Mixed-effects Logistic Regression Analysis Research Articles

Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival?

ObjectiveAcute myeloid leukaemia (AML) prognosis is enhanced with intensive remission induction chemotherapy (ICT) in eligible patients. However, ICT eligibility perceptions may differ among healthcare professionals. This nationwide, population-based study aimed...

P-398 Lower ectopic pregnancy prevalence with natural endometrial preparation in single euploid frozen embryo transfers

Abstract Study question Does the endometrial preparation approach for an euploid-frozen embryo transfer have an impact on the incidence of an ectopic pregnancy? Summary answer The natural cycle endometrial preparation approach seems to have a lower incidence of ectopic pregnancies compared to a hormonal replacement therapy cycle. What is known already Ectopic pregnancy (EP) is an uncommon complication of pregnancy and is associated with significant morbidity. IVF pregnancies have been implicated as a risk factor, but this finding is mostly confounded by multiple embryo transfer and complicated medical history of women undergoing IVF treatment (tubal disease, surgery, endometriosis, etc.). Recent studies have suggested that frozen embryo transfer may reduce the risk of EP, but it is not yet known whether embryo ploidy status and different endometrial preparation regimens affect the risk of EP. Study design, size, duration Retrospective cohort of 1517 pregnancies from 2607 single euploid frozen embryo transfers. Comparator estimates were estimated using multiple large cohort studies in the literature including 58,203,239 pregnancies from unselected cohorts and 220,167 pregnancies from IVF-treated women with the transfer of non-tested embryos. Participants/materials, setting, methods The rate of ectopic per pregnancies were compared to ectopic rate derived from multiple cohorts of IVF-treated women and population level reports of unselected pregnancies (natural conception and IVF). Comparator estimates were obtained with proportion meta-analyses using generalized linear mixed models. Factors associated with ectopic pregnancies were investigated with mixed-effects logistic regression analyses. Main results and the role of chance EP rate in our cohort was 10/1000 pregnancies (95% CI: 5 to 16 per 1000) resulting from single euploid embryo transfers (1.1%, 16/1517). The observed prevalence of EP was 12/1000 pregnancies (95% CI: 6.8 to 21 per 1000) in unselected cohorts and 14/1000 pregnancies (95% CI: 13 to 15 per 1000) after IVF-treatment. Ectopic rate in our study was not significantly different than rates reported in the literature from unselected and IVF pregnancies (P = 0.579 and 0.223, respectively). There were no significant differences between women with ectopic pregnancies and those with clinical pregnancies in terms of age (33.6±5.5 vs. 35.1±5.2 years, P = 0.290), BMI (26.7±4.8 vs. 25.8±4.6 kg/m2, P = 0.475) and serum AMH levels (3.3±2.9 vs. 3.4±3.9 ng/mL, P = 0.854), nor between the quality of embryo transferred between top, good, fair and poor (1.8% vs 0.7% vs 1.9% vs 0.9%, p = 0.088, 0.997 and 0.508 respectively). Ectopic rates were also similar between women with history of cesarean section (1.1% vs 1.0%, P = 0.847) or isthmocele (1.0 vs 1.1%, P = 0.857). There were less ectopic pregnancies following transfers with natural endometrial preparation (0.5 vs 1.5%, natural vs programmed) and the effect showed statistical significance in multivariable analyses (OR: 0.28, 95% CI: 0.06 – 0.88, P = 0.049). Limitations, reasons for caution Small sample size as well as infrequent occurrence of the studied event reduces the power of our study to detect small but clinically meaningful effects with statistical significance. Wider implications of the findings We did not observe a lower than reported prevalence of EP among euploid embryo transfer. However, rate of EP was significantly lower in natural endometrial preparation cycles compared to preparation with exogenous hormones, indicating that a natural cycle might have a protective effect against the development of an ectopic pregnancy. Trial registration number Not applicable

The effect of the athletes' origin and type of impairment on participation and the likelihood of winning a medal in the Paralympic Games.

