Backward Multivariate Logistic Regression Research Articles

Predicting Spinal CSF Leaks in Intracranial Hypotension: A Scoring System Based on Brain MRI Findings

Background: Various signs may be observed on brain magnetic resonance imaging (MRI) in patients with spontaneous intracranial hypotension (SIH). However, the lack of a classification system integrating these findings limits decision making in clinical practice. The objective was to assess the likelihood of an underlying spinal CSF leak based on a probability score taking into account the most relevant brain MRI findings. Methods: Three blinded readers retrospectively reviewed the brain MRI of 56 SIH patients with a proven spinal CSF leak and 60 healthy controls, evaluating seven quantitative and nine qualitative signs. We then derived a predictive diagnostic score based on multivariable backward logistic regression analysis. Its performance was further validated internally in a prospective cohort of 20 patients presenting with clinical signs of SIH. Findings: Six imaging findings were included in the final scoring system. Three were weighted as major (2 points): pachymeningeal enhancement, engorgement of venous sinus, effacement of the suprasellar cistern 5, respectively. The discriminatory ability of the proposed score could be demonstrated in the validation cohort. Interpretation: The three-tier predictive scoring system we propose is based on the six most relevant brain MRI findings and allows to assess the likelihood (low, intermediate or high probability) of finding a spinal CSF leak in SIH patients. It may be useful in triaging patients who may or may not benefit from further invasive myelographic examinations before considering targeted therapy. Funding Statement: The authors declare: This study was not funded, as all examinations were part of our routine clinical protocol. Declaration of Interests: PJM receives Swiss National Science Foundation (SNSF) grants for research on brain aneurysms. JG is a global PI of STAR, CEC member of the PROMISE study (Penumbra) PI for the SWIFT DIRECT study (Medtronic), Consultancy; and receives Swiss National Science Foundation (SNSF) grants for magnetic resonance imaging in stroke. JB is global PI of SWITCH and TOSCAN studies. He received SNSF grant for ultrasound perfusion imaging. All other authors declare no competing interests. Ethics Approval Statement: Institutional review board approval was obtained for this single-center study (Kantonale Ethikkommission Bern, Switzerland, number: 2017–00861).

Transfer status: A significant risk factor for mortality in emergency general surgery patients requiring colon resection.

Patients requiring emergency surgery have increased rates of morbidity and mortality. Transfer from outside institution delays effective control of ongoing infection and has been linked with worse outcomes. Previous research suggests transfer status negatively impacts survival but has not examined the effect of location and type of institution prior to transfer. This study aims to characterize the effect of type of transferring institution on postoperative outcomes after emergency colon surgery. Data originated from the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2012. Patients undergoing emergent colectomy were stratified based on location: not transferred, transferred from outside emergency department (ED), transferred from outside hospital inpatient unit, or transferred from a nursing home. Patient variables were stratified and compared via χ and analysis of variance. A backward-multivariable logistic regression and adjusted multivariate Cox regression analysis were performed to determine factors predicting 30-day mortality. A total of 14,245 patients were identified, of whom 22% (3,203) were transfer patients. Among transfers, 48% (1,531) came from outside hospital inpatient units. Thirty-day mortality varied significantly (p < 0.001) among transfer location: 12.8% when not transferred, 19.4% from outside EDs, 25.7% from outside hospital inpatient units, and 34.2% from nursing homes. Hazard ratios were 1.30 (p < 0.001) after transfer from outside hospital inpatient ward and 1.50 (p < 0.001) after transfer from nursing home. Patients transferred from nursing homes were more likely to have septic shock (26.9% vs. 11.6%, p < 0.001) and longer hospitalizations (13 days vs. 10 days, p < 0.001) versus those not transferred. Transfer status is an independent contributor to death in emergency general surgery patients undergoing colectomy. Patients transferred from an outside hospital ED, nursing home or chronic care facility have the poorest outcomes. These results reinforce the importance of rapid triage and transfer of patients with early physiologic decompensation to ensure timely surgical evaluation and intervention. Prognostic, level III; Therapeutic, level IV.

Development and internal validation of a multivariable prediction model for tinnitus recovery following unilateral cochlear implantation: a cross-sectional retrospective study

ObjectiveTo develop and internally validate a prediction model for tinnitus recovery following unilateral cochlear implantation.DesignA cross-sectional retrospective study.SettingA questionnaire concerning tinnitus was sent to patients with bilateral severe to profound...

