Chi-square Test For Linear Trend Research Articles

Declining Trend of HIV Seroprevalence in Pregnant Women: A Retrospective Observational Analysis of 12 Years’ Experience at a Tertiary Care Hospital in Central India

Introduction: Human Immunodeficiency Virus (HIV) infection among antenatal women has been reported throughout the country, with a relatively high prevalence in the state of Maharashtra. Data on HIV seroprevalence in antenatal women serve as an indirect indicator of the HIV epidemic's burden in the general population and aid in predicting the same in young children. Diagnostic and treatment services for HIV are concentrated in selected states and districts with high seroprevalence, making it necessary to accurately calculate the prevalence of HIV. Aim: To assess the effectiveness of Prevention of Parentto-Child Transmission (PPTCT) services and to study the effectiveness of the National Acquired Immunodeficiency Syndrome (AIDS) Control Programme (NACP) in the functioning of PPTCT services. Materials and Methods: A retrospective observational analysis of 12-year data, from January 2007 to December 2018, was conducted in the Department of Microbiology at the Government Medical College and Hospital, Nagpur, Maharashtra, representing Central India. Data collection took place from June 2019 to December 2019, and analysis occurred over the subsequent two months (January 2020 to February 2020). The total sample size was 101,865 patients. All pregnant women registered in the Antenatal Clinic (ANC) under the PPTCT Program were included in the present study, and Strategy III of the National HIV testing algorithm was followed. The women's ages, their partners' serostatus, and records of babies born to HIV seropositive mothers were obtained and analysed. The statistical analysis of the data was performed using Stata (version 10.4.2009, STATA Corp., Texas, USA) and Epi Info 7 (version 7.1.06, 2012, CDC, Atlanta, USA), employing the Chi-square test for linear trend (Extended Mantel-Haenszel). A p-value <0.05 was considered significant. Results: The seroprevalence of HIV infection among pregnant women was 1.04% in 2007, decreasing to 0.23% by 2017. In 2009, 88.9% of women were counselled, and 100% were tested for HIV, with pretest counselling steadily increasing to 100% by 2012. The trend in HIV testing, however, remained at 100% over the span of 10 years. Post-test counselling varied from 89.6% to 99.9%, whereas the trend of HIV testing among partners fluctuated from 50% to 94.44%. The overall HIV positivity among babies, after 18 months of follow-up, was 4.77%. Conclusion: The HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing themselves of the facilities at Integrated Counselling and Testing Centre (ICTC). Intensive health education and the availability of diagnostic and therapeutic services across the country have reduced the burden of the HIV/AIDS problem in the country

Evaluation of Platelet Distribution Width as an Early Predictor of Acute Kidney Injury in Extensive Burn Patients.

The extensive burns devastate trauma. The research was designed to analyse the predictive value of early platelet (PLT) indices on the development of acute kidney injury (AKI) after severe burns. 186 patients with extensive burns (burn area ≥30%) were eventually involved. Multivariate analyses pointed out that platelet distribution width (PDW) in the first 24 h after admission was an independent risk factor for AKI, severe AKI, and RRT requirement in patients with severe burns, and AKI risk showed an increase of 30.9% per increase of 1% in PDW (OR = 1.309, CI, 1.075-1.594, and P = 0.007). It was found that the area under the ROC curve (AUC) of PDW predicting AKI was 0.735 and that the AUC value was 0.81 for AKI after combining PDW and blood urea nitrogen (BUN). Based on the cut-off value PDW = 17.7%, patients were divided into high- (PDW ≥17.7%) and low-risk (PDW <17.7%) groups. In the KM analysis, there was a higher cumulative incidence of AKI if patients were in a high-risk group (in 30 days); and the stages of AKI showed a linear upward trend (chi-square test for linear trend P < 0.001) as there was an increase in the risk level. The PDW level in the early stage serves as an important risk factor for AKI, severe AKI, and RRT requirement in extensive burns. When PDW >17.7%, burn patients are not only at a higher risk for AKI but may also have higher AKI severity. Due to low cost and wide availability, PDW has the potential to be the tool that can predict AKI in extensive burn patients.

