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Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane's Q and I2 statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies. [ABSTRACT FROM AUTHOR]

The distinctive mental health features associated with COVID-19 have gained importance as the psychological effects of the pandemic on the community become more visible. This study aims to assess the COVID-related stress status and associated factors in the community sample of Turkey. The sample of this cross-sectional study is composed of 2.065 people between the ages of 18–90. Data were collected through an online survey prepared by Google.docs between October-December, 2020. Mild to moderate stress was found in the community with the most common symptoms of the fear of contamination and danger. Some variables, such as being female and the severity of COVID-19 illness, were associated with higher COVID-related stress. Vulnerable groups associated with high stress should be monitored during the pandemic. The findings of this study will guide the practices of professionals working in the field of public health, healthcare, or mental health in possible future pandemics. [ABSTRACT FROM AUTHOR]

Objective. To document the state of lead poisoning in the pediatric population in Mexico, to identify populations at greater risk, and present public policy recommendations to address the problem. Materials and methods. Integrated analysis of 1 747 children aged 1-4 years from the Encuesta Nacional de Salud y Nutrición Continua 2022-2023. Lead concentrations were measured in capillary blood by anodic stripping voltammetry. The prevalence of lead poisoning (PbS>5µg/dL) adjusted for different sociodemographic and social vulnerability level was estimated. Populations with a higher risk of lead poisoning were identified. Results. The national prevalence of poisoning was 17.2%, reaching 29% in the indigenous population, 25% in those with chronic malnutrition, 25% with higher levels of socioeconomic deprivation; 20% in rural and urban areas, 12% in metropolitan areas. No differences were found by sex. The highest risk of lead poisoning (52%) occurs in the indigenous population, with chronic malnutrition, residing in rural areas and using glazed clay; a risk 15 times greater than the lowest vulnerability profile (3.5%). Conclusions. Lead poisoning is an environmental justice issue. It is necessary to implement a national strategy to remove the main source of exposure; an epidemiological surveillance system for the identification and care of cases and population biomonitoring in the pediatric population and pregnant women; Monitoring of current regulations is imperative. [ABSTRACT FROM AUTHOR]

Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane’s Q and I2 statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies.

Background: To inform future response planning we aimed to assess SARS‐CoV‐2 trends in infection‐ and/or vaccine‐induced immunity, including breakthrough infections, among (sub)groups, professions and regions in the Dutch population during the Variant of Concern (VOC)‐era. Methods: In this prospective population‐based cohort, randomly selected participants (n = 9985) aged 1–92 years (recruited early‐2020) donated home‐collected fingerstick‐blood samples at six timepoints in 2021/2022, covering waves dominated by Alpha, Delta, and multiple Omicron (sub‐)variants. IgG antibody assessment against Spike‐S1 and Nucleoprotein was combined with vaccination‐ and testing data to estimate infection‐induced (inf) and total (infection‐ and vaccination‐induced) seroprevalence. Results: Nationwide inf‐seroprevalence rose modestly from 12% (95% CI 11–13) since Alpha to 26% (95% CI 24–28) amidst Delta, while total seroprevalence increased rapidly to 87% (95% CI 85–88), particularly in elderly and those with comorbidities (i.e., vulnerable groups). Interestingly, highest infection rates were noticeable among low/middle educated elderly, non‐Western, those in contact professions, adolescents and young adults, and in low‐vaccination coverage regions. Following Omicron emergence, inf‐seroprevalence elevated sharply to 62% (95% CI 59–65) and further to 86% (95% CI 83–90) in late‐2022, with frequent breakthrough infections and decreasing seroprevalence dissimilarities between most groups. Whereas > 90% of < 60‐year‐olds had been infected at least once, 30% of vaccinated vulnerable individuals had still not acquired hybrid immunity. Conclusions: Groups identified to have been infected disproportionally during the acute phase of the pandemic require specific attention in evaluation of control measures and future response planning worldwide. Furthermore, ongoing tailored vaccination efforts and (sero‐)monitoring of vulnerable groups may remain important. [ABSTRACT FROM AUTHOR]

Abstract Introduction Herpes zoster (HZ) is a painful disease that mainly affects individuals whose immune system has been weakened because of increasing age (> 50 years) or certain diseases or treatments. We estimated the complete burden of HZ. Methods This population-based register study analysed healthcare data from the VEGA and Digitalis databases of Västra Götaland Region (VGR), Sweden. The VEGA database includes all patients in VGR, covering both hospital and primary care. The Digitalis records prescribed medications. The study population included patients aged ≥ 18 years with at least one registered primary or secondary HZ diagnosis (based on International Classification of Diseases [ICD] codes) between 2005 and 2021. Incidence rates (95% confidence intervals [CI]) were stratified by age, sex and diagnosis/analgesic prescription. Results Overall HZ incidence increased from 2.5 (95% CI 2.4–2.6) in 2005 to 4.2 (95% CI 4.1–4.3) in 2021. The increase in incidence was rapid from 2005 to 2013, followed by a plateauing trend. From 2014–2019, the lifetime risk of HZ, excluding recurrent cases, was 36.5% (95% CI 35.5–37.4%). Municipal differences ranged from 34.4% (95% CI 32.5–36.4%) to 43.6% (95% CI 39.9–47.4%). Recurrence rates of HZ were 8.7% and 9.1% with follow-up periods of 5.5 and 10.5 years, respectively. Reported postherpetic neuralgia (PHN) cases increased five-fold over the study period. In 2019, 19% of all HZ patients developed HZ-related neuropathic pain; 13.6% had signs of persistent pain (> 90 days; i.e. PHN). An increased occurrence of cerebral and cardiovascular disease was observed in HZ patients. Among high-risk groups the occurrence of HZ peaked among those with inflammatory and autoimmune diseases. Conclusion HZ and PHN risk in Sweden is comparable to that in other European countries prior to implementing HZ national vaccination programs. Municipal differences suggest that the lifetime risk of HZ in Sweden is at least 36.5%. Clinical Trial Registration NCT Number ( www.clinicaltrials.gov ). Graphical Abstract

ABSTRACTRespiratory syncytial virus (RSV) is associated with considerable morbidity and mortality among older adults (aged ≥60 years) and adults with certain chronic conditions in the United States (US). Despite this burden, no previous studies have assessed the knowledge, attitudes, and perceptions (KAP) of RSV among these populations. This study evaluates RSV-related KAP among US adults at increased risk of severe RSV infection. A cross-sectional, web-based survey was administered from May to June 2022 to better understand respiratory infection- and RSV-related KAP among US adults who are at risk of severe RSV infection. The survey included ≥200 adults in each of 4 subgroups: adults aged 60–89 years, and adults aged 18–59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes mellitus. Survey responses were analyzed descriptively overall and by subgroup, with exploratory logistic regression modeling used to evaluate characteristics associated with RSV awareness and concern. Among the 827 survey respondents, only 43.3% had ever heard of RSV (n = 358/827). The study identified key knowledge gaps (e.g. bacterial vs. viral nature of respiratory infections, RSV seasonality, common RSV symptoms, extent to which RSV causes respiratory infections in specific patient populations). Although 33.7% of RSV-aware adults (n = 120/356) reported being worried/very worried about RSV, 67.3% (n = 241/358) rarely consider RSV as a potential cause of their cold/flu-like symptoms. Results from this study highlight important knowledge gaps related to RSV, perceived risk, and severity of RSV. Findings can be used to support the development of tailored education efforts to support RSV prevention.

