Confidence Interval For Odds Ratio Research Articles

Persistent cat ownership and asthma in a longitudinal study of Puerto Rican youth

BackgroundEpidemiologic studies have reported conflicting findings for cat or dog exposure and childhood asthma. No study has evaluated whether persistent pet exposure from early life to school age is associated with asthma or allergic sensitization in youth. ObjectiveTo evaluate whether persistent ownership of a cat or a dog throughout childhood is associated with asthma in Puerto Rican youth, a group disproportionately affected with asthma. MethodsProspective study of 384 youth who completed a baseline visit at ages 6 to 14 years and a second visit at ages 9 to 20 years. Persistent cat or dog ownership was defined as ownership of a cat or a dog in early life (during pregnancy or the first year of life) at either study visit (at school age). An allergen-specific IgE result was considered positive if more than or equal to 0.35 IU/mL. Logistic regression was used for the multivariable analysis of asthma and allergic sensitization. ResultsIn an analysis adjusting for household income, family history of atopy, persistent overweight or obesity, a persistent unhealthy diet, the time interval between study visits, and other covariates, persistent cat ownership was significantly associated with 68% reduced odds of asthma (95% CI for odds ratio = 0.11-0.92) but not with any allergic sensitization or sensitization to cat allergen. In contrast, persistent dog ownership was not significantly associated with asthma or allergic sensitization. ConclusionAmong school-aged Puerto Rican youth followed for an average of 5 years, persistent cat ownership from early life to school age was inversely associated with asthma.

Confidence intervals for odds ratio from multistage randomized phase II trials.

A multi-stage randomized trial design can significantly improve efficiency by allowing early termination of the trial when the experimental arm exhibits either low or high efficacy compared to the control arm during the study. However, proper inference methods are necessary because the underlying distribution of the target statistic changes due to the multi-stage structure. This article focuses on multi-stage randomized phase II trials with a dichotomous outcome, such as treatment response, and proposes exact conditional confidence intervals for the odds ratio. The usual single-stage confidence intervals are invalid when used in multi-stage trials. To address this issue, we propose a linear ordering of all possible outcomes. This ordering is conditioned on the total number of responders in each stage and utilizes the exact conditional distribution function of the outcomes. This approach enables the estimation of an exact confidence interval accounting for the multi-stage designs.

Depression and its associated factors among health care workers in Saint Paul's hospital millennium medical college, Ethiopia.

Depression is a common mental disorder that affects 3.8% of the general population and 24% of healthcare workers globally. Healthcare professionals are more susceptible to depression because they face higher amounts of professional stress in their jobs and academic lives. However, there is limited knowledge regarding health professionals' level of depression in Ethiopia. This study aimed to assess the prevalence of depression and associated factors among health professionals, at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. We conducted an institution-based cross-sectional study among 439 randomly selected healthcare workers using interviewer-administered patient health questionnaire-9 from April to May 2023. Ordinal logistic regression was performed to identify predictors of depression. Reported p-values < 0.05 or a 95% Confidence Interval of Odds Ratio excluding one was considered statistically significant. The overall prevalence of depression among healthcare workers was 21.9% (95%CI: 18%, 27.76%). There were reports of mild (35%), moderate (13%) and severe (9%) depression, respectively. Marital status of being single (AOR = 7.78, 95%CI: 1.123, 49.01), history of childhood abuse (AOR = 2.57, 95%CI:1.49, 4.42), history of suicidal attempt (AOR = 2.66, 95%CI:1.25,5.67), having a history of stressful life event (AOR = 1.527, 95%CI: 1.02,2.3), back pain over the past 30 days (AOR = 2, 95%CI: 1.30,3.11), working for more than 8 hours (AOR = 3.03, 95%CI: 1.12,8.24), and having experience of 5-10 year (AOR = 4, 95%CI: 1.05,15.27) and 10-15 years (AOR = 4.24, 95%CI: 1.08,16.58) and poor social support (AOR = 2.09, 95%CI: 1.09,3.99) were statistically associated with increased level of depression. Healthcare professionals' higher rate of depression was due to the higher workload, childhood abuse, history of stressful life, back pain, and poor social support. Thus, the hospital should give special attention to early screening and treatment for depression for those healthcare workers who have a high workload, childhood abuse, back pain, a history of stressful life and poor social support. Similarly, the Ministry of Health should also design strategies to screen, detect and treat depression among healthcare workers.

