Log-linear Research Articles

Acquisition of key clinical communication skills through simulation-based education: findings from a program for postgraduate psychiatry trainees (ComPsych)

ObjectiveFew studies have investigated the maintenance of skills acquired in classroom-based clinician education. Using an advanced simulation-based clinical communication skill training program for postgraduate psychiatry education (ComPsych), we aimed to investigate skill acquisition through assessing changes in competence (abilities) and performance (practice).MethodsForty trainee psychiatrists (15 males; age range 26–48) participated. Video-recorded Standardized Patient Assessments (SPAs) were delivered twice pre- and post-training to assess learning. Skills were coded by independent psychologists using the Core Communication Skills (CCS) coding system. Simulated patients (SPs) rated trainees' communication performance using the Sim-Patient SPA checklist. Paired t-tests, linear mixed models and logistic mixed models assessed changes in communication skills over time.ResultsFor SPAs, reliability of coder ratings was deemed acceptable (ICC range 0.67 to 0.87). Mean post-training communication performance significantly increased for skills in agenda setting (p < 0.001), information organization (p < 0.001), empathic skills (p = 0.046), and overall skills performance (p = 0.001). Significant decreases for questioning skills were indicative of reduced reliance on these skills post-training. SPs rated all skillsets higher post-training. A modest relationship was detected between frequency (coded) and (SP-rated) quality of communication skills. Improvements in agenda setting and information organisation skills were retained ~ 6 weeks post-training.ConclusionsTraining improved patient-centered communication skills in psychiatry trainees, particularly skills in agenda setting and information organization, with skills retained ~ 6 weeks post-training. There was reduced reliance on questioning skills, which are well utilised generally. The study supports the benefits of this method of communication skills training into postgraduate psychiatry education.

Impact of Government Funded Health Insurance Scheme on OOP and Quality of Health Care: A Study of Maternal Health Care in Rajasthan

There has been a gradual shift of India’s health policies in favour of government-funded health insurance schemes rather than investment in public health facilities. The impact of this shift on quality of health care, especially for the poor and vulnerable population, is yet to be fully understood. The current study has been undertaken to study the effectiveness of one such state government-funded health insurance scheme, known as Bhamashah Swasthya Bima Yojana (BSBY), on out-of-pocket (OOP) expenditure and quality of health care services for the child delivery cases in a low-income community in the capital city of Jaipur in Rajasthan, India. While this study contributes to knowledge on the impact of access to health insurance on OOP expenditure, it covers a critical gap in the literature regarding its effect on quality of health care. The empirical analysis, conducted using log-linear and logit models, indicates that BSBY has a positive impact on reduction of OOP and improvement in quality of treatment in the study area.

Application of UV LEDs to inactivate antibiotic resistant bacteria: Kinetics, efficiencies, and reactivations

Unregulated antibiotic use has led to the proliferation of antibiotic-resistant bacteria (ARB) in aquatic environments. Ultraviolet light-emitting diodes (UV LEDs) have evolved as an innovative technology for inactivating microorganisms offering several advantages over traditional mercury lamps. This research concentrated on utilizing UV LEDs with three distinct wavelengths (265 nm, 275 nm, and 285 nm) to inactivate E. coli DH10β encoding the ampicillin-resistant blaTEM-1 gene in its plasmid. Non-linear models, such as Geeraerd's and Weibull, provided more accurate characterization of the inactivation profiles than the traditional log-linear model due to the incorporation of both biological mechanisms and a deterministic approach within non-linear models. The inactivation rates of ARB were higher than antibiotic-sensitive bacteria (ASB) when subjected to UV LEDs. The highest inactivation rates were observed when all microorganisms were exposed to 265 nm. Photoreactivation emerged as the primary mechanism responsible for repairing DNA damage induced by UV LEDs. 285 nm showed the highest reactivation efficiencies for ARB under different fluences. At higher fluences, both 265 and 275 nm displayed similar effectiveness in suppressing reactivation, while at lower fluences, 275 nm exhibited better efficacies in controlling the reactivation. Therefore, the inhibition of reactivation was influenced by the extent of damage incurred to both DNA and enzymes. In nutrient-poor media (0.9 % NaCl), ASB did not exhibit any reactivation potential. However, the addition of Luria-Bertani (LB) broth promoted the reactivation of ASB. Lower fluence rate was more beneficial at 265 nm whereas higher fluence rates were more effective for longer wavelengths. The inactivation of ARB was enhanced by dissolved organic carbon (DOC) at low fluences. However, the removal of ARB was reduced due to the presence of DOC at higher fluences. The highest energy demand for ARB inactivation was reported at 285 nm. Environmental implicationThe excessive and unregulated utilization of antibiotics has emerged as a significant issue for public health. This paper presents a comprehensive analysis of the effectiveness of UV LEDs, an emerging technology, in the inactivation of antibiotic-resistant bacteria (ARB). This research paper explores the kinetics of UV LEDs with different wavelengths to inactivate ARB along with the reactivation efficiencies. This research work also explores the impact and relevant mechanisms of the impact of dissolved organic carbon (DOC) on the inactivation of ARB by UV LEDs.