Among uterine malignancies, endometrial cancer (EC) is the most common cancer of the female reproductive tract. Traditionally, risk stratification in EC is determined by standard clinicopathological risk factors. Although circulating tumor DNA (ctDNA) has emerged as a prognostic biomarker in various malignancies, its clinical validity in EC remains to be established. In this analysis of real-world data, 267 plasma samples from 101 patients with stage I EC were analyzed using a tumor-informed ctDNA assay (Signatera™ bespoke mPCR-NGS). Patients were followed post-surgically and monitored with ctDNA testing for a median of 6.8 months (range: 0.37–19.1). Patients who tested ctDNA-positive at both their first time point and longitudinally experienced inferior recurrence-free survival (RFS) (HR = 6.2; p = 0.0006 and HR = 15.5; p < 0.0001, respectively), and showed a recurrence rate of 58% and 52%, vs. 6% and 0%, respectively for the ctDNA-negative patients. Most ctDNA-positive patients had high-risk histologies or sarcoma, versus low-risk and high-intermediate risk (H-IR) EC. Furthermore, patients with high-risk histologies who were ctDNA-positive showed shorter RFS compared to those who tested negative (HR = 9.5; p = 0.007), and those who tested positive in the low/H-IR cohort (HR = 0.25; p = 0.04). Post-surgically, detectable ctDNA was highly prognostic of clinical outcome and remained the only significant risk factor for recurrence when adjusted for clinicopathological risk factors, such as histologic risk group, mismatch repair (MMR), and p53 status. Incorporating ctDNA monitoring along with traditional known risk factors may aid in identifying patients with stage I EC who are at highest risk of recurrence, and possibly aid in treatment stratification. • Post-surgical ctDNA detection is prognostic of poor recurrence-free survival in patients with stage I endometrial cancer. • Most ctDNA-positive patients had high-risk histologies or sarcoma. • ctDNA-positivity in the high-risk cohort was associated with shorter recurrence-free survival. • Detectable ctDNA post-surgery was the only significant risk factor prognostic for recurrence. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is a chronic immune-mediated disorder triggered by the ingestion of gluten in genetically predisposed individuals, affecting about 1% of the general population in the developed world. In 2012, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommendations for CD diagnoses in children and adolescents were introduced, allowing the "no-biopsy" approach if certain criteria were met. This approach was also confirmed in the revised guidelines published in 2020. Thus, the aim of this study was to assess—over a one-year period—the clinical presentations and current status of the management of children and adolescents diagnosed with CD in Poland. Medical records of children and adolescents, newly diagnosed with CD in 2022/2023 in three medical centers in Poland, were involved. Gastroenterologists completed the specific anonymous web-based forms developed in the CD SKILLS project, including data routinely assessed at individual visits about the diagnostic approach and clinical presentation of the disease. Our study assessed 100 patients (56% girls) with an age range 1.6–18.0 years. We found that 98% of patients were serologically tested prior to a CD diagnosis and 58% of patients were diagnosed using the "no-biopsy" approach. In the analyzed group, 40% belonged to a known risk group, only 22% had annual screening before the CD diagnosis (the longest for 9 years), and 19% showed no symptoms at the time of the CD diagnosis. Our research confirmed the applicability of the "no-biopsy" approach for the diagnosis of CD in children and adolescents in Poland, and also showed changes in the clinical picture of CD. Moreover, we highlight the need to introduce broad CD serological screening in risk groups of the Polish population. [ABSTRACT FROM AUTHOR]

• Study of determinants of COVID-19 autumn booster uptake in risk groups in the Netherlands. • Booster uptake was 68 % among people ≥ 60 years and 30 % among medical risk group 18–59 years. • Most important determinant for booster uptake in both target groups was age. • Political preference, migration status and household type are important determinants. • Findings are important for future campaigns targeting people at increased risk of severe COVID-19. A booster with bivalent COVID-19 vaccine was offered in the Netherlands in autumn, 2022. We aimed to investigate vaccine uptake during the autumn 2022 booster round among the population subgroups at risk for severe COVID-19 that were specifically targeted by this campaign: the medical risk group aged 18–59 years and individuals ≥ 60 years. We calculated booster uptake in both populations and analyzed determinants of booster uptake among those who had received at least one prior COVID-19 vaccination. Having had an autumn 2022 booster dose was defined as having received a COVID-19 vaccination between 19 September 2022 and 7 March 2023. The study population included individuals who received at least one previous COVID-19 vaccination. National registries of sociodemographic determinants and COVID-19 vaccination were linked by a unique person identifier. Voting proportions for political parties were included at neighborhood level. Determinants of COVID-19 vaccine autumn booster uptake were ranked by importance by random forest analyses. Booster uptake was 68 % among those aged ≥ 60 and 30 % among those aged 18–59 years with a medical risk factor for severe disease. For both target groups the most important determinant for booster uptake was age (15 % in 18–29 years to 72 % in 80 + years). Voting proportions for progressive liberal political parties ranked second in the random forest analysis in both groups, with an increasing proportion of votes associated with higher uptake. In the 60 + group, household type ranked third, with highest vaccine uptake among married couples without children (72 %) and the lowest uptake among unmarried couples with children (47 %). In the medical risk group, migration status ranked third. Migrants with two parents born abroad had the lowest uptake (18 %), whereas migrants with both parents born in the Netherlands had the highest uptake (35 %). The target group of people aged ≥ 60 years was much better reached than the target group of people with a medical risk aged 18–59 years. Uptake varied considerably among subgroups in both target groups. The findings of this study can be used in future vaccination strategies as well as for further research to better understand the drivers and barriers of vaccine uptake among the subgroups with notably low uptake. [ABSTRACT FROM AUTHOR]

Introduction: Herpes zoster (HZ) is a painful disease that mainly affects individuals whose immune system has been weakened because of increasing age (> 50 years) or certain diseases or treatments. We estimated the complete burden of HZ. Methods: This population-based register study analysed healthcare data from the VEGA and Digitalis databases of Västra Götaland Region (VGR), Sweden. The VEGA database includes all patients in VGR, covering both hospital and primary care. The Digitalis records prescribed medications. The study population included patients aged ≥ 18 years with at least one registered primary or secondary HZ diagnosis (based on International Classification of Diseases [ICD] codes) between 2005 and 2021. Incidence rates (95% confidence intervals [CI]) were stratified by age, sex and diagnosis/analgesic prescription. Results: Overall HZ incidence increased from 2.5 (95% CI 2.4–2.6) in 2005 to 4.2 (95% CI 4.1–4.3) in 2021. The increase in incidence was rapid from 2005 to 2013, followed by a plateauing trend. From 2014–2019, the lifetime risk of HZ, excluding recurrent cases, was 36.5% (95% CI 35.5–37.4%). Municipal differences ranged from 34.4% (95% CI 32.5–36.4%) to 43.6% (95% CI 39.9–47.4%). Recurrence rates of HZ were 8.7% and 9.1% with follow-up periods of 5.5 and 10.5 years, respectively. Reported postherpetic neuralgia (PHN) cases increased five-fold over the study period. In 2019, 19% of all HZ patients developed HZ-related neuropathic pain; 13.6% had signs of persistent pain (> 90 days; i.e. PHN). An increased occurrence of cerebral and cardiovascular disease was observed in HZ patients. Among high-risk groups the occurrence of HZ peaked among those with inflammatory and autoimmune diseases. Conclusion: HZ and PHN risk in Sweden is comparable to that in other European countries prior to implementing HZ national vaccination programs. Municipal differences suggest that the lifetime risk of HZ in Sweden is at least 36.5%. Clinical Trial Registration: NCT Number (www.clinicaltrials.gov). Plain Language Summary: What is the context? The varicella-zoster virus (VZV) can reactivate after primary infection and cause herpes zoster or shingles. Shingles is painful and mostly affects people aged > 50 years or those who have weakened immunity due to age, illness or medical treatments. The National Immunization Program (NIP) in Sweden does not currently include vaccination against shingles. We evaluated how often individuals from Västra Götaland Region, Sweden, experienced shingles and its complications. What is new? Overall, the number of shingles and PHN cases increased significantly from 2005 to 2021. We found that 14% of patients with shingles had pain persisting for > 3 months after a shingles episode. Most people developing shingles (about 70%) are healthy individuals without comorbidities, although those with underlying health issues have more risk of getting shingles. Over a follow-up period of 5.5 years, 8.7% of patients with shingles had more than one shingles episode. What is the impact? The occurrence of shingles and postherpetic neuralgia in Sweden is higher than what was reported previously and is comparable to other European countries before the implementation of shingles vaccination programmes. [ABSTRACT FROM AUTHOR]

