Multivariate Binary Logistic Regression Research Articles

Knowledge of mothers on diaper dermatitis management and associated factors in Ethiopia

Diaper dermatitis is an inflammatory reactions of the skin under a diaper due to prolonged skin contact with irritants (urine and faeces), seborrhoea, allergic reaction, fungal (candida), and bacterial infections. It is more common in children aged 1–24 months, with the majority of instances occurring in newborns younger than one year. Over half of newborns suffer from the case at least once throughout their diaper-wearing phase. In low- and middle-income countries like Ethiopia, there is a lack of published data regarding the degree of parental knowledge of diaper dermatitis, its management, and the risk factors associated with the disease. Moreover, the topic receives little to no attention. Therefore, this study aims to assess the mothers’ knowledge of diaper dermatitis and the risk factors linked with the disease. Data was collected from 396 mothers who came for immunization services from August 01 to September 01, 2024, consecutively. The data was cleaned, checked for completeness manually, and entered into SPSS version 26 for analysis. A binary multivariable logistic regression was used to analyze the association between the independent and the outcome variables. Variables with a p-value < 0.05 were considered statistically significant, and an adjusted odds ratio with a 95% confidence interval was reported. The study findings revealed that 84.6% of mothers had self-reported good knowledge of DD and its management, and their main source of information is family members and relatives (35.4%). Nearly two-thirds (65.4%) of children experienced DD, and only 23.6% sought healthcare. Over one-third (37.1%) of mothers used Vaseline to treat DD at home, followed by baby powder (35.1%). The majority (83.6%) of mothers uses disposable diapers only, and 84.8% change 0–2 times per day. The output of logistic regression shows that being a 7–12 month-old child (aOR = 4.03; 95% Cl (1.41–11.50)), being a male child (aOR = 2.16; 95% Cl (1.14–4.06)), and being firstborn (aOR = 5.95; 95% Cl (1.39, 25.53)) variables had a significant association with knowledge of mothers. The study found that although the majority of mothers have self-reported good knowledge, a significant number of them have no awareness of the diapering practice, how to treat DD, when to seek medical attention, and how to take care of their skin after a bowel movement. Therefore, we suggest a structured teaching program to increase mothers’ understanding of DD, including its prevention and management.

Suicidal ideation among medical and surgical inpatients at South Gondar Public Hospitals, Northwest Ethiopia, 2023: a multicenter institution-based cross-sectional study.

Suicide is a significant global public health issue impacting individuals, families, and communities across the world. People with medical and surgical conditions are at an elevated risk of experiencing suicidal thoughts. However, to the best of our knowledge, in Ethiopia, there has not been any published research that examines the magnitude and associated factors of suicidal ideation in this context. The objective of this study was to assess the prevalence of suicidal ideation among medical and surgically admitted patients in South Gondar public hospitals, Northwest Ethiopia, 2023. A multi-center institutional-based cross-sectional study was conducted in South Gondar public hospitals. A systematic random sampling technique was used to select 616 individuals with a response rate of 98.2%. Suicidal ideation was measured using the World Health Organization's Composite International Diagnostic Interview suicide module. Descriptive, bivariate, and multivariate binary logistic regressions were employed, with odds ratios and 95% confidence intervals. The significance of the association was determined with a p-value of less than 0.05. The prevalence of suicidal ideation in this study was 24.7% (95% CI: 20.8, 27.7). Poor life satisfaction (AOR = 2.64, 95% CI, 1.63, 4.3), poor social support (AOR: 3.38; 95% CI; 1.97, 5.8), being female (AOR: 1.98; 95% CI; 1.19, 3.3), depression (AOR: 2.67; 95% CI; 1.67, 4.22), prior suicidal ideation and/or attempt (AOR = 2.73, 95% CI; 1.47, 5.1), having high perceived threat (AOR = 3.0; 95% CI; 1.69, 5.29), and having poor sleep quality (AOR: 2.54; 95% CI 1.5, 4.25) were significantly associated with suicidal ideation at p-value < 0.05. The prevalence of suicidal ideation is notably high among patients hospitalized in surgical and medical wards. Effective screening, timely intervention, and enhanced support systems are essential for individuals, particularly for females, with poor social support, high perceived threat, prior suicidal ideation and/or attempt, poor sleep quality, depression, and low life satisfaction.

