Final Multivariate Logistic Regression Analysis Research Articles

Neurodevelopmental impairment following surgical necrotizing enterocolitis with gestational age ≥ 28weeks: who is at risk?

Surgical necrotizing enterocolitis (NEC) is a severe medical condition that, even after surgery, a portion of the survival infants may still have neurological sequelae. The objective of this study was to identify the risk factors associated with the development of permanent neurodevelopmental impairment (NDI) in neonates with surgical NEC. Between January 2016 and June 2022, a retrospective data collection was conducted on 98 individuals who experienced surgical NEC with gestational age ≥ 28weeks. Among these patients, 27 patients were diagnosed with NDI, while the remaining 71 patients did not have NDI. Based on this division, the patients were categorized into the NDI group and the Non-NDI group. Demographics, comorbidities, and admission lab results were analyzed using univariate and logistic regression analyses. Of the 98 neonates following surgical NEC, 27(27.6%) developed permanent neurodevelopmental impairment (NDI). Predictors of NDI were identified through the final multivariable logistic regression analysis, which revealed that gestational age ≤ 32weeks (p = 0.032; odds ratio [OR], 5.673), assisted mechanical ventilation after NEC onset (p = 0.047; OR, 5.299), postoperative acute kidney injury (p = 0.040; OR, 5.106), CRP day 3 after NEC onset (p = 0.049; OR, 1.037), time from presentation to surgery (p = 0.003; OR, 1.047) were significant risk factors. Our study identified gestational age ≤ 32weeks, assisted mechanical ventilation after NEC onset, postoperative acute kidney injury, CRP day 3 after NEC onset, and time from presentation to surgery as significant risk factors for NDI in neonates with surgical NEC. These factors would be helpful to refine treatment modalities for better disease outcomes. We also determined the cut-off values of CRP day 3 after NEC onset and time from presentation to surgery, allowing for the individualized evaluation of NDI risk and the implementation of earlier targeted laparotomy.

The impact of both-bone forearm fractures on acute compartment syndrome: An analysis of predisposing factors

ObjectivesAcute compartment syndrome (ACS) is a severe medical condition that, if left untreated, can cause permanent nerve and muscle damage, and may even require amputation. The objective of this study was to identify the risk factors associated with the development of ACS in patients with both-bone fractures of the forearm. MethodsBetween November 2013 and January 2021, a retrospective data collection was conducted on 611 individuals who experienced both-bone forearm fractures at a level 1 trauma center. Among these patients, 78 patients were diagnosed with ACS, while the remaining 533 patients did not have ACS. Based on this division, the patients were categorized into two groups: the ACS group and the non-ACS group. Demographics (including factors such as age, gender, body mass index, crush injury, etc.), comorbidities (including conditions such as diabetes, hypertension, heart disease, anemia, etc.), and admission lab results (including complete blood count, comprehensive metabolic panel, and coagulation profiles, etc.) were analyzed using univariate analysis, logistic regression, and ROC curve analysis. ResultsPredictors of ACS were identified through the final multivariable logistic regression analysis, which revealed that crush injury (p < 0.001, OR = 10.930), the levels of neutrophils (NEU) (p < 0.001, OR = 1.338) and the levels of creatine kinase (CK) (p < 0.001, OR = 1.001) were significant risk factors. Additionally, age (p = 0.045, OR = 0.978) and albumin (ALB) level (p < 0.001, OR = 0.798) were found to provide protective effects against ACS. Furthermore, the receiver operating characteristic (ROC) curve analysis determined cut-off values for NEU and CK to predict ACS: 7.01/L and 669.1 U/L respectively. ConclusionsOur study identified crush injury, NEU, and CK as significant risk factors for ACS in patients with both-bone forearm fractures. We also determined the cut-off values of NEU and CK, allowing for the individualized evaluation of ACS risk and the implementation of early targeted treatments.