Copyright of Revista Científica de Enfermería (2071-5080) is the property of Colegio de Enfermeros del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Despite the ongoing successes in utilizing physical education and health technologies to address physique disorders arising from an accumulation of excess adipose tissue, the imperative to further investigate preventive measures against such metabolic disorders in the adult population remains pertinent. Research aim: To identify additional risk factors influencing the development of excess body weight and obesity among individuals in the Republic of Kazakhstan, considering varying levels of weekly physical activity. Materials and methods. This research project was conducted at medical clinics in the city of Semey (Republic of Kazakhstan), involving the participation of 299 individuals, comprising 86 men (28.8%) and 213 women (71.2%), with an average age of 34.9 years. An anthropometric examination was performed, measuring length (cm) and body weight (kg) to calculate body mass index (BMI). Each participant in the study answered questions in a questionnaire that contained information about gender, education, profession, and social and living conditions. Responses to each question were assessed within a range of five answer options on a Likert scale. According to the level of weekly physical activity, all respondents were divided into two groups. The first group included respondents who had moderate weekly physical activity of more than 150 minutes per week or intense physical activity of at least 75 minutes per week. The second group included respondents whose weekly moderate or intense physical activity was less than 150 or 75 minutes per week, respectively. Results. A normal body mass index value was found in 52.5% of respondents. Insufficient weight was noted in 7.35%. Excess body weight - in 23.41% of surveyed respondents and obesity - in 16.72%. Most often, overweight and obesity are registered at the age of 42-49 years, as well as in the group of respondents over 50 years old. This allows us to classify them as a risk group for metabolic disorders in the body. Overweight and obesity were more often recorded in the group of women with low weekly physical activity (≤150 min per week). With physical inactivity, women can be considered at risk for overweight and obesity. Of all the respondents, the greatest satisfaction with physical activity was recorded in the group of respondents with a normal body mass index (47.1%). In the group of respondents with overweight or obesity, the minimum number of people who are satisfied with their physical activity was found. Respondents with normal weight in most cases prefer to engage in physical activity every day or 1-3 times a week. Respondents with overweight or obesity engage in physical activity mainly once a month or not at all. Conclusions. When organizing physical education and recreational activities to correct body weight, it is necessary to take into account the identified age and gender characteristics of risk groups of people with excess body weight and obesity and their relationship with the level of physical activity. [ABSTRACT FROM AUTHOR]

Ostracism—being excluded and ignored—is commonly investigated in experimental settings, leaving specific societal risk groups greatly unexplored. Here, we examined whether individuals' employment status and age affect ostracism frequency and outsider feelings. Using panel data from two countries, we find that especially younger unemployed (vs. younger employed or older unemployed) adults report experiencing ostracism more frequently (SOEP‐IS; N = 1,750) and feeling more like outsiders (NZAVS; N ∼ 30,000 per wave). A subsequent survey study (N = 331) additionally tested three possible mediators for why younger (vs. older) unemployed individuals are more at risk of experiencing ostracism (occupational future time perspective [FTP], descriptive work norms, and work centrality). Moreover, unemployment stigma consciousness—expected stigmatisation—positively correlates with ostracism frequency and outsider feelings. The findings identify unemployed individuals as one at‐risk group for experiencing ostracism and make a first informative step in minimising ostracism experiences and their consequences for those affected. [ABSTRACT FROM AUTHOR]

Upon pooling and analyzing patient-level data from four randomized trials of frontline immuno-oncology/tyrosine kinase inhibitor combination therapy, benefit was shown to be greater in the intermediate/poor-risk group as per the available follow-up data. While frontline immuno-oncology/tyrosine kinase inhibitor (IO/TKI) combination therapy has established a benefit in metastatic renal cell carcinoma (mRCC), this may differ by International Metastatic RCC Database Consortium (IMDC) risk grouping. Looking at individual trials, we noted an apparently smaller magnitude of benefit for favorable-risk disease. We aimed to assess treatment benefit by risk groupings, especially in favorable-risk, augmenting patient numbers via a pooled analysis. We pooled four frontline mRCC trials of IO/TKI combinations including 3,098 patients (839 favorable-risk) with approvals from 2019 to 2021. All trials used IO/TKI combinations as the treatment option and sunitinib as the control. We analyzed progression-free survival (PFS) and overall survival (OS) by IMDC groupings. To specifically address the favorable-risk group, we combined all others into an intermediate/poor-risk group. In this exploratory analysis adjusted for baseline covariates, IO/TKI combinations have yet to demonstrate an OS benefit in favorable-risk (hazard ratio [HR] 1.24; 95% confidence interval [CI]: 0.86, 1.78) despite demonstrating an OS benefit in the intermediate/poor-risk group (HR 0.64; 95% CI: 0.55, 0.75). In contrast, IO/TKI demonstrated a PFS benefit for both the favorable-risk (HR 0.63; 95% CI: 0.50, 0.79) and the intermediate/poor-risk (HR 0.52; 95% CI: 0.45, 0.60) group. For objective response rate, a smaller difference was observed between the combination and sunitinib arms in favorable-risk (68.2% vs 49.9%) versus intermediate/poor-risk (59.9% vs 36.5%) groups, while the difference in complete response rate was larger for favorable-risk (15.3% vs 6.0%) versus intermediate/poor-risk (9.1% vs 3.4%) groups. The frontline IO/TKI combination therapy benefit was shown to be greater in the intermediate/poor-risk group than in the favorable-risk group. The OS benefit observed with IO/TKI for mRCC has yet to be demonstrated for favorable-risk patients; longer follow-up is needed. Patients with intermediate/poor-risk metastatic renal cell carcinoma derive an overall survival benefit from immuno-oncology/tyrosine kinase inhibitor combinations, while data for favorable-risk remain immature. [ABSTRACT FROM AUTHOR]

Pile construction projects cause significant time and expense overruns. The pile installation activity is the primary reason for project underperformance and uncertainties. Additionally, the risks associated with pile installation are mostly considered independent in the overall risk management process, leading to inadequate risk assessment and response. However, few studies have evaluated the risks associated with pile installation. Thus, this study aims to establish the risks of the time and cost of pile installation, using an interdependency network model with a particular emphasis on sand and rocky terrain conditions. In addition, this study introduces a new method for establishing a model that considers the interrelationships among risks via a partial least squares structural equation model (PLS-SEM). The research methodology involves assessing the probability and impact of 53 risk factors of pile installation time and cost. Twelve pile construction experts participated in this assessment. Then, a Monte Carlo Simulation was utilized before the data were integrated into the PLS-SEM. The research findings reveal that the site and economic risks indirectly affect the cost of installing pile in sand through construction risks. Also, the risk group comprising site and equipment risks indirectly affects the cost of installing pile in rock through design risks. This study's findings will help construction organizations to improve time and cost risk assessments for pile installation projects. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatitis B virus (HBV) epidemiology in Europe differs by region and population risk group, and data are often incomplete. We estimated chronic HBV prevalence as measured by surface antigen (HBsAg) among general and key population groups for each country in the European Union, European Economic Area and the United Kingdom (EU/EEA/UK), including where data are currently unavailable. Methods We combined data from a 2018 systematic review (updated in 2021), data gathered directly by the European Centre for Disease Control (ECDC) from EU/EEA countries and the UK and further country-level data. We included data on adults from the general population, pregnant women, first time blood donors (FTBD), men who have sex with men (MSM), prisoners, people who inject drugs (PWID), and migrants from 2001 to 2021, with three exceptions made for pre-2001 estimates. Finite Mixture Models (FMM) and Beta regression were used to predict country and population group HBsAg prevalence. A separate multiplier method was used to estimate HBsAg prevalence among the migrant populations within each country, due to biases in the data available. Results There were 595 included studies from 31 countries (N = 41,955,969 people): 66 were among the general population (mean prevalence ( $$\stackrel{-}{p}$$ ) 1.3% [range: 0.0-7.6%]), 52 among pregnant women ( $$\stackrel{-}{p}=$$ 1.1% [0.1–5.3%]), 315 among FTBD ( $$\stackrel{-}{p}=$$ 0.3% [0.0-6.2%]), 20 among MSM ( $$\stackrel{-}{p}=$$ 1.7% [0.0-11.2%]), 34 among PWID ( $$\stackrel{-}{p}=$$ 3.9% [0.0-16.9%]), 24 among prisoners ( $$\stackrel{-}{p}=$$ 2.9% [0.0-10.7%]), and 84 among migrants ( $$\stackrel{-}{p}=$$ 7.0% [0.2–37.3%]). The FMM grouped countries into 3 classes. We estimated HBsAg prevalence among the general population to be 1% for most countries. Portugal had the highest estimated prevalence of HBsAg among migrants (5.0%), with the other highest prevalences mostly seen in Southern Europe. Conclusions We estimated HBV prevalence for each population group within each EU/EAA country and the UK, with general population HBV prevalence to be

