Chi-square Test For Trend Research Articles

Time and cause of death in patients after acute coronary syndrome

Abstract Background Acute coronary syndrome (ACS) remains a substantial mortality burden despite enormous progress achieved in treatment and prevention in recent decades, yet systematic investigation of detailed causes of death among ACS patients remains limited. Objective This study aimed to describe the association between time and cause of death in patients after ACS using data from a large, multicenter, contemporary cohort. Methods Patients’ data from the China Chest Pain Database between 2015 and 2021 were linked to the China National Death Registration System Database using unique national IDs to obtain accurate vital status. Patients with documented death records were extracted into a merged database, which encompassed all deaths that occurred in the hospital and post-discharge out-of-hospital. Patients were enrolled with a discharge diagnosis of ACS. Cardiovascular (CV) mortality was defined as a death certificate with a CV diagnosis using the ICD-10 classification listed as the primary cause of death. A trend chi-square test was performed to assess the causes of death at different times after ACS. Results Among the 126,704 eligible patients, the mean age at baseline was 74 (66, 81) years old, 39.3% were women. Of these patients, 16,546 (13.1%) died during hospitalisation, 53,980 (42.6%) within the first six months after discharge, 19,664 (15.5%) from 6 to12 months after discharge, and 36,514 (28.8%) beyond 12 months after discharge. The most common cause of CV death was ischemic heart disease (70.1%), followed by ischemic stroke (7.1%) and hemorrhagic stroke (6.8%). The main causes of non-CV death were malignant tumours (37.1%) and respiratory disease (21.5%). For death in-hospital, within the first six months, from 6 to 12 months post-discharge, and beyond 12 months, the proportion of CV causes was 86.3%, 78.3%, 70.7%, and 67.9%, respectively (P<0.001). The proportion of deaths due to haemorrhagic stroke and aortic aneurysm/dissection increased progressively with time to death increasing (P<0.001). Meanwhile, the proportion of non-CV deaths continuously increased, reaching 13.7%, 21.7%, 29.3%, and 32.1%, respectively. Conclusion Despite cardiovascular diseases being the primary cause of death in patients after ACS, the causes of death vary among patients with different times of death, highlighting the importance of categorising patients into distinct population groups according to time after ACS for targeted cause-specific preventive strategies.

Association of biological aging with prostate cancer: insights from the National Health and Nutrition Examination Survey.

The link between biological aging and prostate cancer (PCa) risk, particularly as indicated by elevated prostate-specific antigen (PSA) levels, remains uncertain. This study utilized data from the National Health and Nutrition Examination Survey (2001-2010) to explore this association. Biological age was assessed using Klemera-Doubal method age (KDMAge) and phenotypic age (PhenoAge). PCa was identified through self-reported diagnoses, and highly probable PCa was determined by PSA levels. We analyzed the prevalence of PCa and PSA-defined highly probable PCa across quartiles of biological age measures using weighted chi-square and linear trend tests. Associations were evaluated using weighted multiple logistic regression models. Among 7,209 and 6,682 males analyzed, the overall weighted prevalence of PCa was 2.86%, increasing to 9.60% in those aged 65 and above. A significant rise in PCa prevalence was observed with higher quartiles of KDMAge or PhenoAge (P for trend < 0.001), particularly in those under 65. In this younger group, higher PhenoAge acceleration quartiles were linked to increased PCa prevalence and higher risk of PCa (OR = 1.50, P = 0.015) as well as highly probable PCa in those without a diagnosis (OR = 1.28, P = 0.031). These findings suggest that accelerated biological aging is associated with an increased risk of PCa and may indicate early risk as signaled by PSA levels, even in those without a PCa diagnosis.

Prevalence and epidemic pattern of ecdemic multidrug-resistant tuberculosis during 2012–2022 in Hangzhou, China: implication for public health strategies

BackgroundTo assess the prevalence and epidemic pattern of multidrug-resistant tuberculosis in Hangzhou City, Zhejiang Province, China during 2012–2022.MethodsAll the tuberculosis cases undergoing drug susceptibility testing during 2012–2022 were included in this study. De-identified information was extracted from the electronic database Tuberculosis Information Management System for analysis of drug resistance prevalence in Hangzhou and ecdemic multidrug-resistant tuberculosis which originated from other regions. Chi-square tests were used to compare drug resistance rates between different groups, while Chi-square tests for trend were used to evaluate the change of drug resistance rates over the years of 2012–2022. The sources and destinations of ecdemic multidrug-resistant tuberculosis were illustrated using a Sankey diagram.ResultsOf 21,127 cases included in this study, 1119 (5.3%) were multidrug-resistant tuberculosis. A significant decline in multidrug-resistant tuberculosis rates was observed during 2012–2022. There was a significant difference in multidrug-resistant tuberculosis rates among immigrant population and local residents in Hangzhou City. Of 1119 multidrug-resistant tuberculosis cases, 515(46%) were ecdemic multidrug-resistant tuberculosis cases, of which 277(53.8%) were from other parts of Zhejiang Province and 238(46.2%) were from other provinces in China. Anhui, Jiangxi and Sichuan were among top three provinces which were the source of ecdemic multidrug-resistant tuberculosis cases. Three districts including Xiaoshan, Shangcheng and Linping districts had the most cases in Hangzhou. The proportion of ecdemic multidrug-resistant tuberculosis cases in Binjiang, Xiaoshan, Qiantang and Linping districtalso exceeded 30% of total cases.ConclusionsMultidrug-resistant tuberculosis prevalence has been declining in Hangzhou. Migrant population contributed to a significant potion of cases in Hangzhou. Interventions should be tailed to local and migrant residents.

