Decreased Odds Ratio Research Articles

Exploring the Effect of an Obesity-Prevention Intervention on Various Child Subgroups: A Post Hoc Subgroup Analysis of the Kiel Obesity Prevention Study.

This study investigated potential subgroups of children within the Kiel Obesity Prevention Study (KOPS) for differing treatment effects for the outcome measures of overweight or obesity at 4 years. The KOPS study delivered a multicomponent school intervention to cohorts of children in Kiel but found no overall effect on the weight status outcome. However, KOPS authors suggested there may be subgroup variations in treatment effect. Data were collected as part of the KOPS for samples of 6-year-olds between 1996 and 2001, with 4-year follow-up measurements between 2000 and 2004. The present study conducted a post hoc subgroup analysis of the odds of obesity or overweight at 4-year follow-up compared to normal weight (n = 1646). A generalized linear mixed-effects model, including a treatment-subgroup interaction term, was used to estimate subgroups as a moderator of the treatment effects on the outcomes of obesity or overweight at 4-year follow-up. The findings indicated several subgroup-treatment interaction effects relating to physical activity indicators. TV or PC not being one of a child's top 3 activities at baseline was associated with a significantly decreased odds ratio of obesity at 4 years in the intervention group (OR, 0.04; 95% CI, 0.004 to 0.45) compared to the non-intervention group (OR, 0.96; 95% CI, 0.29 to 3.14), p = 0.02. Weekly activity in a sports club at baseline was associated with a decreased odds ratio of overweight at 4 years in the intervention group (OR, 0.38; 95% CI, 0.16 to 0.85) compared to the non-intervention group (OR, 0.91; 95% CI, 0.70 to 1.17). This was a significant difference (p = 0.04). These findings suggest that children's baseline physical activity may impact treatment effects on the outcomes of overweight and obesity, creating opportunities to increase the effectiveness of interventions on preventing obesity.

United States opioid prescribing trends after shoulder surgery and their correlation with opioid misuse

BACKGROUNDOrthopedic surgery has been highlighted as a contributor to the opioid epidemic. There is a paucity of literature focused specifically on opioid prescribing trends following shoulder surgery. Our aims were to describe national and regional trends in opioid prescribing following total shoulder arthroplasty (TSA), proximal humerus fracture fixation, and rotator cuff repair (RCR), and to correlate opioid prescribing trends after shoulder surgery with regional heroin use and new opioid misuse diagnoses. METHODSThis is a retrospective study of 218,577 patients from a commercial insurance dataset who had undergone orthopedic shoulder procedures from 2014-2020. Opioid prescription data within 90-day postop were converted to morphine milligram equivalents (MME). Multivariate modelling was used to evaluate independent associations between MME’s prescribed and subsequent new postoperative diagnosis of opioid dependence. Additionally, longitudinal mixed effects modeling was employed to understand aggregated prescriber habits by state over time and the subsequent effects on estimates of state heroin use and drug overdose deaths. RESULTSFrom 2014 to 2020, the mean number of MMEs prescribed nationally decreased by over 50% for TSA, proximal humerus fracture fixation, and RCR. Over the study period, most states demonstrated an overall downtrend of 90-day opioid prescribing for these procedures.Individuals with a new opioid misuse diagnosis following shoulder surgery were found to be younger (SMD=0.27, p<0.001), have increased comorbidities (SMD=0.38, p<0.001), and increased MME’s prescribed (SMD=0.94, p<0.001). Increased comorbidity score (OR=3.28, p<0.001) and increased 90-day MME’s prescribed (OR=1.05, p<0.001) were all found to increase the odds ratio of a postoperative opioid misuse diagnosis in patient’s undergoing shoulder surgery, while increased age (OR=0.97, p<0.001) and patient’s undergoing RCR (OR=0.79, p=0.001) were found to have a decreased odds ratio of developing a new opioid misuse diagnosis.The predictors of regional heroin use included the within-state 90-day MMEs prescribed (p=0.002). The predictors of drug overdose death included year (p<0.001), but did not include type of surgery or 90-day MMEs. CONCLUSIONOrthopedic surgeons successfully reduced the number of opioids prescribed nationally after shoulder surgeries by over 50% during our study period with similar trends seen at the state level. Our data indicate a relationship between increased opioid prescribing after shoulder surgery and heroin use. This study highlights that while progress has been made, there is evidence that opioid prescribing following shoulder surgery is associated with the more widespread opioid epidemic, and that more research is needed to further lower postoperative opioid misuse in the future.

