Multivariate Logistic Regression Analysis Research Articles

COVID-19, a natural experiment. Did it create an opportunity to reduce racial disparities in psychosocial oncology and change how we deliver care?

There is evidence to support the acceptability of telehealth among oncology patients, but inconsistencies regarding access and use in underserved populations. This study used the COVID-19 pandemic as a natural experiment to test whether implementation of telehealth for patients referred to a psychosocial oncology (PSO) service would 1) increase PSO access and utilization and 2) reduce racial disparities. Demographic, medical and appointment completion data for patients referred to a PSO service at an NCI-Designated Comprehensive Cancer Center from March, 2018 to March, 2022 were examined. Descriptive and multivariate logistical regression analyses at both the patient and visit level were conducted. Outcomes were patient follow-up (i.e. ≥ one scheduled PSO appointment) and visit outcome (completed vs. canceled/no-show). The sample included 934 White and 610 Black adult patients (69.8% female) aged 18-95 (M = 56.0, SD = 15.3) who scheduled 5,782 PSO visits. Follow-up rates significantly increased post-COVID among White (66.2%-72.2%; Z = 2.17, p = .03), but not Black patients (73.6%-70.4%; Z = 0.88, p = .38). Among N = 1,089 patients who scheduled at least one PSO appointment, telehealth had a significant effect on visit outcomes (X2 = 466.6, df = 2, p < .001). Completed appointments increased (52.5%-79.2%), while rates of canceled (21.8%-11.2%) and no-show appointments (25.7%-9.6%) decreased. Moreover, telehealth resulted in a significantly greater increase in completed appointments for Black patients (44.7%-74.3%), in comparison to White patients (59.4%-81.4%; X2 = 4.02, df = 1, p = .045). Black patients were less likely than White patients to show an increase in follow-up with PSO services following onset of COVID. However, among patients with one or more scheduled appointments, the use of telehealth significantly decreased racial disparities in appointment completion rates. Findings suggest that the relationship between telehealth and racial disparities in PSO care is nuanced.

Medical students’ knowledge, attitudes, and motivation towards antimicrobial resistance efforts in Eastern Uganda

Introduction Learning beyond the classroom is important for holistic engagement in antimicrobial resistance(AMR) mitigation. Extracurricular interventions can catalyze multidisciplinary engagement and inspire innovative solutions. This study aimed to determine the knowledge, attitudes, and motivations influencing medical students’ engagement in AMR Club initiatives at Busitema University, Uganda. Methodology This was a descriptive cross-sectional study conducted at Busitema University among undergraduate students pursuing Bachelors of Medicine and Surgery, Bachelor of Science in Nursing, and Bachelor of Science in Anesthesia and Critical care. Data collection was performed using a semi-structured, pre-tested questionnaire and administered to the participants The Bloom’s cut-off method was used to analyse the knowledge of the participants, while bivariate analysis was conducted using the chi square test. Multivariable logistic regression analysis was used to identify factors independently associated with students’ engagement in AMR club activities. Results Of the 193 study participants, 71.5%(n) demonstrated sufficient knowledge about antimicrobial resistance (AMR), as determined using Bloom’s cutoff categories (≥60% classified as sufficient, &lt;60% as insufficient), with an average knowledge score of 68.18% (SD ±16.12). Additionally, 90% of participants acknowledged the significance of incorporating AMR topics into their curriculum, while 87.5% emphasized the need for AMR training using a One Health approach. The major motivations for students to engage in extracurricular activities addressing AMR were peer influence (n = 42), university support (n = 35), and inspiration drawn from peer mentors’ work (n = 35). Conclusion The students demonstrated a high level of knowledge and positive attitudes towards AMR but highlighted the need for further in-depth training. Participation in extra-curricular activities such as involvement in an AMR Club, was found to significantly influence students’ engagement in AMR related interventions.

Remote Site Delayed Extradural Hematoma Secondary to Decompressive Craniectomy for Traumatic Brain Injury: Incidence, Predictors, Characteristics, and Outcomes

