Final Multiple Logistic Regression Model Research Articles

Occurrence and predictors of delirium in critically ill older patients: a prospective cohort study

Abstract Objectives: This study aims to analyze the occurrence of delirium in critically ill older patients and to identify predictors of delirium. Methods: This prospective study included critically ill older patients admitted into level II units of Intensive Care Medicine Department of a University Hospital. Patients with Glasgow Coma Scale score ≤11, traumatic brain injury, terminal disease, history of psychosis, blindness/deafness, or inability to understanding/speaking Portuguese were excluded. The Confusion Assessment Method-Short Form (CAM-4) was used to assess the presence of delirium. Results: The final sample (n = 105) had a median age of 80 years, most being female (56.2%), widowed (49.5%), and with complete primary education (53%). Through CAM-4, 36.2% of the patients had delirium. The delirium group was more likely to have previous cognitive decline (48.6% vs 19.6%, P = .04) and severe dependency in instrumental activities of daily living (34.3% vs 14.8%, P = .032), comparing with patients without delirium. The final multiple logistic regression model explained that patients with previous cognitive decline presented a higher risk for delirium (odds ratio: 4.663, 95% confidence Interval: 1.055–20.599, P = .042). Conclusions: These findings corroborate previous studies, showing that cognitive decline is an independent predictor for delirium in older patients. This study is an important contribution for the knowledge regarding the predictors of delirium. The recognition of these factors will help to identify patients who are at high risk for this syndrome and implement early screening and prevention strategies. However, further studies with larger samples, recruited from other clinical settings as well as analyzing other potential factors for delirium, will be needed.

Maternal Antibiotic Exposure and the Risk of Developing Antenatal or Postpartum Depressive Symptoms: The Maternal Experience Study Protocol.

Limited epidemiological evidence suggests a link between antibiotic use and developing depression. This study seeks to investigate this association in depth, using a cohort of pregnant individuals. The primary aim is to explore any association between the use of antibiotics during pregnancy and the development of antenatal depressive symptoms up to the third trimester, as well as the use of antibiotics during pregnancy and within 12 months postpartum and the development of postpartum depressive symptoms. A national prospective, observational, longitudinal cohort study has been designed to examine these relationships. A sample size of 1500 pregnant individuals has been sought for this study, assuming 10 potential predictor variables (including antibiotic use) in the final multiple logistic regression model and allowing for a 30% drop-out rate. The development of depressive symptoms is considered either a diagnosis by a medical doctor and/or a scoring 13 or higher on the Edinburgh Postnatal Depression Scale. Data will be collected during the third trimester and at 6 weeks, 6 months, and 12 months postpartum. These surveys include variables previously identified as associated with antenatal and postpartum depression (e.g., level of social support, experience of intimate partner abuse, and obstetric complications), as well as antibiotic and probiotic use. This study will provide an update on the prevalence of the symptoms of depression during pregnancy and postpartum and its associated risk factors. It will also, for the first time, comprehensively explore the potential association between antibiotic use during pregnancy and up to 12 months postpartum and the development of depressive symptoms.

Cognitive Deficits in Executive and Language Functions Predict Postoperative Delirium

Postoperative delirium (POD) remains the most common complication in older adults, with cognitive impairment being the main risk factor. Patients with mild cognitive impairment, in particular, have much to lose from delirium; despite this, their cognitive impairment might be clinically overlooked. Understanding which cognitive domains are particularly predictive in this regard may improve the sensitivity of preoperative testing and allow for a more targeted application of resource-intensive measures to prevent delirium in the perioperative period. The authors conducted this study with the aim of identifying the most indicative cognitive domains. A secondary analysis of a randomized controlled trial. At a single center, the University Medical Centre Hamburg in Hamburg, Germany. Patients ≥60 years without major neurocognitive disorders (dementia, Mini-Mental State Examination score ≤23) scheduled for cardiovascular surgery. Preoperative neuropsychologic testing and delirium screening were performed twice daily until postoperative day 5. A multiple logistic regression model was applied to determine the predictive ability of test performances for the development of delirium. A total of 541 patients were included in the analysis; the delirium rate was 15.6%. After controlling for confounders, only low performance within the Trail Making Test B/A (odds ratio [OR]=1.32; 95% CI: 1.05-1.66) and letter fluency (OR=0.66; 95% CI: 0.45-0.96) predicted a particularly high risk for delirium development. The discriminative ability of the final multiple logistic regression model to predict POD had an area under the curve of 0.786. Impairment in the cognitive domains of executive function and language skills associated with memory, inhibition, and access speed seem to be particularly associated with the development of delirium after surgery in adults ≥65 years of age without apparent preoperative neurocognitive impairment.

