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We develop a proportional incidence model that estimates vaccine effectiveness (VE) at the population level using conditional likelihood for aggregated data. Our model assumes that the population counts of clinical outcomes for an infectious disease arise from a superposition of Poisson processes with different vaccination statuses. The intensity function in the model is calculated as the product of per capita incidence rate and the at‐risk population size, both of which are time‐dependent. We formulate a log‐linear regression model with respect to the relative risk, defined as the ratio between the per capita incidence rates of vaccinated and unvaccinated individuals. In the regression analysis, we treat the baseline incidence rate as a nuisance parameter, similar to the Cox proportional hazard model in survival analysis. We then apply the proposed models and methods to age‐stratified weekly counts of COVID‐19–related hospital and ICU admissions among adults in Ontario, Canada. The data spanned from 2021 to February 2022, encompassing the Omicron era and the rollout of booster vaccine doses. We also discuss the limitations and confounding effects while advocating for the necessity of more comprehensive and up‐to‐date individual‐level data that document the clinical outcomes and measure potential confounders. [ABSTRACT FROM AUTHOR]

Background: To evaluate the correlation between elevated maternal serum alpha-fetoprotein (AFP) in the second trimester and ischemic placental disease (IPD). Methods: A retrospective cohort study was conducted to analyze the data of 22,574 pregnant women who delivered in the Department of Obstetrics at Hangzhou Women's Hospital from 2018 to 2020, and were screened for maternal serum AFP and free beta-human chorionic gonadotropin (free ß-hCG) in the second trimester. The pregnant women were divided into two groups: elevated maternal serum AFP group (n = 334, 1.48%); and normal group (n = 22,240, 98.52%). Mann-Whitney U-test or Chi-square test was used for continuous or categorical data. Modified Poisson regression analysis was used to calculate the relative risk (RR) and 95% confidence interval (CI) of the two groups. Results: The AFP MoM and free ß-hCG MoM in the elevated maternal serum AFP group were higher than the normal group (2.25 vs. 0.98, 1.38 vs. 1.04) and the differences were all statistically significant (all P < .001). Placenta previa, hepatitis B virus carrying status of pregnant women, premature rupture of membranes (PROM), advanced maternal age (=35 years), increased free ß-hCG MoM, female infants, and low birth weight (RR: 2.722, 2.247, 1.769, 1.766, 1.272, 0.624, 2.554 respectively) were the risk factors for adverse maternal pregnancy outcomes in the elevated maternal serum AFP group. Conclusions: Maternal serum AFP levels during the second trimester can monitor IPD, such as IUGR, PROM, and placenta previa. Maternal women with high serum AFP levels are more likely to deliver male fetuses and low birth weight infants. Finally, the maternal age (=35 years) and hepatitis B carriers also increased maternal serum AFP significantly. [ABSTRACT FROM AUTHOR]

Background Recent work in the UK estimated the prevalence of current cannabinoid-based vaping to be higher than in the USA, a factor previously associated with e-cigarette or vaping-associated lung injury (EVALI). Research in the USA has demonstrated that attendances to emergency departments relating to e-cigarettes began to rise before the EVALI outbreak, suggesting that vapers also experience milder forms of vaping-related illness. Aim Quantify symptom prevalence and healthcare utilization amongst current UK vapers. Design Voluntary online survey of individuals aged 16 and over within the UK. Methods Anonymized data were collected on demographics, vaping/smoking status and vaping substances used. Current vapers were asked about the presence of 10 prevalent symptoms from previous US EVALI case series, healthcare attendances and diagnoses given. Risk-ratios were calculated to compare the likelihood of symptoms and attendances between substances. Results A total of 2477 complete responses were analysed. In all, 397 respondents were current vapers. Symptom prevalence within the previous 12 months ranged from 3.8% to 30.5% (bloody sputum, cough). Healthcare attendances per symptomatic respondent ranged from 0.1 to 1.4 (bloody sputum, shortness of breath). Current vapers of cannabinoid-based products (alone/in combination) had the most attendances per symptomatic respondent for 9/10 symptoms and were more likely to report symptoms aside from 'cough' (nicotine-free e-liquids [risk ratio = 1.7]). Clinicians reportedly never diagnosed vaping-related illness. Conclusions UK vapers experience symptoms previously reported in EVALI cases for which they also seek healthcare. Users of cannabinoid-based products were more likely to report symptoms and accounted for a higher healthcare burden. UK vapers may also experience vaping-related illness that does not meet EVALI case criteria. [ABSTRACT FROM AUTHOR]

Summary: Background: Robustly examining associations between long-term conditions may be important in identifying opportunities for intervention in multimorbidity but is challenging when evidence is limited. We have developed a Bayesian inference framework that is robust to sparse data and used it to quantify morbidity associations in the oldest old, a population with limited available data. Methods: We conducted a retrospective cross-sectional study of a representative dataset of primary care patients in Scotland as of March 2007. We included 40 long-term conditions and studied their associations in 12,009 individuals aged 90 and older, stratified by sex (3039 men, 8970 women). We analysed associations obtained with Relative Risk (RR), a standard measure in the literature, and compared them with our proposed measure, Associations Beyond Chance (ABC). To enable a broad exploration of interactions between long-term conditions, we built networks of association and assessed differences in their analysis when associations are estimated by RR or ABC. Findings: Our Bayesian framework was appropriately more cautious in attributing association when evidence is lacking, particularly in uncommon conditions. This caution in reporting association was also present in reporting differences in associations between sex and affected the aggregated measures of multimorbidity and network representations. Interpretation: Incorporating uncertainty into multimorbidity research is crucial to avoid misleading findings when evidence is limited, a problem that particularly affects small but important subgroups. Our proposed framework improves the reliability of estimations of associations and, more in general, of research into disease mechanisms and multimorbidity. Funding: National Institute for Health and Care Research.