Objective: Remote site delayed extradural hematoma (RDEDH) is an uncommon but serious complication that can occur after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). This study aims to clarify the incidence, predictors, clinical and radiological characteristics, and outcomes of RDEDH to improve the authors' understanding and management of this complication. Methods: This study identified 36 patients with TBI who developed RDEDH after DC. The incidence, predictors, clinical and radiological characteristics, and outcomes were analyzed retrospectively. Continuous variables were compared using the student t test, whereas categorical variables were assessed using the χ2 test. Variables with a P value of &lt;0.05 in univariable analysis were included in the multivariable logistic regression analysis. Results: The incidence of RDEDH after DC was 14.6%. Preoperative pupillary dilation [bilaterally; odds ratio (OR): 8.797; 95% CI: 1.969–39.297; P = 0.004], intraoperative acute brain swelling (OR: 33.696; 95% CI: 5.073–227.005; P &lt; 0.001), and pupillary abnormalities after DC (OR: 8.141; 95% CI: 2.117–31.307; P = 0.002) were identified as independent risk factors for the development of RDEDH after DC. The average length of hospitalization in the RDEDH group was significantly longer than that in the non-RDEDH group (P = 0.018). The Glasgow Outcome Scale score at 6 months in the RDEDH group was significantly lower than that in the non-RDEDH group (P = 0.01). The incidence of poor prognosis in the RDEDH group (80.6%) was significantly higher than that in the non-RDEDH group (59.8%; P = 0.017). Conclusion: Preoperative bilateral pupillary dilation, intraoperative brain swelling, and pupillary abnormalities after surgery were independent risk factors for the development of RDEDH after DC in patients with TBI. The occurrence of RDEDH in patients with TBI after DC did not significantly increase mortality, it was associated with a prolonged length of stay and an increased incidence of poor prognosis.

Systemic risk factors contributing to sialolithiasis: a big-data retrospective analysis.

To investigate systemic risk factors contributing to the formation of sialolithiasis. A retrospective big-data cohort study was conducted using data from Clalit HMO in Israel. Sialolithiasis patients were identified based on ICD-10 codes and matched with controls. Univariate and multivariable logistic regression analyses were performed to assess the relationship between systemic conditions and sialolithiasis. P-value < 0.05 was considered significant. 5100 sialolithiasis cases were collected. The statistical analysis revealed that hypertension (OR = 1.14, 1.08-1.24, p < 0.001), dyslipidemia (OR = 1.33, 1.27-1.41, p < 0.001), nephrolithiasis (OR = 1.55, 1.42-1.63, p < 0.001) and cholelithiasis (OR = 1.22, 1.16-1.27, p < 0.001) were significantly correlated with sialolithiasis. Systemic diseases, particularly dyslipidemia, play a role in the development of sialolithiasis. Further research is needed to explore the underlying mechanisms linking these conditions and to develop targeted strategies for the prevention of sialolithiasis. This study highlights the potential interplay between systemic conditions and sialolithiasis. Recognizing these associations can inform clinical practice in understanding the pathogenesis of the disease, risk assessment, early diagnosis, and preventive measures.

Long-Term Results of Intensity Modulated Radiotherapy (IMRT) with Helical Tomotherapy in Non-Metastatic Breast Cancer Patients: Final Analysis

Background: Intensity modulated radiotherapy with helical tomotherapy (IMRT-HT) is used in the breast cancer (BC) treatment for years now to obtain homogeneous dose distribution in the treated volumes and reduce the doses to organs at risk. The purpose of this study was to evaluate our experience in terms of local control, overall survival, progression free survival and adverse events in BC patients treated with IMRT-HT with long term follow-up. Methods: This study is a retrospective data analysis of patients irradiated with IMRT-HT. Overall survival (OS) and progression free survival (PFS) curves were plotted with Kaplan-Meier method. We also analyzed the OS and PFS data by molecular subgroups of the population. Long-term toxicities including skin, cardiac and pulmonary complications were also evaluated. Multivariant logistic regression analysis was performed to determine the independent predictors of the side effects. Results: Between 2009 and 2015, a total of 194 breasts in 179 women with nonmetastatic breast cancer were treated. Most of the tumors were grade III and N+. With a median follow-up of 10 years, we observed 9 local recurrences, 2 loco-regional recurrences, and 29 patients experienced metastatic disease. Only 18 patients are dear, of them 7 cases with breast cancer death. At 10 years, the Local recurrence free survival was 95.3% [95%CI: 92.1–98.5], the loco-regional relapse free survival was 94.5% [91.1–98.1]. The metastases free survival was 82.9% [76.9–89.3]. The progression free survival was 79.9 [73.6–86.7]. The cancer specific survival was 94.3%, and the overall survival 88% [82.8–93.5]. At long term, there were no cardiac, lung, thyroid, digestive radio induced toxicities. A small number of patients experienced grade I or II fibrosis. Conclusions: IMRT-HT could be safely used for adjuvant breast cancer irradiation in patients with complex anatomy. IMRT-HT provides favourable long-term prognosis, while late toxicity is acceptable.

Risk factors for prolonged air leak after uniportal anatomical segmentectomy.