This study investigated whether the origin (acquired or congenital) and type of impairment affect the participation and likelihood of winning a medal in different sports at the Paralympic Games. We analyzed competition data and athlete biographies web scraped from the International Paralympic Committee's website (www.Paralympic.org). In some sports, athletes with one origin or type of impairment were overrepresented. E.g., 76% of Para-snowboarders had an acquired impairment. Further, mixed-effects logistic regression analyses showed that the origin of impairment had no effect on the likelihood of winning a medal in most sports. However, athletes with a congenital impairment had a significantly higher likelihood of winning a medal compared to those with an acquired impairment in Para-athletics, Para-alpine skiing, and Para-biathlon (OR: 1.71, p < 0.01, OR: 3.69, p = 0.002, and OR: 3.70, p = 0.016, respectively). Athletes with a given origin-type of impairment combination also may have an advantage or disadvantage in some sports. E.g., athletes with an acquired spinal cord injury win proportionally fewer medals in Para-powerlifting. Understanding potential effects of the origin and type of impairment on participation and medaling chances in Paralympic sports can help shape the development of Para-sports, and support talent identification.

The receipt of health information on neonatal dangers signs during the immediate postpartum period and its determinants in Ethiopia: a multilevel mixed-effects logistic regression analysis of the 2016 Ethiopian demographic health survey report

BackgroundIdentification of neonatal danger signs and immediate access to health care are two global efforts aimed at enhancing newborn and child survival by preventing 75% of neonatal deaths. Despite various small-scale studies on women’s awareness of neonatal danger signs in Ethiopia, little is known about the level of receiving health information on those danger signs during the immediate postpartum period at the national level. Hence, this study aimed at assessing the level, and its determinants of the service uptake in Ethiopia.MethodsThe data for this study was taken from the Ethiopian Demographic and Health Survey (EDHS), which took place from January to June 2016 and covered all administrative regions of Ethiopia. A weighted sample of 7,589.8 women was analyzed using STATA version 16. To account for data clustering, a multivariable multilevel mixed-effect logistic regression analysis was employed to determine the effects of each predictor on the outcome variable. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the explanatory variables.ResultsThe receipt of health information on neonatal danger signs during the immediate postpartum period was 10.70% [95% CI:10.01, 11.40]. Variables namely living in Metropolitans [AOR = 2.06; 95%CI: 1.48, 2.88] and Large central [AOR = 1.83; 95%CI: 1.38, 2.42] regions, being in the highest wealth quintile [AOR = 1.87; 95% CI: 1.23, 2.84], being nulliparous [AOR = 0.27; 95% CI: 0.08, 0.87] and primiparous[AOR = 0.61;95% CI: 0.46, 0.79], getting adequate antenatal visits [AOR = 2.42; 95% CI: 1.75, 3.33], institutional delivery [AOR = 5.91; 95% CI: 4.66, 7.53], and receipt of postnatal visits [AOR = 3.52; 95% CI: 2.84, 4.38] were identified as significant determinants of receiving health information on newborn danger signs.ConclusionThe findings revealed that unacceptably low uptake of health information on newborn danger signs during the immediate postpartum period in Ethiopia. A concerted effort is needed from all stakeholders in the health sector to enhance the uptake of maternal health services (antenatal care, skilled delivery service, and postnatal care). Healthcare providers should pay special attention to nulliparous and primiparous women during and after delivery, and the government should also focus on women of peripheral regions, who make up a large portion of the low coverage.

Iron-rich food consumption and predictors among children aged 6-59 months old in Ethiopia: A multilevel complex sample analysis of the Ethiopian mini-demographic and health survey 2019 data.

Children with inadequate iron consumption had slower growth, weaker immunity, and poor cognitive development. Although the public health importance of iron-rich consumption in Ethiopia is known, evidence for iron-rich food consumption and predictors among children aged 6-59 months old in Ethiopia is sparse. This study aimed to assess iron-rich food consumption and predictors among children aged 6-59 months old in Ethiopia. This study used Ethiopia mini demographic and health survey 2019 (EMDHS-2019) data with a total weighted sample size of 5,112 among children aged 6-59 months old. A multilevel mixed effect logistic regression analysis was used to identify predictors of good iron-rich food consumption. The proportion of good consumption of iron-rich foods among children aged 6-59 months was 27.99% (24.22, 32.10%). The findings revealed that children born to mothers who completed primary education [AOR = 1.88, 95% CI: 1.11, 3.19], a higher education [AOR = 4.45, 95% CI: 1.28, 15.48], being born to the poorer family [AOR = 1.89, 95% CI: 1.04, 3.43], richer [AOR = 2.12, 95% CI: 1.03, 4.36], and richest [AOR = 3.57, 95% CI: 1.29, 9.93] were positively associated with good iron-rich food consumption among children aged 6-59 months old. Nevertheless, being 24-59 month-old children [AOR = 0.58, 95% CI: 0.44, 0.72], residents of the Afar [AOR = 0.23, 95% CI: 0.08, 0.67], Amhara region [AOR = 0.30, 95% CI: 0.14, 0.65], and Somali region [AOR = 0.01, 95% CI: 0.01, 0.07] were negatively associated with good iron-rich food consumption among children aged 6-59 months old. The finding revealed that there was low consumption of iron-rich foods among children aged 6-59 months in Ethiopia compared to reports from East African countries. Improving women's literacy and economic empowerment would improve iron-rich food consumption among children aged 6-59 months old. This study's findings would have implications for policymakers in Ethiopia to enhance iron-rich food consumption.