Co-occurrence of depression, anxiety and increased alcohol use during the late stage of the COVID-19 pandemic in Saskatchewan, Canada: a cross-sectional survey

BackgroundImpact of the COVID-19 pandemic on mental health and substance use is well recognised. COVID-19 impacted Saskatchewan particularly hard as it has a higher prevalence of alcohol consumption than the...

Risk factors for the delayed discharge from anesthesia intensive care unit: a single-center retrospective study

BackgroundA single-center retrospective study was designed to investigate the risk factors associated with delayed discharge from the Anesthesia Intensive Care Unit (AICU).MethodsThis retrospective study involved patients admitted in the AICU from January 2017 to December 2022. Risk factors for the delayed discharge from the AICU were analyzed by the binary multivariate logistic regression analysis. Nomogram was constructed to predict the risk of delayed discharge from AICU. The performance of the nomogram was assessed using the receiver operating characteristic curve and calibration curve. A decision curve analysis was also performed to determine the net benefit threshold of prediction.ResultsA total of 14,338 patients admitted in the AICU were retrospectively recruited, involving 9,271 males and 5,067 females. The incidence of delayed discharge from the AICU in the cohort was 1.54% (221/14,338). Binary multivariate logistic regression analysis showed that younger than 18 years or older than 64 years, the American Society of Anesthesiologists physical status of class III-IV, body mass index of less than 18 kg/m2 or greater than 25 kg/m2, preoperative complications, emergency surgeries and intraoperative massive hemorrhage were risk factors for the delayed discharge from an AICU. We utilized nomograms to visually express data analysis results. Based on receiver operating characteristic analysis, calibration plots, and decision curve analysis, we concluded that the nomogram model exhibited excellent performance. Patients undergoing spine surgeries suffered from the highest proportion of delayed discharge from the AICU, followed by those receiving orthopedic and vascular surgeries. Postoperative hemorrhage was the major cause of delayed discharge from an AICU, followed by septic shock, hypoperfusion and pulmonary insufficiency.ConclusionThe incidence of delayed discharge from the AICU in a single-center tertiary hospital is 1.54%. It is influenced by various risk factors, including age, ASA physical status classification, BMI, preoperative complications, type of surgery and intraoperative blood loss. The nomogram model exhibits excellent performance.Trial registrationThe single-center retrospective study was approved by the Ethics Committee of Nanjing Drum Tower Hospital (No. 2021-563-01, Data: 22 November 2021) and registered on the Chinese Clinical Trial Registry (No. ChiCTR2300078251, Data: 01 December 2023).

Determinants of minimum meal frequency among children in Kumbungu District of Ghana: a cross-sectional study

