Bivariate Analysis Research Articles

The influence of continuous improvement and clinical practice on emergency department (ED) operational performance

PurposeThe study tests the relationships between continuous improvement (CI) and clinical practices (CP) with perceived operational performance in Australian and New Zealand (NZ) emergency departments.Design/methodology/approachA survey instrument was designed to collect data from Australian and NZ Emergency Department physicians to test a model developed from the literature, the continuous improvement and clinical practice (CICP) model. Hypotheses were developed and tested using bivariate correlation analysis and multiple regression analysis.FindingsED operational performance is positively impacted by CI culture, reinforced by an established CI governance structure built on employee education of CI tools and methods. The lack of nonclinical time allocation for CI activities has remained a major impediment for the implementation of a sustainable CI culture. The study found physicians experience tension between continuous improvement and clinical practice.Practical implicationsDeveloping a CI mindset across all levels of emergency departments would encourage staff to embrace change to support the implementation of CI and to improve clinical practices. The study highlights potential implications for national bodies, academics, policymakers and ED physicians. Study insights suggest that continuous improvement and effective clinical practices are crucial for enhancing ED performance results in their day-to-day responsibilities.Originality/valueThe paper is original by applying methodological rigour to identify the best predictors of performance in EDs and how a theoretical causal model can be tested to identify the best predictors of operational performance in EDs.

Responsiveness and clinical utility of PROMIS instruments in pediatric Crohn's disease: insights from a longitudinal study

BackgroundInflammatory bowel disease (IBD) may adversely affect physical, psychological, and social well-being. Integrating patient-reported outcomes (PROs) into clinical practice is crucial for comprehensive disease management.ObjectiveTo evaluate the responsiveness and clinical utility of Patient-Reported Outcomes Measurement Information System (PROMIS) instruments, compared with standard clinical assessment tools in pediatric CD patients.MethodsA longitudinal, prospective study with 31 pediatric Crohn's disease (CD) patients aged 8–17 years recruited from a Pediatric Gastroenterology Unit. Data were collected at baseline and every 6 months over 18 months. PROMIS pediatric measures assessed PROs. Disease activity was evaluated using the pediatric Crohn's disease activity index (PCDAI) and clinical markers. IMPACT-III was also applied. Linear mixed-effects models (LMMs) and bivariate analyses were used to assess changes over time.ResultsPROMIS Global Health scores showed significant improvement over time, indicating enhanced overall health perceptions among patients. Notable reductions were observed in PROMIS Pain Interference and Fatigue scores, indicating better physical health. PROMIS depression scores generally decreased, suggesting improved mental health. PCDAI scores, hemoglobin, and platelet count significantly changed and correlated with PROMIS measures. Globally, the study demonstrated significant and clinically relevant changes in multiple PROMIS measures, confirming their responsiveness to changes in disease activity.ConclusionPROMIS instruments are clinically useful in managing pediatric CD, providing valuable insights into global health and quality of life. Integrating PROMIS measures into routine clinical practice may enhance disease management and treatment strategies for pediatric IBD patients.

Hepatitis C Virus Seroprevalence, Incidence, and Screening Patterns in Ontario Pre-exposure Prophylaxis Users

Abstract Background Hepatitis C virus (HCV) has emerged as a sexually transmitted infection in gay, bisexual, and other men who have sex with men (GBM). We estimated the seroprevalence and incidence of HCV infection and examined patterns of HCV testing among GBM using HIV pre-exposure prophylaxis (PrEP) in Ontario, Canada. Methods We analyzed data from the Ontario PrEP Cohort Study (ON-PrEP), a prospective cohort of PrEP users from 10 Ontario clinics. Participants completed an online questionnaire and study staff collected clinical information into a study database biannually for two years. We estimated the baseline seroprevalence and incidence of HCV infection and examined patterns of HCV testing during follow-up. We further explored differences in sociodemographic/clinical variables between those with and without prevalent/incident HCV infection through bivariate analysis. Results Among 557 eligible PrEP users, 382 (68.6%) underwent baseline HCV antibody testing, of whom five tested HCV-seropositive, giving a seroprevalence of 1.3% (95% CI=0.43-3.03). Only 245 (43.9%) participants underwent HCV antibody testing after baseline, and median time to participants’ first follow-up test was 245 days. During follow-up, two participants tested newly HCV-seropositive, giving an incidence of 0.47/100 PY (95% CI=0.06-1.69) over 428.9 years of follow-up. Participants with prevalent/incident HCV infection during the study appeared more likely to report giving money, drugs, gifts, or services for sex in the three months preceding enrolment compared to those who never tested HCV-seropositive (P=0.02). Conclusion HCV seroprevalence and incidence were low but not negligible among Ontario PrEP users. HCV antibody and RNA testing were suboptimal.

