Chi-square Test For Trend Research Articles

Trends in sales of antidepressants in Brazil from 2014 to 2020: A time trend analysis with joinpoint regression

BackgroundThis study aimed to investigate the trends in antidepressants sales in Brazil. MethodsWe performed a joinpoint analysis of antidepressants sales in Brazil from 2014 to 2020, recorded in the Brazilian National Controlled Products Management System. The primary outcomes were the defined daily dose per 1000 inhabitants per day (DID) and the market shares for each antidepressant per year. We used joinpoint regression to assess the changes in antidepressant consumption in DID to obtain the average annual percent change (AAPC) and 95 % confidence intervals (95 % CI). Changes in market shares were tested by chi-square trend test (p < 0.05 as significant). ResultsFrom 2014 to 2020, 42,252,989 antidepressant sales were recorded in the system. Antidepressant sales increased from 13.7 to 33.6 DID in the period (AAPC: 15.7; 95 % CI: 13.0–18.4; p < 0.001); the largest increases were observed for serotonin reuptake inhibitors and ‘other’ antidepressants (including serotonin-norepinephrine reuptake inhibitors), whereas tricyclics remained steady. Escitalopram and sertraline were the most sold drugs. Market share of serotonin reuptake inhibitors decreased, particularly for paroxetine (13.1 % to 6.5 %; p = 0.016), while ‘other’ antidepressants' market share expanded from 21.9 % to 33.3 % (p = 0.027), especially for desvenlafaxine (2.9 % to 14.3 %; p < 0.001). LimitationsThe dataset does not include antidepressants dispensed in hospitals, public services, and compounding pharmacies, neither their therapeutic indications. ConclusionSales of antidepressants significantly increased in Brazil from 2014 to 2020, which were mainly driven by higher prescriptions of serotonin reuptake inhibitors and ‘other’ antidepressants classes. Market share changes seem to be driven by novelty of products.

P018Defining hemorrhage using modified quantitative blood loss in abortion patients

<h3>Objectives</h3> To identify if quantitative blood loss with dilation and evacuation procedures correlates with clinically relevant outcomes. <h3>Methods</h3> We used a de-identified family planning database to identify dilation and evacuation procedures performed at UC Davis Health from April 2019 through March 2020. Surgeons determined quantitative blood loss during procedures and estimated blood loss if excessive post-procedure (during recovery). We extracted patient demographic and procedure-related information. We defined clinically relevant bleeding as cases with use of ≥2 uterotonics or any of the following interventions: tranexamic acid administration, uterine balloon tamponade, blood transfusion, hospitalization, return to operating room, or other bleeding-related interventions within 24 hours post-procedure. We used chi-square test for trend to evaluate bleeding outcomes. <h3>Results</h3> We evaluated 431 procedures with a mean gestational age of 19±3 weeks. Clinically significant bleeding outcomes occurred in 6/305 (2%), 14/109 (13%) and 8/17 (47%) patients with total blood loss <250mL, ≥250mL and ≥500mL, respectively (p<0.0001). Seventeen patients had uterine etiologies and 11 had cervical injuries, with QBLs ranging from 150-1800mL (median QBL 312.5mL, interquartile range [IQR] 250-500mL). Patients without clinically relevant bleeding had median QBL of 150 mL (interquartile range [IQR] 75-200mL). Among patients who received no or 1 uterotonics, median QBLs were 115 mL (IQR 50-200mL) and 200 mL (IQR 150-300mL), respectively. <h3>Conclusions</h3> More than half of patients with quantitative blood loss ≥500 mL do not have clinically relevant bleeding outcomes. Although higher blood loss correlates with clinical interventions, the need for intervention rather than a single amount of blood loss should be used to define hemorrhage with dilation and evacuation procedures.

Abstract 13858: The Epidemiological Characteristics &amp; Outcome Trend of Cannabis Abuse Among Stroke Hospitalizations in the United States - A Nationwide Study