Our aim was to investigate the incidence and risk factors for prolonged air leak in patients undergoing minimally invasive single-port pulmonary segmentectomy. A retrospective analysis of all patients undergoing uniportal segmentectomy in our department from March 2015 to September 2023 was performed. Univariable, multivariable logistic regression analyses and machine learning were used to investigate risk factors for prolonged air leak (>5 days). 575 segmentectomies were performed using uniportal video-assisted thoracoscopic surgery. 333 patients (57.9%) were men and the mean age was 64.8 years.Prolonged air leak occurred in 88 patients (15.3%). Length of stay and duration of chest drainage were 8.6 (SD 4.86) and 10.6 (SD 8.12) days in the subgroup with prolonged air leak, compared to 3.6 (SD 2.25) and 2.0 (SD 1.3) days in the subgroup without air leak (p < 0.0001). Multivariable analysis revealed that upper lobe location, lower BMI, an additional wedge resection on another segment and hypertension were associated with increased risk of PAL.Machine learning was used to develop models that predicted the occurrence of prolonged air leak with an accuracy of 70%. The first model detected the following parameters as significant: resection of segment 2, diabetes, inhalers, and squamous cell carcinoma. The second model recognized DLCO (%), pack-years, FEV1 (%) and surgery time respectively. Low BMI, DLCO% or FEV1% values, increased pack-years, inhalers, diabetes, hypertension, histology of primary lung cancer, longer surgery time, an additional wedge resection, segment 2 removal and upper lobe surgery were identified as risk factors for prolonged air leak.

Dietary glycemic index and load during pregnancy and offspring behavioral outcomes: exploring sex differences

Given the importance of carbohydrates during pregnancy and the limited evidence on the impact of its excessive intake on offspring neurodevelopment, this study aimed to assess the associations between maternal glycemic index (GI) and glycemic load (GL) during early and late pregnancy and behavior problems in 4-year-old children, considering potential sex-related differences in susceptibility to maternal diet. This observational study included 188 mother–child pairs from the ECLIPSES study. GI and GL were estimated from a validated food frequency questionnaire. Offspring behavior was assessed using the Child Behavior Checklist 1.5–5. Multivariable linear and logistic regression analyses were employed to assess the association between GI, GL, and child behavior. Children of mothers in the highest tertile of GL during the first trimester of pregnancy showed elevated scores of both internalizing (β = 5.77; 95% CI, 2.28–9.26) and externalizing (β = 3.95; 95% CI, 0.70–7.19) problems, including anxiety and depression problems, withdrawn, attention problems, aggressive behavior, and attention-deficit/hyperactivity problems, as well as total (β = 5.24; 95% CI, 1.71–8.77) and autism spectrum problems (β = 3.30; 95% CI, 1.11–5.50). Similarly, higher odd ratios were observed for internalizing (OR = 2.37; 95% CI, 1.09–5.18), externalizing (OR = 3.46; 95% CI, 1.49–8.00), and total problems (OR = 3.83; 95% CI, 1.68–8.71). These associations were more pronounced in girls. No associations were observed during the third trimester. Regarding GI, no associations were found for the evaluated outcomes in any of the trimesters. Conclusion: These findings indicated that elevated maternal GL during the early pregnancy, but not later stages, was associated with adverse behavioral outcomes in offspring.Trial registration: EUCTR-2012–005480-28, NCT03196882.What is Known: • Carbohydrate intake is important during pregnancy as glucose is the main energy source for an optimal fetal brain development.• Elevated prenatal glycemic index and glycemic load have been associated with adverse offspring outcomes but their impact on behavioral development remains insufficiently explored.What is New:• A high maternal glycemic load during pregnancy may increase the risk of behavioral impairments in preschool-aged offspring.• Female offspring may be more vulnerable to behavioral disturbances to elevated maternal glycemic load during gestation.

Association Between Comorbidities and Inpatient Postpartum Permanent Contraception Completion

OBJECTIVE: To evaluate whether comorbidities (defined as both medical conditions and peripartum complications) are associated with inpatient postpartum permanent contraception by tubal surgery completion. METHODS: This is a secondary analysis of a multisite retrospective cohort study of patients who had documented plans for permanent contraception. Our primary outcome was inpatient completion of postpartum permanent contraception by tubal surgery. We used univariable and multivariable logistic regression analyses to examine associations between aggregate and individual comorbidities and the attainment of inpatient postpartum permanent contraception. RESULTS: In this study of 2,226 pregnant people, 53.4% of patients received postpartum permanent contraception by the time of hospital discharge, and 70.8% of patients had documented comorbidities. Although patients with medical conditions initially had lower odds of permanent contraception completion compared with those without any comorbidities (adjusted odds ratio [aOR] 0.77, 95% CI, 0.64–0.93), this association was no longer significant after adjusting for multiple comparisons (adjusted P=.06). This association also was not significant for patients with peripartum complications (aOR 0.86, 95% CI, 0.64–1.16, adjusted P=.42). Similarly, when individual comorbidities were assessed, patients with hypertension (aOR 0.80, 95% CI, 0.65–0.97, adjusted P=.06), mental health diagnoses (aOR 0.80, 95% CI, 0.66–0.96, adjusted P=.06), and elevated body mass index (BMI, 40 or higher) (aOR 0.77, 95% CI, 0.63–0.95, adjusted P=.06) had no significant differences in odds of immediate permanent contraception attainment after adjusting for multiple comparisons. CONCLUSIONS: Though the balance of risks and benefits is imperative for surgical care, it is imperative that modifiable barriers to desired permanent contraception are mitigated. There were no statistically significant differences in inpatient postpartum permanent contraception attainment for patients with medical conditions in our study; however, further study is needed to better elucidate the complex relationships between medical comorbidities and contraception.

