Log-normal Regression Research Articles

Expanded assessment of xenobiotic associations with antinuclear antibodies in the United States, 1988-2012.

The prevalence of autoimmunity in the U.S. has increased recently for undetermined reasons. Little is known about associations between autoimmunity and environmental causes. In a large representative sample of the U.S. population, we expanded our prior exploratory study of how exposures to selected xenobiotics and dioxin-like (DL) mixtures relate to antinuclear antibodies (ANA), the most common biomarker of autoimmunity. We analyzed cross-sectional data on 12,058 participants aged≥12years from three time periods of the National Health and Nutrition Examination Survey between 1988 and 2012, of whom 14% were ANA-positive. We used lognormal regression models and censored-data methods to estimate ANA associations with xenobiotic concentrations overall and in sex, age, and race/ethnicity subgroups. Our analyses adjusted for potential confounders and appropriately handled concentrations below detection limits. Observed ANA associations were positive for most DL compounds and nonDL polychlorinated biphenyls (PCBs), negative for most phthalates, and mixed for other xenobiotic classes. After correcting for multiple comparisons, some associations remained statistically significant. In subgroup analyses, the most significant finding was a positive ANA association with N-acetyl-S-(2-hydroxy-3-butenyl)-L-cysteine (MHB2) in males, followed by positive associations with 2,2',3,5'-tetrachlorobiphenyl (PCB 44), 2,2',4,5'-tetrachlorobiphenyl (PCB 49), and 2,2',3,4',5',6-hexachlorobiphenyl (PCB 149) in 12-19year-olds, and with 3,4,4',5-tetrachlorobiphenyl (PCB 81), 2,2',3,3',4,4',5,5',6-nonachlorobiphenyl (PCB 206), and N-acetyl-S-(phenyl)-L-cysteine (PMA) in Mexican Americans. Negative associations were found with mono-benzyl phthalate (MBzP) in 20-49year-olds and mono-n-butyl phthalate (MnBP) in 12-19year-olds. In overall analyses, combining stratum-specific results across race/ethnicity strata revealed a positive ANA association with PCB 81 and a negative ANA association with N-acetyl-S-(2-hydroxyethyl)-L-cysteine (HEMA). This study identified potential associations between ANA and various xenobiotics. Further investigation to confirm these observations and elucidate effects of certain xenobiotics on immune regulation could have important mechanistic, preventive, and treatment implications for a variety of immune-mediated disorders.

Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children

BackgroundChildren who are stunted (length-for-age Z-score<-2) are at greater risk of infectious morbidity and mortality. Previous studies suggest that stunted children have elevated inflammatory biomarkers, but no studies have characterised their capacity to respond to new infections (i.e., their immune function). We hypothesised that antibacterial immune function would differ between stunted and non-stunted children and relate to their health and environment during early life.MethodsWe enrolled a cross-sectional cohort of 113 HIV-negative children nested within a longitudinal cluster-randomised controlled trial of household-level infant and young child feeding (IYCF) and water, sanitation and hygiene (WASH) interventions in rural Zimbabwe (SHINE; Clinical trials registration: NCT01824940). Venous blood was collected at 18 months of age and cultured for 24 h without antigen or with bacterial antigens: heat-killed Salmonella typhimurium (HKST) or Escherichia coli lipopolysaccharide (LPS). TNFα, IL-6, IL-8, IL-12p70, hepcidin, soluble (s)CD163, myeloperoxidase (MPO) and IFNβ were quantified in culture supernatants by ELISA to determine antigen-specific immune function. The effect of stunting status and early-life exposures (anthropometry, inflammation at 18 months, maternal health during pregnancy, household WASH) on immune function was tested in logit and censored log-normal (tobit) regression models.ResultsChildren who were stunted (n = 44) had higher proportions (86.4% vs. 65.2%; 88.6% vs. 73.4%) and concentrations of LPS-specific IL-6 (geometric mean difference (95% CI): 3.46 pg/mL (1.09, 10.80), p = 0.035) and IL-8 (3.52 pg/mL (1.20, 10.38), p = 0.022) than non-stunted children (n = 69). Bacterial antigen-specific pro-inflammatory cytokine concentrations were associated with biomarkers of child enteropathy at 18 months and biomarkers of systemic inflammation and enteropathy in their mothers during pregnancy. Children exposed to the WASH intervention (n = 33) produced higher LPS- (GMD (95% CI): 10.48 pg/mL (1.84, 60.31), p = 0.008) and HKST-specific MPO (5.10 pg/mL (1.77, 14.88), p = 0.003) than children in the no WASH group (n = 80). There was no difference in antigen-specific immune function between the IYCF (n = 55) and no IYCF groups (n = 58).ConclusionsAntibacterial immune function among 18-month-old children in a low-income setting was shaped by their stunting status and prior exposure to maternal inflammation and household WASH. Heterogeneity in immune function due to adverse exposures in early life could plausibly contribute to infection susceptibility.

