Background and purpose
The bacillus Calmette–Guerin (BCG) vaccine could reduce the incidence of multiple sclerosis (MS) through immunomodulation. Previous studies, presenting some limitations, ...reported no association. We re‐examined this association in a large cohort focusing on relapsing–remitting MS (RRMS).
Methods
The cohort included 400,563 individuals, and was linked with the Quebec provincial BCG vaccination registry and administrative health data. Individuals were followed up from 1983 to 2014 and then within Period 1 (1983–1996) and Period 2 (1997–2014), for the occurrence of MS. Incident MS cases were defined as those with ≥3 hospital or physician claims for MS. Subjects with ≥1 drug reimbursement for MS disease‐modifying therapies were classified as RRMS. Cox proportional hazards regression was used to estimate hazard ratios (HRs) over the follow‐ups, adjusting for potential confounders. Possible effect modification due to sex was assessed.
Results
A total of 178,335 (46%) individuals were BCG vaccinated. There were 274 (0.06%) incident MS cases identified in 1983–1996, and 1433 (0.4%) in 1997–2014. No association was found with RRMS, either in Period 1 (adjusted HR HRadj = 0.96, 95% confidence interval CI = 0.63–1.45; 96 cases) or in Period 2 (HRadj = 1.02, 95% CI = 0.85–1.23; 480 cases). The remaining MS cases, for whom the phenotype was unknown, were positively associated with BCG over the entire follow‐up (HRadj = 1.25, 95% CI = 1.10–1.41; 1131 cases) and in Period 2 (HRadj = 1.33, 95% CI = 1.17–1.52; 953 cases). No interaction with sex was found.
Conclusions
Findings suggest that BCG vaccination does not decrease the risk of RRMS, and that future studies should consider phenotypes of MS.
Bacillus Calmette–Guerin (BCG) vaccination was not associated with incidence of relapsing–remitting multiple sclerosis (MS) over the entire follow‐up (1983–2014). For the remaining MS cases, of unknown phenotype and likely including all forms of MS, an association with BCG vaccination was observed only in the second period of follow‐up (1997–2014).
Background
Primary prevention strategies for asthma are lacking. Its inception probably starts in utero and/or during the early postnatal period as the developmental origins of health and disease ...(DOHaD) paradigm suggests.
Objectives
The main objective of Nutrition in Early Life and Asthma (NELA) cohort study is to unravel whether the following factors contribute causally to the developmental origins of asthma: (1) maternal obesity/adiposity and foetal growth; (2) maternal and child nutrition; (3) outdoor air pollution; (4) endocrine disruptors; and (5) maternal psychological stress. Maternal and offspring biological samples are used to assess changes in offspring microbiome, immune system, epigenome and volatilome as potential mechanisms influencing disease susceptibility.
Population
Randomly selected pregnant women from three health areas of Murcia, a south‐eastern Mediterranean region of Spain, who fulfilled the inclusion criteria were invited to participate at the time of the follow‐up visit for routine foetal anatomy scan at 19–22 weeks of gestation, at the Maternal‐Fetal Medicine Unit of the “Virgen de la Arrixaca” University Clinical Hospital over a 36‐month period, from March 2015 to April 2018.
Design
Prospective, population‐based, maternal‐child, birth cohort study.
Methods
Questionnaires on exposures and outcome variables were administered to mothers at 20–24 gestation week; 32–36 gestation week; and delivery. Children were surveyed at birth, 3 and 18 months of age and currently at 5 years. Furthermore, physical examinations were performed; and different measurements and biological samples were obtained at these time points.
Preliminary results
Among the 1350 women invited to participate, 738 (54%) were finally enrolled in the study and 720 of their children were eligible at birth. The adherence was high with 612 children (83%) attending the 3 months’ visit and 532 children (72%) attending the 18 months’ visit.
Conclusion
The NELA cohort will add original and unique knowledge to the developmental origins of asthma.
