Chi-square Test For Trend Research Articles

P0836 Real-world application of the Crohn’s disease clinical decision support tool (CDST) in both intravenous and subcutaneous vedolizumab

Abstract Background The clinical decision support tool (CDST) was developed from GEMINI II to help inform patient selection for intravenous (IV) vedolizumab (VDZ) in Crohn’s disease (CD). The tool’s applicability in the subcutaneous (SC) formulation of VDZ was tested post-hoc in VISIBLE-2 and also appears valid. Our aim was to examine its predictive performance in a real-world cohort of patients treated with either IV or SC VDZ. Methods We retrospectively collected data on all CD patients commenced on VDZ from January 2015 to October 2023 in two tertiary IBD centres. Baseline data was retrieved to calculate the CDST: prior exposure to tumour necrosis factor (TNF) antagonists, prior surgery for CD, prior fistulating disease, baseline albumin and C reactive protein (CRP). All patients with a minimum of 12 months follow up were included. Patients were categorised into the SC group if they switched to SC within 6 months of commencing VDZ. Our primary outcome was treatment persistence at 12 months. In addition, we looked at clinical, biochemical and endoscopic outcomes at 12 months, requirement for dose escalation and progression to CD-related surgery. Kaplan Meier analysis with logrank test for trend was used for treatment persistence. Categorial outcomes and continuous variables were compared using the chi square test for trend and ANOVA respectively. Results 408 patients were included, 278 (68%) received IV VDZ and 130 (32%) SC. 336 (82%) had prior exposure to TNF antagonists, 107 (26%) had fistulating disease, 191 (47%) had prior resectional surgery for CD. The CDST stratified patients into 3 groups by probability of treatment response: low (n=35, 9%), intermediate (n=152, 37%) and high (n=221, 54%). The low and intermediate groups were combined in the analysis of treatment persistence due to lower numbers in the former. In both IV and SC cohorts, CDST was able to predict greater treatment persistence in the high probability group versus the low/intermediate group. The high probability cohort was also statistically more likely to achieve mucosal healing (p<0.0001) and surgery-free survival (p<0.0001) at 12 months. Conclusion This is to our knowledge the first application of CDST to a real-world cohort of CD patients receiving either IV and/or SC VDZ. Our data demonstrates that the tool has predictive ability for long term treatment persistence regardless of the method of administration, as well as outcomes at 12 months. Our study supports a role for CDST in guiding treatment selection in clinical practice.

P1064 Association of subcutaneous infliximab CT-P13 serum levels and therapeutic outcomes in patients affected by Inflammatory Bowel Disease: A retrospective international multicentric study

Abstract Background The association between therapeutic outcomes and serum levels associated with the use of subcutaneous (SC) IFX CT-P13 in patients with inflammatory bowel disease [IBD] has been poorly studied. We aimed to define SC-IFX thresholds associated with therapeutic outcomes. Methods Patients receiving SC-IFX who had at least one therapeutic drug monitoring [TDM] were enrolled. Therapeutic outcomes were assessed as follows: clinical remission [HBI <5, SCCAI ≤2]; fecal calprotectin [FCAL] remission [<250 mg/g]; C-reactive protein [CRP] remission [CRP <5 mg/L]; deep remission [clinical + biomarker remission]. Chi-squared test for trend was used to analyze serum levels quartile data. Results 177 patients [54% male; 67% Crohn’s disease; Weight ≥ 80 kg 51%; 7% active smoker; 39% on immunosuppressants [IMM]; 9% on steroids; 26% with previous biologic exposure] from 4 centres had a total of 263 TDM measurements. Of these, were available 242 concurrent clinical measurement, 244 CRP and 152 FCAL.Median duration of SC treatment at time of TDM was 24 months (4-135). Proportion of patients achieving outcomes is described in table 1. The median IFX serum level was significantly higher in patients with clinical remission as well as in those with clinical and CRP remission (Figure 1), compared with patients who did not reach these targets. Conversely, there was no significant difference for the FCAL, clinical and FCAL, clinical and CRP and FCAL outcomes. In univariate analysis of factors associated with clinical remission (p<0.1) were sex, concomitant IMM, concomitant steroids, and previous biologic exposure and were included in a multivariate analysis in which only concomitant IMM showed remained significant [OR 0,1796 CI 95% 0,028-0,633]. Quartile analysis showed better outcome on higher drug levels for clinical remission, but not for other outcomes. Based on the ROC analysis and the Youden index, the cut-off levels for the therapeutic outcomes were respectively: clinical remission 12.85 mg/ml [sensitivity 0.85, specificity 0.5]; FCAL remission 11.8 mg/ml [sensitivity 0.82, specificity 0.32]; clinical and CRP remission 14.55 mg/ml [sensitivity 0.77, specificity 0.44]; clinical and FCAL remission 12.05 mg/ml [sensitivity 0.85, specificity 0.35]; clinical, CRP and FCAL remission12.05 mg/ml [sensitivity 0.85, specificity 0.33]. Conclusion An association between drug levels and clinical outcomes was identified in patients with IBD treated with SC IFX. Clinical remission was associated with a level of 12.8 mg/ml but the association between higher drug levels and deeper remission that has been described previously was not seen. References Roblin X, Nancey S, Papamichael K, et al. Higher Serum Infliximab Concentrations Following Subcutaneous Dosing are Associated with Deep Remission in Patients with Inflammatory Bowel Disease. J Crohns Colitis. 2024;18(5):679-685. doi:10.1093/ecco-jcc/jjad188 Iborra M, Caballol B, Garrido A, et al. Subcutaneous infliximab cut-off points in patients with inflammatory bowel disease. Data from the ENEIDA registry. J Crohns Colitis. Published online August 22, 2024. doi:10.1093/ecco-jcc/jjae127

