Multiple Logistic Regression Models Research Articles

Association between lower geriatric nutritional risk index and low cognitive functions in United States older adults: a cross-sectional study

BackgroundWe aimed to explore the association between the Geriatric Nutritional Risk Index (GNRI) and the risk of low cognitive functions among older adults in the United States (US).MethodsUtilizing data from the National Health and Nutrition Examination Study (NHANES) database, a cross-sectional analysis was conducted. The GNRI served as a tool for evaluating the nutritional status of participants, who were categorized into two groups based on their initial GNRI scores: those with scores >98 indicating normal nutrition, and those with scores ≤98 indicating malnutrition. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer’s disease word list learning test (CERAD W-L), the Digit Symbol Substitution Test (DSST), the Animal Fluency Test (AFT), and the composite-z score which was calculated by summing the z scores of individual tests, respectively. Weighted multiple logistic regression models were used to evaluate the association between GNRI and cognitive function. Interaction and stratified analyses were conducted.ResultsAmong a sample of 2,925 individuals aged 60 years or older, 51.3% were women. Among these individuals, 233 were identified as malnourished. Weighted multivariate logistic regression analyses indicated that individuals with malnutrition had an increased risk of low cognitive function, as evidenced by lower CERAD W-L scores (OR:1.68, 95%CI 1.19–2.36, p = 0.003), AFT scores (OR: 1.74, 95%CI 1.26–2.41, p = 0.009), DSST scores (OR:1.63, 95%CI 1.11–2.38, p = 0.012), or composite z-scores (OR:1.87, 95%CI 1.29–2.71, p = 0.001). According to the variables evaluated, the interaction effects between low GNRI level and the elderly and stroke in specific cognitive domains were significant (P interaction < 0.05).ConclusionLower GNRI level is associated with significantly low cognitive function among older adults, particularly among those who have experienced a stroke or the elderly (aged 70 years and older) population.

Abstract 4116486: Association of assessment of clinical congestion in patients with heart failure compared with assessment using bioimpedance and microwave spectroscopy

Background: Physicians have to find a balance between decongestion therapy and the risk of dehydration so non-invasive methods assessing congestion are of great importance. Purpose: The study aimed to compare the clinical assessment of congestion to bioimpedance and microwave spectroscopy. Methods: 27 hospitalized HF patients with congestion (40% females) (Congestion Group) and 59 HF patients without fluid overload (66% females) (NON-Congestion Group) were included. Clinical examination, chest x-ray, laboratory results, echocardiography, non-invasive body mass analysis (Tanita Pro), NT-poBNP, and selected modern biomarkers concentrations [GDF-15, galectin-3, FABP, copeptin, VEGF were performed. Additionally, we assessed pulmonary congestion using a proprietary sensor with a microwave spectroscopy method based on analyzing the dielectric properties of an object (patent applications P.442466). Results: There were no differences in body mass index, blood pressure values, left ventricular ejection fraction (LVEF), and echocardiographic parameters of diastolic left ventricular function between groups. In the Congestion Group, we observed significantly more patients in NYHA Class 3 and 4 (p<0.001), lower values of fT3 (median 2.4 vs 2.7; p=0.02), higher a FIB-4 index (p=0.04), lower GFR MDRD (median 52.7 vs 66.7;p=0.04), higher concentrations of: NT-proBNP (pg/ml) (median 545 vs 101; p<0.001), galectin-3 (ng/ml) (median 15.01 vs 11.35; p=0.01), GDF-15 (pg/ml) (median 2069.27 vs 734.64; p=0.01), FABP (pg/ml) (median 293.6 vs 101; p=0.008) compared to NON-Congestion Group, and a larger number of detected congestion in chest x-ray (p<0.01) and more patients with limb edema (p= 0.0037). The patients with congestion also needed longer hospitalizations (p=0.008). Patients with congestion had lower total body water content in kg and intracellular water (ICW) (kg) (p=0.02 and p=0.01, respectively), and the higher extracellular water/total body water index (ECW/TBW) (p=0.001) assessed in bioimpedance and significantly higher Absorption Loss evaluated with the use of microwave spectroscopy (p=0.02). In a multiple logistic regression model, the factor that was independently associated with clinically diagnosed congestion was NT-proBNP >1095 pg/ml (OR 111.6, 95% CI: 2.6-50.6; p=0.001) (Figure 1). Conclusions: Absorption Loss and ECW/TBW are valuable new diagnostic tools in diagnosing lung congestion in patients with heart failure.

Fetal Gastroschisis: Maternal Epidemiologic Profile and Influence of Possible Risk Factors on Neonatal Outcomes.