Background: With the legalization of cannabis in many states for medical or recreational purposes, cannabis utilization has been increased to treat various health concerns. However, little is known about the prevalence of cannabis abuse and outcome trend among acute ischemic stroke (AIS) patients. This study examines the epidemiological characteristics and outcome trend of cannabis abuse among adults with AIS hospitalizations in the USA. Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample over year from 2003 to 2017 in adult hospitalizations for AIS to compare the outcomes [death, risk mortality &amp; discharge disposition (short-term hospital / skilled nursing home/home health care)] in cannabis abusers using ICD 9 &amp; 10 codes. We performed weighted analyses using chi-square, t-test, and Cochran-Armitage trend test. Results: Amongst the total of 5,690,773 AIS hospitalizations, 50,895 (0.89%) cannabis users were identified from 2003 to 2017. The prevalence trend of cannabis abuse has increased among stroke hospitalizations (2003: 0.22% to 2017:1.64%; p-trend &lt; 0.0001). The cannabis abuse was higher among the younger to middle age compared to older aged stroke hospitalization (&lt;50 year: 3.89% vs 50-75 year: 1.09% vs &gt;75 year: 0.02%; p &lt;0.0001). Cannabis abuse was more prevalent among the male (1.32% vs female: 0.50%), Black (2.29% vs White: 0.61%; p&lt;0.0001). The cannabis abusers had lower median household income (1.39% vs higher income:0.44%), medicaid insurance (3.61% vs medicare: 0.31%), highly prevalent in midwest (1.05% vs northeast: 0.57%; p&lt;0.0001). There was also increased trend in mortality (2003: 0.38% to 2017: 0.97%), extreme/major likelihood of dying (2003: 0.21% to 2017: 1.22%), extreme/major loss of function (2003: 0.19% to 2017: 1.52%), discharge to non-home (2003: 0.14% to 2017: 1.25%; p-trend&lt;0.0001) among cannabis abusers following stroke hospitalizations. Conclusion: This study identified a higher prevalence of abuse, abuse-related poor outcomes, and higher stroke-related mortality among stroke survivors. Cannabis use in patients with neurovascular insults has raised safety concerns, and more long-term research is needed to determine its risks and benefits in stroke patients.

Cannabis use in Tunisian adolescents: Alarming trends from 2013 to 2021

Abstract Background Cannabis is the most widely used illicit psychoactive substance worldwide. In Tunisia, the prevalence of cannabis use and its association with other risky behaviours were reported in several publications interesting mainly early adolescence. However, no publications exploring trends based on national epidemiological data are available yet. Our purpose was to determine cannabis prevalence in Tunisian high school adolescents and assess significant trends from 2013 to 2021. Methods Pooled data from Mediterranean school surveys on alcohol and other drugs conducted in 2013, 2017, and 2021, were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of cannabis use and chi square test for trend was used for global, by gender and by sector (private/public) trends assessement. STATA software was used for statistical analysis. Results A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of cannabis use increased from 1.4%, to 3.8% then to 7.9% for 2013, 2017 and 2021 respectively. Trend assessement concludes to significant increase in overall cannabis use (p &amp;lt; 10-3). Besides, there was a significant increase in both public and private schools, and among both boys and girls. However, the greatest increase was among male students (3.5% in 2013, 9.2% in 2017 and 16.1% in 2021) (p &amp;lt; 10-3). Conclusions Despite the reinforcement of restrictive legislative measures, the prevalence of cannabis use among Tunisian high school adolescents is significantly increasing. Moreover, it’s important to further investigate problematic cannabis use and its effects on adolescents’ physical and mental health. Key messages • Trend assessement confirmed the significant increase in lifetime cannabis use in high school adolescents in Tunisia, for both sexes and for both private and public sector. • This alarming public health issue requires urgent legislation review and close multisectoral collaboration to control supply and demand.

Trends in mortality associated with surgical site infections: a cohort study in Italy, 2009-2019

Abstract Background Surveillance programs have proven to be effective in reducing surgical site infection (SSI) rates. In 2008 Piedmont joined the Italian national surveillance system. The aim of this study was to evaluate mortality rates and trends associated with SSIs in Piedmont from 2009 to 2019 for the two most frequently performed surgical procedures, hip arthroplasty (HPRO) and colon surgery (COLO). Methods Data were collected through the national surveillance system, which includes 42 hospitals in Piedmont who participated in the surveillance program from 2009 to 2019. Procedure-specific SSI rates, overall mortality rates and case fatality rates (CFR) associated with SSIs were calculated, overall and per year. Trends were evaluated using the chi-squared test for trends. Analyses were performed using Epi Info v. 7.2. Results A total of 33438 surgical procedures (21645 HPRO, 11793 COLO) were monitored over the study period from the hospitals participating in the network. 1215 SSIs (293 HPRO, 922 COLO) were observed and 617 deaths were registered (222 HPRO, 395 COLO). For HPRO procedures, an overall SSI rate of 1.35% was found, with an overall mortality of 1.03% and a CFR of 3.75%. No significant trend was observed. Considering COLO interventions, an overall SSI rate of 7.82% was found, with an overall mortality of 3.35% and a CFR of 6.94%. There was a statistically significant downward trend in SSI and overall mortality rates (p = 0.046 and 0.005, respectively). Conclusions Considering HPRO, it is possible that the lack of significant trends could be due to the already low SSI and overall mortality rates, with the protective effect of surveillance having reached a plateau. Regarding COLO procedures, a significant reduction in SSI and overall mortality rates was observed during the study period. The reduction in mortality could be due to the decrease in SSI rates, however other factors not analysed in our study could have contributed. Key messages • This study brings further evidence to the protective effect of surveillance, attributable to an improvement in healthcare quality and patients’ safety. • A significant decrease in COLO mortality rates was observed, which could be due to the decreasing trend in SSI rates.