BackgroundChild malnutrition is a public health concern in developing countries including Ghana. Ensuring a child’s minimum meal frequency is met is critical for preventing malnutrition and improving nutrient intake. However, minimum meal frequency and its context-specific determinants among children in the Kumbungu District of Ghana are yet to be investigated. This study therefore examined minimum meal frequency and its determinants among children aged 6 to 23 months in Kumbungu District, Ghana.MethodsAn analytical cross-sectional study design was used and involved 395 mother-child pairs selected through systematic random sampling. A semi- structured questionnaire was used to obtain respondents’ socio-demographic characteristics, maternal nutritional knowledge and feeding practices and anthropometric information of children. Multivariate binary logistic regression analysis was used to determine the determinants of minimum meal frequency.ResultsOf the 395 children studied, about 51.4% of them were females, with about 25.8% and 74.2% of them aged 6–8 months and 9–23 months respectively. About 72.4% of the children met the minimum meal frequency. Children aged 9–23 months were 3.48 times more likely to meet the minimum meal frequency as compared to children aged 6–8 months [Adjusted odds ratio (AOR): 3.48, 95% CI: 1. 33-9.03, p = 0.011]. Moreover, children who met the minimum dietary diversity were 46.32 times more likely to achieve the minimum meal frequency as compared to those who did not meet the minimum dietary diversity [AOR: 46.32, 95% CI: 17.78-120.64, p < 0.001].ConclusionsThe proportion of children who received minimum meal frequency was high. Child age and minimum dietary diversity were significant determinants of minimum meal frequency. To achieve optimal minimum meal frequency for all children, mothers should be encouraged to practice age appropriate meal frequency, particularly, those with children aged 6–8 months as well as feed their children diversified diets.

Individual, household, and community-level factors associated with high-risk fertility behaviour among Nigerian women: secondary analysis of the 2018 demographic and health survey data

BackgroundHigh-risk fertility behaviour (HRFB) remains a significant public health concern in Nigeria, contributing to increase in maternal and child morbidity and mortality. The existence of HRFB presents significant barrier to accomplishing the Sustainable Development Goals. The objective of this study was to examine the prevalence and contextual factors of HRFB among Nigerian women.MethodsIn this study, cross-sectional data with national representativeness from the 2018 Nigeria demographic and health survey (NDHS) were used. The sample was made up of 21,792 women aged 15–49 years selected from 1389 enumeration areas. A multilevel multivariable binary logistic regression model was utilised to examine the factors associated with HRFB.ResultsThe weighted prevalence of HRFB was 64% (95% CI 62–65%). Women having at least a secondary education had 14% (aOR = 0.86; 95% CI 0.77–0.98) reduction in the odds of HRFB when compared with women with at most a primary education. Muslim women had 20% (aOR = 1.20; 95% CI 1.06–1.36) increase in the odds of HRFB, when compared with the Christian women. Those who had 3–4 living children had 3.97 times higher odds of HRFB, when compared with women with no child (aOR = 3.97; 95% CI 2.92–5.40). Women aged 25–34 and 35–49 years had higher odds of HRFB when compared with women aged 15–24 years respectively. Women exposed to media use had 12% (aOR = 0.88; 95% CI 0.80–0.97) reduction in the odds of HRFB when compared with women not exposed to media use. The non-poor women had 12% (aOR = 0.88; 95% CI 0.79–0.99) reduction in the odds of HRFB when compared with poor women. Respondents from female-headed households had 21% reduction in the odds of HRFB when compared with those from households with male head (aOR = 0.79; 95% CI 0.69–0.92). The geographical region was significantly associated with HRFB among women.ConclusionThe high prevalence of HRFB among Nigerian women underscores the need for policies and programmes targeted to address the issue. Addressing socioeconomic factors, improving education and healthcare access, and promoting family planning could significantly reduce HRFB.

Exploring burn first aid knowledge and water lavage practices in Uganda: A cross-sectional study.

Low- and middle-income countries experience higher burn-related morbidity and mortality compared to high-income countries. Prehospital Burn First Aid (BFA) improves outcomes. We assessed BFA knowledge and water lavage practices and their associated factors among burn victims, caregivers, and visitors at a tertiary health facility in Uganda. A cross-sectional study was conducted at the Burns Unit of Kiruddu National Referral Hospital in Kampala between 1st April 2022 and 30th November 2022. Participants included burn patients, caregivers, and hospital visitors. Data on BFA knowledge and practices were collected using an interviewer-administered questionnaire. BFA knowledge was evaluated using 13 questions, with a ≥80% score considered adequate. Logistic regression was used to assess for associations. We enrolled 404 participants, comprising 68 (16.8%) burn victims, 161(39.9%) primary caregivers, and 175 (43.3%) hospital visitors. Overall, 339 (83.9%) participants had never received BFA information, and 392 (97.0%) had no first aid training. The mean BFA knowledge score was 56±13.9%, with only 5.4% of the participants demonstrating adequate knowledge. Only 26 (27.7%) of current and former burn victims used water lavage as BFA. No statistically significant associations were found between BFA knowledge, water lavage usage, and demographic variables at univariable and multivariable binary logistic regression analyses. We highlight inadequate BFA knowledge and practices among victims of burns, their caregivers, and the general population. Addressing these deficiencies through community-based initiatives is crucial to improving burn care in Uganda.