The Impact of Body Mass Index on In-Hospital Mortality in Post-Cardiac-Arrest Patients-Does Sex Matter?

A number of factors influence mortality in post-cardiac-arrest (CA) patients, nutritional status being one of them. The aim of this study was to assess whether there are sex differences in the prognostic impact of BMI, as calculated on admission to an intensive care unit, on in-hospital mortality in sudden cardiac arrest (SCA) survivors. We carried out a retrospective analysis of data of 129 post-cardiac-arrest patients with return of spontaneous circulation (ROSC) admitted to the Intensive Care Unit (ICU) of the University Teaching Hospital in Wrocław between 2017 and 2022. Female patients were significantly older than male patients (68.62 ± 14.77 vs. 62.7 ± 13.95). The results of univariable logistic regression analysis showed that BMI was not associated with the odds of in-hospital death in either male or female patients. In an age-adjusted model, age was an independent predictor of the odds of in-hospital death only in male patients (OR = 1.034). In our final multiple logistic regression model, adjusted for the remaining variables, none of the traits analysed were a significant independent predictor of the odds of in-hospital death in female patients, whereas an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) was an independent predictor of the odds of in-hospital death in male patients (OR = 0.247). BMI on admission to ICU is not a predictor of the odds of in-hospital death in either male or female SCA survivors.

Non-surgical patient characteristics best predict outcome after 6 months in patients surgically treated for chronic subdural haematoma

BackgroundChronic subdural haematoma (CSDH) is one of the most common conditions encountered in neurosurgical practice. After surgery, the patients often improve dramatically; but their long-term outcome is more uncertain. The purpose of this study was to investigate predictors of outcome 6 months after surgery. MethodsRetrospective data were collected on patients in Orebro County, Sweden, who had undergone surgery for CSDH at the Orebro University Hospital between 2013 and 2019. The outcomes were defined as favourable or unfavourable in terms of the modified Rankin Scale (mRS). A favourable outcome was defined as either mRS 0–2 or an unchanged mRS score in patients scoring 3–5 before surgery. From the variables in the data collected, a multiple logistic regression model was constructed. ResultsThe study comprised 180 patients, of whom 134 (74.4%) were male. Median age was 79.2 years (IQR 71.7–85.5), and 129 (71.7%) patients had a favourable outcome at 6 months. In the group with an unfavourable outcome, 18 (10%) had died and 33 (18.3%) had either lost their independence in daily living or become somewhat less independent. The final multiple logistic regression model consisted of pre-surgery variables only: age (OR 0.92, 95% CI 0.87–0.97), CRP (OR 0.96, 95% CI 0.94–0.99), GCS > 13 (OR 3.66, 95% CI 1.09–12.3), Hb (OR 1.03, 95% CI 1.00–1.05), and ASA score < 3 (OR 2.58, 95% CI 0.98–6.79). The whole model had an AUC of 0.88. ConclusionCSDH requiring surgery is associated with high morbidity and mortality at 6 months after surgery. Age, CRP, GCS, Hb and ASA score on admission for surgery are the variables that best predicts outcome. This knowledge can help to identify the patients at greatest risk for an unfavourable outcome, who may need additional support from the health care system. Unstructured abstractChronic subdural haematoma (CSDH) is one of the most common conditions encountered in neurosurgical practice. After surgery, the patients often improve dramatically; but their long-term outcome is more uncertain. The purpose of this study was to investigate predictors of outcome, in terms of the modified Rankin Scale (mRS), 6 months after surgery. The study comprised 180 patients, of whom 134 (74.4%) were male. Median age was 79.2 years (IQR 71.7–85.5), and 129 (71.7%) patients had a favourable outcome at 6 months. In the group with an unfavourable outcome, 18 (10%) had died and 33 (18.3%) had either lost their independence in daily living or become somewhat less independent. The final multiple logistic regression model consisted of pre-surgery variables only: age (OR 0.92, 95% CI 0.87–0.97), CRP (OR 0.96, 95% CI 0.94–0.99), GCS > 13 (OR 3.66, 95% CI 1.09–12.3), Hb (OR 1.03, 95% CI 1.00–1.05), and ASA score < 3 (OR 2.58, 95% CI 0.98–6.79). The whole model had an AUC of 0.88. In conclusion, CSDH requiring surgery is associated with high morbidity and mortality at 6 months after surgery. Age, CRP, GCS, Hb and ASA score on admission for surgery are the variables that best predicts outcome. This knowledge can help to identify the patients at greatest risk for an unfavourable outcome, who may need additional support from the health care system.

