Binomial Regression Analysis Research Articles

A-228 Performance Evaluation of the LabGenius C-CT/NG-BMX Assay for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae

Abstract Background The LabGenius C-CT/NG-BMX assay (LabGenius CT/NG; BIOMEDUX, Gyeonggi-do, Republic of Korea) is a recently developed real-time polymerase chain reaction assay that can simultaneously detect sexual transmitted pathogens (Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)) in vaginal swab specimen or urine specimen. Methods To evaluate the analytical performance, a total of 343 vaginal swab and 167 urine specimens were selected to compare the LabGenius CT/NG with the BD MAX™ CT/GC/TV (Becton, Dickinson and Company, NJ, USA). In addition, using binomial logistic regression analysis, we estimated the limit of detection which 95% (Lod95) detection rate were achieved in the LabGenius CT/NG. Results The LabGenius CT/NG showed almost perfect agreement with the BD MAX™ CT/GC/TV (κ = 0.826 for CT, κ = 0.944 for NG), and overall agreements between two assays were 91.6% for CT and 97.8% for NG, respectively. The LoD95 values using vaginal swab and urine specimens were 9.9 and 7.8 copies/uL for CT, and 7.6 and 5.1 copies/uL for NG, respectively. Conclusion In this study, LabGenius CT/NG demonstrated acceptable analytical performance compared to BD MAX™ CT/GC/TV, and this assay could be a cost-effective option for routine and follow-up test for detection of sexual transmitted pathogens.

Relationship between Self-Compassion and Uneasiness about the Professional Future among Dental Hygiene Students: A Cross-Sectional Study.

To examine the self-compassion of dental hygiene students in Japan and the correlation between their self-compassion and uneasiness about their professional future. This study was conducted from May to September 2021. Students were invited from three colleges and one university in Fukuoka Prefecture to take the survey. Participants provided information regarding demographic variables (e.g., gender and year of study) and answered six questions regarding feeling uneasy about one's future, matters of learning, and what might happen after graduation. Self-compassion was assessed using the Japanese short version of the self-compassion scale (SCS), with the positive- and negative-SCS subdomains. Resilience was measured using the bidimensional resilience scale with the subdomains of innate and acquired resilience. For the statistical analysis, participants were divided into the "yes" group, where members felt uneasy and the "no" group, where members did not feel uneasy. Data were obtained from 464 participants (response rate: 96.3%). The scores of total-, positive-, and negative-SCS were 36 (12-56), 18 (6-29), and 19 (6-30), respectively; 55.2% of students felt uneasy about their professional future. There was a statistically significant difference in scores for positive- and negative-SCS and innate resilience between the "yes" and "no" groups. Binomial logistic regression analysis revealed that when negative-SCS increased by one point, the risk of feeling uneasy about one's professional future was 1.12 times higher (95% confidence interval: 1.07-1.17) after adjusting for resilience and the answers to the remaining five questions. Our findings suggest that the negative factor of self-compassion is related to increasing the risk of feeling uneasy about one's professional future as a dental hygienist.

Association between willingness to participate in physical and social activities and loneliness in older adults: A stratified analysis by social isolation status

BackgroundThis study aimed to examine the relationship between willingness to participate in physical activity (PA) and social activity (SA) and loneliness among community-dwelling older adults and to identify differences depending on whether or not they were socially isolated. MethodThis study included 4,590 participants aged 65 years or older. The study used the UCLA Loneliness Scale and a questionnaire to assess the willingness to participate in PA/SA. Social isolation was defined as the presence of two or more of the following conditions: domestic isolation, less social contact, and social disengagement. A binomial logistic regression analysis was conducted with loneliness as the dependent variable and willingness to participate in PA/SA as the independent variable, stratified by social isolation. ResultsThose who experienced loneliness (n=1,595, 34.7%) were significantly more unwilling to participate in PA/SA than those who did not (p<0.05). For those in social isolation (n=321, 7.0%), there was no association between willingness to participate in PA/SA and loneliness [odds ratio (95% confidence interval); PA, 0.89 (0.41–1.92); SA, 0.52 (0.22–1.20)]. Those without social isolation showed no association between willingness to participate in PA and loneliness; however, there was a significant association with willingness to participate in SA [PA, 1.05 (0.81–1.36); SA, 0.54 (0.41–0.72)]. ConclusionAmong people without social isolation, the willingness to participate in SA was associated with reduced loneliness. However, the results suggest that environmental factors may limit activity and increase loneliness among people with social isolation, even when willing to participate in PA/SA.

