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"Case-Control Studies"
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Risk factors for Borna disease virus 1 encephalitis in Germany - a case-control study
In 2018, Borna Disease Virus 1 (BoDV-1) was confirmed as a human zoonotic pathogen causing rare but fatal encephalitis in Germany. While diagnostic procedures and the clinical picture have been described, epidemiology remains mysterious. Though endemic areas and a natural reservoir host have been identified with the shrew Crocidura leucodon shedding virus in secretions, transmission events, routes and risk factors are unclear. We performed the first comprehensive epidemiological study, combining a large case series with the first case-control study: We interviewed family members of 20 PCR-confirmed BoDV-1 encephalitis cases deceased in 1996-2021 with a standardized questionnaire covering medical history, housing environment, profession, animal contacts, outdoor activities, travel, and nutrition. Cases' median age was 51 (range 11-79) years, 12/20 were female, and 18/20 lived in the federal state of Bavaria in Southeastern Germany. None had a known relevant pre-existing medical condition. None of the interviews yielded a transmission event such as direct shrew contact, but peridomestic shrew presence was confirmed in 13 cases supporting environmental transmission. Residency in rural areas endemic for animal BoDV-1 was the common denominator of all cases. A subsequent individually matched case-control study revealed residence close to nature in a stand-alone location or on the fringe of the settlement as a risk factor for disease in multivariable analysis with an adjusted OR of 10.8 (95% CI 1.3-89.0). Other variables including keeping cats were not associated with disease. Targeted prevention, future post-exposure-prophylaxis, and timely diagnosis remain challenging.
Journal Article
Malignant narcissism and power : a psychodynamic exploration of madness and leadership
\"Using psychodynamic theory and riveting case material, this book dissects the figure of the malignant narcissist leader (MNL). Across the world today, individuals and societies are impacted by unprecedented disruptive influences, from globalization and climate change to economic uncertainty and mass migration. The rise of populists and would-be saviours have promised certainty for anxious populations, but how far are such leaders suffering from the MNL pathology? Through the psychoanalytic lens of Otto Kernberg, the authors explain the etiology of the charismatic MNL's clinical features: charisma, grandiosity, criminality, sadism, and paranoia. The book outlines the limitations and complexity of diagnosis, contextualizing the MNL within the transcendental and millenarian movements, and discusses the patho-dynamics of high-pressure groups and totalitarian regimes, including: types of groups, methods of mind control, categories of constituents, the corporate totalitarian state, and the authoritarian demagogue. The book looks at a wide range of leaders including Donald Trump, Bhagwan Shree Rajneesh, Roger Ailes, Keith Raniere, Jan of Leiden, and Credonia Mwerinde. Distinguishing the disordered personality of the MNL from other personality disorders, and presenting a new model of overlapping descriptors to categorize high-pressure group types and identifying types of followers as well, this book represents essential reading for psychodynamically-minded psychologists, psychiatrists, social workers, sociologists, political scientists, and those working in organizational development\"-- Provided by publisher.
Book
Association between blood microbiome and type 2 diabetes mellitus: A nested case‐control study
Background Although recent studies have indicated that gut microbiome dysbiosis was significantly associated with the onset of type 2 diabetes mellitus (T2DM), information on the role of blood microbiome in T2DM development is scarce. Methods Fifty incident T2DM cases and 100 matched non‐T2DM controls were selected from a prospective cohort study of “135.” The composition of the blood microbiome was characterized using bacterial 16S ribosomal RNA (16S rRNA) gene sequencing from pre‐diagnostic blood sample. The amplicons were normalized, pooled, and sequenced on the Illumina MiSeq instrument using a MiSeq Reagent Kit PE300 v3 kit. Results Totally, 3 000 391 and 6 244 227 high‐quality sequences were obtained from T2DM patients and non‐T2DM controls, respectively. The mean diversity of the blood microbiome (Simpson, Chao1 and Shannon indices) was not different between two groups at baseline. At genus level, the Aquabacterium, Xanthomonas, and Pseudonocardia were presented with lower abundance, while Actinotalea, Alishewanella, Sediminibacterium, and Pseudoclavibacter were presented with higher abundance among T2DM cases compared to those in non‐T2DM controls. As the results shown, participants carried the genus Bacteroides in blood were significantly associated with a decreased risk for T2DM development, with 74% vs 88% (adjusted OR: 0.367, 95% CI: 0.151‐0.894). However, participants carried the genus Sediminibacterium have an increased risk for T2DM, with adjusted OR (95% CI) being 14.098 (1.358, 146.330). Conclusions Blood microbiome may play an etiology role in the development of T2DM. These findings would be useful to develop microbiota‐based strategies for T2DM prevention and control.
Journal Article
Adjuvant platinum-based chemotherapy in radically resected adrenocortical carcinoma: a cohort study
Background
After radical resection, patients with adrenocortical carcinoma (ACC) frequently experience recurrence and, therefore, effective adjuvant treatment is urgently needed. The aim of the study was to investigate the role of adjuvant platinum-based therapy.
Methods
In this retrospective multicentre cohort study, we identified patients treated with adjuvant platinum-based chemotherapy after radical resection and compared them with patients without adjuvant chemotherapy. Recurrence-free and overall survival (RFS/OS) were investigated in a matched group analysis and by applying a propensity score matching using the full control cohort (
n
= 268). For both approaches, we accounted for immortal time bias.
Results
Of the 31 patients in the platinum cohort (R0
n
= 25, RX
n
= 4, R1
n
= 2; ENSAT Stage II
n
= 11, III
n
= 16, IV
n
= 4, median Ki67 30%, mitotane
n
= 28), 14 experienced recurrence compared to 29 of 31 matched controls (median RFS after the landmark at 3 months 17.3 vs. 7.3 months; adjusted HR 0.19 (95% CI 0.09–0.42;
P
< 0.001). Using propensity score matching, the HR for RFS was 0.45 (0.29–0.89,
P
= 0.021) and for OS 0.25 (0.09–0.69;
P
= 0.007).