Early Marriage Among Young Girls in Eastern Ethiopia: Trends From 2008 to 2018

This study examined the trend of early marriage among adolescent girls in eastern Ethiopia. We analyzed data extracted from the Kersa community-based surveillance database for girls in the age group of 10 to 17 for the decade ending in 2018. The Kersa Health and Demographic Surveillance System (Kersa HDSS) is a demographic and health surveillance and research center established in 2007 by Haramaya University to serve as a research center and source of health and demographic data in Eastern Ethiopia. The annual incidence of early marriage was calculated per 1,000 person-time. Chi-square test for linear trend was done using Epitools Software to examine the change in rates over time. The overall incidence of early marriage among the study participants was 40.48/1,000 per year (95% confidence interval [CI], 39.1–41.9) with an increasing incidence rate from 32.38/1,000 girls per year in 2008 (95% CI, 27.4–38.3) to 40.18/1,000 girls per year in 2018. A relatively high incidence of early marriage was observed among rural girls, those who had no formal education, and unemployed girls. Empowering rural girls through increased access to education is needed to reduce the incidence of early marriage.

Injection Drug Use and Healthcare Utilization in Patients Newly Diagnosed With HIV.

To determine recent trends in: (1) human immunodeficiency virus (HIV) diagnoses, (2) the proportion of patients newly diagnosed with HIV with injection drug use (IDU) and (3) patients' patterns of healthcare utilization in the year before diagnosis at an urban, academic medical center. We performed a cross sectional study of patients newly diagnosed with HIV at a healthcare system in southern New Jersey between January 1st, 2014 and December 31st, 2019. Patients 18 years or older with HIV diagnosed during the study period were included. Demographics, comorbidities, HIV test results, and healthcare utilization data were collected from the electronic medical record. Of 192 patients newly diagnosed with HIV, 36 (19%) had documented IDU. New HIV diagnoses doubled from 22 to 47 annual cases between 2014 and 2019. The proportion of patients with newly diagnosed HIV and documented IDU increased from 9% in 2014 to 32% in 2019, chi-square test for linear trend P value = 0.001. Eighty-nine percent of patients with IDU had at least one contact with the healthcare system in the year before diagnosis compared to 63% of patients without IDU, P value 0.003. The median (interquartile range IQR) number of healthcare visits was 7 [2 - 16] for patients with IDU versus 1 [0 - 3] for patients without IDU, P < 0.001. We observed an increase in new HIV diagnoses with an increase in the proportion of newly diagnosed patients with IDU. Patients with newly diagnosed HIV and IDU had high rates of health care utilization in the year before diagnosis presenting an opportunity for intervention.

Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study.

BackgroundWe previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda.MethodsWe performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified early warning scores (MEWS). We calculated amalgamated qSOFA scores by inserting UVA cut-offs into the qSOFA score, and modified UVA scores by removing the HIV criterion. The performance of each score determined by the area under the receiver operator characteristic curve (AUC) was the primary outcome measure.ResultsWe included 573 hospitalized adult patients with acute infection of whom 40 (7%) died in-hospital. The admission AUCs (95% confidence interval [CI]) for the prediction of mortality by the scores were: UVA, 0.77 (0.68–0.85); modified UVA, 0.77 (0.68–0.85); qSOFA, 0.66 (0.56–0.75), amalgamated qSOFA, 0.71 (0.61–0.80); and MEWS, 0.74 (0.64, 0.83). The positive predictive values (95% CI) of the scores at commonly used cut-offs were: UVA >4, 0.35 (0.15–0.59); modified UVA >4, 0.35 (0.15–0.59); qSOFA >1, 0.14 (0.07–0.24); amalgamated qSOFA >1, 0.44 (0.20–0.70); and MEWS >5, 0.14 (0.08–0.22). The 72 hour (N = 236) AUC (95% CI) for the prediction of mortality by UVA was 0.59 (0.43–0.74). The Chi-Square test for linear trend did not identify an association between mortality and delta UVA score at 72 hours (p = 0.82).ConclusionsThe admission UVA score and amalgamated qSOFA score had good predictive ability for mortality in adult patients admitted to hospital with acute infection in Rwanda. The UVA score could be used to assist with triage decisions and clinical interventions, for baseline risk stratification in clinical studies, and in a clinical definition of sepsis in Africa.

