Beyond the bias! Sex distribution in paediatric growth hormone deficiency reexamined.

OBJECTIVES: Various biases pertaining to stature account for a male sex predominance in growth hormone deficiency (GHD) cases diagnosed by endocrinology clinics. This manuscript will assess the sex distribution when biases are minimised. METHODS: Retrospective chart review was conducted on patients diagnosed with GHD between 3 and 16 years of age. The sex distribution of cases was ascertained according to: (1) peak GH (pGH) by groups; based on growth hormone provocative testing, (2) pituitary gland imaging results, and (3) isolated GHD (IGHD) versus multiple pituitary hormone deficiencies (MPHD). The relative frequency of each sex was compared according to these subgroups with significance evaluated at α = .05 level. RESULTS: Of the 5880 clinic referrals for short stature, there were 3709 boys (63%) and 2171 girls (37%). Of these, 20% of boys (n = 745) and 15.3% of girls (n = 332) underwent provocative testing for GHD. Of those tested, 39.2% of boys (n = 292) and 32.2% of girls (n = 107) were diagnosed with GHD, all p < .001. There was a male predominance in GHD cases based on pGH or GHD severity. Though not significant, girls were more likely than boys to have MPHD (p = .056), even across pGH groups (p = .06). Both boys and girls had a similar distribution of imaging abnormalities. CONCLUSION: Stratifying by sex, we found similar percentages of pituitary imaging abnormalities (including tumours) and the number of pituitary hormone deficiencies in boys and girls as the cause of GHD. For these classifications, we did not find the historically reported male sex predominance.

Sex estimation by volumetric evaluation of the maxillary canine using cone-beam computed tomographic images.

BACKGROUND: Teeth can be a reasonable part of sex estimation in case of being the single evidence available or in doubt although they are not as accurate as bones in sex estimation. The size of teeth is greater in males than in females. In this study, it was aimed to determine cut-off values of the tooth volume (TV) and root volume (RV) of the maxillary canines and to evaluate the validity of the method for discriminating between males and females. METHODS: Cone beam computed tomography (CBCT) images of 250 individuals aged 18 to 63 years with equal age and sex distribution were assessed retrospectively. The sample divided into reference set including 168 images of 84 females and 84 males and validation set including 82 images of 48 females and 34 males. Receiver operating characteristic (ROC) curve analysis, and Youden's index were used to determine cut-off values of the volumetric measurements and to test the discriminative performance of the method. RESULTS: The optimal cut-off values of TV ≥ 581 mm3 and RV ≥ 334 mm3 for estimating sex were established from the reference set. The sensitivity (Se), specificity (Sp), and accuracy (Ac) were 0.77 for TV ≥ 581 mm3 while they were 0.82, 0.77, and 0.79 for RV ≥ 334 mm3. When we tested the previously derived cut-off values of TV of the maxillary canine, the Se, Sp, and Ac were found to be respectively 0.71, 0.90, and 0.82 for TV ≥ 619 mm3 and 0.97, 0.27, and 0.56 for TV ≥ 510 / 460 mm3 (right/left). CONCLUSIONS: The identified cut-off values of TV and RV of the maxillary canines can be used to estimate sex with moderate accuracy when the only evidence available is teeth or in case of doubt. The method's applicability should be assessed for different populations.

Asociación de alteraciones de la función tiroidea con turnicidad/nocturnidad laboral y antecedentes de patología tiroidea en profesionales sanitarios / Relationship between thyroid function changes with work-/night-shifts and history of thyroid pathology among health personnel

