Forward Stepwise Logistic Regression Research Articles

Risk factors for the deterioration of periventricular\u2013intraventricular hemorrhage in preterm infants

Preterm infants with periventricular–intraventricular hemorrhage (PV–IVH) have a high risk of neurological sequelae, with severity depending on the severity of the PV–IVH. Previous studies on the pathogenesis of PV–IVH have focused mainly on comparisons of perinatal risk factors between patients with and without PV–IVH. Notably, most cases of PV–IVH occur within the first 3 days after birth, and the condition may worsen within 1 week following the initial diagnosis. However, the risk factors that contribute to the deterioration of PV–IVH have not been investigated. In this cohort study, 514 PV–IVH infants with a gestational age (GA) < 32 weeks were enrolled. The dependent variable was initially diagnosed as mild PV–IVH (grade I or II) that subsequently progressed to severe PV–IVH (grade III or IV) within 1 week. A stepwise forward multivariate logistic regression model was adopted to select potential or related factors that affected the deterioration of PV–IVH in preterm infants. Overall, 42 of the 514 infants with PV–IVH (8.2%) showed deterioration within 1 week. The results showed that maternal lower genital tract infection (OR 3.73, 95% CI 1.75–7.95) was an independent risk factor for PV–IVH deterioration. Higher GA (OR 0.62, 95% CI 0.48–0.80) was a protective factor. Our results suggest that maternal lower genital tract infection and a lower GA may contribute to PV–IVH deterioration in preterm infants.

&lt;p&gt;Dietary Behaviours Among Han, Tujia and Miao Primary School Students: A Cross-Sectional Survey in Chongqing, China&lt;/p&gt;

Background and PurposeExploring the differences of children’s dietary behaviours from different nationalities could provide a reference for targeted nutritional interventions. This study aims to assess the dietary behaviours among Han, Tujia and Miao primary school students and the differences among the ethnic groups.Materials and MethodsThis cross-sectional survey included 556 primary school students (249 Han, 76 Tujia and 231 Miao students) aged 6–13 years from the representative minority areas of Chongqing, China. Data were collected with a self-administered or one-on-one interview-based questionnaire encompassing questions on sociodemographics, eating habits and dietary intake. Eating habits and dietary intake were categorized into health-protective and health-risk dietary behaviours. χ2 tests were conducted to examine the differences in eating habits and dietary intake among the three ethnic groups. Forward stepwise logistic regression models were performed to check the factors affecting dietary intake.ResultsFewer than half of the students had health-protective dietary behaviours in terms of rice, fruit, fish, eggs and milk intake. Compared with Han students, Tujia students were more likely to meet the recommended intake of vegetables (OR = 2.13, 95% CI [1.22–3.69]), less likely to meet the recommended intake of meat (OR = 0.58, 95% CI [0.35–0.94]) and fish (OR = 0.55, 95% CI [0.32–0.94]); Miao students were more likely to meet the recommended intake of vegetables (OR = 1.73, 95% CI [1.20–2.51]), fruits (OR = 1.62, 95% CI [1.16–2.28]) and water (OR = 1.59, 95% CI [1.12–2.26]) than those of Han students.ConclusionThe low proportion of health-protective dietary behaviours among primary school students from Han, Tujia and Miao ethnicities was found in this study. There were differences in dietary behaviours among the three ethnic groups. This study could provide a reference for implementing national dietary guidelines in consideration of socioeconomic status, ways of preparing and consuming foods, traditional foods and customs of different ethnic groups.

Outcomes of Substance Use Disorder Monitoring Programs for Nurses

Introduction Substance use disorder (SUD) continues to be a leading public health concern for state boards of nursing (BONs). Aims To assess the SUD program completion rates and determine the program characteristics associated with program completion. Methods A retrospective cohort study of 7,737 nurses participating in SUD programs between the years 2007 and 2015 was conducted. Bivariate analyses explored variables of successful program completion, and a forward stepwise logistic regression model was run to assess predictors of program success or failure. Results Successful program completion correlated with the number of years in the program (r = 0.30). The highest percentage of nurses completing a program was at around the 5-year mark. Additionally, 26 random drug tests, 25 support group meetings, and 55 to 60 mutual support group meetings per year were associated with successful program completion. Conclusions Bimonthly random drug tests, daily check-ins, and a minimum 3-year length of stay in a program were associated with successful program completion. Attending structured support group meetings and mutual support meetings were also useful. Convening an expert panel to review these results and develop formal guidelines that can be tested by BONs are recommended next steps.