Rate and risk factors for inpatient falls following single-level posterior lumbar fusion: A national registry study

BackgroundPosterior lumbar fusion (PLF) is frequently considered for various spinal pathologies. While many outcome metrics have been assessed, to our knowledge, there has yet to be literature specifically investigating inpatient falls (IPFs) and its risk factors. MethodsAdult patients who underwent single-level PLF were abstracted from the 2010–Q1 2022 M161Ortho PearlDiver Database. Patients who had an IPF were determined based on administrative coding. Various patient variables were extracted and variables independently associated with IPFs were assessed with multivariate logistic regression. Incidence of secondary injuries and cost incurred related to the IPF were determined. ResultsOf the 342,890 patients who underwent PLF, IPF was identified for 4,379 (1.4%). Independent predictors of an IPF in decreasing odds ratio (OR) order were those with: active psychosis (OR=3.35), active delirium (OR=2.83), history of falling (OR=2.47), commercial insurance (OR=1.59 relative to Medicare), Medicaid insurance (OR=1.47 relative to Medicare), dementia (OR=1.17), older age (OR=1.12 per decade), alcohol use disorder (O=1.11), higher comorbidity (OR=1.08 per Elixhauser comorbidity index point) (p<.05 for each).Of patients with IPF, 44 (1.0%) sustained a head injury, and 42 (1.0%) sustained a fracture. On average, those with IPF incurred greater inpatient costs compared to patients who did not ($36,865 vs. $33,921, p<.001). ConclusionIn this national sample of patients who underwent single-level PLF, postoperative IPFs were identified for 1.4% and were associated with defined patient variables. These findings have potential patient outcome, financial, and medicolegal implications and should help guide refinement of fall prevention programs.

Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial.

The aim of this study was to identify prognostic variables at baseline associated with being responding favorably to multidisciplinary rehabilitation in patients with chronic low back pain (CLBP). A responder analysis was conducted based on data from a randomized controlled trial with 26-week follow-up including 165 patients with CLBP treated at a Danish multidisciplinary rehabilitation center. Patients were dichotomized into responders and non-responders based on the outcome of a minimal clinically important difference of six points on the Oswestry Disability Index. The associations between prognostic variables and responders were analyzed using logistic regression. A total of 139 patients completed the study, of which 42% were classified as responders. Sex and employment status were statistically significant, with a decreased odds ratio (OR) of being a responder found for males compared to females (OR = 0.09, 95% CI = 0.02-0.48) and for being on temporary or permanent social benefits (OR = 0.28, 95% CI = 0.10-0.75) compared to being self-supporting or receiving retirement benefits. Statistically significant interaction (OR = 8.84, 95% CI = 1.11-70.12) was found between males and being on temporary or permanent social benefits. In patients with CLBP, female patients as well as patients who were self-supporting or receiving retirement benefits were significantly more likely than male patients or patients on temporary or permanent social benefits to be a responder to multidisciplinary rehabilitation.

Cardiovascular safety of using non-steroidal anti-inflammatory drugs for gout: a Danish nationwide case-crossover study.

Gout attacks are treated with uric-lowering and anti-inflammatory drugs. In patients with gout, non-steroidal anti-inflammatory drugs (NSAIDs) could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic side effects. We, therefore, examined the risk of cardiovascular events associated with NSAID use in patients with gout. We conducted a nationwide, population-based case-crossover study of all Danes ≥ 18years of age with first-time gout during 1997-2020, who experienced a cardiovascular event (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation/flutter, or cardiovascular death) (n = 59,150). The exposure was use of NSAIDs, overall and according to type (ibuprofen, naproxen, or diclofenac). We used the dates 300, 240, 180, and 120 before the outcome date as reference dates. We used the Mantel-Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and cardiovascular events. NSAID use was overall associated with 12% decreased odds of a cardiovascular event (OR = 0.88, 95% CI: 0.85-0.91). This decreased odds ratio was observed for the use of ibuprofen (OR = 0.92, 95% CI: 0.88-0.97) and naproxen (OR = 0.85, 95% CI: 0.74-0.97), but not for the use of diclofenac (OR = 0.97, 95% CI: 0.90-1.05).Overall, use of NSAIDs was associated with decreased odds of all the individual components of the composite outcome. NSAIDs were not associated with an increased cardiovascular event rate when used in gout patients.Ibuprofen and naproxen appeared to have better cardiovascular risk profiles than diclofenac.

