Exact Test For Association Research Articles

Can Self-Reported Symptoms Be Relied on for COVID-19 Screening in Low-Resource Settings?

Background: Understanding the extent of the disease penetration and assessing its impact is critical during a pandemic. However, laboratory-based COVID-19 estimation can be resource-intensive and may not be feasible during an emergency, particularly in low-resource settings. Aim: To investigate whether self-reported symptoms can be used for COVID-19 screening to estimate the burden among individuals aged 18 years and above in a rural setting. Methods: A community-based cross-section study was conducted in a rural district of Haryana, a state in north India, using a self-reported semi-structured questionnaire developed on a digital platform. Information on COVID-19 manifestations as essential and non-essential, confirmed laboratory tests, and disability data using Washington Groups of Short Set were obtained. The sensitivity of the COVID-19 symptoms was estimated against laboratory-confirmed true positives. A chi-square or Fisher exact test for association and a multivariable regression to determine the predictors of the prevalence was carried out. Results: In total, 2954 respondents (79.8%), out of 3700 enumerated, were interviewed. The mean age of respondents was 42 years (SD 17.2), with 54.8% female respondents. The prevalence of COVID-19 based on self-reported symptoms was 6.2% (95%CI: 5.3–7.1). The age-adjusted prevalence was 6.04% (95%CI: 5.9–6.1). Of the total COVID-19 cases, 170 (5.7%, 95%CI: 4.9–6.5) revealed a laboratory-confirmed test. Given three essential symptoms to declare provisionally COVID-19 cases, the sensitivity was 82.9% (141/170), but considering two or more essential symptoms along with two or more non-essential, the sensitivity reached up to 91.8% (156/170). The multivariable analysis showed that increased age, higher education attainment, students, entrepreneurs, persons working in private sectors, and participants with poor hygiene were predictors. Conclusions: A symptoms-based identification of COVID-19 cases can give a reliable estimate and valuable insight into the extent of the penetration, especially in low-middle-income countries, and can be a supplement, not a replacement, to a laboratory test.

An assessment of Brazilian dentists' knowledge about tooth fragment reattachment: A cross-sectional study.

Crown fractures are common traumatic dental injuries and tooth fragment reattachment is a viable option for restoring a fractured tooth. The aim of this study was to assess the knowledge and experience of dentists in the Federal District regarding the tooth fragment reattachment technique for enamel and dentin fractures. For the cross-sectional observational study, an electronic form was designed with objective and self-report questions for dentists. The data were analyzed using descriptive statistics, with their absolute and relative frequencies. For the analysis of categorical variables, the nonparametric chi-squared or Fisher exact association tests were used in the statistical software R (version 4.2.1). A total of 416 dentists participated in the study (58.9% female and 41.1% male). Of these, 70% declared they knew about fragment reattachment, but only 42.3% reported previous experience with this procedure. The most common storage medium used for the fractured fragment was milk (78.1%), and the bonding material used for reattachment was light-cured composite resin (86.3%). A majority (66.3%) reported that for a patient with enamel and dentin fracture, with the crown fragment in good condition, they would choose to do the reattachment. Dentists demonstrated that they had adequate knowledge about the tooth fragment technique, although many did not have previous experience with this procedure.

Factors Influencing Physiotherapy Attendance among Stroke Patients during the COVID-19 Era

Background: Stroke can greatly impact both physical capabilities and overall quality of life (An and Shaughnessy, 2011, Bártlová et al., 2022). While the 2019 novel Coronavirus (COVID-19) significantly impacted various sectors including access to healthcare services, access to routine stroke rehabilitation were not well documented in referral hospitals of Lusaka. Objectives: To assess factors affecting routine rehabilitation of stroke survivors during COVID-19 in referral hospital settings of Lusaka. Method: This was a cross-sectional study involving 26 stroke survivors who were present before and during the COVID-19 pandemic lockdown. All respondents were from 5 referral hospitals in Lusaka. Data was collected using researcher-administered structured questionnaires and analyzed using SPSS v27.0. Bivariate analysis was carried out using chi-squared and Fishers exact test of association. Results: There was an overall higher stroke patient response rate from females (57.7%, n=15) than males (42.3%, n=11). The outcome variable was significantly associated with only two intrinsic factors namely fear (mean rank of 1.69) seconded by patients’ perception of physiotherapist’s attitude (mean rank of 2.50). An overall decline in physiotherapy attendance from 2-3 times a week (69.2%, n=18) to once in a week (54%, n=14) was observed. Conclusion: A notable shift inclination towards home-based rehabilitation raises important considerations for healthcare practitioners and policymakers. It prompts a critical examination of the potential consequences of this shift on the quality and effectiveness of rehabilitation. Clinical implications: The identified barriers, particularly fear, highlight the need for targeted interventions. The study serves as a reminder of the complexities inherent in balancing patient needs, safety considerations, and healthcare system capacities.