Prediction of Mild Cognitive Impairment using eye movements and other easily accessible measures

AbstractBackgroundThe early identification of patients at risk of dementia and timely medical intervention can be effective in preventing disease progression and mitigate burdens and costs of health insurance. Although the current diagnostic tests for preclinical and prodromal Alzheimer’s disease (AD) using neuropsychological evaluation and biomarkers can accurately predict the progression to AD dementia, the high cost, invasive nature, and limited availability restrict their use to wealthy clinics only. Therefore, we developed a model to predict cognitive impairment based on non‐invasive information, including eye movement (EM) data.MethodEye‐tracking data was extracted from 594 subjects, 428 cognitively normal (CN) controls, and 166 patients with mild cognitive impairment (MCI) while they performed Prosaccade/Antisaccade (PS/AS) and Go/No‐go tasks. EM behavior was compared by task after stratification by cognitive status and controlling for age, sex, and education. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) from the EM metrics.ResultLogistic regression models suggested increased OR of MCI from EM metrics, including wider latency variability, fixation duration variability, a higher number of errors committed, anticipations, and omissions with 95% CI of OR between 1.213‐1.621.ConclusionEM metric changes linked with MCI are associated with deficits in attentional and executive functions. The models built from non‐invasive data allow the discrimination of patients with MCI from cognitively normal adults. In summary, our results suggest that eye tracking, in combination with demographics and brief cognitive tests, might significantly improve the diagnostic prediction of MCI.

Association between radiographic soft-tissue thickness and increased length of stay, operative time, and infection rate after reverse shoulder arthroplasty

Reverse shoulder arthroplasty (RSA) is a widely performed surgical procedure to address various shoulder pathologies. Several studies have suggested that radiographic soft-tissue thickness may play a role in predicting complications after orthopedic surgery, but there have been limited studies determining the use of radiographic soft-tissue thickness in RSA. The purpose of this study was to evaluate whether radiographic soft-tissue thickness could predict clinical outcomes after RSA and compare the predictive capabilities against body mass index (BMI). We hypothesized that increased radiographic shoulder soft-tissue thickness would be a strong predictor of operative time, length of stay (LOS), and infection in elective RSA. A retrospective review of patients undergoing RSA at an academic institution was conducted. Preoperative radiographic images were evaluated including measurements of the radius from the humeral head center to the skin (HS), deltoid radius-to-humeral head radius ratio (DHR), deltoid size, and subcutaneous tissue size. Different correlation coefficients were used to analyze various types of relationships, and the strength of these associations was classified based on predefined boundaries. Subsequently, multivariable linear and logistic regressions were performed to determine whether HS, DHR, deltoid size, and subcutaneous tissue size could predict LOS, operative time, or infection while controlling for patient factors. HS was the most influential factor in predicting both operative time and LOS after RSA, with strong associations indicated by standardized β coefficients of 0.234 for operative time and 0.432 for LOS. Subcutaneous tissue size, deltoid size, and DHR also showed stronger predictive values than BMI for both outcomes. In terms of prosthetic joint infection, HS, deltoid size, and DHR were significant predictors, with HS demonstrating the highest predictive power (Nagelkerke R2 = 0.44), whereas BMI did not show a statistically significant association with infection. Low event counts resulted in wide confidence intervals for odds ratios in the infection analysis. Greater shoulder soft-tissue thickness as measured with concentric circles on radiographs is a strong predictor of operative time, LOS, and postoperative infection in elective primary RSA patients.

Early and late urinary continence outcomes after unilateral and bilateral nerve-sparing robot-assisted radical prostatectomy: A retrospective multicentre cohort study in Japan (the MSUG94 group).

The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established. We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method. The pad-free rates at 12months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12months of surgery did not significantly differ between the unilateral and bilateral NS groups. NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP.