Deriving biomass conversion factors for southern temperate benthic fauna; analytical methods matter

Biomass is a fundamental ecological measure used to quantify ecosystem structure and function. It is costly to measure but can be estimated using conversion factors based on established relationships between different biomass measures, however such conversion factors may not be applicable across broad geographic regions. For temperate benthic fauna, currently available mass-to-mass conversion factors were largely established in Northern Hemisphere ecosystems. Here, we present conversion factors for temperate Australian benthic fauna typically found in microtidal coastal bays and estuaries (14 taxa encompassing five classes: Polychaeta; Bivalvia; Gastropoda; Crustacea; Insecta). We derived 126 conversion factors using two statistical techniques between several mass measures (e.g. wet mass, dry mass, ash-free dry mass, shell-free masses) with specimens from three preservation methods (ethanol, formalin, frozen). Our conversion factors were generally not congruent with those obtained from the literature. We also found that the choice of prediction method used to derive conversion factors can be a substantial source of error in biomass estimation that has largely been overlooked in mass-to-mass conversion. Log-linear ordinary least squares regression models provided substantially more accurate predictions than simple mean ratios. We outline an analytical approach for future use to derive more globally comparable conversion factors for estuarine benthic fauna.

Changing Trends in the Global Disease Burden of Pancreatic Cancer from 1990 to 2030.

To explore the global burden of pancreatic cancer (PC) from 1990 to 2019, evaluate independent effects of age, period, and cohort on the incidence of PC, and predict the incidence of PC in the next decade. Data were obtained from the Global Burden of Disease Study 2019. We calculated the age-standardized disability-adjusted life years (DALY) rate, age-standardized mortality rate (ASMR), age-standardized incidence rate (ASIR), and age-standardized prevalence rate (ASPR) of PC. Joinpoint Poisson regression analysis was performed to identify the temporal trends in the incidence of PC. Then, a two-factor model was constructed using the Poisson log-linear model, and a three-factor model was constructed using the intrinsic estimator (IE) method to estimate the independent effects of age, period, and cohort on the incidence of PC. Finally, the Bayesian age-period-cohort (BAPC) model was also used to predict the age-standardized global incidence rate of PC and age-standardized new PC cases from 2020 to 2030. Overall, the DALY rate, ASMR, ASIR, and ASPR all increased from 1990 to 2019. The ASIR in males increased from 6 per 100,000 in 1990 to 7.5 per 100,000 in 2019 and was predicted to rise to 8.2 per 100,000 by 2030. Meanwhile, the ASIR in females rose from 4.5 per 100,000 in 1990 to 5.7 per 100,000 in 2019 and was predicted to rise to 6.3 per 100,000 by 2030. The age effect on the incidence of PC showed sharp increasing trends from 40 to 79years. The period effect continuously increased with advancing periods, but the cohort effect showed substantial decreasing trends. The age and period effect on the incidence of PC presented increasing trends, while the cohort effect showed decreasing trends. All indicators of the global burden of PC are increasing in both males and females, and the ASIR is predicted to rise at an alarming rate by 2030. Thus, timely screening and intervention are recommended, especially for earlier birth cohorts at high risk.