Adolescents with Persistent Symptoms Following Acute SARS-CoV-2 Infection (Long-COVID): Symptom Profile, Clustering and Follow-Up Symptom Evaluation.

Few studies have evaluated long-COVID in adolescents. Cohort study. Demographics, clinical data, and the presence of 30 symptoms were collected with a modified WHO form. Mean values were compared by Student's t test and proportions by the chi-square test or Fisher test, with trends over time analysed using the chi-square test for trend. Potential risk factors independently associated with persisting symptoms were evaluated in a multivariable logistic regression model. Clustering of cases was analysed by two-step automatic clustering. A total of 97 adolescents aged 12-17 (54.6% females, 45.4% males) were evaluated. After a mean interval of 96 days (SD 52) from acute infection, the mean number of symptoms (2.8 overall) was higher for pre-Omicron (3.2 vs. 2.5 in Omicron, p = 0.046) and moderate/severe acute infections (4.2 vs. 2.7 in mild, p = 0.023). Fatigue (62.9%) and dyspnea (43.3%) were the most common symptoms, followed by headache (28.9%), thoracic pain (22.7%), diarrhea (20.6%), palpitations/tachycardia (17.5%), articular pain (15.5%), difficult concentration (14.4%), muscle pain (12.4%), taste reduction (8.2%), smell reduction (8.2%), fever (6.2%), and skin disorders (5.2%). The symptom profile was similar in males and females but showed significant differences from that observed in concurrently followed adults. After a mean interval of 340 days from infection, 45.3% still presented symptoms, with persistence associated with higher number of initial symptoms. Two clusters were defined that differed in the phase of acute infection and the number and profile of symptoms. Long-COVID manifestations in adolescents may differ from those observed in adults. Polisymptomaticity may predict long-term persistence.

Pregnancy complications associated with maternal near-miss in an undeveloped province in south-central China, 2012–2022

ObjectiveTo explore the relationship between pregnancy complications and maternal near-miss (MNM).MethodsData were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012–2022. The MNM ratio refers to the number of MNM per 1000 live births, and maternal mortality refers to the number of maternal deaths per 100,000 live births. Chi-square trend tests (χ2trend) were used to determine trends in proportions by year. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.ResultsOur study included 780,359 women with 731,185 live births, a total of 2461 MNMs, and 52 maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23–3.50), and the maternal mortality was 7.11 per 100,000 live births (95%CI: 5.18–9.04). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). From 2012 to 2022, the proportion of coagulation/hematological dysfunction among MNM increased from 49.14% in 2012 to 86.39% in 2022, which was the only cause of MNM that showed an increased trend (χ2trend = 7.43, P = 0.01). Results of multivariate logistic regression analysis showed that 10 pregnancy complications were risk factors for MNM: hemorrhage disorder (aOR = 21.50, 95%CI: 19.64–23.54), infections (aOR = 1.91, 95%CI: 1.64–2.22), hypertension (aOR = 4.50, 95%CI: 4.08–4.98), heart disease (aOR = 14.96, 95%CI: 11.51–19.44), embolic disease (aOR = 171.70, 95%CI: 94.08-313.36), liver disease (aOR = 1.54, 95%CI: 1.25–1.90), anaemia (aOR = 4.72, 95%CI: 4.29–5.19), renal disease (aOR = 5.44, 95%CI: 4.00-7.40), pulmonary disease (aOR = 14.85, 95%CI: 8.33–26.50), and connective tissue disease (aOR = 5.15, 95%CI: 3.06–8.66).ConclusionThe MNM ratio was relatively low in Hunan Province. Several pregnancy complications increased the risk of MNM. It is helpful for clinical counseling and public health policies, which may contribute to preventing MNM.