Factors Associated With Low Childbirth Self-Efficacy for Vaginal Birth in High-Risk Pregnant Women.

Low childbirth self-efficacy is a significant indicator of vaginal birth and is closely related to adverse perinatal outcomes. This study aimed to evaluate factors associated with low childbirth self-efficacy for vaginal birth in high-risk pregnant women. This descriptive study was conducted between July and December 2022 in Van, Turkey, with a total of 200 participants. Data collection instruments included a Socio-demographic Questionnaire and the Self-Efficacy Regarding Vaginal Birth (SEVB) scale. Independent t-test, chi-square test and multivariable binary logistic regression were employed for data analysis. The mean age of the participants was 27.74 ± 5.12 years, and the mean gestational age was 33.22 ± 4.28 weeks. Unplanned pregnancy status (p = 0.002), a history of caesarean section (p = 0.013), multiparity (p = 0.001), age (p < 0.01) and gestational age (p = 0.001) were associated with low childbirth self-efficacy for vaginal birth. In multivariate analysis, only age (B: 1111; 95% CI: 1038-1189; p = 0.002) and gestational age (B: 1120; 95% CI: 1034-1214; p = 0.004; and p = 0.005) were independently associated with low childbirth self-efficacy. Low childbirth self-efficacy for vaginal birth was associated with higher maternal age and gestational ages. Identifying high-risk pregnant women with low childbirth self-efficacy will improve the care process for women and their newborns.

Magnitude of urban malaria and its associated risk factors in Damboya town, Kambata zone, Central Ethiopia.

As Sub-Saharan African country urban malaria is potential catastrophe in Ethiopia, particularly in relation to rapidly growing small towns, which requires updating the epidemiology of malaria. There was lack of information regarding the study area, hence this study was designed to determine the prevalence of malaria and associated risk factors in Damboya town. A Community-based cross-sectional study was carried from March 7 to May 29, 2023 among 422 randomly selected participants. Prevalence of malaria was determined using microscopic examination of thick and thin smear and rapid diagnostic test using kits to standard of the manufacturer. Pretested structured questionnaire was employed to collect socio-demographic data and associated risk factors. Data were entered in Epi data 3.1 and analyzed using SPSS version 25 software. Factors associated with malaria was analyzed using bivariable and multivariable binary logistic regression. The strength of the association was determined by computing Adjusted Odds Ratio (AOR) at Malaria is one of the most vital leading cause of morbidity and mortality in developing countries particularly in Sub Saharan Africa (Bugssa and Tedla, 2020). About 95 % of all malaria cases and 96 % of all malaria deaths in 2021 occurred in Africa (Bugssa and Tedla, 2020). Sub-Saharan Africa accounted for 60 % of global cases and 90 % of global fatalities (WHO, 2022). Over the two peak years of the pandemic (2020-2021), COVID-related setbacks increased malaria cases by around 13 million and fatalities by 63,000 (WHO, 2022). Malaria is thought to directly cost Africa $12 billion annually and reduce GDP growth by 3 %. In addition, it is thought to cause cognitive disorders and school absences, which are barriers to the development of human capital (Monroe et al., 2022). 95% confidence interval (CI) and p-value of <0.05. The prevalence of malaria was 5% (20, 95% CI: 3-7), Plasmodium vivix account for 14 (61.9%) of the infection. Presence of stagnant water (AOR=3.630, 95% CI: 1-13, P<0.049), unavailability of Insecticide-treated bed net (AOR=3.89, 95% CI: 1.08-14.01, P<0.038), living in a house with eaves (AOR=5.06, 95%CI: 1.25-20.58, p<0.023), travel history (AOR=3.58, 95%CI: 1-12.79, p<0.049), low-income (AOR=5.3, 95%CI: 1.09-25.2, P<0.038), were significantly associated with malaria occurrence. Malaria is still a public health concern in Damboya town. Thus, implementing intervention strategies properly and evaluate the access and utilization status of the suburb community and improve accordingly was required to interrupt the transmission in the community of this town.