Assessment of postoperative pain in children following sclerotherapy of vascular malformations: a retrospective single centre cohort study

BACKGROUND Inadequately controlled postprocedural pain following sclerotherapy in patients with vascular malformations is a well recognised problem. Reliable epidemiological data and risk factors associated with postprocedural pain in children are lacking. OBJECTIVES To evaluate and quantify postprocedural pain in children and identify possible risk factors based on characteristics of the patient, treatment, and medication. DESIGN A retrospective single centre cohort study. SETTING A tertiary single centre study in the Netherlands. PATIENTS Two hundred and nine chiuldren with ‘simple’ subtypes of congenital vascular malformation who had undergone sclerotherapy. PRIMARY OUTCOME MEASURE Quantifying inadequately controlled postprocedural pain. SECONDARY OUTCOME MEASURES Identifying potential patient and treatment characteristics associated with inadequately controlled postprocedural pain. RESULTS A total of 209 patients who underwent 679 procedures were included in this study. The mean age at first intervention was 11.8 ± 4.5 years. Inadequately controlled postprocedural pain was found in 34.8% of the 679 procedures. Venous malformations (VM) were the most prevalent subtype of vascular malformation (80%), followed by arteriovenous malformations (AVM) (14.6%) and lymphatic malformations (LM) (5.4%). The odds ratio (OR) (95% confidence intervals), and P values obtained from multivariable mixed effect logistic regression analysis for patient and treatment characteristics found to be associated with inadequately controlled postprocedural pain were: chronic use of analgesics (OR 2.74 (1.40 to 5.34), P = 0.003), treatment with ethanol (OR 2.39 (1.01 to 5.65, P = 0.05) or esketamine (OR 7.43 (1.32 to 41.81), P = 0.02). Patients treated with lauromacrogol (OR 0.42 (0.22 to 0.82, P = 0.01) and patients receiving intra-operative NSAIDs (OR 0.32, (0.12 to 0.85), P = 0.02) were less likely to experience inadequately controlled postprocedural pain. CONCLUSIONS Despite aiming to achieve best practice, the 34.8% incidence of unsatisfactory postoperative pain management in the children studied confirms that postprocedural pain after sclerotherapy is a common problem that requires further attention.

Intrapartum exposure to synthetic oxytocin, maternal BMI, and neurodevelopmental outcomes in children within the ECHO consortium

BackgroundSynthetic oxytocin (sOT) is frequently administered during parturition. Studies have raised concerns that fetal exposure to sOT may be associated with altered brain development and risk of neurodevelopmental disorders. In a large and diverse sample of children with data about intrapartum sOT exposure and subsequent diagnoses of two prevalent neurodevelopmental disorders, i.e., attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), we tested the following hypotheses: (1) Intrapartum sOT exposure is associated with increased odds of child ADHD or ASD; (2) associations differ across sex; (3) associations between intrapartum sOT exposure and ADHD or ASD are accentuated in offspring of mothers with pre-pregnancy obesity.MethodsThe study sample comprised 12,503 participants from 44 cohort sites included in the Environmental Influences on Child Health Outcomes (ECHO) consortium. Mixed-effects logistic regression analyses were used to estimate the association between intrapartum sOT exposure and offspring ADHD or ASD (in separate models). Maternal obesity (pre-pregnancy BMI ≥ 30 kg/m2) and child sex were evaluated for effect modification.ResultsIntrapartum sOT exposure was present in 48% of participants. sOT exposure was not associated with increased odds of ASD (adjusted odds ratio [aOR] 0.86; 95% confidence interval [CI], 0.71–1.03) or ADHD (aOR 0.89; 95% CI, 0.76–1.04). Associations did not differ by child sex. Among mothers with pre-pregnancy obesity, sOT exposure was associated with lower odds of offspring ADHD (aOR 0.72; 95% CI, 0.55–0.96). No association was found among mothers without obesity (aOR 0.97; 95% CI, 0.80–1.18).ConclusionsIn a large, diverse sample, we found no evidence of an association between intrapartum exposure to sOT and odds of ADHD or ASD in either male or female offspring. Contrary to our hypothesis, among mothers with pre-pregnancy obesity, sOT exposure was associated with lower odds of child ADHD diagnosis.