Critical analysis of risk factors for intrapartum fetal death.

Intrapartum fetal death is devastating for both parents and medical caregivers. The purpose of this study was to evaluate the risk factors for intrapartum fetal death, which often influence management in subsequent pregnancies. This population-based cohort study included all singleton deliveries between the years 1991-2016 at Soroka University Medical Center. Trends over the years, risk factors for intrapartum fetal death and the effect of day of the week were examined. A generalized estimation equation (GEE) model was used to control for confounders. During the study period 344,536 deliveries were recorded, of which 251 (0.1%) suffered intrapartum fetal death. Rates did not change significantly over the years (p = 0.130, using the chi-square test for trends). Preterm delivery, placental abruption, uterine rupture, shoulder dystocia, congenital malformations, severe preeclampsia and fetal malpresentation were significantly more common in pregnancies complicated by intrapartum death. Using a GEE model; shoulder dystocia (aOR 23.8, 95% CI 9.9-57.3, p < 0.005), uterine rupture (aOR 19.0, 95% CI 7.0-51.4, p < 0.05), preterm delivery (aOR 11.9, 95% CI 8.6-16.5, p < 0.001), placental abruption (aOR 6.2, 95% CI 4.1-9.4, p < 0.001), fetal malpresentation (aOR 3.6, 95% CI 2.6-4.9, p < 0.005) and congenital malformations (aOR 2.6, 95% CI 1.9-3.5, p < 0.05) were all independent risk factors for intrapartum fetal death. Weekend deliveries were not at increased risk of intrapartum fetal death. Several risk factors were identified for intrapartum fetal death, with shoulder dystocia demonstrating the highest risk. Unfortunately most factors are neither preventable nor predictable and interventions to decrease the rate of intrapartum fetal death remain elusive.

Psychiatric Symptoms and Frequency of Eating out among Commuters in Beijing: A Bidirectional Association?

Background: Mental illness places as a distant first in global burdens, exceeding both cardiovascular and circulatory diseases, in terms of the years lived with the disability. The emergence of the new and burgeoning area of “Nutrition Psychiatry” offers promise in improving mental health with diet. Mental health and well-being are critical to commuters but rarely recieve the attention they need. This study aimed to examine the bidirectional relationship between the frequency of eating out and depression, anxiety, and stress symptoms in a sample of Beijing commuters. Methods: A total of 3337 commuters (mean (SD) age, 38.78 (10.41); 74.74% males) from the cohort study CHCN-BTH were included. The psychiatric symptoms were evaluated using a 21-item self-reported depression–anxiety–stress scale (DASS-21). A Cochran–Armitage trend chi-square test, restricted cubic spline, multiple logistic regression, multinomial logit models, and E-values were performed to estimate the associations between eating out and psychiatric symptoms in both directions. Results: A daily rate of eating out more than 50% had a higher risk for depression (OR, 95% CI: 1.68, 1.184–2.393), anxiety (1.73, 1.259–2.369), and stress (1.99, 1.191–3.329) than the individuals eating at home. A higher frequency of eating out for lunch was significantly associated with an increased risk of depression (1.78, 1.28–2.46), anxiety (1.67, 1.26–2.23), and stress (2.05, 1.31–3.22). Similar results were found when eating out for dinner with increased risks for depression 2.20 (1.59, 3.06), anxiety 1.91 (1.42, 2.59), and stress 2.61 (1.68, 4.05). There is limited evidence supporting the effects of psychiatric symptoms on the frequency of eating out in the reverse analyses. Conclusions: The frequency of eating out is positively associated with an increased risk of psychiatric symptoms, especially when eating out for lunch and dinner. People eating at home have the lowest risk of suffering psychiatric symptoms, followed by those eating in the workplace canteen. Eating at home should be considered for future recommendations for the prevention of psychiatric symptoms.

