Inter Quartile Research Articles

Determinants of recovery time from severe acute malnutrition among cholera-exposed and unexposed children in Ethiopia: a prospective cohort study.

There is a vicious interplay between severe acute malnutrition (SAM) and diarrheal diseases including cholera. The lack of sufficient evidence on the time to recovery and its determinants among children with cholera prompted this investigation. The study aimed to evaluate the time to recovery and determinants among children with severe acute malnutrition, comparing cholera-exposed and unexposed children. A prospective cohort study was carried out from September 10, 2022, to February 21, 2023, among 224 children below 15 years. The study was conducted at cholera treatment centers and nearby communities in the Bale and Guji Zones of Oromia Regional state in Ethiopia. A structured questionnaire was used to obtain information and anthropometric measurements were conducted weekly. After checking all assumptions, a multivariable Cox Proportional Hazards model was used to identify independent determinants of time to recovery using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). Statistical significance was declared at p < 0.05. Nearly 80% of participants recovered from SAM with a recovery rate of 40/1000 person-week observation and a median time to recovery of 21 days [Inter Quartile Range14-28]. The recovery time from SAM for cholera-exposed children was delayed by 54% [ARR: 0.46, 95% CI: 0.30-0.69] compared to unexposed children. Similarly, the recovery time from SAM for food-insecured families was delayed by 39% [ARR: 0.61, 95% CI: 0.38-0.96] compared to food-secured families. Moreover, children with more than three meal frequencies per day had 1.61 times [ARR: 1.61, 95% CI: 1.04-2.50] higher probability of fast recovery from SAM, compared to children with less than three meals. Children from families with good attitudes toward nutrition had more than two times [ARR: 2.23, 95% CI: 1.45-3.41] higher probability of faster recovery from SAM than families with poor attitudes. The study revealed that cholera exposure is one of the main determinants of prolonged recovery time for children with SAM. Food insecurity, meal frequency, and the attitude of parents toward children's dietary habits were determinants for the recovery of children from SAM. The findings imply the need for designing interventions to enhance child feeding during cholera illness, focusing on key determinants.

Evaluation of data quality in the Swedish National Penile Cancer Register.

The National Penile Cancer Register (NPECR) in Sweden was initiated in year 2000 and currently contains more than 3,900 men diagnosed with penile cancer. The aim of this study was to evaluate data quality in the NPECR in terms of completeness, timeliness, comparability, and validity. Completeness was assessed by cross-linkage to the Swedish Cancer Register. Timeliness, defined as time from date of diagnosis to date of reporting in the NPECR, was calculated. Comparability was evaluated by reviewing and comparing coding routines in the NPECR with national and international guidelines. To assess validity, medical records of 375 men with a penile cancer diagnosis in the NPECR between 2017 and 2020 were reviewed and selected variables were re-abstracted and compared with previously registered data. Completeness was high (93%). Timeliness was in median 4.6 (Inter Quartile Range 2.6-8.8) months. Comparability was good with coding routines and the registration forms were in compliance with current guidelines. Overall, the validity was high. The majority of variables showed an exact agreement exceeding 90%. Data quality in the Swedish NPECR is generally high with respect to completeness, timeliness, comparability, and validity. Hence, the NPECR represents a reliable data source for monitoring the quality of penile cancer care and research. Data quality can be further improved by revision of reporting forms and manuals, training of reporting staff, and by organizational adjustments.

Brain electrical activity in Newly diagnosed Generalized Anxiety Disorder: A Quantitative EEG analysis

Background: Generalized Anxiety Disorder (GAD) is one of the most common global mental disorders with negative impact on social life. Quantitative EEG can objectively estimate the anxiety status. Relatively increase beta activity along with decrease alpha activity is associated with GAD. Objectives:To evaluate power of all brain waves in female patients with GAD. Methods:This observational study was conducted on 20 female patients with GAD (age 20-40 years),For comparison, 20 healthy female volunteers of same age were enrolled as control. In this study, EEG was recorded for 3 minutes by placing electrodes on scalp according to 10-20 system. To assess brain electrical activities, the band power of delta, theta, alpha and beta brainwave was recorded from an EEG data acquisition device, EEG Traveler Brain Tech 32+ CMEEG -01, India. Power spectral analysis of EEG data was done by BT40 analysis software. Data were expressed as median (Inter Quartile Range). Statistical analysis was done by Mann-Whitney U test.Results: The significantly higher absolute power of beta was found in most of the electrodes of prefrontal, frontal and temporal region as well as significantly lower power of alpha, theta and delta werefound in all cortical regions in female GAD patients compared to healthy controls at baseline. Conclusion: This study concluded that GAD patients had high excitable state in most of cortical region associated with lack of relaxing ability. J Bangladesh Soc Physiol 2023;18(2): 78-88