Nurses' knowledge, attitudes, and practices about rehabilitation of patients after heart valve surgery in Namibia.

A cardiac rehabilitation programme is a medically supervised intervention to assist patients in recovery after heart surgeries and to prevent potential complications. Nurses should have the knowledge, a positive attitudes, and good practices to improve patient quality of life during the recovery process. This study aimed to describe the knowledge, attitudes, and practices of the nurses regarding cardiac rehabilitation for patients after heart valve surgery. The study setting was Windhoek Central Hospital, Cardiac Unit, in Windhoek, Namibia. A quantitative and descriptive research design was used for convenient non-probability sampling of (N = 23) nurses who consented to participate in the study. Data were collected through self-administered questionnaires and analyzed using SPSS Version 26. Descriptive statistics were used and Fischer's Exact test for associations of variables was performed. The study results showed a high level of knowledge, good attitudes, and poor to fair practices toward cardiac rehabilitation. However, the respondents demonstrate a lack of knowledge about the indications, and benefits of cardiac rehabilitation, negative attitudes regarding counselling of patients on sexual activities, and poor practice regarding exercises and counseling of patients and caregivers on cardiac rehabilitation. Furthermore, there is a positive relationship between the respondents' older age, senior rank, and having been trained I cardiac conditions and their knowledge, attitudes and practices regarding some core components of cardiac rehabilitation with P-value < 0.050. There is a need for a cardiac rehabilitation programme to improve nurses' attitudes and practices toward cardiac rehabilitation. Understanding the gap in knowledge, attitudes, and practices among the nurses regarding cardiac rehabilitation would guide the Ministry of Health and Social Services (MoHSS) in the implementation of the cardiac rehabilitation for patients after heart valve surgery.

Retrato das mães doadoras e variáveis associadas à doação de leite materno em um Banco de Leite Humano

ABSTRACT Objective To describe and analyze the donor mothers’ profile and variables associated with breast milk donation at Human Milk Bank in the municipality of Guarapuava, Paraná, Brazil. Methods This was a cross-sectional study obtained from information contained in the donor registration form between the period July 2013 (implementation of the service) to December 2019. The collected data were tabulated and descriptive analysis of variables and Chi-square and Fischer’s exact association tests were performed. Results Of 1,491 records analyzed, this research identified that 70.73% of donors were between 20 to 34 years old; 67.69% had prenatal care at public health network and 61.37% have had cesarean delivery. Most mothers (61.44%) remained as donor for 29 days and 53.83% of them donated up to 500 ml of milk. In addition, statistically significant association was observed between milk volume donated and donation time for the following variables: prenatal place care, gestational age, child's birth weight, child age, and smoking. Maternal age was associated with a higher volume of donated milk. Conclusion The study's findings reinforce the approaching importance the possibility of human milk donation during prenatal care, with emphasis on private health service, and throughout the women's and children's health care network, as well as on the community.

Anthracyclines versus No Anthracyclines in the Neoadjuvant Strategy for HER2+ Breast Cancer: Real-World Evidence.