Clinical Predictors of Pathologically Positive Temporal Artery Biopsy

Temporal arteritis (TA) can present with a wide spectrum of symptoms and lab findings, including temporal headaches, vision changes, jaw or tongue claudication, fevers, and elevated serum inflammatory markers. Here, we review a large series of patients who have undergone temporal artery biopsies. A retrospective review of all patients who underwent temporal artery biopsies within our health system from January 2005 to January 2022 was performed. Patients were selected using the Current Procedural Terminology code for temporal artery biopsy (37609). Chart review was performed to determine demographic, clinical, laboratory, and operative characteristics, as well as pathologic outcome. The primary outcome was the final pathology result of the biopsy. Patients with non-diagnostic pathology reports were excluded from the study. Variables that met a P-value < .1 in univariate analysis were included in the final multivariable logistic regression analysis. A separate sensitivity analysis was performed on a cohort with complete lab data. We identified 613 patients who underwent temporal artery biopsies across three hospitals within our health system from January 2005 to January 2022. The average age of the cohort was 73.2 ± 11.2 years. The majority of the patients, 70.5% (n = 430), were female. The most common presenting symptom was a headache, which was present in 254 (41.4%) of patients. Older age (>65), white race, lower body mass index (BMI), presence of jaw claudication, lack of blurry vision, elevated erythrocyte sedimentation rate, elevated C-reactive protein, elevated platelet count, and longer biopsy length were associated with a positive biopsy on univariate analysis (P < .05) (Table I). Specimen length did not differ significantly between groups with positive and negative pathology, nor by bilateral versus unilateral biopsy or surgeon specialty. On multivariate analysis, the presence of jaw claudication (odds ratio [OR], 3.69; P < .001) was associated with a positive biopsy. Black race was associated with a lower odds of a positive biopsy (OR, 0.27; P < .001). On sensitivity analysis, erythrocyte sedimentation rate levels above 40 were significantly associated with increased odds of a positive biopsy (OR, 7.53; P = .009). Platelet counts of 401 to 600 (OR, 7.60; P < .001) and above 600 (OR, 7.15; P = .006) were also significantly associated with a positive biopsy. Clinical and patient features including the symptom of jaw claudication, elevated erythrocyte sedimentation rate, elevated platelet count, and white race are associated with positive temporal artery biopsy. Further work is needed to determine who benefits most from this procedure.TablePatient characteristics and biopsy outcomesTotalNegative biopsy resultPositive biopsy resultP-valueN = 613n = 523n = 90Age, years <5011 (1.8)10 (1.9)1 (1.1).009 50-64109 (17.8)103 (19.7)6 (6.7) 65-79313 (51.1)266 (50.9)47 (52.2) 80+180 (29.4)144 (27.5)36 (40.0)Sex Female430 (70.5)374 (71.8)56 (62.9).090 Male180 (29.5)147 (28.2)33 (37.1)Race/ethnicity White322 (52.8)250 (48.1)72 (80.0)<.001 Black229 (37.5)216 (41.5)13 (14.4) Other/unknown59 (9.7)54 (10.4)5 (5.6)BMI Underweight (BMI <18.5)11 (1.8)7 (1.3)4 (4.4)<.001 Healthy (18.5 ≤ BMI < 25)168 (27.4)123 (23.5)45 (50.0) Overweight (25 ≤ BMI < 30)172 (28.1)150 (28.7)22 (24.4) Obese (BMI ≥30)262 (42.7)243 (46.5)19 (21.1)Preoperative steroid use Yes392 (68.7)330 (67.8)62 (73.8).27Preoperative aspirin use Yes254 (45.3)218 (45.5)36 (43.9).79Past medical history of other rheumatic disease Yes147 (25.2)130 (26.1)17 (20.2).26History of polymyalgia rheumatica Yes62 (26.6)53 (26.4)9 (28.1).83Bruit Yes3 (0.5)3 (0.6)0 (0.0).47Fever Yes41 (6.7)32 (6.1)9 (10.0).17Headache Yes254 (41.4)216 (41.3)38 (42.2).87Tenderness Yes130 (21.2)111 (21.2)19 (21.1).98Bilateral tenderness Yes26 (4.2)19 (3.6)7 (7.8).072Jaw claudication Yes95 (15.6)64 (12.3)31 (34.8)<.001Tongue claudication Yes0 (0.0)0 (0.0)0 (0.0)Blurry vision Yes111 (18.1)102 (19.5)9 (10.0).030Double vision Yes18 (2.9)13 (2.5)5 (5.6).11Tinnitus Yes6 (1.0)5 (1.0)1 (1.1).89Erythrocyte sedimentation rate at diagnosis <2050 (9.4)48 (10.6)2 (2.5).008 20-4059 (11.1)55 (12.1)4 (5.1) 40+423 (79.5)350 (77.3)73 (92.4)C-reactive protein at diagnosis <3140 (33.5)128 (36.1)12 (19.0)<.001 3-1083 (19.9)68 (19.2)15 (23.8) 11-2060 (14.4)58 (16.3)2 (3.2) 20+135 (32.3)101 (28.5)34 (54.0)Platelet count at diagnosis <200112 (20.5)104 (22.3)8 (9.9)<.001 200-400356 (65.1)314 (67.4)42 (51.9) 401-60063 (11.5)38 (8.2)25 (30.9) 601-800+16 (2.9)10 (2.1)6 (7.4)Alk-Phos (continuous)93.1 (65.9)92.9 (66.8)94.2 (62.1).90White blood cells (continuous)11.0 (17.8)10.8 (19.0)11.6 (8.1).71Longest length of biopsy specimen, cm (continuous)1.9 (0.9)1.9 (0.9)2.1 (1.0).057Boldface P indicates P-value < .1, used in multivariate analysis.Data are presented as number (%) or mean (standard deviation). Open table in a new tab

Factors and cytokine signatures associated with the response to therapy in patients with primary biliary cholangitis-autoimmune hepatitis overlap syndrome: a real-world study.