Vaping: The Key to Quitting Cigarettes or a Gateway to Addiction?

Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their bodies. While e-cigarettes are often advertised as a way to help people quit traditional tobacco products, the World Health Organization (WHO) has stated that there is no proof of e-cigarettes being effective at reducing an individual's tobacco use. The objective of this study is to determine why adolescents start smoking e-cigarettes. Materials and Methods: For the following study, the National Youth Tobacco Survey (NYTS) 2021 was used. This is a nationally representative cross-sectional survey that includes middle and high school students. The data were analyzed using SAS v.9.4. The odds ratio for smoking e-cigarettes was evaluated for both sex and race via a logistic regression. Results: It was discovered that the percentage of only e-cigarette smokers (12.10%) was 5.5 times the percentage of only traditional smokers (2.19%). Additionally, the median age at which adolescents started smoking e-cigarettes was fifteen years with an IQR (Inter Quartile Range) of two. We used a logistic regression to show that biological sex and race were significant predictors of e-cigarette usage. Conclusions: In general, we saw that adolescents were mostly starting to smoke e-cigarettes because their friends were doing it, out of curiosity, they were depressed or anxious, and/or to get a "high", implying that adolescents mostly started smoking in order to fit in and/or to numb themselves. Interestingly, reasons like cost, using them to quit smoking, seeing them in the media, and ease of attainment were ranked the lowest when it came to smoking e-cigarettes. However, their lower costs naturally lead to increased accessibility compared to traditional cigarettes, making them easier to reach the hands of teenagers. Overall, in this paper, we aim to identify if adolescents are choosing e-cigarettes as their first foray into tobacco products and why.

Web-based application of descriptive statistics for data dispersion analysis to support statistic learning

Statistics is a branch of science that studies ways of collecting, processing, presenting, analyzing, interpreting and drawing conclusions from data. Descriptive Statistics is a part of statistics that carries out the tasks of collecting data, classifying, processing and presenting quantitative data. Statistics has a very important and necessary role in various areas of life, so that statistics courses are taught in almost all departments, both exact and non-exact, at various educational institutions. A common problem found in studying statistics courses is that students in non-exact majors are less interested in courses involving numerical data processing, so that learning outcomes for this course are generally relatively low. With advances in information technology, several statistical applications have been developed, but these applications directly present the final results of data processing without displaying the steps to obtain the final results. This is inadequate from a learning perspective, because students do not get a clear picture of the steps for solving problems based on statistics. This research uses the method waterfall [8] [9] or linear sequential, namely a sequential and systematic software development method consist of : Analysis, Design, Coding and Testing. The result of making this application is an analysis of data dispersion measures consisting of Range, Inter Quartile Range, Quartile Deviation, Average Deviation, Standard Deviation, Variance, Coefficient Variation and Coefficient Quartile. This application will show in detail the steps to solve the problem according to theory, formulas and calculation steps to get the final result. These results will make it easier for students to understand and it is hoped that this course will be presented more interestingly and ultimately increase learning outcomes.