Deescalation strategies omitting anthracyclines (AC) have been explored in early human epidermal growth factor receptor 2-positive breast cancer (HER2+ EBC), showing similar efficacy regarding pathological complete response (pCR) and long-term outcomes as AC-containing regimens. The standard treatment for this tumor subtype is based on chemotherapy and dual HER2 blockade with trastuzumab and pertuzumab, with AC-containing regimens remaining a frequent option for these patients, even in non-high-risk cases. The primary aim of this study was to assess and compare the effectiveness of neoadjuvant regimens with and without AC used in the treatment of HER2+ EBC in the clinical practice according to the pCR achieved with each. This retrospective multicentric study included patients with HER2+ EBC from Portuguese, Spanish, and Chilean hospitals (January 2018-December 2021). Patients receiving neoadjuvant therapy (NAT) with dual HER2 blockade (trastuzumab and pertuzumab), followed by surgery, were included. Statistical analysis used chi-squared/Fisher's exact test for associations, multivariate logistic regression for pCR, and Kaplan-Meier method for event-free survival (EFS). IBM SPSS Statistics 29.0 analyzed the data. The study included 371 patients from eight hospitals. Among them, 237 received sequential AC and taxane-based chemotherapy with 4 cycles of trastuzumab and pertuzumab, while 134 received 6 cycles of TCHP (docetaxel, carboplatinum, trastuzumab, and pertuzumab). The average age of the patients was 52.8 years and 52.7 years, respectively. Omitting AC from the neoadjuvant approach did not preclude achieving pCR [p=0.246, 95% confidence interval (CI) 0.235-0.257] and was safe regardless of patient characteristics. Relapse rates were 6.8% (16 patients) in the AC group and 4.5% (6 patients) in the TCHP group. Over a median follow-up of 2.9 years, the estimated 3-year EFS was 92.5% in the AC group and 95.4% in the TCHP group (hazard ratio 0.602, 95% CI 0.234-1.547, p=0.292, favoring TCHP). This study reports real-world evidence showing similar pCR and EFS outcomes with treatment regimens with and without AC and raises awareness of possible overtreatment and long-term toxicity in some patients with HER2+ EBC with the use of AC.

Abstract WP124: Necessity Of Universal Echocardiograms In First-time Stroke: A Retrospective Study

Background: Transthoracic echocardiogram (TTE) is a “moderate” recommendation under the 2021 AHA/ASA Guidelines. We aimed to identify in which patients TTE is most likely to reveal a clinically relevant finding that helps guide workup and secondary stroke prevention. Methods: We reviewed records of patients at an academic stroke center with primary discharge diagnosis of ischemic stroke between January 1-December 31, 2019 excluding those with prior stroke. Stroke location was classified as cortical, subcortical, brainstem, multiple/multifocal. TTE findings defined as clinically significant included reduced ejection fraction, enlarged left atrial size, patent foramen ovale, vegetations, thrombus, and atrial fibrillation during the procedure. Chi-square and Fisher’s exact association tests were used for two-way tables, relative risk, and logistic regressions. Results: Of the 307 identified patients admitted for first time stroke, 181(59.0%) were male, and median age was 63.6+/-14.3 years. Stroke location was cortical in 99(32.2%), subcortical in 41(13.4%), brainstem in 39(12.7%), and multiple/multifocal in 128(41.7%). Clinically significant findings on TTE were found in 150 patients(48.9%). Age predicted clinically significant TTE (risk ratio per 10 year interval 1.11, 95% CI 1.02-1.20). Atrial fibrillation and cortical location predicted clinically significant TTE findings (table). Other locations and risk factors were not associated with clinically significant TTE. Discussion: Cortical stroke was the only location associated with clinically significant TTE findings. The lack of association with multifocal strokes was surprising as they are often presumed cardioembolic. This suggests that TTE may be most beneficial in evaluating cortical stroke, but given that nearly half of all stroke patients had TTE findings that would inform further management suggests that continuing universal TTEs.

Phonological productive processes in full-term schoolchildren and small for gestational age: a case-control study.

To characterize the use of phonological productive processes in a group of full-term children and small for gestational age and compare it with children appropriate for gestational age. Observational, analytical, case-control and non-paired study, nested in a cohort with the outcome of phonological disorder. We assessed 36 children according to the predetermined sample calculation, 24 (66.7%) without phonological disorders and 12 (33.3%) with phonological disorders. Of these, 24 (66.7%) children were classified as small for gestational age (SGA) and 12 (33%) as appropriate for gestational age (AGA). Phonological aspects of oral language were assessed by the ABFW children's language test (2004). The results were subjected to descriptive analysis and, in order to assess the existence of an association among categorical variables, we used Fisher's exact test for association. The SGA group revealed a significantly higher number of phonological processes that change the syllable structure when compared to the AGA group. We noted that the phonological processes present and unexpected for age in the SGA population were: fricative plosivation, liquid simplification, palatal posteriorization and frontalization, plosive and fricative deafening, in addition to simplifying the consonant cluster and simplifying the final consonant, which were the most frequent in both groups. Although no association was found between phonological disorders and SGA children, we have noted a greater use of productive phonological processes in this group.

