arterial phase, 4.77 ± 0.45 vs. 4.93 ± 0.24, AUCVGA 0.572 [95% CI, 0.507–0.638]; portal phase, 4.83 ± 0.38 vs. 4.92 ± 0.26, AUCVGA 0.535 [95% CI, 0.469–0.601]). Furthermore, DLDCT showed significantly superior quantitative results for the lesion contrast-to-noise ratio (7.55 ± 4.55 vs. 3.70 ± 2.64, p < 0.001) and lesion detectability (0.97 vs. 0.86, p = 0.003). Conclusions: In patients with chronic liver disease, DLDCT using DL-CB can provide acceptable image quality without impairing the detection and evaluation of hepatic focal lesions compared to SDCT. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Discussion Hemodialysis is frequently used as a primary treatment for individuals with end‐stage kidney disease (ESKD), and it significantly impacts the quality of life in adolescents undergoing this procedure. Providing a hemodialysis education to these patients is a valuable strategy for enhancing their well‐being. The aim of the study is to assess the effect of the video‐assisted educational program on the quality of life among adolescents undergoing hemodialysis in Palestine.This study employed a quasi‐experimental design, a pre‐test–post‐test interventional study, involving a sample of 68 adolescent patients between the ages of 13 and 18 diagnosed with ESKD. The quality of life level was assessed in both groups using an Arabic version of the Pediatric Quality of Life Inventory™ version 3.0 ESKD Module survey. The study was conducted at the dialysis units in four hospitals associated with Augusta Victoria Hospital, An‐Najah University Hospital, Palestine Medical Complex/Ramallah, and Beit Jala (Al Housain) Hospital. The study involved providing tailored face‐to‐face educational sessions with video assistance to the experimental group, while the control group received regular face‐to‐face education.The Generalized Estimating Equation analysis revealed no significant differences in quality of life between the experimental and control groups over time, across pre‐test, post‐test, and follow‐up periods (p ≥ 0.05). However, within the experimental group, there was a significant improvement in total quality of life scores between the pre‐test, post‐test, and post‐test follow‐up (p ≤ 0.001), although the difference between the pre‐test and follow‐up approached significance but was not statistically significant (p = 0.056). In contrast, the control group showed significant differences in quality of life across the pre‐test, post‐test, and follow‐up time points (p ≤ 0.05).Implementing suitable interventions can potentially enhance the quality of life for individuals undergoing hemodialysis. Consequently, we suggest using video‐based education as a cost‐effective, uncomplicated, and engaging approach for educating hemodialysis patients. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors encounter significant psychological suffering and are prone to develop depressive symptoms. Work contributes to personal fulfillment and social connections, and by doing so, enhances a cancer survivor's resilience against adversities. However, maintaining employment can be challenging for some cancer survivors. This research aimed to identify the association between changes in work status and depressive symptoms among cancer survivors in South Korea. Methods: This study used the panel data from the Korean Longitudinal Study of Ageing (KLoSA) and included 199 cancer survivors–799 observations–aged 65 or younger, between 2005 and 2018. Changes in work status consisted of continuous unemployment or employment, quitting a job, and getting a job. We defined depressive symptoms as a CES-D-10 score of 10 or higher and a cut-off of 4 was utilized for sensitivity analysis. Multivariable generalized estimating equation was employed to estimate the odds ratio (OR), adjusting for the number of household members, education level, sex, age, marital status, occupations, cancer treatment, cancer type, catastrophic healthcare expenditure (CHE), and survivorship. Subgroup analysis and interaction between changes in work and cancer types were further explored. Results: For depressive symptoms, the OR of the continuous unemployment group was 2.27 (95% CI = 1.10–4.69), and the OR of the group that quit a job was 2.20 (95% CI = 1.03–4.72), compared to the continuous employment group. As survivorship increased, the odds of depressive symptoms decreased (OR = 0.94, 95% CI = 0.89–1.00). CHE was associated with depressive symptoms (OR = 2.23, 95% CI = 1.18–4.20). In cancer types with a low tendency to depression, continuous unemployment was associated with depressive symptoms (OR = 3.19, 95% CI = 1.12–9.06). In sensitivity analysis, changes in work, survivorship, and CHE were consistently associated with depressive symptoms. Conclusions: Cancer survivors who quit a job or continued unemployment were more likely to experience depressive symptoms. The findings of this study imply that assistance for cancer survivors to continue a job or return to employment, including adjustment of workload and hours, may be helpful. Psychological care may be crucial, particularly in the early stage of cancer survivorship. Furthermore, support may be needed to alleviate the burden of healthcare expenditure. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsObjective structured clinical examination (OSCE) is used worldwide. This study aims to explore potential alternatives to the OSCE by using entrustable professional activities (EPA)-based assessments in the workplace.This study enrolled 265 six-year undergraduate medical students (UGY) from 2021 to 2023. During their rotations, students were assessed using 13 EPAs, with the grading methods modified to facilitate application. Before graduation, they participated in two mock OSCEs and a National OSCE. We used generalized estimating equations to analyze the associations between the EPA assessments and the OSCE scores, adjusting for age and sex, and developed a prediction model. EPA8 and EPA9, which represent advanced abilities that were not significant in the regression models, were removed from the prediction model.Most EPAs were significantly correlated with OSCE scores across the three cohorts. The prediction model for forecasting passing in the three OSCEs demonstrated fair predictive capacity (area under curve = 0.82, 0.66, and 0.71 for students graduated in 2021, 2022, and 2023, respectively all p < 0.05).The workplace-based assessments (EPA) showed a high correlation with competency-based assessments in simulated settings (OSCE). EPAs may serve as alternative tools to formal OSCE for medical students. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Materials and Methods Results Conclusions To assess the influence of the emergence angle on marginal bone loss (MBL) and supracrestal soft tissue around dental implants.In six mongrel dogs, the mandibular premolars and molars were extracted. After 3 months of healing, four dental implants were placed in each hemimandible. The implants were randomly allocated to receive one of four customized healing abutments, each with a different value of the restorative emergence angle: 20°, 40°, 60° or 80°. Intra‐oral radiographs were taken after placing the healing abutments and at 6, 9, 16 and 24 weeks of follow‐up. Then, micro‐CT and undecalcified histology and synchrotron were performed. MBL over time was analysed with generalized estimating equations (GEEs) and adjusted for baseline soft‐tissue thickness.From implant placement to 24 weeks, GEE modelling showed that the MBL at mesial and distal sites consistently increased over time, indicating MBL in all groups (p < 0.001). The model indicated that MBL varied significantly across the different restorative angles (angle effect, p < 0.001), with 80° showing the greatest bone loss. Micro‐CT, histology and synchrotron confirmed the corresponding trends and showed that wide restorative angles (60° and 80°) impaired the integrity of the junctional epithelium of the supracrestal tissue.A wide restorative angle increases MBL and impairs the integrity of the junctional epithelium of the implant supracrestal complex. [ABSTRACT FROM AUTHOR]

Background: Lymphatic filariasis (LF) is an infectious neglected tropical disease caused by mosquito-borne nematodes such as Wuchereria bancrofti, Brugia malayi, and Brugia timori. Globally, LF affects 51 million people, with approximately 863 million at risk in 47 countries. In Kenya, filariasis is endemic along the entire coastal strip, and more recently, at the Kenya–Ugandan border. The World Health Organization (WHO) recommends mass drug administration to reduce disease transmission and morbidity. Monitoring the effectiveness of such interventions relies on robust surveillance, achieved through microscopic examination of microfilariae in nighttime blood, detection of circulating filarial antigens (CFA), and molecular xenomonitoring. We focused on molecular xenomonitoring along the Kenyan coast due to its noninvasive nature and the opportunity to identify new vectors. Methods: In 2022, mosquitoes were collected from Kilifi, Kwale, and Taita-Taveta counties located within the LF endemic region in Kenya. Subsequently, genomic deoxyribonucleic acid (gDNA) was extracted from these mosquitoes for speciation and analysis of Wuchereria bancrofti infection rates. The impact of sociodemographic and household attributes on infection rates was assessed using generalized estimating equations. Results: A total of 18,121 mosquitoes belonging to Culicinae (63.0%, n = 11,414) and Anophelinae (37.0%, n = 6707) subfamilies were collected. Morphological