Changes in cardiovascular risk factors in patients undergoing first time coronary revascularization from 2003–2020, A nationwide population study

Abstract Introduction Current knowledge of cardiovascular risk factors is primarily based on older studies that may not reflect current populations. Monitoring risk factors may influence decisions about prevention and treatment of ischemic heart disease. We hypothesize that the prevalence of traditional risk factors in patients undergoing first-time coronary revascularization has changed over time. Purpose We examined the proportion of patients with traditional cardiovascular risk factors from year 2003–2020 in patients undergoing first-time coronary revascularization. Methods We identified all adults undergoing first-time coronary revascularization (percutaneous intervention and bypass grafting) from 2003–2020 using Danish nationwide registries. Risk factors were defined as either medical prescriptions or diagnosis prior to first-time revascularization. We calculated the proportion of individual risk factors per year with associated 95% CI, and calculated the trend using chi-squared test for trend in proportion. Results We identified 152,692 patients who underwent first-time coronary revascularization. 78.5% of the patients underwent percutaneous coronary intervention and 21.5% underwent coronary artery bypass grafting, 73.8% were male, mean age 65 (SD 11.5), and 67.9% had at least 1 risk factor at first-time revascularization. Figure 1 shows the trends in risk factors from 2003 to 2020. From 2003–2005 to 2018–2020, the proportion of patients with at least 1 risk factors changed from 70.9 to 64.0%, hypertension changed from 41.4 to 36.0%, hypercholesterolemia decreased from 47.6 to 43.6%, aspirin use decreased from 52.4 to 32.06%, diabetes increased from 11.7 to 15.8%, chronic kidney disease increased from 2.4 to 4.4%, and chronic obstructive pulmonary disease increased from 4.95 to 4.96% (p-value for trend &amp;lt;0.001 for all risk factors, except chronic obstructive pulmonary disease (p-value 0.96)). Conclusion We assessed the temporal trends in coronary risk factors over a 17-year period in patients undergoing first-time coronary revascularization. We found a large decrease in the proportion of patients with any risk factor, hypertension, hypercholesterolemia, and aspirin use, and an increase in diabetes and chronic kidney disease. The proportion of patients with chronic obstructive pulmonary disease was unchanged. Funding Acknowledgement Type of funding sources: None.

Epidemic Characteristics of HIV Drug Resistance in Hefei, Anhui Province.

To study the characteristics of HIV pretreatment drug resistance (PDR) and acquired drug resistance (ADR) in Hefei, a cross-sectional survey was used to collect 816 samples from newly reported HIV infections from 2017 to 2020 and 127 samples from HIV infections with virological failure from 2018 to 2019 in Hefei. HIV drug resistance levels and drug resistance mutations were interpreted using the Stanford Drug Resistance Database. Molecular networks were constructed by HIV-TRACE. Among the newly reported infections in Hefei, the prevalence of PDR was 6.4% (52/816). The drug resistance mutations were mainly V179E/D/T (12.4%), K103N (1.3%), and V106I/M (1.3%). In addition, it was found that the CRF55_01B subtype had a higher drug resistance rate than other subtypes (p < 0.05). Molecular network analysis found that K103N and V179E may be transmitted in the cluster of the CRF55_01B subtype. The prevalence of ADR among HIV infections with virological failure was 38.6% (49/127), and the drug resistance mutations were mainly M184V (24.4%), K103N/S (15.7%), Y181C (11.0%), G190S/A/E (10.2%), and V106M/I (10.2%). The molecular network was constructed by combining HIV infections with virological failure and newly reported infections; M184V and Y181C may be transmitted between them. The chi-square trend test results indicated that the higher the viral load level, the greater the number of newly reported infections linked to the infections with virological failure in the molecular network. In conclusion, interventions should focus on infections of the CRF55_01B subtype to reduce the transmission of drug-resistant strains. However, improving the treatment effect of HIV infections is beneficial for reducing the second-generation transmission of HIV.

Community prescribing trends and prevalence in the last year of life, for people who die from cancer