Factors influencing international and U.S. dentists\u2019 interest in advanced periodontal education: a pilot study

BackgroundThe enrollment of international periodontal students in U.S. dental schools has been increasing in recent years. Interest in applying to a periodontics specialty program may differ between U.S and international dental school graduates. The purpose of this study is to assess, from the perspective of periodontal residents, (1) factors that interest dental students to apply to periodontics programs and (2) differences in background and interest between U.S and international graduates.MethodsA 20-question survey was sent out electronically to periodontics residents. The survey questions were designed to obtain information on the participants’ backgrounds, factors that influenced them to specialize in periodontics, and their preferred features of graduate periodontics programs. The data were analyzed using descriptive statistics for socio-demographic variables, a Wilcoxon two sample test to compare mean Likert scale scores, and Fisher’s exact test for associations between comparison groups.ResultsOf the two hundred residents invited to participate, 28% responded. The majority of the respondents stated that interest in implantology, previous exposure to periodontal procedures, interest in improving periodontal surgery skills, a good relationship with periodontics faculty, the residency curriculum, advanced program and faculty reputation as influencing factors in selecting periodontics as specialization. The majority of international graduates have up to $50,000 dollars in student debt; by comparison, half of the domestic graduates have a debt of over $250,000 dollars (p ≤ 0.05). Working experience as a dentist was significantly greater among international residents (73%) in comparison to U.S graduates (32%). In contrast with international graduates, U.S graduates more frequent reported that good relationships with the periodontics predoctoral faculty contributed to their interest in periodontics (p ≤ 0.05). Program cost and location had a greater impact on the decision of U.S. graduates than international graduates (p ≤ 0.05).ConclusionsOverall, factors associated with personal finance and predoctoral education have a greater impact on the decision of American graduates than international graduates to pursue an advanced education in periodontics, which may influence the increased enrollment of international students.

Incidence of Postpartum Depression and Its Association With Antenatal Psychiatric Symptoms: A Longitudinal Study in 25 Villages of Rural South Karnataka.

Background:Postpartum depression (PPD) is the commonest mental health disorder post-childbirth, yet there is a paucity of data in rural areas regarding the actual incidence of PPD, which excludes pre-existing or antenatal depression. To estimate the incidence of PPD among rural women of south Karnataka and identify predictors of PPD, including antenatal psychiatric disorders.Methods:A longitudinal study in 25 villages in south Karnataka among 150 pregnant women in the third trimester of pregnancy using simple random sampling. Baseline data collected and revised Clinical Interview Schedule used to screen antenatal psychiatric disorders. Participants followed-up 6–8 weeks postpartum, end-line data collected, and Edinburg Postnatal Depression Scale administered. Chi-square and Fischer’s exact tests for association between PPD and covariates. Logistic regression to calculate adjusted odds ratios.Results:Prevalence of antenatal psychiatric disorders was 15.3%. The incidence of PPD was 11%. A significantly higher proportion of PPD was found among women with adverse events in the last year, low socioeconomic status, and perceived lack of care/support at home. Predictors of PPD were antenatal psychiatric disorders (AOR = 4.3, 95% CI = 1.22–5.11; P = 0.028), mothers reporting worry about their infant’s health (AOR = 7.7, 95% CI = 1.22–48.32; P = 0.012) and mothers receiving postpartum care by caregivers other than their own mother (AOR = 4.0, 95% CI = 1.13–8.09; P = 0.030).Conclusions:Our study found that one in ten rural women is developing PPD and there is a strong link between PPD and antenatal psychiatric disorders and family factors. This calls for capacity building of general physicians and village-level workers and strengthening of the Home-Based Newborn Care Program, where weekly postpartum home visits by ASHA are an opportunity for screening and counselling mothers.

The prevalence of malnutrition and analysis of related factors among adult patients with the Coronavirus Disease 2019 (COVID 19) in a tertiary government hospital: The MalnutriCoV study.