Fundamento. El objetivo de este estudio es analizar la asociación entre la patologia funcional tiroidea y la exposición a turnicidad/nocturnidad laboral, y describir los trastornos tiroideos más prevalentes por turno de trabajo. Metodología. Estudio transversal realizado en un servicio de urgencias hospitalario de Almería (España). Se relacionaron los niveles de tiroxina y tirotropina (TSH) con el turno, la categoría profesional y los antecedentes de patologia tiroidea. Resultados. Se incluyeron 133 trabajadores, 80,5% mujeres, edad media 46,11 años (38 a 65) y 52% personal enfermero; las mujeres mostraron más frecuentemente antecedentes tiroideos. El 81,2% trabajaba en turno rotatorio y el 11,3% en turno nocturno (12,1% de mujeres y 7,7% de hombres). El 27% mostró alteraciones tiroideas, más frecuentemente niveles elevados de TSH con niveles normales de tiroxina, especialmente en turno nocturno (61,1%). Las alteraciones de TSH fueron más frecuentes en turno nocturno que en rotatorios (53,3 vs 13,0%; p<0,001). El turno nocturno presentó valores medios de TSH en rango normal pero significativamente superiores al resto de turnos, mientras los niveles de tiroxina fueron similares. El turno diurno no presentó alteraciones. El turno nocturno y la presencia de antecedentes fueron predictores independientes de presentar alteraciones tiroideas. Conclusiones. El turno nocturno y los antecedentes de patología tiroidea fueron más frecuentes en mujeres, y ambos se asociaron con la presencia de alteraciones tiroideas, indicando la necesidad de incluir la evaluación de dichas alteraciones en los programas de vigilancia de salud y de analizar las diferencias por sexo. (AU)

Background. The study aim was to analyze the relationship between functional thyroid pathology and the exposure to work shifts / night shifts, and describe the most prevalent thyroid disorders based on the type of shift. Methodology. Cross-sectional study performed in the emergency department of a hospital in Almeria (Spain). Relationships between thyroxine and thyrotropin levels (TSH) and work shifts, professional category and history of thyroid pathology were analyzed. Results. The study included 133 workers; 80.5% female, average age was 46.11 years (38 – 65), and 52% were part of the nursing staff; thyroid disorders were more frequent in female participants. Most participants (81.2%) had rotating shifts schedules and 11.3% night shifts (12.1% female and 7.7% male). Thyroid alterations were found in 27% of the participants (usually elevated TSH levels and normal thyroxine levels), particularly in those doing night shifts (61.1%). TSH alterations were more frequent in individuals doing night shifts than in rotating shifts (53.3 vs 13.0%; p<0.001). Individuals working night shifts had mean TSH values in the normal range, although significantly higher than the individuals in the rest of the shifts; thyroxine levels were found to be similar. No thyroid disorders were found in day shift participants. Night shift and a history of thyroid pathology were independent predictors of thyroid disorders. Conclusions. Night shift schedules and history of thyroid disorders are more frequent in female, both related to the presence of thyroid disorders, indicating the need to include the evaluation of these disorders in health surveillance programs and analyze gender differences. (AU)

Análisis de Red de la Ideación Suicida Pasiva y Activa en Adolescentes / Network analysis of passive and active suicidal ideation in adolescents

La ideación suicida es un problema psicológico complejo y ambivalente que fluctúa entre pensamientos pasivos y activos acerca de la propia muerte de la persona. La adolescencia es una etapa de desarrollo importante para el bienestar físico y psicológico, sin embargo, la presencia de problemas psicológicos puede afectar su salud y supervivencia. El objetivo del estudio fue analizar la asociación de la ideación suicida pasiva y activa en adolescentes peruanos de población general. Participaron 1444 adolescentes entre 11 a 19 años (56.6% mujeres; edad media = 14.03;DT = 1.54) que respondieron un cuestionario de ideación suicida. Se estimó un modelo de red gaussiano, examinando sus propiedades globales, locales y comparación según sexo. Los resultados indicaron que los deseos de no existir, creer que no merecía vivir y pensamientos de suicidarse fueron los nodos más centrales. La ideación suicida pasiva (deseos de no existir y creer que no merecía vivir) se relacionó con la ideación suicida activa (pensamientos en suicidarse y hacerse daño). Además, para las mujeres y hombres, el deseo de no existir tuvo la mayor centralidad, aunque los hombres mayormente se asociaron con pensamientos en suicidarse a comparación de las mujeres. En conclusión, la evaluación de la ideación suicida pasiva y activa, en su conjunto y no enfatizando solo un tipo, es una práctica recomendable para la valoración del riesgo de suicidio en población adolescente. En esta etapa, es oportuno considerar las diferencias de sexo sobre la gravedad de ideación suicida en las entrevistas psicológicas y actividades psicoterapéuticas. (AU)