7334 Changing Trends In Oral Bisphosphonate Therapy: A 25-Year Surveillance In A US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. M.M. Khan: None. L.D. Carbone: None. E.A. Garcia: None. G.H. Tabada: None. D. Low: None. R.L. Hui: None. Introduction: Bisphosphonate (BP) drugs remain one of the first line therapies for fracture prevention, but treatment patterns have changed since BPs were first approved for osteoporosis. This study examines trends among adults initiating oral BP in a large US healthcare system over a 25-year period (1988-2022) and in each successive 5-year period. Methods: The study cohort comprised adults aged 50-89y who initiated alendronate, risedronate or oral ibandronate during 1998-2022 in an integrated healthcare delivery system, excluding those with select bone disorders, multiple myeloma, secondary metastatic cancer, end stage renal disease, and receipt of intravenous BP. Covariates included age (proportion age &amp;lt;65y), sex, race and ethnicity, and prior fracture (diagnosed within 5 years) using electronic health record data. Demographic trends and fracture status were examined across time periods. The chi-squared test and Cochrane-Armitage test for trend were used to examine differences and trends. This report extends findings from an earlier report of women initiating oral BP during 2004-2012 in the same healthcare population. Results: Among 208,780 adults (86% women) who initiated BP, including 26,646 (1998-2002, 35% &amp;lt;65y), 44,726 (2003-2007, 35% &amp;lt;65y), 34,005 (2008-2012, 24% &amp;lt;65y), 35,248 (2013-2017, 19% &amp;lt;65y), and 38,743 (2018-2022, 17% &amp;lt;65y) women and 2348 (1998-2002, 28% &amp;lt;65y), 4895 (2003-2007, 26% &amp;lt;65y), 5172 (2008-2012, 17% &amp;lt;65y), 5331 (2013-2017, 13% &amp;lt;65y), and 11,666 (2018-2022, 5% &amp;lt;65y) men in each 5-year period. Over time, an increasing proportion were age ≥65y (p&amp;lt;0.001 for trend), with larger numbers of older adults in later years partly reflecting initiatives targeting secondary fracture prevention (since 2008 for women, 2015 for men) and BMD screening (since 2011 for women, 2017 for men). Among women initiating BP, the proportion with prior fracture increased from 24-30% (pre-2008) to 43-45% (post-2008), partly reflecting secondary fracture prevention initiatives for women. For men, this proportion increased from 33% (1998-2002) to 42% (2003-2007), 47% (2008-2012), and 54% (2013-2017), but fell to 36% (2018-2022) after BMD screening initiatives began in 2017 for older men (primary prevention efforts). Racial and ethnic diversity in treatment also increased, comparing 1988-2002 (75.2% White, 2.5% Black, 8.6% Hispanic, 12.7% Asian/Pacific Islander) to 2018-2022 (61.5% White, 2.9% Black, 12.2% Hispanic, 21.1% Asian/Pacific Islander, p&amp;lt;0.001 for overall differences and % non-White). Conclusions: In a primary care population of adults initiating oral BP, a larger proportion in later years were age &amp;gt;65y, including larger numbers both with and without fracture coinciding with initiatives for fracture prevention. Among those initiating BP, the relative proportions with prior fracture in each period were likely influenced by primary or secondary prevention efforts. Presentation: 6/2/2024