NON-DIPPING PHENOMENON MEASURED BY 24H-AMBULATORY BLOOD PRESSURE MONITORING IS A STRONG PREDICTOR OF LEFT VENTRICULAR HYPERTROPHY IN CHRONIC KIDNEY DISEASE

Objective: Few studies have assessed the role of 24 h ambulatory blood pressure monitoring (ABPM) in adults suffering from non-dialysis chronic kidney disease (CKD). We examined potential determinants of left ventricular hypertrophy (LVH) and mass index (LVMI) in this population. Design and method: We conducted a cross-sectional study on 69 stage 3b-5 CKD adults who had ABPM and transthoracic echocardiography performed simultaneously. Hypertension (HT) was defined as 24 h blood pressure (BP) > or = 130/80 mmHg. ABPM parameters considered were BP dipping status, BP load and BP nighttime/daytime ratio. We conducted stepwise backward multivariate linear and logistic regression to assess determinants of LVH and LVMI. ABPM parameters were considered main predictors whereas HT, ACEI/ARAII use, GFR < 30 ml/min/1.72m2, diabetes, smoking, age, gender, Hb and PTH levels were considered covariates. Results: LVH was present in 22 (31.8%) patients. In linear regression analysis, systolic (β=−13.8, 95% CI = −26.3; −1.3, p = 0.031) and mean (β=−13.5, 95% CI = −25.7; −1.2, p = 0.031) dipping statuses were negatively associated with LVMI. BP load and nighttime/daytime ABPM ratio were not associated with LVMI. In logistic regression analysis, systolic dipping status (OR = 0.27, 95% CI = 0.08; 0.91, p = 0.036) was negatively associated with LVH. Amongst covariates, eGFR < 30 ml/min/1.72m2 and HT were positively associated with LVH and LVMI. At one-year follow-up, mean dipping status on the initial ABPM remained significantly associated with LVMI (β=−19.8, 95% CI = −36.6; −3.0, p = 0.022). Conclusions: These data confirm the high incidence of LVH amongst non-RRT CKD patients and suggest that non-dipping phenomenon on ABPM is an independent and strong predictor of LVH and LVMI in this population.

Correlates of suicidal ideation in college women with eating disorders.

To identify the correlates of suicidal ideation (SI) in a large sample of college women with eating disorders (EDs). A total of 690 female college students from 28 US colleges who screened positive for an ED, with the exception of anorexia nervosa, were assessed for SI. Univariate logistic regression analyses were performed to determine independent correlates of SI. Measures included: ED psychopathology, ED behaviors (i.e., binge eating, vomiting, laxatives, compulsive exercise), current co-morbid psychopathology (i.e., depression, anxiety, insomnia), weight/shape concerns, ED-related clinical impairment, and body mass index (BMI). All significant variables were included in a backward binary multivariate logistic regression model to determine which variables were most strongly associated with SI. A total of 25.6% of the sample reported SI. All variables examined were significantly independently associated with SI, with the exception of compulsive exercise. Depression, anxiety, and vomiting remained as significant correlates of SI in the multivariate logistic regression model. ED screening on college campuses should assess for suicidality, and prevention and treatment efforts should target vomiting and co-morbid depression and anxiety symptoms to reduce risk of SI for high-risk individuals.

Emergency department performances during overcrowding: the experience of the health protection agency of Brianza.

Background: Hospital emergency departments (ED) can contribute to improve health outcomes and reduce costs of health care system. This study evaluated ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care in order to understand factors involved in ED overcrowding and promote adequate management. Methods: This retrospective study analyzed a twelve months window, with in-depth focus on December/January when almost all EDs reported overcrowding. All ED admissions were recorded in electronic schedules including: demographic characteristics, time/date of the access, incoming triage code, diagnosis, performed procedures, discharge, time/date of discharge. A backward multivariable logistic regression model was used to estimate relationships between investigated variables and ED pattern mortality. Results: A total of 416,299 ED admissions were analyzed. During the overcrowded period there was an increase in patients admissions (+32 patients per day, p = 0.0079) with a statistically significant rise of critical patients (+1.7% yellow codes and +0.7% red codes, p < 0.001) and older subjects (+1.4% patients aged 75 or more years, p < 0.001). Moreover, there were statistically significant increases in waiting times and in length of visits, a higher percentage of patients who were hospitalized (13.3% vs. 12.2%, p < 0.001), left ED (4.46% vs. 4.15%, p < 0.001) and died (0.27% vs. 0.17%, p < 0.0001). This latter result maintained a marginal statistical significance (OR = 1.16, 95% CI = 0.98–1.38, p = 0.075) after adjustment for confounding. Conclusion: Our study highlights that ED crowding can determine measurable worsening in ED services and patient outcomes as mortality, waiting times, lengths of stay, percentage of abandonment without being seen and, probably, costs. Thus, address ED crowding has to be considered an important public health priority requiring policymakers involvement.

