Different effects of metformin and insulin on primary and secondary chemoprevention of colorectal adenoma in diabetes type 2

Metformin and insulin differently affect the risk of colon cancer in type 2 diabetic patients, however their effects on colon adenoma is not clear. PubMed, ISI, Scopus and Cochrane databases were searched for studies reporting. The outcomes were total adenoma; advanced adenoma and recurrent adenoma. Traditional and Bayesian metaanalysis were conducted via random-effects models. Odds ratios (OR) with 95 % confidence intervals (CIs) / or credible intervals (CrI) were used to describe the ratio of different events. A random-effects model described by DerSimonian and Laird was performed, when significant between-study heterogeneity existed. Alternatively, an inverse variance fixed effects model was used, when there was no significant heterogeneity across studies. The potential publication bias was assessed with funnel plot, Egger and Begg's regression asymmetry tests. Moreover, “trim and fill” procedure was used to assess the possible effect of publication bias. For metformin intake, 11 studies (51991 patients) were included. The results showed that metformin significantly decreased the risk of advance adenoma (OR= 0.51, p< 0.001). The risk of total adenoma was not associated with metformin use (OR= 0.86, p=0.274), and metformin did not affect the risk of adenoma recurrence (OR= 0.89, p=0.137). Five studies (2678 patients) were included in the analysis to determine the effect of insulin therapy. Insulin significantly increased the risk of colorectal adenoma (OR= 1.43, p=0.002). These findings indicate that metformin has no protective effect on total and recurrent adenoma, whilst it significantly reduces the risk of advanced adenoma, but insulin increases the risk of total adenoma

Exploring Factors Related to Metastasis Free Survival in Breast Cancer Patients Using Bayesian Cure Models

CEEQUAL är ett klassningssystem utvecklad av ICE, den brittiska Institutionen för Civilingenjörer, för att bättra på anläggningsbranschens sociala, ekonomiska och miljömässiga hållbarhetsarbete. Systemet utvecklades år 2003 och användes fram till år 2011 endast i Storbritannien och Irland. År 2011 utvecklades en internationell version för organisationer som är intresserade av att certifiera projekt i andra delar av världen. Syftet med rapporten är att utvärdera konsekvenser för ett projekt som skall miljöcertifieras. Detta sker med hjälp av tre fallstudier från Skanska Sverige AB: Projekt Skarplöt, exploatering av en åkermark i Västerhaninge. Projekt Folkparksvägen, ombyggnation av en 1500 meter vägsträcka. Projekt Tyresövägen-Simvägen, en avsmalning av Tyresövägen från  motorvägsstandard till stadsväg.           Målet med rapporten är att: Identifiera förbättringsåtgärder för att främja hållbarhet och resurseffektivitet i produktion. Uppskatta vilka resurser förbättringsåtgärderna för certifiering kräver. Resultat från fallstudierna visar att Skanska har väl inarbetade rutiner i företagets ledningssystem, dock finns det förbättringspotential som kan uppnås med integrering av CEEQUALs krav i dagens arbetssätt. Merkostnaden av förbättringsåtgärderna består mestadels av tjänstemannatid för ett utökat samhällsengagemang, planering och bevakning av åtgärder som främjar hållbarhet samt insamling av bevismaterial för certifiering. Ändringar som uppkommer i arbetssättet är projektberoende och belyses i produktionsplaneringsskedet i varje enskilt projekt med hjälp av den extra planeringen som en CEEQUAL certifiering kräver. Rekommendationer för Skanska är att integrera en del av CEEQUALs krav i ledningssystemet och att skapa färdiga mallar som är anpassade till CEEQUALs frågeställningar med avsikt att effektivisera framställning av bevisdokumentationen i varje enskilt projekt. CEEQUAL is an assessment and award scheme developed by ICE, The Institution of Civil Engineers in Great Britain, in order to improve the Civil engineering industry´s social, economic and environmental sustainability. The system was developed in 2003 and it was only used in the UK and Ireland until 2011. Year 2011, was an international version developed for organizations that are interested in certifying projects in other parts of the world. The report aims to evaluate the consequences for a project that is going to be assessed. This is done by using three case studies from Skanska Sverige AB: Project Skarplöt, exploitation of previous farming land in Västerhaninge. Project Folkparksvägen, refurbishment of a 1500 meter stretch of road. Project Tyresövägen - Simvägen, a narrowing of Tyresövägen from motorway standard to a city road with cycle lanes. The objective of this report is to: Identify improvement measures to promote sustainability and resource efficiency under production. Estimate the resources that such improvements and the works associated with the certification requires. Results of case studies show that Skanska has well-established work practices, however, there is potential for improvement that can be achieved with the integration of CEEQUALs requirements in the company’s management system. The additional cost of the improvement measures consist mostly of extra working time needed to administrate, plan and monitor measures that promote sustainability as well as gather evidence for certification. Adjustments to the production process that arises in the planning stages of the sustainability measures cannot be generalised and depend mostly on the project prerequisites. Recommendations to Skanska are to integrate CEEQUALs requirements in their management system and to create pre-designed templates for the required documentation and procedures in order to streamline planning and monitoring in each individual project that is going to be certified