Abstract Objectives The aim of this study is to evaluate the 2015 introduction of prebiopsy magnetic resonance imaging of the prostate (MRI‐P) as the standard of care for diagnosing prostate cancer (PCa) by the Norwegian public health care authorities. There were three specific objectives of this study: first, to evaluate the consequences of using different TNM manuals for clinical T‐staging (cT‐staging) in a national setting; second, to determine if the data reveals that MRI‐P based cT‐staging is superior to digital rectal examination (DRE)‐based cT‐staging compared with pathological T‐stage (pT‐stage) post radical prostatectomy; and third, to assess whether treatment allocations have changed over time. Materials and Methods All patients registered in the Norwegian Prostate Cancer Registry between 2004 and 2021 were retrieved and 5538 were eligible for inclusion. Concordance between clinical T‐stage (cT‐stage) and pT‐stage was assessed by percentage agreement, Cohen's kappa and Gwet's agreement. Results MR visualisation of lesions influences reporting of tumour extension beyond DRE findings. Agreement between cT‐stage and pT‐stage declined from 2004 to 2009, which coincided with an increase in the percentage being pT3. From 2010, agreement increased, which aligned with changes in cT‐staging and the introduction of MRI‐P. From 2017, regarding the reporting of cT‐DRE and cT‐Total (overall cT‐stage), agreement diminished for cT‐DRE but remained relatively stable (>60%) for cT‐Total. Regarding treatment allocation, the study suggests that staging with MRI‐P has shifted treatment towards radiotherapy in locally advanced high‐risk disease. Conclusion Introduction of MRI‐P has affected cT‐stage reporting. Agreement between cT‐stage and pT‐stage appears to have improved. This study suggests that use of MRI‐P influences treatment decisions in certain patient subgroups.

Abstract Background One of the primary aims of contact restriction measures during the SARS-CoV-2 pandemic has been to protect people at increased risk of severe disease from the virus. Knowledge about the uptake of contact restriction measures in this group is critical for public health decision-making. We analysed data from the German contact survey COVIMOD to assess differences in contact patterns based on risk status, and compared this to pre-pandemic data to establish whether there was a differential response to contact reduction measures. Methods We quantified differences in contact patterns according to risk status by fitting a generalised linear model accounting for within-participant clustering to contact data from 31 COVIMOD survey waves (April 2020-December 2021), and estimated the population-averaged ratio of mean contacts of persons with high risk for a severe COVID-19 outcome due to age or underlying health conditions, to those without. We then compared the results to pre-pandemic data from the contact surveys HaBIDS and POLYMOD. Results Averaged across all analysed waves, COVIMOD participants reported a mean of 3.21 (95% confidence interval (95%CI) 3.14,3.28) daily contacts (truncated at 100), compared to 18.10 (95%CI 17.12,19.06) in POLYMOD and 28.27 (95%CI 26.49,30.15) in HaBIDS. After adjusting for confounders, COVIMOD participants aged 65 or above had 0.83 times (95%CI 0.79,0.87) the number of contacts as younger age groups. In POLYMOD, this ratio was 0.36 (95%CI 0.30,0.43). There was no clear difference in contact patterns due to increased risk from underlying health conditions in either HaBIDS or COVIMOD. We also found that persons in COVIMOD at high risk due to old age increased their non-household contacts less than those not at such risk after strict restriction measures were lifted. Conclusions Over the course of the SARS-CoV-2 pandemic, there was a general reduction in contact numbers in the German population and also a differential response to contact restriction measures based on risk status for severe COVID-19. This differential response needs to be taken into account for parametrisations of mathematical models in a pandemic setting.

Background: Haiti's hypertension prevalence among adults ≥40 years of age is nearly twice that of nations in the Americas. Haiti Health Initiative (HHI) developed a hypertension management protocol for use in outreach clinics in Timo, a rural mountainous community in Haiti. This study aimed to evaluate the effectiveness of the hypertension protocol for treating adults ≥40 years of age and pregnant women with severe hypertension. Methods: This retrospective longitudinal study included 209 patients across 1148 clinic visits/encounters. De-identified medical records from 11 biannual outreach clinics between April 2014 to April 2019 were reviewed for analysis. Descriptive statistics, paired t-tests, and multilevel models were performed. The primary outcome was systolic and diastolic blood pressure measurements at each clinic visit. Findings: In the study (n = 1148 visits), hypertension and severe hypertension prevalence were respectively 79·8% and 38·4%. Multilevel models showed a decrease of 0·29 mmHg (p = 0·37) in systolic blood pressure and a decrease in diastolic blood pressure of 0·66 mmHg (p

Foreign capital banks operating in a country have positive and negative aspects to the country's financial system and banking activities. One of the negativities is that banks with foreign capital are not prepared for certain risks and crises; and they tend to leave the country in the face of social and political problems in the country. The aim of this study is to analyze the sensitivity of foreign banks to market risk and to test whether these attitudes of foreign banks have changed despite the impositions of globalization. In line with this determined purpose, it is investigated by cluster analysis whether public, private and foreign capital deposit banks operating in Turkey differ from each other in terms of market risk sensitivity ratios. In other words, their risk groups are investigated by cluster analysis. Results of the analysis, for the period 2018-2020 which includes the pandemic crisis have emphasized that the banks with foreign capital did not differ significantly from other deposit banks. On the contrary, there exist similarities with other banks. This shows that the banking sector has adapted to the globalization phenomenon and does not perform much differently than local banks in terms of sensitivity to market risks. [ABSTRACT FROM AUTHOR]

Introduction: Studies indicate a high prevalence of vitamin D deficiency in both the general population and at-risk groups. Given the association between vitamin D deficiency and various diseases, addressing this concern becomes crucial, especially in situations where routine monitoring is challenging. Materials and methods: A systematic literature review of the current knowledge on vitamin D dosing in diverse at-risk populations and the application of the findings to a broader clinical perspective. Results: The reviewed studies revealed a high prevalence of vitamin D deficiency among patients with musculoskeletal disorders, systemic connective tissue diseases, corticosteroid use, endocrine and metabolic conditions, malabsorption syndromes, obesity, chronic kidney disease, cancer, and central nervous system diseases. Vitamin D deficiency was often more severe compared to the general population. Higher dosages of vitamin D beyond the recommended levels for the general population were shown to be effective in improving vitamin D status in these at-risk individuals. Additionally, some studies suggested a potential link between intermittent vitamin D administration and improved adherence. Conclusion: Simplified dosing could empower clinicians to address vitamin D deficiency, particularly in high-risk populations, even without routine monitoring. Further research is needed to establish the optimal dosing regimens for specific at-risk populations. [ABSTRACT FROM AUTHOR]

Information on Covid-19 disease highlights the importance of preventive measures, especially for those in risk groups. Industrial workers in these groups had to work on the front lines to continue their operation during the pandemic period. In addition to individual measures in controlling the pandemic, it is important to take the necessary measures by the enterprise and to spread these measures on a social level. A total of 194 people from the factory with 347 employees were surveyed in the study, which aimed to emphasize the importance of personal, institutional and social measures, healthy living habits, adequate and balanced eating habits that support the immune system and the importance of controlling the disease. In the study, it was found that healthy living habits and awareness of corona protection are paralleled, diet increases as healthy life habits increase, and corona and its effects decrease. [ABSTRACT FROM AUTHOR]

