Modifiable Predictors Research Articles

Factors Associated with Nonspecialist Quality of Delivery within a Family Strengthening Intervention in Rwanda: a Parallel Latent Growth Model.

In task-shared, mental health, and psychosocial support interventions, monitoring the quality of delivery (fidelity and competence) of nonspecialist providers is critical. Quality of delivery is frequently reported in brief, summary statistics, and while both fidelity and competence scores tend to be high, rarely have factors associated with quality of delivery in low-resource, mental health, and psychosocial support interventions been examined using inferential statistics. Understanding both modifiable and non-modifiable predictors of quality of delivery is important for adapting training and supervision approaches throughout intervention delivery. In this study, we use a parallel process latent growth model to examine the association of non-modifiable, demographic characteristics of nonspecialists and changes in both fidelity and competence over time. We find that nonspecialist age is significantly associated with higher initial fidelity and competence scores and smaller improvements in fidelity and competence over time, although this finding is interpreted in the presence of ceiling effects. In addition, nonspecialists in a certain district were more likely to have higher initial fidelity and competence scores but also see smaller changes over time. Fidelity and competence were found to significantly co-vary. This study provides conceptual and measurement guidance regarding quality of delivery, suggesting that fidelity and competence are theoretically distinct and must be measured separately, but linked together under the umbrella of quality of delivery. This study also has implications for recruiting, training, and supporting nonspecialists delivering behavioral interventions, suggesting that future implementation teams can further contribute to research on how to better support high-quality training, supervision, and personal and professional growth among the growing nonspecialist workforce globally.

Undergraduates' lifestyle and Suboptimal Health Status (SHS): A cross-sectional study in the Ha'il region of Saudi Arabia.

University students in Saudi Arabia are embracing some of the negative traits of the fast-paced modern lifestyle, typified by unhealthy eating, low physical activity, and poor sleep habits that may increase their risk for poor health. Health and holistic well-being at the population level are among the priorities of the 2030 vision of a vibrant society in the Kingdom of Saudi Arabia. The current study thus aims at determining the prevalence and predictive factors of Suboptimal Health Status (SHS) among university students. A cross-sectional study was conducted among 9,026 undergraduate students between 31st May and 15th June 2023. The data was collected through an online questionnaire using the Arabic translation of the SHS (ASHSQ-25) and the Simple Lifestyle Indicator Questionnaire (SLIQ). The chi-square test, Canonical Correlation Analysis (CCA), hierarchical multiple regression, and Receiver Operating Characteristic (ROC) were performed to analyze the data using IBM SPSS software (version 25.0) at a significance level of p<0.05. The findings showed that 33.7% (3038) of the students were classified as having SHS. The prevalence of SHS was statistically higher among younger and those studying social science discipline, overweight, had poor diets, engaged in low physical activity, and slept <6 hours (p<0.001). Canonical loadings of these factors were significant in predicting the five SHS dimensions range (0.52-0.97). Furthermore, the extracted significant variables from the multiple regression analysis indicated the final model (Model 3) was statistically significant, R2 = 0.646, F (6,9019), p <0.0001, suggesting that 64.6% of the variance in the SHS can be explained by the predictor variables in the model. These variables included age, college, academic level, diet, BMI, and sleeping duration. Findings show that modifiable predictors such as poor sleep quality, higher BMI scores, and poor dietary habits increase SHS risk among university students in Saudi Arabia. Therefore, the findings of this study emphasize the necessity of early interventions that promote healthy lifestyles.

Predicting College Students Lack of Longevity Promotion: From Family-of-origin chaos, through Current Unmet Interpersonal Needs, to Life-Diminishing Behavior