Abstract 6478: Intracranial neoplasms: Disparities in access to care

Abstract Purpose: Excision of intracranial neoplasms is a life-saving procedure. However, there is not much research that has demonstrated how demographic variables interact with a patient’s access to healthcare for intracranial neoplasms. Methods: The Nationwide Inpatient Sample was queried from 2018 to 2020 to identify patients with an intracranial neoplasm. Multivariable logistic regression with patient- and hospital-level characteristics as covariates was used to identify factors associated with receiving an intracranial tumor excision. Results: From 2018 to 2020, there were 97,795 hospital encounters with a primary diagnosis of an intracranial neoplasm. Of these patients, 64.6% underwent a tumor excision procedure during their hospital visit. The average age of all patients with intracranial neoplasm was 58.90.2 years. Most intracranial neoplasm patients were male (59.0%), White (73.8%), Medicare beneficiaries (45.1%), and of the highest income quartile (26.4%). These patients commonly presented to hospitals in the West (35.0%), with a medium number of beds (36.4%), and to rural hospitals (39.1%). The most common locations of these neoplasms were the frontal (18.9%), temporal (12.0%), and parietal (7.5%) lobes. Neoplasms in more than one location in the brain occurred in 5.8% of patients. Multivariable logistic regression identified the following factors as significantly associated with a decreased odds ratio (OR) of receiving an excision surgery: identifying as Black (OR=0.63; p&amp;lt;0.001), Hispanic (OR=0.82; p=0.001), or Asian or Pacific Islander (OR=0.78; p=0.009) and being a Medicaid Beneficiary (OR=0.84; p=0.008). Presenting to a hospital in the South (OR=1.30; p&amp;lt;0.001) or in the West (OR=1.38; p&amp;lt;0.001) were associated with higher chances of having a surgical excision. Conclusion: There are very substantial differences in access to care for brain cancer patients. Race and insurance status are related to a patient’s chance of receiving tumor excision therapy. Citation Format: Jayla Hsiung, Kamil Taneja, Lauren Ladehoff, Karan Patel, Eric Toloza. Intracranial neoplasms: Disparities in access to care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6478.

Association of dietary carbohydrate and fiber ratio with postmenopausal bone mineral density and prevalence of osteoporosis: A cross-sectional study.

This study aimed to investigate the associations of carbohydrate to dietary fiber ratio with bone mineral density (BMD) and the prevalence of osteoporosis in postmenopausal women. This cross-sectional study retrieved the data of 2829 postmenopausal women from the National Health and Nutrition Examination Survey (NHANES) database. Weighted univariable logistic regression models were used to investigate the correlations of carbohydrate, dietary fiber, or carbohydrate to fiber ratio with osteoporosis. Higher dietary fiber intake was correlated with decreased odds ratio of osteoporosis [odds ratio(OR) = 0.96, 95% confidence interval (CI): 0.93 to 0.99]. The odds ratio of osteoporosis in postmenopausal women was elevated as the increase of carbohydrate to fiber ratio (OR = 1.80, 95%CI: 1.10 to 2.96). Carbohydrate to fiber ratio >17.09 was related to increased odds ratio of osteoporosis (OR = 1.63, 95%CI: 1.04 to 2.56). Compared to the carbohydrate to fiber ratio ≤11.59 group, carbohydrate to fiber ratio >17.09 was associated with decreased total femur BMD (β = -0.015, 95%CI: -0.028 to -0.001) and femur neck BMD (β = -0.020, 95%CI: -0.033 to -0.006) in postmenopausal women. The femur neck BMD in postmenopausal women was decreased with the increase of carbohydrate to fiber ratio (β = -0.015, 95%CI: -0.028 to -0.001). In postmenopausal women, a high carbohydrate/fiber ratio >17.09 is associated with an increased risk of osteoporosis and lower hip BMD and high fiber intake is associated with less osteoporosis and higher hip BMD.

Physical Therapy Utilization After Single-level Posterior Lumbar Fusion.

