Immortal time bias (ITB) is common in cohort studies and distorts the association estimates between the treated and untreated. We used data from an Italian study on COVID-19 vaccine effectiveness, with a large cohort, long follow-up, and adjustment for confounding factors, affected by ITB, with the aim to verify the real impact of the vaccination campaign by comparing the risk of all-cause death between the vaccinated population and the unvaccinated population. We aligned all subjects on a single index date and considered the \"all-cause deaths\" outcome to compare the survival distributions of the unvaccinated group versus various vaccination statuses. The all-cause-death hazard ratios in univariate analysis for vaccinated people with 1, 2, and 3/4 doses versus unvaccinated people were 0.88, 1.23, and 1.21, respectively. The multivariate values were 2.40, 1.98, and 0.99. Possible explanations of this trend of the hazard ratios as vaccinations increase could be a harvesting effect; a calendar-time bias, accounting for seasonality and pandemic waves; a case-counting window bias; a healthy-vaccinee bias; or some combination of these factors. With 2 and even with 3/4 doses, the calculated Restricted Mean Survival Time and Restricted Mean Time Lost have shown a small but significant downside for the vaccinated populations.

Colibacillosis is one of the most important infectious diseases in modern poultry production. The complex nature of colibacillosis has made it challenging to produce an effective vaccine. As a control measure for colibacillosis outbreak in Finland, a vaccination program with a commercial colibacillosis vaccine and later also an autogenous vaccine was started for parent flocks in 2017. In this retrospective observational study from years 2016-2019, we evaluated first week and total mortality of broiler flocks (n= 6969) originating from parents with different colibacillosis vaccination status. Broiler flocks were divided into three groups according to vaccination status of their parent flocks. First group were flocks from parents with no colibacillosis vaccines; second group was flocks from parents vaccinated with commercial vaccine only; and third group was flocks from parents with both commercial and autogenous vaccine. Bayesian modelling was used to predict posterior distributions of first week mortality and total mortality of the broiler flocks. Results of the modelling revealed that broiler flocks from unvaccinated parents had the highest mortality rates (mean first week mortality 1.40 % and mean total mortality 4.33 %, respectively) whereas flocks from parents with a combination of commercial and autogenous vaccinations had the lowest mortality rates (mean first week mortality 0,91 % and mean total mortality 3,14 %). The mortalities from broilers flocks from parents with only commercial vaccine fell in between these groups. Also, standard deviations of mortality rates were lower in broilers from parents with commercial or both vaccines. This demonstrates that in addition to lowering the mean mortality rates, the vaccinations made high mortality broiler flocks less common. Best performance was obtained when autogenous vaccine was combined to the commercial vaccine. The autogenous vaccine consists of the same type of Escherichia coli strain that was causing most colibacillosis cases during the study period in Finland. This study adds to the evidence of benefits of colibacillosis vaccines during outbreaks. It also demonstrates the importance of the knowledge of the types of APEC strains causing outbreaks to produce effective autogenous vaccines.

The objective of this scoping review is to evaluate the updated evidence on the consumption of alcohol and health outcomes regarded as relevant for the Nordic and Baltic countries, including cardiovascular disease, cancer, and all-cause mortality. It is based on the previous Nordic Nutrition Recommendations of 2012 and relevant papers published until 31 May 2021. Current evidence from mainly observational epidemiological studies suggests that regular, moderate alcohol consumption may confer protective effects against myocardial infarction (MI) and type 2 diabetes. Mendelian randomization analyses do not fully support these findings, possibly because these analyses may fail to identify low alcohol intake. For several cancers, it is not possible to set any safe limit. All-cause mortality is not increased with light to moderate alcohol intake in middle-aged and older adults who do not engage in binge drinking. Total abstinence is associated with the lowest risk of mortality in young adults. Observational studies on alcohol consumption are hampered by a number of inherent methodological issues such as ascertainment of alcohol intake, selection of appropriate exposure groups, and insufficient control of confounding variables, colliders, and mediators. It should also be emphasized that there is a socio-economic contribution to the alcohol-health axis with a stronger detrimental effect of alcohol in the lower social classes. The above issues contribute to the complexity of unravelling the causal web between alcohol, mediators, confounders, and health outcome.