Association between the triglyceride glucose index and obstructive sleep apnea and its symptoms: results from the NHANES

BackgroundCertain studies have indicated a link between obstructive sleep apnea and insulin resistance in specific populations. To gain more clarity, extensive research involving a broad sample of the overall population is essential. The primary objective of this study was to investigate this correlation by utilizing data from the National Health and Nutrition Examination Survey database.MethodsThe analysis incorporated data from the National Health and Nutrition Examination Survey database spanning the time periods from 2005 to 2008 and from 2015 to 2018, with a focus on American adults aged 18 years and older after applying weight adjustments. Key variables such as obstructive sleep apnea, triglyceride glucose index, and various confounding factors were considered. A generalized linear logistic regression model was used to investigate the association between obstructive sleep apnea and the triglyceride glucose index, with additional exploration of the consistency of the results through hierarchical analysis and other techniques.ResultsThe study included participants aged between 18 and 90 years, with an average age of 46.75 years. Among the total sample, 50.76% were male. The triglyceride glucose index demonstrated a diagnostic capability for obstructive sleep apnea, with an AUC of 0.701 (95% CI: 0.6619–0.688). According to the fully adjusted model, individuals in the fourth quartile of the triglyceride glucose index showed an increased likelihood of having obstructive sleep apnea compared to those in the first quartile (OR: 1.45; 95% CI: 1.02–2.06; P < 0.05). Subgroup analysis indicated that male sex (OR: 2.09; 95% CI: 1.76–2.45; P < 0.05), younger age (OR: 2.83; 95% CI: 2.02–3.96; P < 0.05), white ethnicity (OR: 2.29; 95% CI: 1.93–2.73; P < 0.05), and obesity (OR: 1.54; 95% CI: 1.28–1.85; P < 0.05) were correlated with an elevated risk of OSA.ConclusionsThis study demonstrated a strong association between an elevated TG index and OSA. Additionally, the triglyceride glucose index could serve as an independent predictor of obstructive sleep apnea.

Nonlinear relationship between oxidative balance score and hyperuricemia: analyses of NHANES 2007–2018

BackgroundLimited data regarding the correlation between oxidative balance score (OBS) and hyperuricemia highlights the necessity for thorough investigations. This study aims to examine the link between OBS, which incorporates dietary and lifestyle factors, and the occurrence of hyperuricemia.MethodsWe conducted a cross-sectional study involving 13,636 participants from the 2007–2018 National Health and Nutrition Examination Survey (NHANES). The oxidative balance score (OBS) was determined based on four lifestyle factors and sixteen dietary nutrients. We assessed the levels of serum uric acid (SUA) and the occurrence of hyperuricemia as outcomes. Weighted logistic regression and linear models were used for statistical analysis, using Restricted Cubic Splines (RCS) to examine potential nonlinear associations. Subgroup analysis and sensitivity assessments were performed to identify any variations and ensure the robustness of the findings.ResultsHigher OBS was consistently correlated with decreased SUA levels and a reduced prevalence of hyperuricemia. RCS highlighted a significant negative nonlinear association, particularly in females. Subgroup analysis revealed gender-based differences and interactive correlation, providing additional insights regarding OBS and hyperuricemia relationship.ConclusionThis study underscores a robust negative correlation between OBS and SUA levels as well as the incidence of hyperuricemia, emphasizing the importance of dietary and lifestyle factors. Incorporating RCS, subgroup analysis, and sensitivity assessments enhances the depth of our findings, providing valuable insights for further research.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Increased regional body fat is associated with depressive symptoms: a cross-sectional analysis of NHANES data obtained during 2011–2018