Advances in mixed cell deconvolution enable quantification of cell types in spatial transcriptomic data

Mapping cell types across a tissue is a central concern of spatial biology, but cell type abundance is difficult to extract from spatial gene expression data. We introduce SpatialDecon, an algorithm for quantifying cell populations defined by single cell sequencing within the regions of spatial gene expression studies. SpatialDecon incorporates several advancements in gene expression deconvolution. We propose an algorithm harnessing log-normal regression and modelling background, outperforming classical least-squares methods. We compile cell profile matrices for 75 tissue types. We identify genes whose minimal expression by cancer cells makes them suitable for immune deconvolution in tumors. Using lung tumors, we create a dataset for benchmarking deconvolution methods against marker proteins. SpatialDecon is a simple and flexible tool for mapping cell types in spatial gene expression studies. It obtains cell abundance estimates that are spatially resolved, granular, and paired with highly multiplexed gene expression data.

Sustainable management of a marine protected area in Vietnam: An application of visitors’ willingness to pay for conservation in Cu Lao Cham

As an important area in terms of biodiversity and fish stocks in Vietnam, Cu Lao Cham or Cham Islands (CLC) marine protected area (MPA) is under increasing threat from human activities. Conservation efforts have recently been implemented but economic analysis of the CLC MPA’s natural values did not investigate what may affect policy decisions on CLC MPA’s sustainable development. Using a structured questionnaire and a payment card technique (based on the contingent valuation method), we estimate visitors’ willingness to pay (WTP) for conservation of marine resources in the CLC MPA. The log-normal regression results indicate that the visitors’ WTP for conservation is affected by their characteristics, perceptions of environmental protection and conservation, and their assessment of the current CLC MPA entrance fee. Visitors are WTP an additional amount of US$2.26 per person for conservation while visiting the CLC MPA. This indicates that with the introduction of the proposed entrance fee (the mean WTP added to the current entrance fee), the CLC MPA management would not only have sufficient funds for their management and conservation programmes, but also that the number of visitors may decline slightly, which would reduce some of the pressure on the environment, natural resources, and coral reefs.

Influence Diagnostics in Log-Normal Regression Model with Censored Data

Dealing with the biological data, the skewed distribution is approximated by the Log-Normal Regression model (LNRM). Traditional estimation techniques for the LNRM are sensitive to unusual observations. These observations greatly affect the model analysis, which makes imprecise conclusions. To overcome this issue, we proposed to develop diagnostics measures based on local influence diagnostics to identify such curious observations in the LNRM under censoring. The proposed measures are derived by perturbing the case weight, response, and explanatory variables. Furthermore, we also consider the One-Step Newton-Raphson method and generalized cook’s distance. We study the Monte Carlo simulation and its application to real data to illustrate the developed approaches.

Abstract 13730: In-Hospital Outcomes for Takotsubo Cardiomyopathy Among Patients With Psychiatric Diagnosis