9212 Changing Trends In Oral Bisphosphonate Therapy: A 25-Year Surveillance In A US Healthcare System

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. M.M. Khan: None. L.D. Carbone: None. E.A. Garcia: None. G.H. Tabada: None. D. Low: None. R.L. Hui: None. Introduction: Bisphosphonate (BP) drugs remain one of the first line therapies for fracture prevention, but treatment patterns have changed since BPs were first approved for osteoporosis. This study examines trends among adults initiating oral BP in a large US healthcare system over a 25-year period (1988-2022) and in each successive 5-year period. Methods: The study cohort comprised adults aged 50-89y who initiated alendronate, risedronate or oral ibandronate during 1998-2022 in an integrated healthcare delivery system, excluding those with select bone disorders, multiple myeloma, secondary metastatic cancer, end stage renal disease, and receipt of intravenous BP. Covariates included age (proportion age &amp;lt;65y), sex, race and ethnicity, and prior fracture (diagnosed within 5 years) using electronic health record data. Demographic trends and fracture status were examined across time periods. The chi-squared test and Cochrane-Armitage test for trend were used to examine differences and trends. This report extends findings from an earlier report of women initiating oral BP during 2004-2012 in the same healthcare population. Results: Among 208,780 adults (86% women) who initiated BP, including 26,646 (1998-2002, 35% &amp;lt;65y), 44,726 (2003-2007, 35% &amp;lt;65y), 34,005 (2008-2012, 24% &amp;lt;65y), 35,248 (2013-2017, 19% &amp;lt;65y), and 38,743 (2018-2022, 17% &amp;lt;65y) women and 2348 (1998-2002, 28% &amp;lt;65y), 4895 (2003-2007, 26% &amp;lt;65y), 5172 (2008-2012, 17% &amp;lt;65y), 5331 (2013-2017, 13% &amp;lt;65y), and 11,666 (2018-2022, 5% &amp;lt;65y) men in each 5-year period. Over time, an increasing proportion were age ≥65y (p&amp;lt;0.001 for trend), with larger numbers of older adults in later years partly reflecting initiatives targeting secondary fracture prevention (since 2008 for women, 2015 for men) and BMD screening (since 2011 for women, 2017 for men). Among women initiating BP, the proportion with prior fracture increased from 24-30% (pre-2008) to 43-45% (post-2008), partly reflecting secondary fracture prevention initiatives for women. For men, this proportion increased from 33% (1998-2002) to 42% (2003-2007), 47% (2008-2012), and 54% (2013-2017), but fell to 36% (2018-2022) after BMD screening initiatives began in 2017 for older men (primary prevention efforts). Racial and ethnic diversity in treatment also increased, comparing 1988-2002 (75.2% White, 2.5% Black, 8.6% Hispanic, 12.7% Asian/Pacific Islander) to 2018-2022 (61.5% White, 2.9% Black, 12.2% Hispanic, 21.1% Asian/Pacific Islander, p&amp;lt;0.001 for overall differences and % non-White). Conclusions: In a primary care population of adults initiating oral BP, a larger proportion in later years were age &amp;gt;65y, including larger numbers both with and without fracture coinciding with initiatives for fracture prevention. Among those initiating BP, the relative proportions with prior fracture in each period were likely influenced by primary or secondary prevention efforts. Presentation: 6/2/2024

Prevalence and molecular characterization of carbapenem-resistant Enterobacterales in patients from a public referral hospital in a non-metropolitan region of Brazil during and post the SARS-CoV-2 pandemic.

Antimicrobial resistance (AMR) poses a global threat, with carbapenem-resistant Enterobacterales (CRE) representing a significant concern due to limited therapeutic options. This study investigated the prevalence of carbapenemase genes in CRE strains isolated from tracheal aspirates of patients at a Brazilian university hospital between January 2020 and August 2023. Bacterial identification was conducted using MALDI-TOF, while carbapenemase genes were detected by qPCR. Demographic and clinical data were collected, and univariate analysis was performed using the chi-square test (p < 0.05). Variables with p ≤ 0.10 were further investigated using the chi-square test for linear trend, along with stratified analysis. Out of 1,133 samples, 111 (9.79%) showed CRE growth, with 46 isolates included in the final sample, predominantly comprising Klebsiella pneumoniae (65.21%) and Serratia marcescens (19.57%). The blaKPC gene was prevalent (78.26%), while blaNDM was detected in 21.74% of cases. The identified population was predominantly male (67.39%), elderly (69.57%), white (56.52%), unmarried (63.04%), and had a low level of education (56.52%). Most patients (69.57%) were in the intensive care unit and remained hospitalized for more than 30 days (76.08%). There was a significant inverse trend between Klebsiella pneumoniae and age (p = 0.045), as well as a direct linear trend between blaNDM and the annual increase in COVID-19 cases in Brazil (p = 0.050). A high probability of finding non-Klebsiella pneumoniae bacteria was observed in patients with prolonged hospital stays, independent of COVID-19 (p = 0.006) and the type of resistance genes (p = 0.020). The persistent prevalence of CRE, especially with blaKPC, underscores the urgency of effective control measures.