Identifying modifiable predictors of life-diminishing behaviors is paramount for health professionals seeking to promote the probability of longevity among young adults who can be at risk for suicide, overdose, and accidental injury and death. Family-of-origin experiences and unmet interpersonal needs are well-known risk factors for suicide; however, they have yet to be tested as predictors of a broad array of life-diminishing behaviors. College student participants (N=522, M=19.6 years) who were majority female (66.7%) and diverse (57.3% White) completed measures of family of-origin chaos, interpersonal needs, and engagement in four types of life-diminishing behaviors as measured via the Life-Attitudes Schedule: Short Form (LAS:SF). The LAS:SF assesses engagement in both potentially life-diminishing as well as potentially longevity-promoting behaviors; the overall construct assessed has been labelled lack of longevity promotion or suicide proneness. As expected, a history of greater family-of-origin chaos and current unmet interpersonal needs were associated with overall LAS:SF scores with medium effect sizes. Furthermore, the interaction between perceived burdensomeness and thwarted belongingness mediated the relationship between family-of-origin chaos and total LAS:SF scores, accounting for 20% of the variance in college students’ lack of longevity promotion. Importantly, the model held for each of the four lack of longevity proneness/suicide proneness domains (Lack of Health/Illness Promotion, Lack of Safety/Risk Promotion, Lack of Future Orientation/ Death or Suicide Promotion, and Lack of Self-Promotion) and across multiple demographic groups. Assessing and addressing interpersonal needs is an emerging intervention target for those seeking to improve at-risk young adults’ well-being while promoting longevity and preventing suicide and accidental death.

Factors impacting sleep center no-show rates post hospital discharge utilizing geospatial coding in Appalachia.

Screening for early detection of sleep-disordered breathing (SDB) in hospitalized patients has been shown to reduce readmission rates. However, post-discharge polysomnography for confirmation of diagnosis is required. We analyzed factors for "no-shows" using geospatial techniques. Data were obtained between September 2019 and September 2023. The outcome for the study was patient's no-show rate (non-compliant) for polysomnography post hospital discharge. Predictors included patient age, gender, BMI, health literacy, distressed community index (DCI) score and distance to sleep center for the patient's zip code of residence. Logistic regression was applied to estimate odds of patient compliance at the patient-level utilizing geospatial mapping technique. Geographically weighted logistic regression was applied to estimate the odds of a zip-code having compliant patients. Of the 1318 hospitalized patients established as high risk for SDB and referred for an overnight sleep study who were able to be geocoded, 228 were compliant and 1130 were non-compliant. In non-spatial regression analyses, health literacy (aOR = 1.06, 95%CI = 1.03, 1.09), age (aOR=0.99, 95% CI=0.98, 0.99), and drive time (aOR=0.95, 95% CI = 0.92, 0.97) were identified as statistically significant predictors of patient compliance. Spatial regression analyses identified areas that had high and low predictive probability of patient compliance, as well as which community level factors were co-occurring in those areas. The findings suggest that both patient-level factors and the community where patients live may impact no-show rates. Health literacy was identified as a key modifiable predictor at the patient level. At the community level, we found that predicted probability of patient compliance varied throughout the state. Efforts should focus on enhancing patient education at the individual level and understanding geographical factors to improve compliance.

Cytomegalovirus Disease in Renal Allograft Recipients in the Current Immunosuppression Era.

The high prevalence of cytomegalovirus (CMV) after kidney transplantation, along with its significant morbidity, mortality, and financial burden, makes it a serious infectious complication. This retrospective observational study aimed to determine the incidence of CMV infection and recurrence in renal transplant recipients during the era of immunosuppression (IS), and to identify modifiable predictors of CMV infection. A total of 233 patients were screened for CMV disease incidence and predictors and were prospectively followed. The incidence of CMV disease was found to be 14.6% (95% CI, 11.7%-18%), with no recurrence observed. Multivariate analysis revealed that factors such as CMV serostatus and a positive B-cell crossmatch at transplantation were associated with an increased risk of CMV. Specifically, patients with a positive B-cell crossmatch had a threefold higher risk of developing CMV compared to those with a negative crossmatch (p = 0.025). This association is a novel finding and should be considered when assessing risks and complications in patients. There was a lower incidence of CMV infection among kidney transplant recipients within the first 2-5 years after transplantation. A positive B-cell crossmatch at the time of transplantation was strongly associated with an increased risk of developing CMV disease.

Association of commission on cancer accreditation with receipt of guideline-concordant care and survival among patients with colon cancer.