Epidemiological features and risk factors of human psittacosis in Hangzhou City, eastern China

ObjectivesThis study aimed to investigate the epidemiological characteristics and risk factors associated with human psittacosis in Hangzhou city, eastern China.MethodsThe human psittacosis data from 2021 to 2024 were obtained from the China information system for diseases control and prevention infectious disease surveillance system. Epidemiological investigations were carried out on the patients' past medical history, clinical manifestations, chest CT results and treatment status. A community-based 1:3 matched case-control study was performed to investigate the risk factors associated with Chlamydia psittaci infection.ResultsDuring the study period, 137 confirmed cases of human psittacosis were identified through laboratory tests, of which 24 (17.52%) were classified as critical cases, including one fatality. The epidemic curve indicated that the majority of cases occurred between October and March. Among the cases, 48.91% were female, and the median age was 63 years. There were more female cases among those aged &amp;lt;60 years, while there were more male cases among those aged ≥60 years. Multivariate logistic regression analysis revealed that the presence of bird habitats within 500 m of the living area [odds ratio (OR) = 3.81, 95% confidence interval (CI) = 2.19–6.61], parrots kept (OR = 2.95, 95%CI = 1.10–7.89) and poultry kept (OR = 2.15, 95%CI = 1.02–4.53) remained significantly associated with the risk of disease infection.ConclusionsHuman psittacosis has become a notable public health concern in Hangzhou city, with an increase in psittacosis cases reported in recent years. Exposure to poultry, birds, or environments contaminated with Chlamydia psittaci was associated with infection. Urgent actions to reduce psittacosis cases and mitigate the impact of outbreaks are needed, including strengthening surveillance, raising public awareness, and promoting collaboration between the agricultural and health sectors.

Spectral computed tomography in the assessment of metastatic lymph nodes in cervical cancer patients treated with definitive radiotherapy: a single-center, prospective study.

Identifying metastatic lymph nodes (LNs) in patients with cervical cancer treated with definitive radiotherapy may inform treatment strategy and determine prognosis, but available methods have limitations, especially in developing regions. Herein, we aimed to evaluate the performance of quantitative parameters in spectral computed tomography (CT) scanning in this context, focusing on its complementary role alongside conventional diagnostic approaches like 18-fluorine-fuorodeoxyglucose positron emission tomography computed tomography (18F FDG-PET/CT). Patients with cervical cancer, who underwent pretreatment spectral CT simulation scanning and planned radiotherapy, were enrolled in this prospective study. The LNs were categorized as "metastatic" and "non-metastatic", based on a procedure that included 18F FDG-PET/CT as well as CT, magnetic resonance imaging, Node Reporting and Data System and follow-up results. Iodine concentrations (IC), normalized IC (NIC), effective atom number (effZ), and spectral curve slope (λHU) in the arterial (AP) and venous (VP) phases, were compared between metastatic and non-metastatic LNs. IC were derived from iodine-based material decomposition through manual delineation and normalized to the iodine concentration in the adjacent artery (NIC). effZ and λHU were calculated based on the effective atom number image and virtual monochromatic images. Univariate and multivariate logistic regression analyses were used to determine spectral CT factors independently associated with LNs metastasis, and their diagnostic efficacies were assessed using the area under the curve (AUC) analysis. The diagnostic efficiency of 18F FDG-PET/CT and spectral CT was compared. A total of 115 metastatic and 97 non-metastatic LNs were detected, and spectral CT parameters (IC, NIC, effZ, λHU) significantly differed between the two groups. In univariate and multivariable logistic regression analysis, λHU in the AP and NIC in the VP were independent predictors for metastatic LNs and their combination improved AUC to 0.923, with a sensitivity of 84.4%, and a specificity of 85.6%. Spectral CT could achieve similar sensitivity as 18FFDG-PET/CT in total LNs, and, more importantly, a higher sensitivity (95.5% vs. 59.1%) and diagnostic accuracy (92.9% vs. 67.9%) for para-aortic LNs. Quantitative spectral CT parameters can help distinguish metastatic from non-metastatic LNs in patients with cervical cancer treated with definitive radiotherapy. Combination of λHU in AP and NIC in VP further improves diagnostic performance. Spectral CT, while promising, complements rather than replaces PET/CT, especially for diagnosing para-aortic LNs, where PET/CT may have limitations. It could be a valuable adjunct to conventional imaging, particularly in settings with limited access to advanced tools.