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family. MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care. ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR=1.05, CI=1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR=1.84, CI=1.04–3.24). Child's psychosocial care use was more likely among older children (OR=1.94, CI=1.20–3.15); greater social support by family and friend (OR=1.03, CI=1.00–1.06); more psychosocial problems (OR=1.75, CI=1.04–2.97); and when there were more parenting concerns (OR=1.19, CI=1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR=1.27, CI=1.17–1.38, and OR=1.39, CI=1.25–1.55). ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.

Systematic Analysis of Risk Factors for 30-Day Readmission in Gastrointestinal Bleeding

Introduction: Gastrointestinal bleeding (GIB) is a frequent cause of hospital admission in the United States with estimated rates of hospitalization of 375 per 100,000 individuals. Readmission events are associated with increased healthcare costs, morbidity and mortality. Our aim was to utilize the novel National Readmission Database (NRD) to determine the risk factors for 30-day readmission in patients with GIB and evaluate the predictive ability of the created model. Methods: We utilized the Healthcare Cost and Utilization Project's (HCUP) 2013 and 2014 NRD. Index admissions had either a primary or secondary diagnosis of upper GIB (UGIB) or a primary diagnosis of lower GIB (LGIB) utilizing previously identified diagnosis codes. Patients with an index admission death or an index admission in December were excluded. The primary outcome of interest was risk factors for 30-day readmission. Data was analyzed using Student's t-test and stepwise, backward multivariate logistic regression analysis. Results: We identified 97,919 (2013) and 102,010 (2014) index admissions with UGIB and 54,480 (2013) and 57,053 (2014) admissions with LGIB. In the combined data set the average patient age was 67.9 years and chronic conditions per patient was 6.0. Utilizing the combined data sets, within 30 days, 30,973 (15.5%) readmissions were identified for UGIB and 13,234 (11.9%) for LGIB. Thirty-one variables were included in the UGIB model and twenty-one in the LGIB model. Common variables included in both models included insurance types Medicare and Medicaid, the performance of a blood transfusion, and the comorbidities lung disease, malignancy, renal failure, coagulopathy, cirrhosis and diabetes. Model performance created utilizing the 2013 dataset was evaluated using a receiver operating characteristic curve (AUROC) and validated in the 2014 dataset. The AUROC for UGIB was 0.641 (95% CI 0.636-0.646). Validation of the model utilizing 2014 data demonstrated a similar AUROC of 0.639 (95% CI 0.634-0.643, P=0.518). Similar results were obtained in LGIB with an AUROC of (2013): 0.633 (95% CI 0.626-0.64) and (2014): 0.627 (95% CI 0.62-0.634, P= 0.244). Conclusion: Utilizing a cross-sectional nationally available dataset we were able to identify readmission risk factors among patients with gastrointestinal bleeding that is replicated across data sets with moderate predictive ability. Further studies should aim at creating interventions in this identifiable population in order to limit readmission events.

Risk Factors for 30-Day Readmission for Pancreatitis in the National Readmission Database (NRD)