Trend Analysis and Spatial Distribution of Meteorological Disaster Losses in China, 2004–2015

Meteorological disasters caused a lot of losses. We involved six categories (all disasters, floods, hail, typhoon, snow and heatwave) to observe their death and economic losses’ spatial-time distribution. The time trend of mortality was analyzed using a chi-square test for linear trends. Economic loss was described by direct economic loss and loss rate of GDP, whose trends were described by a trend line. Using annual percent change (APC) estimated by fitting weighted linear regression model, the change degree of mortality was assessed. On a national level, there was a statistically significant decreasing trend in mortality of all disasters (Z = −39.82, p &lt; 0.05), floods (Z = −18.79, p &lt; 0.05), hail (Z = −20.43, p &lt; 0.05), typhoon (Z = −37.47, p &lt; 0.05), snow (Z = −9.02, p &lt; 0.05) and heatwave (Z = −8.76, p &lt; 0.05) from 2004 to 2015 in China. The time trend of the loss rate of GDP was decreasing while the trend of direct economic losses was increasing. Western China was the most seriously hit area. APCs remained in downward trends (APCs &lt; 0) in most of the provinces, while central provinces were with upward trends (APCs &gt; 0). Areas with increasing mortality (APCs &gt; 0) for different disasters included the southwest areas and Zhejiang (for floods), the northwest and south areas (for hail), Sichuan, Guangxi and Hainan (for typhoon), the west and northeast areas (for snow) and Hebei, Henan and Shanghai (for heatwave). As for economic losses, eastern areas were hit with a high amount of economic losses, but central areas were hit with a high GDP loss rate. Generally, nationwide death and economic losses caused by meteorological disasters have decreased. However, there were some relatively serious effects in the central and western areas for which urgent attention from policymakers is required.

Social distancing as protection factor against COVID-19 in a non-metropolitan area in the State of Rio Grande do Sul, BrazilLas medidas de distanciamiento social como factor de protección contra la COVID-19 en el interior de Rio Grande do Sul, Brasil

RESUMOObjetivo.Investigar a soroprevalência de SARS-CoV-2 na região do Vale do Rio Pardo, Rio Grande do Sul, Brasil, e analisar a associação entre soroprevalência e adesão por parte da população às medidas de distanciamento social.Método.Este estudo transversal de base populacional compreendeu quatro etapas de coleta domiciliar de dados entre agosto e outubro de 2020. A soroprevalência foi avaliada utilizando teste rápido de anticorpos IgM e IgG. Foram coletados, ainda, dados demográficos, socioeconômicos, clínicos e comportamentais, com aplicação de um questionário de três perguntas sobre adesão a medidas de distanciamento social, com foco no nível de distanciamento social que o entrevistado conseguia praticar, rotina de atividades do entrevistado e circulação de pessoas na casa. A associação entre os dados sociodemográficos e a prática de distanciamento social foi avaliada pelo teste do qui-quadrado para tendência linear e heterogeneidade de proporções, e a associação entre o distanciamento social e a soroprevalência foi avaliada pela regressão de Poisson (intervalo de confiança de 95% [IC95%]; P < 0,05).Resultados.Dos 4 252 indivíduos testados e entrevistados, 11,8% (IC95%: 10,8; 12,8) não aderiram ao distanciamento social. A prevalência de teste rápido reagente foi de 4,7% entre aqueles que não realizaram distanciamento social e de 1,9% entre aqueles que realizaram distanciamento social (P < 0,05). As variáveis sexo masculino, faixa etária de 20 a 59 anos, ensino médio, renda familiar mensal de R$ 3 136,00 a R$ 6 270,00 e morar na zona urbana apresentaram associação com a não adesão ao distanciamento social (P < 0,05). A adesão a todas as medidas de distanciamento social foi fator de proteção contra a infecção de SARS-CoV-2 (razão de prevalência: 0,37; IC95%: 0,19; 0,73).Conclusões.Os resultados indicam uma redução da soroprevalência pelas medidas de distanciamento social.