Prevalence, influencing factors, and prediction model construction of anemia in ankylosing spondylitis based on real-world data: An exploratory study.

This study aimed to explore the prevalence and influencing factors of anemia in patients with ankylosing spondylitis (AS) using real-world data and to construct a predictive model for anemia in AS. In November 2023, we accessed the database from China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN). Clinical data of AS collected from the CERTAIN between March 2022 and September 2023 were analyzed. Demographic information, clinical assessment scales, and laboratory test results of the patients were collected. According to the anemia diagnostic criteria established by the World Health Organization (WHO) in 2018, patients were divided into anemia group and non-anemia group. Statistical analyses were performed using SPSS 25.0 software, including χ2 tests, independent sample t-tests to compare differences between the two groups, and multivariate stepwise logistic regression analysis to explore the influencing factors of anemia in AS. The predictive efficacy of the model was evaluated by plotting receiver operating characteristic (ROC) curves. Calibration was assessed through the Hosmer-Lemeshow goodness-of-fit test, and a calibration curve was plotted to comprehensively evaluate the predictive capability of the model. A total of 251 patients were included in this study, among which 58 cases had anemia (23.1%). There were significant differences in gender, ossification, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) indicators, and clinical assessment scale results between the two groups (P < 0.05). The results of multivariate stepwise logistic regression analysis showed that female gender, underweight, ossification, abnormal CRP and ESR were independent risk factors for anemia in AS (P < 0.05). Based on the results of multivariate stepwise logistic regression analysis, a predictive model for anemia in AS was established as Logit(P) = -5.02 + 2.041 × gender -1.11 × BMI(body mass index) category + 1.103 × ossification category + 0.942 × CRP category + 1.476 × ESR category. The ROC curve analysis showed that the area under the curve of the model for predicting anemia in AS was 0.857 (95% CI: 0.808 ~ 0.906). The Omnibus test of model coefficients yielded χ2 = 85.265, P < 0.001. The Hosmer-Lemeshow test showed χ2 = 7.005, P = 0.536 (P > 0.05). Analysis of real-world AS diagnosis and treatment data showed that the prevalence of anemia in Chinese AS was 23.1%. The occurrence of anemia was closely related to female gender, underweight, ossification, and abnormal CRP and ESR. The logistic model constructed based on these indicators for predicting the risk of anemia in AS demonstrated good efficacy.

Low ITN utilization among households in SWEPR Ethiopia: challenge for malaria elimination, a mixed design approach

IntroductionTo prevent malaria starting from 2005 more than 2 billion insecticide-treated nets (ITNs) have been distributed globally. Even though Ethiopia has been doing nationwide ITN distribution starting from 2016 with 64% ITN coverage, there is a significant gap in its utilization in different settings. Therefore, this study aimed to assess the utilization of ITN and associated factors among households in SWEPRS, 2023.MethodsCommunity-based mixed study designs were applied in the present study. Firstly, the malaria area was selected purposively and the study participants were reached by using multi-stage stratified sampling techniques. Data was collected by using structured and pre-tested tools through an electronic data collection software, Kobo tool kit was analyzed by using STATA version 14. The multicollenearity between independent variables and model fitness were checked by using the variable inflation factor (VIF) and Hosmer Lemeshow model fitness test, respectively. A binary Logistic Regression model was fitted to identify the associated factors. In the multivariable analysis, an adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) was used to measure the strength of the association and the statistically significant association was declared at a P-value less than 5%. Focus group discussion (FGD) and in-depth interviews (IDI) were employed for the qualitative study and analyzed using Quirkos. The findings of qualitative data were presented in thematic analysis.ResultsIn this study, a total of 1,552 households participated. In all households, the ownership of at least one mosquito net per household was found to be 89% (95%: CI: 87.62–90.72%) whereas the proper use of ITNs was found to be 20.38% (95%: CI: 18.25–22.50%) in the region. From the multivariable logistic regression analysis, the urban residents, NGO employees, having a corrugated iron sheet house type, having good knowledge toward malaria, having good knowledge toward ITNs, having a favorable attitude towards malaria and having a favorable attitude towards ITNs had higher odds of the proper utilization of ITNs as compared to their counterparts. In addition to these, misconceptions about ITNs, unfair distribution of ITNs, lack of health education from health extention workers (HEWs), community resistance, improper use (use for other purposes) of ITNs and shortage of HEWs were explored barriers to ITNs use from the qualitative data.ConclusionsThis study showed relatively a high coverage of ITNS, but low proper ITN utilization among the households. Therefore, behavioral change communications (BCC) interventions and education and communication (IEC), interventions should be done in the region.