BACKGROUND: Tadalafil is a long-acting phosphodiesterase-5 inhibitor (PDE-5i) indicated for erectile dysfunction (ED).
OBJECTIVE: Our hypothesis was that tadalafil will reduce the risk of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction, coronary revascularization, unstable angina, heart failure, stroke) and all-cause death in men with ED.
METHODS: A retrospective observational cohort study was conducted in a large US commercial insurance claims database in men with a diagnosis of ED without prior MACE within 1 year. The exposed group (n = 8156) had ≥1 claim for tadalafil; the unexposed group (n = 21 012) had no claims for any PDE-5i.
RESULTS: Primary outcome was MACE; secondary outcome was all-cause death. Groups were matched for cardiovascular risk factors, including preventive therapy. Over a mean follow-up of 37 months for the exposed group and 29 months for the unexposed group, adjusted rates of MACE were 19% lower in men exposed to tadalafil versus those unexposed to any PDE-5i (hazard ratio [HR] = 0.81; 95% confidence intervals [CI] = 0.70-0.94; p = .007). Tadalafil exposure was associated with lower adjusted rates of coronary revascularization (HR = 0.69; 95% CI = 0.52-0.90; p = .006); unstable angina (HR = 0.55; 95% CI = 0.37-0.81; p = .003); and cardiovascular-related mortality (HR = 0.45; CI = 0.22-0.93; p = .032). Overall mortality rate was 44% lower in men exposed to tadalafil (HR = 0.56; CI = 0.43-0.74; p < .001). Men in the highest quartile of tadalafil exposure had the lowest rates of MACE (HR: 0.40; 95% CI: 0.28-0.58; p < .001) compared to lowest exposure quartile.
CONCLUSIONS: In men with ED, exposure to tadalafil was associated with significant and clinically meaningful lower rates of MACE and overall mortality.

BACKGROUND: The urinary albumin to creatinine ratio (UACR) is a widely used indicator of albuminuria and has predictive value for adverse cardiovascular events.
OBJECTIVE: To evaluate the correlation between the UACR and the risk of developing major adverse cardiovascular events (MACEs) and total mortality in patients with type 2 diabetes mellitus (T2DM).
METHODS: This post hoc analysis included 10 171 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the ACCORD follow-up study (ACCORDION) with baseline UACR data. The natural logarithm (ln) of each UACR measurement was calculated. Univariate and multivariate Cox proportional hazard regression analyses were conducted to examine the association between the UACR and the risk of MACEs and total mortality. The additional predictive value of UACR was further evaluated. Similar methods were used to analyze the correlation between the UACR and MACEs and total mortality within the normal range.
RESULTS: During a median follow-up period of 8.83 years, 1808 (17.78%) participants experienced MACEs, and there were 1934 (19.01%) total deaths. After adjusting for traditional cardiovascular risk factors, the multivariate analysis revealed a significant association between the UACR and the risk of MACEs and total mortality. The inclusion of UACR in the conventional risk model enhanced the predictive efficacy for MACEs and total mortality.
CONCLUSIONS: An elevated UACR is associated with a higher risk of MACEs and total mortality in patients with T2DM, even when it falls within the normal range. The UACR improves prediction of MACE and total mortality risk in patients with T2DM.

The effects of oral health on mortality have been reported; however, the association between mortality and Oral Health-Related Quality of Life (OHQOL) is unknown. We investigated the effect of OHQOL on total mortality in a cohort consisting of dentists.
In this cohort study, we analyzed data from the Longitudinal Evaluation of Multi-phasic, Odonatological and Nutritional Associations in Dentists study. We conducted a baseline survey of general and oral health factors. We called for 31,178 participants and collected responses from 10,256 participants. We followed up with 10,114 participants (mean age ± standard deviation, 52.4 ± 12.1 years; females, 8.9%) for 7.7 years, until March 2014, to determine the average total mortality. OHQOL was assessed using the General Oral Health Assessment Index (GOHAI). The total score was divided into quartiles (Q1 ≤ 51.6, Q2 = 51.7-56.7, Q3 = 56.8-59.9, and Q4 = 60.0), with higher GOHAI scores indicating better OHQOL (score range, 12-60). The association between OHQOL and total mortality was analyzed using the Cox proportional hazards model.
We documented 460 deaths. Males with low GOHAI scores possessed a remarkably high risk of total mortality. The multivariate adjusted-hazard ratios (aHRs), were 1.93 (95% confidence interval [CI], 1.07 - 3.48) for Q1, 1.69 (95% CI, 0.90 - 3.17) for Q2, and 0.65 (95% CI, 0.29 - 1.46) for Q3, relative to Q4 (trend p = 0.001). The aHRs in the multivariate model with all background variables were 1.69 (95% CI, 1.15-2.46) for Q1, 1.53 (95% CI, 1.04-2.27) for Q2, and 1.09 (95% CI, 0.71-1.70) for Q3, relative to Q4 (trend p = 0.001). In females, there was no significant association between the quartiles, in both the multivariate-adjusted model (trend p = 0.52) and multivariate-adjusted model with all background variables (trend p = 0.79).
A lower OHQOL indicated an increased risk of total mortality in dentists. OHQOL may be used as an indicator for selecting treatment plans and personalized care interventions, thus contributing to increased healthy life expectancy.
Aichi Cancer Center, Nagoya University Graduate School of Medicine, and Hiroshima University (Approval numbers: 33, 632-3, 8-21, and E2019-1603).