Effect of Diabetes type-II on Eye disease and its risk factors; A Logit Model Analysis

To know the effect of Diabetes type-II on Eye disease and its risk factors in a tertiary eye care hospital in Karachi. This was a cross-sectional study with retrospective data collection. The data was retrieved from January to June 2019 from the Hospital Information Management System (HIMS) software of the Institute. Non-probability purposive sampling method was used to collect data. Inclusion criteria were all the diabetics type-II patients came for routine check-ups at Diabetes Eye Department irrespective of age, gender and duration of diabetes. Statistical analysis was done using STATA version 13.0 software for windows. A total of 6090 cases were analyzed. Mean age of the participants was 51.01±10.8 years. There were 2954 (48.5%) male and 3136 (51.5%) female observed in this study. Table 1 shows the results of the binary logistic regression analysis with coefficients and their standard errors (S.E.), Wald test values, p values, odd ratios, and 95% confidence intervals for odds ratios. When all explanatory variables treat as continuous variables, we found that all variables which include age, height, random blood sugar (RBS) and duration of diabetes was statistically significant at the significance level 0.05 except weight and fasting blood sugar (FBS) for individual regression slope coefficients. This study reveals findings through binary logistics regression analysis. It indicates that there is an association found in the patients of eye disease with age, height, weight, RBS, FBS. This stated that there were some risk factors observed in these variables related to eye disease. Those who have the disease have risk factor to developed the others associated disease.

Demographic, health, and prognostic characteristics of Australians with liver cancer: a cohort study of linked data in New South Wales for informing cancer control

BackgroundAustralian age-standardized incidence and death rates for liver cancer are lower than world averages, but increasing as in other economically advanced western countries. World Health Organization emphasizes the need to address sociodemographic disparities in cancer risk. A more detailed sociodemographic risk profiling was undertaken for liver cancer in New South Wales (NSW) by diagnostic stage, than possible with NSW Cancer Registry (NSWCR) alone, by incorporating linked data from the Australian Bureau of Statistics (ABS). The purpose was to inform targeting and monitoring of cancer services.MethodsThe ABS manages the Multi-Agency Data Integration Project (MADIP) which includes a wide range of health, educational, welfare, census, and employment data. These data were linked at person level to NSWCR liver cancer registrations for the period post 2016 census to December 2018. De-identified data were analyzed. Sex-specific age-adjusted odds ratios (95%CIs) of liver cancer were derived using logistic regression by age, country of birth, residential remoteness, proficiency in spoken English, household income, employment status, occupation type, educational attainment, sole person household, joblessness, socioeconomic status, disability status, multimorbidity, and other health-related factors, including GP consultations. These data complement the less detailed sociodemographic data available from the NSWCR, with alignment of numerators and population denominators for accurate risk assessment.ResultsResults indicate liver cancer disproportionately affects population members already experiencing excess social and health disadvantage. Examples where 95% confidence intervals of odds ratios of liver cancer were elevated included having poor English-speaking proficiency, limited education, housing authority tenancy, living in sole-person households, having disabilities, multiple medicated conditions, and being carers of people with a disability. Also, odds of liver cancer were higher in more remote regions outside major cities, and in males, with higher odds of more advanced cancer stages (degrees of spread) at diagnosis in more remote regions.ConclusionsLinked data enabled more detailed risk profiling than previously possible. This will support the targeting of cancer services and benchmarking.

The magnitude and associated factors of immediate postpartum anemia among women who gave birth in east Gojjam zone hospitals, northwest- Ethiopia, 2020.