Analysis of acute non-pharmaceutical toxic exposures in children: a 5-year retrospective study

ObjectiveThis study aims to systematically analyze the epidemiological characteristics, clinical interventions and outcomes of children with acute non-pharmaceutical toxic exposures.MethodsThis retrospective study included all children with acute non-pharmaceutical toxic exposure admitted to the emergency department of the Capital Institute of Pediatrics between January 1, 2019, and December 31, 2023. Eligible patients were triaged into red, yellow, and green groups according to their severity condition. Clinical information including demographics, exposure details, clinical manifestation, laboratory results, treatments, and outcomes were extracted from electronic medical records. Univariate and multivariate logistic regression analyses were conducted to identify risk factors associated with hospitalization.ResultsOverall, a total of 718 patients with acute non-pharmaceutical toxic exposures was included in this study, infants and toddlers accounting for 57.9%. The male-to-female ratio was 1.16:1. The majority exposure events occurred at home (89.3%) and in urban settings (78.4%). Accidental poisoning was the predominant cause, accounting for 94.7%, and the primary route of exposure was oral (93.6%). Mercury was the most common exposed substance, representing 18.8% of cases, particularly among preschool-aged children (31.7%). Patients triaged to red zone had a higher proportion of clinical manifestation and required more aggressive treatments. Although most patients discharged without treatment (78.4%), 19.1% need emergency observation, and 2.5% required hospitalization. Logistic regression analysis showed that corrosive household products exposure (OR = 42.747, 95% CI[5.041–362.520]), skin and mucosal damage (OR = 37.052, 95% CI[5.339–257.153]), pesticides exposure (OR = 33.322, 95% CI[3.863–287.423]), heavy metals exposure (OR = 31.636, 95% CI[1.471–680.210]), neurological manifestation (OR = 22.656, 95% CI[4.766–107.711]), positive toxicology results (OR = 15.105, 95% CI[6.584–34.656]), industrial products exposure (OR = 10.294, 95% CI[1.144–92.641]), and intentional poisoning (OR = 3.060, 95% CI[1.733–5.405]) associated with hospitalization.ConclusionPediatric patients exposed to some specific toxicants like industrial products and corrosive household products might associated with a higher risk of severe clinical outcomes. Advocating for enhanced safety regulations or educations and public health initiatives to mitigate the incidence of such exposures is still important for protecting children's health.

A sarcopenia prediction model based on the calf maximum muscle circumference measured by ultrasound

BackgroundThe correlation between calf circumference（CC）and sarcopenia has been demonstrated, but the correlation between calf maximum muscle circumference (CMMC) measured by ultrasound and sarcopenia has not been reported. We aims to construct a predictive model for sarcopenia based on CMMC in hospitalized older patients.MethodsThis was a retrospective controlled study of patients > 60 years of age hospitalized in the geriatric department of Hunan Provincial People’s Hospital. The patients were thoroughly evaluated by questionnaires, laboratory, and ultrasound examinations, including measuring muscle thickness and calf muscle maximum circumference using ultrasound. Patients were categorized into sarcopenia and non-sarcopenia groups according to the consensus for diagnosis of sarcopenia recommended by the Asian Working Group on Sarcopenia 2019 (AWGS2). Independent predictors of sarcopenia were identified by univariate and multivariate logistic regression analyses, and a predictive model was developed and simplified. The prediction performance of the models was assessed using sensitivity, specificity, and area under the curve (AUC) and compared with independent predictors.ResultsWe found that patient age, albumin level (ALB), brachioradialis muscle thickness (BRMT), gastrocnemius lateral head muscle thickness (Glh MT), and calf maximum muscle circumference (CMMC) were independent predictors of sarcopenia in hospitalized older patients. The prediction model was established and simplified to Logistic P = -4.5 + 1.4 × age + 1.3 × ALB + 1.6 × BR MT + 3.7 × CMMC + 1.8 × Glh MT, and the best cut-off value of the model was 0.485. The sensitivity, specificity, and AUC of the model were 0.884 (0.807–0.962), 0.837 (0.762–0.911), and 0.927 (0.890–0.963), respectively. The kappa coefficient between this model and the diagnostic criteria recommended by AWGS2 was 0.709.ConclusionWe constructed a sarcopenia prediction model with five variables: age, ALB level, BR MT, Glh MT, and CMMC. The model could quickly predict sarcopenia in older hospitalized patients.