Magnitude and determinants of intimate partner violence against women in Somalia: evidence from the SDHS survey 2020 dataset

BackgroundIntimate partner violence (IPV) is a pervasive issue across Sub-Saharan Africa and other developing countries, including Somalia. Understanding the prevalence and drivers of IPV against women is crucial for effective prevention and intervention efforts. However, limited research has focused on identifying these determinants specifically in the Somali context.PurposeThis study aims to identify the prevalence and key determinants of IPV in Somalia, including age groups, administrative regions, place of residence, educational level, household size, husband/partner’s education and work, respondent’s work, and total children ever born.MethodsData from the Somali Demographic and Health Survey (SDHS) 2020 were analyzed. Univariate analysis, bivariate analysis and multivariable logistic regression models were used to assess the associations between the identified determinants and IPV.ResultsThe study found significant associations between several factors and IPV. Age, region of residence, type of residence, educational level, husband/partner’s education and work, respondent’s work, and total children ever born were identified as significant determinants of IPV in Somalia. Younger age groups, rural residence, lower educational attainment, unemployment of the husband/partner and respondent, and larger household size were associated with an increased risk of IPV.Conclusion and recommendationsThe findings highlight the importance of addressing socio-demographic factors to effectively combat IPV in Somalia. Based on the results, recommendations include implementing comprehensive educational programs promoting gender equality and challenging traditional norms, enhancing economic opportunities for women and men, tailoring interventions to address regional disparities, strengthening the legal framework, and improving support services for IPV survivors. Future research should focus on longitudinal studies, qualitative research, intervention evaluation, multi-sectoral collaboration, and the impact of IPV on children. By addressing these recommendations and conducting further research, stakeholders can work towards preventing and reducing IPV in Somalia and other similar contexts.

Characterizing Difficulties and Management of Sleep Disturbances in a Tertiary Palliative Care Unit—A Retrospective Review

Objective: Difficulty sleeping is common in palliative care, however often unrecognized by palliative care physicians. This retrospective review aims to gain a better understanding of the causes and treatment of sleeping disturbances in a tertiary palliative care unit. Methods: This study included 200 palliative care inpatients admitted between January 1, 2015, and August 31, 2020. Patients with sleep disturbances were placed into 3 subgroups: insomnia, delirium, and those with an unclear diagnosis. These categories were analyzed by bivariate analysis (ANOVA, Kruskal-Wallis) to determine statistical significance. Results: A total of 156 (78%) patients had symptoms suggestive of sleep disturbance and 163 (81.5%) patients were prescribed a sedative for sleep disturbance. Most patients were prescribed lorazepam (52 [26%]), followed by haloperidol (47 [23.5%]), and zopiclone (33 [16.5%]). Benzodiazepine and zopiclone prescribing decreased over time, while antipsychotic prescribing remained stable. When analyzed according to the most likely cause of the sleep disturbance, patients with insomnia had a higher Palliative Performance Score ( P < .035) and were more likely to have a previous medical history of insomnia ( P < .0003) than those with delirium. Both insomnia and delirium were quickly diagnosed but patients with unclear sleep disturbances took longer to recognize and treat. Conclusion: These results suggest that sleep disturbances are common at the end of life and can be challenging to categorize. Using specific criteria may be helpful in differentiating insomnia versus delirium and ultimately lead to more consistent approaches to management.

Factors affecting decision making among nurse managers working in government hospitals

BackgroundEffective nursing management and leadership are essential for the provision of desired patient care that will contribute to the improvement of any country's health indicators. However, nurses' views and experiences on the multitude of personal and organizational factors which may impact their decision-making abilities are often neglected in the literature. The study aimed to assess magnitude of poor decision making and its associated factors among nurse managers in South Wollo Zone Governmental Hospitals, Amhara Regional State, Ethiopia, 2023.MethodsNon experimental cross-sectional study was conducted among 168 nurse managers in South Wollo Zone Public Hospitals from April 01 2023 to May 15/2023. Participants were selected by using a simple random sampling technique. The data were collected by using structured questionnaire from the study participants. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. The bi-variable logistic regression analysis model was used to identify the potential predictor variable, with p-value <0.25 was fitted into the multivariable logistic regression analysis model; p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare, factors associated with the outcome variable. The model fitness was checked by using the Hosmer and Lemeshow test. Data were presented with frequency tables, graphs, and pie charts.ResultsThe study found that the overall magnitude of poor decision-making among nurse managers was 35.7%. Being self-confident [AOR = 0.01, 95% CI: (00.002, 0.05)], receiving feedback [AOR = 0.24, 95% CI: 0.08, 0.76], and getting managerial support [AOR = 0.22, 95% CI: (0.06, 0.81)] were negatively associated with poor decision-making among nurse managers.ConclusionSelf-confidence, receiving feedback, and getting managerial support were variables significantly associated with poor decision-making. Authors strongly emphasize providing managerial support for nurse managers, increasing their habit of receiving feedback from colleagues, and encouraging them to build their self-confidence.