Associations between residential environments and late-onset schizophrenia in UK Biobank: Interaction with genetic risk factor

BackgroundEnvironment and genes both contribute to schizophrenia. However, the impact of different natural environments surrounding residential addresses on schizophrenia in urban settings remains unknown. This study aimed to investigate the association of urbanisation, measured by residential environments, with late-onset schizophrenia and explore whether genetic risk for schizophrenia modified the associations. MethodsWe examined the associations between residential environments and late-onset schizophrenia and its interaction with genetic risk factors in UK Biobank, followed from 2006 to 2010 (baseline) to Dec 2021. Residential environments, including greenspace, domestic garden, blue space, and total natural environment, were evaluated using land use coverage percentage. The polygenic risk score (PRS) of schizophrenia was derived using a Bayesian approach and adjusted it against ancestry. Cox proportional hazard regression model was used to assess the associations between per interquartile (IQR) increase of each type of residential environments and late-onset schizophrenia. Interactive effects of PRS and residential environments on late-onset schizophrenia were assessed on both additive and multiplicative scales. ResultsA total of 393,680 participants were included in the analysis, with 844 cases of late-onset schizophrenia being observed after 12.8 years of follow-up. Within 300 m buffer surrounding the residential addresses, per interquartile increase in greenspace (31.5 %) and total natural environment (34.4 %) were both associated with an 11 % (HR = 0.89, 95 % CI 0.80, 0.99) lower risk of late-onset schizophrenia. Domestic garden and blue space did not show significant protective effects on late-onset schizophrenia. A strong dose-response relationship between schizophrenia PRS and schizophrenia was found, while no additive or multiplicative interaction effects were present between residential environments and PRS on late-onset schizophrenia. ConclusionResidential greenspace and total natural environment may protect against late-onset schizophrenia in older people regardless of genetic risk. These findings shed light on the prevention of schizophrenia and urban planning to optimise ecosystem benefits linked to schizophrenia.

Air pollution, greenspace exposure and risk of Parkinson's disease: a prospective study of 441,462 participants.

The current understandings of the relationship between air pollution (AP), greenspace exposure and Parkinson's Disease (PD) remain inconclusive. We engaged 441,462 participants from the UK Biobank who were not diagnosed with PD. Utilizing Cox proportional hazard regression model, relationships between AP [nitrogen dioxide (NO2), and nitrogen oxides (NOX), particulate matter < 2.5μm in aerodynamic diameter(PM2.5), coarse particulate matter between 2.5μm and 10μm in aerodynamic diameter(PM2.5-10), particulate matter < 10μm in aerodynamic diameter(PM10)], greenspace exposure, and PD risk were determined independently. Our analyses comprised three models, adjusted for covariates, and affirmed through six sensitivity analyses to bolster the robustness of our findings. Moreover, mediation analysis was deployed to discern the mediating effect of AP between greenspaces and PD. During a median follow-up of 12.23years (5,574,293 person-years), there were 3,293 PD events. Each interquartile (IQR) increment in NO2 and PM10 concentrations were associated with 10% and 8% increase in PD onset risk, while the increases in NOX, PM2.5 and PM2.5-10 were not associated with PD risk. Additionally, greenspace may safeguard by reducing NO2 and PM10 levels, with the effect mediated by NO2 and PM10 in greenspace-PD relationship. Our findings indicate that an IQR increase in ambient NO2 and PM10 concentrations was associated with risk of PD development, while other pollutants (NOX, PM2.5 and PM2.5-10) were not associated with PD risk. Firstly, we find that augmented exposure to greenspace was associated with the lower PD risk by reducing NO2 and PM10 levels.

Association of residential greenness with incident pneumonia: A prospective cohort study

Residential greenness is considered beneficial to human health, and its association with respiratory function has been found in previous studies. However, its link with pneumonia remains unclear. To explore the association of residential greenness with incident pneumonia, we conducted a prospective cohort study based on participants of the UK Biobank, followed from 2006 to 2010 to the end of 2019. Residential greenness was measured by Normalized Difference Vegetation Index (NDVI) within 500 m and 1000 m buffer. Cox proportional hazard models were conducted to assess the association, and restricted cubic spline models were also constructed to estimate their exposure-response relationship. Results demonstrate that residential greenness was negatively related to the risk of incident pneumonia. An interquartile (IQR) increase in NDVI 500-m buffer was associated with 4 % [HR (95 % CI) =0.96 (0.94, 0.97), P < 0.001] lower risk of incident pneumonia. Compared to the lowest greenness quartile (Q1), the highest quartile (Q4) had a lower risk of incident pneumonia, with the HR (95 % CI) estimated to be 0.91 (0.87, 0.95) (P values <0.001). Analyses based on NDVI 1000-m buffer obtained similar results. Furthermore, a significant effect of modifications by age and income on the linkage between residential greenness and incident pneumonia was found. These findings propose a potential effective prevention of incident pneumonia and provide the scientific basis for promoting the construction of residential greenness.