Evaluation of intrinsic and extrinsic risk factors for dog visceral hemangiosarcoma: A retrospective case-control study register-based in Lazio region, Italy

The genetic and breed susceptibility of visceral hemangiosarcoma in dogs has been studied, but there is no evidence of environmental risk factors as reported in human medicine. We conducted a case-control study in which the sampling population was the list of canine oncology cases of the Animal Tumour Registry of Lazio region, Italy (2009–2017). We defined cases as dogs with visceral hemangiosarcoma and controls as dogs affected by another neoplasm. The ratio between controls and cases was 3:1. Analysed variables were: age, weight, sex, reproductive status, size, breed, nutrition habit, living environment and location of the house. We performed a preliminary univariate analysis to select potential risk factors (p-value < 0.2) then entered in a forward stepwise logistic regression model. Ninety-three cases enrolled in the study were compared with 279 controls. The multivariable logistic regression identified age, reproductive status and breed as significant risk factors. Results showed an increasing risk with increasing age for age classes 6−10 and > 10 years old (OR = 9.69, 95 % CI: 1.21–77.62; OR = 14.01, 95 % CI: 1.65–119.03). Neutered animals (male and female) were at greater risk compared to intact ones. The breeds at greatest risk were German shepherd (OR = 4.17, 95 % CI: 1.25–13.86) and mixed breed (OR = 3.50, 95 % CI: 1.44–8.51). The last finding could be explained by the genetic origin of the animals, which may include German shepherd or another possible breed at risk. No other individual or environmental variables were identified as risk factors. The findings of this work indicate that genetic predisposition is the key element in visceral hemangiosarcoma development.

P0873GLA-RICH PROTEIN (GRP) AS AN EARLY AND NOVEL MARKER ASSOCIATED WITH VASCULAR CALCIFICATION AND CKD-MINERAL AND BONE DISORDER (MBD) IN DIABETIC PATIENTS WITH CKD: A PILOT COHORT STUDY