Polymorphisms in Cyclooxygenase, Lipoxygenase and TP53 genes predict colorectal polyp risk reduction by aspirin in the seAFOod polyp prevention trial.

Aspirin and eicosapentaenoic acid (EPA) reduce colorectal adenomatous polyp risk and affect synthesis of oxylipins including prostaglandin E2. We investigated whether 35 single nucleotide polymorphisms (SNPs) in oxylipin metabolism genes such as cyclooxygenase [PTGS] and lipoxygenase [ALOX], as well as 7 SNPs already associated with colorectal cancer (CRC) risk reduction by aspirin (eg. TP53; rs104522), modified the effects of aspirin and EPA on colorectal polyp recurrence in the randomised 2x2 factorial seAFOod trial. Treatment effects were reported as the incidence rate ratio (IRR) and 95% confidence interval (CI) by stratifying negative binomial and Poisson regression analyses of colorectal polyp risk on SNP genotype. Statistical significance was reported with adjustment for the false discovery rate as the P and q value. Five hundred and forty-two (of 707) trial participants had both genotype and colonoscopy outcome data. Reduction in colorectal polyp risk in aspirin users compared with non-aspirin users was restricted to rs4837960 (PTGS1) common homozygotes (IRR 0.69 [95%CI 0.53,0.90]; q=0.06), rs2745557 (PTGS2) compound heterozygote-rare homozygotes (IRR 0.60 [0.41,0.88]; q=0.06), rs7090328 (ALOX5) rare homozygotes (IRR 0.27 [0.11,0.64]; q=0.05), rs2073438 (ALOX12) common homozygotes (IRR 0.57 [0.41,0.80]; q=0.05), and rs104522 (TP53) rare homozygotes (IRR 0.37 [0.17,0.79]; q=0.06). No modification of colorectal polyp risk in EPA users was observed. In conclusion, genetic variants relevant to the proposed mechanism of action on oxylipins are associated with differential colorectal polyp risk reduction by aspirin in individuals who develop multiple colorectal polyps. SNP genotypes should be considered during development of personalised, predictive models of CRC chemoprevention by aspirin.

Racial, Ethnic, and Language-Based Inequities in Inpatient Opioid Prescribing by Diagnosis from Internal Medicine Services, a Retrospective Cohort Study.

Opioid administration is extremely common in the inpatient setting, yet we do not know how the administration of opioids varies across different medical conditions and patient characteristics on internal medicine services. Our goal was to assess racial, ethnic, and language-based inequities in opioid prescribing practices for patients admitted to internal medicine services. We conducted a retrospective cohort study of all adult patients admitted to internal medicine services from 2013 to 2021 and identified subcohorts of patients treated for the six most frequent primary hospital conditions (pneumonia, sepsis, cellulitis, gastrointestinal bleed, pyelonephritis/urinary tract infection, and respiratory disease) and three select conditions typically associated with pain (abdominal pain, acute back pain, and pancreatitis). We conducted a negative binomial regression analysis to determine how average administered daily opioids, measured as morphine milligram equivalents (MMEs), were associated with race, ethnicity, and language, while adjusting for additional patient demographics, hospitalization characteristics, medical comorbidities, prior opioid therapy, and substance use disorders. The study cohort included 61,831 patient hospitalizations. In adjusted models, we found that patients with limited English proficiency received significantly fewer opioids (66 MMEs, 95% CI: 52, 80) compared to English-speaking patients (101 MMEs, 95% CI: 91, 111). Asian (59 MMEs, 95% CI: 51, 66), Latinx (89 MMEs, 95% CI: 79, 100), and multi-race/ethnicity patients (81 MMEs, 95% CI: 65, 97) received significantly fewer opioids compared to white patients (103 MMEs, 95% CI: 94, 112). American Indian/Alaska Native (227 MMEs, 95% CI: 110, 344) patients received significantly more opioids. Significant inequities were also identified across race, ethnicity, and language groups when analyses were conducted within the subcohorts. Most notably, Asian and Latinx patients received significantly fewer MMEs and American Indian/Alaska Native patients received significantly more MMEs compared to white patients for the top six most frequent conditions. Most patients from minority groups also received fewer MMEs compared to white patients for three select pain conditions. Discussion. There are notable inequities in opioid prescribing based on patient race, ethnicity, and language status for those admitted to inpatient internal medicine services across all conditions and in the subcohorts of the six most frequent hospital conditions and three pain-associated conditions. This represents an institutional and societal opportunity for quality improvement initiatives to promote equitable pain management.