Guideline-concordant care (GCC) is associated with improved survival for patients with cancer; however, variations in receipt of GCC remain a concern. The objective of this study was to evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of GCC and survival among patients with colon cancer. This retrospective observational study identified patients diagnosed with stage I-IV colon cancer from 2018 to 2020 from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program Database. Guideline concordance was defined as receipt of stage-appropriate lymphadenectomy or chemotherapy. Multivariable logistic regression models investigated associations with receipt of GCC. Cox proportional hazards regression models assessed 3-year cancer-specific mortality risk. Of 222,583 patients with colon cancer, 146,629 (91.2%) of eligible patients received guideline-concordant lymphadenectomy and 70,586 (81.9%) of the eligible patients received guideline-concordant chemotherapy. Treatment at CoC-accredited hospitals was the strongest modifiable predictor for receipt of guideline-concordant lymphadenectomy (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.75-1.88) and chemotherapy (OR 2.14; 95% CI 2.06-2.23). Among patients treated at CoC-accredited hospitals, risk adjusted mortality was decreased for patients with stage I-II disease (hazard ratio [HR] 0.94; 95% CI 0.80-0.99), stage III disease (HR 0.93; 95% CI 0.88-0.98), and stage IV disease (HR 0.88; 95% CI 0.84-0.92). For patients with colon cancer, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk. Benchmarking data may serve as a valuable accountability tool for quality assessment to improve cancer treatment and outcomes.

Predicting hospital readmission in multimorbid patients with the use of AI: A systematic review

Abstract Background Multimorbid patients are at higher risk of hospital readmission due to the complex nature of their conditions. Identifying those who may be at particularly high risk would allow us to intervene early and potentially delay or prevent such readmissions occurring, thus reducing healthcare costs. We conducted a systematic review investigating the use of machine learning models in predicting 30-days unplanned hospital readmission of multimorbid patients. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, and was registered with PROSPERO (CRD42022373937). We searched MEDLINE, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Included studies developed an AI model for prediction of 30-days hospital readmission for adult patients with two or more health conditions. The CHARM and PROBAST checklists for data extraction and bias assessment were used. The quality of included studies was assessed with the CASP checklist. Results Eighteen papers were eligible for inclusion. A total of 669 predictors were reported with an average of 37 used per model. Predictors were classified as modifiable and non-modifiable with the most common modifiable predictors being hospital length of stay, hypertension, anaemia and obesity. Average sensitivity and specificity of the models was reported to be 72% in 13 studies and 79.2 in 11 studies, respectively. Area under the curve (AUC) was reported in 13 studies, five of which were considered to have good discrimination power (AUC&amp;gt;0.8). Conclusions Machine learning models are capable of accurately predicting 30-days hospital readmission of multimorbid patients. Identifying modifiable predictors with highest weight allows for better planning and resource allocation to potentially reduce the risk of 30-days readmissions. An important area for future work would be the implementation of these high performance models in practice. Key messages • Hospital readmissions are preventable and identifying those at higher risk allows us to intervene early. • Machine learning models are capable of predicting 30-days readmission of multimorbid patients.

Spatial Analysis of Prediabetes and Associated Risk Factor Prevalence Among Late Adolescents in San Luis Potosí, México.

Introduction The prevalence of prediabetes is increasing worldwide. However, the determinants that contribute to its onset in young individuals remain poorly understood. An essential aspect of directing control and preventive initiatives is comprehending the geographical distribution of these disorders and pinpointing regions with a high prevalence. Objective The objective of this study was to determine the spatial distribution of prediabetes and associated risk factor prevalence among late adolescents in the metropolitan area of San Luis Potosí (MASLP), México, during the years 2008, 2009, and 2010. Methods This was a cross-sectional study that included 15,672 participants between the ages of 18 and 21 years. We made a cartographic overlay of the body mass index (BMI), systolic blood pressure (BP), diastolic BP, and impaired fasting glucose (IFG) using a 2010 marginalization index. Results The prevalence of prediabetes was 5.5%, whereas the prevalence of overweight and obesity remained stable for three years. However, in 2010, the prevalence of both diastolic BP and prediabetes increased.Spatial analysis revealed that the urban basic geostatistical area (Area Geo-Estadística Básica (AGEB)), with 11-20 participants with prediabetes, was mainly concentrated in the areas of medium and low marginalization throughout all years. Conclusion We found a yearly increase in prediabetes prevalence and increased diastolic BP. Prediabetes varies across the region. MASLP has statistically detected significant high hot spots in prediabetes. The findings of this study are valuable for directing resource distribution and highlighting intervention programs that target modifiable prediabetes predictors. To improve health coverage, it is necessary to consider different local realities.