Nursing Care and Quality of Life Among Children with Hepatolenticular Degeneration

Hepatolenticular degeneration also known as Wilson’s disease (WD), is an autosomal recessive inherited copper metabolic disorder. Objective: The study aimed to determine the relationship between nursing care and the quality of life among children with hepatolenticular degeneration in Anhui Province, China. Methods: This research used the descriptive-correlational design. The researcher investigated 45 regular staff nurses and 96 children with hepatolenticular degeneration ages 12 and 18 years old. Two instruments were used. First, the Nursing Care Score Tool was developed by the researcher based on review of related the literature which is used to measure nursing care. Second, the revised PedsQLTM4.0 Generic Core Scales (Pediatric Quality of Life Inventory™ Version 4.0) is used to measure the quality of life among children with hepatolenticular degeneration. The data were analyzed using the following: Frequency, Percentage distribution, Mean, Median scores, IQR (Inter Quartile Range), One-Way Analysis of Variance (ANOVA), t-Test and Pearson Coefficient. Results: In terms of quality of life, except for age, significant differences were found in terms of children’s sex and educational status. Except for knowledge, there were significant differences in terms of physiological care, medication, psychological care, therapeutic communication and functional training as rated by the children and nurses. There was a significant positive correlation (r = .583, p = .000) between nursing care as rated by the children and quality of life of children with hepatolenticular degeneration. Conclusion: Nursing care is positively correlated with quality of life. A closer look at the results revealed that the quality of life of female children is generally lower than that of male, hence, more attention is recommended to be given to female children in improving their quality of life. Children with hepatolenticular degeneration should be encouraged to continue to receive education for a better quality of life. It is necessary for nurses to continuously explain to the child the disease process and the signs and symptoms of the disease. Careful observation of the physiological status of the child, the provision of timely care, regular functional training, making accurate judgements in the response to medications guidance in the intake of oral injectable medications, regular provision of psychological care and therapeutic communication to the children with this condition important tasks of the nurses. All these can lead to having these children live a better quality of life.

A photoaging smartphone application to promote sun safety behaviors among youth in late childhood and adolescence.

Ultraviolet (UV)-exposure behaviors can directly impact an individual's skin cancer risk, with many habits formed during childhood and adolescence. We explored the utility of a photoaging smartphone application to motivate youth to improve sun safety practices. Participants completed a preintervention survey to gather baseline sun safety perceptions and behaviors. Participants then used a photoaging mobile application to view the projected effects of chronic UV exposure on participants' self-face image over time, followed by a postintervention survey to assess motivation to engage in future sun safety practices. The study sample included 87 participants (median [interquartile (IQR)] age, 14 [11-16] years). Most participants were White (50.6%) and reported skin type that burns a little and tans easily (42.5%). Preintervention sun exposure behaviors among participants revealed that 33 (37.9%) mostly or always used sunscreen on a sunny day, 48 (55.2%) experienced at least one sunburn over the past year, 26 (30.6%) engaged in outdoor sunbathing at least once during the past year, and zero (0%) used indoor tanning beds. Non-skin of color (18 [41.9%], p = .02) and older (24 [41.4%], p = .007) participants more often agreed they felt better with a tan. Most participants agreed the intervention increased their motivation to practice sun-protective behaviors (wear sunscreen, 74 [85.1%]; wear hats, 64 [74.4%]; avoid indoor tanning, 73 [83.9%]; avoid outdoor tanning, 68 [79%]). The findings of this cross-sectional study suggest that a photoaging smartphone application may serve as a useful tool to promote sun safety behaviors from a young age.

Cystectomy for bladder cancer in Sweden - short-term outcomes after centralization.

Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC has decreased in Sweden over time, and since a formal regional centralization in 2017 cystectomy care is currently provided by nine hospitals. In the Swedish National Urinary Bladder Cancer Register (SNRUBC) 90-day complications after RC have been registered with high coverage since 2012. Descriptive data and short-term outcomes were compared in relation to centralization of the cystectomy care by stratifying data before (2012-2016) and after (2017-2023). Out of all 4,638 cystectomies, 2,738 (59%) were performed after the centralization in 2017 and onwards. The median age at RC increased from 71 (Inter Quartile Range [IQR] 65-76) to 73 (IQR 67-77) years, and the proportion of patients with comorbidity (American Society of Anesthesiologists [ASA] 3 or 4) increased from 32% to 37% after the centralization (p < 0.001). The number of patients suffering from high-grade complications within 90 days of surgery corresponding to Clavien grade three were 345 (18%) and 407 (15%), and corresponding to Clavien grade four 61 (3%) and 64 (2%) before and after centralization, respectively. Reoperations within 90 days of RC decreased from 234/1,900 (12%) to 208/2,738 (8%) (p < 0.001), and 90-day mortality decreased from 84/1,900 (4%) to 85/2,738 (3%) (p = 0.023) before and after centralization, respectively. After the centralization of the cystectomy-care in Sweden, older patients and individuals with more extensive comorbidity were offered RC whereas 90-day mortality and the proportion of patients subjected to reoperations within 90 days of surgery decreased without increasing waiting times.

Paediatric-onset immune-mediated inflammatory disease is associated with an increased mortality risk-A nationwide study.

Paediatric-onset immune-mediated inflammatory diseases (pIMID) show more aggressive phenotypes than when diagnosed in adults. However, data on mortality are often extrapolated from adult studies. To estimate the effect of pIMID on mortality. In a population-based cohort study using the nationwide Danish healthcare registers, we included all patients diagnosed with pIMID in Denmark from 1980 to 2018. PIMID were defined as ICD codes indicative of autoimmune hepatitis, primary sclerosing cholangitis, Crohn's disease, ulcerative colitis, juvenile idiopathic arthritis, lupus erythematosus, or vasculitis registered before age 18 years. All-cause mortality was the primary outcome; cause-specific mortality was the secondary outcome. We used Cox survival analysis to estimate hazard ratios (HR), and Aalen survival analysis to estimate rate differences. We included 11,581 individuals diagnosed with pIMID and 99,665 reference individuals, accounting for 1,371,994 person-years of follow-up. Median and interquartile (IQR) age at diagnosis was 12.6 (7.9-15.9) years. During follow-up, 152 patients with pIMID and 316 reference individuals died; adjusted HR (aHR) was 3.8 (95% confidence interval [CI] 3.1-4.7). This corresponded to 6.9 (95% CI: 5.3-8.5) additional deaths per 10,000 person-years. The strongest associations were found for gastrointestinal diseases (aHR 22.8; 95% CI 9.6-64.1), gastrointestinal cancers (aHR 19.2; 95% CI 5.0-74.2) and lymphoproliferative disorders (aHR 6.8; 95% CI 2.8-16.8). Patients diagnosed with pIMID have a fourfold higher risk of mortality when followed into early adulthood compared with reference individuals. This underlines the severe disease course of pIMID and highlights the need for multidisciplinary care.

Association of land surface temperature anomalies from GOES/ABI, MSG/SEVIRI, and Himawari-8/AHI with land earthquakes between 2010 and 2021

Every year, earthquakes cause numerous casualties and billions of dollars in economic damages, and so far, it is impossible to predict them. Many researchers have studied the land surface temperature (LST) anomalies as promising potential earthquake precursors. In this work, more than 30,000 land earthquakes with a Magnitude (Mw) larger than 4 have been studied from 2010 to 2021. Global LST nighttime (0–6 am) data from Meteosat Second Generation (MSG), Himawari-8, and the Geostationary Operational Environmental Satellite (GOES) satellites have been used to evaluate the LST anomalies in the zones affected by earthquakes with spatial resolutions of 1, 2, and 4 km, respectively. The time series moving standard deviation (STD) and Interquartile (IQT) have been used to estimate the LST anomalies. The Confusion Matrix (CM), the receiver operating curve (ROC), and some other figures of merit are computed to assess the goodness of positive LST anomalies and detection thresholds as potential proxies of earthquake occurrence. A positive LST anomaly is typically observed a few days [1–7 d] before the earthquake’s occurrence, followed by a negative LST anomaly afterwards [1–3 d].