Suicidal ideation is a complex and ambivalent psychological problem that fluctuates between passive and active thoughts about the person’s own death. Adolescence is an important developmental stage for physical and psychological well-being, however, the presence of psychological problems can affect their health and survival. The aim of the study was to analyze the association of passive and active suicidal ideation in Peruvian adolescents from the general population. The participants were 1444 adolescents between 11 to 19 years (56.6% female; mean age = 14.03; SD = 1.54) who responded to a suicidal ideation questionnaire. A Gaussian network model was estimated, examining its global and local properties and comparing according to sex. The results indicated that wishes of not existing, believing that one did not deserve to live, and thoughts of suicide were the most central nodes. Passive suicidal ideation (wishes of not existing and believing that one did not deserve to live) was related to active suicidal ideation (thoughts of committing suicide and hurting oneself). In addition, for women and men, the desire not to exist had the greatest centrality, although men were more likely to be associated with thoughts of suicide than women. In conclusion, the evaluation of passive and active suicidal ideation, as a whole and not emphasizing only one type, is a recommended practice for the assessment of suicide risk in the adolescent population. At this stage, it is appropriate to consider gender differences in the severityof suicidal ideation in psychological interviews and psychotherapeutic activities. (AU)

Female Homicide Victims in Cook County, Illinois: A Retrospective Review.

ABSTRACT: Female homicide is a broad term that includes any homicide in which the victim is a female, representing the most extreme form of violence against women. This study investigated the characteristics of female homicides to determine the types and characteristics of injury, circumstances of the events, and other aspects in this specific population. The Cook County Medical Examiner's Office files were searched for homicides in female subjects between January 2017 and January 2022, with no limits for age, race, or cause of death. A total of 527 cases met the criteria. Most homicides occurred in Chicago during the summer. The most common cause of death was firearm(s) wounds, followed by sharp force traumas, asphyxia, and blunt force injuries. The remaining deaths were due to combined and "other" mechanisms. Different patterns of injuries were observed at the autopsy. Alleged offenders were mostly male subjects and were frequently in a romantic relationship with the victim, and the reasons for homicide were related to jealousy and personal conflicts. This study offers an overview of homicidal deaths in female subjects in a large metropolitan area.

25-Year fatal workplace suicide trends in North Carolina: 1992-2017.

BACKGROUND: Suicide is a serious public health problem in the United States, but limited evidence is available investigating fatal suicides at work. There is a substantial need to characterize workplace suicides to inform suicide prevention interventions and target high-risk settings. This study aims to examine workplace suicide rates in North Carolina (NC) by worker characteristics, means of suicide used, and industry between 1992 and 2017. METHODS: Fatal workplace suicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificate. Sex, age, race, ethnicity, class of worker, manner of death, and industry were abstracted. Crude and age-standardized homicide rates were calculated as the number of suicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% confidence intervals (CIs) were calculated, and trends over calendar time for fatal workplace suicides were examined overall and by industry. RESULTS: 81 suicides over 109,464,430 w-y were observed. Increased rates were observed in workers who were male, self-employed, and 65+ years old. Firearms were the most common means of death (63%) followed by hanging (16%). Gas service station workers experienced the highest fatal occupational suicide rate, 11.5 times (95% CI: 3.62-36.33) the overall fatal workplace suicide rate, followed by Justice, Public Order, and Safety workers at 3.23 times the overall rate (95% CI: 1.31-7.97). CONCLUSION: Our findings identify industries and worker demographics that were vulnerable to workplace suicides. Targeted and tailored mitigation strategies for vulnerable industries and workers are recommended.

Prevalence of mental disorders among middle-aged population of primary healthcare centers in Northeastern Iran.

BACKGROUND: Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders. METHODS: This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22. RESULTS: This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant. CONCLUSIONS: Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.

Trends in Myopia and High Myopia from 1966 to 2019 in Olmsted County, Minnesota.