Factors and cytokine signatures associated with the response to therapy in patients with primary biliary cholangitis-autoimmune hepatitis overlap syndrome: a real-world study.

Epidemiological factors associated with helminths and coccidia in zebu calves under pastoralism in Isiolo County Kenya

In Kenya, helminthosis and coccidia infections in cattle, are the second highest cause of death in zebu calves up to 12 months old, estimated at 12% mortality rate. The aim of our study was to investigate the factors associated with helminth and coccidia infection among zebu beef calves in Isiolo County Kenya. A cross-sectional study was conducted between November and December on 2020 in Isiolo North and South Constituencies. Garbatulla and Burat wards in Isiolo North and Kinna in Isiolo South were purposively selected due to high number of large cattle herds compared to other areas. A total of 411 calves from 34 herds aged between 3 weeks and 12 months were randomly selected for the study. Calf level and management and environmental data were collected through semi-structured questionnaires, observations and physically. Faecal samples were obtained from the rectum or immediately after defaecation for laboratory analysis located in Kinna Ward in Isiolo South Constituency. In the laboratory, faecal egg counts were estimated using the McMaster faecal floatation technique. Descriptive, univariate and multivariable logistic regression analyses were carried out with outcome as parasites eggs or oocysts per gram of faecal sample. The factors associated with coccidia infections in the final multivariable logistic regression analysis for coccidia were: Location (Constituencies), availability of drinking water, lush pasture, floor condition, availability of extension services and herd size. In the multivariable logistic regression final model for strongyle infection, age of the calf, herd size, co-infestation with other parasites, and availability of extension services were significant. The results of this study indicated that prevalence of helminth and coccidia infections in calves is high and the calf, environmental and management factors were associated with such infections.

Factors associated with nonunion of the posttraumatic subtalar arthrodesis after displaced intra-articular calcaneal fractures

BackgroundThis study investigated the incidence of and risk factors for nonunion in patients with posttraumatic subtalar arthrodesis (SA). MethodsWe retrospectively reviewed 165 posttraumatic SA cases. Nonunion was diagnosed at 6 months after surgery based on the findings of clinical evaluations, plain radiographs, and CT scans. Patient-specific factors and surgeon-specific factors were evaluated as potential risk factors. ResultsThe overall nonunion rate was 13.3 % (22 of 165 cases). In the final multivariate logistic regression analysis, smoking (odds ratio [OR] = 3.64; 95 % confidence interval [CI] = 1.23–10.75), parallel screw configuration (OR = 5.70; 95 % CI = 1.62–20.06), and freeze dried iliac crest (OR = 9.16; 95 % CI = 2.28–36.79) were demonstrated as risk factors for nonunion of posttraumatic SA. ConclusionPatients with a history of smoking, parallel screw configuration fixation, and those who received freeze dried iliac crest as an interpositional graft, had a significantly higher rate of nonunion.

Prevalence status and associated factors of wrist postural injury in the Chinese occupational population.

This study investigated the prevalence of wrist injuries in 15 industries and different types of work in China. Study on the associated factors of wrist injuries provides a scientific basis for prevention and treatment of wrist diseases in occupational workers. A cross-sectional study of musculoskeletal symptoms of related practitioners in 15 industries, including automobile manufacturing, was conducted to retrieve worker demographic information, working wrist posture, and pain conditions. Multivariable binary logistic regression analyses were performed to identify factors associated with work-related musculoskeletal disorders (WMSDs). The prevalence of wrist injuries among the study population was 13.2%. Toy manufacturing, animal husbandry, automobile manufacturing, shoe manufacturing, and biopharmaceutical manufacturing had the highest wrist injury rates at 29.1, 19.1, 14.9, 14.9, and 14.0%, respectively. Among the types of jobs, enamel workers (63.0%), butchers (43.6%), combers (32.5%), welders (31.3%), and scaffolders (26.5%) had the highest prevalence rates. Based on the final multivariate logistic regression analysis: female [odds ratios (OR) = 1.24; 95% confidence interval (CI), 1.15-1.35], 6-10 years of service (OR = 1.11; 95% CI, 1.03-1.18), >10 years of service (OR = 1.15; 95% CI, 1.06-1.25), frequent upward and downward flexion in wrist posture at work (OR = 1.81; 95% CI, 1.84-2.11), and frequent wrist placement on the edge of angular objects increased the OR of injury (OR = 1.52; 95% CI, 1.44-1.61). Need to squeeze objects tightly while working (OR = 1.72; 95% CI, 1.57-1.89), prolonged wrist flexion (OR = 1.86; 95% CI, 1.75-1.97), and work hand position above the shoulder for prolonged periods (OR = 1.11; 95% CI, 1.04-1.19) also suggested the relationship between these factors and the higher prevalence of wrist injury in the workers. The associated factor was physical activity (OR = 0.86; 95% CI, 0.80-0.94). This study suggested the relationship between these factors and the higher prevalence of wrist injury in the toy manufacturing, animal husbandry, automobile manufacturing, and shoe-making industries, enamel workers, butchers, and combers. And are work types that require special attention. Females, working age, physical activity, and abnormal posture of the wrist were factors significantly associated with WMSDs.