Associations of neighborhood greenspace, and active living environments with autism spectrum disorders: A matched case-control study in Ontario, Canada

BackgroundIncreasing evidence links early life residential exposure to natural urban environmental attributes and positive health outcomes in children. However, few studies have focused on their protective effects on the risk of autism spectrum disorder (ASD). The aim of this study was to investigate the associations of neighborhood greenspace, and active living environments during pregnancy with ASD in young children (≤6 years). MethodsWe conducted a population-based matched case-control study of singleton term births in Ontario, Canada for 2012–2016. The ASD and environmental data was generated using the Ontario Autism Spectrum Profile, the Better Outcomes Registry & Network Ontario, and Canadian Urban Environmental Health Research Consortium. We employed conditional logistic regressions to estimate the odds ratio (OR) between ASD and environmental factors characterizing selected greenspace metrics and neighborhoods conducive to active living (i.e., green view index (GVI), normalized difference vegetation index (NDVI), tree canopy, park proximity and active living environments index (ALE)). ResultsWe linked 8643 mother-child pairs, including 1554 cases (18%). NDVI (OR 1.034, 0.944–1.024, per Inter Quartile Range [IQR] = 0.08), GVI (OR 1.025, 95% CI 0.953–1.087, per IQR = 9.45%), tree canopy (OR 0.992, 95% CI 0.903–1.089, per IQR = 6.24%) and the different categories of ALE were not associated with ASD in adjusted models for air pollution. In contrast, living closer to a park was protective (OR 0.888, 0.833–0.948, per 0.06 increase in park proximity index), when adjusted for air pollution. ConclusionsThis study reported mixed findings showing both null and beneficial effects of green spaces and active living environments on ASD. Further investigations are warranted to elucidate the role of exposure to greenspaces and active living environments on the development of ASD.

Effects of long-term exposure to outdoor air pollution on COVID-19 incidence: A population-based cohort study accounting for SARS-CoV-2 exposure levels in the Netherlands

Several studies have linked air pollution to COVID-19 morbidity and severity. However, these studies do not account for exposure levels to SARS-CoV-2, nor for different sources of air pollution. We analyzed individual-level data for 8.3 million adults in the Netherlands to assess associations between long-term exposure to ambient air pollution and SARS-CoV-2 infection (i.e., positive test) and COVID-19 hospitalisation risks, accounting for spatiotemporal variation in SARS-CoV-2 exposure levels during the first two major epidemic waves (February 2020–February 2021). We estimated average annual concentrations of PM10, PM2.5 and NO2 at residential addresses, overall and by PM source (road traffic, industry, livestock, other agricultural sources, foreign sources, other Dutch sources), at 1 × 1 km resolution, and weekly SARS-CoV-2 exposure at municipal level. Using generalized additive models, we performed interval-censored survival analyses to assess associations between individuals’ average exposure to PM10, PM2.5 and NO2 in the three years before the pandemic (2017–2019) and COVID-19-outcomes, adjusting for SARS-CoV-2 exposure, individual and area-specific confounders. In single-pollutant models, per interquartile (IQR) increase in exposure, PM10 was associated with 7% increased infection risk and 16% increased hospitalisation risk, PM2.5 with 8% increased infection risk and 18% increased hospitalisation risk, and NO2 with 3% increased infection risk and 11% increased hospitalisation risk. Bi-pollutant models suggested that effects were mainly driven by PM. Associations for PM were confirmed when stratifying by urbanization degree, epidemic wave and testing policy. All emission sources of PM, except industry, showed adverse effects on both outcomes. Livestock showed the most detrimental effects per unit exposure, whereas road traffic affected severity (hospitalisation) more than infection risk. This study shows that long-term exposure to air pollution increases both SARS-CoV-2 infection and COVID-19 hospitalisation risks, even after controlling for SARS-CoV-2 exposure levels, and that PM may have differential effects on these COVID-19 outcomes depending on the emission source.