Introduction: Thirty-day readmissions have become a focus for cost reduction for select clinical conditions. In addition, early readmission has been an identified risk factor for mortality in acute pancreatitis. Our aim was to utilize the novel National Readmission Database (NRD) to determine the risk factors for 30-day readmission in patients with pancreatitis and evaluate the predictive ability of the created model. Methods: We utilized the Healthcare Cost and Utilization Project's (HCUP) 2013 and 2014 NRD. Index admissions had either a primary or secondary diagnosis of pancreatitis (ICD-9: 577, 577.0). Patients with an index admission death and those with an index admission in the month of December were excluded. The primary outcome of interest was risk factors for 30-day readmission. Data was analyzed using Student's t-test and stepwise, backward multivariate logistic regression analysis. Results: We identified 93,641 (2013) and 98,579 (2014) index admissions with pancreatitis. The average patient age was 52.3 years with an average of 4.5 chronic conditions per patient in the combined data set. The average length of stay (LOS) of the index hospitalization was 4.8 days and average cost was $ 40167.76. Utilizing the 2013 data set, within 30 days, 11,659 (12.5%) readmissions were identified. Twenty-four variables were included in the final multivariate model to include: Medicaid insurance (OR 1.45, 95% CI 1.36 - 1.55), malnutrition (OR 1.33, 95% CI 1.24 - 1.43), congestive heart failure (OR 1.33, 95% CI 1.23 - 1.45) and active malignancy (OR 1.89, 95% CI 1.67 - 2.12). Protective risk factors included: obesity (OR 0.89, 95% CI 0.84 - 0.94), alcohol use (OR 0.94, 95% CI 0.89 - 0.99) and the performance of a cholecystectomy (OR 0.46, 95% CI 0.43 - 0.5). The final multivariate model had an area under the curve (AUROC) of 0.631 (95% CI 0.626-0.636). Validation of the model utilizing 2014 data demonstrated a similar AUROC of 0.633 (95% CI 0.628-0.639, P=0.518). Conclusion: Utilizing a cross-sectional nationally available dataset we were able to identify plausible readmission risk factors among patients with pancreatitis that is replicated across data sets. However, the predictive ability of the final model limits the application of the model and dataset. Further study utilizing factors outside of discharge diagnosis codes is required in order to create validated predictive models.

Seroprevalence, Risk Factors and Genotype Distribution for Hepatitis C Infection: A Study from Rural Hospital in Maharashtra

Background and Objectives: Hepatitis C is global health problem affecting a significant portion of the world’s population. Available data in Western Maharashtra on seroprevalence, risk factors and genotype distribution are very limited. Objectives: The present study was carried out to estimate the seroprevalence, factors influencing transmission and distribution of genotype of hepatitis C virus (HCV) in a hospital-based population. Materials and Methods: This was a cross-sectional, hospital-based study. A total of 25193 serum samples were tested for HCV and HBV infection. All samples from HCV antibody-positive patients were subjected for HCV RNA detection and genotype. Chi-square, unpaired t-test, logistic regression analysis was used for statistical analysis. Results: The seroprevalence for anti-HCV-Ab was 0.46%. Backward multivariate logistic regression analysis revealed increasing age; alcoholic, blood transfusion and dialysis were significant risk factors. Of 116 patients with HCV, 8 (6.89%) patients had HCV-HBV co-infection. The most common genotype (61.90%) was 3 followed by Genotype 1 (38.09%). Conclusions: In the present study, significant risk factors were a history of blood transfusion, habit of alcohol, dialysis. The prevention of HCV infection can be achieved by screening of blood and blood products and creating awareness about risk factors. Since the efficacy of current and new therapies differ by genotype, genotype study is essential.

Prevalence and risk factors for cardiac arrest and myocardial infarction after pelvic reconstructive surgery: a national, multi-institutional, surgical database study

There is limited data available regarding the risk for perioperative cardiac morbidity following pelvic reconstructive surgery (PRS). We sought to determine the incidence of cardiac arrest and myocardial infarction within 30days of pelvic organ prolapse (POP) surgery and determine which factors may contribute to an increased risk of these complications. Using the American College of Surgeons National Quality Improvement Program (NSQIP) database, we identified patients who underwent PRS procedures between 2010 to 2015 using Current Procedural Terminology (CPT) codes. Patient demographics and clinical and surgical factors were obtained. Patients who experienced myocardial infarction or cardiac arrest (MICA) were compared with patients without these complications. Differences between groups were calculated using the chi-square and Student's t test. Stepwise backward multivariate logistic regression was used to identify factors associated with acute cardiac morbidity. A total of 46, 367 women were identified. The incidence of MICA was 0.11% and of death was 0.01% for the entire cohorot. Age >70years [adjusted odds ratio (aOR)=2.99, 95% confidence interval (CI) 1.56-5.73], length of stay >1 day (aOR=3.34, 95% CI 1.70-6.40), dependent functional status (aOR=5.99 95% CI 1.95-16.32), hypertension (aOR=2.86, 95% CI 1.36-6.04), American Society of Anesthesiologists (ASA) class 3 (aOR=2.01, 95% CI 1.10-3.64), and inpatient status (aOR=4.35, 95% CI 1.78-10.49). The rate of MICA is low following PRS. Additional studies are necessary to determine whether more extensive preoperative cardiac evaluation is warranted in this patient population.