Background : Heritability of alcohol use disorders (AUDs) varies widely, with reported estimates of 30–78% in twin studies. This variation might be due to methodological differences (e.g., using different thresholds for AUDs, age differences between samples). Aim : To investigate the heritability of AUDs in a nation-wide sample of male and female twins in late adolescence (18 years). Participants : The study is based on data from 8,330 18-year-old Swedish monozygotic (MZ) and dizygotic (DZ) twins from the Child and Adolescent Twin Study (Sweden). Method : Univariate sex-limitation twin analyses were performed using (a) total AUDIT score, (b) different AUDIT cut-offs (AUDIT-10: potentially harmful alcohol use and most likely alcohol dependent ; AUDIT-C: potential hazardous alcohol consumption/active alcohol use disorders), and (c) a risk-group classification for alcohol dependence based on AUDIT total score. Results : Prevalence of potential hazardous alcohol consumption/active alcohol use was 57.1%, and for potentially harmful alcohol use prevalence was 26.5%. Prevalence was higher among females (59.0% and 31.1% respectively) than males (54.4% and 20.0% respectively). Overall, the results of the univariate model fitting indicated that there were qualitative sex differences in the genetic and environmental influences on AUDs, with generally moderate heritability estimates ranging between 0.37 and 0.50. Discussion : At odds with previous research, a harmful/hazardous drinking pattern was more common in this age group among females than a low-risk drinking pattern (where males were overrepresented). Heritability estimates were moderate throughout all measures and cut-offs, with equally high contributions from shared and non-shared environment. Sex-limitation models revealed qualitative sex differences for AUDs, suggesting that different genetic and/or environmental factors influence variation in AUDs in males and females. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) epidemiology in Europe differs by region and population risk group, and data are often incomplete. We estimated chronic HBV prevalence as measured by surface antigen (HBsAg) among general and key population groups for each country in the European Union, European Economic Area and the United Kingdom (EU/EEA/UK), including where data are currently unavailable. Methods: We combined data from a 2018 systematic review (updated in 2021), data gathered directly by the European Centre for Disease Control (ECDC) from EU/EEA countries and the UK and further country-level data. We included data on adults from the general population, pregnant women, first time blood donors (FTBD), men who have sex with men (MSM), prisoners, people who inject drugs (PWID), and migrants from 2001 to 2021, with three exceptions made for pre-2001 estimates. Finite Mixture Models (FMM) and Beta regression were used to predict country and population group HBsAg prevalence. A separate multiplier method was used to estimate HBsAg prevalence among the migrant populations within each country, due to biases in the data available. Results: There were 595 included studies from 31 countries (N = 41,955,969 people): 66 were among the general population (mean prevalence () 1.3% [range: 0.0-7.6%]), 52 among pregnant women ( 1.1% [0.1–5.3%]), 315 among FTBD ( 0.3% [0.0-6.2%]), 20 among MSM ( 1.7% [0.0-11.2%]), 34 among PWID ( 3.9% [0.0-16.9%]), 24 among prisoners ( 2.9% [0.0-10.7%]), and 84 among migrants ( 7.0% [0.2–37.3%]). The FMM grouped countries into 3 classes. We estimated HBsAg prevalence among the general population to be < 1% in 24/31 countries, although it was higher in 7 Eastern/Southern European countries. HBsAg prevalence among each population group was higher in most Eastern/Southern European than Western/Northern European countries, whilst prevalence among PWID and prisoners was estimated at > 1% for most countries. Portugal had the highest estimated prevalence of HBsAg among migrants (5.0%), with the other highest prevalences mostly seen in Southern Europe. Conclusions: We estimated HBV prevalence for each population group within each EU/EAA country and the UK, with general population HBV prevalence to be < 1% in most countries. Further evidence is required on the HBsAg prevalence of high-risk populations for future evidence synthesis. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is a chronic immune-mediated disorder triggered by the ingestion of gluten in genetically predisposed individuals, affecting about 1% of the general population in the developed world. In 2012, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommendations for CD diagnoses in children and adolescents were introduced, allowing the “no-biopsy” approach if certain criteria were met. This approach was also confirmed in the revised guidelines published in 2020. Thus, the aim of this study was to assess—over a one-year period—the clinical presentations and current status of the management of children and adolescents diagnosed with CD in Poland. Medical records of children and adolescents, newly diagnosed with CD in 2022/2023 in three medical centers in Poland, were involved. Gastroenterologists completed the specific anonymous web-based forms developed in the CD SKILLS project, including data routinely assessed at individual visits about the diagnostic approach and clinical presentation of the disease. Our study assessed 100 patients (56% girls) with an age range 1.6–18.0 years. We found that 98% of patients were serologically tested prior to a CD diagnosis and 58% of patients were diagnosed using the “no-biopsy” approach. In the analyzed group, 40% belonged to a known risk group, only 22% had annual screening before the CD diagnosis (the longest for 9 years), and 19% showed no symptoms at the time of the CD diagnosis. Our research confirmed the applicability of the “no-biopsy” approach for the diagnosis of CD in children and adolescents in Poland, and also showed changes in the clinical picture of CD. Moreover, we highlight the need to introduce broad CD serological screening in risk groups of the Polish population.

Introduction: Although it is known that the frequency of venous thromboembolism is increased in patients with malignancy, literature data on disease severity, prognosis and optimal treatment approach is still unclear, especially in the acute pulmonary embolism (APE) subgroup. In this retrospectiveobservational study, a large single-center APE patient series was analyzed for the presence of malignancy. Method: 864 patients diagnosed with APE and treated with different pharmacological or interventional treatments according to risk categories were analyzed retrospectively. Clinical features, vital signs, pulmonary embolism severity index (PESI)/simplified PESI (sPESI) scores, shock indices, echocardiographic and CT pulmonary angiograpy (CTPA) data of all patients at admission and after treatment were recorded. Results: The numbers and rates of low-risk, intermediate-low-risk, intermediate-high-risk and high-risk APE patients were 121(14%), 146(16.9%), 516(59.7%), 81(9.4%), respectively. Of these patients, 235(27.2%) were treated with ultrasound-assisted thrombolysis (USAT), 56(6.5%) with rheolytic thrombectomy (RT), 144(16.7%) with IV t-PA infusion, and 429(49.7%) with parenteral anticoagulation alone. In-hospital and long-term mortality, minor and major bleeding rates were 59(6.8%), 118(13.7%), 40(4.6%), and 41(4.7%), respectively. 127(14.7%) patients were suffered from oncological disorder in study group. When the patients were evaluated for the presence of malignancy, statistically significant differences were observed in terms of age, initial systolic, diastolic blood pressure, heart rate, room air oxygen saturation, shock index, risk status, PESI and sPESI scores. There was no significant difference in other baseline characteristics, echo and CTPA measurements (Table-1). Considering the risk status of APE, it was determined that patients with malignancy were statistically more frequently in the IHR and HR groups (p=0,001) (Table 2-a). When the treatment preferences were compared in terms of the presence of malignancy, it was reported that USAT and IV t-PA infusion were utilizeded less proportionally, the use of RT and only anticoagulation were applied more frequently in patients with malignancy (p>0.05) (Table 2-b). Statistically significant increase was observed in patients with malignancy for both in-hospital and long-term mortality (OR:2.32, 95%CI (1.26-4.27), p<0.05 and OR:4.78, 95%CI (2.97-7.7), p<0.05). There was no significant difference between major and minor bleeding rates (p>0.05). [ABSTRACT FROM AUTHOR]

Molecular heterogeneity in prostate cancer (PCa) is one of the key reasons underlying the differing likelihoods of recurrence after surgical treatment in individual patients of the same clinical category. In this study, we performed RNA-Seq profiling of 58 localized PCa and 43 locally advanced PCa tissue samples obtained as a result of radical prostatectomy on a cohort of Russian patients. Based on bioinformatics analysis, we examined features of the transcriptome profiles within the high-risk group, including within the most commonly represented molecular subtype, TMPRSS2-ERG. The most significantly affected biological processes in the samples were also identified, so that they may be further studied in the search for new potential therapeutic targets for the categories of PCa under consideration. The highest predictive potential was found with the EEF1A1P5, RPLP0P6, ZNF483, CIBAR1, HECTD2, OGN, and CLIC4 genes. We also reviewed the main transcriptome changes in the groups at intermediate risk of PCa—Gleason Score 7 (groups 2 and 3 according to the ISUP classification)—on the basis of which the LPL, MYC, and TWIST1 genes were identified as promising additional prognostic markers, the statistical significance of which was confirmed using qPCR validation. [ABSTRACT FROM AUTHOR]