Background: Phentermine is approved for short-term weight loss and is the most commonly prescribed obesity drug in the US. Previous studies on adverse cardiovascular effects of phentermine were not ...conclusive. We aimed to evaluate the association between short-term phentermine use and major adverse cardiovascular events (MACE). Methods: We conducted a case-crossover study in MarketScan Research Databases (2005-2019) and identified MACE cases as acute myocardial infarction, stroke (ischemic or hemorrhagic), or in-hospital cardiovascular death. Our primary analysis assigned the risk, washout, and control windows in two-month increments before the event date. We considered a study window exposed when at least one day of supply for phentermine was present. Sensitivity analyses varied window length and used prescription fill as the exposure definition. Considering the seasonal and temporal trends in phentermine use, we conducted case-time-control and case-case-time-control analyses to improve effect estimation. We also conducted a post hoc retrospective cohort study (2013-2019) with a new-user, active-comparator design to contrast the risk of MACE between phentermine and other obesity drugs (liraglutide, lorcaserin, or bupropion/naltrexone). We followed patients for four months and adjusted for potential confounders via the high dimensional propensity score procedure. Results: We identified 325,927 MACE, of whom 405 cases had exposure to phentermine in any window before MACE (262 acute myocardial infarctions, 133 strokes, 10 in-hospital cardiovascular deaths). The adjusted odds ratio was 0.75 (0.57, 0.98) in the case-crossover analysis, 0.68 (0.50, 0.91) in the case-time-control analysis, and 0.97 (0.55, 1.71) in case-case-time-control analysis. Sensitivity analyses confirmed robustness in primary findings, and the adjusted risk ratio in the cohort study was 0.89 (0.54-1.46). Conclusions: In our real-world study, short-term exposure to phentermine was not associated with an increased risk of MACE.
The increases in suicide among middle-aged baby boomers (born between 1946 and 1964) in the United States since 1999 suggest a changing epidemiology of suicide. Using data from 1935 to 2010, this ...paper conducts age-period-cohort analyses to determine the impact of cohorts in shaping temporal patterns of suicide in the United States. The analysis demonstrates that age, period and cohort effects are all important in determining suicide trends. Net of age and period effects, the cohort pattern of suicide rates is U-shaped, with cohorts born between 1915 and 1945 possessing among the very lowest suicide rates. Suicide rates begin to rise with boomers and subsequent cohorts exhibit increasingly higher rates of suicide. The general pattern exists for both men and women but is especially pronounced among males. The average suicide rate over the entire period for males is about 28 per 100,000, 95% CI 27.4, 28.7. For males born in 1930–34, the suicide rate is estimated to be 17.4 per 100,000, 95% CI 15.9, 18.8; for males born between 1955 and 1959, the rate is essentially the same as the average for the period while for males born between 1985 and 1989, the suicide rate is estimated to be 37.8 per 100,000, 95% CI 33.1, 43.4. The results dispute popular claims that boomers exhibit an elevated suicide rate relative to other generations, but boomers do appear to have ushered in new cohort patterns of suicide rates over the life course. These patterns are interpreted within a Durkheimian framework that suggests weakened forms of social integration and regulation among postwar cohorts may be producing increased suicide rates.
•Rising suicide rates among U.S. middle-aged baby boomers suggest a changing epidemiology of suicide.•Age–period–cohort analyses are used to describe suicide patterns from 1935 to 2010.•Cohorts born between 1915 and 1945 possess among the very lowest suicide rates.•Suicide rates start to increase with boomers and continue to do so for subsequent cohorts.•Weakened forms of social integration and regulation may be producing increased risks for suicide.
•Post-COVID syndrome requires, besides symptoms, comprehensive organ damage assessment.•Post-covid syndrome is not limited to severe acute COVID19 patients.•Symptoms are mostly mild, improve with ...time, and with no identified predictors.•Radiological and spirometric changes are mild and observed in 25% of patients.•Our findings contribute to efficiently designing follow-up plans for COVID patients.
This study aims to analyze the incidence of Post-acute COVID-19 syndrome (PCS) and its components, and to evaluate the acute infection phase associated risk factors.
A prospective cohort study of adult patients who had recovered from COVID-19 (27th February to 29th April 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10–14 weeks after disease onset. PCS was defined as the persistence of at least one clinically relevant symptom, or abnormalities in spirometry or chest radiology. Outcome predictors were analyzed by multiple logistic regression (OR; 95%CI).