Retrospective cohort study. Characterize physical therapy (PT) utilization following single-level posterior lumbar fusion (PLF). PLF is a common procedure that is increasing in frequency. After such surgeries, PT may be considered to facilitate mobilization and return to activities. However, the usage of such therapy has not been well-characterized in the literature. Patients undergoing single-level PLF were identified from the 2010 to 2021 PearlDiver administrative database. These patients were stratified based on usage of therapy, home versus outpatient therapy, and timing of therapy within the year after surgery. To determine predictors of therapy, patient characteristics were determined and multivariable regressions were performed. A total of 213,240 patients undergoing single-level PLF were identified, of which therapy was done in the year after surgery for 63,231 (29.0%, of which home therapy accounted for 16.5% of therapy visits). Of those who utilized PT, the average number of visits was 10.6±10.6. Home therapy peaked within the first month after surgery and outpatient therapy peaked at month two. Factors associated with any PT following PLF in decreasing odds ratio (OR) were having commercial insurance (OR: 1.68), being from the Northeast (OR: 1.41), age (OR: 1.13 for 70+ of age) female sex (OR: 1.09), and ECI (OR: 1.04 per point) ( P <0.001 for all). Of those who received therapy, factors associated with home PT utilization were being from the Northeast (OR: 2.55), age (OR: 1.91 for 70+ of age), Medicaid insurance (OR: 1.48), female sex (OR: 1.39), and interbody fusion (OR:1.07) ( P <0.001 for all). After single-level PLF, the minority of patients received home or outpatient PT. Of those who did, there was significant variation in the number of visits, with nonmedical factors such as insurance plan and geographic region being strongly associated suggesting room for more consistent practice patterns. Level 3.

Performance Improvement Program Review of Institutional Massive Transfusion Protocol Adherence: An Opportunity for Improvement.

Given the acuity of patients who receive MTPs and the resources they require, MTPs are a compelling target for performance improvement. This study evaluated adherence with our MTP's plasma:red blood cell ratio (FFPR) of 1:2 and platelet:red blood cell ratio (PLTR) of 1:12, to test the hypothesis that ratio adherence is associated with lower inpatient mortality. The registry of an urban level I trauma center was queried for adult patients who received at least 6 units of packed red blood cells within 4 hours of presentation. Patients were excluded for interfacility transfer, cardiac arrest during the prehospital phase or within one hour of arrival, or for head AIS ≥5. Univariate analysis and multiple logistic regressions were performed to identify variables associated with early transfusion protocol noncompliance and the effect on inpatient mortality. Three hundred and eighty-three patients were included, with mean ISS of 25.9 ± 13.3 and inpatient mortality of 28.5%. Increasing age, ISS, INR, and total units of blood product transfused were associated with increased odds of mortality, while an increase in revised trauma score was associated with a decreased odds ratio of mortality. Achieving our goal ratios were protective against mortality, with OR of .451 (P = .013) and .402 (P=.003), respectively. Large proportions of critically injured patients were transfused fewer units of plasma and platelets than our MTP dictated; failure to achieve intended ratios at 4 hours was strongly associated with inpatient mortality. MTP processes and outcomes should be critically assessed on a regular basis as part of a mature performance improvement program to ensure protocol adherence and optimal patient outcome.

The immune inflammation factors associated with disease severity and poor prognosis in patients with COVID-19: A retrospective cohort study

Coronavirus disease 2019 (COVID-19) is associated with immune dysregulation and cytokine storm. It is essential to explore the immune response characteristics of peripheral circulation in COVID-19 patients to reveal pathogenesis and predict disease progression. In this study, the levels of total immunoglobulins (IgG, IgM, IgA), complement (C3, C4)，lymphocyte subsets (CD3+ cell，CD4+ cell，CD8+ cell, NK cell, CD19+ cell and CD45+ cell) and cytokines (IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17, IL-12p, IL-1β, TNF-α, IFN-α and IFN-γ) were retrospectively analyzed in COVID-19 patients. A total of 513 patients were enrolled in this study, cases were distributed according to clinical status as mild or moderate (n = 212), severe survivors (n = 197) and severe non-survivors (n = 104). IL-6, IL-8, IL-10 and IFN-γ were increased in severe patients compared with non-severe patients, despite decreased CD45+ cell, CD3+ cell, CD4+ cell, CD8+ cell, CD19+ cell, and NK cell. Compared with severe survivors, the levels of L-6, IL-8 and IL-10 in non-survivors increased significantly, and levels of C3, CD45+ cell, CD3+ cell，CD4+ cell，CD8+ cell, and NK cell decreased. Moreover, age, IL-8, IL-10, CD8+cells and NK cell were independent risk factors for the severity of COVID-19. Multivariable regression showed increasing odds ratio of in-hospital death associated with tumor, older age, higher IL-8 level, and decreasing odds ratio of in-hospital death associated with increased levels of CD8+cell and NK cell. Finally, patients with tumor, or high IL-6 or high IL-10 expression and lower CD8+ or lower NK levels exhibited a significantly shorter survival time. In conclusion, our study provides findings of the immunological characteristics associated with disease severity to predict the progression of COVID-19. The immune inflammation factors, such as IL-6, IL-8, IL-10, CD8+ cell and NK cell, could serve as excellent biomarkers for monitoring or predicting COVID-19 progression therapeutic to COVID-19 patients.