Relevance. Violation of the regulations on the use of personal protective equipment (PPE) by medical workers when providing medical care to patients with COVID-19 (COVID-19) at their workplaces and in other situations requiring PPE is fraught with serious consequences for the health and life of medical personnel and patients. Aims. To assess the impact of violations in the use of PPE on the incidence of COVID-19 of personnel of medical organizations of various profiles, including when providing medical care to patients with COVID-19. Materials and methods. The study used the method of cross-sectional retrospective simultaneous online questionnaire to assess the effectiveness of preventive measures against the spread of COVID-19, conducted from January to March 2022. The results of an anonymous online survey of various categories of personnel of medical, scientific and educational medical organizations of the Russian Federation providing medical care to patients with COVID-19 (n = 6032 people) were analyzed. Results. The study showed the greatest epidemiological significance in the formation of the risk of SARS-COV-2 infection by the irregular use of masks and gloves in the workplace (when providing medical care). The results of the assessment of the strength of the connection of violations in the use of personal protective equipment with infection with SARS-CoV-2 of the studied groups of personnel are presented. It is shown that the irregular wearing of face masks in the workplace when providing medical care has the most pronounced association with the risk of infection of all the factors studied. It is noted that statistically significantly more often the irregular use of masks and gloves in the workplace was allowed by students and nursing staff. Conclusions. The importance of compliance with the regulations for the use of personal protective equipment by medical workers is shown, not only when providing medical care to patients with COVID-19, but also at home, as well as the impact on the incidence of COVID-19 of the irregularity of the use of PPE by medical personnel in various conditions, including when providing medical care to patients with COVID-19.

Chronic persistent viral infection leads to developing immune deficiency and may induce lesions in many organs, the hepatobiliary system included. This, in its turn, may facilitate the onset of diseases of the digestive system under exposure to technogenic chemicals, especially those able to produce hepatotoxic effects. In this study, our aim was to examine risks of developing hepatobiliary disorders in children under combined exposure to persisting herpes infection and technogenic chemicals. We conducted a clinical examination of 324 children aged between 6 and 17 years living either in a large industrial city or on a territory where the sanitary-hygienic situation was favorable. The examination included a clinical checkup, laboratory diagnostic tests identifying herpes markers, chemical analyses aimed at establishing levels of technogenic chemicals in blood, and ultrasound scanning of hepatobiliary organs. We established that exposure to airborne technogenic chemicals created elevated levels of aromatic hydrocarbons and formaldehyde in 64.9–97.6 % of the exposed children; elevated manganese and chromium levels, in 20.8–34.6 % of them. Markers of cytomegalovirus (CMV) and Epstein Barr virus (EBV) were detected in 75 % of the exposed children; each second child had HSV-1 or HSV-2; each third child had human herpesvirus 6. Hepatobiliary disorders occurring under combined exposure to persistent herpes and echnogenic chemicals were represented by structural liver changes in 30.8 % of the examined children; abnormally shaped gallbladder or reactive changes in its walls and dyscholia, in 15.7–48.8 %. These disorders entail elevated levels of direct bilirubin and greater ALT against imbalance of oxidant and antioxidant systems and manifest themselves as biliary pathology in 69.5 % of cases. Exposed children with persistent herpes infection have 1.2–2.3 times higher likelihood of developing structural changes in the liver and gallbladder pathology and up to 4.3 times higher risks of biliary dysfunction and chronic gastroduodenitis.

Objectives: The risk of severe COVID-19 in children with a solid organ transplant (SOT) is not well established. We compare the relative risk of severe COVID-19 infection between pediatric SOT and non-SOT children. Methods: The newly constructed K-COV-N cohort (Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service) was used. Children with COVID-19 (

Background Heatwaves represent the main indices of climate change, while mortality is one of the established markers of their human effects. For unknown reasons populations adapt to temperature variations/challenges differently. Thus, to allow better precision and prediction, heatwave evaluations should be enriched by historical context and local data. Methods The mortality data for 1987 were collected from the Piraeus municipality registry, whereas data for Athens were obtained from literature retrieved from PUBMED. Ambient characteristics were extracted from the Geronikolou’s 1991 BSc thesis and the reports of national organizations. From the death events, the odds ratio and relative risk in Piraeus compared to the Athens were calculated. Finally, a simple neural network proposed the dominant ambient parameter of the heatwave effects in the city residents of each location. Results The 1987 heatwave was more lethal (seven-fold) in Athens than in Piraeus and dependent on atmospheric nitric oxide (NO) concentration (with probability 0.999). In the case of Piraeus in 1987, ozone characterized the phenomenon (with probability 0.993). Conclusions The odds of dying due to a heatwave are highly dependent on lifestyle, population sensitivity to preventive measures and public health policy, while the phenomenon was mainly moderated by ozone in Piraeus in 1987, and NO in Athens irrespective of year.

BackgroundIt is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors.ObjectiveThis study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality.Study designThis was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions.ResultsWe enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32-2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25-2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17-3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99-2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99-5.49) and 6.26 (95% confidence interval, 4.35-9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63-2.86; risk ratio, 2.53; 95% confidence interval, 1.44-4.45; and risk ratio, 2.84; 95% confidence interval, 1.67-4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32-2.35), 2.07 (95% confidence interval, 1.20-3.57), and 2.77 (95% confidence interval, 1.66-4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios.ConclusionCOVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.

Abstract Background Short-term exposure to air pollution is associated with acute lower respiratory infections (ALRI) in children. We investigated the relationship between hospitalization for ALRI in children and air pollutant concentrations from January 1, 2014 to December 31, 2020 in Lanzhou City. Methods We collected data on air pollutant concentrations and children’s hospitalization data during the study period. A time series regression analysis was used to assess the short-term effects of air pollutants on ALRI in children, and subgroup analyses and sensitivity analyses were performed. Results A total of 51,206 children with ALRI were studied, including 40,126 cases of pneumonia and 11,080 cases of bronchiolitis. The results of the study revealed that PM2.5, PM10, SO2 and NO2 were significantly associated with hospitalization for ALRI in children aged 0–14 years. For each 10 µg/m3 increase in air pollutant concentration in lag0-7, the relative risk of ALRI hospitalization in children due to PM2.5, PM10, SO2 and NO2 increased by 1.089 (95%CI:1.075, 1.103), 1.018 (95%CI:1.014, 1.021), 1.186 (95%CI:1.154. 1.219) and 1.149 (95%CI:1.130, 1.168), respectively. Conclusions PM2.5, PM10, SO2 and NO2 short-term exposures were positively associated with ALRI, pneumonia and bronchiolitis hospitalizations in Lanzhou, China. Local governments should make efforts to improve urban ambient air quality conditions to reduce hospitalization rates for childhood respiratory diseases.