Abstract Background and Aims Cardiovascular disease (CVD) is the most life-threatening complication in chronic kidney disease (CKD) patients. In addition to traditional risk factors, most patients with CKD display abnormal mineral metabolism with underlying hormonal dysregulation, defined as chronic kidney disease-mineral and bone disorder (CKD-MBD). CKD-MBD involves changes in mineral ion homeostasis, bone quality and turnover, cardiovascular and soft tissue calcifications, which highly contribute for cardiovascular complications. Vascular calcification (VC) is associated with significant morbidity and mortality and a strong predictor of cardiovascular risk in CKD patients. Early preventive measures, including new diagnostic/prognostic tools, are required to reduce the development and progression of VC, left ventricular hypertrophy and arterial stiffness, which are crucial for the prevention of CVD outcomes in CKD patients. Gla-rich protein (GRP) is a vitamin K-dependent protein with a dual capacity to function as an inhibitor of pathological calcification and anti-inflammatory agent in the cardiovascular system, whose clinical utility is unknown. Our aim with this study was to evaluate the potential of GRP as a new marker for CKD-MBD and vascular calcification, in type 2 diabetic patients with chronic kidney disease (CKD) stages 2-4. Method In an observational prospective study including all eligible type 2 diabetic patients with CKD stages 2-4 (n=80) followed in outpatient nephrology consultation from 2010 to 2017, we explored correlations between levels of GRP in serum with mineral metabolism and inflammation markers, CKD developmental stage, vascular calcification and pulse pressure (PP). Vascular calcification score (VCS) was evaluated using the plain x-ray of the hands and pelvis (Adragão score), and increased cardiovascular risk was considered for VCS≥3. Measurements of GRP in serum were performed using a recently developed sandwich ELISA assay. Descriptive statistics, ANOVA and post hoc analysis with Scheffe test were used for analysis. Forward stepwise logistic regression (likelihood ratio) analysis was applied to identify predictive factors for VCS and PP, and ROC curves were used to assess the sensitivity and specificity of GRP in relation to these exposure factors. Results Spearman’s correlation analysis revealed the strong positive correlation between levels of serum GRP and eGFR (r=0.863, p&amp;lt;0.0001) and α klotho (r=0.647, p&amp;lt;0.0001), while a negative correlation with phosphate (P) (r=-0.715, &amp;lt;0.0001), FGF23 (r=-0.676, &amp;lt;0.0001), VCS (r=-0.822, p&amp;lt;0.0001), PP (r=-0.533, p&amp;lt;0.0001), calcium x phosphate (CaxP) (r=-0.302, p=0.006) and IL-6 (r=-0.349, p=0.002). Serum GRP levels were found to progressively decreased from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 as independent risk factors for both the VCS and PP. The area under the ROC curves for GRP was 0.865±0.046, 95% CI (0.776-0.955), p&amp;lt;0.0001 for VCS and 0.782±0.054, 95% CI (0.677-0.887), p&amp;lt;0.0001 for PP. Conclusion Reduced levels of GRP were associated with higher levels of vascular calcification promoters such as P, FGF-23 and CaxP, and with lower levels of the VC inhibitor α-Klotho, indicating a correlation between GRP and the dysregulation of phosphate metabolism characteristic of CKD-MBD. In addition, this pilot cohort study indicates that GRP levels might be a significant clinical predictor of vascular calcifications in diabetic patients with CKD. Funding This research was funded by the Portuguese Society of Nephrology (SPN) through project funding 2016, by the Portuguese national funds from FCT - Foundation for Science and Technology through the transitional provision DL57/2016/CP1361/CT0006 and project UID/Multi/04326/2019. Acknowledgments To SPN by the attribution of the Jacinto Simões award (2018) financed by Fresenius medical care.

0580 Habitual Sleep Pattern, Anxiety and Depression are Predictive of Excessive Daytime Sleepiness in a Large-Scale Clinical Samples of Obstructive Sleep Apnea

Abstract Introduction Excessive daytime sleepiness (EDS) is a common symptom that patients with obstructive sleep apnea (OSA) seek medical attention for. Prevalence ranged from 20% to 60%. Previous studies reported factors associated with EDS included age, body mass index (BMI), depression, and OSA severity. In most studies, the sample size was small, participants having specific co-morbidities, and the definitions of EDS was heterogeneous. Moreover, the association between anxiety, depression, habitual sleep pattern, and EDS has not been widely studied. Therefore, the present study aims to investigate the prevalence of EDS and associated factors, especially anxiety, depression, and habitual sleep pattern, in a large-scale clinical sample. Methods Data was prospectively collected from 8,081 adult patients who underwent initial overnight polysomnography (PSG) for the first time were referred from 2009 to 2016. Patients with total recording time less than 240 minutes and missing data were excluded. Data collected include demographics, anthropometrics, co-morbidities, and self-reported habitual sleep patterns. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS) with EDS defined as ESS ≥10. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). The stepwise forward Logistic regression was used to identified predictors for EDS. Results In 5,780 (82.6%) patients with OSA (apnea-hypopnea index, AHI≥5/h), mean age was 63.9±0.2 yr, BMI was 27.7±0.1, and ESS was 10.4±0.1 and 80.5% were male. Prevalence of EDS in all OSA patients was 55.1% where the patients with severe OSA had higher prevalence (59.8%) than that in mild (49.5%) and moderate OSA (51.8%). Anxiety (OR: 2.036, 95% CI:1.153-1.502), depression (OR: 1.159, 95% CI:1.01-1.33), and short sleep (&amp;lt;6hr/night) (OR:1.316, 95% CI:1.32,1.70) were top three risk factors for EDS. Other risk factors for EDS included AHI, arousal index, % total sleep time with SpO2&amp;lt;90%, %REM, smoking while hypnotic use and long sleep (≥ 8hr/night) were associated with lower risk. Conclusion Anxiety, depression, short sleep are predictive and OSA severity are predictive of EDS while long sleep was associated with lower risk. Support National Taiwan University (NTU-EPR-104R8951-1; 105R8951-1; 106R880301), Center of electronics technology integration (NTU-107L900502, 108L900502) by the Ministry of Education in Taiwan and MediaTek Inc (201802034RIND).