Nipple-Sparing Mastectomies in Patients over the Age of 60 Years: Factors Associated with Surgical Outcomes.

Nipple-sparing mastectomy (NSM) outcomes in the elderly have not been well characterized. The goal of this study was to evaluate NSM outcomes in patients over age 60. A single-institution retrospective cohort study was performed for NSM patients over the age of 60 from January 2004 to January 2022. Demographic, intraoperative, and postoperative variables were collected. We identified 136 women who underwent a total of 200 NSMs at a mean age 65.2 years and with mean body mass index of 25. Most (56%) had invasive breast cancer, requiring neoadjuvant chemotherapy in 15%, and 17.5% had radiation prior to NSM. A total of 91% had immediate tissue expander placement. The infection rate was 19%, with 11.5% requiring expander explantation in the follow-up period. In binomial logistic regression analysis, prior radiation increased the odds of any complication by 2.9 (OR 2.93, CI 1.30-6.58, p = 0.009) and increased the odds of infection by 5.7 (OR 5.70, CI 1.95-16.66, p = 0.001), but no associations were seen for other covariates including age, comorbidities, prior chemotherapy, or presence of invasive disease. Diabetes increased the odds of wound breakdown specifically by 9.0 (OR 8.97, CI 2.01-39.92, p = 0.004). Local recurrence was 3% in mean 3.4-year follow-up. Our data support NSM in patients over the age of 60 years with acceptable outcomes within the standard of care. Locoregional recurrence was within the cited range of 0-5%, and only diabetes and prior radiation were associated with reconstructive complications. NSM should thus be offered when appropriate regardless of increased age to achieve oncologic and reconstructive goals.

To rest or to compete? A 4-week cohort study of analgesic use and willingness to compete hurt in Danish youth elite athletes

ObjectivesTo assess the association between analgesic use and willingness to compete hurt (WCH) in Danish youth elite athletes, and to explore factors associated with such willingness. Design4-week prospective cohort study. Methods592 Danish youth elite athletes (15–20 years) completed a baseline questionnaire assessing demographic information, sport history, and WCH, and provided weekly reports on analgesic use for 4 weeks via text messages. Analgesic use was categorized as no use (0 weeks) or use across 1, 2, 3, or 4 weeks, and as the total number of days with analgesic use. Multinomial logistic regression and zero-inflated negative binomial regression analyses estimated the association between analgesic use and WCH. Linear backward stepwise regression analysis was used to identify factors associated with WCH. ResultsOverall, risk of analgesic use increased significantly with increasing WCH scores (relative risk ratios ranging from 1.06 (95% CI 1.0 to 1.12%) to 1.34% (95% CI 1.15 to 1.57)). The incidence rate of analgesic use increased significantly with increasing WCH scores (incidence rate ratio 1.09 (95% CI 1.04 to 1.14)). Associations between the investigated possible antecedent factors and WCH were weak and not considered practically important (R2 = 0.05 or lower). ConclusionsHigher WCH scores were associated with increasing risk of analgesic use, irrespective of the underlying reason for the use, in Danish youth elite athletes, suggesting that analgesics may be an ingrained part of a sport-specific culture of risk acceptance. Future studies should include measures of culture, norms, and social interaction to better explain the variance in WCH.