Background and aimsAs of November 2020, the Coronavirus Disease 2019 (COVID 19) has infected more than 396,000 people in the Philippines. Although no study has been done on malnutrition among a general cohort of patients with COVID 19, it has long been associated with increased mortality and poor long-term outcomes. We aimed to determine the prevalence of malnutrition among patients with COVID 19 admitted in a tertiary government hospital.MethodsCross-sectional study on COVID 19-confirmed patients admitted to the COVID 19 wards from July 15 to September 15, 2020. Nutritional status was assessed using the Philippine Society for Parenteral and Enteral Nutrition (PhilSPEN) modified Subjective Global Assessment Grade (SGA) tool. Malnutrition was defined as those with SGA grades B and C. Chi-square test or Fisher exact test of association, as appropriate, was used to identify factors that have a significant association with malnutrition. Furthermore, logistic regression was done on factors with significant association.ResultsAmong the 355 adult patients in the study, 71.83% (255/355) were malnourished [SGA B: 67.84% (173/255); SGA C: 32.16% (82/255)]. The following were shown to have significant association with malnutrition: community-acquired pneumonia (CAP) [p-value < 0.001], hospital-acquired pneumonia (HAP) [p-value 0.002], and chronic kidney disease (p-value 0.033). Multivariable logistic regression revealed that age [OR 1.02, CI 95% 1.00, 1.04, p-value 0.027] and CAP-Moderate Risk (MR) [OR 3.02, CI 95% 1.73, 5.27, p-value < 0.001] are significant predictors of malnutrition. All patients with CAP- High Risk and HAP were malnourished.ConclusionThe prevalence of malnutrition was high (71.83%) in a general cohort of COVID 19 patients as measured by the modified SGA tool. The following are risk factors of malnutrition among patients with COVID 19: age, CAP, and HAP. Nutritional support and management of comorbidities are of paramount importance in the care of patients with COVID 19.

Pattern of alcohol consumption among motorcycle taxi drivers

Objective: to identify the factors associated with the pattern of alcohol consumption among motorcycle taxi drivers. Methods: cross-sectional study, carried out with 68 motorcycle taxi professionals. A socio-demographic questionnaire, work-related aspects, traffic accidents and the Alcohol Use Disorders Identification were used, for the pattern of alcohol use. The Chi-square and Fisher’s exact association tests were used for data analysis and logistic regression. Results: it was found that 48.5% consumed alcoholic beverages, 75.0% had low risk consumption, 16.2% risk, 7.4% harmful use and 1.5% possible dependence. The variables that obtained significance were naturalness, use of alcoholic beverages and quantity of drinks drunk in the day. Conclusion: there was a trend between naturalness and risky consumption. In addition, using alcoholic beverages monthly and the amount of doses greater than five doses, on the same day, increased 20 times and 10.0% more the chance of triggering problematic alcohol consumption.

Patient's perceptions of physical examination in the setting of chronic pain.

Despite its clinical utility, progressive reliance on imaging technology can lead to devaluing the physical examination in patients with chronic pain. The primary objective of this study was to determine whether chronic pain patients have a positive or negative perception of the physical examination. After institutional ethics committee approval, 120 adult patients as a convenience sample who attended a chronic pain clinic were included. Participants completed a 10-item survey regarding their overall perception of the physical examination. Kruskal-Wallis and Mann-Whitney U test analyses were conducted to explore associations between test items and patient ages, gender, employment, pain diagnosis, and duration of pain. All cross-tabulations of categorical variables were analyzed using Fisher's exact test for associations. The majority of participants were male (51%), aged 50-70 (44%). The most common pain diagnosis was back pain (62%). Most patients (77%) indicated that the overall experience of being examined was highly positive. Patients believe in the value of the physical examination as a diagnostic tool (97%). Patients believe in the relational value of the physical examination (92%). Age, gender, employment, pain diagnosis, and duration of pain were not associated with a more positive perception of the physical examination. Patients with chronic pain indicate that the physical examination is a highly positive aspect of their care. There are some negative aspects of been examined which physicians should be aware of. This study adds to our knowledge regarding the physical exam in chronic pain patients. It will inform practice and training.

Mothers/Caregivers Age and Family Structure Predicted Knowledge on Recommended Nutrition Practices for Children under 5 Years

Introduction: There are recommendations regarding infant and young child feeding and when followed children’s growth are optimum. These feeding practices are age definitive, starting from exclusive breastfeeding, to the transition of the child to complementary foods. Objective: The objective of this study was to assess factors that determine nutritional knowledge among mothers/caretaker regarding children under five years. Methods: A cross sectional study design employing quantitative methods was chosen for this study. The study population comprised 285 caregivers and their children aged of 6 and 59 months. Respondents were chosen randomly from four hard-to-reach communities and two peri-urban communities within three sub-municipalities, who lived in and accessed child welfare services during the study period. Face-to-face interviews were used to collect background and nutritional knowledge data from the respondents. Maternal/caretaker knowledge on recommended nutritional practice was split into two with scores were greater than 7 out of the 13 knowledge items was considered as good. STATA version 14 was used to analyze data and statistical significance determine at 95% confidence interval.Results: The average age of the children under 5 years and their mothers/caretakers were 32 months and 29 years respectively. About 73% had nuclear family structure. Results of Chi square and Fisher’s exact tests for association indicated that, mother’s/caretaker’s age (p&lt;0.001), family structure (p=0.010) and access to media information (p&lt;0.001) were significantly associated with mother’s good nutritional knowledge on recommended practices. Mothers/caretakers age (OR=0.17; 95%CI: (0.70-0.43); family structure (OR=0.30; 95% CI (0.11-0.78) and access to media (AOR=5.12; 95% (2.46-10.69) predicted mothers nutritional knowledge. Conclusions: Maternal/caretaker factors predicted nutritional knowledge when feeding a child in both peri-urban and rural areas. These factors should be considered when promoting child nutrition.