Knowledge and attitude towards organ donation: a study among medical and nursing students of a medical college

Background: Organ transplantation is one such field of modern medical sciences which has progressed over the years and has given hope for those suffering with end stage organ diseases. There are lot of advancement in technology to preserve and transplant of organs but with this technological advancement also there are still gaps in awareness regarding the subjects. To find the gaps this study was carried out in medical college students.Methods: A cross-sectional analytical study was conducted in medical college of Pune. 400 students were included in study with keeping 50% of prevalence about awareness in mind. Tool of data collection was a pre-structured questionnaire. Frequency, percentage, and chi square test Chi-square test for linear trend and was used to find associationResults: The 308 (77%) MBBS students and 92 (23%). Nursing students of all batches were included in the study. The 49.3% were aware about brain death, 68% students had fair knowledge and 10% had good knowledge about organ donation issues. The 82% students were positive, 94.5% students opined positively on policy on promotion of organ donation. The 52% students were ready to donate to anyone, while 30% students preferred to donate their organs to family members, 16% were ready to donate to their friends.Conclusions: Encouraging level of knowledge regarding organ donation, its legislative implications were present in medical and nursing students which was brought in this study.

Evolution of care during pregnancy and childbirth in the extreme south of Brazil.

ABSTRACTOBJECTIVES To describe the evolution of care during pregnancy and childbirth among postpartum women living in the municipality of Rio Grande, Southern Brazil, using data from surveys carried out every three years between 2007 and 2019.METHODS Within 48 hours after delivery, a single, standardized questionnaire was applied to all mothers who had children in local hospitals and met the inclusion criteria. Demographic and reproductive characteristics, lifestyle habits, socioeconomic level of the family, and care received during pregnancy and childbirth were investigated. In the analysis, the chi-square test for linear trend was used to assess the distribution of indicators per survey.RESULTS A total of 12,645 parturients were interviewed (98% of the women eligible to participate in the surveys). In the period evaluated, the proportion of births fell 35% among adolescents and increased 25% among women aged 35 years and over. Mothers gained, on average, two years of schooling, and their families experienced an important economic improvement, followed by loss of income in the last survey. Maternal smoking, before and during pregnancy, fell by half. The rate of mothers who started prenatal care in the first trimester and the number of consultations and laboratory tests increased. Almost 60% of prenatal consultations and 80% of births took place in the Brazilian Unified Health System. In 2019, vaginal delivery was once again the most common. The rates of low birth weight (9%) and prematurity (17%) virtually remained unchanged.CONCLUSIONS We found an important change in the reproductive profile and increased coverage of various prenatal care and delivery services. Children continue to be born well, but low birth weight and prematurity remain endemic.

Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection.

We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82–2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15–4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46–1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.

Non-pharmaceutical Interventions and the Infodemic on Twitter: Lessons Learned from Italy during the Covid-19 Pandemic

The COVID-19 pandemic changed expectations for information dissemination and use around the globe, challenging accepted models of communications, leadership, and social systems. We explore how social media discourse about COVID-19 in Italy was affected by the rapid spread of the virus, and how themes in postings changed with the adoption of social distancing measures and non-pharmaceutical interventions (NPI). We used topic modeling and social network analysis to highlight critical dimensions of conversations around COVID-19: 1) topics in social media postings about the Coronavirus; 2) the scope and reach of social networks; and 3) changes in social media content as the nation moved from partial to full social distancing. Twitter messages sent in Italy between February 11th and March 10th, 2020. 74,306 Tweets sent by institutions, news sources, elected officials, scientists and social media influencers. Messages were retweeted more than 1.2 million times globally. Non-parametric chi-square statistic with residual analysis to identify categories, chi-square test for linear trend, and Social Network Graphing. The first phase of the pandemic was dominated by social media influencers, followed by a focus on the economic consequences of the virus and placing blame on immigrants. As the crisis deepened, science-based themes began to predominate, with a focus on reducing the spread of the virus through physical distancing and business closures Our findings highlight the importance of messaging in social media in gaining the public’s trust and engagement during a pandemic. This requires credible scientific voices to garner public support for effective mitigation. Fighting the spread of an infectious disease goes hand in hand with stemming the dissemination of lies, bad science, and misdirection.

Seroprevalence of hepatitis C virus in voluntary blood donors at a tertiary care hospital, Ahmedabad, India