Prevalence and determinants of the dangerous selfie among medical and nursing students: a cross-sectional study from eastern India

BackgroundGlobally, there has been an exponential rise in smartphone use and selfie taking among youth. To make selfies exciting, dangerous selfies are often taken that may lead to catastrophic consequences, including death. This study aims to estimate the prevalence of dangerous selfies and to determine the factors associated with dangerous selfies among medical and nursing students in India.MethodsThe study was conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India, in April–August 2018. The inclusion criteria were students enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) and nursing courses of AIIMS, Bhubaneswar. Students who did not use smartphones were excluded from the study. The interview schedule and Selfitis Behaviour Scale (SBS) were used to collect information on sociodemographic variables, smartphone use and variables related to selfies and dangerous selfies. Forward stepwise logistic regression was undertaken with the probability of entry and removal as 0.05 and 0.10, respectively.ResultsOf 633 eligible participants, 595 were included in the study. The mean (SD) age of the participants was 21.2 (1.6) years. More than half (56.8%) of the participants were female, 384 (64.5%) were medical students and 211 (35.5%) were nursing students. Nearly two-thirds of the participants (70.6%) preferred to take selfie. One hundred thirty three (40.3%) of the participants posted selfies on social media daily. The prevalence of dangerous selfies was 8.74% (95% CI: 6.73–11.28). Eight injury episodes while taking selfies were reported by seven (1.2%) participants. Being male (AOR 4.96, 95% CI 2.53–9.74), posting selfies on social media daily (AOR 3.33, 95% CI 1.71–6.47) and an SBS score > 75 (AOR 4.97, 95% CI 1.43–17.28) were independent predictors of dangerous selfies.ConclusionNearly one in ten medical and nursing students reported having taken a dangerous selfie, and one in one hundred reported having been injured while attempting to take a selfie. Being male, posting selfies on social media daily and an SBS score > 75 were independent predictors of dangerous selfies. Further research is required to identify the community burden of dangerous selfies and to develop strategies to prevent selfie-related fatalities among youths.

Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study.

BackgroundDrug therapy problems (DTPs) are of major concern in health care because of the associated increased cost of treatment, morbidity, and mortality. Thus, clinical practice should constitute the mainstream practice of clinical pharmacy in every ward. However, nothing is known about DTPs and the role of clinical pharmacist in the surgical ward of Ethiopia (the neglected ward).ObjectiveTo assess the prevalence of DTP among patients hospitalized at the surgical ward and the role of clinical pharmacists in their identification and resolution.MethodsHospital-based prospective observational and interventional study design was used with daily patients’ chart review using a semi-structured questionnaire among hospitalized adult patients at the surgical ward. After identification of DTP, verbal communication was used as a means of intervention with the treating physician. Acceptance of clinical pharmacist’s intervention was considered only if a change was made to the patients’ medication order. To identify determinants of DTPs, multiple stepwise forward logistic regression analysis was done by SPSS version 20.0. Statistical significance was considered at p-value < 0.05. Written informed consent was sought and the data were secured.ResultsThe response rate was 97.1% (300) for the final analysis. The mean (±SD = standard deviation) age of the participants was 42.62 ±18.29 with male (67%) predominance. DTP was identified in 76% of study participants. A total of 449 DTPs were identified, which equates with an average of 1.97 per patient. Dose too low 124/449 (27.6%) and dose too high 81/449 (18.0%) were found to be the most common types of DTPs. The intervention rate was 86.0% (196/228 per patients) and 86.2% (387/449 DTPs), with the acceptance rate of 85.2% (167/196 per patients) and 78% (302/387 per DTP) which mean (67.3%) 302/449 of the problems were fully resolved by the clinical pharmacist. Poly-pharmacy [AOR, 7.23; 95% CI, 2.29–22.13: P-value < 0.001] and hospital stay > 20 days [AOR, 5.42; 95% CI, 2.74–10.70; p < 0.001] were the only independent predictors for DTPs.Conclusion and RecommendationThis study identified a high prevalence of DTP which was independently predicted by the presence of poly-pharmacy and >20 days of hospital stay. The rate of intervention provided and acceptance from the physician was high, which is one indicator that the role of clinical pharmacists in the identification and resolution of DTP was paramount in the surgery ward and should be implemented as a must not as optional.