Statistical Analysis of the TSAD Interactome in Multiple Sclerosis: Multiple Testing, High Dimensional Regression and Interactions

Multiple Sclerosis (MS) is a chronic inflammatory disease of the Central Nervous System (CNS). The presence of Oligoclonal Band (OCB) in Cerebrospinal Fluid (CSF) is an important diagnostic tool in MS. The main aim of this study was to determine SNPs and SNPs-SNPs interactions in the genomic TSAD (T-Cell Specific Adaptor Proteins) region which explain the difference between two MS conditions: OCB positive vs. OCB negative in sampled Norwegian patients. The data to this study was obtained from the MS Registry Ulleval University Hospital, Oslo, Norway. Of 899 patients, 802 were OCB positive and 97 OCB negative, each has 923 SNPs at specific position in their chromosome measure. The study incorporated two different statistical methods to our data analysis. First, we apply variable selection based on Lasso method, here we discuss Lasso for Logistic Regression Analysis and see interaction effect for the Lasso selected SNPs. In the second section, we analyze variable selection based on test of association. Here, we used Chi-Square and Fisher’s exact test of association to see association between the statuses of OCB to each SNP. We found out that the Chi-Square test of association selected 34 significant SNPs and the association test for Fisher’s exact test selected 38 significant SNPs at significance level of 0.05. Then we used Boferroni and False Discovery Rate to statistically significant SNPs for the multiple testing corrections. Finally, we looked for interaction effects to some selected SNPs from test of association and we have determined SNPs and SNP-SNP interactions which appear to have significant associated to the OCB subpopulation of MS patients, based on our study of the Norwegian cohort. These are selected SNPs which have been selected by any of the methods that we used (various hypothesis testing and regressions). This is the SNPs that we think should be studied further and validated on a new dataset. Of particular importance are the seven SNP-SNP interactions which we found. It is the first time a SNP-SNP study has been performed on these data, and the finding will be communicated to the Norwegian molecular biologists to be followed up. Keywords: Multiple Sclerosis, OCB, TSAD, Multiple Testing, High Dimensional Regressions, LASSO DOI : 10.7176/JMPB/61-01 Publication date: November 30 th 2019

Impact of dental insurance coverage on presentation, long-term outcomes, and symptom burden in locally advanced head and neck cancer.

e18230 Background: Medical insurance coverage is known to correlate with improved long-term (LT) outcomes in head and neck cancers (HNC) patients. However, associations with dental insurance coverage (DI) are not established. Methods: In 2012, we sent surveys to determine DI and LT symptom (Sx) burden (EORTC QLQ-30, National Health and Nutrition Examination Survey Oral Health, and Vanderbilt Head and Neck Sx Survey) to patients who had completed definitive chemoradiotherapy (sequential or concurrent) for locally advanced (LA) HNC at the Dana-Farber Cancer Institute from 2002-2011 (2013 ASCO annual meeting, abstract 9530). In 2019, we retrospectively collected demographic and clinical information from patient charts and publicly available records and correlated these data with 2012 survey data. We used Fisher’s exact tests for association of categorical variables and Student’s t-tests for continuous variables. We used univariate and multivariate Cox proportional hazard modeling for hazard ratios (HRs). Results: Of the 103 survey responders, 84% were male. Most had oropharyngeal (90, 88%) or unknown primary (9, 9%) and 52 (50%) tested positive for human papilloma virus-associated disease (40% not tested). 71 (69%) had DI, while 100 (98%) had medical health insurance. Subjects with DI were diagnosed (Dxed) at a younger age (53 vs. 59, p &lt; 0.01). Stage at Dx did not vary by DI status (p = 0.27). At median follow-up of 10.4 years from Dx (range 2.0 -16.6), recurrence was not associated with DI status (6 (8%) for DI vs. 4 (13%) for no DI, p = 0.27, HR 0.55, 95% CI 0.15-1.93, p = 0.35). We identified 9 subjects (9%) who had died of any cause. Subjects with DI experienced lower mortality from all causes than those without (3% vs. 19%, p = 0.01) and longer median overall survival (OS) (range 4.3 - 16.6 years, HR 0.19, 95% CI 0.05-0.76, p = 0.02) on univariate analysis. The longer OS was not significant when controlling for age and stage at Dx (p = 0.12). DI was also associated with less frequent need for liquid supplements to maintain weight (p = 0.01). Conclusions: In our cohort, DI was associated with Dx at a younger age and longer OS, although future work should consider possible confounding factors such as differences in socioeconomic status. Our data highlight the need for further research to investigate the importance of DI in improving LT outcomes in HNC patients.

