BACKGROUND: Increased lung cancer risks for low socioeconomic status (SES) groups are only partially attributable to smoking habits. Little effort has been made to investigate the persistent risks related to low SES by quantification of potential biases. METHODS: Based on 12 case-control studies, including 18 centers of the international SYNERGY project (16,550 cases, 20,147 controls), we estimated controlled direct effects (CDE) of SES on lung cancer via multiple logistic regression, adjusted for age, study center, and smoking habits and stratified by sex. We conducted mediation analysis by inverse odds ratio weighting to estimate natural direct effects and natural indirect effects via smoking habits. We considered misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by genetic risk, both separately and by multiple quantitative bias analyses, using bootstrap to create 95% simulation intervals (SI). RESULTS: Mediation analysis of lung cancer risks for SES estimated mean proportions of 43% in men and 33% in women attributable to smoking. Bias analyses decreased the direct effects of SES on lung cancer, with selection bias showing the strongest reduction in lung cancer risk in the multiple bias analysis. Lung cancer risks remained increased for lower SES groups, with higher risks in men (fourth vs. first [highest] SES quartile: CDE, 1.50 [SI, 1.32, 1.69]) than women (CDE: 1.20 [SI: 1.01, 1.45]). Natural direct effects were similar to CDE, particularly in men. CONCLUSIONS: Bias adjustment lowered direct lung cancer risk estimates of lower SES groups. However, risks for low SES remained elevated, likely attributable to occupational hazards or other environmental exposures.

• MeSH
• analýza mediace * MeSH
• dospělí MeSH
• kouření * epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• nádory plic * epidemiologie   MeSH
• odds ratio MeSH
• rizikové faktory MeSH
• senioři MeSH
• společenská třída * MeSH
• studie případů a kontrol MeSH
• zkreslení výsledků (epidemiologie) * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Decision-analytic models assessing the value of emerging Alzheimer's disease (AD) treatments are challenged by limited evidence on short-term trial outcomes and uncertainty in extrapolating long-term patient-relevant outcomes. To improve understanding and foster transparency and credibility in modeling methods, we cross-compared AD decision models in a hypothetical context of disease-modifying treatment for mild cognitive impairment (MCI) due to AD. METHODS: A benchmark scenario (US setting) was used with target population MCI due to AD and a set of synthetically generated hypothetical trial efficacy estimates. Treatment costs were excluded. Model predictions (10-year horizon) were assessed and discussed during a 2-day workshop. RESULTS: Nine modeling groups provided model predictions. Implementation of treatment effectiveness varied across models based on trial efficacy outcome selection (clinical dementia rating - sum of boxes, clinical dementia rating - global, mini-mental state examination, functional activities questionnaire) and analysis method (observed severity transitions, change from baseline, progression hazard ratio, or calibration to these). Predicted mean time in MCI ranged from 2.6 to 5.2 years for control strategy and from 0.1 to 1.0 years for difference between intervention and control strategies. Predicted quality-adjusted life-year gains ranged from 0.0 to 0.6 and incremental costs (excluding treatment costs) from -US$66 897 to US$11 896. CONCLUSIONS: Trial data can be implemented in different ways across health-economic models leading to large variation in model predictions. We recommend (1) addressing the choice of outcome measure and treatment effectiveness assumptions in sensitivity analysis, (2) a standardized reporting table for model predictions, and (3) exploring the use of registries for future AD treatments measuring long-term disease progression to reduce uncertainty of extrapolating short-term trial results by health-economic models.