PURPOSE: To investigate the prevalence of myopia and high myopia in Olmsted County, Minnesota, from 1966 to 2019. DESIGN: Retrospective, cross-sectional, trend study. METHODS: Manifest refractions or lens prescription were converted to spherical equivalent (SE) to estimate the prevalence of adult myopia and high myopia. Age, sex, race, and visual acuity were recorded. Subjects with an SE of -0.5 diopters (D) or less were considered to have myopia; those with an SE of -6.0 D or less were considered to have high myopia. Exclusion criteria included visually significant cataract, pseudophakia, prior refractive surgery, or age less than 18 years. RESULTS: Among 81,706 sampled subjects, the myopia prevalence increased from 33.9% (95% CI, 31.1-36.8) in the 1960s to 57.1% (95% CI, 56.6-57.6) in the 2010s (P < .001). The high myopia prevalence increased from 2.8% (95% CI, 1.95-3.98) in the 1960s to 8.3% (95% CI, 8.08-8.62) in the 2010s (P < .001). Both male (32.0%-55.1%, P < .001) and female (40.6%-58.5%, P < .001) subjects experienced increasing myopia prevalence from the 1960s to the 2010s; both male (2.6%-7.4%, P < .001) and female (3.4%-9.1%, P < .001) subjects also had higher high myopia prevalence rates from the 1960s through the 2010s. Increasing myopia and high myopia prevalence was detected by decade in nearly all age groups (excluding 18- to 24-year-old high myopia subjects). White and Asian subjects had the highest myopia prevalence, whereas Black subjects had the lowest. From the 2000s to the 2010s, White (53.3%-57.0%, P < .001) and Black (41.0%-47.0%, P = .001) subjects had significant increases in myopia prevalence. The mean SE decreased from the 1960s (-0.42 D; 95% CI, -0.59 to +2.49) to the 2010s (-1.85 D; 95% CI, -1.88 to +2.96) (P < .001). CONCLUSIONS: From 1966 to 2019 in Olmsted County, Minnesota, there was a 68% and 199% increase in myopia and high myopia prevalence, respectively.

Prevalence of subungual melanoma in patients with cutaneous malignant melanoma: A systematic review and meta-analysis.

BACKGROUND: Subungual melanoma (SUM) is a rare type of cutaneous malignant melanoma (CMM) associated with poor prognosis, while data regarding its prevalence are scarce. OBJECTIVES: We sought to provide a comprehensive systematic review and meta-analysis of the prevalence rates of SUM among all types of CMM, considering certain demographic and clinical characteristics. METHODS: The MEDLINE electronic database was searched systematically to identify eligible studies providing prevalence rate estimates of SUM in patients with CMM. Included studies were further analysed to estimate the relative prevalences of SUM according to study design, study years, geographical region and sex distribution. RESULTS: Twenty-eight studies met the inclusion criteria. The overall SUM prevalence was 1.9% (95% CI [1.5%-2.3%]). The prevalence of SUM did not differ significantly between population- and hospital-based studies and remained stable over time. However, it was found to be significantly higher in Asians compared to patients of other geographical regions as well as in studies with more men than women compared to those with female preponderance (p < 0.001). CONCLUSIONS: In all, the overall SUM prevalence among all subtypes of CMM was estimated at 1.9%, without significant changes over time, and was found to exhibit significant variability between subgroups of different geographical regions.

Incidence and prevalence of myasthenia gravis in the United States: A claims-based analysis.

INTRODUCTION/AIMS: Myasthenia gravis (MG) is a rare neuromuscular disorder with geographically variable prevalence and incidence rates. A global trend of increasing prevalence of MG has been observed in the last few decades, and this study aimed to assess the current prevalence and incidence rates of MG in the United States. METHODS: Data were extracted from the Clarivate Real-World Data Repository (2016-2021), a US claims and electronic health records database. The prevalence and incidence of MG were calculated for the year 2021 for males and females who were <2, 2-5, 6-11, 12-17, 18-49, 50-64, and ≥65 years of age, using population estimates from the US Census. RESULTS: The diagnosed prevalence and incidence of MG in the United States in 2021 were calculated to be 37.0 per 100,000 persons and 3.1 per 100,000 persons, respectively. While the incidence and prevalence of MG increased with age in both men and women, higher prevalence and incidence of MG were observed in younger women (<50 years) compared with men of matching age, and in older men (≥65 years) compared with women of the same age group. DISCUSSION: The updated prevalence and incidence of MG in the United States in 2021 are higher than previous reports from the 1980s and early 2000s, following a global trend of increased prevalence and incidence for this disorder in the last few decades.

Association of Socioeconomic Status, Sex, Racial, and Ethnic Identity With Sustained and Cultivated Careers in Surgery.

