Multiple Binary Logistic Regression Models Research Articles

Alveolar Bone Reconstruction Simultaneous to Implant Removal due to Advanced Peri-Implantitis Defects: A Proof of Concept.

To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis. Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥ 50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose cross-linked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes. In total, 20 patients (nimplant = 39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants. The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

Night Eating Syndrome Among University Students in Bangladesh: Investigation of Prevalence and Associated Factors.

Night eating syndrome (NES) has been associated with psychological issues and academic performance among university students in several countries, yet research on NES in Bangladesh remains limited. Therefore, the purpose of the study was to examine the prevalence and factors associated with NES among university students in the country. This cross-sectional study included 500 students from five public universities in Bangladesh. A validated 14-item night eating questionnaire was used to assess NES as the outcome variable. Demographic factors, depressive symptoms measured via the Patient Health Questionnaire (PHQ-9), and internet addiction levels measured via Orman's Internet Addiction Survey (OIAS) were explored as predictor variables. A multiple binary logistic regression model was fitted to identify the correlation of NES and its associated factors, with results presented as adjusted odds ratio (AOR) and level of significance set at p values <0.05. The prevalence of NES among participants was 16.6% (mean age = 21.6 years, 53.6% male). Adjusted binary logistic regression revealed that male participants (AOR = 2.03, 95% CI = 1.09-3.74, p = 0.024), smoking (AOR = 1.92, 95% CI = 1.02-4.44, p = 0.044), depressive symptoms (AOR = 2.17, 95% CI = 1.26-3.72, p = 0.005), and severe internet addiction (AOR = 2.69, 95% CI = 1.28-5.62, p = 0.009) were significantly associated with increased odds of experiencing NES. These findings underscore the need for heightened healthy eating awareness programs along with targeted mental health interventions with students attending Bangladeshi universities. Further research that explores longitudinal patterns of NES and the risk factors addressed in this study is warranted to better understand and inform the development of future interventions to benefit the Bangladeshi university student population.

Dental Anxiety Amongst Pregnant Women: Relationship with Dental Attendance and Sociodemographic Factors

Purpose: The purposes of this study were to investigate the relationship between dental anxiety amongst pregnant women and their dental attendance patterns, considering various sociodemographic factors, at health centers in the Kingdom of Saudi Arabia. Materials and Methods: Participants in this cross-sectional descriptive study were 386 pregnant women seeking care at Saudi Ministry of Health centers. A validated version of the Modified Dental Anxiety Scale (MDAS) was used to measure dental anxiety. Questionnaires including background data and dental anxiety were used and clinical data were collected. The association between oral health literacy and dental anxiety was evaluated with Spearman’s correlation coefficient. A multiple linear regression model with dental anxiety (MDAS score) as the dependent variable was developed to investigate further the relationship dental anxiety amongst pregnant women and their dental attendance patterns. Results: The prevalence of dental anxiety was very anxious (3.595). According to a multiple binary logistic regression model, previous experiences with dentists, household income, educational level, number of times and months of pregnancy, and the perception that oral care should be avoided during pregnancy were independently associated with dental anxiety. Conclusions: Dental anxiety in pregnant women is linked to social and psychological factors, in addition to oral health. Specifically, prior experiences with dentists, attitudes toward dental care, and general fear appear to have the strongest influence on dental anxiety. The prevalence of dental anxiety was high among this sample of pregnant women. The study shows that dental care providers need to pay attention to providing a supportive dental care situation, where patients should not experience pain. There is a need to understand the psychological factors associated with dental care procedures.

Smartphone use associated with overweight and obesity in adolescents in a family medicine unit in Mexico