BackgroundPeople who die from cancer (‘cancer decedents’) may latterly experience unpleasant and distressing symptoms. Prescribing medication for pain and symptom control is essential for good-quality palliative care; however, such provision is variable, difficult to quantify and poorly characterised in current literature. This study aims to characterise trends in prescribing analgesia, non-analgesic palliative care medication and non-palliative medications, to cancer decedents, in their last year of life, and to assess any associations with demographic or clinical factors.MethodsThis descriptive study, analysed all 181,247 prescriptions issued to a study population of 2443 cancer decedents in Tayside, Scotland (2013–2015), in the last year of life, linking prescribing data to demographic, and cancer registry datasets using the unique patient-identifying Community Health Index (CHI) number. Anonymised linked data were analysed in Safe Haven using chi-squared test for trend, binary logistic regression and Poisson regression in SPSSv25.ResultsIn their last year of life, three in four cancer decedents were prescribed strong opioids. Two-thirds of those prescribed opioids were also prescribed laxatives and/or anti-emetics. Only four in ten cancer decedents were prescribed all medications in the ‘Just in Case’ medication categories and only one in ten was prescribed breakthrough analgesia in the last year of life. The number of prescriptions for analgesia and palliative care drugs increased in the last 12 weeks of life. The number of prescriptions for non-palliative care medications, including anti-hypertensives, statins and bone protection, decreased over the last year, but was still substantial. Cancer decedents who were female, younger, or had lung cancer were more likely to be prescribed strong opioids; however, male cancer decedents had higher odds of being prescribed breakthrough analgesia. Cancer decedents who had late diagnoses had lower odds of being prescribed strong opioids.ConclusionsA substantial proportion of cancer decedents were not prescribed strong opioids, breakthrough medication, or medication to alleviate common palliative care symptoms (including ‘Just in Case’ medication). Many patients continued to be prescribed non-palliative care medications in their last days and weeks of life. Age, gender, cancer type and timing of diagnosis affected patients’ odds of being prescribed analgesic and non-analgesic palliative care medication.

Association between the Number of Repeated Praziquantel Treatments and Kidney Parenchymal Change in Northeast Thailand.

In Northeast Thailand, Praziquantel (PZQ) is used to treat infection with the Opisthorchis viverrnini (OV). OV has highly prevalence in this area due to the traditional consumption of uncooked cyprinid fish. The nephrotoxic effects of PZQ metabolite excretion through the kidney have not been assessed yet. This study investigated the relationship between number of Praziquantel treatments and kidney parenchymal change. A study was carried out on participants from the Cholangiocarcinoma Screening and Care Program (CASCAP) between 2013 - 2018. The frequency of PZQ use was reported using a standardized questionnaire. Kidney parenchymal change (KPC) was defined as having a kidney abnormality based on ultrasonography diagnosed by well-trained general practitioners. Adjusted odds ratios (ORs) measured associations between PZQ frequency and KPC controlling for the effects of other extraneous factors using multiple logistic regression. A total of 490,969 subjects with mean age of 55.2 (SD = 9.15) years were enrolled among them 62.1% were female. Prevalence of KPC was 1.2% while prevalence of KPC were 1.2%, 1.3%, 1.4%, and 1.5% for participants with one, two, three, and more than 3 PZQ treatment occasions respectively. Those dose-response relationship was statistically significant based on chi-square test for trend (p-value <0.001). After controlling for possible confounders, compared to non-treatment, subjects with more than 3 treatment occasions were 25% more likely to have a KPC positive result (OR = 1.25; 95% CI: 1.02 - 1.52; p-value = 0.028). The number of repeated PZQ treatments is statistically significantly related to KPC. This relationship could be included in health messaging for those who continue eating uncooked fish with an understanding that the OV infection can easily be cured by PZQ without any other health concerns. For positive OV cases, however, the known efficacy of PZQ could over-ride the small magnitude of the adverse effect.

Sub-regional Trend of HIV Infection Among Antenatal Clinic Attendees in Andhra Pradesh (2003-2019).

The analyses of local risks at sub-national levels and tailored interventions are being emphasized for effective HIV management. Andhra Pradesh (AP) is a high HIV prevalence state in India, with the second-highest number of People with HIV (PWH) and a consistent decline in HIV prevalence at the state level. Probing further into the region and district-wise levels and trends of HIV prevalence will provide critical insights into sub-regional epidemic patterns. Hence, this paper analyzes the regional and district-level trends of HIV prevalence among pregnant women attending antenatal clinics (ANC) from 2003 to 2019 in AP, South India. HIV prevalence data collected from pregnant women in AP during HIV Sentinel Surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into three regions (Coastal Andhra, Rayalaseema and Uttar Andhra), totaling 39 sites, including 21 rural and 18 urban sites. Regional and district-level HIV prevalence was analyzed using the Chisquare trend test, and spatial analysis was done using QGIS software. For the last three HSS rounds, HIV prevalence based on sociodemographic variables was calculated to understand the factors contributing to HIV positivity in each region. In total, 143,211 pregnant women were recruited. HIV prevalence in AP was 0.30% (95% CI: 0.22 - 0.39) in 2019. The prevalence was 0.31%, 0.35% and 0.22% in Coastal Andhra, Rayalaseema and Uttar Andhra, respectively. HIV prevalence had significantly (P < 0.05) declined in all regions. The overall trend indicated that the HIV prevalence was higher among older pregnant women and in urban regions. However, recent trends consistently report HIV positivity among young and new pregnant mothers, illiterates, and rural regions. The overall trend indicated that the HIV prevalence was higher among older pregnant women and in urban regions. However, recent trends consistently report HIV positivity among young and new pregnant mothers, illiterates, and rural regions. Identifying the contextual risk patterns associated with HIV transmission will further improve HIV preventive and management programs among the general population.