Background. Prostate cancer is the second most common cancer in men and the fifth leading cause of death worldwide. Our aim in this study was to investigate the relationship between exposure to cadmium and the incidence of prostate cancer through conducting a systematic review and meta-analysis method. Methods. The Studies that investigated the relationship between cadmium and prostate cancer were searched and retrieved from the international databases until May 2022. (x2) and (I2) statistical tests were used respectively to determine the presence and size of heterogeneity; Egger's and Bagg's tests were used to determine the existence of diffusion bias; and meta-regression and sensitivity analysis were used to identify the source of heterogeneity. All analyses were performed by Stata (Version 15) statistical software. Results. It was observed that the relative risk of prostate cancer occurrence compared to the base group, in people exposed/exposed to a dose higher than the base level was equal to 1.05(95% CI:0.94-1.17; P=0.372); Meanwhile, no statistically significant relationship was observed between exposure to cadmium or exposure levels exceeding the baseline and prostate cancer. According to the results of Egger's test (P = 0.989) and Begg's (P= 0.787), diffusion distortion was not observed in this study. Conclusion. Based on the available evidence, although exposure to cadmium leads to an increase in the risk of prostate cancer, this risk increase is not statistically significant. Practical Implications. The World Health Organization should think with a more serious approach to the relationship between environmental health and cancers.

The contemporary educational process involves growing diversity and complexity of educational programs and intensity of educational loads. All this, in its turn, affects schoolchildren’s health. Diseases of the eye and adnexa occupy the leading place among pathologies that are caused by unfavorable educational conditions. Prevalence of such diseases grows steadily over the whole period of getting secondary education. The aim of this study was to examine peculiarities and assess risks of myopia in children attending comprehensive schools with different educational programs. Overall, we examined 804 children from the 1st to 11th grade. The test group was made of 312 children who attended comprehensive schools with profound studies of some subjects. The reference group included 492 children who attended ordinary comprehensive schools. Both groups were identical as regards sex and age (р = 0.203–0.479). The study involved handing out questionnaires; estimating whether the organization of the educational processes conformed to the sanitary legislation of the Russian Federation. The research data were analyzed by conventional statistical methods, ROC-analysis, and logistic modeling. We established several leading risk factors that caused myopia in students of comprehensive schools with profound studies of some subjects. They included 5.4–19.2 % higher educational loads; 1.4 times longer periods of PC use during classes; 1.5 times longer periods of work with digital technologies. The children from the test group tended to have myopia, including moderate and high one, 1.3–2.4 times more frequently; the disease occurred at a younger age; risks of the disease were typically higher in such schools (OR = 1.48–2.5). Causation of myopia by factors related to the educational process and digital initiation equaled R2 = 0.52–0.77. Use of ROC-curves identified cut-off points that showed how long it took myopia to develop under the specific educational conditions in comprehensive schools with profound studies of some subjects (the 5th grade) and in ordinary comprehensive schools (the 7th grade). ROC-analysis data indicate it is necessary to apply a differentiated approach to organizing preventive activities for children who attend comprehensive schools with different educational programs.

Background Heatwaves represent the main indices of climate change, while mortality is one of the established markers of their human effects. For unknown reasons populations adapt to temperature variations/challenges differently. Thus, to allow better precision and prediction, heatwave evaluations should be enriched by historical context and local data. Methods The mortality data for 1987 were collected from the Piraeus municipality registry, whereas data for Athens were obtained from literature retrieved from PUBMED. Ambient characteristics were extracted from the Geronikolou’s 1991 BSc thesis and the reports of national organizations. From the death events, the odds ratio and relative risk in Piraeus compared to the Athens were calculated. Finally, a simple neural network proposed the dominant ambient parameter of the heatwave effects in the city residents of each location. Results The 1987 heatwave was more lethal (seven-fold) in Athens than in Piraeus and dependent on atmospheric nitric oxide (NO) concentration (with probability 0.999). In the case of Piraeus in 1987, ozone characterized the phenomenon (with probability 0.993). Conclusions The odds of dying due to a heatwave are highly dependent on lifestyle, population sensitivity to preventive measures and public health policy, while the phenomenon was mainly moderated by ozone in Piraeus in 1987, and NO in Athens irrespective of year.

Background Meteorological factors play an important role in human health. Clarifying the occurrence of dog and cat bites (DCBs) under different meteorological conditions can provide key insights into the prevention of DCBs. Therefore, the objective of the study was to explore the relationship between meteorological factors and DCBs and to provide caution to avoid the incidents that may occur by DCBs. Methods In this study, data on meteorological factors and cases of DCBs were retrospectively collected at the Shanghai Climate Center and Jinshan Hospital of Fudan University, respectively, in 2016–2020. The distributed lag non-linear and time series model (DLNM) were used to examine the effect of meteorological elements on daily hospital visits due to DCBs. Results A total of 26,857 DCBs were collected ranging from 1 to 39 cases per day. The relationship between ambient temperature and DCBs was J-shaped. DCBs were positively correlated with daily mean temperature (rs = 0.588, P