Background: Hepatitis C virus (HCV) is the most common cause of post transfusion non-A, non-B hepatitis worldwide. The prevalence of HCV in blood donors in high-income countries ranges from 0.002% to 0.05%, in middle-income countries ranges from 0.03% to 0.80%, and in low-income countries, prevalence varies from 0.50% to 2.23%. Objectives: The objectives of this study are to assess the seroprevalence and the trend of HCV in healthy voluntary blood donors at a tertiary care hospital in Ahmedabad over a period of 3 years. Settings and Design: Observational, retrospective study. Materials and Methods: During January 2017 to December 2019, 9477 voluntary blood donors were tested for the presence of anti-HCV antibody by using a 3rd-generation enzyme-linked immunosorbent assay test. Statistical Analysis Used: Data were statistically analyzed by using the Chi-square test, and Chi-Square test for linear trends using the Statistical Package for the Social Sciences (SPSS) software trial version 19. Results: Out of 9477 voluntary blood donors, 9229 (97.38%) donors were male and 248 (2.62%) were female. Ten donors (0.11%) were positive for anti-HCV. All seropositive donors were male. Out of total 0.11% seropositive donors, maximum (0.07%) were within the age group of 21–30 years. Seroprevalence of HCV showed a statistically significant decreasing trend over 3 years. Conclusion: Hepatitis C is a common cause of transfusion-related hepatitis. Early identification of persons with chronic HCV infection would enable infected persons to receive the necessary care and treatment to prevent or delay the onset of liver disease.

PREVALENCE AND RISK FACTORS OF OBESITY AMONG CHILDREN AND ADOLESCENTS IN SAUDI ARABIA: A META-ANALYSIS

Background: Although there is a plethora of studies concerning obesity in Saudi Arabia, there is a lack of a systematic analytical approach of obesity prevalence among children and adolescents. Objectives: To assess the prevalence and risk factors of obesity among children and adolescents in Saudi Arabia. The trend of obesity prevalence over the past two decades was additionally investigated. Methods: A meta-analysis was conducted involving cross-sectional studies published between 2000 and 2020 in PubMed, Embase, and Google Scholar. Pooled logit-transformed prevalence rates were computed for all studies and for subgroups based on the used diagnostic criteria, period of data collection, and region. Personal and parental sociodemographic risk factors were collected and expressed as odds ratio and 95% confidence intervals (95% CIs). Trend analysis was performed using a chi-squared test for linear trend, and a meta-regression was applied to assess the sources of heterogeneity. Results: Twenty-six studies met the inclusion criteria (43,187 subjects, 54.3% males). The pooled prevalence of obesity was 14.13%, and it increased significantly in 2016-2020 compared to 2000-2005 (OR=2.58, p&lt;0.0001). Obesity was significantly associated with male sex (OR=1.36, p=0.007), performing a physical activity &lt;3 times/week (OR=1.59, p=0.025), consuming soft drinks ≥2 times/day (OR=1.73, p=0.014), having a working mother (OR=1.20, p=0.036), and living in an urban region (OR=1.44, p=0.033). Between-study heterogeneity was significant, and it was explained by regional variation (F(2,5)=12.519, p=0.028). Conclusion: The high obesity prevalence among young populations in Saudi Arabia underscores the importance of implementing intensified school- and community-based preventive programs, focusing on the established risk factors.

Association Between Chronic Diseases, Sports Participation And Obesity: Findings From A Brazilian Longitudinal Study

PURPOSE: To analyze the association between leisure-time physical activity (specifically sports participation), obesity and the incidence of chronic diseases among Brazilian adults. METHODS: The sample was composed of 620 adults (166 males and 454 females) aged 50 years or older followed from 2010 to 2014 in the city of Bauru, Sao Paulo, Brazil. Physical activity was assessed using a questionnaire (Baecke et al. Am J Clin Nutr, 1982 [face-to-face interview]) and subjects were stratified according to the engagement in sports in leisure-time (180 minutes/week over the last four months) as: Engaged (n= 99) and Non-engaged (n= 521). Body mass index (kg/m2) was used as diagnosis of obesity (BMI ≥30). Sports participation and obesity were combined and participants were stratified as follow: Obese/Non-sport (n= 230), Obese/Sport (n= 33), Non-obese/Non-sport (n= 291) and Non-obese/Sport (n= 66). The incidence of new cases of arterial hypertension, dyslipidemia and diabetes mellitus were verified through medical records. Chi-squared test for linear trend analyzed associations and statistical significance was set as p-value <5%. RESULTS: The incidence of arterial hypertension was not associated with the combination of sports participation and obesity (p-value= 0.853). However, the incidence of new cases of dyslipidemia (Obese/Non-engaged [37.8%], Obese/Engaged [30.3%], Non-obese/Non-engaged [27.8%] and Non-obese/Engaged [22.7%]; p-value= 0.004) and diabetes mellitus (Obese/Non-engaged [15.2%], Obese/Engaged [12.1%], Non-obese/Non-engaged [8.6%] and Non-obese/Engaged [6.1%]; p-value= 0.006) were associated with the lack of sports participation and obesity. CONCLUSION: There was an association between non-engagement in sports, obesity, and the incidence of dyslipidemia and diabetes mellitus among Brazilian adults. This finding highlight the importance of public health actions promoting healthy behaviors aiming the prevention of chronic diseases, especially in countries with universal health systems. Supported by the Sao Paulo Research Foundation (FAPESP), process number: 2018/01744-7 and CAPES.