Background: Takotsubo (or stress) cardiomyopathy (TC) is a transient regional systolic dysfunction, clinically and echocardiographically resembling acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The prevalence of psychiatric disorders is high in TC. However, it is unclear whether presence of underlying psychiatric condition impacts outcomes of TC. Methods: Hospitalizations for TC from 2012 to 2018 were identified using the National Inpatient Sample (NIS) and stratified by presence or absence of concomitant psychiatric diagnoses (major depression, dysthymia, anxiety, bipolar, substance abuse). Outcomes of interest included mortality, cardiac arrest, cardiogenic shock, intra-aortic balloon pump (IABP), mechanical ventilation, and length of stay. Differences in outcome rates were compared using the Rao-Scott chi-square test; length of stay was compared using a lognormal regression model. All analyses accounted for the NIS sampling design. Results: A total of 51,625 hospital discharges with TC were identified, of which 21,690 (42%) carried a psychiatric diagnosis. There were no statistically significant differences in mortality (1.2% vs. 1.6%; p=0.087), cardiac arrest (1.5% vs. 1.5%; p=0.853), cardiogenic shock (4.6% vs. 4.9%; p=0.427), IABP use (1.6% vs. 1.7%; p=0.695), mechanical ventilation (4.9% vs. 4.2%; p=0.113) for patients with and without psychiatric diagnosis, respectively. The length of stay among patients with psychiatric diagnosis, was marginally higher (median 3.7, IQR [3.6-3.8] days vs. 3.5 [3.4-3.6] days; p&lt;0.01). Conclusion: Our analysis demonstrates that in-hospital mortality and complications of TC patients with and without psychiatric illness are statistically similar.

Survival to intensive care unit discharge among in‐hospital cardiac arrest patients by applying audiovisual feedback device

AimsSurvival rates after in‐hospital cardiac arrest remain very low. Although there is evidence that the use of audiovisual feedback devices can improve compression components, there are no data on patient survival. Therefore, we conducted this study to analyse the survival rate of patients with in‐hospital cardiac arrest after discharge from the intensive care unit.Methods and resultsThis study was a secondary analysis of a prospective, randomized, controlled, parallel study of patients who received either standard manual chest compression or a real‐time feedback device. Parametric and semi‐parametric models were fitted to the data. Different survival time of length of stay was investigated by univariate and multiple analyses. Pearson's correlation between length of stay and hospital length of stay was obtained. A total of 900 patients with a mean survival time of 35 days were included. Intervention was associated with a higher length of stay. Relative time was significant in adjusted fitted log‐normal regression for intervention group, female gender, and cardiopulmonary resuscitation in the night shift. A positive correlation between length of stay and hospital length of stay was found.ConclusionsImplementation of feedback device improved survival and length of stay. Cardiopulmonary resuscitation performance during the night shift decreased the survival time, which could be due to the inexperienced staff available outside working hours.

Calibrating safety-based design charts for horizontal curves using system reliability analysis and multivariate models

The majority of previous studies on reliability-based highway design focussed on assessing the risk associated with only one mode of non-compliance (i.e. insufficient sight distance on horizontal curves using 2 D sight distance calculations). Only a handful number of studies established a link between risk levels and collisions. This paper calibrates safety-based design charts for horizontal curves considering a system reliability analysis (i.e., multi-mode) where the non-compliance could result from limited sight distance and vehicle skidding. The paper first utilised LiDAR data to collect curve attributes and assess the Available Sight Distance in a 3 D environment on 244 horizontal curves in Alberta, Canada. Monte Carlo Simulation was then used to calculate the associated risk levels, and full-Bayes multivariate Poisson lognormal regression was utilised to develop statistically significant safety performance functions that relate risk levels to collisions. Safety-based design charts were calibrated to relate curve attributes to risk levels and collisions. The calibrated charts showed the importance of using multi-mode reliability analysis. An example of using the calibrated charts in estimating the expected safety benefits of geometric improvements was introduced. The developed charts can offer designers a tool to estimate the safety consequences of design alternatives and aid the decision-making process of rehabilitation projects.

The Importance of Country-of-Origin Information on Food Product Packaging.