Subcortical auditory neural synchronization is deficient in pre-reading children who develop dyslexia.

Auditory processing of temporal information in speech is sustained by synchronized firing of neurons along the entire auditory pathway. In school-aged children and adults with dyslexia, neural synchronization deficits have been found at cortical levels of the auditory system, however, these deficits do not appear to be present in pre-reading children. An alternative role for subcortical synchronization in reading development and dyslexia has been suggested, but remains debated. By means of a longitudinal study, we assessed cognitive reading-related skills and subcortical auditory steady-state responses (80Hz ASSRs) in a group of children before formal reading instruction (pre-reading), after 1year of formal reading instruction (beginning reading), and after 3years of formal reading instruction (more advanced reading). Children were retrospectively classified into three groups based on family risk and literacy achievement: typically developing children without a family risk for dyslexia, typically developing children with a family risk for dyslexia, and children who developed dyslexia. Our results reveal that children who developed dyslexia demonstrate decreased 80Hz ASSRs at the pre-reading stage. This effect is no longer present after the onset of reading instruction, due to an atypical developmental increase in 80Hz ASSRs between the pre-reading and the beginning reading stage. A forward stepwise logistic regression analysis showed that literacy achievement was predictable with an accuracy of 90.4% based on a model including three significant predictors, that is, family risk for dyslexia (R=.31), phonological awareness (R=.23), and 80Hz ASSRs (R=.26). Given that (1) abnormalities in subcortical ASSRs preceded reading acquisition in children who developed dyslexia and (2) subcortical ASSRs contributed to the prediction of literacy achievement, subcortical auditory synchronization deficits may constitute a pre-reading risk factor in the emergence of dyslexia.

Volar Cortical Integrity in Non-Operatively Treated Adult Distal Radius Fractures.

Background: We sought to independently validate published data that volar cortical integrity (VCI) is an independent predictor of maintenance of closed reduction in a series of non-surgically treated distal radius fractures, while simultaneously investigating previously reported predictors of instability. Our null hypothesis was that volar cortical integrity would not affect maintenance of reduction. Methods: Four hundred thirty-three adult distal radius fractures were screened from our Orthopedic database with 112 meeting inclusion criteria. Two groups were determined on the basis of maintenance of reduction (MOR) or loss of reduction (LOR) at 5-6 weeks post-reduction. Bivariate analysis was applied to previously published instability factors along with VCI. A forward stepwise logistic regression was then used to identify instability factors that, as a group, are most predictive of outcome. Results: Results of 112 patients were collected. Reduction was maintained in 62 patients (55.35%) at 5-6 weeks Biivariate analysis showed a statistically significant difference in volar cortical integrity between the 2 groups (80.6% MOR vs 59.2% LOR). Forward stepwise logistic regression analysis of subgroups revealed that post-reduction radial height and VCI were together statistically significant in the model. The presence of VCI, post-reduction radial height greater than or equal to ulnar neutral at the time of initial reduction resulted in a 67.8% successful MOR. Conclusions: We were able to confirm the importance of volar cortical integrity as a predictor of successful maintenance of reduction in non-surgically managed distal radius fractures. When combined with post-reduction radial height greater than or equal to ulnar neutral at the time of initial reduction, it showed a 67.8% MOR with non-operative management in our data-set.

