Firth Logistic Regression Research Articles

Concurrent sodium channel myotonia and amyotrophic lateral sclerosis supports shared pathogenesis

Amyotrophic lateral sclerosis (ALS) is an invariably fatal adult-onset neurodegenerative disorder; 10% of ALS is autosomal dominant but even sporadic ALS exhibits significant heritability. Dysfunctional voltage- gated sodium channels (NaVs) have been implicated in both sporadic and familial forms of the disease, but it is unclear whether these are an upstream cause or a downstream consequence. Rare missense mutations in the SCN4A gene, encoding NaV1.4, disrupt membrane excitability and cause autosomal dominant muscle channelopathies such as myotonia and hypo/hyperkalaemic periodic paralysis. We report two patients with congenital SCN4A channelopathy due to p.S1159P and p.R672H mutations who developed ALS in later life. Based on our finding we hypothesised that ALS may be linked to genetic mutations in other voltage gated ion channels. Rare-variant burden testing using whole genome sequenc- ing data from 4,495 ALS patients and 1,925 controls within the superfamily of voltage-gated ion channels (Accession: ssf81324) identified one gene, SCN7A, which passed multiple testing correction (p=0.0002, Firth logistic regression) consistent with an enrichment of ALS-associated mutations. We propose that genetic mutations within NaVs leading to neuromuscular excitotoxicity are an upstream cause of ALS. Early identification of ALS patients carrying NaV mutations might lead to personalised therapy with a sodium channel-blocking agent such as riluzole.j.franklin@doctors.org.uk

Inflammation‐related immune proteins in maternal plasma as potential predictive biomarkers for rescue cerclage outcome in women with cervical insufficiency

This study aimed to determine whether various novel plasma mediators of immune regulation associated with inflammation could independently predict the clinical outcome of rescue cerclage in patients with cervical insufficiency (CI). A total of 41 singleton pregnant women (17-25weeks) who underwent rescue cerclage for CI were retrospectively evaluated. Stored plasma samples were assayed for IGFBP-1, -2, -3, IL-6, latexin, LBP, lipocalin-2, M-CSF, MIP-1α, MMP-8, -9, pentraxin 3, resistin, S100A8, S100A8/A9, thrombospondin-2, TIMP-1, and TNFR2 levels. The primary outcome measures were spontaneous preterm birth (SPTB) at<28 and<34weeks after cerclage placement. Multivariate Firth's logistic regression analysis revealed that high levels of IGFBP-3 and S100A8/A9, and low levels of MIP-1α were significantly associated with SPTB at<28weeks after cerclage placement, whereas only low MIP-1α levels were significantly associated with SPTB at<34weeks, even after adjustment for baseline clinical covariates (e.g., cervical dilatation). For the prediction of SPTB at<28weeks, the area under the curves (AUC) of IGFBP-3, MIP-1α, and S100A8/A9 were of .686, .691, and .693, respectively. Similarly, the AUC of MIP-1 α was of .659 to predict SPTB at<34weeks. These findings suggest that plasma IGFBP-3, MIP-1α, and S100A8/A9 can represent noninvasive independent biomarkers for identifying women with CI at high risk for SPTB following rescue cerclage. Nonetheless, further in large, multicenter clinical studies should be performed to confirm the clinical value of these biomarkers.

MO340: Acute Kidney Disease in the Outpatient Setting: From Big Data Phenotyping to Biomarker Validation Using the NGAL and DNLITE-IVD103 Tests