OBJECTIVE: Examine the association between sex, race, ethnicity, and family income, and the intersectionality between these identities, and sustained or cultivated paths in surgery in medical school. METHODS: This retrospective cohort study examines US medical students who matriculated in academic years 2014-2015 and 2015-2016. Data were provided by the Association of American Medical Colleges, including self-reported sex, race, ethnicity, family income, interest in surgery at matriculation, and successful placement into a surgical residency at graduation. This study examined 2 outcomes: (1) sustained path in surgery between matriculation and graduation for students who entered medical school with an interest in surgery and (2) cultivated path in surgery for students who entered medical school not initially interested in surgery and who applied to and were successfully placed into a surgical residency at graduation. RESULTS: Among the 5074 students who reported interest in surgery at matriculation, 2108 (41.5%) had sustained path in surgery. Compared to male students, female students were significantly less likely to have sustained path in surgery [adjusted relative risk (aRR): 0.92 (0.85-0.98)], while Asian (aRR: 0.82, 95% CI: 0.74-0.91), Hispanic (aRR: 0.70, 95% CI: 0.59-0.83), and low-income (aRR: 0.85, 95% CI: 0.78-0.92) students were less likely to have a sustained path in surgery compared to their peers. Among the 17,586 students who reported an initial interest in a nonsurgical specialty, 1869 (10.6%) were placed into a surgical residency at graduation. Female students, regardless of race/ethnic identity and income, were significantly less likely to have cultivated paths in surgery compared to male students, with underrepresented in medicine female students reporting the lowest rates. CONCLUSIONS AND RELEVANCE: This study demonstrates the significant disparity in sustained and cultivated paths in surgery during undergraduate medical education. Innovative transformation of the surgical learning environment to promote surgical identity development and belonging for females, underrepresented in medicine, and low-income students is essential to diversify the surgical workforce.

Alerting trends in epidemiology for non-rheumatic degenerative mitral valve disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease Study 2019.

BACKGROUND: The global and national burden of rheumatic mitral valve disease (MVD) has been well studied and estimated before. However, little is known about non-rheumatic degenerative MVD. Therefore, this study aimed to assess the trends in non-rheumatic degenerative MVD (NRDMVD) epidemiology, with an emphasis on NRDMVD mortality, leading risk factors, and their associations with age, period, and birth cohort. METHODS: Using the data derived from the Global Burden of Disease Study 2019, including prevalence, mortality, and disability-adjusted life years, we analyzed the burden of NRDMVD and the detailed trends of NRDMVD mortality over the past 30 years in 204 countries and territories by implementing the age-period-cohort framework. RESULTS: Globally, the number of deaths due to NRDMVD increased from 5695.89 (95% uncertainty interval [UI]: 5405.19 to 5895.4) × 1000 in 1990 to 9137.79 (95% UI: 8395.68 to 9743.55) × 1000 in 2019. The all-age mortality rate increased from 106.47 (95% UI: 101.03 to 110.2) per 100,000 to 118.1 (95% UI: 108.51 to 125.93) per 100,000, whereas the age-standardized mortality rate decreased from 170.45 (95% UI: 159.61 to 176.94) per 100,000 to 117.95 (95% UI: 107.83 to 125.92) per 100,000. The estimated net drift of mortality per year was -1.1% (95% confidence interval: -1.17 to -1.04). The risk of death due to NRDMVD increased with age, reaching its peak after 85 years old globally. Despite female patients being associated with lower local drift than male patients, no significant gender differences were observed in the age effect across countries and regions for all sociodemographic index (SDI) levels, except low-SDI regions. CONCLUSIONS: We estimated the global disease prevalence of and mortality due to NRDMVD over approximately a 30-year period. The health-related burden of NRDMVD has declined worldwide; however, the condition persisted in low-SDI regions. Moreover, higher attention should be paid to female patients.

Pediatric vehicular heatstroke: An analysis of 296 cases from the National Fatality Review Case Reporting System.