identification revealed that Anopheline mosquitoes were dominated by An. funestus (45.4%, n = 3045) and An. gambiae (42.8%, n = 2873). Wuchereria bancrofti infection rates were highest in Kilifi (35.4%; 95% CI 28.0–43.3%, n = 57/161) and lowest in Taita Taveta (5.3%; 95% CI 3.3–8.0%, n = 22/412). The major vectors incriminated are An. rivulorum, An. funestus sensu stricto, and An. arabiensis. Mosquitoes of the An. funestus complex were significantly associated with LF transmission (OR 18.0; 95% CI 1.80–180; p = 0.014). Additionally, a higher risk of transmission was observed outdoors (OR 1.74; 95% CI 1.08–2.82; p = 0.024) and in homesteads that owned livestock (OR 2.00; 95% CI 1.09–3.66; p = 0.025). Conclusions: In this study, we identified An. funestus s.l. sibling species, An. rivulorum and An. funestus s.s., as the primary vectors of lymphatic filariasis along the Kenyan coast. These findings also highlight that a significant portion of disease transmission potentially occurs outdoors where indoor-based vector control tools, including long-lasting insecticidal nets and indoor residual spray, may not be effective. Therefore, control measures targeting outdoor resting mosquitoes such as zooprophylaxis, larval source management, and attractive sugar baits may have potential for LF transmission reduction. [ABSTRACT FROM AUTHOR]

Traffic‐related air pollutants inside vehicle cabins are often extremely high compared to background pollution concentrations. The study of the determinants of these concentrations is particularly important for professional drivers and commuters who spend long periods in vehicles. This study is aimed at identifying and quantifying the effect of several exposure determinants on carbon monoxide (CO), equivalent black carbon (eBC), two particulate matter (PM) fractions (PM0.3–1 and PM1–2.5), and ultrafine particle (UFP) concentrations inside a passenger car cabin. The novelty of this work consists in examining the effects of the emissions of the first vehicle ahead (henceforth called "leading vehicle") on pollutant concentrations inside the cabin of the following vehicle (i.e., the car that was equipped with the air monitoring devices), with particular emphasis on the role of the leading vehicle characteristics (e.g., emission reduction technologies). The real‐time instrumentation was placed inside the cabin of a petrol passenger car, which was driven by the same operator two times per day on the same route in real driving conditions. The in‐cabin ventilation settings were set as follows: windows closed, air conditioning and recirculation modes off, and the fanned ventilation system on. The measurements were conducted over a total of 10 weekdays during two different seasons (i.e., summer and autumn). A video camera fixed to the windscreen was used to retrieve information about traffic conditions and leading vehicle characteristics through careful video analysis. The associations among pollutant concentrations and their potential determinants were evaluated using generalized estimating equation univariate and multiple models. The results confirmed the significant impact of several well‐known determinants such as seasonality, microclimatic parameters, traffic jam situations, and route characteristics. Moreover, the outcomes shed light on the key role of leading vehicle emissions as determinant factors of the pollutant concentrations inside car cabins. Indeed, in the tested cabin ventilation conditions, it was demonstrated that in‐cabin pollutant concentrations were significantly higher with leading vehicles ahead (from +14.6% to +67.5%) compared to empty road conditions, even though the introduction of newer technologies with better emissions reduction helped mitigate their effect. Additionally, diesel‐fuelled leading vehicles compared to petrol‐fuelled leading vehicles were impactful on in‐cabin CO (−7.2%) and eBC (+45.3%) concentrations. An important effect (+30.4%) on in‐vehicle PM1–2.5 concentrations was found with heavy‐duty compared to light‐duty leading vehicles. Finally, this research pointed out that road‐scale factors are more important determinant factors of in‐cabin concentrations than local pollution and meteorological conditions. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminths (STH) affect approximately 1.5 billion people globally. The current STH control strategy is annual or twice-annual preventive chemotherapy, typically school-based deworming targeting children and women of reproductive age. Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration (cMDA). DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption. The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels. Methods: From 2018–2020, DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin, India, and Malawi. We report coverage, treatment uptake, and directly observed therapy across all rounds. Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations, while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models. Results: Coverage was high across all clusters and rounds, exceeding the WHO target of 75% in all sites and across all rounds (78% to 95%); cluster-level coverage tended to increase over time. Younger, unmarried, and migratory adults were more likely to be untreated at all sites; adult males were more likely to be untreated in Benin and Malawi. Among children, girls were more likely to be untreated, as were non-school-attending and migratory children. Higher adult education was associated with greater odds of non-treatment among adults, but lower odds among children in the household. Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children. Conclusions: It is possible to deliver community-wide MDA with high coverage. Unique individual and community-level factors influence treatment across settings, and these may be addressed through targeted programming. Trial Registration: Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths (STH), NCT03014167. [ABSTRACT FROM AUTHOR]

The study investigates whether a 3-day pretreatment course with a GnRH antagonist in the early follicular phase has an impact on the number of retrieved COCs in a GnRH antagonist stimulation protocol. This is a retrospective single center crossover study involving women who did not conceive after one GnRH antagonist stimulation cycle ("standard cycle") and proceeded with another GnRH antagonist stimulation cycle preceded by early administration of GnRH antagonist for 3 days ("pretreatment cycle") with fresh embryo transfer or frozen embryo transfer. 430 patients undergoing 860 cycles were included. The mean female age was 34.4 ± 4.8 years. Indications for fertility treatment included unexplained infertility (34.3%), male-factor infertility (33.3%), age (16.9%), PCOS (8.2%), tubal (4.7) and endometriosis (2.6%). All cycles were divided into two groups: group 1 (standard, 430 cycles) and group 2 (pretreatment, 430 cycles). The mean duration of stimulation was similar in both groups (10.3 vs 10.3 days, p = 0.28). The starting dose of gonadotropin (234.9 vs 196.8 IU, p<0.001), total amount of gonadotropin used (2419 vs 2020 IU, p<0.001), the total number of retrieved COCs (10 vs 7.8 p<0.001) and the number of mature oocytes (8 vs 5.8 p<0.001) were significantly higher in group 2 than in group 1. The Generalized estimating equation (GEE) regression analysis showed that the pretreatment strategy had a significant positive effect on the number of COCs (coefficient 2.4, p <0.001 after adjusting for known confounders (age, indication, stimulation dose, type, and duration of stimulation). In conclusion, A 3-day course of GnRH antagonist pretreatment increases the number of COCs obtained after ovarian stimulation. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Despite increasing numbers of working‐age cancer survivors, evidence on their future work‐related circumstances is limited. This study examined their future sick leave, disability pension, and unemployment benefits compared to matched cancer‐free individuals.A matched cohort study was conducted using nationwide Swedish registers. In total, 94,411 individuals aged 25 to 59 years when diagnosed with incident cancer in 2001–2012 and who returned to work after cancer were compared with their matched cancer‐free individuals (N = 354,814). Follow‐up started from the year before cancer diagnosis and continued up to 14 years. Generalized estimating equations were used to calculate incidence rate ratios (IRR) and odds ratios for the difference between cancer survivors and matched cancer‐free individuals.Compared with cancer‐free individuals, cancer survivors had six times higher sick‐leave days per year after cancer (IRR 6.25 [95% CI, 5.97–6.54] for men; IRR, 5.51 [5.39–5.64] for women). This higher number of sick‐leave days declined over time but a two‐fold difference persisted. An approximate 1.5 times higher risk of receiving disability pension remained during follow‐up. The unemployment days tended to be lower for cancer survivors (IRR, 0.84 [0.75–0.94] for men; IRR, 0.91 [0.86–0.96] for women). Risk of sick leave and disability pension was higher among those with leukemia, colorectal, and breast cancer than skin and genitourinary cancers.Cancer survivors who returned to work experienced a high and persisting sick leave and disability pension for over a decade. Prolonged receipt of a high amount of benefits may have long‐term adverse impacts on financial circumstances; more knowledge to promote the environment that encourages returning to and remaining in work is needed. [ABSTRACT FROM AUTHOR]