Incidence and predictors of radial artery occlusion following transradial coronary procedures

Abstract Background Transradial access for percutaneous coronary procedures has grown in popularity because of its advantages over the femoral approach. However, the benefit is overshadowed by an increased rate of radial artery occlusion (RAO). We aim to assess incidence and predictors of RAO after transradial catheterization. The anatomic variations of the radial artery (RA) were also studied. Methods This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. An ultrasound evaluation of forearm arteries was performed. In case of RAO, another ultrasound check-up was performed after 1 month and 3 months of the procedure. Results Our study population includes 288 patients (32.6% female). The mean age was 61.9 ± 11.1 years. RAO occured in 48 patients (11.24%), among whom spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, a younger age (OR 0.642 [CI 95%: 0.480 – 0.858], P = 0.031), low periprocedural systolic blood pressure, (OR 0.598 [CI 95%: 0.415 – 0.862], P = 0.007), a small radial diameter (OR 0.371 [CI 95%: 0.323 – 0.618], P = 0.031), insufficient anticoagulation (OR 0.287 [CI 95%: 0.163 – 0.505], P &amp;lt; 0.001), occlusive hemostasis (OR 0.128 [CI 95%: 0.047 – 0.353], P &amp;lt; 0.001), and a long duration of hemostasis emerged as independent predictors of radial occlusion. The overall incidence of radial artery anatomic variations was 14,8% (n=63). Among these patients, 40 (63.5%) had a high radial origin, 18 (28.6%) had extreme radial artery tortuosity, and 5 (7.9%) had a full radioulnar loop. Conclusion The incidence and prevalence of radial artery occlusion is expected to increase. Insufficient heparinization and occlusive hemostasis are the main modifiable predictors. The preventive strategy should focus primarily on these 2 predictive factors.

Predictors of functional status and disability among patients living with chronic kidney diseases at St Paul’s hospital millennium medical college, Ethiopia: findings from a cross-sectional study

BackgroundThe rise in risk factors like obesity, hypertension, and diabetes mellitus has partly led to the increase in the number of patients affected by chronic kidney disease, affecting an estimated 843 million people, which is nearly 10% of the general population worldwide in 2017. Patients with CKD have an increased risk of functional difficulties and disability. This study aimed to assess the level of functional status and disability and its associated factors among patients with chronic kidney attending Saint Paul Hospital, Millennium Medical College, Addis Ababa, Ethiopia.MethodsAn institution-based cross-sectional study was conducted with 302 enrolled study participants through systematic random sampling techniques. Face-to-face interviews and chart reviews were used to collect data using a semi-structured questionnaire adapted from works of literature. The Health Assessment Questionnaire Disability Index (HAQ-DI) was used to assess the functional status and disability of the participants. Data was entered into EPI info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables with a p-value less than 0.05 in multivariate analysis were taken as statistically significant.ResultsA total of 219 (72.5%) CKD patients had moderate to severe functional limitation and disability (HAQ-Di > 0.5-3). Age > 50 years [AOR = 1.65; 95% CI (1.23, 3.15)], being at stage 2 and 3 CKD [AOR = 4.05; 95% CI (1.82, 9.21), being at stage 4 and 5 CKD [AOR = 2.47; 95% CI (1.87, 4.72)], and having MSK manifestations [AOR = 2.97; 95% CI (1.61, 5.55)] were significantly associated with functional status and disability.ConclusionThe findings of this study suggest that CKD-associated functional disabilities are common. The advanced stage of CKD, higher age, and presence of musculoskeletal manifestations appear to be important variables predicting self-reported functional status. Healthcare professionals treating CKD shall be vigilant about the CKD-associated disability, the modifiable predictors, and interventions to limit the CKD-related disability.

Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.

While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates. This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes. Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], laborin a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)). Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.

Causes and predictors of premature death in the pars cohort study, Iran: a cohort study

BackgroundWhile death in old age is inevitable, premature death at younger ages is within our control. Premature mortality (death < 70 years) is a crucial indicator of health status and access to healthcare, with variations observed across regions. In North Africa and the Middle East, ischemic heart disease (IHD), road injuries, stroke, and chronic kidney disease are projected to be the main causes of premature mortality. Unfortunately, few studies have been conducted on premature mortality worldwide. This study aimed to analyze the causes of premature death and associated risk factors within the Pars Cohort Study.MethodsThe Pars Cohort Study is a prospective cohort study conducted in Fars Province, Iran, involving 9,264 individuals aged 40–75 years, 53.8% of whom were women. We assessed participants from baseline (2012–2014) to 2021. The data were gathered through interviews, biological samples, and physical examinations. The causes of premature mortality, hazard ratios (HRs), and population attributable fraction (PAF) with 95% confidence intervals (95% CIs) for the variables were calculated.ResultsOut of 388 deaths, 54% were premature. The most common causes of premature death included IHD (40%), stroke (11%), road traffic injuries (6%), lower respiratory infections (5%), and COVID-19 (3%). The predictive factors [adjusted HRs (95% CIs)] associated with premature mortality included age [year, 1.07 (1.04, 1.10)], tobacco [1.43 (0.96, 2.11)], opium [2.12 (1.39, 3.24)], hypertension [1.52 (1.10, 2.12)], waist circumference [cm, 1.03 (1.00, 1.05)], female sex [0.30 (0.19, 0.47)], education [> 8 years vs. no formal schooling, 0.46 (0.24, 0.88)], being married [0.60 (0.37, 0.97)], physical activity [3rd vs. 1st tertile, 0.38 (0.26, 0.57)], hip circumference [cm, 0.96 (0.92, 0.99)], estimated GFR [mL/min/1.73 m², 0.99 (0.978, 0.999)], and wealth score [4th vs. 1st quartile, 0.54 (0.32, 0.90)]. The PAF (95% CI) for all modifiable predictors was 0.83 (0.62, 0.92).ConclusionsThe predominant causes of premature mortality were IHD and stroke. To mitigate premature deaths, it is recommended to address both socioeconomic and behavioral factors simultaneously.

Risk factors and population attributable fractions for displaced abomasum in Iranian dairy cattle: a retrospective analysis of field data.

Displaced abomasum (DA) usually occurs in the early postpartum period and can negatively affect production and welfare of dairy cows. The objective of this research was to identify predictors for the occurrence of DA in Iranian Holsteins. Therefore, we analyzed data collected from six commercial dairy farms in Iran (calving between January 2011 and October 2020). We used generalized linear mixed-effects model to identify predictors based on estimates of odds ratios (ORs). Population attributable fractions (PAFs) were then calculated, as these are expected to more accurately prioritize risk factors on population level by considering the association between the risk factor and the its prevalence in the population. Over the 6 herds, the average percentage of DA was 2.5% (range 1.1-3.4% across herds). The results showed that calving during winter increased the odds of DA 1.4 times. Cows with high milk fat-to-protein ratio before the occurrence of disease, abnormal calving (including dystocia, stillbirth, and twinning) and long pregnancy length (≥ 280 d) showed increased odds of DA with ORs of 1.52, 1.31 and 1.30, respectively. Milk yield was also positively associated with DA in next lactation. Among the modifiable predictors of DA, the highest PAF was for the ratio of milk fat-to-protein (11.0%); other PAFs were retained placenta (4.1%), metritis (3.1%), abnormal calving (2.7%), and ketosis (2.7%). The results of the present study can provide managers with the a helpful strategy to reduce the occurrence of DA.

Predictors of fracture in middle-aged and older adults with type 2 diabetes and overweight or obesity.