Factors Affecting the Use of Private Outpatient Services among the Adult Population in Malaysia.

The proportion of Malaysians of all ages who use private outpatient services has dropped over time, highlighting the overstretched condition of public outpatient facilities compared to their private counterparts. This paper aims to determine the prevalence of outpatient care, characteristics of outpatient care users by sector, and the factors affecting the utilisation of private outpatient services among the adult population of Malaysia using Andersen’s behavioural model. Data from the National Health Morbidity Survey 2019 (NHMS 2019), a nationwide survey, were analysed. Logistic regression analysis was performed to explore the association of predisposing (locality, age, sex, ethnicity, education level, and marital status), enabling (working status, health care coverage, and household income), and need factors (perceived and evaluated needs) with the use of private outpatient services. Variables with a statistical significance ≤ 0.25 in the univariate regression analysis were included in the final multivariable logistic regression analysis. A total of 11,674 respondents, estimated to represent 22.4 million adults aged 18 years and above in Malaysia, were included for analysis. Overall, 8.3% of the adult population of Malaysia used outpatient care and 33.9% used the private sector. Those living in urban areas (OR = 1.80, 95% CI = 1.02, 3.18), non-Malays (OR = 1.74, 95% CI = 1.04, 2.93), those working (OR = 2.47, 95% CI = 1.48, 4.10), those with employer coverage (OR = 4.73, 95% CI = 2.79, 8.01), and those with health problems (OR = 2.26, 95% CI = 1.26, 4.05) were more likely to utilise private outpatient services. Those who self-rated their health status as fair (OR = 0.54, 95% CI = 0.33, 0.91) and who had diabetes, hypertension, or hypercholesterolemia (OR = 0.56, 95% CI = 0.31, 1.02) were less likely to utilise private outpatient services. The predisposing and enabling factors were associated with the use of private outpatient services, and the need factors were strong predictors of private outpatient care utilisation among adults. Understanding the factors associated with the utilisation of private outpatient services could aid in the development of effective initiatives designed to enhance outpatient care access among the population of Malaysia and balance the burden of outpatient care provision on the public and private sector.

Factors associated with acute symptomatic seizure occurrence among patients with posterior reversible encephalopathy syndrome

ObjectivesWe aimed to define the factors associated with acute symptomatic seizure occurrence in posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. Materials and methodsWe conducted a retrospective cohort study enrolling patients with PRES admitted to the hospital between 2006 and 2019. In addition to seizure characteristics, baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the seizure and non-seizure groups. Factors with p-value <0.05 in the univariate analysis were entered into the first model of multivariate logistic regression analysis to determine the factors associated with seizure occurrence if the p-value <0.05. The interaction of associated factors was also analyzed in the final multiple logistic regression analysis model. ResultsAcute symptomatic seizure, which is mainly based on the clinical documentation without electroencephalography, occurred in 50.0% of 136 patients with PRES. Of these, early seizures within 14 days of PRES occurred in 98.5% which mostly developed at presentation (82.4%) with a single seizure attack (55.9%). Convulsive seizures (77.9%) were the most common seizure semiology. The seizure group was significantly younger (median [interquartile range: IQR] 36.00 years old (21.75–48.50) vs 46.50 years old (31.25–61.00), p = 0.003). In univariate analysis, the seizure group had a higher prevalence of consciousness impairment (61.76% vs 26.47%, p < 0.001), Glasgow coma scale (GCS) score of 0–13 (42.46% vs 13.23%, p < 0.001), preeclampsia (20.58% vs 4.41%, p = 0.004), autoimmune disease (17.65% vs 5.88%, p = 0.033), and frontal lesions (25.00% vs 11.76%, p = 0.046) than those in the non-seizure group. In contrast, the seizure group had a lower prevalence of headache (27.94% vs 61.76%, p < 0.001). In the final multivariate logistic regression analysis which included the interaction terms, the acute symptomatic seizure occurrence directly associated with preeclampsia (adjusted odds ratio (aOR) 6.426, 95% confidence interval (CI) 1.450–27.031, p = 0.016) and autoimmune disease (aOR 4.962, 95% CI 1.283–18.642, p = 0.025), while headache showed a reverse association (aOR 0.310, 95% CI = 0.158–0.721, p = 0.008). ConclusionsAcute symptomatic seizure occurred in a half of patients with PRES in this cohort. Preeclampsia and autoimmune disease were directly associated with seizure occurrence, while headache showed a reverse association.

Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia.

BackgroundVertical transmission of HIV remains one of the most common transmission modes. Antiretroviral therapy (ART) decreases the risk of transmission to less than 2%, but maintaining adherence to treatment remains a challenge. Some of the commonly reported barriers to adherence to ART include stress (physical and emotional), depression, and alcohol and drug abuse. Integrating screening and treatment for psychological problem such as depression was reported to improve adherence. In this study, we sought to determine the prevalence of depression and its association with adherence to ART among HIV-positive pregnant women attending antenatal care (ANC) clinics in Addis Ababa, Ethiopia.MethodsWe conducted a cross-sectional survey from March through November 2018. Participants were conveniently sampled from 12 health institutions offering ANC services. We used the Patient Health Questionnaire-9 (PHQ-9) to screen for depression and the Center for Adherence Support Evaluation (CASE) Adherence index to evaluate adherence to ART. Descriptive statistics was used to estimate the prevalence of depression during third-trimester pregnancy and nonadherence to ART. A bivariate logistic regression analysis was used to get significant predictors for each of the two outcome measures. The final multivariable logistic regression analysis included variables with a P<0.25 in the bivariate logistic regression model; statistical significance was evaluated at P<0.05.ResultsWe approached 397 eligible individuals, of whom 368 (92.7%) participated and were included in the analysis. Of the total participants, 175(47.6%) had depression. The participants’ overall level of adherence to ART was 82%. Pregnant women with low income were twice more likely to have depression (AOR = 2.10, 95%CI = 1.31–3.36). Women with WHO clinical Stage 1 disease were less likely to have depression than women with more advanced disease (AOR = 0.16, 95%CI = 0.05–0.48). There was a statistically significant association between depression and nonadherence to ART (P = 0.020); nonadherence was nearly two times higher among participants with depression (AOR = 1.88, 95%CI = 1.08–3.27).ConclusionWe found a high prevalence of depression among HIV-positive pregnant women in the selected health facilities in Addis Ababa, and what was more concerning was its association with higher rates of nonadherence to ART adversely affecting the outcome of their HIV care. We recommend integrating screening for depression in routine ANC services.

Factors associated with lifetime suicide attempts in bipolar disorder: results from an Italian nationwide study

The purpose of the present study was to detect demographic and clinical factors associated with lifetime suicide attempts in Bipolar Disorder (BD). A total of 1673 bipolar patients from different psychiatric departments were compared according to the lifetime presence of suicide attempts on demographic/clinical variables. Owing to the large number of variables statistically related to the dependent variable (presence of suicide attempts) at the univariate analyses, preliminary multiple logistic regression analyses were realized. A final multivariable logistic regression was then performed, considering the presence of lifetime suicide attempts as the dependent variable and statistically significant demographic/clinical characteristics as independent variables. The final multivariable logistic regression analysis showed that an earlier age at first contact with psychiatric services (odds ratio [OR] = 0.97, p < 0.01), the presence of psychotic symptoms (OR = 1.56, p < 0.01) or hospitalizations (OR = 1.73, p < 0.01) in the last year, the attribution of symptoms to a psychiatric disorder (no versus yes: OR = 0.71, partly versus yes OR = 0.60, p < 0.01), and the administration of psychoeducation in the last year (OR = 1.49, p < 0.01) were all factors associated with lifetime suicide attempts in patients affected by BD. In addition, female patients resulted to have an increased association with life-long suicidal behavior compared to males (OR: 1.02, p < 0.01). Several clinical factors showed complex associations with lifetime suicide attempts in bipolar patients. These patients, therefore, require strict clinical monitoring for their predisposition to a less symptom stabilization. Future research will have to investigate the best management strategies to improve the prognosis of bipolar subjects presenting suicidal behavior.

Associated Factors of Plasmodium Knowlesi Malaria among Registered Malaria Cases in Terengganu, Malaysia 2011- September 2019 via Vekpro Online Database