History of Pica, Obesity, and Their Associations with Anemia in Pregnancy: A Community-Based Cross-Sectional Study.

Anemia in pregnancy represents a major global health problem, and progress is insufficient to meet the World Health Assembly's global nutrition target of halving anemia prevalence by 2030. We assessed the prevalence and factors associated with anemia among pregnant women in northern Sudan. This community-based cross-sectional study was conducted at Almatamah, River Nile State, Sudan. Sociodemographic and obstetric data were collected using a questionnaire. Hemoglobin (Hb) was measured using an automated hematology analyzer. Multivariate and simple linear regression analyses were performed. A total of 586 pregnant women were enrolled. Their median (interquartile range, IQR) age was 25 (21-30) years. The median (IQR) of body mass index (BMI) was 26.67 (24.34-30.04) kg/m2. The median (IQR) for Hb was 11.0 (10.0-11.9) g/dL. Of the 586 women, 271 (46.2%) had anemia (Hb: <11 gm/dL). In multivariate analysis, increasing BMI and obesity were significantly associated with decreased odds ratios (ORs) of anemia, while pica was associated with increased ORs of anemia. In conclusion, anemia in pregnant women is a major public health problem, as approximately half of pregnant women in northern Sudan have anemia. Increasing BMI and obesity were associated with a lower risk for anemia. More efforts are needed to improve the maternal nutritional status for good pregnancy outcomes.

Abstract 207: Soluble Urokinase-Type Plasminogen Activator Receptor in Comatose Survivors After Out-of-Hospital Cardiac Arrest Treated With Targeted Temperature Management

Introduction: Exposure to whole-body ischemia/reperfusion after out-of-hospital cardiac arrest (OHCA) triggers a systemic inflammatory response where soluble urokinase plasminogen activator receptor (suPAR) is released. Aims: This study investigated serial levels of suPAR in patients treated with differentiated target temperature management (TTM) and the associations with mortality and neurological outcome. Methods: In this single center sub-study of the randomized Targeted Temperature Management for 24 vs 48h (TTH-trial), we included 82 patients and measured serial levels of suPAR at 24, 48 and 72 h. We assessed all-cause mortality and neurological function evaluated by the Cerebral Performance Categories at six months after OHCA. Levels of suPAR between TTH groups were evaluated in repeated measures mixed models. Mortality was assessed by the Kaplan-Meier method. Good neurological outcome at six months was assessed by logistic regression analyses. The predictive value of suPAR was evaluated with the area under the receiver operating characteristic (ROC) curve. Results: Levels of suPAR were significantly different between TTH-groups (p interaction =0.04) with the highest difference at 48h, 4.7 ng/mL (95%CI: 4.1-5.4 ng/mL) in the TTH24 group compared to 2.8 ng/mL (95%CI: 2.2-3.5 ng/mL) in the TTH48 group, p&lt;0.0001. Levels of suPAR above the median value (2.6 ng/mL) was significantly associated with increased all-cause mortality at any timepoint (p log-rank &lt;0.05). The interaction of suPAR levels and TTH group was not significant (p interaction =NS). A two-fold increase in levels of suPAR were significantly associated with a decreased odds ratio of a good neurological outcome in both unadjusted and adjusted analyses without interaction of TTH group (p interaction =NS). AUC at 24h was 0.78 (95%CI: 0.67-88, p&lt;0.0001). The optimal cutoff value for suPAR in predicting 180 mortality was 2.6 ng/mL (sensitivity: 0.75, specificity: 0.63). Conclusion: Prolonged TTM of 48 hours vs. 24 hours was associated with lower levels of suPAR. High levels of suPAR were associated with increased mortality and lower odds for good neurological outcome at six months with no significant interaction of TTH group. The biomarker suPAR was a modest predictor of outcome.

The Relationship between Insulin Resistance and Thyroid Volume in Georgia.