In the context of recent climate change, temperature-attributable mortality has become an important public health threat worldwide. A large number of studies in Europe have identified a relationship between temperature and mortality, while only a limited number of scholars provided evidence for Serbia. In order to provide more evidence for better management of health resources at the regional and local level, this study aims to assess the impact of summer temperature on the population in Serbia, using daily average temperature (Ta) and mortality (CDR (crude death rate) per 100,000). The analysis was done for five areas (Belgrade, Novi Sad, Niš, Loznica, and Vranje), covering the summer (June-August) period of 2001-2015. In order to quantify the Ta-related CDR, a generalized additive model (GAM) assuming a quasi-Poisson distribution with log as the link function was used. Five regression models were constructed, for each area, revealing a statistically significant positive relationship between Ta and CDR in four areas. The effect of Ta on CDR was defined as the relative risk (RR), which was obtained as the exponential regression coefficient of the models. RR indicates that a 1 °C increase in Ta at lag0 was associated with an increase in CDR of 1.7% for Belgrade, Novi Sad, and Niš and 2% for Loznica. The model for Vranje did not quantify a statistically significant increase in CDR due to Ta (RR=1.006, 95% CI 0.991-1.020). Similar results were confirmed for gender, with a slightly higher risk for women. Analysis across lag structure showed different exposure, but the highest effect of Ta mainly occurs over the short term and persists for 3 days.

The generation of rapid information has been an important novelty in the COVID-19 pandemic and a challenge for epidemiology. The methodological frailty and uncertainty of rapid data use has been a consequence. We are talking about an \'intermezzo\' epidemiology between the event and the production of consolidated data that opens up great opportunities to the use epidemiology for rapid public health decisions, provided a careful work to be done before emergencies. In Italy, an ad hoc national COVID-19 information system producing daily data that quickly became essential for public decision-making. Total and all-cause mortality data are derived from the traditional information system of the Italian National Institute of Statistics (Istat), which, at the onset of the pandemic, was unable to provide rapid total and all-causes mortality data at the national level and still produces them with a one- to two-month delay. National cause and place mortality data referred to the first epidemic wave (March and April 2020) was in May 2021 and recently updated (October 2022) for the whole year 2020. Nearly three years after the onset of the epidemic, we have no nationwide rapid information on the distribution of deaths by place of death (hospitals, nursing homes and other care facilities, home) neither on their breakdown in \'by COVID-19\', \'with COVID-19\', and \'non-COVID-19\' deaths. The pandemic being still in progress, new problems arise (the long-term impact of COVID-19, the impact of lockdown policies, etcetera), whose solution cannot be postponed until peer reviewed papers are available. A fine-tuning of the rapid processing of interim data certainly requires the development of national and regional information systems, but first of all a methodologically robust \'intermezzo\' epidemiology.

The literature on the association between intentional weight loss and mortality rates has yielded controversial results, especially when it comes to older groups. The aim of the present narrative review was the critical evaluation of studies exploring the association between intentional weight loss and mortality in middle-aged and older adults (i.e., those aged 50 years or more). The majority of the longitudinal studies identified concluded that losing weight intentionally is not associated with mortality in middle-aged and older adults. However, when it comes to younger adults at the recruitment point, the studies have yielded more mixed results. In any case, more well-designed longitudinal studies and randomized clinical trials are needed in the area, with long follow-up periods and taking into account the underlying disease states.

Periophthalmus chrysospilos is an amphibious fish living in mudflats from eastern India to Indonesia, including the Vietnamese Mekong Delta. Population biological traits play an important role in fishery assessment, but understanding is limited for this species. In total 1,031 specimens were caught in two regions covering four provinces, including the TVST (Duyen Hai, Tra Vinh and Tran De, Soc Trang) and BLCM (Dong Hai, Bac Lieu and Dam Doi, Ca Mau). Results found that the sex ratio was close to 1:1. The parameters of the von Bertalanffy in TVST were L∞ = 12.8 cm, K = 0.41 yr-1, t0 = -0.10 yr and in BLCM were 12.7 cm, 0.38 yr-1 and -0.08 yr, respectively. Although the growth coefficient (Φ\') in BLCM (1.79), was lower than that in TVST (1.83), the species shared a similar size at first capture (7.9 cm in TVST and 7.9 cm in BLCM). The species suffered from heavy pressure of fishing in TVST as fishing mortality in TVST (2.32 yr-1) was higher than that in BLCM (1.38 yr-1), leading to the higher total mortality (Z = 3.60 yr-1) in TVST compared to BLCM (Z = 2.59 yr-1). By contrast, the species showed similar natural mortality over both sites (1.20 yr-1 in TVST and 1.22 yr-1 in BLCM). The Periophthalmus chrysospilos population was reasonably exploited because E values (0.64 in TVST and 0.53 in BLCM) were lower than E10 (0.706 in BTTV and 0.705 in STBL). Nonetheless, to avoid the consequences of overfishing, some sustainable fisheries practices should be implemented, such as protecting mangrove forests, restricting fishing during the recruitment period, using appropriate fishing tools and increasing mesh size.