The combination of computed tomography‐derived muscle mass and muscle density and relationship with clinicopathological characteristics and survival in patients undergoing potentially curative surgery for colorectal cancer

AbstractBackgroundSarcopenia has been defined as a loss of muscle mass and function. CT‐derived muscle measurements, skeletal muscle index (SMI) and density (SMD), taken together may provide an objective measure of sarcopenia. The aim of the present study was to examine the relationship between CT‐derived sarcopenia (low SMI and SMD), clinicopathological characteristics, systemic inflammation and survival in patients undergoing surgery for colorectal cancer.MethodsConsecutive patients who underwent resections for colorectal cancer (TNM I–III) at our institution, between April 2008 and 2018, were identified from a prospectively maintained database. CT‐derived muscle mass (SMI) and density (SMD) measurements were combined to form the CT‐Sarcopenia score (CT‐SS). Thresholds for low SMI and SMD reported by Martin and co‐workers and Caan/Xiao and co‐workers were combined to form two iterations of the CT‐SS. Patients were categorized as normal/high SMI (irrespective of SMD) = 0, low SMI and normal/high SMD = 1 and low SMI and low SMD = 2. The Pearson Chi square test was used to examine the associations between categorical variables and the Chi square test for linear trend was used for ordered variables with multiple categories. Survival data were analysed using univariate and multivariate Cox regression.ResultsOne thousand and two patients met the study inclusion criteria. Fifty‐five per cent (n = 554) of patients were male and 66% (n = 657) were aged 65 years or older. Twenty‐four per cent (n = 240) of patients had TNM stage I disease, 40% (n = 404) stage II and 36% (n = 358) stage III. Eighteen per cent (n = 174) of patients were at risk of malnutrition. Forty‐eight per cent (n = 479) of patients had an NLR ≥ 3 and 27% (n = 271) had an mGPS ≥ 1. Similar numbers of patients defined as CT‐SS 0, 1 and 2 irrespective of thresholds applied (49%/12%/39% vs. 43%/19%/38%, respectively). Eight hundred and thirty four (n = 834) patients who underwent surgical resection for non‐metastatic colorectal cancer with curative intent were alive at 3 years. On univariate analysis, both the CT‐SS (Martin/Martin) and CT‐SS (Caan/Xaio) were significantly associated with age (P &lt; 0.001 and P &lt; 0.001, respectively), ASA (P &lt; 0.01 and P &lt; 0.001, respectively), MUST (P &lt; 0.001 and P &lt; 0.005, respectively), mGPS (P &lt; 0.001 and P &lt; 0.001, respectively), NLR (P &lt; 0.001 and P &lt; 0.001, respectively), and overall survival (P &lt; 0.001 and P &lt; 0.001, respectively). CT‐SS (Caan/Xaio) was significantly associated with TNM stage (P &lt; 0.05), but not CT‐SS (Martin/Martin, P = 0.221).ConclusionsThe objective CT‐SS was significantly associated with older age, co‐morbidity, nutritional risk, systemic inflammation and poorer survival, irrespective of thresholds used. However, the relationship between CT‐SS and TNM stage was inconsistent and threshold dependent.

Trends in Isolated Pelvic Fracture and 30-Day Survival during a Recent 15-Year Period: A Nationwide Study of the Japan Trauma Data Bank.

The epidemiology and treatment of isolated pelvic fracture in Japan are not well understood. This study evaluated epidemiological trends in isolated pelvic trauma and in-hospital survival rates during a recent 15-year period. This retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period, as follows: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using the chi-square, Kruskal-Wallis, and Mantel-Haenszel trend tests. We analyzed change in the main outcome over time in multiple logistic regression analysis fitted with a generalized estimating equation, accounting for within-cluster association. In total, 5,348 isolated pelvic fractures were identified during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization significantly increased with time (p=0.003), as did the survival rate (Phase 1, 77%; Phase 2, 86%; and Phase 3, 91%; p<0.001). The 30-day in-hospital mortality rate was significantly lower in Phase 3 than in Phase 1 and Phase 2, even after adjustment for hospital clustering and other confounders (p<0.01). The 30-day in-hospital survival rate after isolated pelvic fracture improved over a 15-year period in Japan.