Introduction: The use of smartphones has been increasing globally and in the case of adolescents it represents greater vulnerability and health risks. Clinical research that relates Body Mass Index (BMI) or body weight alterations with Information and Communication Technologies (ICT) demonstrates an association. However, the specific association of problematic smartphone use with overweight or obesity is limited and inconclusive in adolescents. General objective: To associate smartphone use with overweight and obesity in adolescents in a family medicine unit (FMU). Material and methods: A cross-sectional and analytical study was carried out from September 2022 to December 2023 in a first-level medical unit, in adolescents aged 10 to 19 years, in whom the Mobile Phone Problem use Scale (MPPUS-A) was applied and BMI was calculated. A Multiple Binary Logistic Regression (RLM) model was used that included age &gt; 14 years, smartphone use and female sex. Odds Ratio (OR), 95% CI and p. Results: Of 338 subjects, it was found that 39% were overweight or obese and had problematic use of the smartphone. 9.1% of overweight or obese adolescents have an adequate use of the smartphone. In the bivariate analysis, it was found that the inappropriate use of smartphones presented a PMR of 2.68 [95% CI (1.63-4.41)] and p&lt;0.001. The multivariate model showed inappropriate smartphone use with an OR of 1.06 [95% CI (1.73-4.87] with p&lt;0.001 and age &gt; 14 years an OR of 1.68 [95% CI (2.80-10.25)] and p &lt;0.001. Conclusion: Adolescents who have problematic smartphone use and an age &gt; 14 years have a higher risk of being overweight or obese. Longitudinal studies are required to verify the findings shown here.

Self-reported cognitive function and its relationship with self-reported health, psychological distress, and life satisfaction among cardiac arrest survivors - a nationwide register study

Abstract Introduction Cognitive problems in terms of memory, executive function, information retrieval, perception, and attention are common in cardiac arrest (CA) survivors. Studies show that cognitive impairment are associated with important outcomes such as lower quality of life, social function, and ability to work. However, cognitive function is commonly assessed by performance-based or observer-reported outcome measures that do not reflect the person’s own experience. To offer a person-centred CA care, this knowledge is of high importance. Purpose To describe self-reported cognitive function and its relationship with self-reported health, psychological distress, and life satisfaction among CA survivors. Methods This nationwide register study utilized data from the (Country) Register of Cardiopulmonary Resuscitation, encompassing survivors of both in-hospital and out-of-hospital CA. Inclusion criteria comprised survivors with a Cerebral Performance Category (CPC) scale score ≤3 at hospital discharge who underwent a follow-up phone interview with a registered nurse 3-6 months post CA. Health status was measured using the EQ-5D Visual Analogue Scale (EQ VAS), psychological distress with the Hospital Anxiety and Depression Scale (HADS), and life satisfaction with a global question about overall satisfaction from the Life Satisfaction Questionnaire (LiSat-11). Self-reported cognitive function was measured by a single question: ‘How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?’ Data was analysed using multiple linear regression and multiple binary logistic regression models. Results The sample consisted of 1,254 CA survivors, 32% females. The mean age was 66 (SD=13.4) years. Most of the CAs occurred in-hospital (74%) and were witnessed (93%). A cardiac aetiology (55%) and a shockable initial rhythm (57%) were most common. In total, 68% reported an unchanged cognitive function while 27% reported worse cognitive function. Better cognitive function was reported by 5%. Experiencing a worse cognitive function in relation to unchanged or better cognitive function was associated with worse self-reported health measured using the EQ VAS (p&amp;lt;0.001), higher levels of symptom of anxiety and depression measured with the HADS (p&amp;lt;0.001 and p&amp;lt;0.001 respectively), and a lower life satisfaction measured by the LiSat-11 (p&amp;lt;0.001). The significant associations remained after the regression models were adjusted for age, sex, place, aetiology, initial rhythm, and witnessed status. Conclusions As CA survivors with worse cognitive function reported poorer health, more psychological distress, and reduced life satisfaction, this study points out the importance to screen for self-reported cognitive function. Using a single question may facilitate the ability to identify survivors with a perceived worse cognitive function in need of support.

Utility of CT Scans for Detecting Operative Malleolar Fractures Associated With Tibial Shaft Fractures.