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason.

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Assessing patient experiences with a Virtual Triage and Assessment Centre (VTAC): a mixed-methods study using an online survey and semi-structured interviews in Renfrew County, Ontario.

In March 2020, the Renfrew County Virtual Triage and Assessment Centre (VTAC) was launched as a large-scale, innovative, hybrid healthcare program. VTAC aims to alleviate pressure on emergency departments by providing additional and more equitable access to family physicians and allied health professionals. This study's objective was to evaluate patients' experiences with VTAC. In this mixed-methods study, we distributed 3,026 surveys, receiving 383 responses that met our inclusion criteria (13%), and conducted 10 semi-structured interviews with Renfrew County residents aged 18 and above who had utilized VTAC at least once since 2023. Survey data were analyzed through descriptive statistics, chi-squared tests, and a multivariate binary logistic regression, while semi-structured interviews were coded and analyzed using reflexive thematic analysis. The majority of survey respondents were aged over 55 (58%), identified as Caucasian (91%) and women (70%), with 76% having college or university-level education. Additionally, 81% were either unattached, or attached to a doctor who was not easily accessible. Our findings demonstrate overall satisfaction with VTAC, with 86% patients reporting that they were satisfied or very satisfied with the program. This was irrespective of demographic characteristics, health status, or appointment modality. In our interviews, four main themes emerged: "Healthcare in Renfrew County", "Accessing VTAC", "VTAC Clinical Care", and "Improving VTAC". These themes underscore major difficulties residents encounter in accessing healthcare in Renfrew County and illustrate that services from VTAC align with a genuine population-level need, contributing to mitigating some of these challenges. Renfrew County, like many other underserved regions, is grappling with a crisis of access to healthcare. VTAC addresses this gap by providing timely access to a family doctor. Our findings demonstrate patient acceptability and satisfaction with VTAC, offering insights that could guide the design of similar healthcare programs. This model may also serve as a scalable solution for improving healthcare access in underserved regions facing similar challenges.

PTSD symptoms in war-displaced refugees diagnosed with hypertension or type 2 diabetes: Prevalence and correlates.

War-displaced refugees are subjected to ongoing mental and somatic health issues that impair their well-being. This study examined the prevalence and risk factors for self-reported PTSD symptoms in war-displaced Syrian refugees residing in Jordan who had been diagnosed with at least with either hypertension or type 2 diabetes. The sample included 165 women (50.3%) and 162 men (49.7%); and 186 (56.7%) were older than 50 years. Self-reported PTSD symptoms were assessed using a validated Arabic scale. Data analysis revealed that 229/327 participants (69.8%) scored above the threshold for severe PTSD symptoms. The multivariable binary logistic regression analysis demonstrated that participants reporting a lack of medications or symptoms of chronic non-specific widespread pain were at significantly higher odds for severe PTSD, respectively. Prompt logistic, medical, and psychiatric care is required to alleviate the high trauma burden in this fragile population.