413 patients with a mean age of 37.3 ± and 11.4 years were included in this study. Out of those, 120 were males, and 293 were females who were studied retrospectively. They had hyperinsulinemia and were referred to the clinic from 2017 to 2019. The factors studied were age, sex, body mass index (BMI), clinical signs, thyroid ultrasound, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lipids, fasting insulin, fasting glucose, thyroid stimulating hormone (TSH), Free thyroxine (FT4), and Zinc (Zn). IR was detected in 252 individuals. The frequency of men with insulin resistance was significantly higher than in the control group - 72.50%, and 56.31%, respectively (F = 9.55, p= 0.0021). Mean thyroid volume in the patients with IR was significantly higher compared to the controls 20.52 + 6.39 cm3 and 15.25 + 6.55 cm3, respectively (p < 0.001). Hyperinsulinemia had a significant positive correlation with Goiter r = 0.445, p < 0.0001. The associated factors for hyperinsulinemia are: Goiter (1) - OR = 5.12 (95% CI:3.02-8.69); Cholesterol - OR = OR = 3.31 (95% CI: 1.54-7.14); Triglycerides - OR = 3.23 (95% CI:1.02-10.28); Obesity (1)- OR = 3.94 (95% CI: 2.23-6.98); Thyroid structural changes (1) - OR = 2.01 (95% CI: 1.12-3.60); ALT/AST-OR = 4.53 (95% CI: 2.33-8.80); Zn decreased Odds Ratio hyperinsulinemia - OR = 0.95 (95% CI: 0.94-0.97). Hyperinsulinemia is the most common cause of diffuse goiter and the heterogeneous structure of the thyroid. The volume of the thyroid gland shows a significant positive association with the characteristics of metabolic syndrome and increased thyroid volume predictors of metabolic syndrome.

In-Hospital Fall Risk Prediction by Objective Measurement of Lower Extremity Function in a High-Risk Population

ObjectivesLimited data exist regarding association between physical performance and in-hospital falls. This study was performed to investigate the association between physical performance and in-hospital falls in a high-risk population. DesignRetrospective cohort study. Setting and ParticipantsThe study population consisted of 1200 consecutive patients with a median age of 74 years (50.8% men) admitted to a ward with high incidence rates of falls, primarily in the departments of geriatrics and neurology, in a university hospital between January 2019 and December 2021. MethodsShort Physical Performance Battery (SPPB) was measured after treatment in the acute phase. As the primary end point of the study, the incidence of in-hospital falls was examined prospectively based on data from mandatory standardized incident report forms and electronic patient records. ResultsSPPB assessment was performed at a median of 3 days after admission, and the study population had a median SPPB score of 3 points. Falls occurred in 101 patients (8.4%) over a median hospital stay of 15 days. SPPB score showed a significant inverse association with the incidence of in-hospital falls after adjusting for possible confounders (adjusted odds ratio for each 1-point decrease in SPPB: 1.19, 95% CI 1.10-1.28; P < .001), and an SPPB score ≤6 was significantly associated with increased risk of in-hospital falls. Inclusion of SPPB with previously identified risk factors significantly increased the area under the curve for in-hospital falls (0.683 vs. 0.740, P = .003). Conclusion and ImplicationsThis study demonstrated an inverse association of SPPB score with risk of in-hospital falls in a high-risk population and showed that SPPB assessment is useful for accurate risk stratification in a hospital setting.

Pregnancy prevalence and outcomes after optic neuritis in South Korea

To compare pregnancy rates and complications in women with and without a history of optic neuritis (ON). A nationwide, population-based, retrospective study using data from the Korean National Health Claims from January 2011, to December 2017 was done. ON cohort (ON group) consisting of women aged 18 to 50 with a history of ON and 1:3 age-matched controls (control group) were compared for pregnancy and delivery rates using logistic regression after adjusting for possible confounders. Pregnancy-ON cohort (pregnancy-ON group), women aged 18 to 55 with a history of ON and pregnancy, and 1:3 age at pregnancy matched controls (pregnancy-control group) were analyzed for pregnancy complications using logistic regression after adjusting for covariates. ON group (n = 2516) showed decreased odds ratio (OR) for pregnancy [Adjusted OR2: 0.716, 95% confidence interval (CI): 0.626–0.820] and delivery (adjusted OR2: 0.647, 95% CI: 0.554–0.756) compared to controls (n = 7548). Pregnancy-ON group (n = 550) showed increased risk of delayed fetal growth (adjusted OR2: 9.867, 95% CI: 1.224–79.564), pre-eclampsia (adjusted OR2: 8.327, 95% CI: 2.911–23.819), preterm delivery (adjusted OR2: 3.914, 95% CI: 2.667–5.742), pregnancy and postpartum infection (adjusted OR1: 1.671, 95% CI: 1.296–2.154), diabetes in pregnancy (adjusted OR2: 1.365, 95% CI: 1.062–1.754) compared to pregnancy-control group (n = 1650). Our population-based cohort study suggests that history of ON is associated with decreased pregnancy and delivery rates. It may be a risk factor for various pregnancy complications.