The purpose of this study was to define the utility of CT scans for detecting articular extension in tibial shaft fractures and determine whether radiographic parameters can predict the presence of operative distal tibial articular fractures (DTAFs). Retrospective cohort study. Single level I trauma center. Patients age 18 years and older who were treated operatively for tibial shaft fractures occurring at or below the tibial isthmus were included. Patients were excluded for extension of the main tibial shaft fracture into the tibial plafond (AO/OTA 43 B/C), ballistic injuries, and absence of a preoperative CT scan. The primary outcome was CT utility, defined as the presence of a DTAF or DTAF displacement on CT that was not recognized on plain radiographs on secondary analysis at the time of the study by a senior-level resident. Secondary outcome was the association between radiographic parameters and operative DTAFs. Variables with P ≤ 0.2 on univariate testing were included in a multiple binary logistic regression model to determine independent predictors of operative DTAFs. One hundred forty-four patients were included, with a mean age of 52 years. Seventy-six patients (53%) were men. CT utility was 41% for the identification of unrecognized DTAFs. CT utility was 79% for isolated pDTAF, 57% for medial DTAF, 83% for isolated anterolateral DTAF, and 100% for multiple DTAFs. Operative DTAFs were independently associated with spiral tibial shaft fracture type (P < 0.001) and low fibular fracture (P = 0.04). In patients who had both spiral tibial shaft fracture type and low fibula fracture, the rate of operative DTAF was 46% (22/48). CT scans identified DTAFs that were unrecognized on plain radiographs in 41% of cases. CT scans were most useful in identifying nonposterior DTAFs. CT scans may be considered for all distal third tibial fractures, but especially those with spiral tibial shaft patterns and low fibular fractures, to avoid missing operative articular injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services.

People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change.

Epidemiological and clinical trends of visceral leishmaniasis in Portugal: retrospective analysis of cases diagnosed in public hospitals between 2010 and 2020

BackgroundLeishmania infantum is endemic in the Mediterranean region, presenting mostly as visceral leishmaniasis (VL). In Portugal, reporting of VL cases to public health authorities is mandatory, but significant underreporting is likely. This study aimed to describe the epidemiological and clinical aspects of the VL cases diagnosed in hospitals of the Portuguese National Health Service (NHS), between 2010 and 2020.MethodsCollaboration was requested to every hospital of the Portuguese NHS in Mainland Portugal. Cases were screened through a search of diagnostic discharge codes or, if not available, by a search of positive laboratory results for Leishmania infection. Sociodemographic and clinical data was retrieved from medical records. Simultaneously, the National Health authority was contacted to request access to data of notified cases of VL between 2010 and 2020. Descriptive, hypothesis testing and multiple binary logistic regression models were performed.ResultsA total of 221 VL cases were identified. A significant increase in estimated national incidence was seen in the years after 2016 (P = 0.030). VL was predominantly diagnosed in people living with HIV (PLWH) and in children (representing around 60% of the new cases), but the outcome was generally poorer in non-HIV patients with associated immunosuppression, with significantly lower rates of clinical improvement at 7 (P = 0.003) and 30 days (P = 0.008) after treatment. Atypical presentations, with gastrointestinal and/or respiratory involvement, were seen in 8.5% of VL cases. Hemophagocytic lymphohistiocytosis was diagnosed in 40.0% of children under 5 years of age. Only 49.7% of incident VL cases were reported. Simultaneous involvement of the skin was confirmed in 5.9% of patients.ConclusionsVL presents a continuing threat in Portugal, especially to PLWH and children, and an increasing threat to other immunosuppressed groups. Recent increases in incidence should be closely monitored to allow prompt interventions. Programs to control the disease should focus on providing tools for earlier diagnosis and on reducing underreporting and promoting an integrated surveillance of human and animal disease. These data should be combined with asymptomatic infection and vector information, following a One Health approach.Graphical

Association of cognitive impairment with the interaction between chronic kidney disease and depression: findings from NHANES 2011–2014

BackgroundCognitive impairment (CoI), chronic kidney disease (CKD), and depression are prevalent among older adults and are interrelated, imposing a significant disease burden. This study evaluates the association of CKD and depression with CoI and explores their potential interactions.MethodData for this study were sourced from the 2011–2014 National Health and Nutritional Examination Survey (NHANES). Multiple binary logistic regression models assessed the relationship between CKD, depression, and CoI while controlling for confounders. The interactions were measured using the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S).ResultsA total of 2,666 participants (weighted n = 49,251,515) were included in the study, of which 700 (16.00%) had CoI. After adjusting for confounding factors, the risk of CoI was higher in patients with CKD compared to non-CKD participants (odds ratio [OR] = 1.49, 95% confidence interval [CI]:1.12–1.99). The risk of CoI was significantly increased in patients with depression compared to those without (OR = 2.29, 95% CI: 1.73–3.03). Furthermore, there was a significant additive interaction between CKD and depression in terms of the increased risk of CoI (adjusted RERI = 2.01, [95% CI: 0.31–3.71], adjusted AP = 0.50 [95% CI: 0.25–0.75], adjusted S = 2.97 [95% CI: 1.27–6.92]).ConclusionCKD and depression synergistically affect CoI, particularly when moderate-to-severe depression co-occurs with CKD. Clinicians should be mindful of the combined impact on patients with CoI. Further research is needed to elucidate the underlying mechanisms and assess the effects specific to different CKD stages.