Cardiac Computed Tomography Measurements in Pulmonary Embolism Associated with Clinical Deterioration

Introduction: Most pulmonary embolism response teams (PERT) use a radiologist-determined right ventricle to left ventricle ratio (RV:LV) cut-off of 1.0 to risk-stratify pulmonary embolism (PE) patients. Continuous measurements from computed tomography pulmonary angiograms (CTPAs) may improve risk stratification. We assessed associations of CTPA cardiac measurements with acute clinical deterioration and use of advanced PE interventions. Methods: This was a retrospective study of a PE registry used by eight affiliated emergency departments. We used an artificial intelligence (AI) algorithm to measure RV:LV on anonymized CTPAs from registry patients for whom the PERT was activated (2018–2023) by institutional guidelines. Primary outcome was in-hospital PE-related clinical deterioration defined as cardiac arrest, vasoactive medication use for hypotension, or rescue respiratory interventions. Secondary outcome was advanced intervention use. We used bivariable and multivariable analyses. For the latter, we used least absolute shrinkage and selection operator (LASSO) and random forest (RF) to determine associations of all candidate variables with the primary outcome (clinical deterioration), and the Youden index to determine RV:LV optimal cut-offs for primary outcome. Results: Artificial intelligence analyzed 1,467 CTPAs, with 88% agreement on RV:LV categorization with radiologist reports (kappa 0.36, 95% confidence interval [CI] 0.28–0.43). Of 1,639 patients, 190 (11.6%) had PE-related clinical deterioration, and 314 (19.2%) had advanced interventions. Mean RV:LV were 1.50 (0.39) vs 1.30 (0.32) for those with and without clinical deterioration and 1.62 (0.33) vs 1.35 (0.32) for those with and without advanced intervention use. The RV:LV cut-off of 1.0 by AI and radiologists had 0.02 and 0.53 P-values for clinical deterioration, respectively. With adjusted LASSO, top clinical deterioration predictors were cardiac arrest at presentation, lowest systolic blood pressure, and intensive care unit admission. The RV:LV measurement was a top 10 predictor of clinical deterioration by RF. Optimal cut-off for RV:LV was 1.54 with odds ratio of 2.50 (1.85, 3.45) and area under the curve 0.6 (0.66, 0.70). Conclusion: Artifical intelligence-derived RV:LV measurements ≥1.5 on initial CTPA had strong associations with in-hospital clinical deterioration and advanced interventions in a large PERT database. This study points to the potential of capitalizing on immediately available CTPA RV:LV measurements for gauging PE severity and risk stratification.

Differences between Recidivists and Non-recidivists Attending a community-based Domestic Violence Perpetrator Program in the Dominican Republic: A Brief Report

Abstract Purpose Previous research in Western samples has found differences between recidivists and non- recidivists among individuals who attended intervention programs designed to reduce intimate partner violence (IPV) offending. However, the extent to which similar characteristics differentiate these groups in a non-Western sample is unknown. Methods This brief report includes data collected by psychologists from men referred to a cognitive behavioral program (n = 1,380) in the Dominican Republic. Bivariate and multivariate logistic regression analyses were conducted on the data. Results Although specific IPV-related factors such as attitudes towards women and jealousy were significantly associated with recidivism at the bivariate level, these effects disappeared when they were controlled by other relevant predictors in the multivariate model. Instead, general criminogenic factors such as employment status, alcohol consumption, relationships with parents and violent offending towards others were the key factors explaining IPV recidivism. Conclusions IPV recidivism is best explained by accounting for those factors which are common to violent re-offending in general. The implications of these findings are discussed in terms of theory and program intervention practices.

The Impact of Antibiotics on Latency When Given at the Time of Membrane Rupture Prior to Viability