Identification of prognostic risk factors associating with lifestyle contributing to the development of health disorders in 9–11 grades students

Introduction. The development of society is largely determined by the level of population health of adolescents, which has a significant impact on the health of the nation as a whole and forms its cultural, intellectual, industrial, military, and reproductive potential. Studying the causes that contribute to the development of health disorders in students will help to identify the main health risk factors to justify priority areas of preventive work among children and adolescents. Materials and methods. Object of the study were 9–11 grades students. Research method: survey. To identify the complex influence of lifestyle risk factors on the likelihood of developing psychoneurological borderline disorders, the method of multivariate binary logistic regression analysis was used. To assess the quality of the models, the ROC curve analysis method was used. Results. The main predictors contributing to the development of psychoneurological borderline disorders in students in grades 9–11 include: being girl, life dissatisfaction, low support for the student from teachers, students being “busy” with electronic media for a long time, manifested by intensive use and preference for online communication; lack of sleep and walks on school days, participation in bullying as a victim or aggressor, lack of intense physical activity; low support for the student from family members, and smoking. The contribution of factors influencing the dependent variables ranged from 26.4% to 35.8%. Limitations. Model construction was based on data collected through an online questionnaire; there was an imbalance in the frequency distribution of syndrome variables. Conclusion. The prognostic risk factors for adolescent lifestyle influencing the development of disorders of well-being in students were determined. There was used multivariate regression analysis allowed identifying the independent impact of each risk factor for the health in students on the outcome, taking into account the correction for other factors included in the model. The results obtained can be used in the future to develop scientifically based recommendations for the prevention of health disorders in students.

Diagnostic prediction model for screening of elevated low-density and non-high-density lipoproteins in young Thai adults between 20 and 40 years of age

BackgroundLow-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels are paramount in atherosclerotic cardiovascular disease risk management. However, 94.4% of Thai young adult are unaware of their condition. A...

P-1906. Early COVID-19 and Severity of Subsequent Omicron Infection in Ontario, Canada

Abstract Background As SARS-CoV-2 evolves, assessing changes in COVID-19 severity over time, and the impact of prior infection on repeat infection, is important. We determined whether developing COVID-19 early in the pandemic was associated with reduced severity of subsequent infection with Omicron sub-lineages. Methods We evaluated COVID-19 severity among patients infected during the Omicron wave. Severity was measured in 3 ways:(1) an ordinal measure combining activities of daily living (ADL) and presence of fever,(2) healthcare required (yes/no),(3) an ordinal measure of illness duration. We compared these outcomes in a study of age and time-period matched cohorts in Toronto, Canada: one with symptomatic COVID-19 between Mar 1 &amp; Sep 30/2020 ('early COVID-19') and another who did not test positive for SARS-CoV-2 during the same period. Participants completed baseline, then biweekly surveys to identify SARS-CoV-2 infection episodes from Jan 2020 to Jan 2023. Multivariable binary and ordinal logistic regression models were used to construct ORs and 95% CI for impact of early COVID-19 on severity, adjusted for social/demographic characteristics, comorbidities, COVID-19 vaccination status, and time from early COVID-19 to first Omicron infection. Results Of 261 participants with COVID-19 due to Omicron (Table 1), 177 had early COVID-19 at a median of 26 months prior. In adjusted analyses, those with early COVID-19 occurring &amp;lt; 24 months prior to their Omicron infection had lower odds of having severe Omicron-related illness; OR 0.35 (95%CI 0.15-0.80); with non-significant lower odds of requirement for healthcare (OR 0.49,95%CI 0.14-1.8) and illness duration (OR 0.80, 95%CI 0.32-2.0) (Table 2). Immunocompromise was associated with more severe illness based on all 3 outcomes; other non-immunocompromising comorbidities were associated with requiring healthcare and longer illness duration, and females reported longer illness duration (Table 2). Conclusion Developing COVID-19 early in the pandemic was associated with reduced severity of first Omicron infection if it occurred &amp;lt; 24 months later. Immunocompromise and the presence of other underlying comorbidities were associated with increased severity, and women reported longer duration of illness. Disclosures Moe H. Kyaw, PhD, Pfizer: Employee Catherine Martin, PhD, Pfizer: employee|Pfizer: Stocks/Bonds (Private Company) Maria Major, B.Sc., M.P.H., Pfizer: Employee Samira Mubareka, MD, Pfizer: Grant/Research Support Srinivas Valluri, PhD, Pfizer: Employee John M. McLaughlin, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Allison McGeer, MD, AstraZeneca: Honoraria|GSK: Honoraria|Merck: Honoraria|Moderna: Honoraria|Novavax: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria|Roche: Honoraria|Seqirus: Grant/Research Support|Seqirus: Honoraria