AimsThe findings from previous epidemiological studies of the association between regional body fat and depressive symptoms have been unclear. We aimed to determine the association between the body fat in different regions and depressive symptoms based on data from the National Health and Nutrition Examination Survey (NHANES).MethodsThis study included 3393 participants aged ≥ 20 years from the NHANES performed during 2011–2018. Depressive symptoms were assessed using the Patient Health Questionnaire-9. The fat mass (FM) was measured in different regions using dual-energy X-ray absorptiometry to determine the total FM, trunk FM, arm FM, and leg FM. The FM index (FMI) was obtained by dividing the FM in kilograms by the square of the body height in meters. Weighted data were calculated in accordance with analytical guidelines. Linear logistic regression models were used to quantify the association between regional FMI and depressive symptoms. Univariate and stratified analyses were also performed.ResultsThe participants in this study comprised 2066 males and 1327 females. There were 404 (11.91%) participants with depressive symptoms, who were aged 40.89 ± 11.74 years and had a body mass index of 30.07 ± 7.82 kg/m². A significant association was found between total FMI and depressive symptoms. In the fully adjusted multivariate regression model, a higher total FMI (odds ratio = 2.18, 95% confidence interval [CI] = 1.08–4.39) was related to a higher risk of depressive symptoms, while increased total FMI (β = 1.55, 95% CI = 0.65–2.44, p = 0.001), trunk FMI (β = 0.57, 95% CI = 0.04–1.10, p = 0.036), and arm FMI (β = 0.96, 95% CI = 0.33–1.59, p = 0.004) were significantly associated with PHQ-9 (Patient Health Questionnaire-9) scores, whereas the leg FMI was not (p = 0.102). The weighted association between total FMI and depressive symptoms did not differ significantly between most of the subpopulations (all p values for interaction > 0.05). The risk of having depression was higher in individuals who were non-Hispanic Whites, smokers, drinkers, obese, and had diabetes and thyroid problems (p < 0.05).ConclusionThese findings suggest that the population with a higher regional FMI is more likely to have depressive symptoms, especially in those who also have an increased total FMI. The association is more pronounced in individuals who are smokers, drinkers, obese, and have diabetes and thyroid problems.

Federal Impacts on Buprenorphine Prescribing in Washington State, 2012 to 2022.

Objectives. To evaluate changes in monthly buprenorphine dispensation associated with federal prescribing policies in Washington State from 2012 to 2022. Methods. We conducted an interrupted time series analysis comparing monthly buprenorphine prescriptions dispensed per 1000 population after the Comprehensive Addiction and Recovery Act (CARA), Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), and new prescribing rules during the COVID-19 pandemic. Buprenorphine formulated for opioid use disorder was included from the Washington State Prescription Monitoring Program. A log-linear autoregressive model measured linear trend changes. Results. Physician prescribing increased by 1.63% (95% confidence interval [CI] = 1.41%, 1.85%) per month after CARA with sustained declines after SUPPORT. Nurse practitioner (NP) prescribing increased by 19.48% (95% CI = 18.8%, 20.16%) per month after CARA with physician assistants (PAs) showing similar trends. Following the implementation of SUPPORT, NP and PA trends continued to increase at a reduced growth rate of 3.96% (95% CI = 2.01%, 5.94%) and 1.87% (95% CI = 0.56%, 3.19%), respectively. No prescribers experienced increases during the COVID-19 pandemic. Conclusions. CARA nearly tripled the buprenorphine prescribing rate. The SUPPORT Act initiated sustained declines for physician prescribing, and the COVID-19 period reversed gains for PAs and NPs. The current opioid crisis requires expanded efforts in Washington State. (Am J Public Health. 2024;114(7):696-704. https://doi.org/10.2105/AJPH.2024.307649).