Background: It is well established that antibiotics administered in preterm prelabor rupture of membranes increases latency to delivery. While data is limited for membrane rupture prior to viability, antibiotics may also increase latency in this population. Objective: To assesses the effect of prophylactic antibiotics on the duration of latency in individuals with previable prelabor rupture of membranes. Study Design: Retrospective cohort of pregnancies with previable prelabor rupture of membranes prior to 23 weeks, 0 days in a single health system(2013-2022). Patients opting for termination or with a contraindication to expectant management were excluded. The primary outcome was latency from previable prelabor rupture of membranes diagnosis to delivery. Secondary outcomes included subanalysis by gestational age as well as maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not received antibiotics. Kaplan-Meier/Cox proportional hazards ratios using significant covariates(p<0.1) in bivariate analysis models examined antibiotic impact on latency. Results: Of 115 patients, 46(40%) met inclusion criteria, of whom 34(74%) received latency antibiotics. Median latency did not differ with antibiotic receipt(1 week, [0.4,2.6] versus 0.6 weeks [0.3,0.9], p=0.27). When adjusted for gestational age at rupture of membranes, antibiotics were not associated with longer latency(hazard ratio1.33 [0.91,1.93]). Antibiotic receipt was associated with lower rates of previable delivery(23.0 weeks, [22.7, 24.0] versus 21.3 weeks [20.5,23.1], p=0.006). Adjusted odds of previable delivery remained lower with receipt of antibiotics(adjusted odds ratio 0.20, [0.04,0.90]). Antibiotics were associated with longer latency in patients with rupture of membranes at less than 22 week’s gestation(2.4wks [1.3,4.4] vs 0.6wks [0.1,0.9], p=0.02). Conclusion: Antibiotic administration at the time of previable prelabor rupture of membranes was associated with longer latency if prior to 22 weeks’ gestation. Antibiotic administration increased the odds of delivering after viability. Further study should address optimal antibiotics strategies for this unique population.

Delayed completion of pneumococcal conjugate vaccination among children 4–48 months in rural Uganda: a socio-demographic inquiry

In spite of the commendable global Pneumococcal Conjugate Vaccine (PCV) coverage in the last two decades, completion and timeliness of receipt of all the required doses are still below target. In Uganda, the 3 + 0 PCV regimen has been reported to have a steady decline in the completion rate and the reasons for the delayed completion are unidentified. This study aimed at assessing the influence of socio-demographic factors on delayed PCV completion among young children. A cross-sectional study design among 362 child/caretakers pairs in Bugongi Town Council was employed. Using stratified sampling – Allocation Proportional to Size, data was collected using pretested questionnaires; entered and analysed using STATA v14 and significant statistical association was considered at P ≤ 0.05. Of the 362 children, majority (53.87%) were boys. Child mean age was 25.1 ± 14.3 months. 87.6% caretakers were females and majorities of them were aged 20–29yrs (47.8%), peasant farmers (79.8%), married (90.6%), attained primary education (63.5%) and earned average monthly income of UGX 10,000 – UGX 50,000 (41.4%). Of the 362 children, 92 (25.4%) had delayed to receive their PCV-3 doses. Only boy child [cOR = 1.65, (95%CI: 1.03–2.66); P = 0.039) and caretaker’s age 30–39 [cOR = 2.12 (95%CI: 1.06–4.24); P = 0.033) showed statistical significance at bivariate analysis. The multivariate model found parent’s age 20–29 years [aOR = 2.39 (1.14–5.01); P = 0.021] and 30–39 years [aOR = 2.51 (1.16–5.45); P = 0.020] as positively associated factors whereas being married [aOR = 0.20 (0.04–0.96); P = 0.044] was the only negatively associated factors to delayed completion of PCV vaccination among young children. Among children who complete the last dose of PCV vaccination, a considerable proportion are actually receiving it late which may result into eventual failure to curb the targeted pneumococcal infections. Thus, concerted efforts in terms of sensitization are un-doubtfully desired especially among caretakers aged 20–39 years as well as those who are not married.

High-risk fertility behavior and associated factors among mothers attending antenatal care at public health facilities in Hossana Town, Central Ethiopia Region: facility based cross sectional study

BackgroundHigh-risk fertility behavior (HRFB) is a serious public health issue that may influence the country’s economic development as well as the health status of mothers mainly in developing countries, like Ethiopia.However, there is a scarcity of evidence about HRFB and associated factors in the study area. Therefore, this study assessed HRFB and associated factors among mothers attending antenatal care in public health facilities in Hossana town, Hadiya zone, Central Ethiopia Region.MethodsA facility-based cross-sectional study was conducted among 276 women who were attending antenatal care follow-up by using a systematic sampling technique from July 01 to 30, 2023. Data were collected through face-to-face interviews. Data entry was done by Epi data version 4.6 and analysis was done by SPSS 25 statistical software. Variables with p-value < 0.25 in bi-variable analysis were moved to multivariable analysis for controlling the possible confounders. In the multivariable analysis, variables with p-values less than 0.05 and a 95% confidence interval were considered statistically significant to HRFB.ResultsIn the study, it was found that 67.39% of the total participants, specifically women, exhibited high-risk fertility behavior (HRFB) (95% CI: 63.91, 71.01). Among these, 41.90% were identified as having a single high-risk factor (95% CI: 39.78, 44.2), while 25.47% were classified as facing multiple high-risk factors (95% CI: 24.13, 26.8). The research indicated that several factors significantly contributed to maternal HRFB, including lack of antenatal care (ANC) follow-up (AOR: 3.36, 95% CI: 1.78, 6.35), having fewer than four ANC visits (AOR: 2.44, 95% CI: 1.38, 4.32), and a poor knowledge of contraceptives (AOR: 2.89, 95% CI: 1.02, 5.11).ConclusionThe findings of this study showed that HRFB is high. Almost two out of three women experience HRFB. Having ANC follows- up, number of ANC visits, and knowledge on contraception were the major factors affecting HRFB. HRFB could seriously indicate the development of the country as well as maternal health issues. Therefore, Health education on advantages of ANC follow up and contraceptive use should get due attention.