Persons with type 2 diabetes have increased fracture risk that existing fracture risk assessment tools underestimate. Identify fracture predictors in persons with type 2 diabetes and overweight or obesity, considering traditional and diabetes-related risk factors. Secondary analysis of the Look AHEAD: Action for Health in Diabetes randomized clinical trial, with randomization from 2001-2004 and fracture follow-up until 2015. Multicenter U.S. study. Men and women 45-75 years old with type 2 diabetes and body mass index≥25 kg/m2. Potential fracture predictors ascertained at randomization included traditional and diabetes-related risk factors (diabetes duration, diabetic neuropathy, antidiabetic medication use, hemoglobin A1c, and renal function). Total hip bone mineral density (BMD) was measured in a subcohort. All incident clinical fractures, ascertained by self-report and centrally adjudicated with medical records review. Over a median 12.2 years follow-up, 649 of the 4,703 participants experienced at least one clinical fracture. Thiazolidinedione use [hazard ratio (HR):1.22, 95% confidence interval (CI):1.02-1.46] and insulin use [HR:1.34, 95% CI:1.08-1.66] were significant diabetes-related predictors of all clinical fractures. When measured in a subcohort (n=1,285), total hip BMD was the strongest modifiable predictor of all clinical fractures [Per 1 standard deviation (SD)=0.1 g/cm2 increase, HR:0.47, 95% CI:0.39-0.58]. Thiazolidinedione and insulin use predict clinical fracture in middle-aged and older persons with type 2 diabetes and overweight or obesity. Evaluating BMD is advisable if these medications are prescribed. Fracture risk prediction tools may consider including thiazolidinedione and insulin use to refine prediction in this population.

P059 IDENTIFYING PREDICTORS OF EARLY-ONSET HYPERTENSION IN MIDDLE-AGED INDIVIDUALS WITH OBESITY

Background: Hypertension is a leading risk factor for cardiovascular diseases, with obesity being one of its primary modifiable predictors. This longitudinal study aims to identify early predictors of developing hypertension in middle-aged individuals with obesity, contributing to targeted prevention strategies. Methods: A cohort of 112 middle-aged participants (mean age 48.6 ± 10.8 years, 55% male) with a body mass index (BMI) ≥ 30 kg/m^2 but without hypertension at baseline were followed for an average of 5.8 ± 2.4 years. The study sought to determine significant predictors for the development of hypertension, including demographic variables, lifestyle factors, and biochemical markers. Cox proportional hazards regression models were employed to estimate hazard ratios (HR) for the development of hypertension, with Kaplan-Meier analysis used to visualize time-to-event outcomes. Statistical significance was determined by p-values &lt; 0.05. Results: Over the follow-up period, 34% of participants developed hypertension. Kaplan-Meier analysis indicated a significant difference in hypertension-free outcomes based on baseline insulin resistance levels and waist-to-hip ratio (WHR) (p &lt; 0.01). Cox regression analysis revealed that insulin resistance (HR = 1.12 per unit increase, 95% CI: 1.06-1.19, p = 0.001) and WHR (HR = 2.48 for the highest quartile vs. lowest, 95% CI: 1.32-4.67, p = 0.005) were independent predictors of developing hypertension. Furthermore, a sedentary lifestyle was associated with an increased risk (HR = 1.89, 95% CI: 1.01-3.54, p = 0.046), whereas dietary factors did not show a significant relationship after adjusting for other variables. Conclusion: This study identifies insulin resistance and WHR as significant predictors of early-onset hypertension among middle-aged individuals with obesity, with lifestyle factors also playing a crucial role. These findings underscore the importance of targeted interventions focusing on reducing insulin resistance and central obesity, along with promoting physical activity, to prevent the development of hypertension in this high-risk population.