Globally around half a million maternal death occurred annually related to labor and delivery of which twenty percent is contributed by post-partum anemia. Postpartum anemia contributes about two percent of total maternal mortality in Ethiopia. Immediate postpartum anemia is a common public health problem in most parts of the globe, being frequent in low and middle-income countries including in the developed world. The previous studies cut off point for immediate postpartum Anemia is 11mg/dl which is the cutoff point of anemia after one week of postpartum, environmental factors like barefoot were not addressed in the previous studies and the previous studies were conducted in a single facility This study aimed to assess the magnitude and associated factors of immediate post-partum anemia among women who gave birth in East Gojjam zone hospitals, Northwest Ethiopia. Institutional based cross-sectional study was conducted from October 20-November 20 2020 on immediate post-partum anemia. During the study 467 study participants were included by using systematic random sampling method Data were collected using a structured interviewer-administered questionnaire and a blood sample was used for hemoglobin determination. Data were checked, coded, and entered into Epi-Data Version 4.2 and then exported to SPSS version 25 for analysis. Binary logistic regressions were done to identify predictors of immediate post-partum anemia and a 95% confidence interval of odds ratio at a p-value less than was taken as a significance level. The overall magnitude of immediate postpartum anemia among mothers who gave birth in East Gojjam Zone Hospitals were found to be 21.63% (95% CI:18.12%, 25.11%), not having antenatal care follow-up (Adjusted Odds Ratio (AOR) = 2.92;95% CI:1.20,7.06), assisted instrumental delivery (AOR = 2.72; 95% CI:1.08,6.78),mid-upper arm circumferences less than 23cm (AOR = 5.75;95% CI:3.38, 9.79), antepartum hemorrhage (AOR = 4.51; 95% CI:2.42, 8.37), never wearing shoes (AOR = 2.60; 95% CI:1.10, 6.14) were found to be significantly associated with immediate postpartum anemia. This study indicates that immediate postpartum anemia is a moderate public health problem in the study area. A more careful strategy is ideal to increase antenatal care follow-up that sticks to national guideline contact schedule, safe reduction of instrumental and cesarean deliveries to the minimum, quick and timely linkage and treatment of malnourished pregnant mothers to the center where they get adequate health care services, along with a high index of suspicion in mothers diagnosed with antepartum hemorrhage, wise and vigilant advice on consistent use of the shoe for pregnant mothers are recommended to tackle the burden of immediate post-partum anemia.

Increasing serum iron levels and their role in the risk of infectious diseases: a Mendelian randomization approach.

Increased iron stores have been associated with elevated risks of different infectious diseases, suggesting that iron supplementation may increase the risk of infections. However, these associations may be biased by confounding or reverse causation. This is important, since up to 19% of the population takes iron supplementation. We used Mendelian randomization (MR) to bypass these biases and estimate the causal effect of iron on infections. As instrumental variables, we used genetic variants associated with iron biomarkers in two genome-wide association studies (GWASs) of European ancestry participants. For outcomes, we used GWAS results from the UK Biobank, FinnGen, the COVID-19 Host Genetics Initiative or 23andMe, for seven infection phenotypes: 'any infections', combined, COVID-19 hospitalization, candidiasis, pneumonia, sepsis, skin and soft tissue infection (SSTI) and urinary tract infection (UTI). Most of our analyses showed increasing iron (measured by its biomarkers) was associated with only modest changes in the odds of infectious outcomes, with all 95% odds ratios confidence intervals within the 0.88 to 1.26 range. However, for the three predominantly bacterial infections (sepsis, SSTI, UTI), at least one analysis showed a nominally elevated risk with increased iron stores (P <0.05). Using MR, we did not observe an increase in risk of most infectious diseases with increases in iron stores. However for bacterial infections, higher iron stores may increase odds of infections. Hence, using genetic variation in iron pathways as a proxy for iron supplementation, iron supplements are likely safe on a population level, but we should continue the current practice of conservative iron supplementation during bacterial infections or in those at high risk of developing them.

Psychological distress in adolescents: prevalence and its relation to high-risk behaviors among secondary school students in Mbarara Municipality, Uganda

BackgroundPsychological distress among adolescents negatively affects their academic performance, relationships with family and friends, and ability to participate fully in the community. Stressful life events in low-income countries and risk-taking behavior of adolescents have raised concerns regarding the impact of psychological distress among adolescents. Therefore, the present study estimated the prevalence of psychological distress and examined the high-risk behaviors associated with psychological distress among Ugandan adolescents.MethodsA community based cross-sectional study was conducted among secondary school students in Mbarara Municipality, Uganda. Multistage cluster sampling was used to recruit 921 adolescents from 12 schools. Psychological distress was assessed using the 10-item Kessler Psychological Distress Scale (K10). Logistic regression was used with p-value estimating regression coefficient and 95% confidence interval for odds ratio and adjusted odds ratio (AOR).ResultsThe prevalence of psychological distress using the K10 was 57%. Logistic regression analyses showed that risky sexual behavior [AOR = 1.52; 95% confidence interval (CI) 1.02–2.28], substance use (AOR = 2.06; 95% CI 1.49–2.84) were associated with psychological distress. Students in mixed schools (comprising both sexes) (AOR = 1.94; 95% CI 1.19–3.15) and adolescents with chronic illness (AOR = 1.68; 95% CI 1.18–2.38) were more likely to report psychological distress.ConclusionThe prevalence of psychological distress among school-going adolescents is high. Risky sexual behavior, substance use as well as chronic illness were associated with psychological distress. In addition, the type of school was significantly associated with psychological distress. The findings suggest the need for policy makers and stakeholders in health and education sectors to institute measures that will address mental health issues among adolescents.