Impact of severe aortic stenosis on quality of life.

Among individuals ≥ 65 years old, aortic stenosis is highly prevalent and the number of cases is expected to increase in the coming decades, due to the increased life expectancy. Nevertheless, the actual aortic stenosis burden is not well known in population settings and the impact of aortic stenosis on quality of life has not been studied. The aim of this study was to evaluate aortic stenosis impact on health-related quality of life in patients > 65 years old. An epidemiological case-control study was carried out to compare quality of life in patients ≥65 years old with severe symptomatic aortic stenosis. Demographical and clinical information was prospectively obtained and quality of life information was collected with the Short Form Health Survey_v2 (SF-12) questionnaire. The association between quality of life and aortic stenosis was determined using multiple logistic regression models. Patients with severe aortic stenosis self-perceived worse quality of life on all dimensions and summary components of the SF-12 questionnaire. In the final multiple logistic regression model a significant inverse association was observed between the dimensions 'physical role' and 'social role' (p = 0.002 and p = 0.005) and an association close to significance with 'physical role' (p = 0.052) of the SF-12 questionnaire. The use of quality of life scales allows the assessment of the impact of aortic stenosis on quality of life and may improve the therapeutic approach to severe aortic stenosis, providing evidence for patient-centered care.

Prevalence and Risk Score for Hypertonic Dehydration among Community-Dwelling Older Adults: An Analysis of the Bangkok Falls Study

Introduction: Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which is potentially useful in predicting HD among community-dwelling Thai older adults. Methods: Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand, between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. Results: A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults: age ≥75 years (adjusted odds ratio [aORs] 2.0, 95% confidence interval [CI]: 1.16–3.46), underlying diabetes mellitus (aORs 3.07, 95% CI: 1.77–5.31), and use of β-blocker medication (aORs 1.98, 95% CI: 1.04–3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8% for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. Conclusion: One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1–4 were at 7.4%–32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation.

Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon.

There was a high proportion of pregnant women who were attending prenatal care who were not tested for syphilis or tested but not treated, among priority countries. The coverage for prenatal care visits, syphilis screening, and treatment are priority indicators for monitoring of the elimination of syphilis. The aim was to determine the factors associated with gestational syphilis among postpartum women who were in a prenatal care program in the Brazilian Amazon. An unmatched case-control study was conducted at the hospital in Brazil. Data collection was carried out from November 2020 to July 2021 during hospitalization using a pretested structured questionnaire. The criteria for selection of cases and control followed the guidelines established by the Ministry of Health of Brazil; postpartum women with a laboratory diagnosis based on treponemal and/or nontreponemal tests, symptoms of syphilis or asymptomatic, treatment or not treated, and in a prenatal care program. Gestational syphilis cases were identified as women who tested positive for syphilis, and those who tested negative were controls, at minimally one prenatal care visit, childbirth, and/or the puerperium. The sample size encompassed 59 cases and 118 controls (1: 2 ratio of cases to controls). Data were analyzed using Minitab 20® and BioEstat 5.3® software. The odds ratio was calculated by multiple logistic regression. One hundred and seventy-seven postpartum women were included in the study, 59 cases and 118 controls. Among all participants, 95.5% (169) were tested for syphilis in any trimester during pregnancy and at the delivery and 4.5% (8) were tested in the maternity only, at the time childbirth and/or puerperium. The final multiple logistic regression model evidenced that cases had higher odds compared to controls if they had past history of sexually transmitted infections (AOR: 55.4; p: 0.00), difficulty talking about condom use with their sexual partner (AOR: 4.92; p: 0.01), one to six prenatal care visits (AOR: 4.93; p: 0.01), had not received a sexually transmitted infections test result in the maternity hospital (AOR: 4.09; p: 0.04), lower monthly income (AOR: 4.32; p: 0.04), or one to three miscarriages (AOR: 4.34; p: 0.01). The sociodemographic, programmatic, obstetric, and sexual factors are associated with gestational syphilis among postpartum women.