Modeling thermal inactivation of Salmonella Enteritidis in ground chicken supplemented with a mixture of ribwort, sorrel, and yarrow extracts

AbstractThermal death kinetics of Salmonella Enteritidis in ground chicken in the presence of ribwort, sorrel and yarrow extracts mixture (1%) was investigated by fitting the inactivation curves to the log–linear and Weibull models. The thermal inactivation curves were fitted well to both models (r2 ≥ 0.94). The times required for 4–log reduction in the S. Enteritidis population were shortened by 47–64% in ground chicken supplemented with the herbal extract mixture (p &lt; 0.05). The 4–log reduction times calculated using the Weibull model were 0.13–13.6% longer than those extrapolated with the log–linear model. The z values in the ground chicken samples with and without herbal extract were 5.08°C (r2 = 0.97) and 5.57°C (r2= 0.94), respectively. The results suggest that the mixture of these extracts increased the thermal sensitivity of S. Enteritidis significantly at tested temperatures. In addition, using the Weibull model to calculate thermal death kinetics may reduce the underestimation of the thermal reduction times.Practical applicationsThis research aimed to investigate the effects of an herbal extract mixture consisting of ribwort, sorrel, and yarrow on the thermal resistance of Salmonella Enteritidis in ground chicken. While these plants are recognized for their antimicrobial and antioxidant properties, there are not many studies conducted to explore their effects on foodborne pathogens in the food matrix. As far as we know, this is the first study that examines the impact of these plants on the thermal resistance of S. Enteritidis in ground chicken. We determined the thermal death kinetics of S. Enteritidis in ground chicken with and without the herbal extract mixture using curve fitting to log‐linear and Weibull models. The findings of this study could help the food industry to develop cooking conditions for Salmonella‐free chicken products.

Salmonella and Listeria monocytogenes Survival on Field Packed Cantaloupe Contact Surfaces

Field-packing of cantaloupes involves numerous food contact surfaces that can contamination melons with foodborne pathogens; the soil on these surfaces increases throughout the harvest day. Data are lacking on the cross-contamination risk from contaminated food contact surfaces under the dry conditions typical of cantaloupe field-packing operations. This study sought to evaluate the survival of Salmonella and Listeria monocytogenes on cantaloupe field-pack food contact surfaces using both a wet and dry inoculum to provide insights into managing foodborne pathogen contamination risks. Five clean or fouled materials (cotton gloves, nitrile gloves, rubber gloves, cotton rags, and stainless steel) were inoculated with a cocktail of either Salmonella or L. monocytogenes. A wet inoculum was spot inoculated (100 µL) onto coupons. A dry inoculum was prepared by mixing wet inoculum with 100 g of sterile sand and shaking the coupons with the inoculated sand for 2 min. Coupons were held at 35°C (35% RH) and enumerated at 0, 2, 4, 6, and 8 h. Significant differences in pathogen concentrations over time were calculated, and the GInaFiT add-in tool for Excel was used to build Log-linear, Weibull, and Biphasic die-off models. Depending on the material type, coupon condition, and inoculum type, Salmonella and L. monocytogenes reductions over 8 h ranged from 0.3 to 3.3 and −0.4 to 4.2 log10 CFU/coupon, respectively. For all material types, Salmonella reductions were highest on wet-inoculated clean coupons; L. monocytogenes varied by material type. Weibull and biphasic models were a better fit of respective pathogen die-off curves than linear models. Overall, faster die-off rates were seen for wet inoculated and clean materials. Since pathogen populations remained viable over the study duration and both inoculum type and coupon condition impacted survival, frequent sanitation or replacement of food contact surfaces during the operational day is needed to reduce the risk of cross-contamination.

Early Hypophosphatemia as a Prognostic Marker in Acute Pancreatitis.

Acute pancreatitis (AP) is a complex disease representing a significant portion of gastrointestinal-related hospitalizations in the U.S. Understanding risk factors of AP might provide attractive therapeutic targets. We evaluated hypophosphatemia a prognostic marker in AP. We performed a retrospective review of electronic health records of patients with AP from 01/ 01/2012-12/31/2021 at Cedars-Sinai Medical Center with serum phosphate measured within 48 hours of admission. Multivariable logistic regression modeling was used to evaluate associations with ICU admission and AP severity. Multivariable log-linear modeling was employed to examine associations with length of stay (LOS). Of 1526 patients admitted for AP, 33% (499) had a serum phosphate level measured within 48 hours. Patients with hypophosphatemia were more likely to have ICU admission (adjusted odds ratio (AOR) = 4.57; 95% confidence interval (CI): 2.75-7.62; P < 0.001), have a longer hospital stay (log-LOS = 0.34; SE; 0.09; 95% CI: 0.17-0.52; P < 0.001), and have moderate or severe AP (AOR = 1.80; 95% CI: 1.16-2.80; P < 0.001) compared with those without hypophosphatemia. Serum phosphate is infrequently measured in patients with AP and shows promise as an early prognostic marker for outcomes of AP.