Pattern and outcome of acute organophosphate poisoning at health facilities of Harari Region, Eastern Ethiopia

Introduction: Pesticides are frequently used by plant cultivars to control pests that could affect yield. Although many local farmers in Eastern Ethiopia use organophosphate insecticides extensively for the production of khat, the pattern and treatment outcome of acute poisoning of these organophosphates has been poorly quantified and reported in this region. Materials and Method: A cross-sectional study design was employed at two public hospitals found in Harari region, Ethiopia. The data were collected through face-to-face interviews and card review, then analyzed with SPSS version 20. Pearson’s Chi-square test was used to compare independent variables with the treatment outcome. Statistical significance is defined at 95% confidence interval of odds ratio not including 1 or p &lt; 0.05. Results: A total of 135 cases of organophosphate were admitted in the emergency departments of the hospitals during the study period. 42.2% of participants were adolescents (age: 11–20 years) while the mean age of all participants was 18.8 ± 12.9 years with a range of 1–61 years. 73.7% of the study participants were rural residents. The result showed that 47.4% of the cases were exposed to the poison accidentally. Family disharmony was the common reason among cases poisoned intentionally. The mean time elapsed between poisoning and reaching the health facility was 3.1 h. Atropine was administered for 47% of the cases. About 11% of cases expired following the poison. The home remedy given, lag time, and residency were found to be factors significantly related to poor treatment outcomes. Conclusion: Easy availability, low cost, and excessive popularity of organophosphate use as pesticides in Eastern Ethiopia have increased the incidence of ingestion, resulting in increasing intentional and unintentional poisoning. In the present study, accidental exposure accounts for 47.4%.

Assess the overall postoperative morbidity among patients with brain tumors by using preoperative functional magnetic resonance imaging

Background and aim: the aim of present study was Assessing the Overall Postoperative morbidity among patients with brain tumors by using preoperative functional Magnetic Resonance Imaging. Method: Databases of PubMed, Scopus, Web of Science, EBSCO, ISI Web of knowledge and Embase were searched for systematic literature between 2012 to July 2022. 95% confidence interval for odds ratio with fixed effect model and Mantel–Haenszel method and were calculated. To deal with potential heterogeneity, random effects were used and I2 showed heterogeneity. Meta-analysis was performed using Stata/MP v.17 software. Result: In the initial review, duplicate studies were eliminated and abstracts of 178 studies were reviewed, the full text of 32 studies was reviewed by two authors, finally, six studies were selected. Odds ratio of Unfavorable outcomes between functional MRI and control group was 0.46 (OR, 95% CI 0.15, 0.76; p&lt;0.001). Odds ratio of Gross total resection between functional MRI and control group was 0.20 (OR, 95% CI -0.20, 0.59; p=0.34). Conclusion: According to the findings of the present study, the use of functional MRI before brain tumor removal is associated with a reduction in the risk of delayed or permanent neurological deficits after surgery with a two-month follow-up period.

Assess the overall postoperative morbidity among patients with brain tumors by using preoperative functional magnetic resonance imaging

Background and aim: the aim of present study was Assessing the Overall Postoperative morbidity among patients with brain tumors by using preoperative functional Magnetic Resonance Imaging. Method: Databases of PubMed, Scopus, Web of Science, EBSCO, ISI Web of knowledge and Embase were searched for systematic literature between 2012 to July 2022. 95% confidence interval for odds ratio with fixed effect model and Mantel–Haenszel method and were calculated. To deal with potential heterogeneity, random effects were used and I2 showed heterogeneity. Meta-analysis was performed using Stata/MP v.17 software. Result: In the initial review, duplicate studies were eliminated and abstracts of 178 studies were reviewed, the full text of 32 studies was reviewed by two authors, finally, six studies were selected. Odds ratio of Unfavorable outcomes between functional MRI and control group was 0.46 (OR, 95% CI 0.15, 0.76; p&lt;0.001). Odds ratio of Gross total resection between functional MRI and control group was 0.20 (OR, 95% CI -0.20, 0.59; p=0.34). Conclusion: According to the findings of the present study, the use of functional MRI before brain tumor removal is associated with a reduction in the risk of delayed or permanent neurological deficits after surgery with a two-month follow-up period.