Financial crisis and its association with parental stress and children’s mental health in Lebanon

BackgroundLebanon has experienced a series of devastating crises that continue to have significant adverse effects on the mental health of parents and their children, especially those who are unemployed, burdened with debt or financial difficulties, and have pre-existing mental health conditions. Accordingly, this study aimed to assess the effect of financial insecurities on parents in Lebanon amid the multiple crises, and the impact of parents’ mental health on their children’s emotional and behavioral wellbeing.MethodsA cross-sectional study including 589 parents in Lebanon was performed using convenience sampling of parents of any gender with children aged 4 to 18 from the five Lebanese governorates. The study collected the sociodemographic data of the participants and incorporated supplementary measures such as the Parental Stress Scale (PSS), Pediatric Symptom Checklist (PSC), and the InCharge Financial Distress/Financial Well-Being (IFDFW) scale. Statistical tests included bivariate analysis, ANOVA test, linear regression, and mediation analyses.ResultsA total of 589 parents, primarily mothers, participated in this study. Most children were males in elementary school. Bivariate analyses revealed that parents with non-Lebanese nationality, primary education, employment, or children in technical schools reported significantly higher PSS and PSC scores. Negative correlations were observed between the IFDFW scale and both PSS (r=-0.200, p < 0.001) and PSC scores (r=-0.086, p = 0.038), indicating lower stress and symptoms with improved financial well-being. Multivariable analysis showed that higher PSC scores, age, complementary education, and Lebanese nationality were associated with increased parental stress, while unemployment, lower age, and higher IFDFW were associated with reduced stress. Similarly, higher PSC scores were linked to increased parental stress, age, non-Lebanese nationality, and IFDFW, whereas university education, higher GPA, and residence outside Beirut/Mount Lebanon were associated with reduced PSC scores. Mediation analysis indicated that parental stress fully mediated the relationship between IFDFW and PSC scores, underscoring the impact of financial well-being on a child’s psychological symptoms via parental stress.ConclusionsThe study revealed significant financial distress and low financial well-being among participants amid Lebanon’s economic crisis, with a notable mediated association between financial well-being, parental stress, and child mental health symptoms. Parental stress was heightened among those with lower education levels, non-Lebanese nationality, and employment in low-wage jobs, with children from these families exhibiting elevated mental health symptoms. Additionally, regional factors and socioeconomic status played a role, as children in urbanized areas and technical schools reported higher distress. Targeted interventions are urgently recommended to alleviate financial and emotional burdens on families and ensure improved mental well-being for both parents and children.

Diabetes and Untoward Outcomes after ACL Reconstruction

Background Diabetes affects approximately 536.6 million adults worldwide and 32.2 million in the United States. Prior studies across multiple specialties have reported the presence of diabetes is associated with adverse outcomes following surgical operations. While several studies have identified diabetes as a risk factor for adverse outcomes following ACL reconstruction (ACLR), literature evaluating the relationship between diabetes status and outcomes after ACLR is lacking. Purpose We aimed to study surgical outcomes following primary ACLR among patients with diabetes compared to those without diabetes. Study Design Retrospective Cohort Study Methods We conducted a cohort study using data from an integrated healthcare system’s ACLR registry. Patients aged ≥12 receiving a primary unilateral ACLR were included (2005–2020). Preoperative diabetes status was the exposure of interest. The two primary outcomes were revision surgery and ipsilateral reoperation following primary ACLR, modeled using multivariable Cox proportional hazards regression that followed patients until an adverse event or loss to follow up. We also examined hospital readmission within 90 days post-surgery, modeled using logistic regression. All models compared patients with diabetes to those without diabetes, adjusting for age, gender, race, smoking status, body mass index, American Society of Anesthesiologist’s score, comorbid conditions, education level, income level, exercise, and graft type. Results There were 18,797 primary ACLR in the study sample with 383 (2.0%) occurring in patients with diabetes. The diabetes group exercised about 90 minutes less per week than the non-diabetes group. In unadjusted bivariate descriptive analyses, patients with diabetes had a lower rate of revision surgery (1.6% vs. 3.6%, p = 0.037) but a higher rate of ipsilateral reoperation (10.7% vs. 8.0%, p = 0.051). The 90-day readmission rate was higher among patients with diabetes compared to those without diabetes (1.8% vs. 0.7%, p = 0.016). However, after adjusting for covariates, these associations were no longer statistically significant. Conclusion After controlling for patient characteristics and other risk factors, the presence of diabetes was not associated with a higher risk of adverse events following primary ACLR.