Interpersonal sensitivity predicts slower change and less change in anxiety symptoms in cognitive behavioural therapy.

Patients in cognitive behavioural therapy (CBT) who are high in interpersonal sensitivity may have difficulty fully engaging in treatment because therapy sessions require intimate interpersonal interactions that are especially uncomfortable for these individuals. The current study tests the hypotheses that patients who are high in interpersonal sensitivity benefit less from CBT for symptoms of depression and anxiety, show a slower rate of change in those symptoms, and are more likely to drop out of treatment. Participants were 832 outpatients who received naturalistic CBT. We assessed interpersonal sensitivity before treatment began and depression and anxiety symptoms at every therapy session. We assessed early, premature, and uncollaborative termination after treatment ended. We constructed multilevel linear regression models and logistic regression models to assess the effects of baseline interpersonal sensitivity on the treatment outcome, the slope of change in depression and anxiety symptoms, and each type of dropout. Higher baseline interpersonal sensitivity was associated with a slower rate of change and less overall change in anxiety but not depressive symptoms. Baseline interpersonal sensitivity was not a predictor of dropout. Interpersonal sensitivity at baseline predicts less change and a slower rate of change in anxiety symptoms. Early detection of elevated interpersonal sensitivity can help therapists take action to address these barriers to successful treatment and help scientists build decision support tools that accurately predict the trajectory of change in anxiety symptoms for these patients.

A Longitudinal Analysis of Mortality Related to Chronic Viral Hepatitis and Hepatocellular Carcinoma in the United States.

(1) Background: Hepatocellular carcinoma (HCC) contributes to the significant burden of cancer mortality in the United States (US). Despite highly efficacious antivirals, chronic viral hepatitis (CVH) remains an important cause of HCC. With advancements in therapeutic modalities, along with the aging of the population, we aimed to assess the contribution of CVH in HCC-related mortality in the US between 1999-2020. (2) Methods: We queried all deaths related to CVH and HCC in the multiple-causes-of-death files from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database between 1999-2020. Using the direct method of standardization, we adjusted all mortality information for age and compared the age-adjusted mortality rates (AAMRs) across demographic populations and by percentile rankings of social vulnerability. Temporal shifts in mortality were quantified using log-linear regression models. (3) Results: A total of 35,030 deaths were identified between 1999-2020. The overall crude mortality increased from 0.27 in 1999 to 8.32 in 2016, followed by a slight reduction to 7.04 in 2020. The cumulative AAMR during the study period was 4.43 (95% CI, 4.39-4.48). Males (AAMR 7.70) had higher mortality rates compared to females (AAMR 1.44). Mortality was higher among Hispanic populations (AAMR 6.72) compared to non-Hispanic populations (AAMR 4.18). Higher mortality was observed in US counties categorized as the most socially vulnerable (AAMR 5.20) compared to counties that are the least socially vulnerable (AAMR 2.53), with social vulnerability accounting for 2.67 excess deaths per 1,000,000 person-years. (4) Conclusions: Our epidemiological analysis revealed an overall increase in CVH-related HCC mortality between 1999-2008, followed by a stagnation period until 2020. CVH-related HCC mortality disproportionately affected males, Hispanic populations, and Black/African American populations, Western US regions, and socially vulnerable counties. These insights can help aid in the development of strategies to target vulnerable patients, focus on preventive efforts, and allocate resources to decrease HCC-related mortality.