A cross-sectional survey: Exploring future healthcare workers' intention to use cannabis through extended theory of planned behavior.

Cannabis is the most extensively abused drug, leading to multiple health burdens such as traffic accidents and psychosis. There is a global wave of legalization of recreational and medical cannabis. This study aimed to understand future healthcare workers' intention to use cannabis through extended Theory of Planned Behavior (TPB). An online cross-sectional survey on cannabis, including validated survey tools and questions on demographics, knowledge, and constructs of the TPB was designed, and distributed during virtual classes in late 2020. Responses were obtained from the Faculty of Medicine of a local university. Nine hundred ninety-six responses were collected, of which 629 were complete and analysed. Age was the only demographic variable associated with cannabis use intention (p = 0.029). Respondents with intention had better knowledge of cannabis. All TPB and additional constructs, including perceived behavioral control (COR = 3.44, 95% CI 2.72–4.35, p < 0.001), descriptive norm (COR = 2.24, 95% CI 1.81–2.77, p < 0.001), injunctive norm (COR = 0.51, 95% CI 0.42–0.61, p < 0.001), attitude (COR = 1.23, 95% CI 1.18–1.28, p < 0.001), knowledge (COR = 1.08, 95% CI 1.03–1.14), and perceived availability (COR = 2.75, 95% CI 2.22–3.40, p < 0.001) were individually associated with intention. In the final multiple logistic regression model adjusted for age, only attitude (AOR = 1.19, 95% CI 1.13–1.25, p < 0.001) and perceived availability (p = 0.004) showed statistically significant associations with intention. Descriptive norm (standardized coefficient = 0.570) had better explanatory power than the injunctive norm (standardized coefficient = −0.143) in the model. Perceived behavioral control was associated with intention among respondents with negative to neutral attitudes towards cannabis (AOR = 2.48, 95% CI 1.63–3.77, p < 0.001), but not among those with positive attitudes. All TPB constructs positively correlated with the intention to use cannabis. Changing the attitudes and perceived control on cannabis use may be useful in preventing cannabis use.

Association between Self-Reported Depression with Severe Symptom Burden

Objective: To assess the prevalence of factors associated with a severe ESAS score of 7 points or more in one or more of its domains. Method: Patients admitted to medical clinic wards for three days or more were evaluated. Sociodemographic and clinical data and the ESAS questionnaire were collected. The ESAS has 10 domains, one of which is related to depression. ESAS was used with 10 domains and 9 domains (no depression domain). ESAS was classified as severe (with a score equal to or greater than 7 points in at least one domain) and not severe. Multivariate statistical evaluation identified the independent variables associated with severe and severe ESAS without the depression domain. Results: 93 patients were included in the study, 40 (43.01%) were female. The mean age was 53.11 ± 18.28 years, religion was considered very important by 74 (79.56%), non-white ethnicity was identified in 70 (75.83%) and depression in 16 (17.20%). Severe ESAS was present in 52.69% of patients. The final multiple logistic regression model showed self-reported depression as the only factor associated with severe ESAS in the 10-domain protocol (p = 0.02; OR = 4.30 (95% CI 1.21-15.24)) and as the only factor associated with severe ESAS without the depression domain (p = 0.04; OR = 3.41 (95% CI 1.01-11.53)). Conclusion: The prevalence of severe ESAS was high and the only independent factor associated was self-reported depression. It is necessary to incorporate the assessment of symptoms into the routine of hospital care, especially in patients with self-reported depression.

FACTORS INFLUENCING INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) DISABILITY AMONG ELDERLY ATTENDING HEALTH CLINICS IN KELANTAN