Characteristics of carbohydrate counting practice associated with adequacy of glycated hemoglobin in adults with type 1 diabetes mellitus in Brazil.

The Carbohydrate Counting (CC) is directly associated with achieving glycemic control by people with Type 1 Diabetes Mellitus (T1DM). Therefore, this study aims to analyze characteristics of the CC practice associated with the adequacy of glycated hemoglobin (HbA1c) in adults with T1DM in Brazil. The study was cross-sectional, carried out using an online form with questions about knowledge of CC, clinical, anthropometric, sociodemographic data, follow-up with health professionals and understanding of the concepts of CC. Pearson's chi-square test and binomial logistic regression analysis (p<0.05) were applied. 173 adults participated, of which 57.2% had increased HbA1c (≥7%). Having the diabetes duration <10 years (p=0.006), performing the CC at lunch (p=0.040) and dinner (p=0.018), using specific applications to perform the CC (p=0.001), having learned to perform CC with a nutritionist (p=0.037) and knowing how to correctly define the concepts of food bolus (p=0.001), correction bolus (p<0.001) and insulin/carbohydrate ratio (p<0.001) was associated with having adequate HbA1c (<7%). Participants who were undergoing CC practice were 3.273 times more likely to have adequate HbA1c and participants with diabetes duration <10 years were 2.686 times more likely to have adequate HbA1c. It was concluded that variables transversal to CC favor adequate HbA1c values in adults with T1DM and that practicing CC and having a diabetes duration of less than 10 years are predictive factors of having adequate HbA1c.

Frailty and Diminished Human Relationships Are Associated with Poor Sleep Quality in Japanese Older Adults: A Cross-Sectional Study.

The purpose of this study was to examine the association between sleep quality, frailty, and human relationships in Japanese older adults (aged 65 years and above, excluding those certified as requiring long-term care). This cross-sectional study used a questionnaire survey to gather demographic information, data on frequency of conversation and conversation partners, and employed the following validated instruments: Kihon Checklist (KCL), a Japanese instrument used to determine the care needs and frailty of older adults; the Dysphagia Risk Assessment for Community-Dwelling Elderly (DRACE) scale; Japanese versions of Pittsburgh Sleep Quality Index (PSQI-J); the Geriatric Depression Scale-15 (GDS-15-J); and the University of California Los Angeles Scale (UCLA-J), an instrument to assess loneliness in older adults. The 500 respondents were divided into two groups based on sleep quality (PSQI-J): low sleep quality group (n = 167, 33.4%) and high sleep quality group (n = 333, 66.6%). Our analyses showed that the low sleep quality group had a KCL score of 5.55 ± 2.47, which indicated frailty. Binomial logistic regression analysis identified age, number of diseases under treatment, DRACE, GDS-15-J, and conversation frequency and discussion partner for important matters as factors (p < 0.05) associated with poor sleep quality. These factors could help enhance the detection of frailty and predictability of caregiving needs.

Predictors of Change in the Anemia Status Among Pulmonary Tuberculosis Patients Following Anti-tuberculosis Treatment in Puducherry, India.