This study aimed to identify selected predictors of country-of-origin (COO) information placed on food packaging. The dependent variable was operationalized in two ways: (1) as a Likert-style question about COO importance in general, and (2) as an indication of COO as the most important food attribute at first purchase, which I called top-of-mind COO importance. The survey was conducted with the use of the internet panel of a research agency in a representative sample of 1051 Polish consumers. In bivariate analyses, I identified the characteristics of consumer segments attaching high importance to each type of COO information. In a multivariate log-normal regression, general COO importance was affected to the largest extent by the product originating from Poland, which confirmed the strong relation between COO importance and consumer ethnocentrism. In multivariate logit regressions, top-of-mind COO importance depended also on the Polish origin of the product to the largest extent. The remaining predictors were sex (men were over 1.5 times more likely to indicate COO as the most important attribute) and age (each year of life contributing to a 2% increase in the likelihood of indicating top-of-mind COO). A theoretical implication is to differentiate between general and top-of-mind COO measures, as different results were obtained depending on whether the COO effect was measured as a response to questions such as “How important is the product COO for you?” or “What is the most important product attribute for you?—COO” Not only were the answer patterns different, but their determinants also varied.

Factors Affecting the Removal Time of Separated Instruments

IntroductionSeparated endodontic instruments may adversely affect the outcome of endodontic treatment. The combination of ultrasonic techniques and dental operating microscopes appears to be effective in the removal of separated instruments compared with more randomized techniques. This study evaluated the roles of root canal curvature and separated instrument length on the time needed to loosen and retrieve the instrument fragments. MethodsThe retrieval procedures of 128 separated instruments referred to a private endodontic practice for retreatment by general practitioners were evaluated in patients who were monitored for a minimum of 6 months. Preoperative cone-beam computed tomographic images were used to measure separated instrument lengths in relation to the degrees of canal curvatures. Ultrasonic instruments were used in the initial phase to remove the tooth structure and to loosen the fractured instrument. In the second phase, ultrasonic instruments, wire loops, or XP Shapers (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) were used for fragment removal. The time periods for all procedures were recorded. Statistical analysis was completed applying log-normal regression, structural equation modeling, and linear regression using Stata Version 14.2 software (StataCorp LLC, College Station, TX). ResultsAll separated instruments were successfully retrieved. Using the protocol in this study, 89.8% of the instruments were removed using ultrasonic instruments alone with a mean time of 221 seconds. The instrument removal time was dependent on both the instrument length and the root canal curvature. Additionally, preparation times were proportionately longer with increasing separated instrument lengths when the loop device was required. ConclusionsThe preparation phase appears to have an important role in the retrieval of separated instruments. Preparation times for both non-loop and loop groups demonstrate that length and curvature are independent predictors of the log-transformed time. Generally, procedure times were extended with increasing file lengths and higher degrees of canal curvature.

The mobility gap: estimating mobility thresholds required to control SARS-CoV-2 in Canada.

BACKGROUND:Nonpharmaceutical interventions remain the primary means of controlling severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) until vaccination coverage is sufficient to achieve herd immunity. We used anonymized smartphone mobility measures to quantify the mobility level needed to control SARS-CoV-2 (i.e., mobility threshold), and the difference relative to the observed mobility level (i.e., mobility gap).METHODS:We conducted a time-series study of the weekly incidence of SARS-CoV-2 in Canada from Mar. 15, 2020, to Mar. 6, 2021. The outcome was weekly growth rate, defined as the ratio of cases in a given week versus the previous week. We evaluated the effects of average time spent outside the home in the previous 3 weeks using a log-normal regression model, accounting for province, week and mean temperature. We calculated the SARS-CoV-2 mobility threshold and gap.RESULTS:Across the 51-week study period, a total of 888 751 people were infected with SARS-CoV-2. Each 10% increase in the mobility gap was associated with a 25% increase in the SARS-CoV-2 weekly case growth rate (ratio 1.25, 95% confidence interval 1.20–1.29). Compared to the prepandemic baseline mobility of 100%, the mobility threshold was highest in the summer (69%; interquartile range [IQR] 67%–70%), and dropped to 54% in winter 2021 (IQR 52%–55%); a mobility gap was present in Canada from July 2020 until the last week of December 2020.INTERPRETATION:Mobility strongly and consistently predicts weekly case growth, and low levels of mobility are needed to control SARS-CoV-2 through spring 2021. Mobility measures from anonymized smartphone data can be used to guide provincial and regional loosening and tightening of physical distancing measures.