#500 Monitoring relative blood volume and calf bioimpedance in hemodialysis patients

Abstract Background and Aims Measurements of relative blood volume (RBV, %) are used to monitor the relative change in blood plasm during hemodialysis (HD). Continuous measurement of calf extracellular volume (cECV) during HD allows the calculation of relative change in cECV (RCE). RCE was defined as the ratio of cECV to its initial value, cECV0 (RCE = 100 × cECV/cECV0, %). The aim of our study was to investigate the relationship between RBV, RCE and the occurrence of intradialytic hypotension (IDH). Method Fifty-five HD patients were studied. We reduced the HD target weight stepwise by 0.1 to 0.2 kg per HD session until clinically defined IDH symptoms occurred. RBV was monitored using the blood volume monitor (BVM, Fresenius Medical Care, Germany). Whole body bioimpedance spectroscopy (wBIS) provided whole body ECV (wECV) and intracellular volume (wICV) pre and post HD. Continuous calf bioimpedance (Hydra 4200, Xitron Technologies, San Diego, CA USA) provided cECV during HD. Pre HD overhydration (OH) was calculated according to whole body composition model (Chamney et al, Am J Clin Nutr 2007; 85:80). Total number of HD sessions in all patients were divided into three groups according to the pre HD OH: 1) normal OH (NOH, OH &amp;lt; 1 L), 2) moderate OH (MOH, 1 ≤ OH &amp;lt; 4 L) and 3) severe OH (SOH, OH ≥ 4 L). Furthermore, patients were stratified by the presence or absence of IDH in each hydration group. Ultrafiltration rate (UFR), pre HD body weight, body mass index (BMI) were measured. Minimal RBV (RBVMin) and minimal RCE (RCEMin) in each HD session were recorded. These measures represent maximum reduction of fluid in the intravascular and interstitial spaces, respectively. Reducing cECV can be considered as refilling fluid from interstitial transferring to intravascular space driving by ultrafiltration. The difference between RCEMin and RBVMin was defined as vascular refilling capacity. Linear mixed-effect logistic regression (LMELR) analysis was applied to explore relationships between IDH with RBVMin, RCEMin, wECV and BMI. Results We studied 621 HD sessions in 55 patients. MOH was present in 57%, SOH in 22% and NOH in 21% of total number of HD sessions respectively. There were significant differences in age, UFR, RBVMin, RCEMin, pre HD wECV, BMI between three groups, while the IDH rate did not differ significantly (Table 1). RBVMin was inversely correlated with UFR (Fig. 1) in all measurements. Pre HD wECV was the only factor associated with IDH in overall measurement. Pre HD wECV was significantly lower in IDH than in non-IDH patients in the NOH group (Fig. 2). In the MOH group, UFR and RCEMin-RBVMin were higher in IDH than in non-IDH patients (Fig. 3a and Fig. 3b). In the SOH group, Pre HD OH is the major factor associated with IDH (Fig. 4). Conclusion This study found that the major factors leading to IDH are 1) lower hydration status; 2) relative higher UFR; and 3) the limited refilling capacity. RBVMin correlated with UFR, but it did not predict IDH. Combined analysis of RBV and calf bioimpedance may provide a means to quantitate the fluid transport between intravascular and interstitial compartments and could add to an early IDH warning system.

Multi-level analysis of intimate partner violence and its determinants among reproductive age group women in Ethiopia: evidence from Ethiopian Demographic Health Survey, 2016