Smoking during pregnancy in an Irish obstetric Population: Prevalence, maternal and ethnic factors

ObjectivesMaternal cigarette smoking during pregnancy is associated with adverse health outcomes for the mother and her fetus in utero. A high prevalence of smoking during pregnancy is reported within an Irish obstetric population. However, there are no recent Irish data regarding change in smoking rates over time, or factors associated with declining smoking prevalence. Therefore, the objectives of this study were: 1. To investigate smoking patterns in pregnancy among an Irish obstetric population, 2. To identify trends over time, and 3. To evaluate associated demographic factors. Study DesignThe data for this study were obtained from EuroKing, a computerised obstetric database, to which data had been entered prospectively during the 8-year period between January 2015 and December 2022 at Galway University Hospital, Ireland. A total of 22,673 deliveries were recorded during this time period. Complete information regarding the mother’s smoking history was available for 19,247 women at the time of antenatal booking, and again at delivery. Statistical analyses was performed using GraphPad Prism (version 10.1.2). Chi-square test for proportions and trend were used to assess differences between groups. ResultsRates of smoking during pregnancy declined over the duration of the study. The percentage of mothers who smoked during pregnancy declined from 8.3 % in 2015 to 6.0 % in 2022 (P = 0.007). The greatest reduction in smoking was observed among those aged 21 to 30 years, from 15.3 % in 2015 to 10.1 % in 2022 (P < 0.001). There was no significant decline in smoking within the other age groups. There was an overall reduction in the rate of smoking from the time of antenatal booking to delivery of 31.9 %. Increasing maternal age was associated with lower rates of smoking (P < 0.001). Increasing parity was associated with higher rates of smoking (P < 0.001). Smoking rates were highest in the White Irish Traveller ethnic group, at 40.3 % across the 8-year study period. Breastfeeding rates were lower in smokers versus non-smokers (P < 0.001). ConclusionThis study indicates that the rate of maternal smoking during pregnancy in Ireland is approximately 6%, which is less than previously reported. A significant proportion of women who smoked at the time of antenatal booking have ceased smoking by the time of delivery. Overall there was a decline in maternal smoking over the duration of the study. However, high rates of smoking were associated with certain sociodemographic characteristics, including younger maternal age, increasing parity and White Irish Traveller background.

Increasing trends of antibiotic resistance in Uganda: analysis of the national antimicrobial resistance surveillance data, 2018–2021

BackgroundContinuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there's limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda.MethodsWe analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018–2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period.ResultsOut of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63–84% for sulfonamides, fluoroquinolones macrolides (46–76%), phenicols (48–71%), penicillins (42–97%), β-lactamase inhibitors (20–92%), aminoglycosides (17–53%), cephalosporins (8.3–90%), carbapenems (5.3–26%), and glycopeptides (0–20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29–78% p < 0.001), ciprofloxacin (17–43%, p = 0.004), ceftriaxone (8–72%, p = 0.003), imipenem (6–26%, p = 0.004), and meropenem (7–18%, p = 0.03).ConclusionThe study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO's Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for "Watch" or "Reserve."

Prevalence and Risk Factors of Hypertension Among Diabetic Patients

Hypertension poses a significant public health concern, leading to increased morbidity and mortality rates. Its coexistence with diabetes often worsens the complications associated with both conditions. The aim of this study was to examine the prevalence of hypertension and the factors influencing its occurrence among diabetic patients receiving follow-up care at the Haidari Internal Medicine, Gastrointestinal Diseases, GI Endoscopy, and Colonoscopy Center in Jalalabad city, Nangarhar Province, Afghanistan. The study was carried out from November 1, 2023, to January 30, 2024. We utilized a cross-sectional design and conducted statistical analysis using SPSS software version 25.0. Categorical data were expressed as frequencies and percentages. The associations between hypertension and various variables in diabetes mellitus (DM) were evaluated using chi-square tests for trend. The findings demonstrated that age ≥ 50 years, higher BMI, and type 2 DM were significant predictors of hypertension among the studied population. Additionally, illiteracy, active smoking, a family history of hypertension, physical inactivity, having diabetes for 5 or more years, and using both non-insulin and insulin treatments were linked to a higher prevalence of hypertension. These findings highlight the need to address these risk factors in the management and prevention of hypertension among individuals with diabetes.

Trends in the Implementation of Workplace COVID-19 Measures in Japanese Companies: A One-Year Prospective Cohort Study.

This study evaluated trends in the implementation of workplace measures against COVID-19 by Japanese companies. We conducted a prospective cohort study, using data from December 2020 and December 2021, with 13,419 respondents participating in the follow-up survey. We evaluated nine workplace measures against COVID-19 (e.g., encouraging mask-wearing at work) and used the McNemar test and the Chi-square test for trend in the analysis. Small-sized companies (1-9 employees) exhibited a significant increase in the implementation of all the measures, with a rate of increase ranging from 8.4% to 16.1% (P-value: <0.001). Medium-sized companies (10-49 employees) also showed significant improvements in nearly all the measures (rate of increase: 3.5% to 10.5%, P-values: <0.001 to 0.004), except for one specific measure. Larger companies (more than 50 employees) displayed a mixed pattern, with some measures increasing and others decreasing. A persistent gap was observed between smaller (fewer than 50 employees) and larger companies in the implementation rates of these measures. The findings revealed a positive shift in workplace measures against COVID-19 among smaller companies in Japan over 1 year, although gaps between them and larger companies persisted.