Instrumental activities of daily living (IADL) is a construct that describes the functional ability to perform complex activities, requiring physical and mental capability that allows an elderly to live independently. Studies on IADL in Malaysia are still lacking. Thus, this study aimed to determine the factors influencing IADL disability among the elderly attending health clinics in Kelantan. A cross-sectional study was conducted using a guided questionnaire consisting of sociodemographic characteristics, health-related conditions, Lawton IADL scale, Elderly Cognitive Assessment Questionnaire (ECAQ), Geriatric Depression Scale (GDS), and Duke Social Support Index (DSSI). Multiple logistic regression (MLR) was performed to assess factors influencing IADL disability. Disabled IADL status was defined as having difficulty performing at least one out of eight activities on the Lawton IADL scale. A sample of 248 elderly from 12 health clinics in Kelantan was included, 36.3% of them had disabled IADL status. In the final MLR model, factors influencing IADL disability were, age group 70 years old and above (Adj. OR 3.52; 95% CI: 1.85, 6.69, p-value&lt;0.001), being unmarried/single (Adj. OR 2.37; 95% CI:1.25, 4.49, p-value=0.008), no formal education (Adj. OR 4.03; 95% CI: 1.64, 9.88, p-value=0.002), low level of income (Adj. OR 2.37; 95% CI: 1.11, 5.07, p-value=0.026) and those who reported fair or poor self-rated health status (Adj. OR 2.53; 95% CI: 1.31, 4.89, p-value=0.006). Therefore, recognition of these factors is critical to promote a better health policy and to provide appropriate care for the elderly in the country.

Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study.

BackgroundIn the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood.ObjectiveThe purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management.MethodsWe conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables.ResultsOur sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps.ConclusionsWhen designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management.

Determinants of Rulindo tea farmers’ perception towards organic farming: a MASS::stepAIC() approach

ABSTRACT: The current study determined the factors influencing the perception of tea farmers towards organic tea production in Rulindo District, Rwanda. This study used both qualitative and quantitative data from face to face interviews and questionnaires completed with 156 tea farmers and other key informants in the tea sector who were randomly selected in 2019. Using function step AIC in R’s MASS package, the final multiple logistic regression model showed that generating income from tea production, participation in Umuganda, conveying messages at Ihangari, participation to agricultural shows, and receiving training from Farmers Field Schools (FFS) influenced farmers’ perceptions towards organic tea production. Thus, the results of this study could be useful to stakeholders in Rwanda’s tea sector, such as policymakers and decision-makers. They can act as a source of information when developing a more sustainable research-based tea extension program. Moreover, the results of this study can be used during the capacity building of farmers about organic tea production.

Latrine Utilization and Associated Factors Among Households in SebetaHawas Woreda, Oromia Special Zone, Ethiopia

In developing regions almost half of the population does not have access to improved latrine facilities. In Ethiopia up to 60% of the current disease burden was attributable to poor sanitation. However, the information regarding latrine utilization was minimal in the study area. This study assessed the magnitude of latrine utilization and associated factors among households in SebetaHawas Woreda Oromia special zone, Ethiopia from June 1-20, 2019. Cross-sectional study design was conducted. Using interviewer administered semi-structured questionnaires and observational checklist; data were collected from 631 households by using stratification sampling technique. Then data were entered in to Epi-Info version 7 and analyzed using statistical package for social science (SPSS) version 21. Descriptive statistics were performed to analyze frequencies, percentages, mean and standard deviation to describe the study population. Using bivariate and multivariate logistic regression, independent variables with P-value of <0.25 was considered a candidate for the final multiple logistic regression model. The association was expressed in odds ratio with 95% confidence interval and P-value <0.05 were used as cut-off points to declare significance in the final model. A total of 631 households were assessed for their latrine utilization status with 100% of response rate. The latrine utilization was 68% [(95%CI: 64.8-71.8)] in the study area. In multivariable analysis, respondents with age greater than or equal to 48 years [AOR: 6.24, 95%CI: 1.23-32.91)], collage and above [AOR: 8.02, 95%CI: 6.96-16.52)], family size greater than or equal to five [AOR: 0.51, 95%CI: 0.32 - 0.82], households with no availability of hand washing facility [AOR: 0.36, 95%CI, 0.14-0.89)], knowledgeable towards the use of latrine [AOR: 0.07, 0.02- 0.27)], and no feces observed around the pit hole [AOR: 4.37, 95%CI, 1.78-10.73)] were factors associated with latrine utilization. The magnitude of latrine utilization among households of SebetaHawas Woreda was low. Age, educational status, family size, availability of hand washing facility, knowledgeable towards the use of latrine, cleanliness of latrine were factors which affects latrine utilization. It needs attention to maximize 100% latrine utilization and zero open defecation.