Failure to scale in digital agronomy: An analysis of site-specific nutrient management decision-support tools in developing countries

While many have extolled the potential impacts of digital advisory services for smallholder agriculture, the evidence for sustained uptake of such tools remains limited. This paper utilizes a survey of tool developers and researchers, as well as a systematic meta-analysis of prior studies, to assess the extent and challenges of scaling decision support tools for site-specific soil nutrient management (SSNM-DST) across smallholder farming systems, where “scaling” is defined as a significant increase in tool usage beyond pilot levels. Our evaluation draws on relevant literature, expert opinion and apps available in different repositories. Despite their acclaimed yield benefits, we find that SSNM-DST have struggled to reach scale over the last few decades and, with strong heterogeneity in adoption among intended stakeholders and tools. For example, the log odds of a SSNM-DST reaching 5–10 % of the target farmers compared with reaching none, decreases by ∼200% when a technical problem is stated as a reason for the tools’ failure to be used at scale. We find a similar decrease in odds ratios when technical, socioeconomic, policy, and R&D constraints were identified as barriers to scaling by national extension and private systems. Meta-regression analysis indicates that the response ratio of using SSNM-DST over Farmer Fertilizer Practice (FFP) varies by non-tool related covariates, such as initial crop yield potential under FFP, current and past crop types, acidity class of the soil, temperature and rainfall regimes, and the amount of input under FFP. In general, the SSNM-DST have moved one step forward compared with the traditional ‘blanket’ fertilizer recommendation by accounting for in-field heterogeneities in soil and crop characteristics, while remaining undifferentiated in terms of demographic and socioeconomic heterogeneities among users, which potentially constrains adoption at scale. The SSNM-DSTs possess reasonable applicability and can be labeled ‘ready’ from purely scientific viewpoints, although their readiness for system-level uptake at scale remains limited, especially where socio-technical and institutional constraints are prevalent.

Is There Any Association between Nutrition and Myopia?: A Systematic Review.

This systematic review indicates that the current evidence shows no association of nutrition with myopia. We systematically reviewed the outcomes of the studies that previously investigated the association between nutrition and myopia. Embase, MEDLINE, and PubMed were searched by two independent authors to identify cross-sectional, cohort, retrospective, or interventional studies that assessed the association of nutrition with myopia from inception to the year 2021. Further, the reference list of the included articles was screened. The data from the included studies were extracted and qualitative analysis was performed. Quality assessment for non-interventional studies and interventional trials was performed using the Newcastle-Ottawa scale and Cochrane RoB 2 respectively. Twenty-seven articles were included in the review. Most of the nutrients and dietary elements investigated in non-interventional studies showed inconsistencies in their association with myopia with the majority indicating no association. Nine studies showed a significant association of diverse nutrients and dietary elements with either an increase (Odds ratio: 1.07) or a decrease (Odds ratio: 0.5 to 0.96) in the risk of myopia development. However, the majority of these studies have minimal odds ratios with wider or overlapping confidence intervals, implicating weaker associations. All three nutrients and dietary elements assessed in the interventional trial had implications for myopia control, with two trials indicating a clinically minimal effect. This review implies that there is some evidence to indicate a potential influence of specific nutrients and dietary elements in myopia development which are supported by several theories. However, given the vast, diverse, and complex nature of nutrition, more systematic investigation is warranted to comprehend the extent to which these specific nutrients and dietary elements are associated with myopia through longitudinal studies by subduing the limitations in the existing literature.

Drivers of environmental conservation agriculture and women farmer empowerment in Namobuddha municipality, Nepal

In 2045, Nepal aims to be carbon neutral by reducing its net emissions in various sectors, most especially in agriculture. Environmental conservation agriculture (ECA) is proven to mitigate climate change effects; however, more efforts are needed to increase its uptake in Nepal. This study, therefore, identified factors that influence ECA continuation among farmers in Namobuddha municipality–one of Nepal's central hubs for organic farming. Using binary logistic regression, seven ECA drivers were identified, with the rise of sea temperature or extremely hot days (under perceived climate change effects) and incentives or subsidies from the government decreasing the odds of ECA continuation among Namobuddha farmers. Meanwhile, the five positive ECA drivers arranged in decreasing odds ratio are: 1) ECA interest; 2) local market/hat bazar (periodical open-market) (under selling place of ECA products); 3) resource-use decision-making (under women decision-making in ECA); 4) ameliorating pests/diseases (under climate change adaptation); and 5) perception that ECA is economically, socially, and environmentally sustainable. This study also reaffirms the knowledge gap between farmers' understanding of ECA and its actual climate change mitigation capabilities, which was also observed in previous studies that identified ECA drivers. The strategic dissemination of information about ECA is thus recommended to further increase farmers' interest in ECA, which was identified as the number one factor driving ECA continuation. Communication of ECA's economic, environmental, and social sustainability is also critical, as farmers are still mostly unaware of this matter. In terms of women empowerment, this study suggests engaging women more in resource-use decision-making (i.e., technology, labor, energy usage, etc.), which could also increase women's ECA continuation. Lastly, this research also found that the lack of knowledge, training, and opportunities remains the primary obstacle to women's engagement in ECA, whereas profitability, better livelihood, and resource availability serve as the main motivators.