Impact of indoor air pollution from cooking fuel usage and practices on self-reported health among older adults in India: Evidence from LASI

This research aims to explore the impact of various components of Indoor air pollution (IAP) on the Self-Reported Health (SRH) of older adults in India. Using a sample of 27,090 from the Longitudinal Aging Study in India (LASI) Wave-1, a multiple binary logistic regression model was employed to identify specific risk factors associated with poor SRH among older adults. Adjusting for demographic, socioeconomic, and IAP-related components, it was revealed that IAP significantly contributes to poor SRH. The adjusted model indicated that individuals using solid cooking fuels face a higher risk of poor SRH compared to those using liquid fuels. Additionally, individuals not using electric chimneys and cooking near windows are associated with an elevated risk of poor SRH, highlighting the importance of adequate ventilation. Health risk factors, including lung disease, diabetes, cough, and depression, further contribute to poor SRH among older adults exposed to IAP. Overall, the study offers crucial insights for policymakers, healthcare professionals, and environmentalists to improve the well-being of the vulnerable older population in India.

Opioids in geriatric units in 14 Belgian hospitals: prevalence, dosage and associated factors

Introduction: Adverse effects of opioids are common among older individuals, and undertreatment as well as overuse can be an issue. Epidemiological data on opioid use in older individuals are available, but scarce in hospitalized patients.Aims: The aim of this study is to examine the one-day prevalence of opioid use among older inpatients and identify the factors associated with both opioid use and dosage.Materials and methods: One-day cross-sectional study with data collected from geriatric units across 14 Belgian hospitals. The primary focus of the study is to assess the prevalence of opioid use and dosage, along with identifying associated factors. To achieve this, a multiple binary logistic regression model was fitted for opioid use, and a multiple linear regression model for opioid dose.Results: Opioids were used in 24.4% of 784 patients, of which 57.9% was treated with tramadol, 13.2% with oxycodone or morphine and 28.9% with transdermal buprenorphine or fentanyl. The odds for opioid use were 4.2 times higher in patients in orthogeriatric units compared to other patients (OR=4.2, 95% CI=2.50-7.05). The prevalence of opioid use was 34% higher in patients without dementia compared to patients with dementia (OR=0.66, 95% CI=0.46-0.95). The overall mean daily dosage was 14.07mg subcutaneous morphine equivalent. After adjustment for age, gender and dementia, dosage was only associated with type of opioid: the estimated mean opioid dose was 70% lower with tramadol (mean ratio=0,30,95% CI=0,23-0,39) and 67% lower with oxycodone and morphine (mean ratio=0,33, 95% CI=0,22-0,48) compared to transdermal buprenorphine and transdermal fentanyl.Conclusions: One in four patients received opioid treatment. It is not clear whether this reflects under- or overtreatment, but these results can serve as a benchmark for geriatric units to guide future pain management practices. The utilization of transdermal fentanyl and buprenorphine, resulting in higher doses of morphine equivalent, poses significant risks for side effects.

Success of Nonsurgical Endodontically Treated Posterior Teeth with Complex Restorative/Prosthodontic Treatments: A Retrospective Study.