Clinical profiles, incidence and predictors of early neonatal mortality at Mbarara Regional Referral Hospital, south-western Uganda

BackgroundThe current neonatal mortality rate in Uganda is high at 22 deaths per 1000 live births, while it had been stagnant at 27 deaths per 1000 live births in the past decade. This is still more than double the World Health Organization target of < 12 deaths per 1,000 live births. Three-quarters of new born deaths occur within the first week of life, which is a very vulnerable period and the causes reflect the quality of obstetric and neonatal care. At Mbarara Regional Referral Hospital (MRRH), the modifiable contributors and predictors of mortality remain undocumented, yet neonates make the bulk of admissions and contribute significantly to the overall infant mortality rate. We therefore examined the clinical profiles, incidence and predictors of early neonatal mortality of neonates admitted at MRRH in south-western Uganda.MethodsWe conducted a prospective cohort study at the Neonatal Unit of MRRH between August – November, 2022 among neonates. We consecutively included all live neonates aged < 7 days admitted to neonatal unit and excluded those whose outcomes could not be ascertained at day 7 of life. We obtained baseline data including; maternal social-demographic and obstetric information, and performed neonatal physical examinations for clinical profiles. We followed up neonates at 24 and 72 h of life, and at 7 days of life for mortality. We summarized the clinical profiles and incidence of mortality as frequencies and percentages and performed modified Poisson regression analysis to identify the predictors of early neonatal mortality.ResultsWe enrolled 384 neonates. The majority of neonates were in-born (68.5%, n = 263) and were admitted within 24 h after birth (54.7%, n = 210). The most common clinical profiles at admission were prematurity (46%, n = 178), low birth weight (LBW) (44%, n = 170), sepsis (36%, n = 139), hypothermia (35%, n = 133), and birth asphyxia (32%, n = 124). The incidence of early neonatal mortality was at 12.0%, 46 out of the 384 neonates died. The predictors of early neonatal mortality were hypothermia, [adjusted Risk Ratio: 4.10; 95% C.I (1.15–14.56)], birth asphyxia, [adjusted Risk Ratio: 3.6; 95% C.I (1.23–10.73)] and delayed initiation of breastfeeding, [adjusted Risk Ratio: 7.20; 95% C.I (1.01–51.30)].ConclusionPrematurity, LBW, sepsis, birth asphyxia and hypothermia are the commonest admission diagnoses. The incidence of early neonatal mortality was high, 12.0%. We recommend targeted interventions by the clinical care team at MRRH to enable timely identification of neonates with or at risk of hypothermia to reduce incidence of adverse outcomes. Intrapartum care should be improved in order to mitigate the risk of birth asphyxia. Breastfeeding within the first hour of birth should be strengthened were possible, as this is associated with vast benefits for the baby and may reduce the incidence of complications like hypothermia.

Outcomes of growth hormone treatment in children with Prader-Willi syndrome over a 30-year period: a single tertiary center experience.

Clinical benefits of growth hormone (GH) in Prader-Willi syndrome (PWS) are proven and scoliosis is a known association of both PWS and GH therapy. The aims of this study were to assess GH prescribing practices and growth outcomes over time, the prevalence and predictors of scoliosis in GH-treated PWS children, and the near-final height of GH-treated PWS patients. This is a retrospective, descriptive study evaluating data from all clinic visits of patients aged 0-18 years with PWS, seen through the Children's Hospital at Westmead between March 1992 and May 2022 (n=75). A total of 64 patients were treated with GH (visits = 1,414). In the recent decade, the diagnosis of PWS and GH commencement were made significantly earlier in life. The prevalence of scoliosis was 41 %, in which age was the only significant predictor for scoliosis (odds ratio 1.19: 95 % CI [1.08-1.31; p=0.001]) adjusted for other predictors. In patients with data available at the age 16 years (23/28 treated with GH), those who were GH treated had significantly higher height SDS vs. nontreated group (SDS-0.67 vs.-2.58; p=0.0001) and lower BMI SDS (1.18 vs. 2.37; p<0.001). Significant improvements in growth and body composition were seen in the GH-treated group vs. non-treated group of children with PWS. There were no significant modifiable clinical predictors of scoliosis in children with PWS, but our findings confirm the high prevalence of scoliosis in GH-treated children with PWS reinforcing the need for close surveillance.

Modifiable Predictors of Social Participation in Older Adults With Chronic Disease: Identifying Targets for OT Intervention

Abstract Date Presented 03/23/24 The social isolation epidemic is particularly dire for older adults. We need to identify modifiable risk factors within the OT practice domain that are associated with the occupation of social participation for this group to develop targeted programs. Primary Author and Speaker: Mansha Mirza Additional Authors and Speakers: Heidi Christine Fischer, Dalmina Arias

The Intra-articular Tendinous Graft Diameter of 10-mm Bone-Patellar Tendon-Bone Autografts in Adolescent Patients: An MRI Analysis of 100 Patients.