Background Pulmonary tuberculosis (PTB) is commonly associated with reversible peripheral blood abnormalities. The evolution of tuberculosis (TB)-associated anemia with anti-tuberculosis treatment (ATT) has not been well elucidated. This study aimed to compare the hematological profiles at the start and end of the ATT among new sputum smear-positive (NSP) PTB patients in Puducherry, India. Methods A prospective cohort study was conducted in the 10 urban primary health centers of Puducherry from 2017 to 2020. All the NSP PTB participants aged ≥18 years registered under the National Tuberculosis Elimination Program (NTEP) were contacted within two weeks of the start of the ATT. All eligible participants were enrolled, and they were followed up till the end of ATT (180 days). Hematological profiles and anthropometric measurements were compared at the start and end of the ATT. Binomial logistic regression analysis was used to assess the predictors of changes in the anemia status at the start and end of the ATT. Results Out of 176 NSP PTB participants, 145 were followed up after treatment. Initially, 63% (111/176) patients had anemia, which decreased to 44% (64/145) by the end of treatment. The risk factors for a negative change in hemoglobin levels were female gender, below poverty level, underweight, and reduced iron intake. The adjusted risk ratios (ARRs) were 1.53 (1.24-1.88), 1.18 (1.01-1.38), 1.29 (1.02-1.64), and 1.26 (1.05-1.51),respectively. Conclusion ATT may lead to the resolution of TB-associated anemia. Moreover, female gender, possession of a red ration card, being underweight, and reduced iron intake were identified as risk factors for negative changes in hemoglobin levels during treatment.

Care Retention Among Veterans with Serious Mental Illness who were once lost-to-Veterans Health Administration care.

To evaluate care retention among Veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care for at least one year and subsequently returned to VHA care via the SMI Re-Engagement program, an outreach program for Veterans with SMI who are lost-to-care. For the 410 Veterans with SMI who returned to care via SMI Re-Engagement between April 4th, 2016 and January 31, 2018, we assessed VHA in-person and telehealth utilization (overall, primary care, mental health care) for two years following the date of return to care. Care retention was common: 70.2% of Veterans had at least one encounter in each year of the two-year follow-up period and an additional 22.7% had at least one encounter during one of the two years. During the two-year follow-up period, 72.4% of Veterans had at least one primary care encounter and 70.7% of Veterans had at least one mental health care encounter. Adjusted binomial logistic regression analyses found a return-to-care encounter in primary care (OR = 2.70; 95% CI: 1.34, 5.42) predicted primary care retention, and a return-to-care encounter in mental health care (OR = 4.01; 95% CI: 2.38, 6.75) predicted mental health care retention. Most Veterans who return to care via the SMI Re-Engagement program remain in VHA care for the subsequent two years.

Healthcare utilization prior to a diagnosis of young-onset Alzheimer’s disease: a nationwide nested case–control study

ObjectiveOur aim was to identify changes in healthcare utilization prior to a young-onset Alzheimer’s disease diagnosis.MethodsIn a retrospective incidence density matched nested case–control study using national health registers, we examined healthcare utilization for those diagnosed with young-onset Alzheimer’s disease in Danish memory clinics during 2016–2018 compared with age- and sex-matched controls. Negative binomial regression analysis produced contact rate ratios.ResultsThe study included 1082 young-onset Alzheimer’s disease patients and 3246 controls. In the year preceding diagnosis, we found increased contact rate ratios for all types of contacts except physiotherapy. Contact rate ratios for contacts with a general practitioner were significantly increased also > 1–5 and > 5–10 years before diagnosis. The highest contact rate ratios were for psychiatric emergency contacts (8.69, 95% CI 4.29–17.62) ≤ 1 year before diagnosis.InterpretationResults demonstrate that young-onset Alzheimer’s disease patients have increased healthcare utilization from 5 to 10 years prior to diagnosis. Awareness of specific alterations in health-seeking behaviour may help healthcare professionals provide timely diagnoses.

