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Underdiagnosis and underreporting of scrub typhus has increasingly affected public health in Bhutan since its initial detection in 2008. Identifying scrub typhus risk factors would support early diagnosis and treatment for this nonspecific febrile disease, reducing the incidence of potentially fatal complications. We conducted a hospital-based, case‒control study during October‒December 2015 in 11 scrub typhus‒prone districts. We identified harvesting cardamom as the major risk factor (odds ratio 1,519; p<0.001); other factors were traditional housing, largely caused by an outside toilet location, as well as owning a goat and frequently sitting on grass. Harvesting vegetables, herding cattle in the forest, and female sex were protective. Age had a nonlinear effect; children and the elderly were more likely to seek treatment for clinical scrub typhus. This study has informed public health policies and awareness programs for healthcare workers through development of National Guidelines for Prevention, Treatment and Control of Scrub Typhus in Bhutan.

This study aims to describe the prevalence of spinal pain among Danish children, explore the differential nature of spinal pain, and investigate socio-demographic factors predisposing spinal pain. A descriptive study of 46,726 11–14-year-olds participating in the Danish National Birth Cohort was conducted. Self-reported spinal pain (neck, middle back, and low back pain) was registered and classified according to severity. Socioeconomic data on children and their parents were identified in Statistics Denmark registers. Associations between socio-demographic factors and aspects of spinal pain were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting (IPW) was applied. Almost 10% boys and 14% girls reported severe spinal pain, whereas around 30% of all children reported moderate pain. Effect estimates indicated the risk to increase with increasing age. Further, children without biological full siblings, not living with both of their parents, or children living in less-educated or lower-income families were more likely to experience spinal pain. The study conclusions were essentially unaffected by IPW.Conclusion: A considerable number of children suffer from spinal pain, and it is more common among children in more disadvantaged families. Etiology of spinal pain needs to be explored further with the aim of informing efficient and targeted prevention.What is Known:• Childhood spinal pain may cause marked discomfort and impairment in children’s everyday life, and is suggested as important predictor of later-in-life spinal pain.• Methodological heterogeneity in previous studies and complexity of measuring pain make inferences at a broader level inadequate.What is New:• Prevalence of severe spinal pain in 11–14-year-olds was estimated to almost 10% for boys and 14% for girls, and children in more disadvantaged families were more likely to experience spinal pain.• The results seemed unaffected by sample selection.

Insulinoma is the most common pancreatic tumor diagnosed in dogs. This study aimed to report incidence risk, breed predispositions and other demographic risk factors for insulinoma diagnosed in dogs under primary veterinary care in the UK. The VetCompass Program supports research on anonymized electronic health records (EHRs) from dogs under UK veterinary care. This study included all VetCompass EHRs from dogs under primary veterinary care during 2019. Multivariable logistic regression analysis was used to evaluate demographic risk factors for insulinoma diagnosis. Of 2,250,741 study dogs, 278 were confirmed as insulinoma cases at any date. The estimated 2019 incidence risk was 0.003% (95% CI 0.002–0.004%). Compared to crossbreeds, predisposed breeds included Dogue de Bordeaux, German Pointer, Flat Coated Retriever, Boxer and West Highland White Terrier. The Labrador Retriever showed decreased odds for insulinoma diagnosis. Additionally, being a terrier breed and being a breed predisposed to other endocrine cancers were associated with increased odds for insulinoma diagnosis. Other risk factors associated with increased odds for insulinoma diagnosis included being female neutered, being 9 - <15 years of age, having an adult median bodyweight of 20 - <30 kg and having a bodyweight above the median for the sex/breed. This is the first study to report the epidemiology of canine insulinoma in dogs under primary veterinary care, resulting in crucial leads for further research in the epidemiology and etiology of canine insulinoma and possible links of canine insulinoma with other canine endocrine cancers. Additionally, the results can aid veterinarians to identify dogs at greater risk of insulinoma.