Clinical Characteristics, Treatment Effectiveness, and Predictors of Response to Pharmacotherapeutic Interventions in Burning Mouth Syndrome: A Retrospective Analysis.

To identify the clinical characteristics of patients with primary and secondary burning mouth syndrome (BMS), to assess the effectiveness of pharmacotherapy in treating BMS, and to determine the clinical variables that may predict significant relief of clinical symptoms. A retrospective chart review of patients who underwent clinical management for BMS in the Massachusetts General Hospital between January 2011 and December 2016 was carried out. Information regarding demographics, diagnostics, and therapeutic characteristics was extracted and analyzed. Of 112 BMS patients, 77 had primary BMS. Patients with primary and secondary BMS had similar clinical characteristics except when it came to the presence of at least one symptom of sensory discrepancy, which was more prevalent in primary BMS. Following pharmacologic intervention, 46.8% of the patients with primary BMS experienced significant relief in symptoms, and this therapy was associated with a lower level of pain, an onset of symptoms of less than 1 year, hyperlipidemia, absence of depression disorder, and nonconcurrent use of other neuropathic medications. In contrast, only 31.4% of patients with secondary BMS experienced significant relief in symptoms, and this was associated with the presence of anxiety disorder. Stepwise forward conditional logistic regression analysis suggested that nonconcurrent use of neuropathic medications was a predictor for significant relief of symptoms in patients with primary BMS. Likewise, the model suggested that presence of anxiety disorder was a predictor in patients with secondary BMS. The prevalence of an associated sensory discrepancy was higher in primary BMS. Pharmacologic intervention provided significant relief for approximately half of the patients with primary BMS and nearly one-third of the patients with secondary BMS. Concurrent use of neuropathic medications was a negative predictor, and presence of anxiety disorder a positive predictor, of therapeutic response among patients with primary BMS and secondary BMS, respectively.

A novel mathematical model of true ovarian reserve assessment based on predicted probability of poor ovarian response: a retrospective cohort study.

To establish a mathematical model for assessing the true ovarian reserve based on the predicted probability of poor ovarian response (POR). In this retrospective cohort study, a total of 1523 GnRH-antagonist cycles in 2017 were firstly analyzed. The ovarian responses were calculated based on the number of retrieved oocytes. The continuous variables were converted into categorical variables according to cutoff values generated by the decision tree method. The optimal model was identified using forward stepwise multiple logistic regression with 5-fold cross-validation and further verified its performances using outer validation data. The predictors in our model were anti-Müllerian hormone (AMH), antral follicle counts (AFC), basal follicle-stimulating hormone (FSH), and age, in order of their significance, named AAFA model. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value of AAFA model in inner validation and outer validation data were 0.861 and 0.850, 0.603 and 0.519, 0.917 and 0.930, 0.655 and 0.570, and 0.899 and 0.915. Ovarian reserve of 16 subgroups was further ranked according to the predicted probability of POR and further divided into 4 groups of A-D using clustering analysis. The incidence of POR in the four groups was 0.038 (0.030-0.046), 0.139 (0.101-0.177), 0.362 (0.308-0.415), and 0.571 (0.525-0.616), respectively. The order of ovarian reserve from adequate to poor followed the order of A to D. We have established an easy applicable AAFA model for assessing true ovarian reserve and may have important implications in both infertile women and general reproductive women in Chinese or Asian population.

Identification of Predictive Factors for Mechanical Complications After Adult Spinal Deformity Surgery: A Multi-Institutional Retrospective Study.

A retrospective multicenter observational study. To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors. The risk factors associated with MCs have not yet been well examined, especially in aged populations. We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (-) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated. Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (-) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (-) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs. Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC. 4.