A risk prediction model for post-stroke depression in Chinese stroke survivors based on clinical and socio-psychological features.

BackgroundPost-stroke depression (PSD) is a frequent complication that worsens rehabilitation outcomes and patient quality of life. This study developed a risk prediction model for PSD based on patient clinical and socio-psychology features for the early detection of high risk PSD patients.ResultsRisk predictors included a history of brain cerebral infarction (odds ratio [OR], 3.84; 95% confidence interval [CI], 2.22-6.70; P < 0.0001) and four socio-psychological factors including Eysenck Personality Questionnaire with Neuroticism/Stability (OR, 1.18; 95% CI, 1.12-1.20; P < 0.0001), life event scale (OR, 0.99; 95% CI, 0.98-0.99; P = 0.0007), 20 items Toronto Alexithymia Scale (OR, 1.06; 95% CI, 1.02-1.10; P = 0.002) and Social Support Rating Scale (OR, 0.91; 95% CI, 0.87-0.90; P < 0.001) in the logistic model. In addition, 11 rules were generated in the tree model. The areas under the curve of the ROC and the accuracy for the tree model were 0.85 and 0.86, respectively.MethodsThis study recruited 562 stroke patients in China who were assessed for demographic data, medical history, vascular risk factors, functional status post-stroke, and socio-psychological factors. Multivariate backward logistic regression was used to extract risk factors for depression in 1-month after stroke. We converted the logistic model to a visible tree model using the decision tree method. Receiver operating characteristic (ROC) was used to evaluate the performance of the model.ConclusionThis study provided an effective risk model for PSD and indicated that the socio-psychological factors were important risk factors of PSD.

Complications of percutaneous liver biopsy with Klatskin needles: a 36-year single-centre experience.

Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited. To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle. Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course. Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre-biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post-biopsy bleeding. Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.

MicroRNA-125b: association with disease activity and the treatment response of patients with early rheumatoid arthritis.

BackgroundMicroRNAs (miRNAs) are small RNAs that regulate gene expression by targeting mRNA. It was proved that some miRNAs are significantly deregulated in rheumatoid arthritis (RA). MicroRNA-125b negatively regulates expression of TNF-α, which plays a crucial role in RA pathogenesis. The aim of this study was to determine the treatment outcome of patients with early RA based on the expression of circulating and cellular miR-125b.MethodsTotal RNA was isolated from the plasma and peripheral blood mononuclear cells (PBMCs) of 58 patients with early RA before and three months after treatment initiation and of 54 age- and sex-matched healthy controls (HC). The expression of miR-125b was measured by TaqMan quantitative PCR. The treatment responders were defined as patients achieving remission or low disease activity (28-joint count disease activity score (DAS28) <3.2). Receiver operating characteristic (ROC) curve and stepwise backward multivariable logistic regression analyses of miR-125b expression were used to predict the disease outcome at three and six months after initiation of treatment.ResultsThe expression of miR-125b in the PBMCs and plasma of treatment-naïve early RA patients was significantly lower than that of HC and increased significantly after three months of treatment, particularly in responders. However, only the cellular expression of miR-125b was inversely correlated with disease activity. MiR-125b expression in PBMCs was higher in responders than in non-responders after three months (p = 0.042). Using ROC analysis, the cellular expression of miR-125b, but not the disease activity at baseline, predicted the treatment response after three months of therapy (area under the curve 0.652 (95 % CI 0.510 to 0.793); p = 0.048).ConclusionThe expression of miR-125b in PBMCs of treatment-naïve patients may present a novel biomarker for monitoring the treatment outcome during the early phase of RA.

The relation between monocyte to HDL ratio and no-reflow phenomenon in the patients with acute ST-segment elevation myocardial infarction