S1140 Gender and ERCP Complications: A Nationwide Inpatient Sample Database Analysis

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) can involve a variety of complications including pancreatitis, hemorrhage, and cholangitis. Some studies have identified female gender as a risk factor for post-ERCP pancreatitis, cholangitis, and overall complications, however other studies have shown contradictory results. Given these discrepancies, we evaluated gender as a risk factor for post-ERCP complications using the National Inpatient Sample database. Methods: The National Inpatient Sample (NIS) database was used to identify hospitalized patients over 18 years old who had an ERCP procedure between 2007 - 2017 using ICD-9 and ICD-10 codes. Patients were divided into two groups: males (726,352 [40.1%]) or females (1,084,048 [59.9%]), as defined by NIS as “indicator of sex”. Patients were matched by age, race, and by Elixhauser comorbidity index. Primary outcomes were rates of post-ERCP pancreatitis, cholangitis, cholecystitis, infection, hemorrhage, and perforation. Chi-squared tests were used to compare categorical data and multivariate analyses were performed to assess primary outcomes. Results: There were 1,810,400 patients hospitalized from 2007-2017 who underwent an ERCP procedure, of which 1,084,048 (59.9%) were female and 726,352 (40.1%) were male. Primary outcomes were significant for increased odds ratio of post-ERCP pancreatitis (OR 1.2, p< 0.001) and decreased odds ratio of post-ERCP cholangitis (OR 0.7, p< 0.001), cholecystitis (OR 0.4, p< 0.001), infection (OR 0.7, p< 0.001), and hemorrhage (OR 0.6, p< 0.001) in females compared to males. No significant difference was found between men and women for post-ERCP perforation. Conclusion: Although there are differences in the effects of gender on post-ERCP complications in the literature, the mechanisms causing these effects are not known. Women are known to have higher risks for biliary stones and sphincter of Oddi dysfunction which can further increase the odds of post-ERCP pancreatitis. We postulate that the decreased rates of cholangitis, cholecystitis, infection, and hemorrhage in women compared to men could be from an anatomical variation in the biliary tree that is gender specific. Therefore, endoscopists should further explore and consider this possibility when performing ERCPs. Table 1. - Clinical Outcomes in Females and Males who underwent ERCP p value Odds Ratio Confidence Interval Post-ERCP Pancreatitis < 0.001 1.2 1.1-1.3 Post-ERCP Cholangitis < 0.001 0.7 0.7-0.8 Post-ERCP Cholecystitis < 0.001 0.4 0.4-0.5 Post-ERCP Infection < 0.001 0.7 0.7-0.7 Post-ERCP Hemorrhage < 0.001 0.6 0.5-0.7 Post-ERCP Perforation 0.304 1.1 1.0-1.2

S691 Assessment of Occult Blood Testing in Acute Hospital Settings: A Multicenter GI Fellow Driven Study