Association of NPAC score with survival after acute myocardial infarction

Background and aimsRisk stratification in acute myocardial infarction (AMI) is important for guiding clinical management. Current risk scores are mostly derived from clinical trials with stringent patient selection. We aimed to establish and evaluate a composite scoring system to improve short-term mortality classification after index episodes of AMI, independent of electrocardiography (ECG) pattern, in a large real-world cohort. MethodsUsing electronic health records, patients admitted to our regional teaching hospital (derivation cohort, n = 1747) and an independent tertiary care center (validation cohort, n = 1276), with index acute myocardial infarction between January 2013 and December 2017, as confirmed by principal diagnosis and laboratory findings, were identified retrospectively. ResultsUnivariate logistic regression was used as the primary model to identify potential contributors to mortality. Stepwise forward likelihood ratio logistic regression revealed that neutrophil-to-lymphocyte ratio, peripheral vascular disease, age, and serum creatinine (NPAC) were significant for 90-day mortality (Hosmer- Lemeshow test, p = 0.21). Each component of the NPAC score was weighted by beta-coefficients in multivariate analysis. The C-statistic of the NPAC score was 0.75, which was higher than the conventional Charlson's score (C-statistic = 0.63). Judicious application of a deep learning model to our dataset improved the accuracy of classification with a C-statistic of 0.81. ConclusionsThe NPAC score comprises four items from routine laboratory parameters to basic clinical information and can facilitate early identification of cases at risk of short-term mortality following index myocardial infarction. Deep learning model can serve as a gatekeeper to facilitate clinical decision-making.

Birth order is associated with caries development in young children: a register-based cohort study

BackgroundBirth order has been shown to affect the health of the child; less is known, however, about how birth order affects caries development in children. Thus, the present study investigated the association between birth order and dental caries development in young children.MethodsThis retrospective registry-based cohort study included all children born in 2000–2003 who were residing in Stockholm County, Sweden, at age 3 years (n = 83,147). The study followed the cohort until subjects reached 7 years of age. Children with registry data on dental examinations and sociodemographic characteristics at ages 3- and 7 years constituted the final study cohort (n = 65,259). The outcome variable was “caries increment from age 3- to 7 years” (Δdeft > 0) and the key exposure, “birth order”, was divided into five groups. A forward stepwise logistic binary regression was done for the multivariate analysis with adjustments for sociodemographic factors.ResultsAt age 3 years, 94% had no fillings or manifest caries lesions. During the study period, 22.5% (n = 14,711) developed dental caries. The final logistic regression analysis found a statistically significant positive association between birth order and caries increment. Further, excess risk increased with higher birth order; with the mother’s first-born child as reference, risk for the second-born child was OR 1.17, 95% CI = 1.12–1.23; for the third-born child, OR 1.47, 95% CI = 1.38–1.56; for the fourth-born child, OR 1.69, 95% CI = 1.52–1.88; and for the fifth-born or higher birth-order child, OR 1.84, 95% CI = 1.58–2.14.ConclusionsThese findings show that birth order influences caries development in siblings, suggesting that birth order can be regarded as a predictor for caries development in young children. This factor may be helpful in assessing caries risk in preschool children and should be considered in caries prevention work in young children with older siblings.

Adverse birth outcomes and the risk of dental caries at age 3years.

Since birth outcome is associated with maternal and newborn health, it can be a predictor of the future health of the child. To investigate the association between adverse birth outcomes and dental caries. The present registry-based cohort study included all children born in 2000-2003, residing in Stockholm County, Sweden and who received a dental examination at the age of 3years (n=74748). National registries supplied data on socioeconomic conditions, maternal health, maternal health behavior, and birth outcomes. Forward stepwise binary logistic regression was performed to determine predictors of caries experience in the 3-year-olds. Of the subjects, 6.0% had caries experience (decayed, extracted, and filled teeth [deft]≥1), 5.6% were born preterm (<37weeks); 2.2% were born small (SGA) and 3.7% large (LGA) for gestational age. Of the studied adverse birth outcomes, only SGA was significantly associated with caries experience at 3years of age, and only for mothers who had refrained from smoking during pregnancy. SGA is associated with caries experience in 3-year-old children; however, this relationship occurs only in mothers who did not smoke during pregnancy.

The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults.

BackgroundBehavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL).MethodsA battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs.ResultsFood addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA.ConclusionLate adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.