BackgroundIntimate partner violence (IPV) is recognized as a main public health challenge, with serious consequences for women’s physical, mental, sexual, and reproductive health. Despite its public health importance, most studies of IPV in Ethiopia mainly focused on individual characteristics and didn’t identify how factors operating at different levels affect IPV. Thus, there is limited evidence regarding the hierarchical-level factors of IPV and the effect of individual and community-level determinants of IPV. The aim of this study is to assess the individual and community-level factors associated with violence against women among ever-married reproductive-age women in Ethiopia.MethodsA retrospective analysis of secondary data retrieved from the Ethiopia Demographic and Health Survey was conducted among reproductive age group women (15–49 years of age) who reported ever being married within the available data set for the domestic violence module. STATA 14 was used to conduct the analysis. A two-level mixed-effects logistic regression analysis was used to determine associations between IPV and individual- and community-level factors. IPV variability across the community was assessed using ICC and PCV. The model’s fitness was assessed using the Akaike information criterion (AIC), the Bayesian information criterion (BIC), and the likelihood ratio test.ResultThe life time prevalence of IPV in this study was 33% [95% CI: 30.74, 34.25]. Women’s age 20–24 (AOR = 5.85, 95% CI: 201 3.10, 11.04), 25–29 age group (AOR = 6.41, 95% CI; 3.34, 12.32), 30–34 age group (AOR = 9.48, 95% CI: 4.71, 19.06), 35–39 age group (AOR = 9.88, 95% CI: 4.79, 20.39), 40–44 age group (AOR = 11.10, 95% CI: 5.16, 23.89), and 45–49, (AOR = 14.15, 95% CI: 6.01, 32.80), early marriage (AOR = 1.21, 95% CI: 1.08, 1.47), witnessing inter-parental violence during childhood (AOR = 2.80, 95% CI: 2.16, 3.96), having a lot of living children (AOR = 0.45, 95% CI: 0.26, 0.74), having a partner who drank alcohol (AOR = 3.00, 95% CI: 2.42–3.67), decision-making autonomy of the women (AOR = 0.77, 95% CI: 0.62, 0.97), Poor wealth index (AOR = 1.64, 95% CI: 1.23, 2.18), middle wealth index (AOR = 1.86, 95% CI: 1.36, 2.54) and exposure to media (AOR = 1.47, 95% CI: 1.06, 2.00) were all significantly associated with IPV.Conclusion and recommendationThis study showed that one-third of the women experienced IPV in their lifetime. The finding suggested that community based interventions and multi-sectorial collaborations are needed to reduce the IPV and its adverse consequences.

Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden

BackgroundAlcohol-attributable medical disorders are prevalent among individuals with alcohol use disorder (AUD). However, there is a lack of research on prescriptions of pharmacological treatment for AUD in those with comorbid conditions. This study aims to investigate the utilization of pharmacological treatment (acamprosate, disulfiram and naltrexone) in specialist care among patients with AUD and comorbid medical diagnoses.MethodsThis was a descriptive register-based Swedish national cohort study including 132,728 adults diagnosed with AUD (N = 270,933) between 2007 and 2015. The exposure was alcohol-attributable categories of comorbid medical diagnoses. Odds ratios (OR) were calculated using mixed-effect logistic regression analyses for any filled prescription of acamprosate, disulfiram or oral naltrexone within 12 months post AUD diagnosis.ResultsIndividuals with comorbid alcohol-attributable medical diagnoses had lower odds of filling prescriptions for any type of AUD pharmacotherapy compared to those without such comorbidities. Cardiovascular (OR = 0.41 [95% CI: 0.39–0.43]), neurological (OR = 0.52 [95% CI: 0.48–0.56]) and gastrointestinal (OR = 0.57 [95% CI: 0.54–0.60]) diseases were associated with the lowest rates of prescription receipt. The presence of diagnoses which are contraindications to AUD pharmacotherapy did not fully explain the low prescription rate.ConclusionThere is a substantial underutilization of AUD pharmacotherapy in patients with AUD and comorbid medical disorders in specialist care. Increasing the provision of pharmacotherapy to this group of patients is essential and may prevent morbidity and mortality. There is a need to further understand barriers to medical treatment both from the patient and prescriber perspective.

Extracardiac Manifestations Fail to Predict the Severity of Cardiac Phenotype in Children and Young Adults with Marfan Syndrome.

We performed a secondary analysis of the Pediatric Heart Network (PHN) Marfan Trial public-use database to evaluate associations between extracardiac features and cardiac and aortic phenotypes in study participants. Aortic aneurysm phenotype was defined as aortic root Z-score ≥4.5, aortic root growth rate ≥75th percentile, aortic dissection, and aortic surgery. Severe cardiac phenotype was defined as aortic dissection, aortic Z-score ≥4.5, aortic valve surgery, at least moderate mitral regurgitation, mitral valve surgery, left ventricular dysfunction, or death. Extracardiac manifestations were characterized by specific organ system involvement and by a novel aggregate extracardiac score (AES) that was created for this study based on the original Ghent nosology. Mixed effects logistic regression analysis compared AES and systems involvement to outcomes. Of 608 participants (60% male), the median age at enrollment was 10.8years (interquartile range: 6, 15.4). Aortic aneurysm phenotype was observed in 71% of participants and 64% had severe cardiac phenotype. On univariable analysis, skeletal (OR: 1.95, 95% CI: 1.01, 3.72; p = 0.05), skin manifestation (OR: 1.62, 95% CI: 1.13, 2.34; p = 0.01) and AES (OR: 1.17, 95% CI: 1.02, 1.34; p = 0.02) were associated with aortic aneurysm phenotype but were not significant in multivariable analysis. There was no association between extracardiac manifestations and severe cardiac phenotype. Thus, the severity of cardiac manifestations in Marfan syndrome (MFS) was independent of extracardiac phenotype and AES. Severity of extracardiac involvement did not appear to be a useful clinical marker for cardiovascular risk-stratification in this cohort of children and young adults with MFS.