Abstract BACKGROUND AND AIMS Acute kidney injury (AKI) and acute kidney disease (AKD), a typical inpatient disease spectrum, pose an exceptional burden on the current healthcare system worldwide. By contrast, developing operative diagnostic criteria for AKD in the outpatient setting (AKDOPT) remains an unattained goal due to the data silos built around the disconnected healthcare systems. In 2017, Taiwan launched the National Cloud-based Health Information Exchange Platform and established the interoperability standard that makes the automated monitoring of change of serum creatinine (S-Cre) in the outpatient setting a possible practice. This study aims to verify our previously proposed AKDOPT diagnostic algorithms using both the conventional neutrophil gelatinase-associated lipocalin (NGAL) and DNlite-IVD103 tests, detecting a novel biomarker, a post-translational modified (PTM) fragment of Fetuin-A [1, 2]. METHOD The Big Data Center of China Medical University Hospital (CMUH) has launched the Acute Kidney Injury Detection System (AKIDS) in the outpatient setting since December 2017 based on our AKDOPT diagnostic algorithms (Fig. 1). In November 2020, we conducted a pragmatic randomized trial to evaluate the clinical effectiveness of AKIDS in reducing the risk of AKDOPT progression to dialysis. Among patients who participated in this trial, both urine and blood were obtained at the enrollment and the urine samples were sent for the quantification of NGAL and the unique PTM-Fetuin-A fragment, an ELISA test developed by Bio Preventive Medicine (BPM). The risk of S-Cre doubling was estimated by Firth's logistic regression. RESULTS A total of 56 patients who were captured by the AKIDS and with the last estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2 recruited in this trial with a median age of 73 years (IQR: 66.2–82.5) and a baseline eGFR of 36.4 (IQR: 21.0–46.3) mL/min/1.7 3 m2. During the follow-up, there were six participants reached the S-Cre double status. The median levels of NGAL and IVD103 were 1360 (IQR: 299–1827) ng/mg and 74.7 (IQR: 37.3–236) ng/mg, respectively, among patients experiencing the endpoint, and they were 187 (81.4–1152) ng/mg and 15.9 (6.16–67.3) ng/mg for patients free of the primary outcome. The odds ratios of the S-Cre doubling for each log unit increase in NGAL and IVD103 were 2.26 (95% confidence interval 0.73–6.98; p-value .16) and 3.48 (0.78–15.6; p-value .10), respectively. In the dose-response plot, we found only IVD103 showed a positive linear relationship with the risk of S-Cre doubling despite the two biomarkers showed comparable area under the receiver operating characteristic curve for predicting poor kidney outcome (NGAL 0.697 versus IVD103 0.723). CONCLUSION This is the first study to phenotypically validate the previously unrecognized phenotype, AKDOPT, by the AKIDS developed under the National Health Insurance (NHI) information technology infrastructure and molecularly validate its prognostic role using kidney injury biomarkers, NGAL and a novel eGFR decline prediction biomarker, a unique PTM-fragment of Fetuin-A (IVD103). The linear association between IVD103 and the risk of S-Cre doubling supports its prognostic value in the risk assessment of AKDOPT.

Factors Influencing Employment of Female Graduates of Technical and Vocational Education and Training Program in the Philippines

Unemployment has been a long-standing problem in many countries, including the Philippines, and the recent pandemic even worsened the economic conditions of Filipinos with a large part of the population losing their jobs. One way to create more platforms that will enable the employability of the population is through the technical and vocational education and training (TVET) program, whose goal is to produce middle- and high-skilled graduates ready to take on the demands of the rapidly changing economy. With the current gender gap in terms of employment, this study focuses on the employment status of female graduates of TVET and the possible factors that influence the employment of Filipino female TVET graduates were determined. The survey data collected by the Technical Education and Skills Development Authority (TESDA) in 2018 for their employability study of 2017 women TVET graduates was utilized in this study. Binary Firth logistic regression models were fitted on subpopulations of TVET female graduates who were employed before and after training. Results have shown a significant increase in the proportion of employed women after graduation, which was indicated in the estimates before and after the training. Among the unemployed Filipino female before the training, more than half of them (52%) were employed after the training. Age, education, region, and reasons for taking up a program showed to be determinants of the employability of female TVET graduates. The factors that hinder women from entering employment despite their TVET training is the primacy of their household and family duties. Their choice or nature of programs shows that women take stereotypical roles associated with women, an issue that is still present today because of prevailing traditional gender norms. With the huge decline in economic activities brought by the pandemic, the results of this study will be particularly important in creating more and better employment opportunities for Filipino women.

Disclosure of HIV-serodiscordant relationships and association with viral suppression: results from the Positive Plus One study

ABSTRACT Background. Little is known about the effects of disclosure of HIV-serodiscordant relationships on clinical outcomes. We aimed to evaluate the effect of relationship disclosure on HIV viral suppression, and hypothesized that disclosure by HIV-positive and HIV-negative partners would be associated with viral suppression in the HIV-positive partner. Methods. We conducted a Canadian national online and telephone-administered survey of HIV-positive and HIV-negative partners in serodiscordant relationships. The primary outcome was self-reported viral suppression. Multivariable analyses were undertaken using Firth logistic regression. Results. We recruited 540 participants in current serodiscordant relationships (n = 228 HIV-negative; n = 312 HIV-positive). Similar proportions of HIV-positive and HIV-negative partners disclosed their relationship to healthcare professionals (82% v. 76%, p = 0.13). Among HIV-positive partners, disclosure of the relationship to healthcare professionals increased the odds of viral suppression (aOR = 4.7; CI: 2.13, 10.51) after adjusting for age, education, and relationship turmoil due to HIV. Increasing age (aOR = 1.28; 95% CI = 1.07, 1.55) and education (aOR = 2.43; 95% CI = 1.15, 5.26) were also associated with viral suppression. Among HIV-negative partners, relationship disclosure was not associated with viral suppression and HIV-negative heterosexual men were less likely to report that their HIV-positive partners were virally suppressed (aOR = 0.24; CI: 0.09, 0.61). Conclusions. Disclosure of HIV-serodiscordant status by HIV-positive participants to healthcare professionals was associated with increased odds of viral suppression. Similar effects were not evident among HIV-negative participants. Future work should explore factors that empower relationship disclosure and incorporate them into supportive services for HIV-serodiscordant relationships.