Diabetic ketoacidosis treatment outcomes and its associated factors among adult patients with diabetes mellitus admitted to public hospitals in Nekemte Town, Ethiopia: a cross-sectional study

BackgroundDiabetic ketoacidosis (DKA) is a serious and acute complication of diabetes mellitus. In Ethiopia, the mortality associated with acute diabetes complications ranges from 9.8% to 12%. Despite this, there is limited information on the clinical outcomes of DKA in our study location. Therefore, this study aimed to assess the magnitude and associated factors of DKA treatment outcomes among adult patients with diabetes admitted to public hospitals in Nekemte Town, Ethiopia.ObjectiveTo assess the DKA treatment outcomes and their associated factors among adult patients with diabetes admitted to public hospitals in Nekemte Town.MethodsA 5-year cross-sectional study was conducted using a systematic random sampling technique among 201 patients from 1 July to 31 August 2023. DKA treatment outcomes were assessed at discharge. Pharmacists collected data by reviewing patient charts using Kobo Toolbox software. The data were then exported to SPSS Version 27 for analysis. Both bivariable and multivariable logistic regression analyses were performed. Variables with a P-value &amp;lt; 0.25 in the bivariable logistic regression were entered into the multivariable regression analysis to control for potential confounders. An adjusted odds ratio with a 95% confidence interval was used to identify predictors of treatment outcomes. A P-value &amp;lt; 0.05 was considered significant in the multivariable analysis.ResultComplete data was available for 201 patients admitted with DKA. The majority, 178 (88.6%), improved and were discharged. Independent predictors of DKA recovery were comorbidities [AOR: 3.45, 95% CI: 1.33, 9.72], admission Glasgow Coma Scale (GCS) score (&amp;lt;8) [AOR: 2.74, 95% CI: 1.02, 7.34], random blood glucose (RBS) (≥ 500) [AOR: 3.07 (95% CI: 1.12, 8.39)], and urine ketones (≥ +3) [AOR: 3.24, 95% CI: 1.18, 8.88].Conclusion and recommendationMost of the treated patients with DKA were discharged with improvement. Comorbidity, admission GCS, RBS, and urine ketones were independently associated with DKA recovery. In general, significant consideration should be given to DKA prevention, early detection, and appropriate hospital management.

Minimum acceptable diet and contributing factors among children aged 6–23 months in Afghanistan: insights from the 2022–2023 Multiple Indicator Cluster Survey

BackgroundUndernutrition among children is a public health concern in most low and middle-income countries (LMICs) and is associated with poor child growth and development. Knowledge about child feeding practices is needed for nutritional policies and programs. Hence, this study assessed the status of minimum acceptable diet (MAD) and its associated factors among children aged 6–23 months in Afghanistan.MethodsThis cross-sectional study was based on a secondary dataset of the 2022–2023 Afghanistan Multiple Indicator Cluster Survey (MICS 2022–23). Complete data from 7,876 children aged 6–23 months were analysed. The outcome variable was MAD and was defined according to the WHO and UNICEF recommendations and indicators for young child feeding practices. Bivariate and multivariate binary logistic regression analyses were used to identify factors associated with MAD.ResultsAbout 7.3% of children aged 6–23 months were fed with the recommended MAD. The likelihood of receiving MAD was higher in children aged 13–18 months [adjusted odds ratio (AOR) 2.01 (95%CI: 1.63–2.48)] and 19–23 months [2.11 (95%CI: 1.68–2.66)], in children belonging to households with higher wealth status [1.39 (95%CI: 1.04–1.87), 2.06 (95%CI: 1.51–2.82), and 3.07 (95%CI: 2.14–4.40) for the 3rd, 4th, and 5th quintile of wealth status, respectively], and in children living in rural areas [1.56 (95%CI: 1.21–2.01)]. On the other hand, the maternal age group 30–39 years [0.79 (95%CI: 0.64–0.96)] and non-institutional delivery [0.67 (95%CI: 0.54–0.83)] were associated with reduced odds of MAD.ConclusionOur study revealed that a small percentage (7.3%) of children received MAD in Afghanistan. This emphasizes the need for policies and interventions aimed at the improvement of child feeding practices to ultimately lead to better child nutrition and health in Afghanistan.