Age-stratified anti-tuberculosis drug resistance profiles in South Korea: a multicenter retrospective study

BackgroundThe emergence of drug-resistant tuberculosis (DR-TB) is a major healthcare concern worldwide. Here, we analyzed age-related trends in DR-TB rates in South Korea.MethodsDrug susceptibility test results were collected from patients with culture-confirmed TB between 2015 and 2018 from eight university-affiliated hospitals. Patients were divided into three subgroups: younger (15–34 years), middle (35–59 years), and older (≥60 years) to compare drug-resistance patterns. To evaluate trends in age-stratified drug-resistance, chi-square test for linear trends was performed.ResultsAmong enrolled native patients aged ≥15 years, 4.1% (179/4417), 1.2% (53/4417) and 7.2% (316/4417) were multidrug-resistant TB (MDR-TB), rifampicin-mono-resistant TB (RR-TB), and isoniazid-mono-resistant TB (Hr-TB), respectively. Proportions of Hr-TB cases were 5.4% (40/734), 7.2% (114/1593), and 7.8% (162/2090) in the younger, middle and older age groups, respectively. MDR/RR-TB case rates decreased significantly with age from 8.6% (63/734) in younger age group to 3.3% (68/2090) in older age group. Fluoroquinolone resistance was highest among second-line drugs, and there were no differences in resistance to fluoroquinolones and second-line injectable drugs among the three age groups.ConclusionsThe number of MDR/RR-TB cases was highest in young patients. Effective public health interventions should include increased focus on rifampicin resistance in young patients.

Atividades físicas de lazer por universitários: inquéritos repetidos nos anos de 2010, 2012 e 2014

O objetivo deste estudo foi comparar as proporções de prática de diferentes tipos de atividades físicas no lazer por universitários entre os anos de 2010, 2012 e 2014. Realizou-se três inquéritos repetidos com amostras de universitários de uma instituição de ensino superior do estado da Bahia. As modalidades foram mensuradas por meio de um questionário validado para aplicação em universitários, tendo sido os seguintes tipos: ciclismo, voleibol, natação, caminhada em esteira, hidroginástica, surfe, caminhada em locais abertos, futebol, basquetebol, handebol, corrida em locais abertos, ginástica aeróbica, lutas, tênis, musculação, corrida em esteira e ginástica em geral com uso de pesos e trampolins. As comparações foram realizadas utilizando o teste qui-quadrado para tendência linear. O nível de significância foi de 5%. Participaram do estudo 1.084, 1.085 e 1.041 universitários, nos anos de 2010, 2012 e 2014, respectivamente. A modalidade mais praticada nos três inquéritos foi a musculação, seguida do futebol. A prática das modalidades de corrida (2010 = 6,9%; 2012 = 8,8%; 2014 = 11,0%) e de lutas (2010 = 4,2%; 2012 = 4,5%; 2014 = 7,6%) aumentaram ao longo dos inquéritos. Houve a diminuição na prática da ginástica com uso de pesos/trampolins (2010 = 3,7%; 2012 = 1,9%; 2014 = 1,4%; p = 0,001). Conclui-se que a tendência de atividade física de lazer ao longo do tempo em universitários foi diferente entre as modalidades e em relação as características sociodemográficas e de vínculo com a universidade, com aumento de praticantes de lutas e corridas, e diminuição dos adeptos da ginástica com pesos/trampolins.