A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

ObjectivesUntil recently, systemic opioids have been standard care for acute pain management of geriatric hip fracture; however, opioids increase risk for delirium. Fascia Iliaca compartment blocks (FICB) may be favored...

Demographic and media factors affecting women’s demand for different types of health insurance: Evidence from a developing country

Background: In the absence of a National Health Insurance Scheme, many Ugandans don’t have access to basic health care because of the high cost of attaining this health care. The problem is even worse among women who are faced with higher rates of morbidity and hospitalization. The objective of the study was to assess demographic and media factors affecting the demand for community, employer provided and private health insurance among women in Uganda. Methods: The study used secondary data from the 2016 Uganda Demographic Health Survey, a nationally representative survey. The sample comprised of 18,506 women aged 15-49 years from a population of 20,880 households. Data were analyzed using STATA version 15. Descriptive statistics, Chi square tests and the Firth logistic regression were used to understand the frequency distribution of different types of health insurance, demographic and media factors, associations between different types of health insurance, demographic and media factors and the demographic and media factors affecting the demand for community, employer provided and private health insurance. Results: The results indicated low demand for different types of health insurance among women. Education and wealth were the demographic factors that affected the demand for community and employer provided health insurance while marital status, age and education were demographic factors that affected the demand for community, employer provided and private health insurance respectively. Watching television, reading newspapers and listening to radio were the media factors that affected the demand for employer provided health insurance while listening to radio was the only media factor that affected the demand for community health insurance. Conclusions: There is a need to expedite the National Health Insurance policy to enhance the uptake of health insurance among women in Uganda.

79 Factors Predicting Burn Survivor Group Interest in an Outpatient Burn Clinic

IntroductionOutpatient peer support groups have been demonstrated to help patients reintegrate with the community and improve self-acceptance following burn injury. Despite this, there is little data examining who desires participation. This is especially true for minority and socio-disadvantaged populations. The purpose of this study is to examine factors that influence desire to participate in burn survivor groups and actual participation rates.MethodsPatients attending outpatient clinic were asked about participation in burn survivor group, interest in joining a group, and administered National Institute of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Managing Emotions (ME) and Managing Social Interactions (MSI) questionnaires. Patient demographics, total body surface area burned (TBSA), initial hospital length of stay (LOS), and surgical intervention were collected from the medical record. While controlling for age and gender, indicators of injury severity and scores on PROMIS questionnaires were each examined for associations with survivor group interest using Firth or standard binary logistic regression.Results70 patients completed surveys in English (60%, 42/70) and Spanish (40%, 28/70). Current or past participation in burn survivor group was low (n=3/70, 4.2%), with greater interest in joining burn survivor group (n=20/66, 30.3%). Most patients interested in burn survivor group were Spanish speaking (65%, 13/20). Interest in joining a burn survivor group was associated with all collected measures of injury severity (Table 1). Scores on ME and MSI were not significantly associated with burn survivor group interest (ME p=.636, MSI p=.133).ConclusionsThere is a gap between interest and participation in burn survivor group, particularly among Spanish speaking patients. Patients with increase in TBSA, LOS, and undergoing surgery were more likely to express interest in burn survivor group participation. Interestingly, patients’ self-reported outcomes on emotional distress and interactions with others were not related to interest in burn survivor group.

Depression and Anxiety, Stigma, and Social Support Among Women in the Postpartum Period

ObjectiveTo examine the relationships among depression and anxiety symptomatology, stigma of mental illness, levels of social support, and select demographics among hospitalized women in the postpartum period. DesignDescriptive, cross-sectional, correlational. SettingA convenience sample of 105 English-speaking and Spanish-speaking women was recruited and enrolled from a 208-bed free-standing Southern California women’s community hospital postpartum unit serving a diverse community. MeasurementsData were collected on potential covariates including participants’ characteristics, depression and anxiety symptomatology, social support, and stigma. ResultsSixteen participants were classified as high risk for depression or anxiety based on the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7. Anxiety was significantly associated with all stigma subscales; the strongest association was with Internal Stigma (r = .46, p < .001, moderate effect), followed by Disclosure Stigma (r = .36, p < .001, moderate effect) and External Stigma (r = .30, p = .002, moderate effect). All social support subscales were negatively associated with depression and anxiety; the Friends subscale had the strongest correlations with depression (r = –.27, p = .006, small effect) and anxiety (r = .34, p = .001, moderate effect). Firth (penalized likelihood) logistic regression analysis was conducted to ascertain the effects of study covariates on the likelihood of participants being at risk for postnatal depression or anxiety. The significant factor that increased the odds of participants being in the high-risk group was decreased social support (adjusted OR = 0.46, 95% CI [0.24, 0.76], p = .003). ConclusionThese results show the enduring prevalence of postnatal depression and anxiety and the relevance of stigma and social support in aggravating or mitigating symptomatology. There is a need for comprehensive standardized screening to ensure the identification of and referral to treatment for women at risk.