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.

144-LB: Pediatric Type 2 Diabetes Prevalence from Real-World Data in the United States

Background: The SEARCH for Diabetes in Youth Study has provided critical insights into the epidemiology of pediatric T2D. The 2021 report estimated an annual percent change (APC) in prevalence of 4.8% between 2009 to 2017. Multi-center longitudinal cohort studies generate robust data, but are time, resource, and effort intensive. Large real-world data repositories may offer cost-effective opportunities to validate and expand on these findings. Hypothesis: Youth-onset T2D prevalence is rising at a rate in excess of 5% per year in the US in the previous five years. Methods: We queried the Trinetx Research Network which includes EHR data from 58 institutions with 86,487,854 total patients. We included patients &amp;lt;22 years of age, who had at least one incidence of an E11 ICD-10 code for T2D associated with an ambulatory, emergency room, or inpatient encounter for each calendar year from 2016 to 2021. Patients with other diabetes ICD-10 codes (E08, E09, E10, or E13) were excluded. Summary statistics of the query cohort describing sex, race and ethnicity, labs, medications, and anthopometrics were extracted from the platform. Chi-squared test for trend was used to determine statistical significance in demographic change. Results: The mean APC in prevalence per center rose by 9.1% between 2016 to 2019 (2016: 127 cases/center, 5334 total cases; 2019: 166.2 cases/center, 7919 total cases) , but subsequently declined by 6.6% between 2019 to 2020. There was a consistent increase in the median BMI percentile over time from 2016 to 2021. The percentage of black youth diagnosed with T2D rose (from 30 to 33%, P&amp;lt;0.0001) whereas that of Hispanic youth was unchanged (25%, P=0.73) . The proportion of male also increased over time (P&amp;lt;0.0001) . Conclusion: Real-world data from Trinetx demonstrates a rising incidence of youth-onset T2D that parallels an increase in median BMI percentile. The decrease in case rate in 2020 may be the result of decreased encounters during the Covid-19 pandemic. The rising prevalence of T2D in black youth and male gender warrants further analysis, to understand the driver behind this trend. Disclosure L. Chao: None. A. Vidmar: None. J. Espinoza: Consultant; AI Health. Funding National Center for Advancing Translational Science (UL1TR001855 and UL1TR000130)

Clinical longevity and trend analysis of 801 ultrathin ceramic veneers: A clinical cohort study

Statement of problemWhether ultrathin ceramic veneers are a suitable treatment alternative to conventional ceramic veneers is unclear. PurposeThe purpose of this prospective clinical cohort study was to evaluate the efficacy and longevity of nonpreparation and minimally invasive ceramic veneers and the influence of existing restorations and ceramic type and to define the relationship between the number of veneers placed on different teeth and in different locations, as well as age and sex correlations. Material and methodsA total of 801 veneers were placed on incisors, canines, and premolars on maxillary and mandibular teeth between January 2011 and August 2019 (ABR number: RNN/92/19/KE). Feldspathic or feldspathic and lithium disilicate veneers were made, etched, silanated, and cemented. The restorations were evaluated 2 weeks after placement and then every 6 months by using the modified United States Public Health Service (USPHS) criteria. The relationship between participant age and number of veneers was analyzed by using the Spearman rank coefficient test and the Mann-Whitney U test. Changes in the number of participants and veneers in subsequent years were analyzed based on the Spearman rank correlation coefficient. The trend between the location of veneers and the sex of the participants was analyzed by using the chi-squared test for trend. Longevity tables and a survival curve for the veneers were prepared based on the Kaplan-Meier method. The relationships between veneer longevity and the type of ceramic used and the presence of restorations were compared by using the Taron-Ware test (α=.05). ResultsThe mean longevity of the intact veneers was 8.45 years. Clinical success was 99.7% after 1 year and 97.9% after 4 years; this value remained constant until the end of the study. Most participants were women (n=122; 84.1%), and the mean age was 41 years; median 40 years. The number of veneers placed on mandibular teeth each year increased over the subsequent years. ConclusionsThe longevity of ultrathin veneers after 9 years of observation was not related to the ceramic used or to the presence of a composite resin restoration. Veneers were more commonly placed in middle-aged women and in mandibular anterior teeth.

The Association between Gestational Age and Risk for Long Term Ophthalmic Morbidities among Offspring Delivered in Different Preterm Subgroups.