Fissure Sealants or Fluoride Varnish? A Randomized Pragmatic Split-Mouth Trial

This study aimed to compare the clinical effectiveness of resin-based fissure sealants (FS) and fluoride varnish (FV) in children at high caries risk. A practice-based split-mouth randomized clinical trial was conducted at 9 Public Dental Service (PDS) clinics in Norway. In total, 409 children age 6 to 10 y at high caries risk (d3mft > 0) meeting inclusion criteria were recruited by dentists and dental hygienists during routine examination. Eligibility criteria were 2 fully erupted first permanent molars (FPMs) in the same jaw, with sound occlusal surfaces or with initial caries. Participation was voluntary, caregivers and eligible children were informed about the study, and written parental consent was obtained. FS and FV were randomly applied on contralateral FPMs in the same jaw, with each participant serving as their own control. FS was applied at baseline and thereafter maintained according to clinicians’ conventional procedures, whereas FV was applied at baseline, 6 mo, and 12 mo. The study outcome was success, with no need for invasive treatment (caries control), while failure was defined as dentin carious lesion or restoration. Two-level mixed-effects logistic regression analysis was used to compare FS and FV groups. Of 409 recruited children, 369 (90%) children/tooth pairs were examined after 36 mo. Intention-to-treat analysis showed 94.1% adjusted predicted probability (aPP) of success (95% confidence interval [CI] 91.7 to 96.4) in the FS group and 89.6% aPP (95% CI 86.5 to 92.7) in the FV group. In the adjusted analysis, the FV group had a lower OR for success compared with the FS group (OR 0.54, 95% CI 0.24 to 0.87). In the population studied, the clinical effectiveness of FS was statistically significantly higher compared with FV but below the estimated minimal clinically important difference of 10%.

Self-reported dyspnoea and shortness of breathing deterioration in long-term survivors after segmentectomy or lobectomy for early-stage lung cancer.

The aim of this study was to assess the self-reported current dyspnoea and perioperative changes of dyspnoea in long-term survivors after minimally invasive segmentectomy or lobectomy for early-stage lung cancer. Cross-sectional telephonic survey of patients alive and disease-free as of March 2023, with pathologic stage IA1-2, non-small-cell lung cancer, assessed 1-5 years after minimally invasive segmentectomy or lobectomy (performed from January 2018 to January 2022). Current dyspnoea level: Baseline Dyspnoea Index score <10. Perioperative changes of dyspnoea were assessed using the Transition Dyspnoea Index. A negative Transition Dyspnoea Index focal score indicates perioperative deterioration in dyspnoea. Mixed effect models were used to examine demographic, medical and health-related correlates of current dyspnoea and changes in dyspnoea level. A total of 152 of 236 eligible patients consented or were available to respond to the telephonic interview(67% response rate): 90 lobectomies and 62 segmentectomies. The Baseline Dyspnoea Index score was lower (greater dyspnoea) in lobectomy patients (median 7, interquartile range 6-10) compared to segmentectomy (median 9, interquartile range 6-11), P = 0.034. 70% of lobectomy patients declared to have a current dyspnoea vs 53% after segmentectomy, P = 0.035. 82% of patients after lobectomy reported a perioperative deterioration in their dyspnoea compared to 57% after segmentectomy, P = 0.002. Mixed effect logistic regression analysis adjusting for patient-related factors and time elapsed from operation showed that segmentectomy was associated with a reduced risk of perioperative dyspnoea deterioration (as opposed to lobectomy) (Odds ratio (OR) 0.31, P = 0.004). Our findings may be valuable to inform the shared decision-making process by complementing objective data on perioperative changes of pulmonary function.