Evaluation of Add-On Individualized Homeopathic Medicines Products in the Treatment of Symptomatic COVID-19 Managed at Home: A Double Blind, Placebo-Controlled, Randomized, Exploratory Clinical Trial

Homeopathy has shown promise in fighting epidemics, leading to potential applications in the COVID-19 clinical cases. To assess the impact of add-on individualized homeopathic medicinal products (IHMP) in improving clinical outcomes and time to medical discharge in COVID-19 patients. A prospective, double-blind, randomized, placebo-controlled, parallel-group exploratory clinical trial was conducted in a São Paulo state municipality, Brazil, between February and July 2021. 82 (unvaccinated) patients with confirmed SARS-CoV-2 infection and manageable mild to moderate COVID-19 symptoms were randomly assigned to placebo or IHMP groups. Utilizing unique global COVID-19 symptom scores, a symptom assessment was performed. Statistical analysis involved 68 patients (36 IHMP; 32 placebo). No significant initial disparity existed in total COVID-19 symptom scores between the groups. The IHMP group exhibited a significantly shorter mean time from initial appointment to medical discharge compared to placebo (p &lt; 0.05: IHMP 74.5 hours (+/- 57.47, 95% CI: 55.73-93.27); placebo 137.42 hours (+/- 87.85, 95% CI: 106.98-167.86)). Employing the chi-square trend test at selected time points (74.5 and 137.42 hours, corresponding to mean discharge times), COVID-19 scores demonstrated sustained IHMP-associated reductions (p &lt; 0.05). COVID-19 symptom scores and time to medical discharge were significantly reduced by treatment with IHMP compared to placebo, suggesting a potential role for IHMP in managing mild to moderate COVID-19 symptoms at home.

Penetrating trauma on the rise- nine-year trends of severe trauma in Sweden.

Sweden has an established trauma system involving national trauma criteria and the Swedish trauma registry (SweTrau), since over a decade. Meanwhile, the injury panorama has evolved, with an increase in gang-related violence in the Swedish community. In this study, we aimed to investigate long-term trends in mortality, management and trauma type in two major Swedish trauma centers over a nine-year period. All trauma patients with a New Injury Score (NISS) > 15 or a Trauma Alert (TA) call during 2013-2021 were identified in the participating centers' SweTrau registries. Data were analysed regarding mortality, proportion of emergency interventions, intensive care unit (ICU) admissions, mechanism of injury and type of trauma (penetrating or blunt). To assess trends, Chi-Squared test for trend and JoinPoint regression method were used. A total of 10,587 patients were included in the study. Mortality remained unchanged over time in patients with NISS > 15 (10.0-10.9%, p = 0.963) but increased in patients with a TA and NISS < 15 (1.3-2.7%, p = 0.005). For NISS > 15, the proportion undergoing emergency interventions was stable (53.9%-48.8%, p = 0.297) while ICU admissions declined (62.1%-45.7%, p < 0.001). Penetrating trauma increased (12.4-19.6%, p < 0.001), including knife (10.0-15.7%, p < 0.001) and gunshot wounds (2.3-3.8%, p < 0.001), whereas accidents involving motorcycles (8.8%-7.0%, p = 0.004) and pedestrians (5.3%-2.2%, p < 0.001) decreased. Assaults (both penetrating and blunt) increased from 14.7 to 21.4% (p < 0.001). In this trend analysis at two major Swedish trauma centers during 2013-2021, penetrating trauma increased with over 50% while traffic injuries decreased. The rise in mortality in patients with a TA and NISS < 15 is concerning and requires further evaluation, as do the reduction in ICU admissions.

Survey on health literacy and related factors among firefighters of emergency management departments in Southwest China