Evaluation of the treatment outcome of tibia shaft fracture by close reduction and internal fixation with interlocking intramedullary nail, Freetown, Sierra Leone, 2023

Introduction: The tibia shaft is a common site for bone fractures and open fractures. Tibia shaft fracture is mostly caused by high-energy trauma such as a fall from a height or a road traffic accident. The objective of this study was to evaluate the treatment outcome of tibia shaft fracture managed by close reduction and internal fixation with interlocking Intramedullary Nails (IMN) and to determine factors that are associated with tibia fracture infection. Methods: This retrospective study was conducted at the Emergency Trauma Hospital, Freetown, Sierra Leone. We analyzed the medical records of a mixed cohort of patients who were treated for, tibia shaft fracture by closed reduction and internal fixation with interlocking intramedullary nails for the period January 2020 to January 2022; with at least 15 months of follow-up. We later used both bivariate and multivariate logistic regressions to determine the factors that are associated with wound infection post-internal fixation. Results: A total of Ninety (n = 90) patients’ medical records were reviewed of which 79 were included for analysis. The median age was 30 years (Inter Quartile Range: 16-67 years). The average hospital stay was 20 days (Inter Quartile Range: 6-156 days). The mean fracture nailing time was 11 days. Infection and non-union rates were at 18.99% and 3.8% respectively. Type of tibia shaft fracture (AOR = 25.51, 95% CI = 2.06-422.75,) and characteristics of wound (AOR = 29.51, 95% CI = 2.06-422.75) were significantly associated with wound infection. The treatment outcome categorization of IMN was successful in 88.61% of the patients. Conclusion: This study concludes that the type of tibia shaft fracture and characteristics of the wound are major predictors of wound infection. The findings of this study suggest that IMN fixation of closed and Gustilo type 1 Tibia shaft fracture led to successful healing in the majority of the cases with a low non-union rate.

Factors associated with Parental Knowledge and Attitudes towards Concussions in the Republic of Korea.

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding concussions among Korean parents of children aged 6-18 years. A cross-sectional online survey was employed to collect data from a panel of parents in the Republic of Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of the total knowledge and total attitude scores, which ranged from 0 to 30 and 7 to 49, respectively, were categorized into three levels based on approximately 33% increments. We conducted multivariable ordinal logistic regression analyses with the participants' and their children's demographics and characteristics as covariates. A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, (Inter Quartile Range (IQR) 18-22.5)). The respondents exhibited favorable attitudes toward concussions (median total score, 39 (IQR 34-43)). Multivariate ordinal regression analysis for outcomes revealed that, except for the careers of healthcare providers (adjusted odds ratio (AOR) 3.15, 95% confidence interval (CI), 1.13-8.75), no factors were associated with parental concussion-related knowledge. Among the factors, none exhibited a statistically significant association with concussion-related parental attitudes. Our results confirmed the knowledge-attitude gap regarding concussions among Korean parents and novel strategies are warranted to improve parental knowledge and attitudes.

Green space, genetic susceptibility, and risk of osteoporosis:a cohort study from the UK Biobank

ObjectiveThis study aimed to investigate the effect of residential exposure to green space on the incident osteoporosis and further explore the modification effect of genetic susceptibility. MethodsParticipants from the UK Biobank were followed from 2006 to 2010 (baseline) to December 31st, 2022. Using land use coverage, we evaluated exposure to residential surrounding green space, natural environment, and domestic gardens. We used the Cox regression to examine the association between the residential environment and incident osteoporosis. The interactive effects between polygenic risk score (PRS) of osteoporosis and residential environments on incident osteoporosis were investigated. ResultsThis study included 292,662 participants. Over a median follow-up period of 13.65 years, we documented 9177 incidents of osteoporosis. Per interquartile (IQR) increase in greenness and natural environment at a 300 m buffer was associated with a 4% lower risk of incident osteoporosis [HR = 0.96 (95% CI: 0.93, 0.99)] and [HR = 0.96 (95% CI: 0.93, 0.98)], respectively. We did not identify any interactive effects between genetic risk and residential environment on incident osteoporosis. ConclusionsThis study found that public greenness and natural environments could reduce the risk of incident osteoporosis regardless of genetic predisposition. Developing sustainable and publicly accessible natural environments might benefit populations' bone health.