Association between operative duration and adverse outcomes after hip fracture surgery: A NSQIP matched cohort study

BackgroundProlonged operative duration is an independent risk factor for surgical complications in numerous subspecialties. However, associations between adverse events and operative duration of hip fracture fixation in older adults have not been well-quantified. This study aims to determine if prolonged operative duration of hip fracture surgery is related to adverse outcomes. We hypothesized that patients with high operative durations experience greater rates of 30-day complications. MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify older adults (55 years and above) who underwent hip fracture fixation between 2015–2019. Prolonged operative duration was defined as >75th percentile, and cases were matched using propensity scores based on demographic, surgical, and comorbidity factors. Univariate differences in adverse events (including readmission, reoperation, mortality, and organ-system complications) were analyzed. Multivariable mixed-effects logistic regression analyses were completed for statistically significant events. ResultsA total of 8827 case-control pairs were identified for comparison. Rates of superficial surgical site infection (SSI) (p= 0.022), any SSI (p= 0.032), and any complication (p < 0.001) were elevated in those with prolonged surgical duration in univariate analyses. In multivariable models, prolonged operative time was associated with superficial SSI (OR 1.50, p= 0.019), any SSI (OR 1.35; p= 0.029) and any complication (OR 1.58; p < 0.001). In subgroup analyses, all findings persisted for IMN with operative time associated with superficial SSI (OR 1.98, p= 0.012), any SSI (OR 1.71; p= 0.019), and any complication (OR 1.84; p < 0.001). Operative time was associated only with any complication for hemiarthroplasty/internal fixation and sliding hip screw (OR 1.27 and 1.89, respectively; p < 0.001). ConclusionOur study demonstrates that duration of surgery is an independent risk factor for superficial SSI, any SSI, and any complication. Notably, our findings suggest that high operative durations may be most concerning for SSIs in IMN fixation, which is currently the most common choice for hip fracture fixation in the US. However, the rate of any complication is significantly elevated when surgical duration is prolonged, regardless of surgery type.

Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes.

To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke. The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m2) and the outcomes, after adjustment for covariates. A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m2 was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)). BMI substantially impacts functional outcomes following IS and ICH. Lower BMI consistently affected post-stroke disability and mortality, while higher BMI values similarly affected these outcomes after large artery stroke.

Outdoor air pollution as a risk factor for testing positive for SARS-CoV-2: A nationwide test-negative case-control study in the Netherlands

Air pollution is a known risk factor for several diseases, but the extent to which it influences COVID-19 compared to other respiratory diseases remains unclear. We performed a test-negative case-control study among people with COVID-19-compatible symptoms who were tested for SARS-CoV-2 infection, to assess whether their long- and short-term exposure to ambient air pollution (AAP) was associated with testing positive (vs. negative) for SARS-CoV-2. We used individual-level data for all adult residents in the Netherlands who were tested for SARS-CoV-2 between June and November 2020, when only symptomatic people were tested, and modeled ambient concentrations of PM10, PM2.5, NO2 and O3 at geocoded residential addresses. In long-term exposure analysis, we selected individuals who did not change residential address in 2017–2019 (1.7 million tests) and considered the average concentrations of PM10, PM2.5 and NO2 in that period, and different sources of PM (industry, livestock, other agricultural activities, road traffic, other Dutch sources, foreign sources). In short-term exposure analysis, individuals not changing residential address in the two weeks before testing day (2.7 million tests) were included in the analyses, thus considering 1- and 2-week average concentrations of PM10, PM2.5, NO2 and O3 before testing day as exposure. Mixed-effects logistic regression analysis with adjustment for several confounders, including municipality and testing week to account for spatiotemporal variation in viral circulation, was used. Overall, there was no statistically significant effect of long-term exposure to the studied pollutants on the odds of testing positive vs. negative for SARS-CoV-2. However, significant positive associations of long-term exposure to PM10 and PM2.5 from specifically foreign and livestock sources, and to PM10 from other agricultural sources, were observed. Short-term exposure to PM10 (adjusting for NO2) and PM2.5 were also positively associated with increased odds of testing positive for SARS-CoV-2. While these exposures seemed to increase COVID-19 risk relative to other respiratory diseases, the underlying biological mechanisms remain unclear. This study reinforces the need to continue to strive for better air quality to support public health.

Spatial variations and determinants of timely completion of vaccination in Ethiopia using further analysis of EDHS 2019 data: Spatial and multilevel analysis.