ADOLESAN SPORCULARIN ERGOJENİK DESTEK KULLANIMINDA, FİZİKSEL VE MENTAL YORGUNLUK DÜZEYİNİN YORDAYICILIĞI

Being involved in the developmental period of adolescent athletes may cause more energy and fatigue levels. At this point, the correct and appropriate use of ergogenic supports can contribute to athletes. The study aims to reveal the predictors of fatigue and physical activity levels in adolescent athletes' use of ergogenic support. 171 (female: 98, male: 73) licensed athletes from the Provincial Directorate of Youth and Sports participated in the research voluntarily. Demographic information questionnaire, International Physical Activity Questionnaire-short form (IPAQ-SF), and Chalder Fatigue Scale were used in the research. The data collected in the study were analyzed in the Jamovi (2.0.0) statistical program at a 95% confidence interval and 0.05 significance level. In the analysis of the data, frequency (N), mean (x̄), standard deviation (ss), percentage (%), minimum (Min.), and maximum (Max.) values, Pearson's correlation and binomial logistic regression analysis were used. According to the findings of the study, most of athletes do not prefer to use ergogenic support. Those who use ergogenic support mostly use sports drinks, fish oil, and protein powder. Fatigue and total MET levels do not predict the use of ergogenic support by athletes. As a result, it can be said that adolescent athletes do not prefer to use ergogenic support and although their total MET scores are high, their fatigue levels are at a normal level.

Examining the association of clinician characteristics with perceived changes in cervical cancer screening and colposcopy practice during the COVID-19 pandemic: a mixed methods assessment.

The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed method study we explored perceived pandemic-related practice changes to cervical cancer screenings and colposcopies. In 2021, a national sample of 1251 clinicians completed surveys, including 675 clinicians who performed colposcopy; a subset (n=55) of clinicians completed qualitative interviews. Nearly half of all clinicians reported they were currently performing fewer cervical cancer screenings (47%) and colposcopies (44% of those who perform the procedure) than before the pandemic. About one-fifth (18.6%) of colposcopists reported performing fewer LEEPs than prior to the pandemic. Binomial regression analyses indicated that older, as well as internal medicine and family medicine clinicians (compared to OB-GYNs), and those practicing in community health centers (compared to private practice) had higher odds of reporting reduced screening. Among colposcopists, internal medicine physicians and those practicing in community health centers had higher odds of reporting reduced colposcopies. Qualitative interviews highlighted pandemic-related care disruptions and lack of tracking systems to identify overdue screenings. Reductions in cervical cancer screening and colposcopy among nearly half of clinicians more than 1 year into the pandemic raise concerns that inadequate screening and follow-up will lead to future increases in preventable cancers. This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.

Factors Associated With the Development of a Confirmed Fracture-Related Infection.

To identify factors associated with the development of fracture-related infection (FRI) in patients who have undergone operative fixation of their fracture. Retrospective study. Academic medical center. Patients with peripheral extremity long-bone fractures and shoulder and pelvic girdle fractures who underwent operative repair. This included patients who had undergone fixation inside and outside of our institution. Chi-square, Fisher exact testing, analysis of variance (ANOVA), and t tests were used for analysis of data, as appropriate. Binomial logistic regression analysis was performed to determine risk factors of FRI. Demographics, fracture location, injury mechanism, open wound status, and wound complication type. One hundred ninety-three patients comprised the FRI cohort. Of those with confirmed signs of FRI, 36 (18.7%) had wound breakdown to bone or implant, 120 (62.1%) had a sinus track, and 170 patients (88.1%) had the confirmed presence of microorganisms in deep tissue samples obtained during operative intervention. Factors associated with development of an FRI were as follows: higher BMI; being of Black and Hispanic race; higher American Society of Anesthesiologists class; history of tobacco, alcohol, and drug use; and fractures of the lower extremity (foot, tibia, and femur/pelvis). The results of binary logistic regression demonstrated that treatment at an urban level I trauma center and drug use positively predicted the development of FRI. Our results demonstrate that higher BMI; being of Black or Hispanic race; higher American Society of Anesthesiologists; history of tobacco, alcohol, and drug use; and fractures of the foot, tibia, and femur/pelvis are all factors associated with development of FRI. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Magnetic resonance imaging pelvimetric measurements as predictors for emergent cesarean delivery in obstructed labor.