Factors associated with delay to video-EEG in dissociative seizures

PurposeWhile certain clinical factors suggest a diagnosis of dissociative seizures (DS), otherwise known as functional or psychogenic nonepileptic seizures (PNES), ictal video-electroencephalography monitoring (VEM) is the gold standard for diagnosis. Diagnostic delays were associated with worse quality of life and more seizures, even after treatment. To understand why diagnoses were delayed, we evaluated which factors were associated with delay to VEM. MethodsUsing data from 341 consecutive patients with VEM-documented dissociative seizures, we used multivariate log-normal regression with recursive feature elimination (RFE) and multiple imputation of some missing data to evaluate which of 76 clinical factors were associated with time from first dissociative seizure to VEM. ResultsThe mean delay to VEM was 8.4 years (median 3 years, IQR 1–10 years). In the RFE multivariate model, the factors associated with longer delay to VEM included more past antiseizure medications (0.19 log-years/medication, standard error (SE) 0.05), more medications for other medical conditions (0.06 log-years/medication, SE 0.03), history of physical abuse (0.75 log-years, SE 0.27), and more seizure types (0.36 log-years/type, SE 0.11). Factors associated with shorter delay included active employment or student status (-1.05 log-years, SE 0.21) and higher seizure frequency (0.14 log-years/log[seizure/month], SE 0.06). ConclusionsPatients with greater medical and seizure complexity had longer delays. Delays in multiple domains of healthcare can be common for victims of physical abuse. Unemployed and non-student patients may have had more barriers to access VEM. These results support earlier referral of complex cases to a comprehensive epilepsy center.

Epilepsy, dissociative seizures, and mixed: Associations with time to video-EEG

PurposeVideo-electroencephalographic monitoring (VEM) is a core component to the diagnosis and evaluation of epilepsy and dissociative seizures (DS)—also known as functional or psychogenic seizures—but VEM evaluation often occurs later than recommended. To understand why delays occur, we compared how patient-reported clinical factors were associated with time from first seizure to VEM (TVEM) in patients with epilepsy, DS or mixed. MethodsWe acquired data from 1245 consecutive patients with epilepsy, VEM-documented DS or mixed epilepsy and DS. We used multivariate log-normal regression with recursive feature elimination (RFE) to evaluate which of 76 clinical factors interacting with patients’ diagnoses were associated with TVEM. ResultsThe mean and median TVEM were 14.6 years and 10 years, respectively (IQR 3–23 years). In the multivariate RFE model, the factors associated with longer TVEM in all patients included unemployment and not student status, more antiseizure medications (current and past), concussion, and ictal behavior suggestive of temporal lobe epilepsy. Average TVEM was shorter for DS than epilepsy, particularly for patients with depression, anxiety, migraines, and eye closure. Average TVEM was longer specifically for patients with DS taking more medications, more seizure types, non-metastatic cancer, and with other psychiatric comorbidities. ConclusionsIn all patients with seizures, trials of numerous antiseizure medications, unemployment and non-student status was associated with longer TVEM. These associations highlight a disconnect between International League Against Epilepsy practice parameters and observed referral patterns in epilepsy. In patients with dissociative seizures, some but not all factors classically associated with DS reduced TVEM.

An alternative formulation of Coxian phase-type distributions with covariates: Application to emergency department length of stay.

In this article, we present a new methodology to model patient transitions and length of stay in the emergency department using a series of conditional Coxian phase-type distributions, with covariates. We reformulate the Coxian models (standard Coxian, Coxian with multiple absorbing states, joint Coxian, and conditional Coxian) to take into account heterogeneity in patient characteristics such as arrival mode, time of admission, and age. The approach differs from previous research in that it reduces the computational time, and it allows the inclusion of patient covariate information directly into the model. The model is applied to emergency department data from University Hospital Limerick in Ireland, where we find broad agreement with a number of commonly used survival models (parametric Weibull and log-normal regression models and the semiparametric Cox proportional hazards model).