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Background: One of the primary aims of contact restriction measures during the SARS-CoV-2 pandemic has been to protect people at increased risk of severe disease from the virus. Knowledge about the uptake of contact restriction measures in this group is critical for public health decision-making. We analysed data from the German contact survey COVIMOD to assess differences in contact patterns based on risk status, and compared this to pre-pandemic data to establish whether there was a differential response to contact reduction measures. Methods: We quantified differences in contact patterns according to risk status by fitting a generalised linear model accounting for within-participant clustering to contact data from 31 COVIMOD survey waves (April 2020-December 2021), and estimated the population-averaged ratio of mean contacts of persons with high risk for a severe COVID-19 outcome due to age or underlying health conditions, to those without. We then compared the results to pre-pandemic data from the contact surveys HaBIDS and POLYMOD. Results: Averaged across all analysed waves, COVIMOD participants reported a mean of 3.21 (95% confidence interval (95%CI) 3.14,3.28) daily contacts (truncated at 100), compared to 18.10 (95%CI 17.12,19.06) in POLYMOD and 28.27 (95%CI 26.49,30.15) in HaBIDS. After adjusting for confounders, COVIMOD participants aged 65 or above had 0.83 times (95%CI 0.79,0.87) the number of contacts as younger age groups. In POLYMOD, this ratio was 0.36 (95%CI 0.30,0.43). There was no clear difference in contact patterns due to increased risk from underlying health conditions in either HaBIDS or COVIMOD. We also found that persons in COVIMOD at high risk due to old age increased their non-household contacts less than those not at such risk after strict restriction measures were lifted. Conclusions: Over the course of the SARS-CoV-2 pandemic, there was a general reduction in contact numbers in the German population and also a differential response to contact restriction measures based on risk status for severe COVID-19. This differential response needs to be taken into account for parametrisations of mathematical models in a pandemic setting. [ABSTRACT FROM AUTHOR]

About 3 billion people of various age groups in all countries of the world suffer from iron deficiency (ID) in recent years. Iron is an important component of many biochemical reactions, and its deficiency causes a number of negative outcomes. The review summarizes literature data on diagnosis, assessment of quality of life, and treatment of ID, which is one of the urgent problems of adolescence, because major changes in the body occur during puberty. A number of factors are involved in the genesis of iron deficiency: rapid growth of the organism, chronic diseases of the digestive tract, menstrual blood loss in teenage girls. The reason of iron deficiency is also insufficient intake of it into the organism. To diagnose anemia is not difficult on the base of a decrease of hemoglobin, blood color index and hematocrit, and the presence of characteristic symptoms. Timely detection of iron deficiency in the organism makes possible to correct it and improve the child's condition. The review includes the data of many clinical studies of ID in children and adolescents, the main laboratory criteria for diagnosis are defined. Special emphasis is placed on the effectiveness of using modern iron preparations with high clinical effectiveness and minimal side effects. [ABSTRACT FROM AUTHOR]

Background. Early identification of risk factors (RF) associated with cardiovascular diseases (CVD) is essential for the prevention of CVDs and their complications. CVD risk factors can be identified using Artificial Intelligence (AI) systems, which are capable of learning, analyzing and drawing conclusions. The advantage of AI systems consists in their capacity to process large amounts of data over a short period of time and produce ready-made information. Objectives. Evaluation of the efficiency of implementing an AI software application by a general practitioner for identifying CVD risk factors.Methods. The study included data from 1778 electronic medical histories of patients aged over 18, assigned to an outpatient and polyclinic department of Muravlenkovskaya Gorodskaya Bolnitsa (Muravlenko municipal hospital), Yamalo-Nenets Autonomous Okrug (Russia). The study was conducted in four stages. The first stage involved a preliminary training of the Artificial Intelligence (AI) system under study using numerous CVD risk assessment scales. The Webiomed predictive analytics and risk management software by K-SkAI, Russia, was selected as a platform for this purpose. The second stage included an analysis of medical data to identify CVD risk factors according to the relative risk scale for patients under 40 and the SCORE scale for patients over 40. At the third stage, a specialist analyzed the previous and new information received about each patient. According to the results of the third stage, four risk groups for CVD (low, medium, high and very high) were formed. At the fourth stage, newly diagnosed patients with a high risk of CVD, who had not been previously subject to regular medical check-up, were directed for additional clinical, laboratory and instrumental follow-up examination and consultations of relevant specialists. Statistical data in absolute terms and as a percentage were obtained. Statistical processing of the results was carried out by a computer program aimed at medical decision support. Content visualization was performed in spreadsheets and charts.Results. Based on the data obtained, the AI system under study divided all patients into CVD risk groups and identified uncounted factors. The AI system confirmed a high and very high risk of CVD according to SCORE (Systematic COronary Risk Evaluation) in 623 people, who were already receiving appropriate cardiological assistance. The RFs that had not previously been taken into account in the diagnosis were recorded in 41 (11.5%) patients from the very highrisk group and in 37 (12.7%) high-risk patients. The AI system identified a high risk of CVD in 29 people who had not been previously under care of a general practitioner or other specialists due to their infrequent visits to health care facilities. These patients were detected by the AI system following periodic and preliminary medical check-ups (35%), full in-patient treatment for other diseases (31%), when seeking help of other specialists (17%), as well as when obtaining a medical certificate for a driving license (12%), admission to a swimming pool (3%) or possessing a weapon (2%). In a group with the newly diagnosed patients at a high risk of CVD, men dominated (24 persons, 82%) and women comprised only 8% (5 persons). All these people were of working age between 40 and 50. In order to confirm the information received, the supervising physician subsequently referred patients for a follow-up examination, as a result of which only 1 person (3%) was not diagnosed with a somatic pathology.Conclusion. The efficiency of the AI system under study comprised 97%. Permanent monitoring of all parameters of electronic medical histories and outpatient records is an efficient method for timely identification of RF at any visit of a person to a health care facility (preventive and periodic medical examinations, regular check-ups, specialist consultations, etc.) and their assignment to respective CVD risk groups. Such monitoring ensures an effective medical supervision of able-bodied populations.

The present study aimed to implement ProMisE classification and risk grouping on a retrospective cohort of 628 patients with endometrial cancer (EC) and determine the molecular heterogeneity across subtypes and subgroups, as well as to investigate the potential beneficiary for TIM-3 checkpoint inhibition in ECs. Protein expressions of p53, MMR, TIM-3 and CD8 were measured by immunohistochemistry, and massively parallel sequencing was conducted for 128 cancer-related genes. Patients were categorized into four ProMisE subtypes: MMR-deficient (MMRd), POLE-ultramutated (POLEmut), p53-wild type (p53wt), and p53-abnormal (p53abn), and were subjected to risk classification. 43 (6.9%) patients belonged to POLEmut, 118 (18.8%) to MMRd, 69 (11%) to p53abn, and 398 (63.3%) to p53wt. Compared to the 2016 stratification system, the 2021 ESGO/ESTRO/ESP risk stratification integrated with molecular classification revealed that 11 patients (11/628, 1.8%) were upgraded due to the p53abn signature, whereas 23 patients (23/628, 3.7%) were downgraded due to the POLEmut signature. JAK1 and RAD50 mutations showed higher frequencies in patients with aggressive phenotypes. RAD51B mutation was significantly related to poor RFS of the p53wt subtype but not of the other three molecular subgroups. TIM-3 expression was detected in 30.9% immune cells (ICs) and 29.0% tumor cells (TCs) in ECs, respectively. It was frequently expressed in POLEmut and MMRd ECs as compared to that in the other two molecular subtypes in TCs and ICs. Our study revealed the molecular heterogeneity across subtypes and subgroups. The new risk stratification system changed the risk grouping of some patients due to the integration of molecular features. RAD51B mutation can further stratify the recurrence risk in the p53wt subtype. Patients with MMRd or POLEmut may benefit most from immunotherapy against TIM-3. • The integration of molecular classification can change the risk grouping to varying degrees. • RAD50 and JAK1 mutations in EC may be associated with aggressive phenotypes. • RAD51B mutation status may further stratify the recurrence risk of the p53wt subtype. • Patients with MMRd or POLEmut may benefit most from immunotherapy against TIM-3 in EC. [ABSTRACT FROM AUTHOR]