This study aimed to investigate the usefulness of various magnetic resonance imaging (MRI) pelvimetric parameters for predicting emergent cesarean delivery due to obstructed labor. This was a prospective observational study. MRI pelvimetry was performed in cases of a clinically suspected maternal narrow pelvis, maternal short stature, fetal overgrowth, and abnormal placental position. MRI pelvimetry was performed at 34.7±4.2 gestational weeks using a 1.5T MRI system. The pelvic inlet angle, pelvic inclination, obstetric conjugate, sacral outlet diameter (SOD), and coccygeal pelvic outlet were measured in the sagittal section. The interspinous diameter and intertuberous diameter were measured in coronal sections. Fetal anomalies, cesarean deliveries before the onset of labor, and non-reassuring fetal status were excluded from the analysis. MRI pelvimetry was performed in 154 patients. After excluding 76 cases, including 19 cases of absolute cephalopelvic disproportion, 78 cases of trial of labor were included. Of these, 63 were vaginal deliveries and 15 were emergent cesarean deliveries due to obstructed labor. The cut-off value for body mass index (BMI) was 22.2, with an area under the curve (AUC) of 0.69, for predicting obstructed labor. The cut-off value for the SOD was 10.7cm with an AUC of 0.69. BMI alone had a sensitivity of 80%, specificity of 66%, positive predictive value (PPV) of 36%, and negative predictive value (NPV) of 93%. When BMI and SOD were combined, sensitivity was 53%, specificity was 90%, PPV was 57%, and NPV was 89%. The odds ratio for emergent cesarean delivery was 5.42 (95% confidence interval 1.06-27.6, p=0.041) if the SOD was less than the cut-off value in the binomial logistic regression analysis in cases with an BMI >22. We confirmed that MRI pelvimetry was a reliable tool for better patient selection for obstructed labor. The SOD was the best predictor of obstructed labor, with a cut-off value of 10.7cm for women with a low BMI.

Interferon-beta exposure in-utero and the risk of infections in early childhood.

Knowledge within the field of multiple sclerosis treatment during pregnancy is vital to ensure the most optimal clinical practice. Immunomodulatory treatment in pregnancy could in theory affect the normal development and maturation of the immune system of the fetus with a potential increased risk of infections, consequently. We therefore set out to investigate whether exposure to interferon-beta in utero affected the risk of acquiring infections in early childhood. This retrospective matched cohort study utilized data from the Danish Multiple Sclerosis Registry linked with national Danish registries to identify all children born of mothers with MS in Denmark from 1998 to 2018. The study included 510 children exposed to interferon-beta in utero. The children were matched 1:1 on various of demographic characteristics with children born to mothers with untreated MS and 1:3 with children born to mothers without MS. Each child was followed for up to five years. Using individual-level data, we investigated all-cause mortality, rate of hospital admissions due to infections, and redeemed prescriptions of antibiotics. The primary statistical model applied was a negative binomial regression analysis. We found no differences in childhood mortality, for hospital admissions the rate ratio compared to healthy controls was 0.79 (0.62-1.00). Regarding antibiotic prescriptions, the results were similar (RR 1.00 (0.90-1.11). Furthermore, we found no certain dose-response relationship between interferon-beta exposure duration and hospital admission rate (P=0.47) or redeemed antibiotic prescription (P=0.71). Exposure to interferon-beta during gestation has little to no impact on the risk of acquiring significant infections during the first five years of childhood.

Oral health risk factors and overall dental treatment needs for incoming air force recruits.

To determine if relationships exist between the total dental treatment needs of incoming Air Force recruits and non-clincal demographic and oral-health related factors. Data from the 2018 Air Force Recruit Oral Health Study (ROHS) was used, an anonymized sample of 1330 AF recruits that included a comprehensive oral exam and survey collecting demographic and oral health behavior information. The primary outcome variable was the total number of dental treatment needs for recruits, and independent predictor variables included select socio-demographic factors and wellness behaviors. Along with descriptive statistics, a multivariable negative binomial regression analysis was performed to assess the relationship between variables with a normalized weight making the final results representative of all incoming recruits. The final adjusted analysis showed that an incoming recruit's self-rated oral health, dental coverage prior to enlistment, needfor a dental visit within the last 12 months,sugar intake, and tobacco use increased their risk for dental treatment needs. This is the first study to assess the relationship between specific risk indicators and increased dental treatment needs while adjusting other related covariates. Factors associated with dental treatment needs were identified that provide Air Force leaders with actionable information to directly improve recruit oral health and military readiness by identifying new airmen at the highest risk for excessive dental care needs while at basic military training.