Abstract P2-08-23: Early intratumoral changes after a single dose of anti-PD-1 treatment in patients with early breast cancer (BC)

Abstract Intro: Despite the growing success of immune checkpoint blockade in BC, the underlying mechanisms of response or resistance to these treatments is still poorly understood. We recently conducted a window-of-opportunity study (BioKey) including 54 patients with early BC (NCT03197389) in which patients were treated with one dose of pembrolizumab 10 ± 4 days before surgery. A tumor biopsy was taken before and after the administration of pembrolizumab. Using single-cell transcriptome profiling, we identified patients with clonotype expansion of PD-1-expressing T-cells after treatment with pembrolizumab (Bassez A, Vos H et al, Nature Medicine 2021). Expansion mainly involved CD8+ T - and CD4+ T cells. We designated these as patients with clonotype expansion or ‘expanders’ (E), whereas patients lacking clonotype expansion were considered ‘non-expanders’ (NE). In this study, we aimed at investigating the association between stromal tumor infiltrating lymphocytes (sTIL) and various immune markers using immunohistochemistry with the E phenotype. Methods: The BioKey trial has 2 cohorts. The first one included 39 treatment-naive patients who were scheduled for upfront surgery. The second cohort included 15 patients with an estimated residual tumor size of at least 1cm on imaging after neo-adjuvant chemotherapy. All molecular subtypes were represented: triple-negative (TN) BC (n= 18, 8 E and 10 NE), HER2-positive BC (n= 5, 1 E and 4 NE) and hormone receptor (HR)-positive/HER2-negative BC (n= 17, 3 E and 14 NE). 7 core biopsies and 5 resection slides were not contributive and were excluded. The expander status of 14 patients was unknown. sTIL were evaluated and immunohistochemical stains (CD3, CD4, CD8, CD68, CD73, FoxP3, Ki67, PD-1 and PD-L1) were performed. Associations between expander status and biomarkers were assessed using firth logistic regressions, adjusting per cohort. Biomarkers were considered as continuous variables and Odds Ratio computed per one unit increase on a non-transformed scale. Given the low number of E in cohort B, subgroup analyses were performed only in cohort A. Results: We observed that 1) higher levels of sTIL, PD-1+ sTIL and FOXP3+ cells in the pre-treatment biopsies, 2) higher levels of sTIL, PD1+ sTIL, PD-L1+, CD3+, CD4+, CD8+, CD68+, FOXP3+ cells and Ki67 in the post-treatment surgical specimen, as well as, 3) higher delta values (surgical specimen - biopsy) of sTIL, CD3+, CD4+, CD8+, CD68+ and Ki67 are associated with the E phenotype (Table 1). With regard to the subgroup analyses, we observed that higher levels of PD-1+ sTIL and CD68+ cells at diagnosis and surgery respectively, as well as higher delta values for CD68+, Ki67 and sTIL were associated with the E phenotype in HR+/HER2- BC, while high levels of FOXP3+ cells and PD-1+ sTILs in the biopsies, high levels of sTIL, CD3+, CD4+, CD8+, CD68+, FOXP3+, PD-1+ sTILs, PD-L1+ and Ki67 as well as higher delta values for PD-L1+ in the resection specimen were associated with the E phenotype in TNBC. Conclusion: We were able to detect associations between various cell populations of the tumor immune microenvironment evaluated before and after a single dose of pembrolizumab and the T-cell expansion phenotype previously defined at the single-cell level. It highlights the possible clinical utility of a biopsy taken early during treatment. Future neo-adjuvant studies will allow the validation of our findings and investigate the association between T-cell expansion and clinical outcomes. Table 1.Association between the various biomarkers and the expanding T-cell phenotypeVariableOdds RatioLower 95% CIUpper 95% CIp-valuePre-treatment. Core biopsyCD31.071.001.160.061CD41.060.981.170.156CD81.130.951.380.161CD681.050.901.230.494CD73.tumor1.070.821.370.609CD73.on sTIL1.010.961.060.713FoxP32.251.394.030.001Ki671.021.001.050.107sTIL1.061.021.140.005PD-1 on sTIL1.731.212.830.001PD-L11.041.011.070.002Post-treatment. Resection specimenCD31.091.031.190.001CD41.151.051.29&amp;lt;0.001CD81.581.192.34&amp;lt;0.001CD681.471.152.15&amp;lt;0.001CD73.tumor1.090.771.520.608CD73.on sTIL1.030.991.080.110FoxP32.051.313.82&amp;lt;0.001Ki671.041.011.070.004sTIL1.081.031.15&amp;lt;0.001PD-1 on sTIL1.641.152.650.004PD-L11.051.021.110.002Delta (resection-biopsy)CD31.071.011.250.029CD41.091.011.280.030CD81.211.021.690.025CD681.221.051.580.007CD73.tumor0.970.731.290.794CD73.on sTIL1.040.991.120.132FoxP31.220.891.810.219Ki671.051.001.130.031sTIL1.071.001.160.046PD-1 on sTIL0.960.701.330.765PD-L11.000.961.040.941 Citation Format: Hanne Vos, Kathleen Lambein, François Richard, Ines Nevelsteen, Ayse Bassez, Diether Lambrechts, Kevin Punie, Hans Wildiers, Giuseppe Floris, Christine Desmedt, Ann Smeets. Early intratumoral changes after a single dose of anti-PD-1 treatment in patients with early breast cancer (BC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-08-23.