Introduction: Plasmodium knowlesi (P. knowlesi), zoonotic malaria cases had been increasing in trend in Terengganu, Malaysia. This study aimed to determine the associated factors of P. knowlesi malaria among registered malaria cases in Terengganu from 2011 to September 2019 via the Vekpro Online Database. Methods: A cross-sectional study was conducted using registered malaria cases in Terengganu from 2011 to September 2019 extracted from the Vekpro Online database and secondary weather data from the Malaysian Meteorological Department. A total sample of 247 malaria cases [(P. knowlesi (n=187), P. falciparum (n=23), P. vivax (n=37), P. malariae (n=4), mixed infection (n=3)] were analysed. The cases were grouped into P. knowlesi group (P. knowlesi, P. malariae, mixed infection) and non-P. knowlesi group (P. falciparum, P. vivax) for comparison of their risk factors. Multiple Logistic Regression analysis was used to identify the associated factors. Results: Plasmodium knowlesi group contributed to 187 out of 247 (75.7%) of all malaria cases. Four factors were found to be significantly associated with P. knowlesi group in the final multivariable logistic regression analysis. Age [AOR=1.04 (95% CI: 1.01,1.08)], Malay race [AOR=39.43 (95% CI: 13.99,111.18)], agriculture and forestry worker [AOR=14.95 (95% CI: 4.10,54.51)] and Passive Case Detection [AOR=11.70 (95% CI: 2.60,52.63)] were the significant associated factors. Conclusion: Identified significant associated factors and characteristics of the high-risk group for P. knowlesi infection can help medical and health front liners in Terengganu in early diagnosis and prompt treatment of the cases. The factors also will help in the planning and development of health interventions in targeting P. knowlesi infection.

Investigation of Foot-and-Mouth Disease Outbreaks in Dairy Cattle from Kageshwari and Shankharapur Municipalities, of Kathmandu, Nepal and Associated Risk Factors from March to April 2020

Foot and mouth disease (FMD) is endemic in Nepal and significantly impacts the livelihood of farmers, national economy, and trade of Nepal. However, outbreak investigations are not frequently conducted, and there have been limited studies to understand the associated risk factors. A case-control study was performed in dairy cattle farms of Shankharapur and Kageshwari Municipalities, Kathmandu from March to April 2020 to describe the outbreak and identify the risk factors associated with FMD. There were 31 case farms, while 62 farms were selected as control farms (1:2). The information from case and control farms was collected by semi-structured questionnaire survey through field visits and observations. The univariable and multivariable logistic regressions were performed. The farm-level prevalence of FMD was 25.2% (n=31/123). Among the FMD affected farms, the proportion of positive farms in Shankharapur (61.3% (19/31)) was significantly higher than Kageshwori (38.7% (12/31)). The final multivariable logistic regression analysis identified four variables: cattle purchased within 14 days (OR=12.9; CI=2.4-69.5), milk market distance less than two kilometers from the farm (OR=32.7; CI=5.8-186.3), sharing of the bull from other farms for natural insemination (OR=5.7; CI=1.2-26.8), and no vaccination against FMD in the past six months (OR=19.1; CI=2.0-186.2) as significant risk factors for the occurrence of FMD. This study suggests farmers vaccinate their dairy cattle with FMD vaccine as per the vaccination schedule suggested by the veterinarians, practice quarantine measures when new animals are introduced to their farms, practice biosecurity measures in their farms, and do not use bulls from areas where there are ongoing FMD outbreaks.

High conversion rate to total hip arthroplasty after hemiarthroplasty in young patients with a minimum 10 years follow\u2010up

BackgroundThis study aimed to evaluate the follow-up results of bipolar hemiarthroplasty (BHA) for more than 10 years in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA.MethodsThis retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons.ResultsReoperation was performed in 44 of the 114 patients (38.6 %). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2 % at 5 years, 48.8 % at 10 years, and 25.9 % at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years.ConclusionsThe minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient’s choice, keeping in mind that long-term survival cannot be guaranteed.

Predictors of Preterm Birth among Mothers Who Gave Birth in Silte Zone Public Hospitals, Southern Ethiopia.

Background A preterm birth is the leading cause of death in both neonatal and children under five years of age every year throughout the world, particularly in Sub-Saharan Africa. The causes of a preterm birth are complex and multifactorial; many risk factors that contribute it are not fully understood. The aim of this study was to identify predictors of a preterm birth among mothers who gave birth in Silte Zone Public Hospitals, Southern Ethiopia (2019/20). Methods and Materials A hospital-based unmatched case-control study design was carried out from July 15th to October 30th, 2019, by assigning mothers who gave preterm births as cases and those with term births as controls. A total of 365 respondents (91 cases and 274 controls) were selected by a consecutive simple random sampling until the required sample size was achieved. For each case, three consecutive controls were included. Data were collected using a structured interview questionnaire complement with record reviewing. The data were entered into Epi Info 7 and exported into SPSS 25 for analysis. Descriptive analysis was computed to obtain summary values for cases and controls separately. All candidate variables in bivariate analysis were entered into the multivariable logistic regression model by using the backward likelihood ratio selection methods. Finally, variables with p value ≤ 0.05 were considered as potential determinants of a preterm birth and reported in the form of adjusted odds ratio with 95% confidence interval. Results Among a total of 365 mothers who gave live birth, 91 (24.9%) were cases compared to 274 (75.1%) which were controls. The final multivariable logistic regression analysis results showed that having history of a previous preterm birth (AOR = 3.51; 95%CI = 1.40 − 8.81), having shorter interpregnancy interval (AOR = 4.46; 95%CI = 1.95 − 10.21), experiencing obstetric complication (AOR = 3.82; 95%CI = 1.62 − 9.00), and having infant born with low birth weight (AOR = 5.58; 95%CI = 2.39 − 13.03) were found to be independent predictors of a preterm birth. Conclusions According to this finding, mothers having previous history of a preterm birth, experiencing obstetric complication, having shorter interpregnancy interval, and having infant born with low birth weight were reported as the independent predictors of a preterm birth. Improving the quality of antepartum and intrapartum, counseling on birth space, creating awareness on family planning, and early screening of preterm determinants are mandatory.