Patient perceptions of primary care providers' knowledge of bariatric surgery.

As the rate of obesity continues to rise, primary care providers (PCPs) must be aware and informed of the treatment options available. Bariatric surgery is the most effective long-term treatment for weight loss and improvement of obesity-related comorbidities. The aim of this study was to assess patients' perception of their PCP's opinion, support and knowledge of bariatric surgery and changes over time. In 2009 and 2015, a 27-question survey was developed and mailed to patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGB) at our institution. Statistical analysis included chi-square and Fisher's exact test for associations between categorical variables, Wilcoxon rank sum test for comparison of ordinal or continuous variables and sign test for comparison of paired ordinal variables. There were 680 and 1106 patients who met inclusion criteria and were mailed the 2009 and 2015 survey, respectively. The survey response rate was 47% in 2009 and 35% in 2015; 125 patients completed both surveys. In 2009 and 2015, 78% and 80% of patients described their PCP's opinion of bariatric surgery as "very supportive" (P = 0.64), and 29% and 40% described their PCP as "very knowledgeable" about bariatric surgery (P = 0.02), respectively. Post-operative support from PCPs was described as "very supportive" by 77% and 79% of patients in 2009 and 2015, respectively (P = 0.07). Overall, Ninety-seven percent of patients would repeat their LRYGB experience. The majority of patients perceived their PCP as being supportive of bariatric surgery. Physicians' knowledge of bariatric surgery could be improved by establishing more opportunities for education. While patients' perception of their PCP's knowledge increased, no significant improvements in PCP opinion or support of bariatric surgery were observed over time. Patients' willingness to repeat their experience with bariatric surgery remained high.

To what extent are midwives adapting antenatal information for pregnant women with intellectual disabilities? A survey of NHS trusts in England

To identify the existing antenatal information provision practices for pregnant women with intellectual disabilities in England. To identify how practices between and within local supervising authorities differed, and if midwives were adapting standard antenatal information for pregnant women with intellectual disabilities, including examples of accessible information being used. Cross-sectional survey. All contact supervisors of midwives from acute trusts with maternity services were accessed via the local supervisor of midwives officers' databases and sent a questionnaire. Quantitative data were collated. Associations between trust size, geographical location, antenatal provision and National Institute for Health and Care Excellence guidelines alongside National policy were examined using Fischer's exact test of association. Contact supervisors of midwives returned a questionnaire on behalf of their trust (74, 53%). The majority worked in maternity units with more than 4000 births a year (50, 66%). Few trusts had a specialist or lead midwife in post for pregnant women with intellectual disabilities (17, 22.9%) but over half (39, 52.7%) reported that their trust had a specialist learning disability nurse in post. Only 28.3% reported availability of post registration training and even fewer (8, 10.8%) had access to written protocols. Less than half reported extra time being offered at the booking (29, 39.1%) or routine antenatal appointments (30, 40.5%). Less than a quarter (17, 22.9%) reported that their trust had routine antenatal written information available in accessible formats. Reasonable adjustments to standard antenatal information for pregnant women with intellectual disabilities were not common practice. Most trusts did not have local guidelines in place or offer midwives post registration education to help support them in this requirement.