Timely vaccination is the practice of administering the vaccine within the first birthday of the child. Not vaccinating the child at the appropriate age is the cause of improper protection of diseases and can be a possible factor in death. The problem of not completing the vaccine in the scheduled period is a globally distributed problem, but especially in sub-Saharan African countries, it is a bottleneck to child health. Even if timely vaccination is crucial for reducing the impact of VPDs, there are no current national-level studies to generate conclusive and tangible evidence in Ethiopia. To assess spatial variations and determinants of timely completion of vaccination in Ethiopia using further analysis of EDHS 2019 data. The secondary data analysis of a community-based cross-sectional study design was employed among 3094 participants. Stata-14 software was used for data cleaning, recording, and analysis. Arc GIS version 10.3 and Kuldorff SAT scan version 9.6 software are used for spatial and SAT scan statistics. A multilevel mixed-effect binary logistic regression analysis was used to identify the predictors of timely vaccination. The clustering effect was also evaluated by Moran's I statistics and intra class correlation. The timely completion of vaccination among Ethiopian women who had a child aged 12-35 months was 19.5% (95%CI: 18.2-20.8), and the spatial distribution of timely completion of vaccinations in Ethiopia was non-randomly distributed. A statistically significant high proportion of timely completion areas were clustered in the eastern part of Amhara, the south part of Afar, Addis Ababa, and Oromia. The primary cluster was located at a 13.11 km radius in Diredawa, which was 3.68 times higher than outside the window (RR = 3.68, LLR = 68.76, p-value < 0.001). History of antenatal care follow-up (AOR = 1.63, 95% CI: 1.3-2.04), giving birth at health facilities (AOR = 1.63, 95% CI: 1.25-2.13), age ≥ 35 years (AOR = 186, 95% CI: 1.35-2.63), age 25-34 years (AOR = 1.72, 95% CI: 1.33-2.21), and being richest (AOR = 2.71, 95% CI: 1.86-3.94) were the factors contributing to the timely completion of vaccination. The prevalence of timely completion of vaccination was low in Ethiopia, and the spatial distribution of timely completion of vaccination in Ethiopia was non-randomly distributed across the regions. The factors associated with the timely completion of vaccinations were ANC follow-up, place of delivery, age of the participant, and wealth index. We recommend expanding facility delivery, antenatal care services, and empowering women to scale up timely vaccination in Ethiopia.

The Association Between State Characteristics and Latinx People's Treated Hypertension in Established and New Latinx Destination States: A Multilevel Analysis.

This study sought to quantify the contributions of state-level factors including income inequality, state's legislature political control, and Medicaid expansion in new and established Latinx destination states on Latinx individuals' treated hypertension. Mixed-effects logistic regression analyses were conducted to analyze 2017 Behavioral Risk Factor Surveillance System data from 7524 Latinx adults nested within 39 states. Overall, 70% reported being pharmacologically treated for hypertension, and 66% resided in established destination states. Compared with Latinx people in established destination states, Latinx people in new destinations had lower odds of having treated hypertension (odds ratio [OR] = 0.72, 95% CI = 0.54-0.95). Within established Latinx destinations, the odds of treated hypertension were lower in states where legislatures expanded Medicaid than in states that did not expand Medicaid (OR = 0.84, 95% CI = 0.79-0.89). However, after controlling for the effects of individual-level factors, this association was no longer statistically significant. In new Latinx destination states, Medicaid expansion, legislatures' political control, and income inequality were not associated with treated hypertension. The study results highlight the importance of considering both individual- and state-level factors, as the interplay of such factors could hinder the successful implementation of cardiovascular risk reduction interventions.

Evaluating the impact of individual and country-level institutional factors on subjective well-being among entrepreneurs

This study examines entrepreneurs' subjective well-being (SWB) in the form of life satisfaction. It presents a multilevel analysis approach explaining the relationship between individual-level variables (demographics and developed personal characteristics), country-level institutional variables (political stability, corruption perception index, paying tax regulations, and business freedom), and entrepreneurs' SWB. The multilevel mixed-effects logistic regression analysis is used to test the econometric model with data from the Life in Transition Survey III for 34 countries. Findings show that both individual and governing factors play a significant role in shaping entrepreneurs' SWB. The individual-level variables such as job satisfaction, financial situation, generalized trust, optimism, and social standing are the most critical factors driving self-employed life satisfaction. On the institutional level, business freedom and political stability are the most instrumental, followed by the corruption perception index and paying tax regulatory. Overall, this research enhances comprehension regarding SWB within the entrepreneurship domain, yielding significant implications for entrepreneurship theory and practice within the well-being framework, along with providing pertinent recommendations for policymakers.

Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI

BackgroundHeadache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury.MethodsA large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors.ResultsA total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury.ConclusionsHeadache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache.Trial registrationClinicalTrials.gov NCT02210221.