P-881. A Retrospective Review of Enterobacter cloacae complex Bacteremia: 2019-2023

Abstract Background Enterobacter cloacae complex is one of the most common Enterobacterales considered at moderate to high risk for clinically significant AmpC production. AMP-C betalactamases confer resistance to broad spectrum cephalosporins and common beta-lactam betalactamases including Amoxicillin-Clavulanate and Piperacillin-Tazobactam. Carbapenems are often used empirically when this organism is isolated but there is a current gap in the literature regarding in which circumstances non-carbapenem antibiotics can be used safely for patients with enterobacter cloacae complex infections. The aim of this study was to examine independent predictors of mortality for patients with enterobacter cloacae complex bacteremia and identify patients which can appropriately receive non-carbapenem based therapy safely and effectively without negative impacts on mortality. Methods We conducted a retrospective analysis of 285 episodes of enterobacter cloacae complex bacteremia. The main outcome measure was mortality at 30 days.The χ2 or Fisher's exact test were used to compare categorical variables. To identify the independent risk factors of infection and mortality, a binary logistic regression model was used to control for the effects of confounding variables. Results Of 285 patients 17.5% (50) were deceased at 30 days, 110 patients received a beta-lactam betalactamase inhibitor combination initially and 80 patients received an initial broad spectrum cephalosporin. Of 209 patients for whom antibiotic data was available 73 were changed to a carbapenem within 24 hours of the initial blood culture being drawn. In univariate analysis only source was identified as a statistically significant risk factor for mortality at 30 days. In univariate and multivariate binary logistic regression analysis change to carbapenem within 24 hours of blood culture was not an independent risk factor of death at 30 days. Conclusion Change to carbapenem within 24 hours of cultures being taken was not an independent risk factor of 30 day mortality. Further studies are needed to determine in what group broad spectrum cephalosporins or beta-lactam betlactamase inhibitors are appropriate therapy for enterobacter cloacae. Disclosures All Authors: No reported disclosures

Ceftaroline versus vancomycin for methicillin-resistant Staphylococcus aureus bacteraemia, a matched cohort study.

Vancomycin remains the treatment-of-choice in MRSA bacteraemia (MRSAB) despite significant limitations. To compare the effectiveness of ceftaroline and vancomycin monotherapy as the initial targeted therapy for MRSAB. We conducted a retrospective matched cohort study. Consecutive adult patients treated with ceftaroline in the years 2019-2021 were matched in a 1:2 ratio with patients who received vancomycin. Controls were matched for performance of trans-oesophageal echocardiography, Charlson comorbidity index and age. The primary outcome was a composite of treatment failure, defined as 90-day mortality or microbiological failure. Descriptive statistics were used to compare the ceftaroline and vancomycin-treated groups. Univariate and multivariable binary logistic regression models were created using ceftaroline treatment as the exposure variable. Forty-five patients treated with ceftaroline for MRSAB were matched with 83 patients who received vancomycin. The groups were well balanced with regards to demographics and clinical characteristics. The primary outcome of treatment failure occurred at a similar rate in patients treated with ceftaroline or vancomycin (51.1%, 23/45% versus 57.8%, 48/83, respectively, P = 0.47). In the multivariable analysis, only age (aOR 1.06, 95% CI 1.01-1.1, P = 0.02) was associated with treatment failure. Acute kidney injury was more common among patients treated with ceftaroline (51.1%, 23/45% versus 18.1%, 15/83, P < 0.001). Ceftaroline was not associated with improved outcomes compared to vancomycin when given as initial treatment for MRSAB, however, it appears to be a viable alternative to vancomycin. Larger studies are needed to provide definitive results and to elucidate the risk of nephrotoxicity.