Purpose: The association between second-hand smoke (SHS) exposure and cervical cancer (CC) risk is still unclear. The aim of this study is to provide an accurate and updated estimate of this association. Methods: Through an original methodology to identify original publications, we conducted a systematic review and meta-analysis of all epidemiological studies published up to October 2022 evaluating the association between SHS exposure and CC risk among female non-smokers. Meta-analytic estimates were obtained using random-effects models and dose–response relationships were derived using log-linear functions. Results: Out of 25 eligible studies, 21 were included in the meta-analysis, providing a pooled relative risk (RR) of cervical intraepithelial neoplasia (CIN) of grade 2 or higher of 1.52 (95% confidence interval, CI 1.30–1.78, 21 studies) for overall SHS exposure versus non-exposure. When restricting the analysis to invasive CC, the pooled RR was 1.42 (95% CI 1.17–1.71, 13 studies), whereas the pooled RR for CIN was 1.50 (95% CI 1.22–1.84, 6 studies). Analyzing RR by setting or source of SHS exposure resulted in significant associations with CC risk for SHS exposure at home (RR for CIN2+ 1.49, 95% CI 1.21–1.84, 14 studies), in non-specified settings (RR for CIN2+ 1.64, 95% CI 1.20–2.23, 8 studies) and from partner (RR for CIN2+ 1.55, 95% CI 1.25–1.94, 10 studies). The risk of CIN2+ significantly increased linearly with the intensity and pack-years of SHS exposure. Conclusion: This comprehensive review and meta-analysis confirmed the association of SHS exposure with CC, further suggesting the need to raise concern about SHS exposure in the population. [ABSTRACT FROM AUTHOR]

In this work we analyze different aspects regarding the terminology, understanding concepts and approaches in modeling and measuring components and variables related to safety and risk. This discussion conversation is open for further interpretations and suggestions. We study it with the help of models (images) artificial, descriptions, scientific approaches, discussions, etc., and using the help of poly-semantic languages. Various kinds of risks arise precisely because of the uncertainty of the situation. Mathematical models use uncertainties in several ways: randomness, which is explained and measured by objective probability and estimated using statistical methods. Uncertainty, measured by subjective probabilities, is estimated by expert methods, or by fuzzy uncertainty methods. Each of these approaches has its advantages and disadvantages. Despite the difference in approaches to measuring uncertainties, the development of a risk situation are described in an appropriate way using an event tree. We show the construction of an event tree, that allows us to see details and specify in the development of a risk situation. We also discuss how this approach can be used to evaluate the sensitivity of the output characteristics of the process to the parameters of the initial information. [ABSTRACT FROM AUTHOR]

The effectiveness of a vaccine is measured by means of protective vaccine efficacy, defined by V E = 1 − A R V A R U , where A R V and A R U are, respectively, the disease attack rates in the vaccinated and the unvaccinated population. For each of the cohoret and case-control designs, methods have been presented in the literature for calculating the required sample size when the desired width of the confidence interval and the probability of coverage are pre-specified, where an equal number of individuals were assumed to be allocated to the vaccine and placebo group. In this article, we present a method for calculating the required sample size with a specified degree of precision when there is an unequal allocation of individuals across the two groups. The sample size required to achieve a desired power for the relevant level α test has also been explored, keeping the unequal allocation proportion in mind. The fraction of individuals allocated to the placebo group (ρ) can be so chosen that the total sample size or the expected number of people developing the disease or some other criteria of interest is minimized. [ABSTRACT FROM AUTHOR]

This study aimed to identify and evaluate the short-term and lag effects of environmental factors on asthma hospitalizations in different regions. The ecological study on asthma is performed in three regions of Guangxi, China, that are distinctly different in geography and climate. We used distributed lag non-linear models to investigate the exposure-response-lag relationship between meteorological factors, air pollutants, and asthma hospital admissions across the three regions during 2015 (January 1 to December 31). Cold was an important meteorological factor affecting asthma. At lag 0, the relative risk (RR; 23°C as reference) of cold in the Northwest, Northeast, and South was 1.10 (10°C), 1.14 (8°C), and 1.30 (11°C), respectively. NO 2 was identified as the most important air pollutant affecting asthma. The RR of asthma hospitalization increased by 10.9% (at lag 4), 8.1% (at lag 0), and 4.2% (at lag 2) for every 10 μg/m3 increase in NO 2 concentration in the Northwest, Northeast, and South, respectively. In the three regions of Guangxi, there were differences in the dominant factors affecting asthma hospitalizations. Differences in geography can inform governments as to how to prepare the healthcare system to meet the expected peaks. [Display omitted] [ABSTRACT FROM AUTHOR]

In the context of recent climate change, temperature-attributable mortality has become an important public health threat worldwide. A large number of studies in Europe have identified a relationship between temperature and mortality, while only a limited number of scholars provided evidence for Serbia. In order to provide more evidence for better management of health resources at the regional and local level, this study aims to assess the impact of summer temperature on the population in Serbia, using daily average temperature (Ta) and mortality (CDR (crude death rate) per 100,000). The analysis was done for five areas (Belgrade, Novi Sad, Niš, Loznica, and Vranje), covering the summer (June–August) period of 2001–2015. In order to quantify the Ta-related CDR, a generalized additive model (GAM) assuming a quasi-Poisson distribution with log as the link function was used. Five regression models were constructed, for each area, revealing a statistically significant positive relationship between Ta and CDR in four areas. The effect of Ta on CDR was defined as the relative risk (RR), which was obtained as the exponential regression coefficient of the models. RR indicates that a 1 °C increase in Ta at lag0 was associated with an increase in CDR of 1.7% for Belgrade, Novi Sad, and Niš and 2% for Loznica. The model for Vranje did not quantify a statistically significant increase in CDR due to Ta (RR=1.006, 95% CI 0.991–1.020). Similar results were confirmed for gender, with a slightly higher risk for women. Analysis across lag structure showed different exposure, but the highest effect of Ta mainly occurs over the short term and persists for 3 days. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led to millions of documented deaths worldwide, with diverse distribution among countries. Surprisingly, Bulgaria, a middle-income European Union member state, ranked highest in COVID-19 mortality. This study aims to assess whether Bulgarian cancer patients experienced a higher relative risk (RR) of death compared to the general Bulgarian population during the pandemic. Materials and Methods: Data from the Bulgarian National Statistical Institute and the Bulgarian National Cancer Registry were analyzed to estimate monthly RR of death in cancer patients compared to the general population before and during the first two years of the pandemic. The impact of the COVID-19 waves and predominant SARS-CoV-2 variants on RR was evaluated on various cancer types and age groups using a multiple linear regression approach. Results: During the COVID-19 waves, both the general population and cancer patients experienced a significant increase in mortality rates. Surprisingly, the RR of death in cancer patients was lower during pandemic waves. The results from the statistical modeling revealed a significant association between the COVID-19 waves and reduced RR for all cancer patients. Notably, the effect was more pronounced during waves associated with the Alpha and Delta variants. The results also showed varying impacts of the COVID-19 waves on RR when we analyzed subsamples of data grouped depending on the cancer type, age and sex. Conclusions: Despite increased overall mortality in Bulgarian cancer patients during the pandemic, the RR of death was lower compared to the Bulgarian general population, indicating that protective measures were relatively effective in this vulnerable group. This study underscores the importance of implementing and encouraging preventive measures, especially in cancer patients, to mitigate the impact of future viral pandemics and reduce excess mortality. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the correlation between environmental PM2.5 and heart failure (HF) hospitalization in Lanzhou. China. Method: The correlation between atmospheric PM, 5 and HF hospitalization was evaluated using a distributed lag nonlinear model. Result: During the study period, 16,122 HF patients were hospitalized. The average concentration of PM2.5 is 45.24 µg/m³. PM2.5 was positively correlated with HIT hospitalization with single lag (lagO) and cumulative lag (lagO], lag02, lag03). The maximum lag effect is estimated to occur in lag03, and with the PM2.5 concentration increasing by 10 µg/m³, HF hospitalization risk increased by 1.023 (95% confidence interval. 1.006-1.039). The risk of hospitalization for HF in the male group, the age group 65 years or older, and the cold season was statistically significant and more positively correlated. Conclusion: PM2.5 exposure increases the risk of HF admission in Lanzhou. [ABSTRACT FROM AUTHOR]