Association Between Concurrent Use of Benzodiazepines and Opioids and Health Care Utilization Among Patients With Cancer in Puerto Rico.

To evaluate the association between concurrent use of opioids and benzodiazepines (BZDs) and emergency room (ER) visits and hospital admissions in patients with cancer. Data were obtained from the Puerto Rico Central Cancer Registry-Health Insurance Linkage. Odds ratios (ORs) with 95% CIs and incidence rate ratio (IRR) were estimated using logistic and negative binomial regression analyses to assess the association between concurrent use of opioids and BZDs (overlap of at least 7 days) and ER visits and hospital admissions. A total of 9,259 patients were included in the main analysis. The logistic regression results showed a significant association between concurrent use of opioids and BZDs and at least one ER visit (OR, 1.28 [95% CI, 1.07 to 1.54]) or hospital admission (OR, 1.42 [95% CI, 1.18 to 1.71]) compared with individuals with BZDs alone, after adjusting for age, sex, comorbidity index, cancer stage, health insurance, and health region. Compared with individuals with opioid use alone, the association did not reach significance. In the negative binomial regression, a significant association was observed for ER visits (IRR, 1.52 [95% CI, 1.31 to 1.76]) and hospitalizations (IRR, 1.34 [95% CI, 1.20 to 1.50]) when compared with individuals with BZDs alone. Compared with individuals with opioids alone, it only reached significance for ER visits (IRR, 1.39 [95% CI, 1.20 to 1.61]). Careful evaluation must be done before prescribing concurrent opioids and BZDs in patients with cancer, as the results suggest that coprescribing may increase the odds of ER visits and hospitalizations.

Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study.

Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality of patients admitted for CAP. A retrospective cohort study was conducted with patients presenting to a Swiss public hospital between January 2019 and December 2019. Zero-truncated negative binomial and multivariable logistic regression analyses were performed to assess risk factors. A total of 300 patients were analyzed (median 78 years, IQR [67.56, 85.50] and 53% males) with an average LOHS of 7 days (IQR [5.00, 9.00]). Of the 300 patients, 31.6% (97/300) were re-hospitalized within 6 months, 2.7% (8/300) died within 30 days and 11.7% (35/300) died within 1 year. The results showed that sex (IRR = 0.877, 95% CI = 0.776-0.992, p-value = 0.036), age (IRR = 1.007, 95% CI = 1.002-1.012, p-value = 0.003), qSOFA score (IRR = 1.143, 95% CI = 1.049-1.246, p-value = 0.002) and atypical pneumonia (IRR = 1.357, 95% CI = 1.012-1.819, p-value = 0.04) were predictive of LOHS. Diabetes (OR = 2.149, 95% CI = 1.104-4.172, p-value = 0.024), a higher qSOFA score (OR = 1.958, 95% CI = 1.295-3.002, p-value = 0.002) and rehabilitation after discharge (OR = 2.222, 95% CI = 1.017-4.855, p-value = 0.044) were associated with a higher chance of being re-hospitalized within 6 months, whereas mortality within 30 days and within one year were both associated with older age (OR = 1.248, 95% CI = 1.056-1.562, p-value = 0.026 and OR = 1.073, 95% CI = 1.025-1.132, p-value = 0.005, respectively) and the presence of a cancer diagnosis (OR = 32.671, 95% CI = 4.787-369.1, p-value = 0.001 and OR = 4.408, 95% CI = 1.680-11.43, p-value = 0.002, respectively). This study identified routinely available predictors for LOHS, rehospitalization and mortality in patients with CAP, which may further advance our understanding of CAP and thereby improve patient management, discharge planning and hospital costs.