Endodontic therapy has been regarded as a safe treatment option with highly promising results in preserving natural teeth. Numerous factors may influence the longevity of endodontically treated teeth (ETT), thus altering their success/survival rate. This study aimed to determine the survival and success rates of endodontically treated premolars and molars with different complex restorative/prosthodontic treatments. A total of 190 patients with an ETT were included, who had received final coronal restoration up to 14 days after the temporary one and at least one year prior to the enrollment. The investigator evaluated the quality of endodontic filling, coronal restoration, mobility, and proximal contacts. Data were analyzed with multiple binary logistic regression and the Chi-Square test. The average duration of follow-up was 28.6±11.9 months. Overall, 89.4% (170/190) of the teeth survived. The overall success rate for the investigated teeth was 70.5% (134/190). Success rates of 100% for crown, 95.7% for post and core crown (PCC), and 94.7% for amalgam build-up with post were achieved. However, the success rates were 75%, 52.5%, and 50% for amalgam build-up, composite build-up, and PCC with crown lengthening, respectively. The Chi-square test revealed that there was a significant difference between the different restorations in terms of success (P<0.001). Multiple binary logistic regression models revealed that coronal leakage (P=0.048), obturation void (P=0.037), obturation length (P=0.020), mobility (P=0.002), type of the restoration (P<0.001), and proximal contact (P<0.001) were significant predictors for success. However, apical lucency, root length, marginal caries, tooth type, and post did not appear to be significant indicators of success (P>0.05). ETT with minimal mobility, exhibiting underfilled obturations without visible voids, and having received crown/PCC/amalgam build-up with a post, along with the presence of both proximal contacts, tend to exhibit a significantly high success rate.

Rural-urban disparities in nutritional status among ever-married women in Bangladesh: A Blinder-Oaxaca decomposition approach

This study aims to investigate socioeconomic disparities in nutritional status among ever-married women in Bangladesh and to break down urban-rural differences in the underlying causes of undernutrition. We utilized data from the Bangladesh Demographic and Health Survey 2017–18, a sample size of 18328 ever-married women, including 5170 from urban residences, and 13159 from rural residences. To explore socioeconomic inequality, we employed a concentration indexing measure, while a multiple binary logistic regression model was carried out to identify the determinants associated with the outcome variable. A Blinder-Oaxaca decomposition analysis was performed to decompose the urban-rural gap in women’s nutritional status using associated factors. The prevalence of undernutrition among ever-married women in Bangladesh was 12 percent. Notably, this percentage varied by region, with urban residents accounting for 8.6% and rural residents accounting for 13.3%. Our findings confirmed that undernutrition was more prevalent among women with lower wealth indexes in Bangladesh, as indicated by the concentration index (CIX = −0.26). The multivariable analysis investigating the determinants of undernutrition status among ever-married women, with a focus on residence revealed significant associations with respondent age, education, marital status, mass media access, wealth status, and division. According to the Blinder-Oaxaca decomposition and its extension, the prevalence was significantly higher in rural residences of Bangladesh than in urban residences, and the endowment effect explained 86 percent of the total urban-rural difference in undernutrition prevalence. The results of this study indicate that the factors that influence women’s nutritional status in rural areas play a significant role in the gap, and the majority of the gap is caused by education and economic position. In order to effectively promote maternal health policies in Bangladesh, intervention techniques should be created that are aimed at the population, that is, the poorest and least educated.

Association Between Influenza Vaccine Uptake and Health Awareness: A Cross-Sectional Questionnaire-Based Study Among Medical Students and Healthcare Workers in Northern Vietnam.

BACKGROUND Seasonal influenza poses a significant global health concern. Despite the proven effectiveness of the influenza vaccine, its uptake remains low in Vietnam. This study aimed to assess the knowledge, attitudes, and practices of medical students and healthcare workers on influenza vaccine uptake in northern Vietnam. MATERIAL AND METHODS A cross-sectional survey was conducted among 585 participants from northern Vietnam institutions through an anonymous online survey via Google form from June to August 2022. The cut-off for a high level of knowledge and a positive attitude was set at 70% for each variable. Bivariate analysis was conducted to establish associations. Multiple binary logistic regression models were used to identify factors associated with knowledge, attitude, and practice. RESULTS Among the participants, 463 (79.15%) were women, 354 (60.51%) were below 25 years old, 426 (72.82%) were of "Kinh" ethnicity, and 454 (77.61%) were single. Only 237 (40.51%) were vaccinated. Good knowledge and attitude were reported by 36.58% and 42.39% of the participants, respectively. Having a high level of knowledge was found positively associated with having a positive attitude (odds ratio 2.11 [1.48-3.01]). Kinh ethnicity was positively associated with knowledge (1.67 [1.12-2.49]) and attitude (1.97 [1.32-2.94]). Female participants displayed a more positive attitude (2.08 [1.33-3.25]). Several factors influenced the uptake, such as being single (2.07 [1.19-3.59]), being a medical doctor (2.34 [1.09-5.06]), and being advised by a healthcare provider (2.96 [2.00-4.37]). CONCLUSIONS A noticeable gap in knowledge and attitude related to influenza vaccine uptake was found among the target population. Tailored interventions are necessary to improve vaccination coverage.