In this report, we validated a novel prognostic model structured by the "International Metastatic Renal Cell Carcinoma Database Consortium (IMDC)" for patients with metastatic renal cell carcinoma. The former favorable risk group was divided into 2 new categories: very favorable and favorable. Patients with very favorable risk had better survival than those with the novel favorable risk. Further studies are needed to evaluate whether less intensive therapies could be as effective as current combinations of therapies in the very favorable risk group. Background: A novel prognostic model was recommended for patients with metastatic RCC (mRCC) by the International mRCC Database Consortium (IMDC). In this study, we aimed to externally validate a novel risk model for the IMDC-favorable risk group in patients with mRCC. Methods: The Turkish Oncology Group Kidney Cancer Consortium (TKCC) is a multicenter registry that includes 13 cancer centers in Turkey. As described by Schmidt et al., 3 parameters (ie, time from diagnosis to systemic therapy < 3 vs. =3 years, Kar nofsky Per for mance Status [KPS] 80 vs. > 80, and the presence of brain, liver, or bone metastasis) were used to divide the IMDC favorable risk group into 2 new categories: very favorable and favorable risk groups. The primary endpoint was overall survival (OS). Time to treatment failure (TTF) and objective response rate (ORR) in the very favorable and favorable risk groups were the secondary endpoints. Results: A total of 545 patients with mRCC from all IMDC risk groups and 112 patients from the favorable risk group were included in this study. According to the novel classification model, 44 (39.3%) and 68 (60.7%) patients with former favorable risk were categorized into very favorable and favorable risk groups, respectively. The median OS (55.8 months vs. 34.2 months, P = .025) and TTF (25.5 months vs. 15.5 months, P = .010) were longer in the very favorable risk group than in the favorable risk group. The concordance index of the new IMDC model in all patients was 0.65 for OS. Despite the higher ORR in the very favorable risk group than in the favorable risk group, the difference between the groups was not statistically significant (52.4% vs. 44.7, P = .573). Conclusions: This was the first study to externally validate the novel IMDC risk model presented in the American Society of Clinical Oncology Genitourinary Cancers Symposium 2021. [ABSTRACT FROM AUTHOR]

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20–30 ng/mL (50–75 nmol/L)], and optimal concentration [30–50 ng/mL (75–125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland. [ABSTRACT FROM AUTHOR]

Cardiovascular risk and diseases among patients recovered from COVID-19 is a recent field of study in the world medical literature and is also of vital importance because a large number of patients develop complications once the acute phase of the disease is over. The broad spectrum of myocardial injury in cardiovascular diseases can range from the asymptomatic elevation of cardiac troponin levels to the development of fulminant myocarditis and/or circulatory shock, which can leave significant sequelae. Despite the fact that there is no clear strategy to treat cardiac events that occur during COVID-19 infection and taking into account that treatment is mainly aimed at relieving patients' symptoms as they arise, the objective of this work was to find out and collect current evidence on this subject, so that readers can be offered a reference guide in Spanish that contributes to the development of their health profession. The methodology used was a literature search in databases including Medline, Scopus and ScienceDirect within a time window between 2019 and 2022. The main results revealed that the molecular and pathophysiological mechanisms involved in post-COVID-19 syndrome include the renin-angiotensin-aldosterone system since SARS-CoV-2 tropism is linked to angiotensin-converting enzyme 2. This causes an alteration of the neurohumoral response of the cardiovascular, renal and digestive systems, generating deficits in the signaling pathways and causing direct damage to the heart, lungs and other organs. Post-COVID-19 syndrome, in general, is defined as the occurrence or persistence of symptoms three or four weeks after the acute phase of the disease. This could then be considered as a time window of risk and strict follow-up to assess in a personalized way the risk among the different groups of patients, especially those with a past history of cardiovascular disease. The main results revealed disorders such as heart failure, arrhythmias, pericarditis and myocarditis, which require early detection and occur days or even weeks after the acute phase of COVID-19. [ABSTRACT FROM AUTHOR]

The article presents expert survey analysis results and defines major behavior models for main population groups in TB, HIV, hepatitis, STD infection risk zone (risk groups) in situation of wide spread of socially dangerous diseases. The correlation was detected between risk groups behavior models/types and their formation factors, including value-motivation, socio-economic, financial, medical, cognitive and social factors, as well as stigmatization and self-stigmatization. The research shows that it is impossible to relate risk groups behavior to only one or two factors. All influential factors should be considered in connection to each other. Th e article determines most effective interventions changing risk groups behavior from passive to health-preserving one, such as information and communication campaign on safe behavior; expanding state funding on HIV, TB, hepatitis, STDs services; legal framework improvement for services in fi eld of HIV infection, TB, hepatitis, STDs for various risk groups; expanding NGOs’ access to risk groups interventions. Th e article emphasizes the fact that preventive work against spreading HIV/AIDS epidemic involves behavioral interventions at individual and social level. It is proposed to consider the problem of socially dangerous diseases resistance not as a part of medical system only, but also as a part of political, managerial, economic, social, humanitarian and cultural problem that cannot be solved by branch medical management or medical means only. [ABSTRACT FROM AUTHOR]

Ioana Munteanu,1 Nicoleta Cioran,1,2 Rob van Hest,3,4 Ibrahim Abubakar,5 Alistair Story,6,7 Domnica Chiotan,1 Gerard de Vries,8,9 Beatrice Mahler1,10 1Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, Romania; 2 3rd Department – Complementary Sciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Tuberculosis Control, Regional Public Health Service Groningen, Groningen, The Netherlands; 4Department of Lung Diseases and Tuberculosis, University Medical Centre Groningen (UMCG), Groningen, The Netherlands; 5Institute for Global Health, University College London, London, UK; 6Institute of Health Informatics, University College London, London, UK; 7Find and Treat, University College Hospitals NHS Foundation Trust, London, UK; 8KNCV Tuberculosis Foundation, The Hague, The Netherlands; 9Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; 10 4th Department – Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaCorrespondence: Nicoleta Cioran, Department of Pneumology, Marius Nasta Institute of Pneumology, Soseaua Viilor nr.90, Sector 5, Bucharest, Romania, Tel +40 745 419 994, Fax +40 213 373 801, Email nicoleta.cioran@umfcd.roPurpose: Romania has the highest tuberculosis (TB) burden in the European Union/European Economic Area (EU/EEA) comprising almost a quarter (23.4%) of the reported patients in 2017, and a TB notification rate six times higher than the EU/EEA average. Although the overall TB notification rate in Romania declined from 154/100.000 individuals to 66/100.000 individuals in the general population between 2002 and 2017, TB notification rates remain high in certain vulnerable populations groups such as prisoners, the homeless population and among drug users.Patients and Methods: We conducted a descriptive study regarding TB monitoring data in Romania, including the aforementioned TB risk groups.Results: Analysis regarding notified TB cases among these risk groups indicates that TB rates are 7 to 18 times higher than in the general population. One of the most alarming aspects regards the exceedingly high proportion of HIV-seropositivity among drug users and the high mortality rates among the homeless population and among drug users with TB.Conclusion: This data underlines the importance of early identification among social risk groups using outreach active case-finding (ACF) activities, possibly combining TB screening with screening for other common, possibly life-threatening, co-morbidities for which an effective treatment is available. ACF could have a decisive role in TB control and eradication in Romania, when aimed at these high-risk groups.Keywords: Romania, tuberculosis, notification rate, risk groups