Recent Incarceration and HIV Risk Among Women Who Use Heroin.

Women who use heroin in sub-Saharan Africa face elevated HIV risk linked to structural vulnerability including frequent incarceration. However, little is known about the association between incarceration and drug use and HIV outcomes among women who use heroin in Africa. To estimate associations between incarceration and adverse HIV-related and drug use-related outcomes among women who used heroin. This cross-sectional study included participants from Dar es Salaam, Tanzania, who were recruited using respondent-driven sampling. Eligible participants were women who used heroin who were aged 18 years or older and reported past-month heroin use. Data were collected from November 2018 to February 2019 and analyzed from September 2023 to May 2024. The exposure was recent incarceration, defined as self-report of being held in prison or jail in the past 6 months. Main outcomes were self-reported HIV testing in the past 6 months, self-reported HIV status, and lifetime nonfatal overdose. Associations between recent incarceration and outcomes were examined using modified Poisson regression with robust variance estimation. This study included 195 women who used heroin (median [IQR] age, 33 [27-39] years); 119 women (61%) reported incarceration in the past 6 months. In bivariate analyses, incarceration was associated with transactional sex (111 of 119 [93.3%]), symptoms of anxiety (104 of 119 [87.4%]), physical violence victimization (83 of 118 [70.3%]), and stigma from family (eg, 99 of 119 women [83.2%] reported being treated differently) and health care clinicians (eg, 46 of 119 women [38.7%] reported receiving poor health care). In adjusted analyses, incarceration was associated with higher prevalence of sexual concurrency (101 of 119 [84.9%] vs 41 of 76 [54.0%]; aPR, 1.43; 95% CI, 1.16-1.78), stimulant use (26 of 119 [21.9%] vs 3 of 76 [4.0%]; aPR, 5.60; 95% CI, 1.63-19.28), and lifetime nonfatal overdose (51 of 119 [42.9%] vs 17 of 76 [22.4%]; aPR, 1.62; 95% CI, 1.01-2.61). Among women who used heroin living with HIV, incarceration was associated with stopping HIV care (9 of 27 [33.3%] vs 1 of 24 [4.2%]; aPR, 9.74; 95% CI, 1.22-77.22). In this cross-sectional study of HIV-related outcomes among recently incarcerated women who used heroin in sub-Saharan Africa, behavioral and structural vulnerabilities associated with incarceration were identified, which may exacerbate HIV disparities. Elevated stimulant use among recently incarcerated women who used heroin is of particular concern, given associations with adverse HIV outcomes. In the context of highly criminalized drug use, interventions targeting policing practices may be effective at reducing incarceration-associated risks. Findings could inform development and evaluation of multilevel interventions to reduce service interruptions and ensure linkage to HIV and substance use services during incarceration and reentry.

APAKAH BEBAN KERJA MENTAL BERHUBUNGAN DENGAN TINGKAT KECEMASAN PADA KARYAWAN BANDARA?

Anxiety was the anticipation of future danger accompanied by feelings of dysphoria and somatic symptoms. Anxiety often occured in employees within the early adults (ages 26-35). Risk factors of anxiety in employees included genetics, social and family environmental factors, and mental workload. The impact of mental workload on employees could affect mental health, specifically the level of anxiety, that could implicate the job performance. The aim of this study was to assess the relationship between gender, age, and mental workload with the anxiety levels of airport employees. The design of the study was observational analytic cross-sectional approach. A sample size of 125 subjects were obtained through cluster random sampling. Primary data was collected using the HARS and NASA-TLX questionnaires. Data were analyzed with SPSS using the Kolmogorov-Smirnov and Kendall's Tau tests. There were 69 male employees and 53 individuals were in the early adulthood (26-35 years). For mental workload, 51 employees had a slightly high workload and 47 employees had severe anxiety.The bivariate analysis indicated that there was no relationship between gender and anxiety levels (p=0.709) as well as age and anxiety levels (p=0.142). However, there was a relationship between mental workload and anxiety levels (p=0.005). Mental workload is related with anxiety levels in airport workers.