Loglinier Model on Immunization of Baduta

This study aims to analyze the relationship between the type of immunization and the province of origin of children under two years of age (BADUTA) in Indonesia in 2020. This study uses a loglinear model approach to analyze DPT-HB-Hib4 and Measles/MR2 immunization data based on gender and home province. Data was obtained from the Directorate General of Disease Prevention and Control of the Indonesian Ministry of Health. Through statistical analysis using IBM SPSS Statistics 22 software, this research found that there is a relationship between the type of immunization and the child's province of origin. The chi-square test results show that there is a significant relationship between the type of immunization and the child's province of origin. Of the several loglinear models tested, the (J, VP) model is considered the best model based on Goodness-of-fit criteria. Thus, this study concludes that there is a relationship between the type of immunization and the province of origin of children under two years old in Indonesia in 2020.

Demographic Disparities in Acute Myeloid Leukemia Mortality Trends in the United States.

Acute myeloid leukemia (AML) is a hematological malignancy with an overall poor prognosis; however, survival rates vary widely by clinical and demographic characteristics. This study sought to identify historical trends in AML mortality in the US and to identify any disparities by sex, race or ethnicity. For each demographic population, the age adjusted mortality rate (AAMR) per 1,000,000 for AML-related deaths from 1999 to 2020 in the United States was accessed from the CDC Wonder Database. These values were then used to calculate the average Annual Percent Change (AAPC) from 1999 to 2020 using the National Cancer Institute (NCI)'s Joinpoint Regression Program (Joinpoint V 4.9.0.0, NCI) with log-linear regression models. Statistical significance for all reported findings was determined using a 2-tailed t-test or parallel pairwise comparison with significance defined as p<0.05. The overall population had a significant downtrend in mortality rate between 2011 and 2020 with an APC of -0.61% [95% confidence interval (CI)=-1 to -0.2]. In 2020, the AAMR due to AML for males was 32 and for females was 20.2. Females did not have a significant overall AAPC from 1999 to 2020. Males had a significant AAPC of 0.5% (95%CI=0-0.9) from 1999 to 2020, signifying an overall uptrend. In 2020, the White population had the greatest mortality rate (29.6), followed by the Black or African American population (20.9), Asian or Pacific Islander (AAPI) population (18.6), and the American Indian/Alaska Native population (8.8). American Indian and Alaska Native population data could not be reliably compared. No race/ethnic group had a significant AAPC trend from 1999 to 2020. However, parallel pairwise comparison found a significant difference in the trend of mortality rates between the Black or African American and AAPI, Black or African American and White, and White and AAPI populations. Our findings highlight disparities in mortality due to AML and underscore the need for additional resources and support in affected populations and areas.

Association of objective sleep duration with cognition and brain aging biomarkers in older adults.

The neuropathological mechanisms underlying the association between sleep duration and mild cognitive impairment remain poorly understood. This population-based study included 2032 dementia-free people (age ≥ 60 years; 55.1% women) derived from participants in the Multimodal Interventions to Delay Dementia and Disability in Rural China; of these, data were available in 841 participants for Alzheimer's plasma biomarkers (e.g. amyloid-β, total tau and neurofilament light chain), 1044 for serum microvascular biomarkers (e.g. soluble adhesion molecules) and 834 for brain MRI biomarkers (e.g. whiter matter, grey matter, hippocampus, lacunes, enlarged perivascular spaces and white matter hyperintensity WMH). We used electrocardiogram-based cardiopulmonary coupling analysis to measure sleep duration, a neuropsychological test battery to assess cognitive function and the Petersen's criteria to define mild cognitive impairment. Data were analysed with multivariable logistic and general linear models. In the total sample (n = 2032), 510 participants were defined with mild cognitive impairment, including 438 with amnestic mild cognitive impairment and 72 with non-amnestic mild cognitive impairment. Long sleep duration (>8 versus 6-8 h) was significantly associated with increased likelihoods of mild cognitive impairment and non-amnestic mild cognitive impairment and lower scores in global cognition, verbal fluency, attention and executive function (Bonferroni-corrected P < 0.05). In the subsamples, long sleep duration was associated with higher plasma amyloid-β40 and total tau, a lower amyloid-β42/amyloid-β40 ratio and smaller grey matter volume (Bonferroni-corrected P < 0.05). Sleep duration was not significantly associated with serum-soluble adhesion molecules, white matter hyperintensity volume, global enlarged perivascular spaces and lacunes (P > 0.05). Alzheimer's and neurodegenerative pathologies may represent common pathways linking long sleep duration with mild cognitive impairment and low cognition in older adults.