Conclusions
Our study provides the first evidence that adjuvant platinum-based chemotherapy may be associated with prolonged recurrence-free and overall survival in patients with ACC and a very high risk for recurrence.
Journal Article
Delivering change : towards fit-for-purpose governance of adaptation to flooding and drought
This book addresses pressing challenges of policy makers, planners and project managers in the water sector to successfully implement adaptation action. Taking into account both strategic planning and implementation of adaptation projects, it provides principles and attributes that contribute to the effective delivery of adaptation to flooding and drought. The book is organised around questions of 'what?', 'when?', 'why?' and 'how?'. It explains that a governance approach to adaptation is effective when it is 'fit-for-purpose' in a specific social-ecological or socio-technical context. The concept of 'fit-for-purpose' governance is applied to evaluate the effectiveness of governance efforts in three Australian cities to adapt to a decade of drought. Based on a case study of the Room for the River flood protection programme in the Netherlands, this book describes how planned adaptation projects in multi-stakeholder settings can be managed effectively and how large scale investment programmes can contribute to a transition of a water system that is adapting to a changed context. The cases in Australia and the Netherlands are used to link governance for strategic planning and governance for the delivery of adaptation. Through combining insights about multi-level governance, adaptive governance, transition management, programme management this book enriches the scientific literature about adaptation to flooding and drought.
Book
Human papillomavirus vaccine to prevent cervical intraepithelial neoplasia in Japan: A nationwide case‐control study
Cervical cancer remains among the most common cancers in women worldwide and can be prevented by vaccination. The Ministry of Health, Labour and Welfare of Japan suspended active recommendation of regular human papillomavirus (HPV) vaccines in 2013 because of various symptoms including chronic pain and motor impairment. This nationwide case‐control study from April 2013 to March 2017 targeted women aged 20‐24 years old at cervical screening. We compared HPV vaccination exposure between those with abnormal and normal cytology. Abnormal cytology was classified based on the results of histological test and we calculated the odds ratio (OR) and 95% confidence interval (CI) of the above endpoints and vaccination exposure using the conditional logistic regression model and estimated vaccine effectiveness using the formula (1 – OR) × 100. A total of 2483 cases and 12 296 controls (one‐to‐five matching) were eligible in 31 municipalities in Japan. The distribution of histological abnormalities among cases was 797 CIN1 (including dysplasia) (32.1%), 165 CIN2 (6.7%), 44 CIN3 (1.8%), and eight squamous cell carcinoma (SCC) (0.3%). The OR of HPV vaccination compared with no vaccination for abnormal cytology, CIN1+, CIN2+, and CIN3+ versus controls was 0.42 (95% CI, 0.34‐0.50), 0.42 (95% CI, 0.31‐0.58), 0.25 (95% CI, 0.12‐0.54), and 0.19 (95% CI, 0.03‐1.15), respectively, equating to a vaccine effectiveness of 58.5%, 57.9%, 74.8%, and 80.9%, respectively. Eight patients had SCC, none was vaccinated. This nationwide case‐control study in Japan demonstrated a substantial risk reduction in abnormal cytology and CIN among women who did versus those who did not receive HPV vaccination. This nationwide case‐control study with official vaccination records in Japan demonstrated a substantial risk reduction in abnormal cytology and CIN among women who did versus those who did not receive HPV vaccination.
Journal Article
Vitamin D deficiency in pregnancy and the risk of preterm birth: a nested case–control study
Background
Each year, an estimated 15 million babies are born preterm. Micronutrient deficiencies, including vitamin D deficiency (VDD), are common in many low- and middle-income countries (LMICs), and these conditions are often associated with adverse pregnancy outcomes. Bangladesh experiences a high prevalence of VDD. The country also has a high preterm birth (PTB) rate. Using data from a population-based pregnancy cohort, we estimated the burden of VDD during pregnancy and its association with PTB.
Methods
Pregnant women (
N
= 3,000) were enrolled after ultrasound confirmation of gestational age at 8–19 weeks of gestation. Trained health workers prospectively collected phenotypic and epidemiological data at scheduled home visits. Trained phlebotomists collected maternal blood samples at enrollment and 24 -28 weeks of gestation. Aliquots of serum were stored at -80
0
C. We conducted a nested case–control study with all PTB (
n
= 262) and a random sample of term births (
n
= 668). The outcome, PTB, was defined as live births < 37 weeks of gestation, based on ultrasound. The main exposure was vitamin D concentrations of 24–28 weeks maternal blood samples. The analysis was adjusted for other PTB risk factors. Women were categorized as VDD (lowest quartile of 25(OH)D; < = 30.25 nmol/L) or not deficient (upper-three quartiles of 25(OH)D; > 30.25 nmol/L). We used logistic regression to determine the association of VDD with PTB, adjusting for potential confounders.
Results
The median and interquartile range of serum 25(OH)D was 38.0 nmol/L; 30.18 to 48.52 (nmol/L). After adjusting for co-variates, VDD was significantly associated with PTB [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI) = 1.10 – 2.12]. The risk of PTB was also higher among women who were shorter (aOR = 1.81, 95% CI: 1.27–2.57), primiparous (aOR = 1.55, 95% CI = 1.12 – 2.12), passive smokers (aOR = 1.60, 95% CI = 1.09 – 2.34), and those who received iron supplementation during pregnancy (aOR = 1.66, 95% CI: 1.17, 2.37).
Conclusion
VDD is common in Bangladeshi pregnant women and is associated with an increased risk of PTB.
Journal Article