The adverse effect of gestational diabetes mellitus and hypertensive disorders of pregnancy on maternal-perinatal outcomes among singleton and twin pregnancies: a retrospective cohort study (2011-2019).

Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complications among singleton and twin pregnancies worldwide. Our primary objective was to explore the adverse effect of GDM and HDP on maternal-perinatal outcomes compared with non-GDM and non-HDP in singleton and twin pregnancies. The secondary objective was to find the risk of adverse maternal-perinatal outcomes in twin pregnancies compared with singleton pregnancies complicated with GDM and HDP in Hubei, China. A tertiary hospital-based retrospective study was conducted at Wuhan University Renmin Hospital, Hubei Province, China, from 2011 to 2019. A chi-square test was used to determine the difference in adverse maternal-perinatal outcomes between singleton and twin pregnancies. A multiple binary logistic regression model and a joinpoint regression model were used to determine the association of GDM and HDP with adverse maternal-perinatal outcomes and GDM and HDP temporal trend among singleton and twin pregnancies. The trend of HDP [average annual percentage change (AAPC) 15.1% (95% confidence interval (95%CI): 5.3, 25.7)] among singleton pregnancies and GDM [AAPC 50.4% (95%CI: 19.9, 88.7)] among twin pregnancies significantly increased from 2011 to 2019. After adjusting for confounding factors, GDM is associated with an increased risk of C-section (adjusted odds ratio (aOR), 1.5; 95%CI: 1.3, 1.6) and macrosomia (aOR, 1.3; 95%CI: 1.1, 1.6) in singleton and preterm birth (PTB) (aOR, 2.1; 95%CI: 1.2, 3.3) in twin pregnancies compared with non-GDM. HDP was associated with a higher risk of C-section, PTB, perinatal mortality, and low birth weight (LBW) in both singleton and twin pregnancies compared with the non-HDP. Compared with singleton pregnancies complicated with GDM and HDP, twin pregnancies showed higher odds of C-section [(aOR, 1.7; 95%CI: 1.1, 2.7), (aOR, 4.6; 95%CI: 2.5, 8.7), respectively], PTB [(aOR, 22.9; 95%CI: 14.1, 37.3), (aOR, 8.1; 95%CI: 5.3, 12.3), respectively], LBW [(aOR, 12.1; 95%CI: 8.2, 18.1), (aOR, 5.1; 95%CI: 3.6, 7.4), respectively], and low Apgar score [(aOR, 8.2; 95%CI: 4.4, 15.1), (aOR, 3.8; 95%CI: 2.4, 5.8), respectively] complicated with GDM and HDP. In conclusion, GDM showed an increased risk of a few adverse maternal-perinatal outcomes and HDP is associated with a higher risk of several adverse maternal-perinatal outcomes in singleton and twin pregnancies compared to non-GDM and non-HDP. Moreover, twin pregnancies complicated with GDM and HDP showed higher odds of adverse maternal-neonatal outcomes compared with singleton pregnancies complicated with GDM and HDP.

Pathogenetic Mechanisms Underlying Major Adverse Cardiac Events in Personality Type D Patients after Percutaneous Coronary Intervention: The Roles of Cognitive Appraisal and Coping Strategies.

This paper aimed to study the association of type D personality, coping strategies, and cognitive appraisal with annual prognosis after a percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). The prospective study included 111 CAD patients who underwent a PCI. All participants, before the PCI, completed questionnaires designed to collect information about type D personality, cognitive appraisal, and coping styles. Information was also collected on the clinical and demographic characteristics of the patients. After 1 year of follow-up, the presence of major adverse cardiac events (MACEs) was assessed. The presence of a MACE was noted in 38 patients, and the absence of a MACE was noted in 53 patients. In patients with type D personality, higher incidences of MACEs (54.1% versus 33.3%; p = 0.0489) and hospitalization rates (29.7% versus 7.4%; p = 0.004) were revealed. Patients with poor prognoses preferred a moderate use of the confrontation strategy than patients without a MACE (78.4% vs. 50.9%; p = 0.0082). Patients with MACEs had statistically significantly lower indicators of strong emotions (11.92 ± 5.32 versus 14.62 ± 4.83 points; p = 0.005) and future prospects (11.36 ± 3.81 versus 13.21 ± 3.41 points; p = 0.015) than patients without a MACE. In a multiple binary logistic regression model, the following factors had significant associations with MACE development: type D, moderate use of confrontation coping, moderate use of self-control coping, and strong emotions in cognitive appraisal. This study showed that not only personality type D, but also certain coping strategies and cognitive appraisals increase the likelihood of developing a MACE after a PCI. This provides a theoretical basis for understanding the mechanism underlying type D personality and MACEs in patients after a PCI.