Orthognathic Surgery in Older Patients: Is Age Associated With Perioperative Complications?

The incidence of older patients undergoing orthognathic surgery is increasing. The purpose of this study is to evaluate the association between age and perioperative adverse outcomes in patients undergoing orthognathic surgery. This is a retrospective cohort study of patients undergoing orthognathic surgery in the 2011 to 2019 American College of Surgeons National Surgical Quality Improvement Program databases. The primary predictor variable was age group (≥40 or <40years). The primary outcome variable was adverse outcomes occurring within 30days of the index operation. Descriptive, bivariate, and Firth logistic regression statistics were utilized to evaluate association between age and adverse outcomes. During the study period, 1,226 patients underwent an orthognathic procedure and 835 subjects were included. Of these subjects, 145 were 40years or older (17.4%) and 690 were less than 40years (82.6%). Subjects 40 years or older were more likely to be American Society of Anesthesiologists (ASA) classification II (P ≤ .001), ASA III (P ≤ .001), or diagnosed with obstructive sleep apnea (P ≤ .001). A total of 34 subjects experienced an adverse outcome (4.07%), though there was no significant difference in the incidence of adverse outcomes between age groups (P=.152). In bivariate analysis, hypertension on medication (P=.037), procedure type (P=.001), and segmented Le Fort I osteotomies (P=.039) were associated with adverse outcomes. After controlling for age, hypertension on medication, segmented Le Fort I osteotomies, and diagnosis of obstructive sleep apnea, isolated mandibular osteotomies were the only independent predictors of adverse outcomes (odds ratio 2.64; 95% confidence interval, 1.06 to 7.24; P=.038). Length of stay was 1.38±1.43days for the 40years or older group compared to 1.06±1.18 in the <40 group (P=.012). Despite higher ASA classifications, older patients did not have a significantly greater incidence of perioperative adverse outcomes including airway complications, nor was increased age associated with adverse outcomes in bivariate or multivariate analysis.

Discovering potential blood-based cytokine biomarkers for Alzheimer’s disease using Firth Logistic Regression

&#x0D; Background: Alzheimer’s disease (AD) is a neurodegenerative disorder where patients suffer from memory loss, cognitive impairment and progressive disability. Individual blood biomarkers have not been successful in defining the disease pathology, progression and diagnosis of AD. There is a need to identify multiplex panels of blood biomarkers for early diagnosis of AD with high sensitivity and specificity. This study focused on identification of cytokine biomarkers. The maximum likelihood estimates of the ordinary logistic regression model cannot be obtained when there is complete separation and the alternative is Firth logistic regression which uses a penalised Maximum Likelihood in parameter estimation. &#x0D; Methods: This paper reports a Firth logistic regression application in finding potential blood-based cytokine biomarkers for Alzheimer’s disease in a matched case control study. We used a principle component analysis to discriminate the correlated, completely separated covariates. &#x0D; Results: The Firth logistic regression results showed that nine individual biomarkers IL-1β, IL-6, IL-12, IFN-γ, IL-10, IL-13, IP-10, MCP-1 and MIP-1α had a significant relationshipwith elevated risk for AD as compared to the healthy control (HC). Principal component analysis with varimax rotation for the nine biomarkers revealed four factors (total variance explained=85.5%). The main principal component biomarkers were IL-1β, IL-6, IL-13 and MCP-1 (total variance explained=62.3%). Firth’s logistic regression model with the first principal component had accuracy of 78.2% with sensitivity and specificity of 71.8% and 75% respectively. &#x0D; Conclusion: Firth’s logistic regression is a useful technique in identification of significant biomarkers when there is an issue of data separation. &#x0D;

Usefulness of Combined Renin-Angiotensin System Inhibitors and Diuretic Treatment In Patients Hospitalized with COVID-19