In the oral health literature, researchers sometimes report measures of association that are inappropriate for their study design. Clinicians using evidence to inform their practice should be able to interpret clinical study results on the basis of the types of measures of association, independent of what the researchers of a study reported. The authors summarized which measures of association can be derived from experimental and observational studies and how to interpret them in the context of different study designs. They also suggested how inferences can be made on the basis of particular designs. Measures of association derived from randomized controlled trials and cohort studies differ from those of case-control and cross-sectional studies. These differences can be attributed to the temporality between exposures and outcomes inherent in the respective study designs. Different measures of association reported from the same study may lead to different clinical decisions. Furthermore, the same measure of association with the same effect estimate derived from different study designs may contribute to different clinical decisions. Measures of association should be interpreted in the context of a particular study design. Study designs and specific measures of association should be considered when drawing conclusions from clinical studies. Clinicians using the literature to inform practice should be cognizant of measures of association reported for a particular study design and whether the authors have interpreted the measure of association correctly in the context of their chosen study design. [ABSTRACT FROM AUTHOR]

• Retrospective cohort study performed using the newly constructed Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service (K-COV-N) cohort. • Occurrence of severe COVID-19 evaluated in Korean pediatric solid organ transplant recipients (SOTRs). • Pediatric SOTRs have a significantly higher risk of severe COVID-19 than non-SOTRs. • Tailored strategies are required to increase vaccine uptake in high-risk children. The risk of severe COVID-19 in children with a solid organ transplant (SOT) is not well established. We compare the relative risk of severe COVID-19 infection between pediatric SOT and non-SOT children. The newly constructed K-COV-N cohort (Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service) was used. Children with COVID-19 (<18 years old) who underwent SOT between January 2008 to January 2022 were included. Non-SOT children with COVID-19 were selected in a ratio of 1:4 using propensity score matching. Three definitions of severe COVID-19 were established based on their requirement for respiratory support: severe I (requiring respiratory support above a high-flow nasal cannula or prolonged hospitalization ≥6 days), severe II (requiring any oxygen supplement), and severe III (requiring any oxygen supplement or prolonged hospitalization ≥6 days). Among 2,957,323 children with COVID-19, 206 pediatric SOT recipients (SOTRs) were identified and included in the analysis along with 803 matched non-SOT children. Most infections (96.6%) occurred during the Omicron period; no cases of mortality were reported. Pediatric SOTR had a 3.6-fold (95% confidence interval = 1.1-11.7, P = 0.03) higher risk of severe I, and a 4.9-fold (95% confidence interval = 1.6-15.0, P = 0.006) higher risk of severe III than non-SOT children. No cases of severe II occurred in the non-SOT children. Although not statistically significant, no severe COVID-19 cases were reported in the vaccinated SOT group (0.0% vs 5.7%, P = 0.09 in severe III). Pediatric SOTRs have a significantly higher risk of severe COVID-19 than non-SOT children. Our findings support the need for tailored strategies for these high-risk children. [ABSTRACT FROM AUTHOR]

The finality of medical research is to improve disease management by identifying the risk factors (epidemiology) and treating the disease or the underlying causes (clinical research). The assessment of the relationship between exposure to a risk factor or a treatment and the disease is a crucial step. As statistical tests provide information only on whether the -association is statistically significant, it is necessary to quantify the strength of the effect using measurements called "effect sizes" in statistics. Several effect sizes (risk difference, relative risk, odds ratio) are commonly used depending on the study design. This statistical note describes how to use and interpret effect sizes when both exposure and disease are dichotomous variables, i.e. the most common situation in practice. [ABSTRACT FROM AUTHOR]

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Research has shown that high amounts of dietary phosphorus that are twice the amount of the U.S. dietary reference intake of 700 mg for adults are associated with all-cause mortality, phosphate toxicity, and tumorigenesis. The present nested case–control study measured the relative risk of self-reported breast cancer associated with dietary phosphate intake over 10 annual visits in a cohort of middle-aged U.S. women from the Study of Women's Health Across the Nation. Analyzing data from food frequency questionnaires, the highest level of daily dietary phosphorus intake, >1800 mg of phosphorus, was approximately equivalent to the dietary phosphorus levels in menus promoted by the United States Department of Agriculture. After adjusting for participants' energy intake, this level of dietary phosphorus was associated with a 2.3-fold increased risk of breast cancer incidence compared to the reference dietary phosphorus level of 800 to 1000 mg, which is based on recommendations from the U.S. National Kidney Foundation, (RR: 2.30, 95% CI: 0.94–5.61, p = 0.07). Despite the lack of statistical significance, likely due to the small sample size of the cohort, the present nested case–control study's clinically significant effect size, dose–response, temporality, specificity, biological plausibility, consistency, coherence, and analogy with other research findings meet the criteria for inferred causality in observational studies, warranting further investigations. Furthermore, these findings suggest that a low-phosphate diet should be tested on patients with breast cancer. [ABSTRACT FROM AUTHOR]