Epidemiological profile of mucosal melanoma in Brazil

Mucosal melanomas are primary malignant neoplasias originated from melanocytes within mucous membranes in any part of mucosal surface lining, more commonly, in the nasal cavity and accessory sinuses, oral cavity, lips, pharynx, vulvar, vaginal, cervix and anorectal mucosa. Epidemiology data regarding mucosal melanomas in Brazil is scarce, hence the motivation to conduct this research paper. The χ2 test was used to compare categorical variables. Forward stepwise logistic regression method was used in the multivariate analysis to identify independent predictors of early death. A total of 801 patients were included in the analysis. Surgical resection is frequently the first approach to primary tumours (65.3%), even though the utility of lymph node surgery and radiation therapy is not well established. Advanced stage was observed in more than two thirds of patients. Early death was observed in 28.3%. MM cases with regional or distant metastases as well as those located in unusual locations had almost 4 times more risk for early death. Besides that, MM located in lips, oral cavity and pharynx and those receiving chemotherapy had 2 times more risk of early death.

Are quantity and content of psychiatric interventions associated with suicide? A case-control study of a Swedish sample

BackgroundResearch is required to identify those psychiatric interventions with a protective effect against suicide. The overarching aim of the current study was to examine whether completed suicide in psychiatric patients in a Swedish population was associated with the quantity and nature of previous medical and psychosocial treatment interventions.MethodsThis retrospective case-control study (n = 308) compared a group of deceased psychiatric patients with matched controls. For every case of suicide, a control was found within psychiatry that matched according to sex, age, and primary psychiatric diagnosis. A stepwise forward logistic regression model with suicide as the dependent outcome variable was used.ResultsReceiving pharmacotherapy combined with psychotherapy [OR: 0.44 (95% CI: 0.226–0.876), p = 0.019] and a higher number of outpatient visits in psychiatry [OR: 0.99 (95% CI: 0.982–0.999), p = 0.028] were negatively associated with suicide. These associations were still significant after controlling for previous serious suicide attempts and somatic comorbidity.ConclusionsFrequent visits and pharmacotherapy combined with psychotherapy seem to be important for preventing suicide in psychiatric patients. The reasons for not receiving such therapy are important issues for further study.

Unrecognized Respiratory Morbidity among Adolescents and Young Adults in Nigeria: Implications for Future Health Outcomes.

Background:Lung function impairment is a major determinant of morbidity and mortality. Unrecognized respiratory morbidity may be a missed opportunity to improve future health outcomes.Aim:The aim of this study was to investigate the prevalence of respiratory symptoms and the relationship to spirometry abnormalities and respiratory diagnosis among medical students in Lagos, Nigeria.Methods:This was a cross-sectional study among students aged 16–35 years. We assessed frequency of respiratory symptoms, previous respiratory diagnosis, and spirometry abnormalities. The relationship between respiratory symptoms, spirometry pattern, and previous respiratory diagnosis was determined using the Chi-square test and stepwise forward logistic regression analysis.Results:Of 640 participants, 464 (72.5%) performed good quality spirometry tests. Two hundred and forty-four (52.6%) had at least one respiratory symptom. Preexisting conditions were only identified in 60 (12.9%): 49 (7.7%) asthma, 29 (4.5%) allergic rhinitis, 16 (2.5%) treated tuberculosis, and 8 (1.3%) bronchitis/chronic obstructive pulmonary disease. Using the Global Lung Function Initiative (GLI) lung function predicted values, obstructive (8.4%) and restrictive abnormalities (25.4%) were common. An obstructive pattern was associated with previous diagnosis of asthma, but there was no significant association for the restrictive spirometry pattern.Conclusions:Among otherwise healthy students, respiratory symptoms and lung function abnormalities are common. The vast majority are without a formal diagnosis. Asthma accounted for the majority of obstructive spirometry pattern seen, but the restrictive abnormalities based on GLI equations remain unexplained. Further research is required to determine the cause of these abnormalities and long-term implications in apparently healthy young individuals.