Lymphocyte Count is a Universal Predictor to the Health Status and Outcomes of Patients with Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Regression Analysis

Background: This study aimed to evaluate the prediction capabilities of clinical laboratory biomarkers to the prognosis of COVID-19 patients. Methods: Observational studies reporting at least 30 cases of COVID-19 describing disease severity or mortality were included. Meta-data of demographics, clinical symptoms, vital signs, comorbidities, and 14 clinical laboratory biomarkers on initial hospital presentation were extracted. Taking the outcome group as the analysis unit, meta-regression analysis with the generalized estimating equations (GEE) method for clustered data was performed sequentially. The unadjusted effect of each potential predictor of the three binary outcome variables (i.e., severe vs. non-severe, critically severe vs. non-critically severe, and dead vs. alive) was examined one by one by fitting three series of simple GEE logistic regression models due to missing data. The worst one was dropped one at a time. Then, a final multiple GEE logistic regression model for each of the three outcome variables was obtained. Findings: Meta-data was extracted from 76 articles, reporting a total of 26,627 cases of COVID-19. Patients were recruited across 16 countries. The number of studies (patients) included in the final models of the analysis for severity, critical severity, and mortality was 38 studies (9,764 patients), 21 studies (4,792 patients), and 24 studies (14,825 patients), respectively. After adjusting for the effect of age, lymphocyte count mean or median ≤ 1.03 (estimated hazard ratio [HR] = 46.2594, p Interpretation: Lymphocyte count should be closely watched for COVID-19 patients in clinical practice.Funding: None to declare. Declaration of Interest: None to declare.

English

Pregnancy-induced hypertension has remained a significant cause of prenatal morbidity and mortality of mothers. So this study aims to assess renal function test, serum total protein, and lipid profile concentrations among pregnancy-induced hypertension women in Asrade Zewudie Memorable hospital (ASZMPH), Gojjam, Ethiopia. A case-control study was done on 200 pregnant women: 100 with pregnancy-induced hypertension (case group) and 100 normotensives (control group) at Asrade Zewudie Memorable Primary hospital Gojjam, Ethiopia from January 24, 2020 to April 30, 2020. 5 ml of venous blood was collected on the SST test tube and analyzed for serum lipid profile, renal function test, and serum total protein. The analysis was done by using SPPS software (version 20.0). The level significance was set at a 95% confidence interval (P-value less than 0.05 was considered clinically significant). In the present study, there was a significant increase in the serum TC, TGs, blood urea, serum creatinine, and LDL (p &lt; 0.05) and a significant decrease in HDL cholesterol in case groups as compared to normal groups (p &lt; 0.05). The elevation of serum total protein was not significant (p &gt;0.05). The outcome of the final multiple logistic regression model indicate that factors like BMI, habits of doing scheduled exercise, habit of drinking alcohol, habit of fruit consumption, trimester and gravidity had significant association with lipid profile tests of the study participants. In the present study, the degree of association between different risk factors selected in multiple logistic regression and lipid profile tests was more significant in case group relative with control group. According to the result of this study, early detection of altered lipid profile and renal function test in preeclamptics showed the incidence of complications can be decreased, which in turn reduces the materno-fetal morbidity and mortality. Key words: Lipid profile, serum total protein, renal function test, PIH, and Ethiopia

Development and validation of a Brazilian nomogram to assess sentinel node biopsy positivity in melanoma.

Although well-established, sentinel node biopsy (SNB) for melanoma is not free from controversies and sometimes it can be questionable if SNB should be considered even for patients who meet the criteria for the procedure. Mathematical tools such as nomograms can be helpful and give more precise answers for both clinicians and patients. We present a nomogram for SNB positivity that has been internally validated. Retrospective analysis of patients who underwent SNB from 2000 to 2015 in a single institution. Single logistic regressions were used to identify variables that were associated to SNB positivity. All variables with a p value < 0.05 were included in the final model. Overall performance, calibration, and discriminatory power of the final multiple logistic regression model were all assessed. Internal validation of the multiple logistic regression model was performed via bootstrap analysis based on 1000 replications. Site of primary lesion, Breslow thickness, mitotic rate, histologic regression, lymphatic invasion, and Clark level were statistically related to SNB positivity. After internal validation, a good performance was observed as well as an adequate power of discrimination (area under the curve 0.751). We have presented a nomogram that can be helpful and easily used in daily practice for assessing SNB positivity.