Geographic risk of general and abdominal obesity and related determinants in Iranian children and adolescents: CASPIAN-IV Study

Background: Obesity, as a risk factor for many noncommunicable diseases, is a common public health problem in developed and developing countries. Among Iranian children and adolescents, the prevalence of being overweight has increased by almost 50% in the past two decades. Aims: To visualize the geographic differences in general and abdominal obesity risks and related determinants among Iranian children and adolescents. Methods: Participants consisted of 14 880 students, aged 7-19 years, living in urban and rural areas of the Islamic Republic of Iran. Spatial patterns of obesity and its association with related risk factors were identified using Bayesian spatial modeling. Results: The highest spatial risks of general obesity (odds ratio 1.21-1.66 for males and 1.81-2.02 for females) and abdominal obesity (odds ratio 1.20-1.82 for males and 1.25-1.78 for females) were observed in the north, northwest and southwest of the country. Risk of obesity was significantly higher in areas with a higher rate of urban residence, active current smokers and prolonged screen time. Conclusion: Identification of high-risk regions for obesity and spatially related risk factors can be used as informative tools for decision-making and planning in health systems at national and subnational levels

Automatic classification between COVID-19 and Non-COVID-19 pneumonia using symptoms, comorbidities, and laboratory findings : the Khorshid COVID cohort study

Coronavirus disease-2019, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was a disaster in 2020. Accurate and early diagnosis of coronavirus disease-2019 (COVID-19) is still essential for health policymaking. Reverse transcriptase-polymerase chain reaction (RT-PCR) has been performed as the operational gold standard for COVID-19 diagnosis. We aimed to design and implement a reliable COVID-19 diagnosis method to provide the risk of infection using demographics, symptoms and signs, blood markers, and family history of diseases to have excellent agreement with the results obtained by the RT-PCR and CT-scan. Our study primarily used sample data from a 1-year hospital-based prospective COVID-19 open-cohort, the Khorshid COVID Cohort (KCC) study. A sample of 634 patients with COVID-19 and 118 patients with pneumonia with similar characteristics whose RT-PCR and chest CT scan were negative (as the control group) (dataset 1) was used to design the system and for internal validation. Two other online datasets, namely, some symptoms (dataset 2) and blood tests (dataset 3), were also analyzed. A combination of one-hot encoding, stability feature selection, over-sampling, and an ensemble classifier was used. Ten-fold stratified cross-validation was performed. In addition to gender and symptom duration, signs and symptoms, blood biomarkers, and comorbidities were selected. Performance indices of the cross-validated confusion matrix for dataset 1 were as follows: sensitivity of 96% [confidence interval, CI, 95%: 94–98], specificity of 95% [90–99], positive predictive value (PPV) of 99% [98–100], negative predictive value (NPV) of 82% [76–89], diagnostic odds ratio (DOR) of 496 [198–1,245], area under the ROC (AUC) of 0.96 [0.94–0.97], Matthews Correlation Coefficient (MCC) of 0.87 [0.85–0.88], accuracy of 96% [94–98], and Cohen's Kappa of 0.86 [0.81–0.91]. The proposed algorithm showed excellent diagnosis accuracy and class-labeling agreement, and fair discriminant power. The AUC on the datasets 2 and 3 was 0.97 [0.96–0.98] and 0.92 [0.91–0.94], respectively. The most important feature was white blood cell count, shortness of breath, and C-reactive protein for datasets 1, 2, and 3, respectively. The proposed algorithm is, thus, a promising COVID-19 diagnosis method, which could be an amendment to simple blood tests and screening of symptoms. However, the RT-PCR and chest CT-scan, performed as the gold standard, are not 100% accurate.Peer ReviewedPostprint (published version

Clinical decision support system, a potential solution for diagnostic accuracy improvement in oral squamous cell carcinoma: A systematic review