Development and validation of a nomogram for predicting early neurological deterioration in patients with moderate traumatic brain injury: a retrospective analysis

ObjectiveEarly neurological deterioration (END) greatly affects prognosis of moderate traumatic brain injury (TBI). This study aimed to develop and validate a nomogram to predict the occurrence of END in patients with moderate TBI.MethodsA total of 371 patients with moderate TBI were enrolled and divided into the training (n = 260) and validation (n = 111) groups at a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify the significant factors for END, which were used to develop a nomogram. The discrimination of the nomogram was evaluated using area under the receiver operating characteristic curves (AUC), the calibration was evaluated using calibration curves and Hosmer-Lemeshow tests. Decision curve analysis (DCA) was used to evaluate the net benefit of the model for patients.ResultsIn the training group, multivariate logistic regression demonstrated that GCS score, epidural hematoma, intracerebral hemorrhage, fibrinogen, and D-dimer were independent risk factors for END in patients with moderate TBI. A nomogram was constructed using the logistic regression prediction model. The AUCs of the nomogram in the training and validation groups were 0.901 and 0.927, respectively. The calibration curves showed that the predicted probability was consistent with the actual situation in both the training and validation sets. DCA curves demonstrated significantly better net benefit with the model. Then a web-based calculator was generated to facilitate clinical application.ConclusionThe present study developed and validated a model to predict END in patients with moderate TBI. The nomogram that had good discrimination, calibration, and clinical utility can provide clinicians with an effective and accurate tool for evaluating the occurrence of END after moderate TBI.

Latent profile and determinants of self-management behaviors among older adult patients with chronic diseases: a cross-sectional study

ObjectiveTo explore latent profiles of self-management behaviors in older adult patients with chronic diseases and identify the factors that influence different profiles, guiding targeted interventions.MethodsThis study used convenience sampling to recruit 536 older adult patients with chronic diseases from three tertiary hospitals in Anhui Province between October 2023 and May 2024. Data were collected using a general information questionnaire, the age-adjusted Charlson Comorbidity Index (aCCI), the Chronic Disease Self-Management Behavior Scale, the Chronic Disease Management Self-Efficacy Scale, the Psychological Status Scale, the Digital Health Literacy Scale, and the Social Support Scale. Latent profile analysis was conducted using Mplus 8.3, and univariate and multivariate logistic regression analyses were performed using SPSS 26.0.ResultsThree profiles of self-management behaviors emerged: “Low Self-Management” (50.2%), “High Exercise and Cognitive Management” (8.6%), and “Moderate Management with Enhanced Communication” (41.2%). Multivariate logistic regression revealed that residence, aCCI, number of digital devices used, perceived usefulness of digital health information, digital health literacy, social support, chronic disease management self-efficacy, and psychological status were significant factors affecting self-management profiles (all p &amp;lt; 0.05).ConclusionSelf-management behaviors in older adult patients with chronic diseases were generally low, with substantial heterogeneity across profiles. Healthcare providers should tailor interventions based on the characteristics of each group to enhance self-management in digital health contexts.

Inverse association between dietary flavonoid intake and nocturia in middle-aged and older adults from NHANES 2007–2010

Nocturia is an increasingly prevalent chronic disease that affects the quality of an individual’s life. The prevalence of nocturia exceeds 50% among older adults in the U.S. Inflammation and oxidative stress are considered potential factors affecting nocturia, according to prior research. Flavonoids have attracted considerable interest due to their anti-inflammatory, antioxidant, and anti-aging properties. The association between flavonoid consumption and nocturia has been rarely investigated. For this cross-sectional study, we selected 5926 middle-aged and older adults over 40 from the 2007–2010 National Health and Nutrition Examination Survey (NHANES). Daily dietary flavonoid consumption was assessed through two 24-hour dietary recall interviews and the principal outcome was assessed based on a standardized questionnaire administered by trained interviewers. Weighted multivariate logistic regression and stratified analysis were employed to evaluate the impact of dietary total flavonoid consumption on nocturia. Restricted cubic spline (RCS) was utilized to explore whether there is a non-linear association between total flavonoid intake and nocturia. In addition, we performed weighted logistic regression and weighted quantile sum (WQS) regression by six flavonoid species (isoflavones, anthocyanins, flavan-3-ols, flavanones, flavonoids and flavonols) to estimate a combined mixture sum effect as well as the contribution of each mixture component. Subgroup analysis help us identify heterogeneity in these relationships and enhances the applicability of the research findings across different groups. After fully adjusting for confounders, weighted logistic regression models indicated that dietary flavonoid intake was significantly associated with a decreased prevalence of nocturia (OR: 0.93; 95% CI: 0.88-1.00, P-value = 0.036). This trend remained significant in the analysis stratified by quartile level of flavonoid intake. RCS analysis demonstrated an inverse linear correlation between total flavonoid consumption and nocturia. Analysis conducted through quartile stratification of six flavonoid species and WQS regressions showed that anthocyanins, flavan-3-ols, and flavonols were crucial elements. Within these subclasses, Peonidin in anthocyanins, Catechin and Theaflavin-3,3’-digallate in flavan-3-ols, and Isorhamnetin, Kaempferol, and Quercetin in flavonols were also investigated and may have contributed significantly. Our study revealed an inverse association between dietary flavonoid intake and nocturia in middle-aged and older adults, and anthocyanins, flavan-3-ols and flavonols were protectively associated with nocturia.