Analysis of the Railway Accident-Related Damages in South Korea

Railway accidents are critical issues characterized by a large number of injuries and fatalities per accident due to massive public transport systems. This study proposes a new approach for evaluating the damages resulting from railway accidents using the two-part models (TPMs) such as the zero-inflated Poisson regression model (ZIP model) and the zero-inflated negative-binomial regression model (ZINB model) for the non-negative count measurements and the zero-inflated gamma regression model (ZIG model) and the zero-inflated log-normal regression model (ZILN model) for the semi-continuous measurements. The models are employed for the evaluation of the railway accidents on Korea Railroad, considering the accident damages, such as the train delay time, the number of trains delayed and the cost of considering the accident count responses, for the period 2008 to 2016. From the results obtained, we found that the human-related factors, the high-speed railway system or the Korea Train Express (KTX) and the number of casualties, are the main cost-escalating factors. The number of trains delayed and the amount of delay time tend to increase both the probability of incurring costs and the amount of cost. For better evaluation, the railway accident data should contain accurate information with less recurrence of zeros.

Early vs late cardiac surgery in patients with native valve endocarditis-United States Nationwide Inpatient database.

Although the standard treatment of infective endocarditis (IE) is antimicrobial therapy, surgical intervention is required in some cases. However, the optimal timing of surgery remains unclear. Hence, we conducted a population-based analysis using the National Inpatient Sample (NIS) database to assess the outcomes of early versus late surgery in patients with native valve IE. We queried the NIS database for all hospitalized patients between 2006 and 2016 with a primary diagnosis of IE who had cardiac surgery. We stratified surgery as early ≤7 or late >7 days of admission. Multivariable logistic regression models were used to assess in-hospital mortality and postoperative complications. Length of stay (LOS) and total hospital cost (HC) were evaluated using multivariable log-normal regression models. A total of 13 056 patients (57.6% in the early group and 42.4% in the late group) were included. The in-hospital mortality rate in the early group was 5.0% compared to 5.4% in the late intervention group (adjusted odds ratio, 1.20, 95% confidence interval [CI] 0.79-1.81). Overall median LOS was reduced in the early group by 48.2% (95% CI, 46.5%-49.9%, 12.4 days in the early group and 25.9 days in late group), as well as HC which was reduced in the early group by 28.3% (95% CI, 26.0%-30.6%). Among patients with native valve IE who needed cardiac surgery, the time of surgical intervention did not affect the in-hospital mortality. However, early surgery was associated with significantly shorter LOS and lower HC.

Metabolic effects of PCSK9 inhibition with Evolocumab in subjects with elevated Lp(a)

BackgroundEpidemiological studies substantiated that subjects with elevated lipoprotein(a) [Lp(a)] have a markedly increased cardiovascular risk. Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) lowers both LDL cholesterol (LDL-C) as well as Lp(a), albeit modestly. Effects of PCSK9 inhibition on circulating metabolites such as lipoprotein subclasses, amino acids and fatty acids remain to be characterized.MethodsWe performed nuclear magnetic resonance (NMR) metabolomics on plasma samples derived from 30 individuals with elevated Lp(a) (> 150 mg/dL). The 30 participants were randomly assigned into two groups, placebo (N = 14) and evolocumab (N = 16). We assessed the effect of 16 weeks of evolocumab 420 mg Q4W treatment on circulating metabolites by running lognormal regression analyses, and compared this to placebo. Subsequently, we assessed the interrelationship between Lp(a) and 14 lipoprotein subclasses in response to treatment with evolocumab, by running multilevel multivariate regression analyses.ResultsOn average, evolocumab treatment for 16 weeks resulted in a 17% (95% credible interval: 8 to 26%, P < 0.001) reduction of circulating Lp(a), coupled with substantial reduction of VLDL, IDL and LDL particles as well as their lipid contents. Interestingly, increasing concentrations of baseline Lp(a) were associated with larger reduction in triglyceride-rich VLDL particles after evolocumab treatment.ConclusionsInhibition of PCSK9 with evolocumab markedly reduced VLDL particle concentrations in addition to lowering LDL-C. The extent of reduction in VLDL particles depended on the baseline level of Lp(a). Our findings suggest a marked effect of evolocumab on VLDL metabolism in subjects with elevated Lp(a).Trial registrationClinical trial registration information is registered at ClinicalTrials.gov on April 14, 2016 with the registration number NCT02729025.