• MeSH
• Alzheimerova nemoc * ekonomika   farmakoterapie   MeSH
• analýza nákladů a výnosů * MeSH
• ekonomické modely MeSH
• kognitivní dysfunkce * ekonomika   MeSH
• kvalitativně upravené roky života MeSH
• lidé MeSH
• metody pro podporu rozhodování MeSH
• progrese nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Colorectal cancer (CRC) is a common, fatal cancer. Identifying subgroups who may benefit more from intervention is of critical public health importance. Previous studies have assessed multiplicative interaction between genetic risk scores and environmental factors, but few have assessed additive interaction, the relevant public health measure. METHODS: Using resources from CRC consortia, including 45,247 CRC cases and 52,671 controls, we assessed multiplicative and additive interaction (relative excess risk due to interaction, RERI) using logistic regression between 13 harmonized environmental factors and genetic risk score, including 141 variants associated with CRC risk. RESULTS: There was no evidence of multiplicative interaction between environmental factors and genetic risk score. There was additive interaction where, for individuals with high genetic susceptibility, either heavy drinking (RERI = 0.24, 95% confidence interval [CI] = 0.13, 0.36), ever smoking (0.11 [0.05, 0.16]), high body mass index (female 0.09 [0.05, 0.13], male 0.10 [0.05, 0.14]), or high red meat intake (highest versus lowest quartile 0.18 [0.09, 0.27]) was associated with excess CRC risk greater than that for individuals with average genetic susceptibility. Conversely, we estimate those with high genetic susceptibility may benefit more from reducing CRC risk with aspirin/nonsteroidal anti-inflammatory drugs use (-0.16 [-0.20, -0.11]) or higher intake of fruit, fiber, or calcium (highest quartile versus lowest quartile -0.12 [-0.18, -0.050]; -0.16 [-0.23, -0.09]; -0.11 [-0.18, -0.05], respectively) than those with average genetic susceptibility. CONCLUSIONS: Additive interaction is important to assess for identifying subgroups who may benefit from intervention. The subgroups identified in this study may help inform precision CRC prevention.

• MeSH
• dieta MeSH
• dospělí MeSH
• genetická predispozice k nemoci * MeSH
• index tělesné hmotnosti MeSH
• interakce genů a prostředí * MeSH
• jednonukleotidový polymorfismus MeSH
• kolorektální nádory * genetika   epidemiologie   MeSH
• kouření škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• pití alkoholu MeSH
• rizikové faktory MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Findings on the link between the number of children and dementia risk are inconsistent, mostly studied in females, suggesting pregnancy-related changes may be a key factor in this association. METHODS: The Adult Changes in Thought Study is a cohort of adults aged ≥65 years from Kaiser Permanente Washington. The primary exposure was the number of children (0, 1, 2, 3 or ≥4), and the outcome was an incident dementia diagnosis. Cox proportional-hazards models were adjusted for demographic and early-life socioeconomic confounders. Models were then stratified by sex and by birth year <1928 versus ≥1928. RESULTS: Among 4668 participants (average age at enrolment 74.1±SD 6.3 years; 59% female), 967 (21%) had 0 children, 484 (10%) had one child, 1240 (27%) had two children, 968 (21%) had three children and 1009 (22%) had four or more children. We found no association between the number of children and dementia overall or after stratification by birth cohort. When stratified by sex and adjusting for confounders, having ≥4 children compared with two children was associated with a higher rate of dementia in males (HR=1.31, 95% CI 1.01 to 1.71). CONCLUSIONS: The number of children was not consistently associated with the risk of dementia. We observed a greater risk of dementia only among males who had ≥4 children, with the lower bound of the 95% CI marginally exceeding 1. These findings suggest that the number of children may influence the risk of dementia through other than pregnancy-related pathways.