African swine fever is a transboundary disease of all members of Suidae family andit causes economic damage to the pigindustry and ecology of wild boar as a species. The ASF epidemiology is complex andit is specifiedby the mechanismsof the agent’s transmission in susceptible animal populations. Choiceof measure saimed to control and prevent the disease spreadin the wild boar population depends mainly on the routes of the disease introduction and stage or phase of the epizootic process. Prevention of the ASFV introduction from an infected region to a free one is the back bone in the infection prevention. Therefore, there search was aimed at the spatiotemporal analysis of African swine feveroutbreaks in the wild boar population in the Russian Federation in 2007–2022 and identification of geographical are as that poser is kof new disease epidemics. The analysis was performed using retrospective space-timescan statistics, which does not require data on the wild boar population and which can beused for the assessment of the possibility of new ASFoutbreak occurrence upon availability of just data on the reported disease case sand out breaks. As are sult of spatiotem poral cluster analysis, 24 clusters of ASF out breaks were identified based on the laboratory-confirmed data on the infection in boars found dead, and 22 clusters in hunted wildboars. The analysis results demonstrated spatial heterogeneity of the outbreak cluster distribution in population of wildboarsdied of the disease and a significant expansion of the passive surveillance geography. Importance and necessity of the enhanced passive surve illance of African swinefever in susceptible animals is demonstrated. The proposed methodcan beused for regular scanning of age ographic region for the presence of developing zone sand areasat risk of re-emerging ASFoutbreaks in the wildboar population at different spatial scales.

BackgroundThroughout the literature, pain burden has been assessed by asking different questions, often cross-sectionally, different populations of interest. We know little about pain re-occurrence and how to translate knowledge between pain questions within the population of interest. We aimed to estimate the burden of musculoskeletal pain by estimating prevalence, incidence rates, and re-occurrence risk of back, hand, hip, knee, and foot pain using different questions from UK population-based samples and predict the number of affected individuals in the UK in 2030.MethodsWe used two UK population-representative studies, with two eight-year-apart follow-ups and two pain questions assessing recent pain episodes and often troubled pain when walking. We estimated prevalence, 8-year incidence rates, and 8-year pain re-occurrence risk for women and men aged 50 years and older and the relation between the two pain questions.ResultsAmong UK individuals older than 50 years, the prevalence of musculoskeletal pain episode was 20%–50%, and the incidence was 20–40/1,000 person-years, while the prevalence of pain when walking was 10%–25%, and the incidence was 6–12/1,000 person-years. The most prevalent musculoskeletal pain types were back and knee pain; of five women experiencing back or knee pain episodes, three are expected to be often troubled by pain. Hip and foot pain had similar estimates in both questions. Hand pain peaked in women aged 50–65 years. Women had higher prevalence and incidence rates, but men had higher 8-year re-occurrence risk of all types of musculoskeletal pain. Reporting a pain episode was associated with two times higher risk, but often troubled by pain when walking was associated with four to seven times times higher risk of the same pain in 8 years. Women and men with a body mass index (BMI) of ≥27 kg/m2 were twice as likely to experience musculoskeletal pain than those with BMI

Objective: The effect of passive smoking exposure on the risk of type 2 diabetes has not been systematically studied. A meta-analysis was conducted to assess the association between passive smoking exposure and the risk of diabetes. Methods: We searched three major databases up to 31 October 2022 to identify relevant prospective cohort studies on the association between passive smoking and the risk of type 2 diabetes. The pooled relative risk (RR) and 95% confidence interval (CI) for the association between passive smoking exposure and the risk of type 2 diabetes were analyzed using a fixed-effect model. Results: Ten prospective cohort studies were included in this meta-analysis, with a total of 251,620 participants involved. The pooled RR showed a significantly positive association between nonsmokers exposed to passive smoking and type 2 diabetes as compared to non-smokers who were not exposed to passive smoking [RR = 1.27; 95% CI (1.19, 1.36); p < 0.001]. Sensitivity analysis indicated that the pooled RR was not substantially affected by any of the individual studies. Conclusion: Exposure to passive smoking increases the risk of type 2 diabetes. This study may have a positive effect on the prevention of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background. Prostate cancer is the second most common cancer in men and the fifth leading cause of death worldwide. Our aim in this study was to investigate the relationship between exposure to cadmium and the incidence of prostate cancer through conducting a systematic review and meta-analysis method. Methods. The Studies that investigated the relationship between cadmium and prostate cancer were searched and retrieved from the international databases until May 2022. (x2) and (I2) statistical tests were used respectively to determine the presence and size of heterogeneity; Egger's and Bagg's tests were used to determine the existence of diffusion bias; and meta-regression and sensitivity analysis were used to identify the source of heterogeneity. All analyses were performed by Stata (Version 15) statistical software. Results. It was observed that the relative risk of prostate cancer occurrence compared to the base group, in people exposed/exposed to a dose higher than the base level was equal to 1.05(95% CI:0.94-1.17; P=0.372); Meanwhile, no statistically significant relationship was observed between exposure to cadmium or exposure levels exceeding the baseline and prostate cancer. According to the results of Egger's test (P = 0.989) and Begg's (P= 0.787), diffusion distortion was not observed in this study. Conclusion. Based on the available evidence, although exposure to cadmium leads to an increase in the risk of prostate cancer, this risk increase is not statistically significant. Practical Implications. The World Health Organization should think with a more serious approach to the relationship between environmental health and cancers. [ABSTRACT FROM AUTHOR]