Antecedent use of renin-angiotensin system inhibitors (RASi) prevents clinical deterioration and protects against cardiovascular/thrombotic complications of COVID-19, for indicated patients. Uncertainty exists regarding treatment continuation throughout infection and doing so with concomitant medications. Hence, the purpose of this study is to evaluate the differential effect of RASi continuation in patients hospitalized with COVID-19 according to diuretic use. We used the Coracle registry, which contains data of hospitalized patients with COVID-19 from 4 regions of Italy. We used Firth logistic regression for adult (>50 years) cases with admission on/after February 22, 2020, with a known discharge status as of April 1, 2020. There were 286 patients in this analysis; 100 patients (35.0%) continued RASi and 186 (65%) discontinued. There were 98 patients treated with a diuretic; 51 (52%) of those continued RASi. The in-hospital mortality rates in patients treated with a diuretic and continued versus discontinued RASi were 8% versus 26% (p = 0.0179). There were 188 patients not treated with a diuretic; 49 (26%) of those continued RASi. The in-hospital mortality rates in patients not treated with a diuretic and continued versus discontinued RASi were 16% versus 9% (p = 0.1827). After accounting for age, cardiovascular disease, and laboratory values, continuing RASi decreased the risk of mortality by approximately 77% (odds ratio 0.23, 95% confidence interval 0.06 to 0.95, p = 0.0419) for patients treated with diuretics, but did not alter the risk in patients treated with RASi alone. Continuing RASi in patients concomitantly treated with diuretics was associated with reduced in-hospital mortality.

Household Food Insecurity in DKI Jakarta Province at The Beginning of The Covid-19 Pandemic

Food insecurity is a global issue that’s concern not only in poor and developing countries, but also in developed countries. Its conditions have worsened since the beginning of the Covid-19 pandemic where social restrictions and economic contraction caused many people to lose their jobs, incomes, and increased poverty. DKI Jakarta was one of the most economically affected provinces at the beginning of the Covid-19 pandemic where economic growth in the first quarter of 2020 recorded grow 5.06 percent year on year (the lowest in the last ten years) and slowed down by 0.56 percent overall quarter to quarter, and an increase of poverty 1.11 percent, the highest in Indonesia. This study examines the effect of household characteristics in DKI Jakarta on their food insecurity status at the beginning of the Covid-19 pandemic. The data used is the March 2020 Susenas which was analyzed descriptively and inferentially using firth logistic regression. The results showed that there were 4.47 percent of households in DKI Jakarta had food insecurity status at the beginning of the Covid-19 pandemic. In general, households with food insecurity status are poor, don’t have social security, the head of the household doesn’t work and less than high school education.

Prognostic Utility of the Gleason Grading System Revisions and Histopathological Factors Beyond Gleason Grade.

BackgroundThe International Society of Urological Pathology (ISUP) revised the Gleason system in 2005 and 2014. The impact of these changes on prostate cancer (PCa) prognostication remains unclear.ObjectiveTo evaluate if the ISUP 2014 Gleason score (GS) predicts PCa death better than the pre-2005 GS, and if additional histopathological information can further improve PCa death prediction.Patients and MethodsWe conducted a case–control study nested among men in the National Prostate Cancer Register of Sweden diagnosed with non-metastatic PCa 1998–2015. We included 369 men who died from PCa (cases) and 369 men who did not (controls). Two uro-pathologists centrally re-reviewed biopsy ISUP 2014 Gleason grading, poorly formed glands, cribriform pattern, comedonecrosis, perineural invasion, intraductal, ductal and mucinous carcinoma, percentage Gleason 4, inflammation, high-grade prostatic intraepithelial neoplasia (HGPIN) and post-atrophic hyperplasia. Pre-2005 GS was back-transformed using i) information on cribriform pattern and/or poorly formed glands and ii) the diagnostic GS from the registry. Models were developed using Firth logistic regression and compared in terms of discrimination (AUC).ResultsThe ISUP 2014 GS (AUC = 0.808) performed better than the pre-2005 GS when back-transformed using only cribriform pattern (AUC = 0.785) or both cribriform and poorly formed glands (AUC = 0.792), but not when back-transformed using only poorly formed glands (AUC = 0.800). Similarly, the ISUP 2014 GS performed better than the diagnostic GS (AUC = 0.808 vs 0.781). Comedonecrosis (AUC = 0.811), HGPIN (AUC = 0.810) and number of cores with ≥50% cancer (AUC = 0.810) predicted PCa death independently of the ISUP 2014 GS.ConclusionThe Gleason Grading revisions have improved PCa death prediction, likely due to classifying cribriform patterns, rather than poorly formed glands, as Gleason 4. Comedonecrosis, HGPIN and number of cores with ≥50% cancer further improve PCa death discrimination slightly.

Awareness and Support of Clinician- and Patient-Collected Human Papillomavirus Testing for Cervical Cancer Screening Among Primary Care Clinicians.