Sex-specific associations between placental corticotropin releasing hormone and problem behaviors in childhood

Placental corticotropin-releasing hormone (pCRH) is a neuroactive peptide produced in high concentrations in mid-late pregnancy, during key periods of fetal brain development. Some evidence suggests that higher pCRH exposure during gestation is associated with adverse neurodevelopment, particularly in female offspring. In 858 mother-child dyads from the sociodemographically diverse CANDLE cohort (Memphis, TN), we examined: (1) the slope of pCRH rise in mid-late pregnancy and (2) estimated pCRH at delivery as a measure of cumulative prenatal exposure. When children were 4 years-old, mothers reported on problem behaviors using the Child Behavior Checklist (CBCL) and cognitive performance was assessed by trained psychologists using the Stanford-Binet Intelligence Scales. We fitted linear regression models examining pCRH in relation to behavioral and cognitive performance measures, adjusting for covariates. Using interaction models, we evaluated whether associations differed by fetal sex, breastfeeding, and postnatal neighborhood opportunity. In the full cohort, log-transformed pCRH measures were not associated with outcomes; however, we observed sex differences in some models (interaction p-values≤0.01). In male offspring, an interquartile (IQR) increase in pCRH slope (but not estimated pCRH at delivery), was positively associated with raw Total (β=3.06, 95%CI: 0.40, 5.72), Internalizing (β=0.89, 95%CI: 0.03, 1.76), and Externalizing (β=1.25, 95%CI: 0.27, 2.22) Problem scores, whereas, in females, all associations were negative (Total Problems: β=−1.99, 95%CI: −3.89, −0.09; Internalizing: β=−0.82, 95%CI: −1.42, −0.23; Externalizing: β=−0.56, 95%CI: −1.34, 0.22). No associations with cognitive performance were observed nor did we observe moderation by breastfeeding or postnatal neighborhood opportunity. Our results provide further evidence that prenatal pCRH exposure may impact subsequent child behavior in sex-specific ways, however in contrast to prior studies suggesting adverse impacts in females, steeper mid-gestation pCRH rise was associated with more problem behaviors in males, but fewer in females.

Abstract TP168: Association of Factors With Disorders of Consciousness in Hemorrhagic Stroke Patients

Objective: Disorders of consciousness (DoC) are known to correlate with worse functional outcome after hemorrhagic stroke. Here we evaluate factors associated low Glasgow Coma Scale [GCS] score at time of admission in patients with hemorrhagic stroke. Methods: We performed a prospective cohort study of patients enrolled in the Neurological Emergencies Outcomes Study between January 2014 and June 2023 of patients with primary intracranial hemorrhage (intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH)). The primary outcome was coma (GCS ≤ 8) at time of admission. Univariable analysis with chi-squared test and Mann Whitney U test followed by adjusted logistic regression were used to assess the relationship between admission factors and DoC. We then confirmed the association with admission GCS and discharge modified Rankin score (mRS). Results: We included 314 patients admitted with intracranial hemorrhage, 51 (16%) of whom had GCS ≤ 8 at time of admission, 51% female and median [interquartile (IQR)] age of 63 [51-73]. The median [IQR] ICH volume was 9.3 ml [2.5-27.2] for ICH patients and the median [IQR] modified Fisher score was 3 [3-4] for SAH patients. Female gender, Asian race, hematoma size, hydrocephalus, peak temperature, lowest hemoglobin, and peak glucose in the first 24 hours were all associated with DoC (p&lt;0.05 for all). Controlling for age, disease process (ICH vs SAH), and all factors with p &lt; 0.05, we found female gender (OR 4.7, 95% CI 1.7-13.4), highest temperature (OR 3.8, 95% CI 1.9-7.3), lowest hemoglobin (OR 0.8, 95% CI 0.6-0.99), and highest glucose OR 1.01, 95% CI 1.00-1.02) remained significantly associated with coma at time of admission. Premorbid dependency as measured by Barthel Index was not a predictor of coma. However, coma at time of admission was associated with a worse discharge mRS (median discharge mRS [IQR] for patients with coma 5 [4-6] vs without 3 [2-4], p &lt; 0.001). Conclusions: We found that female gender, low hemoglobin, high body temperature, and elevated glucose at time of admission were all associated with coma. Low admission GSC (≤ 8) was associated with higher mRS at time of discharge. These modifiable risk factors are an important therapeutic target for improving outcomes for patients with DoC.