Bone-patellar tendon-bone (BPTB) autograft size may be one modifiable predictor of anterior cruciate ligament (ACL) reconstruction postoperative success, as smaller graft diameter has been associated with higher rates of rupture requiring revision. However, measuring the true intra-articular tendinous graft diameter of the soft tissue portion of a BPTB graft with standard intraoperative methods is difficult while keeping the graft intact. The purpose of the study was to use 3-dimensional magnetic resonance imaging (MRI) measurements to determine the cross-sectional area of the soft tissue, tendinous portion of a standard BPTB autograft with 10-mm diameter bone plugs, and, by calculation, the collagen graft size (ie, graft diameter), as would typically be reported in ACL reconstruction studies that consider soft tissue graft size. It was hypothesized that the calculated collagen graft diameter of 10-mm BPTB autografts would be significantly smaller than 10 mm. Cross-sectional study; Level of evidence, 3. A total of 100 patients (10 girls and 10 boys at each age from 13 to 17 years) who underwent a knee MRI at a single academic orthopaedic center without documented extensor mechanism pathology were identified. The central 10-mm width of the patellar tendon that would be harvested for BPTB autograft was measured. The region of interest area tool was then used to measure the cross-sectional area of a 10-mm BPTB graft with subsequent soft tissue autograft diameter calculation. The mean calculated tendinous graft diameter of a 10 mm-wide BPTB graft was 6.3 ± 0.5 mm and was significantly smaller than a 10-mm reference (P≤ .001). There was no significant association between age and cross-sectional area or graft diameter. Modern 3-dimensional imaging-based measurement techniques demonstrated that the true intra-articular tendinous soft tissue portion of 10-mm BPTB autografts shows substantial variation and is significantly smaller in diameter than the tunnels typically reamed to accommodate the bone plug portions of these grafts. Moreover, as graft size is a predictor of rupture rate, preoperative MRI-based evaluation may be an important tool when considering BPTB autograft for ACL reconstruction. Future comparative clinical research utilizing graft size as a study variable should consider quantifying and utilizing the diameter of the soft tissue component of BPTB autografts.

Long term cognitive dysfunction among critical care survivors: associated factors and quality of life—a multicenter cohort study

ObjectivesTo identify the prevalence and associated factors of cognitive dysfunction, 1 year after ICU discharge, among adult patients, and it´s relation with quality of life.MethodsMulticenter, prospective cohort study including ICUs of 10 tertiary hospitals in Brazil, between May 2014 and December 2018. The patients included were 452 adult ICU survivors (median age 60; 47.6% women) with an ICU stay greater than 72 h.ResultsAt 12 months after ICU discharge, a Montreal Cognitive Assessment (tMOCA) telephone score of less than 12 was defined as cognitive dysfunction. At 12 months, of the 452 ICU survivors who completed the cognitive evaluation 216 (47.8%) had cognitive dysfunction.In multivariable analyses, the factors associated with long-term (1-year) cognitive dysfunction were older age (Prevalence Ratio–PR = 1.44, P < 0.001), absence of higher education (PR = 2.81, P = 0.005), higher comorbidities on admission (PR = 1.089; P = 0.004) and delirium (PR = 1.13, P < 0.001). Health-related Quality of life (HRQoL), assessed by the mental and physical dimensions of the SF-12v2, was significantly better in patients without cognitive dysfunction (Mental SF-12v2 Mean difference = 2.54; CI 95%, − 4.80/− 0.28; p = 0.028 and Physical SF-12v2 Mean difference = − 2.85; CI 95%, − 5.20/− 0.50; P = 0.018).ConclusionsDelirium was found to be the main modifiable predictor of long-term cognitive dysfunction in ICU survivors. Higher education consistently reduced the probability of having long-term cognitive dysfunction. Cognitive dysfunction significantly influenced patients’ quality of life, leading us to emphasize the importance of cognitive reserve for long-term prognosis after ICU discharge.