BACKGROUND AND AIM: Oral squamous cell carcinoma (OSCC) is a rapidly progressive disease and despite the progress in the treatment of cancer, remains a life-threatening illness with a poor prognosis. Diagnostic techniques of the oral cavity are not painful, non-invasive, simple and inexpensive methods. Clinical decision support systems (CDSSs) are the most important diagnostic technologies used to help health professionals to analyze patients’ data and make decisions. This paper, by studying CDSS applications in the process of providing care for the cancer patients, has looked into the CDSS potentials in OSCC diagnosis. METHODS: We retrieved relevant articles indexed in MEDLINE/PubMed database using high-quality keywords. First, the title and then the abstract of the related articles were reviewed in the step of screening. Only research articles which had designed clinical decision support system in different stages of providing care for the cancer patient were retained in this study according to the input criteria. RESULTS: Various studies have been conducted about the important roles of CDSS in health processes related to different types of cancer. According to the aim of studies, we categorized them into several groups including treatment, diagnosis, risk assessment, screening, and survival estimation. CONCLUSION: Successful experiences in the field of CDSS applications in different types of cancer have indicated that machine learning methods have a high potential to manage the data and diagnostic improvement in OSCC intelligently and accurately. KEYWORDS: Squamous Cell Carcinoma; Clinical Decision Support System; Neoplasm; Dental Informatic

Cross-sectional and longitudinal assessments of risk factors associated with hypertension and moderately increased albuminuria comorbidity in patients with type 2 diabetes: a 9-year open cohort study.

Background: Moderately increased albuminuria (MIA) is strongly associated with hypertension (HTN) in patients with type 2 diabetic mellitus (T2DM). However, the association between risk factors and coexisting HTN and MIA remains unassessed. Objectives: This study aimed to determine both cross-sectional and longitudinal associations of risk factors with HTN and MIA comorbidity in patients with T2DM. Methods: A total of 1,600 patients with T2DM were examined at baseline and longitudinal data were obtained from 1,337 T2DM patients with at least 2 follow-up visits to assess the presence of HTN alone (yes/no), MIA alone (yes/no) and the coexistence of both (yes/no) in a 9-year open cohort study between 2004 and 2013. Bivariate mixed-effects logistic regression with a Bayesian approach was employed to evaluate associations of risk factors with HTN and MIA‎ comorbidity in the longitudinal assessment. Results: After adjustment for age and BMI, patients with uncontrolled plasma glucose, as a combined index of the glucose profile, were more likely to have HTN [odds ratio (OR): 1.73 with 95% Bayesian credible intervals (BCI) 1.29-2.20] and MIA [OR: 1.34 (‎95% BCI 1.13-1.62)]. The risks of having HTN and MIA were increased by a one-year raise in diabetes duration [with 0.89 (95% BCI 0.84-0.96) and 0.81 (95% BCI 0.73-0.92) ORs, respectively] and a one-unit increase in non-high-density lipoprotein-cholesterol (Non-HDL-C) [with 1.30 (95% BCI 1.23-1.34) and 1.24 (95% BCI 1.14-1.33) ORs, respectively]. Conclusions: T2DM patients with HTN,‎ MIA, and the coexistence of both had uncontrolled plasma glucose, significantly higher Non-HDL-C, and shorter diabetes duration than the other T2DM patients. Duration of diabetes and uncontrolled plasma glucose index showed the stronger effects on HTN and MIA comorbidity than on each condition separately

Developing Non-Laboratory Cardiovascular Risk Assessment Charts and Validating Laboratory and Non-Laboratory-Based Models.

BACKGROUND: Developing simplified risk assessment model based on non-laboratory risk factors that could determine cardiovascular risk as accurately as laboratory-based one can be valuable, particularly in developing countries where there are limited resources. OBJECTIVE: To develop a simplified non-laboratory cardiovascular disease risk assessment chart based on previously reported laboratory-based chart and evaluate internal and external validation, and recalibration of both risk models to assess the performance of risk scoring tools in other population. METHODS: A 10-year non-laboratory-based risk prediction chart was developed for fatal and non-fatal CVD using Cox Proportional Hazard regression. Data from the Isfahan Cohort Study (ICS), a population-based study among 6504 adults aged ≥ 35 years, followed-up for at least ten years was used for the non-laboratory-based model derivation. Participants were followed up until the occurrence of CVD events. Tehran Lipid and Glucose Study (TLGS) data was used to evaluate the external validity of both non-laboratory and laboratory risk assessment models in other populations rather than one used in the model derivation. RESULTS: The discrimination and calibration analysis of the non-laboratory model showed the following values of Harrell's C: 0.73 (95% CI 0.71-0.74), and Nam-D'Agostino χ2:11.01 (p = 0.27), respectively. The non-laboratory model was in agreement and classified high risk and low risk patients as accurately as the laboratory one. Both non-laboratory and laboratory risk prediction models showed good discrimination in the external validation, with Harrell's C of 0.77 (95% CI 0.75-0.78) and 0.78 (95% CI 0.76-0.79), respectively. CONCLUSIONS: Our simplified risk assessment model based on non-laboratory risk factors could determine cardiovascular risk as accurately as laboratory-based one. This approach can provide simple risk assessment tool where laboratory testing is unavailable, inconvenient, and costly