• MeSH
• charakteristiky rodiny MeSH
• demence * epidemiologie   MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé MeSH
• proporcionální rizikové modely * MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Washington MeSH

Kontext: Procento nezralých granulocytů (immature granulocytes, iG%) je časným markerem zánětu s prognostickou hodnotou u řady onemocnění. Cíl: V této studii jsme se pokusili zjistit, zda má procento nezralých granulocytů prognostickou hodnotu z hlediska 28denní mortality pacientů s akutním koronárním syndromem (AKS). Metoda: Jednalo se o retrospektivní studii provedenou v období mezi 1. lednem 2019 a 30. červnem 2019 na Klinice urgentní medicíny lékařské fakulty univerzity v tureckém Mersinu. Do studie byli zařazeni všichni pacienti ve věku nad 18 let, kteří byli dopraveni na kliniku urgentní medicíny s bolestí na hrudi a hospitalizováni s předběžnou diagnózou AKS. Pacienti byli rozděleni do dvou skupin, na ty, kteří přežili, a ty, kteří nepřežili. Byly zaznamenány hodnoty iG% a dalších laboratorních parametrů a následně byl analyzován vztah mezi hodnotami iG% a 28denní mortalitou. Kromě toho byla pro srovnání diagnostické přesnosti hodnot iG% a dalších proměnných provedena analýza roc. Výsledky: Do studie bylo zařazeno celkem 617 pacientů, z tohoto počtu bylo 423 (68,6 %) mužů. Průměrný věk pacientů dosahoval 63,9 ± 12,7 roku. hodnota iG% byla vyšší u nepřeživších pacientů (1,2 ± 1,4) než u přeživších (0,5 ± 0,5 ) (p = 0,007). V predikci 28denní mortality, pokud byla mezní hodnota iG% > 0,6, byla zjištěna specificita ve výši 93,70 % a senzitivita 54,55 % (Auc = 0,717; p = 0,000). V predikci 28denní mortality na AKS představovalo iG% nezávislý rizikový faktor (poměr rizik [hazard ratio, hr] 632,962; 95% interval spolehlivosti 3,389–118 206,572; p = 0,016). Závěr: u pacientů s AKS může hodnota iG% souviset s 28denní mortalitou.

Background: The percentage of immature granulocytes (IG%) is an early marker of inflammation and has a prognostic significance in many diseases. Objective: In this study, we tried to investigate whether the percentage of immature granulocytes has a prognostic value in 28-day mortality in patients with acute coronary syndrome (ACS). Method: This study was carried out retrospectively between 1.1.2019 and 30.6.2019 at Mersin University Faculty of Medicine, Department of Emergency Medicine. Patients older than 18 years who applied to the emergency department with chest pain and were hospitalized with a preliminary diagnosis of ACS were included in the study. The patients were divided into two groups as survivors and non-survivors. IG% and other laboratory parameters were recorded. The relationship between IG% and 28-day mortality was analyzed. In addition, ROC analysis was performed to compare the diagnostic accuracy of IG% and other variables. Results: A total of 617 patients, including 423 (68.6%) men, were included in the study. The mean age of the patients were 63.9 ± 12.7. IG% was higher in non-survivor patients (1.2 ± 1.4) than in surviving patients (0.5 ± 0.5) (p = 0.007). In predicting 28-day mortality, when the cut-off value for IG% was >0.6, the specifi- city was found to be 93.70% and the sensitivity to be 54.55% (AUC = 0.717, p = 0.000). In predicting 28-day mortality for ACS, IG% was an independent risk factor (hazard ratio [HR] 632.962, 95% confidence interval 3.389-118206.572, p = 0.016). Conclusion: IG% may be associated with a 28-day mortality in patients with ACS.

• MeSH
• akutní koronární syndrom * krev   mortalita   MeSH
• biologické markery MeSH
• granulocyty * patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prognóza MeSH
• proporcionální rizikové modely MeSH
• ROC křivka MeSH
• senioři MeSH
• statistika jako téma MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH

The ReAct (Recovery, Activity) project is an ENFSI (European Network of Forensic Science Institutes) supported initiative comprising a large consortium of laboratories. Here, the results from more than 23 laboratories are presented. The primary purpose was to design experiments simulating typical casework circumstances; collect data and to implement Bayesian networks to assess the value (i.e., likelihood ratio) of DNA results given activity level propositions. Two different experimental designs were used to simulate a robbery, where a screwdriver was used to force a door or window. Propositions and case information were chosen following laboratory feedback listing typical casework circumstances (included in the paper). In a direct transfer experiment, the defendant owned and used the screwdriver, but he did not force the door/window in question. An unknown person used the defendant's stolen screwdriver. In an indirect transfer experiment, the defendant neither owned, saw, nor used the screwdriver, nor did they force the door or window. For the second experiment, given the defence view, the defendant never held the screwdriver. We envisaged the situation where an object manipulated by the defendant (or the defendant himself/herself) would be touched by the unknown offender who would then force the window. It was found for the direct transfer experiment that unless a single contributor profile aligning with the known person's of interest profile was retrieved, the results did not allow to discriminate between propositions. On the other hand, for the indirect transfer experiment, both single and major contributor profiles that aligned with the person of interest (POI) supported the proposition that the person used the tool rather than an unknown person who had touched an object, when indeed the former was true. There was considerable variation in median recoveries of DNA between laboratories (between 200pg-5ng) for a given experiment if quantities are taken into account. These differences affect the likelihood ratios given activity level propositions. More than 2700 samples were analysed in the course of this study. Two different Bayesian Networks are made available via an open source application written in Shiny R: Shiny_React(). For comparison, all datasets were analysed using a qualitative method categorised into absent, single, major or other given contributors. The importance of standardising methods is emphasised, alongside the necessity of developing new approaches to assign the probability of laboratory-dependent DNA recovery. Freely accessible open databases play a crucial role in supporting these efforts.

• MeSH
• Bayesova věta * MeSH
• DNA fingerprinting * MeSH
• DNA * genetika   MeSH
• laboratoře * MeSH
• lidé MeSH
• mikrosatelitní repetice MeSH
• pravděpodobnostní funkce MeSH
• soudní genetika metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Research questions about how and why health trends differ between populations require decisions about data analytic procedure. The objective was to document and compare the information returned from stratified, fixed effect and random effect approaches to data modelling for two prototypical descriptive research questions about comparative trends in toothbrushing. METHODS: Data included five cycles of the Health Behaviour in School-aged Children 2006 to 2022, which provided a sample of 980192 11- to 15- year olds from 35 countries. Using logistic regression models and generalized linear mixed models, toothbrushing daily was regressed on time, following the three approaches to analysis of trends. RESULTS: The stratified approach suggested a positive but non-linear trend in toothbrushing from 2006 to 2022 in most countries but provided no statistical inference on the variation. The fixed effect and the random effect approach converged on a positive but flattening overall trend, with a statistically significant country variation in trends. CONCLUSION: Only the fixed effect approach and the random effects approach provided clear answers to the research question. Additional methodological considerations for making an informed choice of analytical approach are discussed.

• MeSH
• chování mladistvých MeSH
• čištění zubů * statistika a číselné údaje   trendy   MeSH
• dítě MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• zdravé chování MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

INTRODUCTION: Despite the widespread use of the Movement Assessment Battery for Children, 2nd edition (MABC-2), little is known about the sensitivity or specificity of the individual items to detect probable Developmental Coordination Disorder (p-DCD). This study examined which specific MABC-2 items were most sensitive to identify children with p-DCD and which items would predict p-DCD. METHODS: Based on a large dataset including European and African children aged 3-16 years (n = 4916, typically developing (TD, 49.6 % boys); n = 822 p-DCD (53.1 % boys), Hedges' g was calculated to establish the standardized mean difference (SMD) between p-DCD/TD. SMDs were considered substantial when absolute values at or above 1.4. Sensitivity and specificity of the raw MABC-2 item scores predicting p-DCD/TD per age band (AB) were established with logistic regression analysis. RESULTS: AB1: Children with p-DCD performed substantially poorer on threading beads (SMD: -1.61) and jumping on mats (SMD: 1.61). By combining all items and the country of origin, the sensitivity was 61.7 % and specificity 98.6 %. AB2: Walking heel-to-toe forwards (SMD: 1.65) was substantially poorer in p-DCD. By combining all items and the country of origin, the sensitivity was 79.0 % and specificity 97.6 %. AB3: Catching a ball with the preferred (SMD: 1.8) or non-preferred (SMD: 1.61) hand, and for walking heel-to-toe backwards (SMD: 1.78) were substantially poorer in p-DCD. All items combined resulted in a sensitivity of 94.4 % and specificity of 99.6 %. CONCLUSION: Not all MABC-2 items are equally sensitive to distinguish between performances of p-DCD and TD. Despite the good specificity, the sensitivity was only moderate in AB1-2, the age at which children learn culturally influenced motor skills.