Factors affecting depression among married adults: a gender-based household cross-sectional study

BackgroundDepression is a common mental health problem all over the world including Bangladesh. World Health Organization included it in the Mental Health Gap Action Programme as one of its priority conditions. Research on this issue is scanty in Bangladesh. Therefore, we designed to a gender-based household study on associated factors of depression among married adults in Rajshahi City of Bangladesh.MethodsWe conducted this household cross-sectional study from August 01 to October 31, 2019. A total of 708 married adults currently living together in Rajshahi City were recruited for this study. We applied a multi-stage random sampling technique for selecting samples and used a semi-structured questionnaire to collect necessary information from them. The Patient Health Questionnaire-9 was used for measuring depression and frequency distribution and binary logistic regression model were used for data analysis.ResultsThe prevalence of depression (moderate to severe) was 14.4% (95% CI: 11.9–16.9) among married adults, and females (21.2%, 95% CI: 17.2–25.4) suffered more than males (7.6%, 95% CI: 4.8–10.5). A multiple binary logistic regression model established four main factors of depression among married females: (i) multiple marriage [AOR = 19.982; 95% CI: 10.081–39.610; p < 0.01]; (ii) poor relationship with spouse [AOR = 2.175; 95%CI: 1.068–4.428; p < 0.05]; (iii) chronic medical comorbidity [AOR = 1.876; 95%CI: 1.009–2.626; p < 0.05]; and (iv) 7–12 years duration of conjugal life [AOR = 2.091, 1.009–4.334; p < 0.05]. Two main factors of depression among married males were (i) multiple marriage [AOR = 24.605; 95% CI: 20.228–40.402; p < 0.01] and hard work [AOR = 4.358; 95%CI: 1.109–7.132; p < 0.05].ConclusionThe prevalence of depression was significantly high among the study population, and females were the most vulnerable group. The concerned authorities and stakeholders should take appropriate measures to manage the problem with special focus on the risk factors and the vulnerable groups.

Logistic regression model for predicting failure of dual antihypertensive therapy: a prospective comparative non-randomized clinical trial

Background. Initial dual antihypertensive therapy is currently considered as the first management step for the majority of patients with arterial hypertension. However, it often fails to achieve the target blood pressure levels. An approved algorithm for predicting the failure of dual antihypertensive therapy is still to be developed. Objectives. To establish predictors of dual antihypertensive therapy failure in patients with high and very high cardiovascular risk and to create a model for predicting negative outcome of dual antihypertensive therapy. Methods. The paper presents a prospective comparative non-randomized clinical trial. The recruiting of participants and recording of results were carried out in March–December 2019 with 3 months of the follow-up period. The trial involved examination of 88 patients with poor blood pressure control, stage II and III arterial hypertension, high and very high cardiovascular risk of stages 1–3. Clinical and laboratory examination was carried out in compliance with the current regulatory documents. Additional examination included tests for uric acid, high-sensitivity C-reactive protein, as well as respiratory polygraphy and computerized capillaroscopy. All patients were prescribed dual antihypertensive therapy. The primary search for predictors was performed using the binary logistic regression. The predictive model was developed by stepwise variable selection. The diagnostic significance of the binary classifier was assessed by means of ROC-curve analysis; the calculation was performed using MedCalc 20.218 software (MedCalc Software Ltd., Belgium). Results. Administration of two hypotensive drugs appears to be effective in 33% of patients. The final model for predicting negative outcomes of dual antihypertensive therapy included such independent predictors as interventricular septal thickness, daily mean systolic blood pressure, and area density of the capillary network. The odds ratio accounted for 9.1 (95% confidence interval 3.12; 26.82). The area under the ROC curve based on the multiple binary logistic regression model comprised 0.805±0.05 with 95% confidence interval: 0.707-0.882 (p&lt;0.0001). The sensitivity and specificity of the method amounted to 83.1 and 69.0%, respectively. The prediction accuracy comprised 77.3%. Conclusion. The development of patient-oriented algorithms for selection of hypotensive treatment is considered to be essential due to poor blood pressure control during dual antihypertensive therapy. The developed prognostic model may be applied when managing hypertension.