OBJECTIVES: To explore the National Fatality Review Case Reporting System (NFR-CRS) as a new data source to (1) characterize pediatric vehicular heatstroke (PVH) deaths among children <15 years of age reviewed by Child Death Review teams, and (2) identify factors independently associated with common PVH scenarios and incident locations. METHODS: Data for 2005-2019 were used to characterize 296 PVH deaths. Frequencies and percentages were calculated to describe child, supervisor, and incident characteristics. Multiple logistic regression with and without imputation were carried out to identify factors associated with the two outcomes of interest: PVH scenario (left in vehicle vs. gained access) and incident place (supervisor workplace vs. other locations). Odds ratios and 95% confidence intervals (OR, 95% CI) were calculated. RESULTS: Most children had been left unattended in vehicles (N = 225, 76.0%) and 13.5% (N = 40) had gained access independently. Children were most often male (N = 168, 56.8%), non-Hispanic White (N = 131, 44.3%), and <2 years of age (N = 172, 58.1%). Disability or chronic illness was noted for 4.7% (N = 14), 13.9% (N = 41) had a history of maltreatment, and 6.1% (N = 18) an open CPS case at the time of incident. Children left unattended were more likely to be <2 years of age (adjusted imputed OR 26.7, CI 7.3-97.2) and less likely to have an open CPS case (0.2, 0.0-0.4) and for the incident to occur at home (0.2, 0.1-0.9) compared to children who gained access. PVH deaths occurring at the supervisor's workplace were more likely to be <2 years of age (6.2, 2.4-15.8), to have occurred on a weekday (5.9, 1.7-20.9), and to have been supervised by their parent at the incident time (2.7, 1.1-6.7) compared to other locations. CONCLUSIONS: The results align with previous PVH findings and added new information on child race/ethnicity, CPS action, disability/chronic illness, and maltreatment. With the exception of parents being more likely to be the supervisor in incidents occurring at home, which was expected, neither supervisor characteristics nor child race/ethnicity or sex were independently significant in multiple regression, suggesting that PVH is pervasive and that education campaigns should be similarly broad.

Implicaciones del covid-19 en el bienestar psicológico: un modelo de rutas / Implications of COVID-19 on psychological well-being: a path analysis

El objetivo del estudio fue determinar el efecto del sexo, la edad, el nivel de instrucción, la gravedad de la condición, perdidas por la enfermedad y las dificultades post-COVID-19 sobre el Bienestar Psicológico, y cómo estas variables se relacionan entre sí. Se empleó un diseño de ru-ta en una muestra de 419 personas con COVID-19. Se utilizó la Escala de Bienestar Psicológico de CarolRyff (1989), y la Encuesta sobre implicaciones del COVID-19. Se encontró que la edad influencia directamente a todas las dimensiones del bienestar, a excepción de Relaciones Posi-tivas y Crecimiento Personal. El nivel educativo influye directamente de forma positiva en la mayoría de las dimensiones de bienestar. Los hombres presentan mayor bienestar en la dimen-sión Autonomía. Otras variables que predicen directamente el bienestar psicológico fueron el poseer algunas dificultades post-COVID. Se concluye que el modelo fue parcialmente compro-bado y permitiría desarrollar algunos planes de intervención. (AU)

The purpose of the study was to determine the effect of sex, age, level of education, severity of the condition, losses associated to the disease, and post-COVID-19 difficulties, on Psycho-logical Well-being, and how these variables relate to each other. Hence, a pathway design was used on a sample of 419 COVID-19 patients. The Carol Ryff’s Psychological Well-Being Scale (1989) and the Survey on the implications of COVID-19 were implemented. A direct influence of age on all dimensions of well-being was found, except for Positive Relationships and Per-sonal Growth. Educational level has a direct positive influence on most dimensions of well-being. Male participants showed greater well-being in the Autonomy dimension. Other varia-bles that directly predicted psychological well-being were having physical difficulties, work difficulties, and other post-COVID-19 difficulties. It is concluded that the model was partially verified and would allow for the development of specific well-being intervention plans. (AU)

Regional outcome disparities in German head and neck cancer patients: Shorter survival in Eastern Germany.

INTRODUCTION: Demographics are important prognostic factors in malignant diseases. A nationwide analysis concerning the prognostic impact of demographics in head and neck cancer (HNC) patients (HNCP) has not been performed previously. METHODS: A retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) and the Federal Statistical Office (Destatis) between 2002 and 2017 was performed. A total of 212'920 HNCP were included. Incidence, tumor stage, age development, sex distribution, age-, residence-, and diagnosis-time-specific survival were examined. RESULTS: Mean age of HNCP increased more rapidly than in the general population (slope coefficient: 0.29 vs. 0.20; p < 0.0001). Higher age and male sex were associated with a worse prognosis. Whereas overall survival (OS) increased from the early to the later observation period for HNCP <70 years, no OS improvement for HNCP >70 years was found. Furthermore, an OS disadvantage was observed for East Germany compared to West Germany (median 47 vs. 60 months; p < 0.0001). This disparity was associated with a disproportionately high ratio of men in East Germany (men/women: 4.4 vs. 3.1; p < 0.0001) and a lower mean age (61 vs. 63 years; p < 0.0001). In addition to stage, age and sex, residence in East Germany were confirmed as an independent factor for OS in a multivariate analysis. CONCLUSION: Finally, three decades after the German reunion, a survival disadvantage for patients in East Germany still exists. This discrepancy may be a result of socioeconomic disparities.