Rural Culture and Diabetes Self-Management Beliefs, Behaviors and Health Outcomes

Abstract Background Rural populations in the United States face a diabetes mortality penalty. Self-management is a core component of treatment for type 2 diabetes, but there is low uptake of self-management education and support interventions in rural areas. Rural structural barriers to diabetes self-management have been described, yet the role of rural culture has not been extensively explored. Objective The purpose was to examine the relationships among rural culture, diabetes beliefs, self-management behaviors and health outcomes. Methods A stratified random sample of 500 adults with type 2 diabetes were recruited from a rural integrated health care system and invited to participate in this non-experimental cross-sectional study. Participants completed a survey that included validated measures of rural identity, self-reliance, perceived diabetes threat, and diabetes self-management behaviors. The most recent A1c was collected from the medical record. Descriptive, bivariate, multivariate and moderation analyses were conducted. Results 128 participants returned completed surveys. Having an A1c &lt; 8% was associated with better diabetes self-management behaviors, lower perceived threat, being female, and older age. Better diabetes self-management behaviors were associated with lower self-reliance, lower perceived threat, and older age. The combined moderation effect of both self-reliance and rural identity on the relationship between perceived threat and self-management behaviors was significant. Discussion Findings highlight the complex relationship between diabetes beliefs and behavior in rural populations and demonstrate that components of the rural culture have both direct and moderating effects on diabetes beliefs and self-management behaviors. These findings have important ramifications for nurses practicing in rural settings.

Factors Influencing the Development of Metachronous Fractures in Patients with Osteoporotic Vertebral Fractures Treated with Conservative Management or Vertebroplasty

Objectives: We aimed to analyze potential predictors for the development of metachronous fractures (MFs) after osteoporotic vertebral fractures (OVFs), with particular focus on radiological variables obtained at initial X-rays and computed tomography (CT) examinations, treatment applied (conservative management [CM] versus percutaneous vertebroplasty [PV]), and fractures located at the thoracolumbar junction (T11-L2). Methods: We conducted a two-center, observational retrospective study, including patients with single-level OVFs treated with CM or VP. We collected socio-demographic, radiological and treatment-related variables. We performed descriptive and contrastive bivariate analyses based on the presence of MFs and univariate and multivariate logistic regression analyses to obtain adjusted and crude odds ratios (aOR and cOR, respectively) for predicting MFs. Finally, we performed receiver-operating characteristic (ROC) curve analyses to determine the discriminative power of the models obtained. Results: Of the 90 patients included, 20 (22.2%) developed one or more MFs (15 in CM and 5 in PV groups, respectively; p = 0.037). The treatment group (aOR for PV, 0.087; 95%CI, 0.015–0.379), presence of intravertebral cleft (aOR, 5.62; 95%CI, 1.84–19.2) and difference in posterior height loss between X-rays and CT (aOR, 0.926; 95%CI, 0.856–0.992) were identified as significant predictors for MFs, while Genant’s numerical classification showed a trend toward significance (aOR, 1.97; 95%CI, 0.983–4.19; p = 0.064). A multivariate model combining these four variables showed optimal fitting and correctly discriminated over 80% of cases (AUC, 0.828; 95%CI, 0.725–0.930). Factors associated with MFs in thoracolumbar junction OVFs were intravertebral cleft, CM, posterior height loss in CT, and DGOU OF3 fractures. Conclusions: The presence of intravertebral cleft, a difference in posterior height loss between X-rays and CT equal to or lower than 2.4%, higher grades of Genant’s numerical classification, and application of CM instead of PV are predictors of MFs. These findings improve our understanding of the factors involved in the development of MFs, but they need to be validated prospectively.

Prevalence and predictors of overweight and obesity among women of childbearing age in the province of Essaouira, Morocco

Low- and middle-income countries are facing a rapid increase in nutritional problems, particularly in Africa, where undernutrition, overweight and micronutrient deficiencies coexist, creating a double burden of malnutrition and a challenge to public health policies. In this context, Morocco stands out for its early nutritional transition, characterized by a moderate prevalence of overweight and undernutrition and elevated levels of micronutrient deficiencies. The aim of this study was to assess the weight status of women of childbearing age and identify its determinants to suggest ways to improve it. The study was conducted in the province of Essaouira in Morocco, which is characterized by a predominance of rural areas and multidimensional poverty. We conducted a quantitative cross-sectional survey of 1,466 married women of childbearing age via stratified random sampling. Data were collected via questionnaires and anthropometric measurements; we applied the WHO curves to classify BMI. Data entry and statistical processing were performed via SPSS® v. 26. The results show that women’s weight status is worrisome, with an average BMI of 26.4 kg/m². The prevalence of overweight was 61.6% (BMI ≥ 25 kg/m2), with 17.9% of women being obese. Bivariate analysis revealed that age, education level, socioprofessional activity, family structure, household income and parity were significantly associated with overweight. Binary logistic regression confirmed that women’s age and level of education are major determinants of overweight/obesity. There is a need to strengthen public health policies aimed at reducing overweight and obesity among women of childbearing age in Morocco, with an emphasis on nutrition education and monitoring their weight status throughout their reproductive lives.