Serum uric acid to creatinine ratio as a predictor of insulin resistance, β cell function, and metabolic syndrome in normal Korean adults: a cross-sectional study

BackgroundThis study aimed to determine the relations between serum uric acid to creatinine ratio(SUA/Cr) and insulin resistance, pancreatic β cell function, and outbreak of metabolic syndrome (MetS) in normal Korean participants.Materials and methodsThis study included 14,984 participants without diabetes mellitus or gout who participated in the 2019–2021 Korea National Health and Nutrition Examination Survey. To evaluate insulin resistance and β cell function, the homeostasis model assessment (HOMA) was used. Insulin resistance was suggested by HOMA-IR, and β cell function was presented as HOMA-β. Multivariate logistic linear regression analysis was used to identify the factors affecting HOMA-IR, HOMA-β, and MetS. Cut-off values of SUA/Cr to predict insulin resistance, β cell dysfunction, and MetS risk were also been suggested.ResultsConsequent to dividing SUA/Cr into tertiles, the higher the SUA/Cr, the higher the HOMA-IR and dysfunction of β cell, and the rate of MetS increased (p < 0.05). SUA/Cr was associated with insulin resistance, β cell function, and existence of MetS (adjusted odds ratio [OR]; 1.231 [95% confidence interval [CI]; 1.204–1.259], 1.033 [1.011–1.057], and 1.065 [1.026–1.106], respectively). In addition, the group with the clinical significance was the 3rd tertile. In this group, insulin resistance, β cell dysfunction, and MetS risk could be predicted when SUA/Cr value was 8.2716, 8.8710, and 7.9762, respectively. Based on the total number of people, meaningful SUA/Cr values were 7.0175, 6.7925, and 6.9369.ConclusionsThe SUA/Cr may be a useful marker for predicting the insulin resistance, β cell function and incidence of MetS in normal Korean participants.

Evaluating the risk of underdiagnosis of invasive breast cancer in needle biopsy-diagnosed ductal carcinoma in situ eligible for radiofrequency ablation

BackgroundRadiofrequency ablation (RFA) is considered a promising alternative to surgical excision for patients with small, unifocal early-stage breast cancer. A significant concern with the application of RFA in patients diagnosed with ductal carcinoma in situ (DCIS) via needle biopsy is the underdiagnosis of invasive cancer. The extent of this underdiagnosis in DCIS patients eligible for RFA has not been clearly defined.MethodsThis retrospective study assessed lesions diagnosed as DCIS via needle biopsy and eligible for RFA at our institution from April 2009 to March 2024. The eligibility criteria for RFA included a lesion size of ≤ 1.5 cm, unifocality, and clinical node negativity. Underdiagnosis was defined as the presence of invasive cancer in surgical specimens. We evaluated the frequency and risk factors associated with underdiagnosis.ResultsDuring the study period, 606 lesions were diagnosed as DCIS via needle biopsy. Of these, 209 lesions met the criteria for RFA, with underdiagnosis determined in 40 lesions (19.1%). The distribution of pathological T (pT) stages among these lesions was as follows: DCIS in 169 lesions (80.9%), pT1mi in 20 lesions (9.6%), pT1a in 5 lesions (2.4%), pT1b in 9 lesions (4.3%), pT1c in 5 lesions (2.4%), and pT2 in 1 lesion (0.5%). Multivariate logistic regression analysis identified lesion size ≥ 10 mm as a significant risk factor for underdiagnosis (p = 0.016). Adjuvant endocrine therapy and chemotherapy were administered to 26 (65.0%) and 6 (15.0%) of the underdiagnosed lesions, respectively.ConclusionsOur findings highlight the risk of underdiagnosing invasive breast cancer in patients undergoing RFA for needle biopsy-diagnosed DCIS. It is crucial to acknowledge the potential for undertreatment when considering RFA as a treatment option.

The relationship between visceral adipose tissue and osteoarthritis among older adults: evidence from the NHANES 1999–2018

ObjectivesThis study aimed to assess any possible links between visceral fat accumulation and an elevated prevalence of osteoarthritis (OA) in the elderly.Methods3,779 subjects aged 65 years or older from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were finally included, of whom 516 had OA. The identification of patients diagnosed with OA was conducted using questionnaire data. The visceral adiposity index (VAI) was computed utilizing body mass index (BMI), waist circumference (WC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C). To investigate the relationship between VAI and OA, weighted multivariable logistic regression analysis, restricted cubic spline (RCS), subgroup analyses, and interaction tests were carried out.ResultsMultivariate logistic regression analysis showed that the increase in VAI is accompanied by an increased prevalence of OA after fully correcting for variables. The top quartile of VAI had a prevalence that was 110% higher than the lowest quartile. A non-linear positive correlation between VAI and OA was found in the RCS.ConclusionThis study suggests a potential correlation between elevated VAI and increased prevalence of OA in older adults, and that lowering VAI may have an impact on the prevalence of OA.