Unsafe disposal of faeces and its correlates among children under three years in Eswatini

Background. It has long been established that human excreta contain over 50 pathogens that are transmitted via the faecal route, yet the common practice of unsafe disposal of children’s faeces still persists in developing countries. Objective. To identify the factors associated with unsafe disposal of children’s faeces among children under three years of age in Eswatini. Methods. The study was based on combined data for the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys, from which 2 765 children aged less than three years were included in the analysis. The analysis was based on logistic regression using weighted survey data. Results. Overall, 41.8% of the childrens’ faeces were disposed of unsafely. In the final multivariable logistic regression analysis, the odds of unsafe disposal of children’s faeces were lower for households whose children were aged 12 months and older, compared with households whose children were under six months. Households with a pit latrine were less likely to dispose of child faeces unsafely, while the practice of unsafe disposal of children’s faeces was more common in households with no toilet facility compared with those from households with a flush toilet. The practice of unsafe disposal of children’s faeces was more common in urban areas than in rural areas. Regionally, lower odds of unsafe disposal of children’s faeces were observed among households from the Manzini and Shiselweni regions, compared with those from the Lubombo region. Conclusion. The study demonstrated that child age, toilet facilities, place of residence, and region of residence were associated with unsafe disposal of children’s faeces.

Urban Health Extension Program and Health Services Utilization in Northwest Ethiopia: A Community-Based Study.

PurposeEthiopia is one of the developing countries striving to achieve universal health coverage using the health extension program (HEP). However, there is limited evidence on the utilization of the urban health extension program (UHEP), particularly in the northwest part of the country. Therefore, this study aimed to assess the level of urban health extension program utilization and its associated factors in Gondar administrative city, northwest Ethiopia.Patients and MethodsA community-based cross-sectional study was employed from March 15 to May 30, 2019. A total of 626 systematically selected mothers were interviewed using an interviewer-administered structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis, a P-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare the factors associated with the utilization of urban health extension services.ResultsThe utilization level of urban health extension services was found to be 59.5% (95% Cl=55.8–63.6). The result indicated that two-fifths of the participants were not utilizing the services. Private employees (AOR=0.37, 95% Cl=0.21–0.63), housewives (AOR=0.36, 95% Cl=0.20–0.64), merchants (AOR=0.08, 95% Cl=0.03–0.17), satisfactory knowledge (AOR=4.37, 95% Cl=2.73–6.96), perceived accessibility of services (AOR=1.68, 95% CI=1.02–2.74), and perceived competence of HEWs (AOR=1.97, 95% Cl=1.22–3.18) were factors significantly associated with the utilization of urban health extension services.ConclusionThe overall utilization of the urban health extension program was low compared to the national recommendation. Occupation, knowledge of participants towards UHEP, accessibility of health extension services, and participants’ perception about the competency of HEWs were factors associated with utilization of UHEP. Therefore, awareness creation, in-service training, improving the accessibility of services and frequency of contact with mothers at the household level will increase the services utilization.

Determinants of postnatal care non-utilization among women in Demba Gofa rural district, southern Ethiopia: a community-based unmatched case-control study

BackgroundMaternal and neonatal mortality remain a significant problem across much of the developing world, especially in sub-Saharan Africa countries. In Ethiopia, most maternal and neonatal deaths occur during the postpartum period; this is a critical time for monitoring the health of women and newborns, but the most neglected period for care. In rural communities of Ethiopia, the utilization of postnatal care service is very low and evidence on which factors contribute to the non-utilization of postnatal care (PNC) is insufficient. Consequently, this study was designed to identify the determinants of postnatal service non-utilization among women who gave birth in Demba Gofa rural district, Southern Ethiopia.MethodsA community-based unmatched case-control study was conducted among 186 cases (postnatal care non-utilizers) and 186 controls (postnatal care utilizers) in Demba Gofa rural district from March 1 to April 10, 2019. A previously tested interviewer-administered structured questionnaire was used for data collection. Binary logistic regression analysis was performed. In the final multivariable logistic regression analysis model, a p-value of less than 0.05 and an Adjusted Odd Ratio (AOR) with a 95% confidence interval (CI) was used to determine variables for postnatal care non-utilization.ResultsIn this study, women who delivered recently were incorporated within 186 cases and 186 controls. Not knowing the availability of PNC services (AOR: 4.33, 95% CI: 1.71–10.99), having a home delivery (AOR: 7.06, 95% CI: 3.71–13.44), ANC non-attendance (AOR: 6.14, 95% CI: 3.01–12.50), unable to make an independent decision (AOR: 9.31, 95% CI: 3.29–26.35), and not participating in the Women’s Development Army (WDA) (AOR: 5.09, 95% CI: 2.73–9.53) comprised the determinants which were assessed for non-utilization of postnatal care services.ConclusionsEncouraging institutional delivery along with integrated health education about postnatal care and postnatal danger signs, empowering women to execute independent decisions, accessing PNC services and strengthening participation in the Model Families will likely improve postnatal care service utilization in the district of Ethiopia.