Association of Nitrate, Nitrite, and Total Organic Carbon (TOC) in Drinking Water and Gastrointestinal Disease

Objective. We aimed to investigate the amounts of nitrate, nitrite, and total organic carbon (TOC) in two drinking water sources and their relationship with some gastrointestinal diseases. Methods. This cross-sectional study was conducted in 2012 in Iran. Two wells located in residential areas were selected for sampling and measuring the TOC, nitrate (NO3−), and nitrite (NO2−). This water is used for drinking as well as for industrial and agricultural consumption. Nitrate and nitrite concentrations of water samples were analyzed using DR 5000 spectrophotometer. The information of patients was collected from the records of the main referral hospital of the region for gastrointestinal diseases. Results. In both areas under study, the mean water nitrate and nitrite concentrations were higher in July than in other months. The mean TOC concentrations in areas 1 and 2 were 2.29 ± 0.012 and 2.03 ± 0.309, respectively. Pollutant concentration and gastrointestinal disease did not show any significant relationship . Conclusion. Although we did not document significant association of nitrite, nitrate, and TOC content of water with gastrointestinal diseases, it should be considered that such health hazards may develop over time, and the quality of water content should be controlled to prevent different diseases

Association of Exposure to Fine Particulate Matter and Risk Factors of Non-Communicable Diseases in Children and Adolescents

Background: Risk factors of non-communicable disease (NCD) origin from early life, and exposure to environmental pollutant may be a predisposing factor. This study aimed to investigate the association of air quality index (AQI) and fine particulate matter (PM2.5) with some NCD risk factors in a sample of Iranian children and adolescents. Materials and Methods: This cross-sectional study was conducted in 2014 to 2016 among children and adolescents, aged 6-18 years, in Isfahan, Iran. Physical examination, including weight, height, and blood pressure, was conducted by standard methods. Fasting blood sample was obtained for fasting blood glucose, total cholesterol, high density lipoprotein-cholesterol, low-density lipoprotein- cholesterol, and triglycerides. The mean AQI and PM2.5 values from the study time till one year prior to the survey were used. Multiple linear regression analysis was conducted for the association of AQI and PM2.5 with other variables. Results: Participants consisted of 186 children and adolescents with mean (SD) age of 10.52(2.38) years. Exposure to higher level of PM2.5 had significant associations with higher levels of systolic blood pressure, low-density lipoprotein cholesterol, and triglycerides. It also had positive relationship with other risk factors and inverse association with low-density lipoprotein cholesterol (LDL-C), but these associations were not statistically significant. The corresponding figures were not significant for AQI. Conclusion: At current study results showed that exposure to higher levels of fine particulates was associated with some NCD risk factors in children and adolescents. Early life prevention of NCDs can lead to large reductions in disease risk; adverse effects of ambient pollutants should be considered in this regard

Target trial emulation using hospital-based observational data: demonstration and application in COVID-19

Methodological biases are common in observational studies evaluating treatment effectiveness. The objective of this study is to emulate a target trial in a competing risks setting using hospital-based observational data. We extend established methodology accounting for immortal time bias and time-fixed confounding biases to a setting where no survival information beyond hospital discharge is available: a condition common to coronavirus disease 2019 (COVID-19) research data. This exemplary study includes a cohort of 618 hospitalized patients with COVID-19. We describe methodological opportunities and challenges that cannot be overcome applying traditional statistical methods. We demonstrate the practical implementation of this trial emulation approach via clone–censor–weight techniques. We undertake a competing risk analysis, reporting the cause-specific cumulative hazards and cumulative incidence probabilities. Our analysis demonstrates that a target trial emulation framework can be extended to account for competing risks in COVID-19 hospital studies. In our analysis, we avoid immortal time bias, time-fixed confounding bias, and competing risks bias simultaneously. Choosing the length of the grace period is justified from a clinical perspective and has an important advantage in ensuring reliable results. This extended trial emulation with the competing risk analysis enables an unbiased estimation of treatment effects, along with the ability to interpret the effectiveness of treatment on all clinically important outcomes.This research was funded by the German Research Foundation (original: Deutsche Forschungsgemeinschaft), grant number WO 1746/5-1.Peer ReviewedPostprint (published version