Willingness to donate eyes and associated factors among adults in Addis Ababa City, Ethiopia: a mixed-methods approach

ObjectiveThis study intended to assess willingness to donate eyes and associated factors among adults in Addis Ababa City, Ethiopia.Methods and analysisThis study used a triangulated phenomenological mixed-methods design, involving 1293...

Do Child-Turcotte-Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study.

Cirrhotic patients face heightened energy demands, leading to rapid glycogen depletion, protein degradation, oxidative stress, and inflammation, which drive disease progression and complications. These disruptions cause cellular damage and parenchymal changes, resulting in vascular alterations, portal hypertension, and liver dysfunction, significantly affecting patient prognosis. To analyze the association between Child-Turcotte-Pugh (CTP) scores and different nutritional indicators with survival in a 15-year follow-up cohort. This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged > 18 years. Diagnosis of cirrhosis was made by liver biopsy. The first year of data collection was 2007, and data regarding outcomes were collected in 2023. Data were gathered from medical records, and grouped by different methods, including CTP, handgrip strength, and triceps skinfold cutoffs. The prognostic values for mortality were assessed using Kaplan-Meier curves and multivariate binary logistic regression models. The coefficient for CTP was the only statistically significant variable (Wald = 5.193, P = 0.023). This suggests that with a negative change in CTP classification score, the odds of survival decrease 52.6%. The other evaluated variables did not significantly predict survival outcomes in the model. Kaplan-Meier survival curves also indicated that CTP classification was the only significant predictor. Although different classifications showed specific differences in stratification, only CTP showed significant predictive potential. CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.

Distress and coping mechanisms among people with diabetes: cross-sectional assessment from an NCD screening clinic of a tertiary care hospital in North India

BackgroundOf the numerous complications encountered by people with diabetes (PWD), the effect on mental health is concerning. Within mental health, diabetes distress (DD) occurs when a patient has unfavourable emotional stress while managing their condition, which can be managed by coping strategies but are less studied together in Indian settings. So, the present study aimed to determine the proportion of DD and associated factors and coping skills among the PWD.MethodsCross-sectional study was conducted among 596 clinically stable, ambulatory PWD visiting the NCD clinic of a tertiary care centre in North India between June 2023 and January 2024 and recruited using a systematic random sampling technique. DD was the primary dependent variable assessed using the Hindi version of the Diabetes Distress Scale (DDS). Coping was assessed using a GlucoCoper scale. Independent variables included socio-demographic and clinic history variables. Bivariate analysis described the sample characteristics. Multivariable binary logistic regression analysis explored the factors affecting the DD. The study was ethically approved, and written informed consent was obtained from the patients.ResultsOf the 596 study participants, 17.4% depicted uncontrolled diabetes, while 18.1% PWD experienced moderate to severe DD, with emotional distress depicting the highest prevalence (23.8%). Significantly increased odds of living with DD in professionals compared to Clerical, shop-owners, farmers with less monthly average income (vs. the group with unstable income), tobacco users, and those with uncontrolled disease. Overall, scores for negative coping were higher than positive coping, with significant differences between the two types among the participants with DD.ConclusionsThe study underscores the complex interplay between diabetes control, distress, and coping mechanisms in patients attending an NCD screening clinic. The findings highlight the need for a holistic approach to diabetes management that addresses not only the physical aspects but also patients’ emotional and psychological well-being.