A prediction model for detrusor overactivity at ambulatory urodynamics in women with urinary incontinence

Objective(s)To develop a multivariable model using both clinical examination findings and validated questionnaires’ scores for predicting the presence of detrusor overactivity observed during ambulatory urodynamic monitoring in women with urinary incontinence. Study DesignThe study population was chosen from a registry of women evaluated with urodynamics for urinary incontinence retrospectively. Data for baseline characteristics, clinical findings, and ambulatory urodynamic records were evaluated for all women included to the study. Urodynamic data were obtained by retrospective review of urodynamic traces with a standardized protocol during single voiding cycle, compatible to the standards of International Continence Society (ICS) for ambulatory urodynamic monitoring. ResultsA total of 395 women with urinary incontinence were included in the study. Detrusor overactivity was diagnosed in 57.1% of women included to the study. Clinical factors positively associated with detrusor overactivity were higher body-mass index (OR = 1.10; 95% CI 1.03−1.15, p < 0.001), higher OAB-V8 (Overactive bladder awareness tool - version 8) scores (OR = 1.04; 95% CI 1.01−1.06, p < 0.001) and presence of urgency urinary incontinence (OR = 2.39; 95% CI 1.47−3.81, p < 0.001). The presence of postural urinary incontinence (OR = 0.51; 95%CI 0.28−0.90, p = 0.021) and insensible loss of urine (OR = 0.33; 95%CI 0.27−0.93, p = 0.005) had negative associations with detrusor overactivity in the final multivariate logistic regression analysis. Conclusion(s)BMI, OAB-V8 scores, urgency urinary incontinence, postural urinary incontinence and insensible loss of urine were associated with the presence of detrusor overactivity according to our prediction model. However, the overall model accuracy suggests urodynamic studies are still needed for a definitive diagnosis. Nevertheless, the prediction may be beneficial for selecting a subgroup of women who are unlikely to benefit from ambulatory urodynamic monitoring for the diagnosis of detrusor overactivity.

Factors associated with institutional delivery practice among women in pastoral community of Dubti district, Afar region, Northeast Ethiopia: a community-based cross-sectional study

BackgroundEighty-five percent of the global burden of maternal mortality was covered by Sub-Saharan Africa. Ethiopia is a major contributor to the death of mothers with a maternal mortality ratio of 676 per 100,000 live births. Only 10% of deliveries in Ethiopia were at health facility with the least (6.4%) in the Afar region. However, there is limited evidence about factors of institutional delivery in the study area. Thus, this study aimed to assess the magnitude and associated factors of institutional delivery practice among women in the pastoral community of Dubti district, Northeast Ethiopia.MethodsA community based cross-sectional study was conducted from April to May 2016, in the pastoral community of Dubti district. A total of 381 women were selected using systematic sampling technique and interviewed using a standardized structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to declare the factors associated with institutional delivery.ResultsThis study revealed that 35.2% (95% CI: 30.5–40.1) of women were delivered at the health facility. Women who had travelled less than an hour to reach the nearest health facilities (AOR: 4.90, 95% CI: 2.62–9.18), attending antenatal care (AOR: 2.50, 95% CI:1.48–4.23), previous history of stillbirth (AOR: 4.34, 95% CI: 1.78–10.58), good knowledge (AOR: 2.09, 95% CI:1.23–3.56), and husband involved in decision making on delivery place (AOR: 4.42, 95% CI: 1.98–9.90) were the factors associated with institutional delivery practice.ConclusionsThe overall institutional delivery practices in the study area was low as compared to the national level. This low practice of institutional delivery was contributed by residing far from the facility, does not received antenatal care, and having low awareness about ANC follow up and institutional delivery services. Therefore, strengthening the accessibility of health facility to nearby mothers resided, antenatal care services, and awareness creation provision at the community level for pregnant women in the pastoral community can improve institutional delivery practice.