BackgroundNo-reflow phenomenon is a prognostic value in ST-segment elevation myocardial infarction (STEMI). Monocyte to high density lipoprotein ratio (MHR) has recently emerged as a marker of inflammation and oxidative stress in the cardiovascular disease. PurposeIn this study, we aimed to investigate the relation between MHR and no-reflow phenomenon in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Material and methodsA total of 600 patients with STEMI (470 men; mean age, 62 ± 12 years) admitted within 12 hours from symptom onset were included into this study. Patients were classified into 2 groups based on postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: no-reflow—TIMI flow grade 0, 1, or 2 (group 1); angiographic success—TIMI flow grade 3 (group 2). ResultsAccording to admission whole-blood cell count results, the patients in the no-reflow group had significantly higher monocyte count and MHR values when compared with those of the reflow patients. After multivariate backward logistic regression, MHR remained independent predictors of no reflow after pPCI. Adjusted odds ratios were calculated as 1.09 for MHR (P< .001; confidence interval [CI], 1.07–1.12). Receiver operating characteristic curve analysis suggested that the optimum MHR level cutoff point for patients with no-reflow was 22.5, with a sensitivity and specificity of 70.2% and 73.3%, respectively (area under curve, 0.768; 95% CI, 0.725–0.811). ConclusionIn conclusion, MHR levels are one of the independent predictors of no reflow in patients with STEMI after pPCI.

Unintentional Home Injury Prevention in Preschool Children; a Study of Contributing Factors.

Different factors such as parents' knowledge and attitudes regarding preventive measures (PM) have a great role in reducing children unintentional home injuries. The present study aims to evaluate the contributing factors of unintentional home injury prevention in preschool victims presented to the emergency department. The subjects consisted of all the mothers of preschool children who were presented to the emergency department of Imam Hossein and Shohadaie-Hafte-Tir Hospitals, with unintentional home injuries, from March 2011 to February 2012. The participants were divided into two groups according to implementation of preventive measures status. The significant confounding factors of PM application was determined by chi-squared test and entered into the backward multivariate logistic regression model. 230 mothers with the mean age of 29.4 ± 5.2 years were evaluated. 225 (97.83%) of them were still married, 74 (32.17%) had high school education or higher, 122 (53.04%) were homemakers, and 31 (13.49%) worked outside the home for at least 8 hours daily. High level of knowledge (OR = 0.05; 95% CI: 0.002‒0.32; P = 0.002), appropriate attitude (OR = 0.12; 95% CI: 0.03‒0.51; P = 0.01), having at least three children (OR = 7.2; 95% CI: 1.1‒32.9; P = 0.04), daily absence of mother for at least 8 hours (OR = 9.2; 95% CI: 2.2‒35.46; P = 0.002), and a history of home injury during the previous 3 weeks (OR = 8.3; 95% CI: 2.1‒41.3; P = 0.001) were independent factors which influenced application of preventive measures. Increasing mothers' knowledge level and improving their attitudes were facilitating factors and mothers' absence from the house for more than 8 hours a day and having at least 3 children were obstacles to application of preventive measures. In addition, a history of same injury during the previous 3 weeks increased the risk of repeated event.

Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013

Objectives: We conducted a large household survey in 2013 to determine the current status of oral health practices and use of oral health services in the Kingdom of Saudi Arabia (KSA). Methods: The Saudi Health Information Survey is a national multistage survey of individuals ≥ 15 years of age. We used a backward elimination multivariate logistic regression model to measure the association between having been to a dental clinic during the last year, and sex, age, marital status, education, time since last routine medical examination, history of diagnosis with a cardiovascular chronic condition, brushing or flossing teeth and use of Miswak (a chewing stick). Results: Between April and June 2013, 10,735 participants completed the survey (89.4% of the households contacted). An estimated 1.5 million (11.5%) and 6.3 million (48.6%) Saudi Arabian people, ≥ 15 years of age, had visited a dental clinic for a routine check-up and for a complaint during the last year, respectively. In total, 16.3%, 85.0% and 52% of Saudi Arabian people never brush their teeth, never floss their teeth or never use Miswak, respectively. The probability of visiting a dental clinic increased with education, among individuals who brushed or flossed their teeth and who used Miswak. Conclusions: Oral hygiene practices are not common among Saudi Arabian people, and use of health care for prevention of oral disease is limited. Hence, the need for oral health promotion is pressing. The KSA Ministry of Health should develop and implement programmes, through its primary health clinics, to increase the awareness of the importance of good oral health.

Major motor-functional determinants associated with poor self-reported health-related quality of life in myasthenia gravis patients.