Introduction: Fecal occult blood testing (FOBT) is an outpatient screening tool for colorectal cancer. It is widely misused in the hospital setting, without accounting for false positives or negatives resulting in unnecessary endoscopic procedures, increased costs and increased length of stay. The aim of our study is to understand the knowledge and current utilization of FOBT among internal medicine residents from multiple programs across the USA. Methods: This is a multicenter survey conducted by a GI fellow in about 25 Internal Medicine Residency programs in Washington-DC, Pennsylvania, New York, New Jersey, Florida, Indiana, Illinois, Georgia, and California. A 15-questionnaire survey on FOBT was emailed on May 18th, 2022, with follow-up reminders until June 3rd, 2022. We considered the end of the academic year as an ideal time to evaluate the understanding and clinical practice of internal medicine trainees. Results: A total of 227 residents responded to our survey {n=96 (42.2%) PGY-I, n=67 (29.5%) PGY-II & n=64 (28.2%) PGY-III}. Overall, 66.7% i.e., 2/3rd of residents sometimes or always ordered FOBT and 67.4% have ordered this test more often in inpatient than in outpatient settings. Approximately 60% of the residents had knowledge of dietary restrictions but only 32% of the residents were questioning the patients before ordering it. The triggers for ordering FOBT were mostly anemia (92.5%) followed by change in stool colour (61%), weight loss (60%) and bleeding per rectum (47.5%). 62% of respondents felt influenced by their supervisors but 57.2% felt that FOBT results will change their management. Overall, as postgraduate year training increased, trainees were less likely to order FOBT for suspected GI bleeding (Table). Conclusion: Our survey results showed that residents were influenced by their supervisors and ordered FOBT largely in the inpatient setting. Although there was noted improvement in understanding of the futility of FOBT in suspected acute GI bleeding, more than half of final year trainees would still order FOBT first. There is a need for better education of internal medicine trainees in the utilization of FOBT. Table 1. - Statistical analysis comparing the level of training with preference to FOBT vs. GI Consult for a suspected GI Bleed For a suspected GI Bleed, which of the following would you consider first Logistic regression analysis, comparing PGY-I with PGY-II & III Postgraduate Year GI Consult FOBT Odds Ratio Confidence Interval P-Value PGY – I 34 (35.4%) 62 (64.6%) Ref Ref Ref PGY – II 28 (41.8%) 39 (58.2%) 0.76 0.40 - 1.44 0.820 PGY – III 37 (43.6%) 27 (56.4%) 0.40 0.21 - 0.77 0.006

Home birth prevalence and associated factors in southwest Ethiopia

Background/Aim In Ethiopia, antenatal care takes a focused approach, where women are encouraged to give birth in a health facility, as there are no services that provide skilled birth attendants for home births. However, nearly half of mothers booked for antenatal care give birth at home, which is associated with a higher risk of maternal mortality and poor outcomes. This study aimed to assess the prevalence of home birth and associated factors among women in southwest Ethiopia. Methods A community-based cross-sectional study was conducted using simple random sampling. Data were collected from 1 February 2018 to 30 April 2018 from 1831 women who had given birth in the last year in selected zones of southwest Ethiopia, using a structured interviewer-administered questionnaire. The data were cleaned and exported to STATA 14 for analysis, both by bivariate and multivariate logistic regression. P≤ 0.05 at 95% confidence interval of odds ratio was taken as significant in the multivariable model. Results Approximately half (54.5%) of the participants gave birth at home. Rural residence (adjusted odds ratio=0.46, P=0.032), listening to the radio (adjusted odds ratio=0.53, P=0.047), attending 3–5 antenatal care visits (adjusted odds ratio=0.40, P=0.031), being widowed or divorced (adjusted odds ratio=2.89, P=0.045), prolonged labour (adjusted odds ratio=0.76, P=0.021) and waiting time for antenatal care services (adjusted odds ratio=1.85, P=0.042) were significantly associated with home birth. Conclusions More than half of the participants gave birth to their last child at home, and this decision was affected by residence, prolonged labour, antenatal care frequency, media, marital status, and waiting time for antenatal care services. Interventions to increase institutional birth should prioritise those who do not attend antenatal care, are not exposed to media or who are widowed or divorced. Similarly, reducing antenatal care waiting time and encouraging mothers to attend antenatal care are vital to improving rates of institutional birth in Ethiopia.

Screening of BRCA1 (c.5177_5180delGAAA rs80357867 and c.4986+6T>C rs80358086) and the BRCA2 (c.6445_6446delAT rs80359592) Genes for Breast Cancer Prevention in Burkina Faso.