Background Electronic health records (EHRs) data provide an opportunity to collect patient information rapidly, efficiently and at scale. National collaborative research networks, such as PEDSnet, aggregate EHRs data across institutions, enabling rapid identification of pediatric disease cohorts and generating new knowledge for medical conditions. To date, aggregation of EHR data has had limited applications in advancing our understanding of mental health (MH) conditions, in part due to the limited research in clinical informatics, necessary for the translation of EHR data to child mental health research. Methods In this cohort study, a comprehensive EHR-based typology was developed by an interdisciplinary team, with expertise in informatics and child and adolescent psychiatry, to query aggregated, standardized EHR data for the full spectrum of MH conditions (disorders/symptoms and exposure to adverse childhood experiences (ACEs), across 13 years (2010–2023), from 9 PEDSnet centers. Patients with and without MH disorders/symptoms (without ACEs), were compared by age, gender, race/ethnicity, insurance, and chronic physical conditions. Patients with ACEs alone were compared with those that also had MH disorders/symptoms. Prevalence estimates for patients with 1 + disorder/symptoms and for specific disorders/symptoms and exposure to ACEs were calculated, as well as risk for developing MH disorder/symptoms. Results The EHR study data set included 7,852,081 patients < 21 years of age, of which 52.1% were male. Of this group, 1,552,726 (19.8%), without exposure to ACEs, had a lifetime MH disorders/symptoms, 56.5% being male. Annual prevalence estimates of MH disorders/symptoms (without exposure to ACEs) rose from 10.6% to 2010 to 15.1% in 2023, a 44% relative increase, peaking to 15.4% in 2019, prior to the Covid-19 pandemic. MH categories with the largest increases between 2010 and 2023 were exposure to ACEs (1.7, 95% CI 1.6–1.8), anxiety disorders (2.8, 95% CI 2.8–2.9), eating/feeding disorders (2.1, 95% CI 2.1–2.2), gender dysphoria/sexual dysfunction (43.6, 95% CI 35.8–53.0), and intentional self-harm/suicidality (3.3, 95% CI 3.2–3.5). White youths had the highest rates in most categories, except for disruptive behavior disorders, elimination disorders, psychotic disorders, and standalone symptoms which Black youths had higher rates. Median age of detection was 8.1 years (IQR 3.5–13.5) with all standalone symptoms recorded earlier than the corresponding MH disorder categories. Conclusions These results support EHRs’ capability in capturing the full spectrum of MH disorders/symptoms and exposure to ACEs, identifying the proportion of patients and groups at risk, and detecting trends throughout a 13-year period that included the Covid-19 pandemic. Standardized EHR data, which capture MH conditions is critical for health systems to examine past and current trends for future surveillance. Our publicly available EHR-mental health typology codes can be used in other studies to further advance research in this area.

This paper investigates the role of proportional reinsurance as a practical and flexible tool for managing demographic risk in life insurance, with a focus on its impact on both the Solvency Capital Requirement (SCR) and expected profitability. While much of the existing literature focuses on mortality modeling or longevity-linked reinsurance instruments, this paper proposes a novel framework for analyzing traditional proportional reinsurance structures within the Solvency II market-consistent valuation environment. The framework integrates proportional reinsurance into the valuation of liabilities and the calculation of Solvency Capital Requirement, beginning with an outline of cash flow structures and their valuation under Solvency II principles. A key contribution is the introduction and decomposition of the net of reinsurance Claims Development Result (CDR), which allows us to assess the dual impact of reinsurance on risk mitigation and profit transfer. Through numerical analysis, we show how proportional reinsurance can effectively reduce capital requirements while quantifying the trade-off in expected profit transferred to the reinsurance company, with insights into how different reinsurance treaties affect capital efficiency and profitability.