Urgent Care Versus Emergency Department Utilization for Foot and Ankle Fractures.

Foot and ankle fractures are common injuries for which patients may need urgent evaluation and care. Many such injuries are managed in emergency departments (EDs), but urgent care facilities may sometimes be an appropriate setting. Understanding which foot and ankle fractures are managed at which facility might help define care algorithms, improve patient experience, and suggest directions for containing costs. This retrospective cohort study used the 2010 to 2020 M151 PearlDiver administrative database. Adult patients less than 65 years old presenting to EDs and urgent care facilities for foot and ankle fractures were identified using ICD-9 and ICD-10 diagnosis codes, excluding polytrauma, and Medicare patients. Patient/injury variables associated with urgent care utilization relative to ED utilization and utilization trends of urgent care relative to ED were assessed with univariable and multivariable analyses. From 2010 to 2020, 1,120,422 patients with isolated foot and ankle fractures presented to EDs and urgent care facilities. Urgent care visits evolved from 2.2% in 2010 to 4.4% in 2020 (P , 0.0001). Independent predictors of urgent care relative to ED utilization were defined. In decreasing odds ratios (ORs), these were insurance (relative to Medicaid, commercial OR 8.03), geographic region (relative to Midwest, Northeast OR 3.55, South OR 1.74, West OR 1.06), anatomic location of fracture (relative to ankle, forefoot OR 3.45, midfoot 2.20, hindfoot 1.63), closed fracture (OR 2.20), female sex (OR 1.29), lower ECI (OR 1.11 per unit decrease), and younger age (OR 1.08 per decade decrease) (P , 0.0001 for all). A small but increasing minority of patients with foot and ankle fractures are managed in urgent care facilities relative to EDs. While patients with certain injury types were associated with increased odds of urgent care relative to ED utilization, the greatest predictors were nonclinical, such as geographic regions and insurance type, suggesting areas for optimizing access to certain care pathways. III.

P147 Predictors of interstitial lung involvement in systemic sclerosis

Abstract Background/Aims Interstitial lung disease (ILD) and pulmonary hypertension are the leading cause of death in patients with systemic sclerosis (SSc). Identifying SSc-ILD development and initiating treatment is essential to optimize therapeutic benefit. We aimed to identify predictors of SSc-ILD and compared early (&amp;lt;5 years from diagnosis) versus late (&amp;gt;5 years from diagnosis) onset. Methods We conducted a retrospective cohort study by including patients diagnosed with SSc from 1980 to 2020 followed in our unit and compared the clinical profile of patients with SSc-ILD to control SSc-non-ILD patients. Demographic features, clinical and immunological characteristics and baseline pulmonary function were retrieved. Logistic regression modelling was run to identify factors associated with SSc-ILD development. Factors associated with ILD were determined as factors associated with early or late onset. Bonferroni correction was used to limit Type I errors. Results We have included 103 patients from our patient registry from 1980 to 2021 (42% with SSc-ILD). Logistic regression identified risk factors associated with increased or decreased odds ratio for developing ILD is summarized in table 1: smoking history, male sex, the presence of myositis, anti-Scl70 and anti-Ro52 positivity, baseline pulmonary function including FVC and DLCO, mMRC (modified medical research council) dyspnea scale&amp;gt;2, mMSS (modified rodnan skin score)&amp;gt;3 and late pattern in capillaroscopy. Older age at SSc diagnosis, the presence of telangiectasias and smoking status was associated with increased odds of SSc-ILD onset before 5 years, while male gender, the presence of myositis and antiphospholid antibodies were associated with late-onset SSc-ILD. Conclusion We identified 11 factors significantly associated with risk of developing SSc-ILD. We identified early and late-onset predictors for ILD-SSc. Disclosure C. Sieiro Santos: None. R. Rego Salgueiro: None. C. Moriano Morales: None. C. Álvarez Castro: None. E. Díez Álvarez: None.