Age and Sex Distributions of 31 Common Racial Groups in Hawai'i: A Shiny Web Application.

Hawai'i is the most ethnically diverse state with the highest proportion of multiracial individuals in the United States. The Stepwise Proportional Weighting Algorithm (SPWA) was developed to bridge the categorization of multiracial Census data into single-race population estimates for common races in Hawai'i. However, these estimates have not been publicly available. A Shiny web application, the Hawai'i Single-Race Categorization Tool, was developed as a user friendly research tool to obtain the age and sex distributions of single-race estimates for common racial groups in Hawai'i. The Categorization Tool implements the SPWA and presents the results in tabular and graphic formats, stratified by sex and age. It also allows the categorization of partial Native Hawaiians as Native Hawaiians in the population estimation. Using this tool, the current paper reports population estimates and distributions for 31 common racial groups using Hawai'i Census 2010 data. Among the major Census races, Asian had the largest population (631 881; 46.5%) in Hawai'i, followed by White (431 635; 31.7%) and Native Hawaiian and Other Pacific Islander (227 588; 16.7%). Among Census detailed races within Asian, Filipino had the largest population estimate (244 730; 18.0%), followed by Japanese (227 165; 16.7%) and Chinese (103 600; 7.6%). Native Hawaiian accounted for 12.3% of the Hawai'i population (166 944). After recategorizing part-Native Hawaiians as Native Hawaiians, Native Hawaiian increased by 150.0%, with the greatest increase among the young. This publicly available tool would be valuable for race-related resource allocation, policy development, and health disparities research in Hawai'i.

The specifics of homicide-suicide in France.

BACKGROUND: Homicide and suicide are two causes of violent death. This study focuses on situations in which these two types of violent death occur at the same time, known as homicide-suicide. AIM: The aim of this study is to review the circumstances surrounding homicide-suicides as well as the features of the victims and perpetrators in France at a recent period. The article characterizes homicide-suicides by comparing them with simple homicides in order to determine whether they exhibit distinctive characteristics and significant links. METHODOLOGY: The data analyzed are based on detailed police operational information collected about 1622 homicides that occurred in France in 2019 and 2020. After presenting the characteristics of all homicide-suicides, this article specifically compares those that take place within the family, whether they result in the suicide of the perpetrator or not, using bivariate tests (chi-square). The tests are based on a distinction between domestic homicide-suicides within a couple and between other family members. RESULTS: Analysis shows that 7 % of them were followed by the suicide of the perpetrator (203 cases). Almost all of them take place within family (91 %), and most often within the couple (60 %). Apart from couple configurations, familial homicide-suicides target the children (21 %) or parents (5 %) of the perpetrators. The perpetrators are mainly men, while most of the victims are women. Analysis revealed significant links between certain variables and suicide (or attempted suicide by the alleged perpetrator) in the context of couple homicide: the modus operandi, the spatio-temporal setting, the gender and average age of the victim and history of domestic violence suffered by the victim, as well as all the variables relating to the alleged perpetrator (age, gender, police and psychiatric history, alcohol consumption, etc.). Among other family members, these variables do not have a significant influence on whether the perpetrator commits suicide following the homicide. Perpetrators of domestic homicide-suicides are less likely to be under the influence of alcohol (8 %), to be known to the police (19 %), and to have a psychiatric history (11 %) than those who do not commit suicide following the homicide (respectively 41 %, 54 %, 22 %). There is also less record of domestic violence when the perpetrator commits suicide (20 %) than when they do not (48 %). CONCLUSIONS: Homicide-suicides are to some extent similar to simple couple homicides. Women are therefore overrepresented among domestic homicide victims; likewise, they are also overrepresented among the victims of homicide-suicides, which are mostly committed in family circumstances. The most significant risk factors are the presence of firearms in the household and history of domestic violence within the couple. RECOMMENDATIONS: The results suggest two areas for action: the screening (interpersonal conflicts, alcohol, depression, domestic violence, presence of a firearm) and the prevention of intra-family homicides. Prevention should focus on screening specific elements: the presence of a firearm, domestic violence, interpersonal conflicts, depression, and alcohol. Prevention could also take place with elderly people at the end of their lives.