Two hundred seventy seven patients recovered from mild (34.3%) or severe (65.7%) forms of SARS-CoV-2 infection were evaluated 77 days (IQR 72–85) after disease onset. PCS was detected in 141 patients (50.9%; 95%CI 45.0–56.7%). Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of PCS development.
A Post-acute COVID-19 syndrome was detected in a half of COVID19 survivors. Radiological and spirometric changes were mild and observed in less than 25% of patients. No baseline clinical features behaved as independent predictors of Post-acute COVID-19 syndrome development.
Display omitted
Some reproductive-aged individuals remain unvaccinated against coronavirus disease 2019 (COVID-19) because of concerns about potential adverse effects on fertility. Using data from an internet-based ...preconception cohort study, we examined the associations of COVID-19 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with fertility among couples trying to conceive spontaneously. We enrolled 2,126 self-identified female participants aged 21-45 year residing in the United States or Canada during December 2020-September 2021 and followed them through November 2021. Participants completed questionnaires every 8 weeks on sociodemographics, lifestyle, medical factors, and partner information. We fit proportional probabilities regression models to estimate associations between self-reported COVID-19 vaccination and SARS-CoV-2 infection in both partners with fecundability (i.e., the per-cycle probability of conception), adjusting for potential confounders. COVID-19 vaccination was not appreciably associated with fecundability in either partner (female fecundability ratio (FR) = 1.08, 95% confidence interval (CI): 0.95, 1.23; male FR = 0.95, 95% CI: 0.83, 1.10). Female SARS-CoV-2 infection was not strongly associated with fecundability (FR = 1.07, 95% CI: 0.87, 1.31). Male infection was associated with a transient reduction in fecundability (for infection within 60 days, FR = 0.82, 95% CI: 0.47, 1.45; for infection after 60 days, FR = 1.16, 95% CI: 0.92, 1.47). These findings indicate that male SARS-CoV-2 infection may be associated with a short-term decline in fertility and that COVID-19 vaccination does not impair fertility in either partner.
Our study aimed to estimate the epidemiological trends of gastric cancer in the United States from 1992 to 2019. This population‐based study used the US Surveillance, Epidemiology and End Results‐12 ...database as a fundamental cohort to analyze gastric cancer incidence, incidence‐based mortality (IBM), overall survival (OS) and cancer‐specific survival (CSS) probabilities from 1992 to 2019. The Global Burden of Disease study (1990‐2018) was used as a likely validation cohort. Age‐period‐cohort analyses were performed to explore the underlying causes of trend changes. We found that the incidence rate of gastric cancer decreased from 1992 to 2019. IBM also decreased significantly from 1997 to 2019. The 3‐year OS and CSS of gastric cancer increased from 22.3% to 28.7% and 25.7% to 33.5%, respectively. However, the proportion of distant gastric cancer cases had unexpectedly increased rapidly from 33.1% in 1992 to 44.7% in 2019. Age‐period‐cohort modeling found that the incidence and IBM rates remained stable in the groups aged below 50 years, while that in all age groups older than 50 years showed a significant downward trend. High incidence and mortality risks were observed in the younger birth cohorts (birth year after 1990). To conclude, we observed a decline in incidence and mortality rates of gastric cancer in the United States in the past decades. We determined that progression of primary and tertiary preventive measures is the main reason for the reduction in the disease burden of gastric cancer. However, secondary preventive measures for gastric cancer still need to be strengthened.
What's new
While advances in prevention and treatment have impacted gastric cancer (GC) incidence and survival, how that progress has shaped trends in GC over time remains unclear. The authors of this investigation evaluated changes in GC incidence, mortality and survival in the United States from 1992 to 2019, revealing declines in incidence and mortality rates. Reductions in GC disease burden were fueled mainly by progress in primary and tertiary preventive measures. The findings highlight the impact of advances in GC prevention and treatment and identify secondary preventive measures as an area in need of attention for furthering reductions in GC burden.
PDF