Objective: To investigate whether there is a linear association between the degree of prematurity and the risk for long-term ophthalmic morbidity among preterm infants. Study design: A population-based, retrospective cohort study, which included all singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. All infants were divided into four groups according to gestational age categories: extremely preterm births, very preterm births, moderate to late preterm births and term deliveries (reference group). Hospitalizations of offspring up to 18 years of age involving ophthalmic morbidity were evaluated. Survival curves compared cumulative hospitalizations and regression models controlled for confounding variables. Results: During the study period, 243,363 deliveries met the inclusion criteria. Ophthalmic-related hospitalization rates were lower among children born at term (0.9%) as compared with extremely preterm (3.6%), very preterm (2%), and moderate to late preterm (1.4%) born offspring (p < 0.01; using the chi-square test for trends). The survival curve demonstrated significantly different hospitalization rates between the gestational ages (p < 0.001). The regression demonstrated an independent risk for ophthalmic morbidity among extremely preterm born offspring (adjusted hazard ratio 3.8, confidence interval 1.6–9.2, p < 0.01), as well as very preterm and moderate to late preterm (adjusted hazard ratio 2.2 and 1.5, respectively) as compared with term deliveries. Conclusions: The risk for long-term ophthalmic-related hospitalization of preterm offspring gradually decreases as the gestational age increases.

Identification of cannabinoids in post-mortem blood samples from the province of New Brunswick before and after recreational cannabis legalization.

Since recreational legalization of cannabis in Canada in 2018, self-reported use in New Brunswick (NB) has increased from 15.1% to 20.3%, the largest increase of any province. Current literature on the impact of recreational cannabis legislation in other jurisdictions is conflicting, though retail availability has often been delayed on enactment. Given the immediate availability of cannabis in NB after legalization, we sought to establish the effect this had on post-mortem cannabinoid detection. Furthermore, we wanted to investigate the impact that age, sex, and manner of death had on cannabis use. We also established if there were any increases in commonly detected drugs over the study period. A retrospective chart review was conducted on all adult Coroner's cases with toxicology analysis in NB between January 2014 and May 2020 (n=3060). Differences in the proportion of cannabinoid-positive samples pre- versus post-legalization in the overall cohort as well as within each demographic parameter were assessed using chi-square tests. The effects of demographic parameters on cannabis presence were further assessed by logistic regression. Lastly, chi-square tests for trend were performed to identify increasing trends in cannabis detection, as well as cocaine, ethanol, opiates/opioids, benzodiazepines, and amphetamines over the study period. After controlling for age, sex, and manner of death, participants that died after recreational legalization had higher odds of having cannabis present post-mortem than those that died pre-legalization. In addition, demographic sub-analysis identified a greater proportion of cannabinoid-positive samples post-legalization in 25- to 44-year-olds and in deaths classified as either suicide or accidental compared to pre-legalization. We also observed a significant increase in the presence of cocaine and amphetamines in post-mortem samples over the study period. This study demonstrates that cannabis use has increased post-legalization in NB, particularly within young adults and those dying by suicide or accidental means. It also highlights the need for future research into the impact that legalization has on cannabis use in other jurisdictions.

Experiencia, actitudes y percepciones hacia la investigación científica en estudiantes de Medicina en el contexto de una estrategia curricular de formación de competencias para investigación

IntroductionThe strategies to generate scientific competencies in physicians can be curricular or extracurricular, compulsory or elective. The objective was to describe the trend of attitudes towards research, motivations and perceived barriers to research, and research experiences among medical students in the context of a compulsory strategy curriculum based. MethodsWe conducted a cross-sectional study using an online survey. The strategy has two components; "research-oriented teaching" and "research-based teaching", which are implemented in all the years of the undergraduate degree. The attitudes towards research (17 items), motivations (7 items) and perceived barriers (11 items) to research were measured on a Likert scale, while the experience was measured with the number of research projects and the participation in research activities measured dichotomously. We evaluated the proportions trend over the years of study with a Chi-square test for trend and the number of research projects with a Kruskal-Wallis test. ResultsWe enrolled 311 students, there was an increase in the number of research projects according to year of study (H = 152.4; p < 0.001). The proportion of authorship of original articles increased from 6.0% in the fourth year to 36.4% in the sixth year (p = 0.001). The percentage agreeing with "the teaching of research methodology should be part of the curriculum" increased from 69.0% in the first year to 100.0% in the sixth (p < 0.01). ConclusionOur mandatory curricular generated positives changes in participation in research projects and their related activities, mainly in the formulation of research protocols, as well as in the performed and publication of their research results.