Background: Cervical cancer screening has shifted toward human papillomavirus (HPV)-based testing, but uptake of primary HPV screening in the United States is unknown and previous studies highlight delays in clinician adoption of guideline updates.Methods: We conducted a cross-sectional electronic survey of primary care clinicians (n = 252; response rate = 30.9%) assessing awareness and support of primary HPV screening. We assessed factors for association with past use of HPV testing and support of clinician- and patient-collected HPV testing individually using Fisher's exact test and jointly using Firth's logistic regression.Results: Most clinicians (79%) were familiar with one or more primary HPV screening guidelines. Support for clinician-collected (89%) and patient-collected (82%) HPV testing was high, but only 34.5% reported prior use. Guideline familiarity was positively associated with HPV testing in practice (p = 0.0001). Support of clinician-collected testing was positively associated with more years in practice (p = 0.03), internal (vs. family) medicine specialty (p = 0.03), and guideline familiarity (p ≤ 0.0001). Male clinicians more frequently supported patient collection for patients overdue for screening (p = 0.013). Physicians more frequently than advanced practice providers (APPs) supported patient collection for screening-adherent women (p = 0.021). Multivariable analysis showed those unfamiliar with guidelines were less likely to have used HPV testing [odds ratio, OR: 0.10 (0.03–0.32)] or to support clinician-collected HPV testing [OR: 0.16 (0.07–0.37)]. APPs were less likely than physicians to support patient-collected HPV testing among screening-adherent women [OR: 0.42 (0.20–0.87)].Conclusions: We observed high levels of guideline awareness and clinician support for primary HPV testing, despite relatively low use. This merits further exploration to inform future interventions to increase uptake.

Epidemiology of Epizootic Lymphangitis Among Carthorses in Ethiopia.

Epizootic lymphangitis caused by Histoplasma capsulatum variety farciminosum is a debilitating disease incurring considerable economic losses and affecting the welfare of carthorses. Understanding of its epidemiology is important for devising effective prevention and control measures. A cross-sectional study was conducted on 4,162 carthorses in 17 towns in Ethiopia between October 2018 and June 2019. Clinical and microscopic examinations, fungal culturing, and polymerase chain reaction were used to undertake this study. The overall prevalence of epizootic lymphangitis was 16.67% (95% CI: 15.55–17.84) in carthorses. Epizootic lymphangitis was detected in carthorses found in 16 of the 17 towns included in the study. The highest prevalence was recorded at Kombolcha Town (33.33; 95% CI: 27.54–39.52) whereas the lowest was recorded at Debre Birhan Town (0.00; 95% CI: 0.00–1.27). The results of univariable firth logistic regression analysis showed that the difference between the prevalence of Kombolcha and the prevalences of all the other towns except Holota and Shashemene were statistically significant. Statistically significantly lower prevalence was observed in other towns. Classification of the cases into different clinical forms showed that 87.18, 4.33, and 0.58% were cutaneous, ocular, and respiratory forms respectively, while the remaining 7.93% (55/694; 95% CI: 6.03–10.19) were classified as mixed form. In terms of the severity of the disease, 28.67, 60.52, and 0.81% were mild, moderate, and severe cases, respectively. The majority of the lesions (43.95%) were observed in the skin followed by forelimbs (14.55%) and neck region (14.27%). Higher mean annual temperature, lower annual rainfall, and higher humidity of the study towns were statistically significantly associated with an increased risk of epizootic lymphangitis. In conclusion this study revealed widespread occurrence of epizootic lymphangitis in carthorses yet a heterogeneous prevalence between towns. The veterinary and livestock authorities should take this into account while devising disease control.

Relationships of Smoking Media Literacy with Smoking Behavior, Attitudes, and Susceptibility among Adolescents in the Republic of Korea

The literature has indicated that higher smoking media literacy (i.e., SML) can buffer adverse effects of exposure to pro-smoking media content (i.e., PMC) on smoking-related outcomes in adolescence. Thus, we aimed to investigate (a) SML levels among Korean adolescents and (b) relationships of SML with smoking behavior, attitudes, and susceptibility. In 2017, we collected cross-sectional data from nine middle or high schools in Korea, using a convenience sampling method (N = 476). For the first aim, we calculated the average score of SML. For the second aim, we conducted multinomial logistic regression (MLR), multiple linear regression, and binary multiple logistic regression. Additionally, we conducted Firth logistic regression and confirmed the robustness of our findings obtained from the MLR. The average SML score was 6.48 out of 10 points, indicating that our respondents’ average SML was slightly above the middle level. In addition, after adjusting for factors potentially affecting associations between SML and the three smoking-related outcomes, we found significant protective relationships of SML with all smoking-related outcomes: smoking behavior, attitudes, and susceptibility. Given our findings, the enhancement of SML through education should be considered an important strategy to weaken the link between exposure to PMC and smoking-related outcomes.