ObjectiveAlthough health literacy (HL) has emerged as a critical public health concern, research on HL in emergency management departments is limited. This study aimed to investigate the awareness of HL and associated factors among firefighters of emergency management departments in southwest China to provide a basis for carrying out targeted health education.MethodsA cross-sectional convenience sample of 1,742 firefighters from an emergency management department in southwestern China was surveyed from February to April 2023 using the Chinese Citizen’s Health Literacy Questionnaire (2019 version). The chi-square test, linear trend chi-square test, Fisher’s test, rank sum test, and multifactorial logistic regression model were used to identify influential factors associated with HL.ResultsThe HL level of the 1742 respondents was 34.3%. Age, ethnicity, education level, length of service, type of job, smoking status, types of parental jobs, annual household income, time of daily internet use, etc. (P < 0.05). The results of multivariate logistic regression analysis indicate that type of job (OR = 0.648, 95%CI:0.426–0.985), length of service (OR = 0.496, 95%CI:0.251–0.981), household income (OR = 1.900, 95%CI:1.443–2.502), daily internet usage time (OR = 0.726, 95%Cl:0.588–0.896), health status (OR = 0.750, 95%Cl:0.585–0.962) and frequency of organizing HL sessions (OR = 1.603, 95%Cl:1.101–2.330) were influencing factors affecting the HL of the officers and soldiers.ConclusionThe health literacy level of firefighters in the Emergency Management Department in Southwest China was 34.3%. Lower levels were found in the health-related skills dimension (HRS, 30.1%) and in infectious disease control (ID, 30.7%). Health information literacy (HI, 34.3%) was lower than the national level. The type of urban and rural areas, literacy level, and household income level may be the factors affecting the level of health literacy among the respondents. Therefore, health education and promotion interventions should target high priority dimensions (HRS, HI, and ID) and should focus on strengthening health literacy levels of firefighters with rural types, low education levels, and low household income to improve their health.

Poster 163: Direct Comparison of Modified Jobe and Docking Reconstructions to UCL Repair with Internal Brace at Mid-Term Follow-Up

Objectives: The modified Jobe and Docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques with prior research demonstrating successful and equivalent outcomes at midterm follow-up. More recently, UCL repair augmented with the Internal Brace (IB) has been investigated as a possible alternative with cadaveric studies demonstrating improved time-zero biomechanics and favorable clinical results at early follow-up, with possible earlier return to play. However, there has been no comparison between UCL repair with IB and these reconstruction techniques, nor has longer term follow-up been reported. The purpose of this study was to directly compare clinical outcomes at mid-term follow-up of these three surgical techniques: the modified Jobe, Docking, and repair with IB when performed by a single surgeon. Methods: Nineteen UCL repair with IB surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Patients were matched by age, gender, and handedness to patients from previously published modified Jobe and Docking cohorts. Conway Scale, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, and need for additional surgery were compared between groups. Continuous variables are displayed as mean ± standard deviation unless otherwise indicated, with groups compared using a Kruskal-Wallis test. Categorical variables are displayed as count (percentage total), with pairwise comparison between groups performed using a Fisher’s exact test. When there were greater than 2 categorical variables, groups were compared with chi square test for trend. For multiple comparisons of categorical variables, the lowest P value is shown in Tables 1 and 2, with no comparison reaching P &lt; 0.05, which was considered significant. Results: Patients were similar with respect to age ( p=0.52), gender ( p&gt;0.60), handedness ( p&gt;0.17), sport ( p&gt;0.16), position ( p&gt;0.07), years played ( p=0.69), level of competition ( p&gt;0.26), future shoulder surgery ( p&gt;0.65), and future elbow surgery ( p&gt;0.48) (Table 1). The mean follow-up was 5.7 ± 3.5 years, 7.4 ± 4.7 years, and 5.4 ± 1.2 years in the modified Jobe, Docking, and repair with IB groups, respectively ( p=0.55). No difference was identified between techniques in KJOC scores (modified Jobe, 73.5 ± 23.6; Docking, 74.5 ± 25.5; repair with IB, 75.5 ± 25.3) or Conway Scale (return to play, any level: 73% vs. 84% vs.78%, p&gt;0.11) (Table 2). Conclusions: No differences in outcomes scores or return to play were found when the modified Jobe and Docking UCL reconstruction techniques were compared with the UCL repair with internal brace technique at greater than 5-year average follow-up. Given the similar outcomes between groups, all three techniques are viable treatment options for UCL injuries. Sufficient clinical equipoise exists in surgical decision making, with repair being a durable option in the proper patient.

Trend of pulmonary tuberculosis and rifampicin-resistance among tuberculosis presumptive patients in Central Tigray, Ethiopia; 2018 -2023: a six-year retrospective study

BackgroundTuberculosis (TB) is a major public health concern in the developing countries. Moreover, the emergence of multidrug-resistant tuberculosis is challenging. However, there are no organized data on the trends of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis in the study area.MethodsA retrospective cross-sectional study was conducted to fill the information gap in Central Tigray at St. Mary General Hospital between 2018 and 2023. Data were collected from the GeneXpert™ tuberculosis registration logbooks using standard checklists and analyzed using Statistical Package for Social Science version 22. After performing logistic regression, a p-value < 0.05 with a corresponding 95% confidence interval was considered statistically significant. Moreover, chi square test for trend was performed to assess the percentage of annual detection of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis during the study years.ResultPresumptive pulmonary tuberculosis patients with complete data (n = 3696) were included in the study. The overall prevalence of pulmonary tuberculosis was 11.7%, of which 8.1% were resistant to rifampicin. The study revealed that the incidence of pulmonary tuberculosis has been increasing, mainly in the recent four years. Likewise, an increase in rifampicin-resistant Mycobacterium tuberculosis was observed with considerable fluctuations. Age, human immunodeficiency virus infection, and presumptive rifampicin-resistant Mycobacterium tuberculosis infection were significantly associated with the presence of pulmonary tuberculosis. Moreover, pulmonary tuberculosis was more prevalent among participants in the productive-age group.ConclusionAlthough there have been fluctuations, an increasing of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis has been observed in recent years. Hence, prevention and treatment strategies for tuberculosis should be strengthened to alleviate the burden of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis in the study area.