Análise perceptivo-auditiva e autopercepção da voz em pastores evangélicos

Objetivo: verificar a associação entre a qualidade da voz e queixa vocal com as variáveis, gênero, idade, tempo de ministério, horas de trabalho, parâmetros vocais e autopercepção vocal em pastores evangélicos. Método: estudo descritivo, analítico de delineamento transversal. Amostra de 52 religiosos, entre 20 a 69 anos; 38 homens e 14 mulheres, média de 8 horas de trabalho, entre 1 a 32 anos de ministério. Foram incluídos pastores ou pastoras, entre 20 a 69 anos, em exercício ministerial e excluídos pastores gagos ou que estivessem resfriados. Procedimentos: gravação das vozes dos participantes, com a emissão da vogal sustentada /a/, dos dias da semana e a leitura de um trecho aleatório do livro de salmos da Bíblia Sagrada. Em seguida, três fonoaudiólogas especialistas em voz, e por consenso, realizaram análise perceptivo auditiva da voz. Houve também aplicação de um questionário com identificação dos dados sociodemográficos e autopercepção da voz e de aspectos da fala em público. Foi realizada análise descritiva dos dados e os testes de associação Qui Quadrado de Pearson e Exato de Fisher. O nível de significância adotado foi de p≤0,05 (5%). Resultados: a qualidade vocal foi avaliada como alterada em 47,2% da amostra, com grau de alteração leve 41,5%. Os demais parâmetros vocais pitch, articulação, loudness, ressonância, velocidade de fala foram considerados adequados na maioria da amostra. 78,85% dos pastores mostrou uma boa autopercepção da fala em público, 52% autoperceberam a voz como razoável e a maioria, 76,9%, relatou queixas vocais de cansaço e rouquidão após o uso da voz; quase todos os pastores (92,5%) disseram que são capazes de manter a atenção e influenciar o ouvinte ao falar em público. Houve associação das queixas vocais com o gênero masculino (p&lt;0,001), faixa etária de 39 a 58 anos (p&lt;0,001) e com profissionais que utilizavam a voz de 5 a 8 horas por dia (p&lt;0,001). As demais variáveis não se associaram com as queixas. Houve associação da qualidade vocal alterada (p&lt;0,034) com a faixa etária de 39 a 58 anos, grau de alteração vocal leve (p&lt;0,001) com a ressonância alterada (p&lt;0,001), pitch (p &lt;0,003) e autopercepção da fala em público (p&lt;0,001) adequados. Conclusão: a maioria dos pastores evangélicos apresenta relato de queixas vocais de cansaço vocal e rouquidão após o uso da voz profissional, mais incidente no sexo masculino, entre 39 a 58 anos, nos pastores que usam a voz de 5 a 8 horas por dia. Quase metade deles apresenta qualidade de voz alterada, associada a esta mesma faixa etária, com alteração da ressonância. Pitch e autopercepção da fala em público adequados.

Factors affecting household decision to allocate credit for livestock production

PurposeThe purpose of this paper is to explore the factors that affect farmer’s decision to allocate credit for livestock production. The results are expected to contribute to the understanding of what motivates smallholders to allocate credit to agricultural production in general and livestock production in particular. A better understanding of the farmers’ behavior in allocating credit for livestock would provide useful information for project implementers and financial institutions that work with small-scale livestock producers.Design/methodology/approachA cross-section data set collected in 2014 from 5,000 households and 497 rural communities in the major highland regions of Ethiopia is examined. The authors developed a conceptual framework for credit allocation decision. Percentiles, means, and standard deviation as well as t, χ2 and Fisher’s exact tests for association and Cramer’s V measure for strength of association have been used to describe the status of farmer’s access to credit and analyze credit utilization, while a three-stage probit model with double sample selection is used to identify factors that affect household’s decision to allocate credit for livestock production.FindingsAfter controlling for potential selection biases, sex and literacy status of household head, land size, wealth and access to livestock centered extension service are found to have a statistically significant effect on farmers’ decision to allocate credit to livestock production. The results showed female-headed households, wealthy farmers, farmers with small plot of land and farmers that have access to livestock centered extension services are more likely to allocate the credit for livestock production. The results suggest that policies aimed at improving access to credit together with access to livestock focused extension service are more effective in increasing livestock production.Research limitations/implicationsThe study’s findings should be viewed with perspective and caution, as only households with excess demand for credit were the subject of the research.Originality/valueThe contribution of this paper is twofold. First, it is one of a very few empirical studies that try to identify factors that affect households credit allocation to livestock in systematic way that removed confounding effects using three-stage probit models. Given the emphasis on financial constraints in livestock development, new empirical insights on household credit allocation are essential to better inform development interventions. Second, the analysis relies on a comprehensive data set that represents the major agricultural system of the country.