Indications of percutaneous umbilical cord blood sampling in prenatal diagnosis

Objective To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS. Methods This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis. Results (1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings. Conclusions Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An improvement in reasonable and standardized application of PUBS needs to be achieved. Key words: Prenatal diagnosis; Phlebotomy; Blood specimen collection; Umbilical veins

Uterine alterations in women undergoing routine hysteroscopy before in vitro fertilization: high prevalence of unsuspected lesions

Objective:The aim of this study was to verify the prevalence of uterine cavity abnormalities diagnosed by routine office hysteroscopy in women preparing to IVF.Methods:We carried out a retrospective cross-sectional study of 1141 consecutive women who underwent outpatient hysteroscopy before IVF at a tertiary academic center. Of these, 961 participants had a normal transvaginal sonography (TVS) of the uterine cavity. The prevalence of hysteroscopic alterations in successive age strata was submitted to Mantel-Haenzsel Chi-square test for linear trend. The diagnostic accuracy of TVS using hysteroscopy as reference was assessed by calculating the sensitivity, specificity, positive and negative likelihood ratios.Results:Hysteroscopic alterations were present in 265/961 of patients with a negative TVS (prevalence 27.6%, 95% confidence interval [CI] 24.8%-30.5%). The prevalence of unsuspected submucous leiomyoma was higher among older women (p=0.005, chi-square test for linear trend) and reached 7.2% (95% CI 3.5%-14.1%) after 40 years. The sensitivity of TVS ranged from 8% (95% CI 2%-20%) for uterine synechiae to 41% (95% CI 28%-56%) for submucous leiomyoma, resulting in low likelihood ratios for negative TVS results.Conclusions:These findings suggest a high prevalence of unsuspected alterations found by routine hysteroscopy before IVF, an age-dependent increase in the frequency of submucous leiomyoma and a low diagnostic sensitivity of TVS to detect intracavitary lesions.

Comparison of stress in freshman and senior nursing students.

To compare stress levels in freshman and senior nursing students. A cross-sectional study was carried out in a public federal university of the state of Bahia, with students who answered questionnaires about sociodemographic variables, academic life, and a scale for assessing stress in nursing students. Chi-square and Fisher's exact tests were applied to analyze the relationship between variables. To assess proportional trends between ordinal variables and groups, a chi-square test for linear trend was applied. The significance level was 5%. One hundred and fifty-four students participated in the study. There was a tendency to higher stress levels among students in the last year compared to those in the first year, in four out of six domains: Performance of Practical Activities (p=0.00), Professional Communication (p=0.00), Environment (p=0.00) and Professional Education (p=0.00). High levels of stress were observed in students taking the last year. There is a need for broader research that includes other years of the course, an institutional reflection on stress factors and the adoption of an institutional policy that favors a better confrontation of stress factors.

Magnitude, trends and causes of maternal mortality among reproductive aged women in Kersa health and demographic surveillance system, eastern Ethiopia

BackgroundDespite efforts at curbing maternal morbidity and mortality, developing countries are still burdened with high rates of maternal morbidity and mortality. Ethiopia is not an exception and has one of the world’s highest rates of maternal deaths. Reducing the huge burden of maternal mortality remains the single most serious challenge in Ethiopia. There is a paucity of information with regards to the local level magnitude and causes of maternal mortality. We assessed the magnitude, trends and causes of maternal mortality using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia.MethodThe analysis used surveillance data extracted from the Kersa HDSS database for the duration of 2008 to 2014. Data on maternal deaths and live births during the seven year period were used to determine the maternal mortality ratio in the study. The data were mainly extracted from a verbal autopsy database. The sample was comprised of all reproductive aged women who died during pregnancy, childbirth or 42 days after delivery. Chi-squared test for linear trend was used to examine the significance of change in rates over time.ResultsOut of the total 311 deaths of reproductive aged women during the study period, 72 (23.2%) died during pregnancy or within 42 days of delivery. The overall estimated maternal mortality ratio was 324 per 100,000 live births (95% CI: 256, 384). The observed maternal mortality ratio has shown a declining trend over the seven years period though there is no statistical significance for the reduction (χ2 = 0.56, P = 0.57). The estimated pregnancy related mortality ratio was 543 per 100,000 live births (95% CI: 437, 663). Out of those who died due to pregnancy and related causes, only 26% attended at least one antenatal care service. The most common cause of maternal death was postpartum haemorrhage (46.5%) followed by hypertensive disorders of pregnancy (16.3%).ConclusionThe magnitude of maternal mortality is considerably high but has shown a decreasing trend. Community-based initiatives that aim to improve maternal health should be strengthened further to reduce the prevailing maternal mortality. Targeted information education and communication should be provided.