breast cancer is the most commonly diagnosed malignancy and an important cause of cancer death among females worldwide. The disease accounted for 25% (1.67 million) of new cancer cases and the fifth cause of cancer deaths. Incidence of all types of cancers is approximately 25% in Sierra Leone. However, there was no documented evidence on risk factors for breast cancer among women in the country. The main aim of this study was to assess risk factors associated with breast cancer among women screened for breast cancer in Freetown Sierra Leone. we conducted a case-control study on breast cancer involving 116 confirmed breast cancer cases and 116 controls. Questionnaire was designed to collect data on socio-demographic, reproductive and behavioral risk factors. Analysis was carried using logistic regression to assess the associations between breast cancer and the risk factors. in the final multiple logistic regression, had formal educational level, (aOR 0.1, 0.03-0.26, p= 0.001) physical activity for more than 30 minutes per week (aOR 0.5 (0.9- 0.7, p=0.001). Cigarette smoking (aOR 4.8, 1.2-18.5, p=0.023) and family history of breast cancer (aOR 9.9 cigarette smoking (OR 4.4, 1.2-18.5, p=0.023) and family history of breast cancer (OR 9.9, 2.7-36.45, p=0.040) were identified as the main risk factors for breast cancer. This study did not find any statistically significant associations between reproductive risk factors and breast cancer. risk factors for breast cancer among women in Sierra Leone include educational level, physical activity, cigarette smoking and family history of breast cancer. We recommended screening program for women above 40 years and had history of breast cancer. Also, to establish breast cancer registry.

A considerable body of published research on meningoencephalitis of unknown origin (MUO) exists; however, certain fundamental aspects relating to the epidemiology remain poorly characterized. These include the frequency of MUO diagnosis at referral level, reliable demographic risk factors, and the extent to which proposed diagnostic criteria are applied in referral clinical settings. Based on 1,121 MUO cases (from 01 January 2017 to 31 December 2021) treated at 13 referral centers in England and 750,000 control dogs from the VetCompass Programme, this study investigated a range of demographic risk factors using multivariable logistic regression analysis. Additionally, we report on clinical methods used for diagnosis. Meningoencephalitis of unknown origin represented 2.21% (95% CI: 2.08-2.34) of new neurological referrals (1,121/50721). Clinical diagnosis included both magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis in 1026 (91.5%) cases. Of these, 961 (89.3%) showed results indicative of MUO in both MRI and CSF. Abnormal MRI but normal CSF were found in 55 cases (5.4%), while normal MRI and abnormal CSF were found in 36 cases (3.5%). Both normal MRI and normal CSF were reported in 19 cases (1.5%). Screening for infectious disease was carried out in 1037 (92.5%) of cases. The diagnosis of MUO peaked at 4 years (median 4.33, IQR 2.50-6.92, range 0.30-15.00) and declined after age 10. Welsh Springer Spaniel (OR 23.76, 95% CI 10.37-54.43), Maltese (OR 20.53, 95% CI 14.53-29.01), Papillon (OR 17.48, 95% CI 7.66-39.91), Boston Terrier (OR 17.31, 95% CI 11.17-26.82), and French Bulldog (OR 9.14, 95% CI 7.14-11.71) had the highest MUO odds compared to crossbreed dogs. Brachycephalic breeds had 2.56 times higher odds (95% CI 2.23-2.95) than mesocephalic breeds. Dogs ≥15 kg had lower odds than those <10 kg. This study provides the largest referral-based analysis of MUO cases to date, offering updated insights into breed predispositions and clinical diagnosis. This more precise characterization of the demographic factors adds valuable context for future research design, particularly in breed-focused investigations and risk stratification. By documenting current diagnostic practices used by referral specialists, this work lays the foundation for greater consistency in case recognition and offers practical guidance for structuring future MUO clinical trials.