The objective of this study is to search for mutations in the BRCA1 (c.5177_5180delGAAA and c.4986+6T>C) and BRCA2 genes (c.6445_6446delAT) in a population of women diagnosed with breast cancer. This is a case-control study that involved 140 participants, including 70 patients with histologically diagnosed breast cancer and 70 healthy women without breast cancer. Mutations in the BRCA1 (rs80357867, rs80358086) and BRCA2 (rs80359592) genes were tested by real-time PCR. The 95% confidence interval Odds Ratio (OR) was used to estimate the associations between specific genotypes and breast cancer. The study revealed that no mutations were detected for rs80359592. Similarly, no reference allele (TTTC/TTTC) of rs80357867 was found in this study. However, the homozygous double mutant (-/) genotype of this rs80357867 was observed in 11.43% and 1.43% of patients and controls respectively, while 88.57% of patients and 98.57% of controls had a heterozygous deletion (TTTC/-). Concerning rs80358086, 8.57% of the patients had a heterozygous mutation (A/G) with no significantly risk association with occurrence of breast cancer (OR = 6.46; 95% CI: 0.75-55.21; p = 0.11). In addition, this heterozygous mutation was significantly associated with a family history of breast cancer (OR=128; 95% CI: 9.46-1730.93) and breast cancer risk in nonmultiparous women (OR=6; 95% CI: 1-35.90; p= 0.05) but no association with overweight/obesity (OR=1.66; 95% CI: 0.18-15.35; p=1). This study shows high frequencies of heterozygous mutation of rs80357867 and rs80358086 from patients. In Burkina Faso, these results could help with early diagnosis of breast cancer in patients.

Proton Pump Inhibitor Use and Efficacy of Nivolumab and Ipilimumab in Advanced Melanoma.

Simple SummaryImmune checkpoint inhibitors have been shown to improve survival in patients with advanced melanoma; however, a proportion of patients do not experience durable clinical benefit with these agents. Findings from a previous study suggested that the use of proton pump inhibitors while receiving immune checkpoint inhibitors may lead to worse clinical outcomes. To validate those results, we performed this retrospective analysis using data from three clinical trials involving patients with advanced melanoma treated with immune checkpoint inhibitors. We found that there is not enough evidence to conclude that proton pump inhibitors influence the efficacy of immune checkpoint inhibitors. Prospective studies are needed to conclusively determine if the use of proton pump inhibitors has any meaningful impact on the efficacy of immune checkpoint inhibitors in patients with advanced melanoma.The impact of proton pump inhibitors (PPIs) on clinical outcomes with first-line immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma was previously analyzed in the phase II study, CheckMate 069. This retrospective analysis utilized data from three phase II/III studies of first-line ICI therapy in untreated advanced melanoma: CheckMate 066, 067, and 069. All randomized patients with PPI use ≤ 30 days before initiating study treatment were included in the PPI-use subgroup. Possible associations between baseline PPI use and efficacy were evaluated within each treatment arm of each study using multivariable modeling. Approximately 20% of 1505 randomized patients across the studies reported baseline PPI use. The median follow-up was 52.6–58.5 months. Objective response rate (ORR), progression-free survival (PFS), and overall survival analyses provided insufficient evidence of a meaningful association between PPI use and efficacy outcomes with nivolumab-plus-ipilimumab, nivolumab, or ipilimumab therapy. In five of the six ICI treatment arms, 95% confidence intervals for odds ratios or hazard ratios traversed 1. Significant associations were observed in the CheckMate 069 combination arm between PPI use and poorer ORR and PFS. This multivariable analysis found insufficient evidence to support meaningful associations between PPI use and ICI efficacy in patients with advanced melanoma.

Memory Perfectionism is Associated with Persistent Memory Complaints after Concussion.

The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory lapses) may help explain why some people report persistent subjective memory problems in the absence of corresponding objective memory impairment. This study investigated the relationship between memory perfectionism and persistent memory complaints after concussion. Secondary analysis of baseline data from a randomized controlled trial. Adults (N = 77; 61% women) with persistent symptoms following concussion were recruited from outpatient specialty clinics. Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Metamemory in Adulthood-Achievement subscale), forgetfulness and other postconcussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8weeks postinjury. Patients with versus without severe memory complaints (based on the RPQ) were compared. Memory perfectionism was associated cross-sectionally with severe memory complaint, after controlling for objective memory ability, overall cognitive ability, and depression (95% confidence interval for odds ratio = 1.11-1.40). Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests nor on inclusion of participants who failed performance validity testing. In a control comparison to test the specificity of identified relationships, memory perfectionism was not associated with severe fatigue (95% confidence interval for odds ratio = 0.91-1.07). Memory perfectionism may be a risk factor for persistent memory symptoms after concussion, with potential relevance to the spectrum of functional cognitive disorders more broadly.