Association of food insecurity with reduced cancer screening rates.

1592 Background: Social determinants of health, including access to adequate food and nutrition, influence many aspects of health, including cancer screening. This study explored the associations between food insecurity and cancer screening. Methods: A retrospective analysis was conducted using the National Health Interview Series from 2018-2022 to capture contemporary screening events. Based on scaled questionnaires, food security was stratified into either food secure or insecure, and then subgrouped into high, marginal, or low security. Associations were made with rates of undergoing at least one screening test. Relationships between variables were evaluated using Chi-Square and Cochran-Armitage trend tests. Logistic regression models were applied to find factors associated with cancer screening. Results: Patients included in analyses included: 51,957 for colon, 40,103 for breast, 45,983 for cervical, and 25,781 for prostate cancer screening. Between 2018-2022, those with food insecurity had significantly lower rates of cancer screening than those with food security across all four cancer screens, including colon (68.1% vs. 76.1%, p &lt; 0.0001), cervical (83.3% vs. 87.5%, p &lt; 0.0001), breast (73.3% vs. 79.5%, p &lt; 0.0001) and prostate (41.3% vs. 54.0%, p &lt; 0.0001) (Table). This was similar when comparing low, marginal, and high food security, respectively, for colon (68.1% vs. 68.2% vs. 76.1%, p &lt; 0.0001), cervical (82.8% vs. 84.1% vs. 87.5%; p &lt; 0.0001), breast (72.7% vs. 74.1% vs. 79.5%, p &lt; 0.0001), and PSA screening (40.7% vs. 42.2% vs. 54.0%; p &lt; 0.0001). Other variables were also analyzed, including insurance type, age, race, BMI, and health status. Those with public health insurance had lower screening rates for cervical cancer compared to those with private insurance (p &lt; 0.0001). Individuals with food insecurity reported worse health than those who were food secure (p &lt; 0.0001). Lower food security disproportionately affected Black patients (p &lt; 0.001), and was associated with younger age (p &lt; 0.0001) and higher rates of obesity (p &lt; 0.0001). Conclusions: Individuals with self-reported food insecurity were found to have lower cancer screening rates than those who were food secure. Further analyses revealed associations between low food security status and obesity, public health insurance, younger age, and Black race. These data suggest that addressing food insecurity should be a priority, as these populations appear most vulnerable to lacking appropriate cancer screening. [Table: see text]

Trends and risk factors analysis of NEC in preterm infants over 9 years

BackgroundInvestigating the trend of changes in the occurrence of necrotizing enterocolitis (NEC) in preterm infants during 9 years and analyzing the risk factors of NEC with the purpose of providing reference for clinical diagnosis and treatment of NEC.MethodsClinical data of NEC in preterm infants with Bell’s stage ≥ II from January 2013 to December 2021 in the Neonatology Department of the Third Affiliated Hospital of Zunyi Medical University was retrospectively analyzed. Trends in the occurrence of NEC in preterm infants were analyzed by the trend chi-square test. Subsequently, the general data (sex, gestational age, singleton or multiple births, birth weight, serum albumin, alkaline phosphatase, sepsis, blood transfusion, mechanical ventilation, RDS, arterial catheterization) and perinatal data (intrauterine distress, turbid amniotic fluid, premature rupture of membranes, mode of delivery, fetal heart abnormalities, diabetes mellitus) were collected; then, the risk factors for NEC were analyzed by univariate and multivariate logistic-regression analysis.ResultsIn the past 9 years, 77 cases of NEC occurred, with the incidence rate of 1.95%, and the incidence of NEC in preterm infants has been increasing year by year (P < 0.05). The results of univariate analysis showed that the morbidity of NEC in preterm infants was associated with premature rupture of membranes, blood transfusion, sepsis, and the of serum albumin (P < 0.05). Multivariate logistic regression analysis revealed that blood transfusion (OR = 2.232, 95% CI: 1.012–4.923) and sepsis (OR = 0.899, 95% CI: 0.809–3.915) were independent risk factors of NEC in preterm infants, while high serum albumin (OR = 0.899, 95% CI: 0.809–3.915) was an independent protective factor of NEC in preterm infants.ConclusionThe morbidity of NEC is gradually increasing. Inhibition of infection and limitation of blood transfusion are effective measures to reduce the occurrence of NEC. Meanwhile, high serum albumin is a protective factor for NEC.