To determine the prevalence and demographic risk factors for latent tuberculosis infection (LTBI) among healthcare workers in Semarang, Indonesia. A cross-sectional study involving 195 healthcare workers from 34 primary health centers was conducted from August to October 2019. The relationship between independent variables and dependent variables was analyzed using a multivariable logistic regression analysis. The prevalence of LTBI among healthcare workers in this study was 23.6%. Comorbidities were the only risk factor for LTBI identified among other risk factors (OR=3.39, 95% CI: 0.99-11.62, =0.04). Other demographic factors such as age (OR=0.93, 95% CI: 0.45-1.92, =0.839), gender (OR=0.79, 95% CI: 0.23-2.72, =0.708, smoking habits (OR=2.54, 95% CI: 0.52-12.38, =0.247), and length of work (OR=1.43, 95% CI: 0.70-2.91, =0.331) were not significant risk factors for LTBI. Healthcare workers suffering from comorbidity have a high risk for tuberculosis infection, and should not work in areas where they would be exposed to patients with tuberculosis. Healthcare workers need to apply occupational safety standards during contact with TB patients or specimens to minimize the disease transmission.

Purpose To study the caries status of 5, 12 and 15-year-old Greek children, assess how disease parameters are related to socio-demographic indicators and identify relevant trends at the national level. Methods A stratified cluster sample of 3702 children in total was randomly selected and examined clinically for caries (ICDAS II criteria). Caries experience was outlined by adapting ICDAS 0–6 criteria to the d / D component of the WHO dmf/DMF index configuration . Percentages (%) of caries experience-free children, of children with initial caries (ICDAS 1–2 ), and the mean d 1–2 t/ D 1–2 T, d 3–6 mft/ D 3–6 MFT and d 3–6 mfs/ D 3–6 MFS indices were calculated. The probability of presenting with d 1–2 t/ D 1–2 T ≥ 1 was assessed by binary logistic regression analysis, whereas negative binomial regression models examined the effect of socio-demographic parameters on d 3–6 mfs/ D 3–6 MFS indices (level of significance: p  ≤ 0.05). Results 60.1%, 48.1%, and 34.7% of the 5, 12, and 15-year-old children, respectively, had no caries experience at the defect level ( d 3–6 mft/ D 3–6 MFT = 0). Initial lesions (ICDAS 1–2 ) were detected in 17.7%, 19.3% and 17.4% of the 5, 12 and 15-year-olds, accordingly. Mean d 1–2 t/ D 1–2 T was 0.93, 1.70, and 2.51, whereas mean d 3–6 mft/ D 3–6 MFT was 1.48, 1.61, and 2.46 for the 5, 12, and 15-year-olds, respectively. Children with higher educated parents and 15-year-old urban residents exhibited significantly less caries experience at the defect level. Initial caries lesions presented a significantly higher probability of being detected in urban-residing 5- and 15-year-olds, while no consistent trend could be identified for parental education level. Caries prevalence and experience levels declined for all age groups in ten years. Conclusion Although the dental health of Greek children has improved disparities remain, calling for organised primary and secondary preventive interventions.

Populations with Type 2 diabetes are exposed to many complications that are due to complex mechanisms combining hyperglycemia, insulin resistance, low-intensity inflammation and accelerated atherogenesis. Cardio-cerebrovascular complications affect the prognosis of diabetes. This study aims to identify sociodemographic and anthropometric risk factors for type 2 diabetes in the population of Nador located in the north of Morocco. This epidemiological study took place in a private medical analysis laboratory in the city of NADOR for a period of one year extending from 01/10/2018 to 01/10/2019. It focused on 830 male and female subjects over the age of 18, all residing in the city of NADOR. The subjects’ blood sugar levels were above 1.26 g / L, with the help of the laboratory reception and collection team of three secretaries and two nurses; we explained the purpose of the study to the population studied. Volunteers signed the consent form and then were interviewed using questionnaires; anthropometric measurements were taken in the sample collection room. Their confidentiality and privacy were respected. This study allowed us to shed light on certain socio-demographic and anthropometric characteristics as well as the problems from which the diabetic population suffers. The study found that female sex and old age are socio-demographic risk factors; it also found that waist circumference and BMI (body mass index) are anthropometric risk factors for T2D.