We identify novel risk groups of patients with suspected low-grade nonmuscle invasive bladder cancer (NMIBC). We utilize regression-tree analysis to characterize those who maximally benefit from intravesical chemotherapy following transurethral resection of bladder tumor (through recurrence-free survival). Cancer control outcomes vary between these risk groups, and the maximum benefit is observed in older patients with a single tumor. Background: Nonmuscle invasive bladder cancer (NMIBC) has an elevated risk of recurrence, and immediate postresection intravesical instillation of chemotherapy (IVC) significantly reduces the risk of recurrence. Questions remain about which subpopulation may maximally benefit from IVC. Our aim was to develop risk groups based on recurrence risk in NMIBC, and then evaluate the impact of a single, postoperative instillation of IVC on the subsequent risk of recurrence for each risk group. Material and Methods: Using the SWOG S0337 trial cohort, we performed a posthoc analysis of 345 patients who were diagnosed with suspected low-grade NMIBC, underwent transurethral resection of the bladder tumor (TURBT), and received post-operative IVC (gemcitabine vs. saline). Using regression tree analysis, the regression tree stratified patients based on their risk of recurrence into low-risk - single tumor and aged < 57 years, intermediate-risk - single tumor and aged ≤ 57 years, and high-risk - multiple tumors. We used Cox proportional hazard models to test the impact of recurrence-free rate, and after adjustment to available covariates. Results: Median age of the cohort was 66.5 (IQR: 59.7-75.8 years) with 85% of patients being males. Median overall follow-up time was 3.07 years (IQR: 0.75-4.01 years). When testing the impact of treatment in each risk group separately, we found that patients in the intermediate-risk treated with gemcitabine had a 24-month recurrence free rate of 77% (95% CI: 68%-86%) vs. 59% (95% CI: 49%-70%) in the saline group. This survival difference was confirmed on multivariable analysis (hazard ratio: 0.39, 95% CI: 23%-66%, P < 0.001). This group represented 53% of our cohort. Conversely, we did not observe a significant difference in recurrence-free survival among patients in the low- (P = 0.7) and high-risk (P = 0.4) groups. Conclusion: Our findings indicate that older patients with a single tumor of suspected low-grade NMIBC at TURBT maximally benefit from immediate postresection IVC (gemcitabine). [ABSTRACT FROM AUTHOR]

Purpose: Women of reproductive age who carry fragile X premutation (PM) alleles have 56 to 200 CGG repeats in the 5′-untranslated region of FMR1 gene are at increased risk for producing children with intellectual disabilities (ID) or autism spectrum disorders (ASD) due to expansion of PM alleles to full mutation alleles (> 200 repeats) during maternal transmission. Methods: In present study fragile X PM carrier screening was performed in total 808 women who were consulting primary health care centers for preconception care in Khyber Pakhtunkhwa region of Pakistan between April, 2018 and December, 2020. Polymerase chain reaction (PCR) was performed for detection of PM carrier women and the CGG repeats number was confirmed by Southern blotting and capillary electrophoresis. Results: The prevalence rate for PM carriers among preconception women was found to be 0.7% that was contributed by 0.5% women in risk group (RG1) with family history of ID and 0.2% in risk group 2 (RG2) with family history of ASD. PM carrier women had at least one affected child or sibling. In addition, the preconception women with FMR1 PM alleles were found to be at increased risk for primary ovary insufficiency (RG1: P = 0.0265, RG2: P = 0.0389), postpartum depression (RG1: P = 0.0240, RG2: P = 0.0501) and neuropsychiatric disorders (RG1: P = 0.0389, RG2: P = 0.0432). Conclusions: Current study provides first evidence of fragile X PM carrier screening in Pakistani preconception women in primary care consultation. Findings of current study may help to improve preconception care and to reduce burden of fragile X associated disorders in our population. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate tne effect of the risk group on the clinical features of the disease, treatment strategies and especially survival in children with Non-Wilms' renal tumors (NWRTs). Materials and Methods: Patients diagnosed with NWRTs followed up and treated between January 2012 and January 2022 were included in the study (n=29; 16 boys and 13 girls). They were categorized into high- and low-risk groups based on their histological type. Patient records were reviewed retrospectively. Clinical characteristics, treatments, and outcomes of these patients were analyzed. Results: The high-risk group comprised clear cell sarcoma (CCSK) (n=8, 27.6%), malignant rhabdoid tumor (MRT) (n=3, 10.3%), renal cell carcinoma (n=2, 6.9%), non-Hodgkin lymphoma (n=1, 3.4%), and primitive neuroectodermal tumor (PNET) (n=1, 4%). The low-risk group comprised congenital mesoblastic nephroma (CMN) (n=9, 31%), angiomyolipoma (n=4, 3.8%), and hemangioma (n=1, 3.4%). Five patients died due to disease progression (mortality rate, 17%), all of whom belonged to the high-risk group (three patients with MRT, one with CCSK, one with PNET). The 5-year survival rate was 72% for the high risk group and 100% for the low risk group. Conclusion: Although low-risk tumors are associated with excellent outcomes, the outcomes vary in high-risk tumors. Physicians should be wary of high mortality rates in children with MRT, CCSK, and PNET, and should design multidisciplinary treatments for NWRTs. [ABSTRACT FROM AUTHOR]

Abstract Purpose Women of reproductive age who carry fragile X premutation (PM) alleles have 56 to 200 CGG repeats in the 5′-untranslated region of FMR1 gene are at increased risk for producing children with intellectual disabilities (ID) or autism spectrum disorders (ASD) due to expansion of PM alleles to full mutation alleles (> 200 repeats) during maternal transmission. Methods In present study fragile X PM carrier screening was performed in total 808 women who were consulting primary health care centers for preconception care in Khyber Pakhtunkhwa region of Pakistan between April, 2018 and December, 2020. Polymerase chain reaction (PCR) was performed for detection of PM carrier women and the CGG repeats number was confirmed by Southern blotting and capillary electrophoresis. Results The prevalence rate for PM carriers among preconception women was found to be 0.7% that was contributed by 0.5% women in risk group (RG1) with family history of ID and 0.2% in risk group 2 (RG2) with family history of ASD. PM carrier women had at least one affected child or sibling. In addition, the preconception women with FMR1 PM alleles were found to be at increased risk for primary ovary insufficiency (RG1: P = 0.0265, RG2: P = 0.0389), postpartum depression (RG1: P = 0.0240, RG2: P = 0.0501) and neuropsychiatric disorders (RG1: P = 0.0389, RG2: P = 0.0432). Conclusions Current study provides first evidence of fragile X PM carrier screening in Pakistani preconception women in primary care consultation. Findings of current study may help to improve preconception care and to reduce burden of fragile X associated disorders in our population.

Abstract: Hospital-acquired pneumonia (HAP) is the most common purulent septic infection among patients treated in intensive care units (ICUs) at cardiac surgery hospitals. Risk factors that can cause HAP, in particular, contribution made by artificial ventilation (AV) have not been studied enough. Our objective was to examine an epidemiological role played by AV in HAP occurrence among children and adults treated in the intensive care unit at a cardiac surgery hospital. We examined health records of 5318 patients (503 children and 4815 adults) who had a cardiac surgery due to congenital heart diseases or acquired cardiovascular disorders over 1 year. HAP was identified according to the epidemiological standards for case definition. Besides, we took into account pre-nosologic HAP cases, that is, patients already having certain pathological symptoms typical for purulent septic infections, but still, even combined, these symptoms were not enough to diagnose a typical HAP case in accordance with the standard case definition. Data were statistically analyzed by calculating the χ2 goodness-of-fit test. We established that most HAP cases occurred among patients of a cardiac surgery hospital who were being treated in the intensive care unit after a surgery. We proved AV to be the leading risk factor causing HAP. Higher incidence rates of HAP were detected among children in comparison with adults. We showed that Klebsiella pneumoniaе was the primary infectious agent that caused HAP. Particularly, background respiratory diseases and diseases of the central nervous system were proven to be endogenous risk factors of developing HAP among patients treated in the ICU at a cardiac surgery hospital.