Study on the Correlation of Elevated Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio With Covid-19 Mortality among Patients in a Hospital Isolation Ward in Baler, Aurora

Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) are inflammatory biomarkers known to assess several disease types effectively. With the surge of Coronavirus disease (COVID-19) cases, many patients manifested various systemic inflammatory conditions suggesting a possible relationship between the predictive values of NLR and PLR to COVID-19 mortality. The study aims to assess a correlation between elevated biomarker values of NLR and PLR with COVID-19 mortality. A single-center, cross-sectional study of COVID-19 patients, admitted to a hospital isolation ward in Baler, Aurora, between May to October 2021 was conducted. Secondary data, namely demographic profiles, complete blood count results, and comorbidities upon admission, were collected. The effect of NLR and PLR on the risk of mortality, along with the impact of covariate variables that may affect the study’s outcome, was determined using a multiple binary logistic regression model and the computation of the odds ratio. 264 COVID-19 patients were included in the study–202 were recovered and 62 were deceased. Multiple binary logistic regression demonstrated a higher mortality risk in patients with elevated NLR (OR=2.607; 95% CI: 1.276 to 5.324; p=.009). Other risk factors such as age (OR=1.053; 95% CI: 1.029 to 1.077; p&lt;.001) and diabetes mellitus (OR=3.537; 95% CI: 1.441 to 8.682; p=.006) are risk factors for COVID-19 mortality. Patients with elevated NLR values indicate poor clinical outcomes with a higher mortality risk compared to those with low NLR in COVID-19 patients. Moreover, age and diabetes must be considered in patient assessment upon admission due to their correlation to COVID-19 mortality. Keywords: COVID-19 mortality, inflammatory biomarker, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR).

Prevalence of osteoporosis in patients awaiting unicompartmental knee arthroplasty: a cross-sectional study.

Osteoporosis may contribute to failure of unicompartmental knee arthroplasty (UKA), yet the prevalence of osteoporosis in the population awaiting UKA has not been adequately studied. The objectives of this study were to report the prevalence of osteoporosis in people awaiting UKA and the rate of anti-osteoporosis treatment, and to explore factors associated with osteoporosis prevalence in people awaiting UKA. Participants awaiting UKA from January 2019 to May 2023 were consecutively enrolled. Participants ' age, gender, BMI, knee K-L score, VAS score, history of previous DXA testing, history of anti-osteoporosis treatment, and possible underlying risk factors were recorded. All participants were given a dual-energy x-ray absorptiometry (DXA) test after the visit. The diagnosis of osteoporosis was made according to the World Health Organization criteria. Compare the prevalence of osteoporosis between people waiting for UKA and the general population. Risk factors associated with osteoporosis were analyzed using multiple linear regression and binary logistic regression models. A total of 340 participants were included in the study, 259 in female and 81 in male, with a mean age of 63.53 years (range: 41-84 years), and all participants completed UKA and had DXA prior to UKA. The prevalence of osteoporosis was 40.88% (44.79% in female and 28.40% in male). The prevalence of osteoporosis was higher in female than in male (p<0.001). The prevalence of osteoporosis in the population waiting for UKA was significantly higher than that in the general population (p < 0.001). DXA testing was performed in 12.06% within 1 year prior to the visit. The percentage of those who had received anti-osteoporosis treatment was 20.59% (20.86% in osteoporosis, 22.39% in Osteopenia and 16.42% in normal bone mass). The correlation between age, gender, body mass index, visual analogue scale score and osteoporosis was statistically significant. Osteoporosis is common in people waiting for UKA, but screening and treatment rates are low. Female patients of advanced age and low weight combined with significant pain should be considered for osteoporosis screening and appropriate treatment before UKA.