• MeSH
• dítě MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• motorické dovednosti MeSH
• pohyb MeSH
• poruchy motorických dovedností * diagnóza   MeSH
• předškolní dítě MeSH
• senzitivita a specificita * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Afrika MeSH
• Evropa MeSH

Limited evidence exists about preserving neurovascular bundles during radical prostatectomy (RP) for high-risk prostate cancer (HRPCa) patients. Hence, we validated an existing algorithm predicting contralateral extraprostatic extension (cEPE) risk in unilateral high-risk cases. This algorithm aims to assist in determining the suitability of unilateral nerve-sparing RP. Among 264 patients, 48 (18%) had cEPE. The risk of cECE varied: 8%, 17.2%, and 30.8% for the low, intermediate, and high-risk groups, respectively. Despite a higher risk of cECE among individuals classified as low-risk in the development group compared to the validation group, our algorithm's superiority over always/never nerve-sparing RP was reaffirmed by decision curve analysis. Therefore, we conclude that bilateral excision may not always be justified in men with unilateral HRPCa. Instead, decisions can be based on our suggested nomogram.

• MeSH
• algoritmy * MeSH
• hodnocení rizik metody   MeSH
• léčba šetřící orgány * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prostaty * chirurgie   patologie   MeSH
• nomogramy MeSH
• prostata chirurgie   inervace   patologie   MeSH
• prostatektomie * metody   MeSH
• roboticky asistované výkony * metody   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• validační studie MeSH

BACKGROUND: This study investigates the association between frailty and mortality in Eastern European populations, which remains largely unexplored compared with Western Europe. The aim is to assess the risk of all-cause and cardiovascular mortality associated with varying levels of frailty. METHODS: A prospective multicentre cohort study was conducted, involving random population samples from the Czech Republic, Poland and Lithuania. The baseline survey (2002-2005) included 26 746 individuals aged 45-69 years, with an average follow-up of 13 years. Frailty was measured using a Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI), calculating the number of deficits in each domain. Cox proportional regression models and inverse probability weighting (IPW) were employed to account for risk factor differences among the frailty groups: robust, prefrail, mild, moderate and severe. RESULTS: The study included 14 287 people, among whom 891 were frail, with a total of 2402 deaths.Compared with non-frail persons, those with mild (IPW HR 2.06, 95% CI 1.60 to 2.66) and severe (IPW HR 2.71, 95% CI 1.45 to 5.07) frailty had more than twofold elevated risk of all-cause mortality. For cardiovascular mortality, the corresponding HRs were (IPW HR 3.05, 95% CI 2.14 to 4.35) and (IPW HR 3.88, 95% CI 1.95 to 7.74). Men exhibited a higher mortality risk at all frailty levels only in unweighted analysis. Country-specific differences were not significant. CONCLUSIONS: A CGA-based FI is an independent predictor of all-cause and cardiovascular mortality, with even mild frailty increasing the risk. Implementing frailty assessments can improve health risk prediction in older adults from Eastern Europe.

• MeSH
• geriatrické hodnocení * MeSH
• kardiovaskulární nemoci * mortalita   MeSH
• křehkost * mortalita   MeSH
• křehký senior * statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• příčina smrti MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH
• Litva MeSH
• Polsko MeSH
• východní Evropa MeSH