Background and Aims: The most available data on the prevalence of cannabis use come from population surveys conducted in high‐income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population‐level cannabis use in sub‐Saharan Africa since 2010. Methods: A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance‐Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high‐risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10–17 years) and adults (≥ 18 years) in sub‐Saharan Africa were extracted. Results: The study included 53 studies for the quantitative meta‐analysis and included 13 239 participants. Among adolescents, the life‐time, 12‐month and 6‐month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4–10.9%], 5.2% (95% CI = 1.7–10.3%) and 4.5% (95% CI = 3.3–5.8%), respectively. The corresponding life‐time, 12‐month and 6‐month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1–21.2%), 2.2% (95% CI = 1.7–2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3–6.4%), respectively. The male‐to‐female life‐time cannabis use relative risk was 1.90 (95% CI = 1.25–2.98) among adolescents and 1.67 (CI = 0.63–4.39) among adults. Conclusions: Life‐time cannabis use prevalence in sub‐Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents. [ABSTRACT FROM AUTHOR]

Background and Objective: Breast cancer is the most common malignancy in women worldwide. Cadmium is one of the most persistent and toxic heavy metals, exposure to which may lead to an increased risk of breast cancer. This study aims to quantitatively summarize the available evidence for the relationship between cadmium exposure and the risk of breast cancer using a systematic review and meta-analysis. Materials and Methods: In this research, observational studies that investigated the relationship between cadmium and breast cancer until May 2022 and were published in international databases were searched and retrieved. To determine the heterogeneity, the statistical tests Chi² and I² were used, to determine the presence of publication bias Egger's and Begg's tests were used, and to detect the root of the heterogeneity, meta-regression, and sensitivity analysis were used. Results: In this study, it was observed that compared to the base group, the relative risk of breast cancer in people exposed/exposed to a dose higher than the base level of cadmium is equal to 1.10 (95% CI: 1.06-1.14; p ≤ 0.001), therefore, a statistically significant relationship was observed between exposure to cadmium or exposure to levels exceeding the baseline and developing breast cancer. In investigating the possibility of publication bias, the result of Egger's test was equal to (p ≥ 0.001), and the result of Bagg's test was equal to (p = 0.099). Conclusion: According to the available evidence, exposure to cadmium leads to an increase in the risk of breast cancer, and this increase in risk is statistically significant. [ABSTRACT FROM AUTHOR]

The aim of this work is to accomplish an in-depth analysis of the air pollution in the two main cities of the Bay of Algeciras (Spain). A large database of air pollutant concentrations and weather measurements were collected using a monitoring network installed throughout the region from the period of 2010–2015. The concentration parameters contain nitrogen dioxide (NO2), sulphur dioxide (SO2) and particulate matter (PM10). The analysis was developed in two monitoring stations (Algeciras and La Línea). The higher average concentration values were obtained in Algeciras for NO2 (28.850 µg/m3) and SO2 (11.966 µg/m3), and in La Línea for PM10 (30.745 µg/m3). The analysis shows patterns that coincide with human activity. One of the goals of this work is to develop a useful virtual sensor capable of achieving a more robust monitoring network, which can be used, for instance, in the case of missing data. By means of trends analysis, groups of equivalent stations were determined, implying that the values of one station could be substituted for those in the equivalent station in case of failure (e.g., SO2 weekly trends in Algeciras and Los Barrios show equivalence). On the other hand, a calculation of relative risks was developed showing that relative humidity, wind speed and wind direction produce an increase in the risk of higher pollutant concentrations. Besides, obtained results showed that wind speed and wind direction are the most important variables in the distribution of particles. The results obtained may allow administrations or citizens to support decisions. [ABSTRACT FROM AUTHOR]

In medical statistics, when the effect of a binary risk factor on a binary response is of interest, relative risk is often the preferred measure due to its direct interpretation. However, statistical inference on this quantity is not as straightforward as for other measures of association, especially when further explanatory variables have to be taken into account. Starting from a review of available methods for inference on relative risk, this paper deals with small and moderate sample size settings for which we show that classical approaches can be problematic. For this reason, we propose the use of improved estimation procedures, aiming at mean or median bias reduction of the maximum likelihood estimator. In particular, these methods are developed for a new alternative specification of a model recently proposed by Richardson et al, where higher computational stability of the estimation methods is achieved. A real-data example and extensive simulation studies show that the proposed methods perform remarkably better than the standard ones. [ABSTRACT FROM AUTHOR]

Treatment effects can be measured on the relative scale (eg, risk ratios, odds ratios) or the absolute scale (eg, risk differences). If the baseline risk of an outcome is different between subgroups, the effect of the treatment will differ between subgroups on at least one scale (relative, absolute, or both). We illustrate this using two examples from the literature where only relative effects were estimated, but conclusions about subgroup differences would likely have changed had absolute effects also been considered. To identify all meaningful subgroup differences, researchers and clinicians should compare effects on the relative and absolute scale. [ABSTRACT FROM AUTHOR]

This paper focuses on choosing a spatial mixture model with implicitly includes the time to represent the relative risks of COVID-19 pandemic using an appropriate model selection criterion. For this purpose, a more recent criterion so-called the widely Akaike information criterion (WAIC) is used which we believe that its use so limitedly in the context of relative risk modelling. In addition, a graphical method is adopted that is based on a spatial-temporal predictive posterior distribution to select the best model yielding the best predictive accuracy. By applying this model selection criterion, we seek to identify the levels of relative risk, which implicitly represents the determination of the number of the model components of all regions over independent time periods. The estimation of parameters and the model selection are both performed in a Bayesian framework. Also, the means of estimated relative risk for the selected mixture model are mapped to give a clearer picture of distributing the disease risks in each district. [ABSTRACT FROM AUTHOR]

The effect of ambient temperature on health continues to draw more and more attention with the global warming. Bacillary dysentery (BD) is a major global environmental health issue and affected by temperature and other environmental variables. In the current study, we evaluated the effect of temperature on the incidence of BD from January 1st, 2008 to December 31st, 2011 in Jiayuguan, a temperate continental arid climate city in the Hexi Corridor of northwest China. A distributed lag non-linear model (DLNM) was performed to evaluate the lag effect of temperature on BD up to 30 days. Results showed the risk of BD increased with temperature significantly, especially after 8 °C. The maximum risk of BD was observed at extreme high temperature (29 °C). The effect of temperature on BD risk was significantly divided into short-term effect at lag 5 days and long-term effect at lag 30 days. Age ≤ 15 years were most affected by high temperature. The maximum cumulative risk for lag 30 days (25.8, 95% CIs: 11.8–50.1) was observed at 29 °C. Age ≤ 15 years and females showed short-term effect at lag 5 days and long-term effect at lag 30 days, while age > 15 years and males showed acute short-term effect at lag 0 and light long-term effect at lag 16 days. [ABSTRACT FROM AUTHOR]