P062 Trust performance in managing inflammatory arthritis over time in England and Wales: a latent class analysis approach

Abstract Background/Aims To evaluate trust-level performance in time to initiation of disease-modifying antirheumatic drug (DMARD) therapy in patients with early inflammatory arthritis (EIA), with identification of change in performance trajectories over time and investigation of trust characteristics associated with this change. Methods We included 130 trusts from the UK contributing to the National Early Inflammatory Arthritis Audit (NEIAA) from 2018 to 2020. The primary outcome was days from referral to initiation of DMARD therapy in patients with EIA. Latent class growth mixture models were applied to identify distinct groups of trusts with similar trajectories of performance change over time. We used mixed-effects linear and multinomial logistic regression models to evaluate the association between delay in treatment and trust-level characteristics. Results The mean (SD) time to DMARD initiation was 53 (18) days, with an average 0.3-day decrease with each month over time. Four latent trajectories were identified in our cohort, with over 77% of individual trusts showing ongoing improvements in decreasing treatment waiting times. Prior to separating by latent class, time to DMARD initiation was shorter in trusts with higher rheumatology staffing, a local EIA treatment pathway and those with access to musculoskeletal ultrasound. Trusts with more nurses in the rheumatology department were less likely to be in the worse performance group (OR = 0.69 [95%CI 0.49, 0.93]). Conclusion In this cohort study, we observed a reduction in treatment waiting time over time. Trusts with better staffed and improved EIA clinical structure are likely to initiate definitive treatment earlier in patients with EIA. Disclosure Z. Yang: None. N. Arumalla: None. M.D. Russell: Honoraria; Lilly, Menarini, Galapagos. Grants/research support; NIHR. Other; Pfizer, Janssen, Biogen, and UCB. K. Bechman: Honoraria; Menarini, Galapagos. Grants/research support; NIHR,Versus Arthritis and Pfizer Global Medical Grants for Quality Improvement in Rheumatology Practice. Other; UCB. E. Alveyn: Other; UCB. S. Gallagher: None. E. Price: None. S. Norton: None. J. Galloway: Honoraria; AbbVie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB.

Silibinin solubilization: combined effect of co-solvency and inclusion complex formation

Objective Belonging to the class II drugs according to the biopharmaceutics classification system, silibinin (SLB) benefits from high permeability but suffers poor solubility that negatively affects the development of any delivery system. This research aimed to improve SLB solubility by combined use of co-solvency and complexation phenomena. Methods Solubility studies were performed using the phase solubility analysis according to the shake-flask method in the presence of ethanol and 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) as a co-solvent and inclusion complexing agent, respectively. SLB release studies from chitosan nanoparticles were carried out in double-wall, diffusion cells using the optimized drug release medium. Results SLB solubility was mathematically optimized constraining to using the lowest concentrations of ethanol and HP-β-CD. SLB solubility increased linearly with the increase of HP-β-CD concentration. The solubility in PBS-ethanol mixtures followed a log-linear model. SLB solubility in the presence of the ethanol co-solvent and HP-β-CD complexing agent was optimized by adopting a genetic algorithm suggesting the phosphate buffer saline solution supplemented by 6%v/v ethanol and 8 mM HP-β-CD as an optimized medium. The optimized solution was examined to study SLB release from chitosan nanoparticles (4.5 ± 0.2% drug loading) at 37 °C under static conditions. The sigmoidal release profile of SLB from the particles indicated a combination of erosion and diffusion mechanisms governing drug release from the nanoparticles. Conclusion SLB solubility in a buffered solution supplemented by ethanol co-solvent and HP-β-CD complexing agent is a function of free drug present in the semi-aqueous media, the drug-ligand binary complex, and the drug/ligand/co-solvent ternary complex.