Persistent gender disparity in leading dental publications across 4 decades: an observational study

ObjectivesThis observational study assessed the differences in the gender of the first and last authors in the most-cited dental articles over the last 4 decades. Study Design and SettingArticles were obtained through an electronic search of the most-cited articles in dentistry by decade (total n = 400 articles). The 100 most-cited studies in each decade (1980–1989, 1990–1999, 2000–2009, and 2010–2019), with any study design, with results in dentistry were eligible. The gender of the first and last authors was determined using the Genderize database. Comparative evaluation of gender distribution in general and across the 4 decades was performed with the Chi-square test, and the contribution of variables on the citation rate of articles was performed using linear regression. ResultsThere were statistical differences between the gender distributions, with a predominance of men in the first (83.8%) and the last (86.8%) positions (P < .001). Over the decades, there was a tendency for an increase in the proportion of women as the last author (P = .002; Chi-square trend Test), with an increase of women from 6% to 22% across the last 4 decades. However, no statistically significant differences were observed between the genders for the first author in the last 4 decades (P = .163; Chi-square trend Test). ConclusionThe findings indicate that men lead a large percentage of the most-cited articles in dentistry and that this trend has not shown substantial modifications over the last years. Nonetheless, for the position of last authorship, an increase in women's representativity was observed over the last decades.

Clinical and epidemiological risk factors associated with hospitalization and mortality rate of COVID-19 patients in Banja Luka County: A retrospective observational cohort study on 40,000 patients.

Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions. The aim of the study was to explore clinical and epidemiological characteristics associated with COVID 19 outcomes. The retrospective observational study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed as reverse transcriptase polymerase chain reaction (RT-PCR) positive on COVID-19 at a primary healthcare centre from March 2020 to September 2022. Epidemiological data were obtained from Web-Medic medical records of patients. The COVID-19 data were obtained from COVID-19 data sheets comprised of patients' RT-PCR testing forms, surveillance forms for severe acute respiratory syndrome coronavirus-2 status, and a map of their positive and isolated contacts. Differences regarding the distributions of patients between groups were analysed using the Pearson chi-square test and Mantel-Haenszel chi-square test for trends, while differences in mean values were compared using an independent sample t-test. The average age of hospitalised patients was significantly higher compared to the age of non-hospitalised patients (P < 0.001). The average age of patients with lethal outcomes was nearly twice as high in comparison to patients with non-lethal outcomes (P < 0.001). Male patients had a higher hospitalization and mortality rate (P < 0.001). The highest hospitalization rate was in patients with chronic renal failure (CRF), diabetes and cardiovascular diseases (CVDs), while the death rate was the highest among patients with CRF and hearth comorbidities. Patients with fatigue and appetite loss had a higher percentage of lethal outcomes. Vaccinated patients had a significantly lower rate of lethal outcome. Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in the clinical outcomes of COVID-19.

Clinical utility, reproducibility, and radiologist acceptance of ILD-RADS

PurposeTo investigate the clinical utility, reproducibility, and radiologists’ acceptance of the Interstitial Lung Disease Imaging-Reporting and Data System (ILD-RADS). MethodIn this single-institutional retrospective study, three radiologists independently reviewed the chest high-resolution CT (HRCT) scans of 111 consecutive patients diagnosed with ILDs. They assessed the HRCT pulmonary features using the ILD-RADS template and assigned an ILD-RADS category (1–4) to each scan based on the identified imaging pattern. Patients were classified into idiopathic pulmonary fibrosis (IPF) (n = 14) and non-IPF ILD (n = 97) groups based on clinical diagnoses determined by multidisciplinary discussion. Association between ILD-RADS categories and clinical diagnoses was assessed using the Chi-square test for trend. Reproducibility was evaluated using kappa (k) scores, and radiologists’ acceptance of the ILD-RADS was evaluated with a questionnaire. ResultsWe found a significant association between the ILD-RADS categories and patients’ clinical diagnoses (P ≤ 0.0001) for the three readers, with a trend toward increased assignment of ILD-RADS-1 to IPF patients (50 %-57.1 %), and ILD-RADS-4 to non-IPF patients (46.4 %-49.5 %). The ILD-RADS categories showed excellent intra-reader agreement (k = 0.873) and moderate inter-reader agreement (k = 0.440). ILD-RADS-1 and −4 categories showed the highest inter-reader agreement (k = 0.681 and 0.481, respectively). Radiologists gave a positive response to using the ILD-RADS in daily practice. ConclusionsThe clinical utility of the ILD-RADS was demonstrated by the significant association between the ILD-RADS categories and patients’ clinical diagnoses, particularly the ILD-RADS-1 and −4 categories. Excellent intra-reader and moderate inter-reader reproducibility was observed. ILD-RADS has the potential to be widely accepted for standardized HRCT reporting among radiologists.