Background. Gestational diabetes is a metabolic disorder that occurs in more than 8% of all pregnancies. Hence, this study aims to investigate the relationship between gestational diabetes and the clinical outcomes of mothers and their infants in Ilam city. Methods. This study was conducted as a retrospective cohort. All diabetic pregnant mothers referring to obstetrics, gynecology clinics, and comprehensive health service centers were randomly selected. The clinical outcomes were analyzed using SPSS20. Results. In total, 332 pregnant women, including 166 diabetics and 166 non-diabetics with a mean age of 32.3 years, participated. Of the diabetic mothers, 31 people had overt diabetes before pregnancy. The results of this study revealed that the relative risk of neonatal jaundice in diabetic mothers was about seven times higher than that of non-diabetic mothers (P=0.001, RR=7). The relative risk of postpartum hemorrhage was about six times (P=0.001, RR=5.9), blood hypertension was two times (P=0.013, RR=2.4) and the need for cesarean delivery was two times (P=0.009, RR=2.6), preeclampsia was 1.4 times (P= 0.011, RR=1.4) neonatal infection was twice (P=0.002, RR=2.1), respiratory distress was one-third (P=0.012, RR=1.3), compared to non-diabetic mothers. Furthermore, diabetes and other clinical outcomes studied in mothers and infants were not significant. Conclusion. The results showed that pregnant mothers with diabetes are more likely to suffer from postpartum hemorrhage and blood pressure as well as toxemia during pregnancy. In addition, their neonates have a higher risk of neonatal icterus. Health care providers and pregnant mothers should consider these risks in prenatal care. Practical Implications. Since diabetes is a dangerous complication during pregnancy and can have detrimental effects on the mother and fetus, therefore, it is crucial to study the factors affecting its occurrence so that by recognizing the risk factors and consequences, an effective step can be taken to control this disorder.

Abstract Background The purpose of this study was to identify how various negative health indicators are associated with energy drink consumption frequency among 13- and 15-year-old Finnish adolescents. Methods Data (N = 2429) from the nationally representative international Health Behaviour in School-aged Children study (2018) were analyzed via descriptive analysis and logistic regression analyses, with control for salient covariates. Relative risks (RR) were derived from the adjusted odds ratios. Results Even infrequent energy drink consumption was associated with various negative health indicators. Moreover, as compared to non-users, frequent energy drink consumers were more likely to report several health-compromising behaviors: current smoking (RR = 9.85, 95% CI: 5.68–16.02), current snus use (RR = 3.62, 95% CI: 1.80–6.85), cannabis use (RR = 3.42, 95% CI: 1.69–6.52), alcohol consumption (RR = 3.08, 95% CI: 2.49–3.71), problematic social media use (RR = 2.53, 95% CI:1.68–3.72), short sleep (RR = 2.12, 95% CI: 1.69–2.60), skipping breakfast (RR = 1.87, 95% CI: 1.51–2.29), drunkenness (RR = 1.59, 95% CI: 1.11–2.23), inadequate tooth brushing (RR = 1.28, 95% CI: 1.05–1.54). In addition, frequent energy drink consumption was associated with perceived negative health indicators: feelings of insufficient sleep (RR = 1.56, 95% CI: 1.11–2.15), low self-rated health (RR = 1.48, 95% CI: 1.15–1.87), and multiple health complaints (RR = 1.31, 95% CI: 1.07–1.56). Conclusions Energy drink consumption, even infrequent, was associated with several negative health indicators, and the reporting of these increased with the frequency of energy drink consumption. The findings support the concerns of health authorities regarding the negative associations between energy drink consumption and health, even among persons as young as 13 years. There is evidence to support specific policy level actions, including restrictions on the sale of energy drinks to adolescents. This measure has been proposed in a Finnish government program, but implementation has yet to occur. Moreover, marketing of these beverages in platforms that are popular among adolescents (e.g., the social media) should be rigorously evaluated, and comprehensive interventions and actions implemented to ensure that adolescents, parents/guardians, and professionals working with adolescents (e.g., in schools) have a good understanding of the links between energy drink consumption and health.

BackgroundThere are few reports of the association of other cancers with Ewing sarcoma in patients and their relatives. We use a resource combining statewide genealogy and cancer reporting to provide unbiased risks.MethodsUsing a combined genealogy of 2.3 million Utah individuals and the Utah Cancer Registry (UCR), relative risks (RRs) for cancers of other sites were estimated in 143 Ewing sarcoma patients using a Cox proportional hazards model with matched controls; however, risks in relatives were estimated using internal cohort-specific cancer rates in first-, second-, and third-degree relatives.ResultsCancers of three sites (breast, brain, complex genotype/karyotype sarcoma) were observed in excess in Ewing sarcoma patients. No Ewing sarcoma patients were identified among first-, second-, or third-degree relatives of Ewing sarcoma patients. Significantly increased risk for brain, lung/bronchus, female genital, and prostate cancer was observed in first-degree relatives. Significantly increased risks were observed in second-degree relatives for breast cancer, nonmelanoma eye cancer, malignant peripheral nerve sheath cancer, non-Hodgkin lymphoma, and translocation sarcomas. Significantly increased risks for stomach cancer, prostate cancer, and acute lymphocytic leukemia were observed in third-degree relatives.ConclusionsThis analysis of risk for cancer among Ewing sarcoma patients and their relatives indicates evidence for some increased cancer predisposition in this population which can be used to individualize consideration of potential treatment of patients and screening of patients and relatives.

Key points Several risk factors for shoulder injuries were identified specifically in handball players Isometric external rotation strength was the only modifiable risk factor supported by strong evidence. Further research is required as only 50% of the studies were of high quality Future studies should address the multifactorial nature of shoulder injuries in handball.