On the Survival Assessment of Asthmatic Patients Using Parametric and Semi-Parametric Survival Models

The goals of asthma management are to prevent or minimize symptoms, avert or reduce risk of asthma attacks and to ensure that asthma does not limit the patient’s activities since it is not curable. Thus in this study, the degrees of success following treatments given to patients over time were assessed based on the patient’s length of stay on admission and factors responsible for patients’ response to treatment were equally examined using survival analysis models of parametric and semi-parametric distributions. The study was conducted on 464 asthmatic patients from four different hospitals in Ogun State. The data were extracted from patients’ records and prognostic factors such as age, sex, smoking, hereditary, obesity, respiratory illness and environmental pollution were considered for survival analysis. It was observed that there was drastic reduction in survival rate from 7 days upward at a cut-off probability value of 0.485, based on Kaplan-Meier (KM) results. Log-normal regression model, a parametric model with the least AIC value (2969.74) and least negative Log likelihood value (1475.87) shows best performance in handling asthma data with prognostic factors of Smoking (HR = 1.32, 95% CI: 0.93 - 1.88), Obesity (HR = 1.25, 95% CI: 0.80 - 1.93), Environmental pollution (HR = 0.79, 95% CI: 0.52 - 1.18) and Respiratory illness (HR = 1.93, 95% CI: 1.33 - 2.79) were found to have significantly affected the length of stay of asthmatic patients in hospital.

Maternal morbidity: a longitudinal study of women’s health during and up to 22 months after pregnancy in Jamaica

ABSTRACT Our study evaluated factors associated with ill-health in a population-based longitudinal study of women who delivered a singleton live-born baby in a 3-month period across Jamaica. Socio-demographics, perception of health, chronic illnesses, frequency and reasons for hospital admission were assessed. Relationships between ill-health and maternal characteristics were estimated using log-normal regression analysis. Of 9,742 women interviewed at birth, 1,311 were assessed at four stages, 27.7% of whom reported ill-health at least once. Hospitalization rates were 20.9% during pregnancy, 6.1% up to 12 months and 0.5% up to 22 months after childbirth. Ill-health, reported by 11% of women, was less likely with better education (RR=0.62, 95%; 0.42-0.84). Hospital admission was associated with higher socio-economic status (RR=1.33, 95% 1.04-1.70) and Caesarean section [CS] (RR=1.57, 95%; 1.21-2.04). One in three (33.7%) women reported chronic illnesses, and the likelihood increased with age, parity and delivery by elective CS (RR=1.44, 95%; 1.20-1.73). In multivariable analyses, ill-health was more likely with chronic illness (RR=2.06, 95%; CI: 1.71-2.48) and hospital admission from 12 to 22 months after childbirth (RR=1.54, 95% CI: 1.12-2.12). Ill-health during pregnancy and after childbirth represent a significant burden of disease and requires a standardised comprehensive approach to measuring and addressing this disease burden.

Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis

BackgroundThe presentation of idiopathic granulomatous mastitis can mimic breast cancer. Therefore, awareness of the condition is important for surgeons. The current series is the largest in a US population. MethodsRetrospective chart review of patients treated at a county, safety-net hospital in Arizona. Cases were identified from January 2006 to January 2019. Sociodemographic information, clinical history, management, and outcomes were collected. ResultsThere were 145 occurrences of idiopathic granulomatous mastitis among 120 women. Most of the patients (92%) were of Hispanic ethnicity and born outside (87%) of the United States. The average age was 35 years. Nearly all patients (95%) were parous, with an average of 3 pregnancies. Most (88%) presented with a palpable mass, and more than half (54%) of these masses were painful. Six patients had prolactinomas or hyperprolactinemia, 11 patients were pregnant, and 5 were postpartum. Early in the time period studied, 6 patients underwent excision of the masses. The remaining 114 underwent planned observation after biopsy confirmation of the diagnosis. Two patients were lost to follow-up, and the other 112 patients with idiopathic granulomatous mastitis resolved spontaneously. Nineteen had more than 1 episode. Average time to resolution was 5 months (range 0–20). Adjusted log-normal regression analysis found that later age of first live birth was associated with greater time to resolution (P < .01). ConclusionIdiopathic granulomatous mastitis is a self-limited, benign condition that waxes and wanes and eventually resolves without resection. After diagnosis, medications are unnecessary, and operations can be limited to drainage procedures for fluid collections.