Comparison of Hematological Parameters and the Associated Factors Among Women with and without Breast Cancer: A Case-Control Study.

Breast cancer (BC) is the most popular and dangerous cancer, with a high mortality rate. Hematological parameters are often used in routine diagnosis of numerous disorders. Therefore, the study aimed to evaluate hematological parameters amongst women with and without BC. Briefly, 200 blood samples (100 cases and 100 controls) were collected at Life Center of Breast Cancer Control, Ibb City, Yemen. The whole blood samples were tested immediately for complete blood count (CBC) parameters. Socio-demographic and reproductive characteristics were collected by using a standardized questionnaire. Kolmogorov-Smirnov test, Unpaired t-test, Mann-Whitney test, Fisher's exact test and chi-square test for trends were calculated using GraphPad Prism 8.0.1. P-values ≤0.05 were statistically significant. The mean and standard deviation (SD) revealed significant differences between BC group and the healthy control group attributed to the variables of age (P<0.0001), weight (P<0.0001), residence (P=0.0218), employment state (P<0.0001), economic state (P=0.0003), education levels (P<0.0001), regular exercise (P<0.0001) and a strict diet (P<0.0008). Marital state, marital age, number of births, and use of contraceptives demonstrated statistical significance (P<0.0001, P=0.0008, P=0.0009, and P<0.0001, respectively). Additionally, Hb, RBCs, WBCs count, neutrophils, lymphocytes and monocytes displayed significant differences (P=0.0393, P=0.0045, P=0.0327, P=0.0441, P=0.0098 and P<0.0001, respectively). Hb, RBCs, WBCs, neutrophils, lymphocytes, monocytes and other parameters scored high points of evidence for BC surveillance. Further studies are required to evaluate hematological parameter differences and biochemical parameters after or during chemotherapy or mastectomy.

Change in mental health service utilization from pre- to post-COVID-19 period in the United States

ObjectivesThis study aimed to explore the change in mental health service utilization before and after the COVID-19 pandemic as well as determine the association of various sociodemographic characteristics and comorbidities on the utilization pattern. MethodsData from the National Health Interview Survey (NHIS) 2019 and 2022 were explored in this study. Along with the univariate analysis, bivariate analysis was conducted using the Chi-square and Cochran-Armitage trend tests. Stepwise binary logistic regression was implemented to find the best-fitted model and examine the effects of different factors on mental healthcare utilization. We also conducted a subgroup analysis for the variables that showed heterogeneous changes in utilization from 2019 to 2022. ResultsAnalysis of a total of 53,856 complete cases showed that the percentage of mental healthcare utilization changed from 20% in 2019 to 23.31% in 2022. Logistic regression results showed that the odds of mental health service utilization in the post-COVID period is 1.41 times of the pre-COVID [95% CI odds ratio (OR) = (1.26, 1.58)]. Sex, age, race, education, income group, insurance coverage, birth country, marital status, limitations of social functioning, having a place for healthcare, symptoms and history of depression/anxiety, diabetes, and hypertension had significant effects on the odds of receiving mental healthcare. Subgroup analysis revealed that the utilization changed significantly from 2019 to 2022 for age group “18–34” [OR = 1.41, 95% CI = (1.26, 1.58)], “35–49” [OR = 1.35, 95% CI = (1.21, 1.50)], and “50–64” [OR = 1.12, 95% CI = (1.01, 1.24)], while for the age group “above 64” was not significant. ConclusionPre- and post-COVID periods were found to be significantly different in terms of the utilization of mental healthcare utilization. Changes in the utilization was also found to differ in terms of different age groups.

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.

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&amp;lt;0.001). The proportion of deaths due to haemorrhagic stroke and aortic aneurysm/dissection increased progressively with time to death increasing (P&amp;lt;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.

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.