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder in which disabling muscle weakness may affect health-related quality of life (HRQoL). The aim of this study was to investigate which common motor-functional deficits and corresponding severity are most determinant of poor HRQoL in these patients. In 41 patients, the dichotomized first item of the Italian Myasthenia Gravis Questionnaire (IMGQ), categorizing patients who report "good" and "poor" HRQoL, was chosen as dependent-outcome variable. All items composing the myasthenia gravis-specific scale (MG-ADL), i.e. talking, chewing, swallowing, breathing, impairment of ability to brush teeth or comb hair, impairment of ability to rise from chair, double vision, and eyelid droop were acquired as independent variables and dichotomized. Stepwise backward LR multivariable logistic regression analysis was performed. In addition, the main characteristics of patients were compared. MG-ADL items "chewing" ≥1, i.e. "fatigue chewing solid food", and "breathing" ≥2, i.e. "shortness of breath at rest" proved to be significant determinants. Higher dose of corticosteroid therapy was significantly (p=0.027; r s =-0.35), correlated with poor HRQoL. At diagnosis, a decremental response to repetitive nerve stimulation (RNS) from the abductor pollicis brevis was significantly more frequent in patients with poor HRQoL. In conclusion, impaired "chewing" and "breathing" functions indicate the need for careful planning of rehabilitation, re-education and patient management. Moreover, decremental response to RNS at diagnosis may identify patients at risk for poor HRQoL.

Analysis on the training effect of criteria and practical guidance for determination of brain death: evoked potentials

Objective To analyze the training results of short-latency somatosensory-evoked potential (SLSEP) for brain death determination and to improve the training program. Methods A total of 101 trainees received theoretical training, simulation skills training, bedside skills training and test analysis for SLSEP in brain death determination. The composition of trainees was analyzed and the error rates of 6 knowledge points were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category, professional qualification and hospital level, on the error rates. Results Among them, trainees of 30-49 years old occupied 76.24% (77/101), most of them were from third grade, grade A hospitals (98.02%, 99/101), and 78 trainees (77.23%) were from Department of Neurology. There were 82 clinicians (81.19%), 31 (30.69%) had senior certificate and 42 (41.58%) had intermediate certificate. Total error rate of 6 knowledge points was 4.50% (91/2020). Of the 6 knowledge points, the error rate of pitfalls was the highest (9.41%, 19/202), followed by result determination (5.94% , 12/202), recording techniques (4.75% , 24/505), procedures (3.96%, 32/808), sequence of confirmatory tests (1.98%, 2/101) and environmental conditions (0.99%, 2/202). Univariate and multivariate Logistic regression analyses showed that age ( OR = 1.566, 95% CI: 1.116-2.197; P = 0.009) and professional qualification ( OR = 1.669, 95% CI: 1.163-2.397; P = 0.005) were independent risk factors associated with high error rates. Conclusions The differences between brain death determination and routine check of SLSEP should be paid more attention to improve the quality of determination for brain death by SLSEP. DOI: 10.3969/j.issn.1672-6731.2015.12.007

Analysis on the training effect of criteria and practical guidance for determination of brain death: clinical diagnosis

Objective Clinical diagnosis is the most predominant in the criteria for determination of brain death. This paper aims to analyze the training results of clinical diagnosis for brain death determination and to improve the training program. Methods A total of 461 trainees received theoretical training, simulation skills training, bedside skills training and test analysis. The composition of trainees was analyzed and the error rates of knowledge points were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional qualification and hospital level, on the error rates. Results Four hundred and sixty-one trainees came from 161 hospitals. Among them, trainees of 30-49 years old occupied 77.87% (359/461), and most of them came from third grade, grade A hospitals (88.29%, 407/461). There were 200 trainees (43.39% ) from Department of Neurology, 109 trainees (23.64% ) from Department of Neurosurgery, and 88 trainees (19.09%) from Intensive Care Unit. Most of them (66.59%, 307/461) had senior certificate. Total error rate of 13 knowledge points was 5.81% (1054/18 128). The error rate of corneal reflex was the highest (24.64% , 104/422), followed by deep coma (11.59% , 365/3149), oculocephalogyric reflex (9.48%, 40/422), step and time of determination (7.48%, 138/1844), and pupillary light reflex (5.10% , 90/1766). Univariate and multivariate Logistic regression analyses showed that age ( OR = 1.558, 95%CI: 1.435-1.693; P = 0.000), specialty ( OR = 1.080, 95%CI: 1.021-1.143; P = 0.007) and hospital level ( OR = 1.395, 95%CI: 1.174-1.659; P = 0.000) were independent risk factors associated with high error rates. Conclusions The training patterns and methods of clinical diagnosis for brain death determination should be further improved, especially the individual training, to rise the training quality. DOI: 10.3969/j.issn.1672-6731.2015.12.006