Immune response to hepatitis B vaccine following complete immunization of children attending two regional hospitals in the Southwest region of Cameroon: a cross sectional study

BackgroundHepatitis B virus (HBV) infection despite being a vaccine preventable disease remains a global public health problem. In Cameroon, the hepatitis B vaccine was introduced in the expanded program on immunisation in 2005, but there has been limited evaluation of the HBV surface antibody response post vaccination.ObjectiveWe investigated the immune response to hepatitis B vaccine in infants who received the DPT-Hep B-Hib vaccine, and we assessed HBsAg carriage in non-responders. We also investigated factors associated with non-response or poor response.MethodsUsing a hospital based cross sectional design and a structured questionnaire over a four-month period (January to April 2019), we collected data to determine factors associated with hepatitis B surface antibody (anti-HBs) response from infants aged 6 to 9 months attending infant welfare clinics (IWC) at the Buea and Limbe regional hospitals. We collected venous blood and measured anti-HBs titres using a quantitative Foresight® ELISA. We entered and analysed data using EpiData version 3.1 and SPSS version 25 respectively.ResultsOf the 161 infants enrolled, 159 (98.8%) developed anti-HBs antibodies. Of these 159, 157 (97.5%) and 117 (72.7%) developed ≥ 10.0 mIU/ml (seroprotection) and ≥ 100.0 mIU/ml anti-HBs titres respectively. Being younger (6 months old) was associated with seroprotection (Cramer V = 0.322, p = 0.001). Spearman rho’s relational analysis showed that immunity against HBV reduced as the duration since the last dose increased (r = −0.172; P = 0.029). However, a Firth logistic regression showed no significant association of factors with inadequate immunity. All 12 (7.5%) infants exposed to HBV at birth, received the hepatitis B vaccine at birth, including four who received HBIG, and all were protected. Four infants (2.5%) had anti-HBs titres < 10.0 mIU/mL (non-responders) but had no peculiarity.ConclusionThe seroprotective rate following hepatitis B vaccination of infants is high even in exposed infants. Our study suggests that Cameroon’s HBV vaccine in the Expanded Program on Immunisation (EPI) is effective against HBV, although we could not account for the 2.5% non-response rate. Large scale studies are needed to further explore non-response to the vaccine.

Long-term retention and predictors of attrition for key populations receiving antiretroviral treatment through community-based ART in Benue State Nigeria: A retrospective cohort study.

BackgroundKey populations (KP) are disproportionately infected with HIV and experience barriers to HIV care. KP include men who have sex with men (MSM), female sex workers (FSW), persons who inject drugs (PWID) and transgender people (TG). We implemented three different approaches to the delivery of community-based antiretroviral therapy for KP (KP-CBART) in Benue State Nigeria, including One Stop Shop clinics (OSS), community drop-in-centres (DIC), and outreach venues. OSS are community-based health facilities serving KP only. DIC are small facilities led by lay healthcare providers and supported by an outreach team. Outreach venues are places in the community served by the outreach team. We studied long-term attrition of KP and virological non-suppression.MethodThis is a retrospective cohort study of KP living with HIV (KPLHIV) starting ART between 2016 and 2019 in 3 0SS, 2 DIC and 8 outreach venues. Attrition included lost to follow-up (LTFU) and death. A viral load >1000 copies/mL showed viral non-suppression. Survival analysis was used to assess retention on ART. Cox regression and Firth logistic regression were used to assess risk factors for attrition and virological non-suppression respectively.ResultOf 3495 KPLHIV initiated on ART in KP-CBART, 51.8% (n = 1812) were enrolled in OSS, 28.1% (n = 982) in DIC, and 20.1% (n = 701) through outreach venues. The majority of participants were FSW—54.2% (n = 1896), while 29.8% (n = 1040), 15.8% (n = 551) and 0.2% (n = 8) were MSM, PWID, and TG respectively. The overall retention in the programme was 63.5%, 55.4%, 51.2%, and 46.7% at 1 year, 2 years, 3 years, and 4 years on ART. Of 1650 with attrition, 2.5% (n = 41) died and others were LTFU. Once adjusted for other factors (age, sex, place of residence, year of ART enrollment, WHO clinical stage, type of KP group, and KP-CBART approach), KP-CBART approach did not predict attrition. MSM were at a higher risk of attrition (vs FSW; adjusted hazard ratio (aHR) 1.27; 95%CI: 1.14–1.42). Of 3495 patients, 48.4% (n = 1691) had a viral load test. Of those, 97.8% (n = 1654) were virally suppressed.ConclusionAlthough long-term retention in care is low, the virological suppression was optimal for KP on ART and retained in community-based ART care. However, viral load testing coverage was sub-optimal. Future research should explore the perspectives of clients on reasons for LTFU and how to adapt approach to CBART to meet individual client needs.