Prevalence of Anxiety and Depression in Persons With Ostomies

PURPOSE: The purpose of this study was to measure the prevalence of anxiety and depression in adults with ostomies and to identify associated factors. DESIGN: A descriptive cross-sectional study. SUBJECTS AND SETTING: The sample comprised 120 adults; all reside in a health region in the state of Minas Gerais in southeastern Brazil. METHODS: Participants responded to a questionnaire designed for purposes of this study. The questionnaire included 2 validated instruments—the Beck Depression Inventory and the Beck Anxiety Inventory. In addition to measuring the prevalence of depression and anxiety, we used logistic regression models to identify factors associated with depression and anxiety. A backward method was adopted and the goodness-of-fit of the model was evaluated through the Hosmer and Lemeshow goodness-of-fit test. An odds ratio (OR) with a 95% confidence interval (95% CI) was used to measure the effect size of these associations. RESULTS: The prevalence of depression in our sample was 26.7% (n = 32; 95% CI, 18.6-34.6). Slightly more than half of respondents (53.1%, n = 17) had mild depression, 34.3% (n = 11) had moderate depression, and 12.6% (n = 4) had had severe depression. The prevalence of anxiety in our sample was 52.5% (n = 63; 95% CI, 43.4-61.5). Slightly less than half 47.6% (n = 30) had mild anxiety; 36.5% (n = 23) reported moderate and 15.9% (n = 10) reported severe anxiety. The final multiple logistic regression model indicated that respondents with less supportive family relationships were more likely to have depression than respondents with greater family support (OR, 3.83; 95% CI, 1.30-11.25). Similarly, respondents with anxiety were more likely to experience depression when compared to individuals reporting no anxiety (OR, 6.32; 95% CI, 2.26-17.65). CONCLUSIONS: Anxiety and depression are prevalent in adults living with an ostomy; anxiety was more prevalent than depression. Respondents with less support from their family and those with anxiety were more likely to experience depression.

Factors associated with high-risk pregnancy: role of environmental contaminants, Brazil

Abstract Introduction The Região Metropolitana da Baixada Santista (RMBS) is considered as a region with the worst maternal and child mortality rates in the state of São Paulo, Brazil. Besides this, RMBS has the worst rates of environmental contamination. High-Risk Pregnancy is one of the factors that lead to a higher chance of morbidity and mortality of the mother and fetus binomial. Objective Evaluate the relationship between exposure to environmental contaminants and high-risk pregnancy. Methodology Case-control study, using a probabilistic sample composed of 402 pregnant women divided into with and without high-risk pregnancy. The instrument used was a self-administered questionnaire and secondary data on contaminated areas obtained from the Environmental Company of the State of São Paulo. Descriptive analysis, Chi-square test, univariate and multiple logistic regression analysis were performed. The participants were also georeferenced by place of residence. Results It was observed an association, by chi-square test between high-risk pregnancy and age over 35 years (p &amp;lt; 0.05), use of insecticide (p &amp;lt; 0.001), consumption of foods packed in plastics (p = 0.050) and manipulation with oil paint (p = 0.002). The final multiple logistic regression model demonstrated that those who live in contaminated areas are 2 times more likely to have a risk pregnancy (OR = 1.993; 95%CI: 1.02; 3.90), as well as identified as jointly important risk factors for pregnancy: working in health services (OR = 3.97 (95%CI: 1.00; 16.09)), use of insecticide (OR = 3.45 (95%CI: 1.66; 7.16)) and use of oil paint (OR = 6.96 (95%CI: 1.38; 35.09)). Conclusions Environmental contaminants play an important role in pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy in RMBS. Key messages Exposure to the environmental contaminants is an important rik factor in the pregnancy. The Região Metropolitana da Baixada Santista (RMBS) is considered as a region with the worst maternal and child mortality rates in the state of São Paulo, Brazil.

Gastroesophageal reflux disease in patients with developmental disabilities

Objetivo: Investigar a prevalência e os fatores associados ao refluxo gastroesofágico em indivíduos de 0 a 33 anos de idade com deficiências do desenvolvimento. Métodos: 628 prontuários odontológicos foram analisados. Os casos de refluxo foram anotados baseados nos relatos dos responsáveis. Variáveis com valor de p menor do que 0.25 foram incluídas no modelo de regressão logística. Variáveis com valor de p menor do que 0.05 foram consideradas como significativas no modelo final. Resultados: ser respirador bucal, usar “outros medicamentos” e ter histórico de convulsões foram fatores associados ao refluxo gastroesofágico entre pacientes com deficiências de desenvolvimento.