The aim of this study was to evaluate the maternal epidemiological profile for gastroschisis as well as to assess whether the presence of meconium at birth was associated with adverse neonatal outcomes. This was a retrospective observational cohort study that included 52 neonates with gastroschisis whose mothers had delivery at our service. The variables observed were the following: 1) socio-demographic data, 2) ultrasonographic data, 3) birth data, and 4) neonatal outcomes. Simple (univariate) and multiple (multivariate) logistic regression models were used to examine the influence of meconium on neonatal outcomes. Mean maternal age and body mass index (BMI) of the pregnant women were 21.9 years and 23.3 kg/m2, respectively. There was a similarity between mixed (50%) and white (48.1%) races, and 27.7% (13) reported to use an oral contraceptive (OC). Mean birth weight was 2,386.9 grams, and 24 of the neonates (46.2%) were premature (<37 weeks). The majority of neonates had neonatal sepsis (40.4%) and 39 were admitted to the neonatal intensive care unit with a median length of stay of 31 days. Forty neonates required mechanical ventilation, with a median duration of 5 days. Primary closure was achieved in 50% (26) of cases. Although not significant and with low precision, the point estimate suggested that the presence of meconium at birth, on average, reduced the chance of primary closure (OR=0.26, CI 95% [0.06; 1.16], p=0.077). Pregnant women with gastroschisis fetuses were more likely to be young, primigravida, with a normal BMI, white or mixed, and with a history of OC use. There was no evidence of an association between the presence of meconium at birth and adverse perinatal outcomes.

Health Disparities in Hospitalized Pediatric Patients with Autism Spectrum Disorder and COVID-19

Background/Objectives: Pediatric patients with autism spectrum disorder (ASD) face unique challenges, especially amongst individuals from historically minoritized racial groups. ASD has also been associated with an increased mortality from COVID-19. This study aims to explore the differences in sociodemographic factors and health outcomes (as measured by length of stay) amongst hospitalized pediatric patients with COVID-19 infections and a diagnosis of ASD compared to individuals with a COVID-19 infection alone; Methods: We performed a retrospective cohort study examining pediatric patients (ages birth to 21) who were hospitalized with a diagnosis of ASD and COVID-19 compared to patients with a diagnosis of COVID-19 alone between January 2019 and June 2023 using Epic Systems Corporation’s Cosmos, a de-identified dataset aggregated from electronic health record data. We examined differences in demographic factors and length of stay (LOS) between groups by utilizing chi-square and Wilcoxon rank sum tests. Multiple logistic regression models were utilized to assess the association between length of stay and diagnosis; Results: A total of 21,708 distinct pediatric patients with a diagnosis of ASD and COVID-19 or COVID-19 alone were included in the analytical dataset. Patients with ASD and COVID-19, compared to patients with COVID-19 alone, had a higher proportion of individuals identifying as male and White. Patients with COVID-19 alone, compared to individuals with ASD and COVID-19, had higher proportions of individuals identifying as Black or African American. Higher proportions of individuals with ASD and COVID-19 had public insurance, compared to individuals with COVID-19 alone. Having a diagnosis of ASD and COVID, after controlling for covariates, was associated with higher odds of having a length of stay greater than the three days (cutoff value determined by the median LOS of three days) compared to having a diagnosis of COVID alone (aOR 1.19, 95% CI 1.04–1.35); Conclusions: Our study highlights the health disparities experienced during hospitalizations by pediatric patients with ASD and COVID-19. Further studies should address barriers and support health outcomes for pediatric patients with ASD.

Expression of Salivary miRNAs, Clinical, and Demographic Features in the Early Detection of Gastric Cancer: A Statistical and Machine Learning Analysis.

Gastric cancer ranks as one of the top five deadliest cancers worldwide and is often diagnosed at late stages. Analysis of saliva may provide a non-invasive approach for detection of malignancies in organs associated with the oral cavity. This research aims to analyze salivary microRNA expression together with clinical and demographic features with the aim of diagnosing gastric cancer. The study included 19 patients with early-stage gastric cancer and 19 healthy controls. Saliva samples were collected and processed for RNA isolation. Salivary expression of miR-223-3p and miR-21-5p were measured using quantitative reverse-transcription polymerase chain reaction (RT-qPCR). Receiver operating characteristic (ROC) curves were generated to evaluate the accuracy of diagnostic models. Machine learning algorithms, multiple logistic regression, and principal component analysis (PCA) were used to assess the predictive power of miRNAs in conjunction with clinical-demographic features. Significant upregulation of miR-223-3p and downregulation of miR-21-5p in saliva were observed in patients with gastric cancer. The area under ROC curve (AUC) values for salivary miR-21-5p, salivary miR-223-3p, and their multiple logistic regression were determined to be 0.723, 0.791, and 0.850, respectively. The AUC for multiple logistic regression model was 0.919. The PCA model led to the highest diagnostic odds ratio (DOR) of 134.33 (sensitivity = 0.785, specificity = 1.00, AUC = 903). Application of machine learning methods, and in particular a random forest algorithm, showed high accuracy in diagnosing patients with gastric cancer (sensitivity = 1.00, specificity = 0.857, AUC = 0.93). The application of validated salivary diagnostics in clinical practice could help facilitate earlier diagnosis of gastric cancer and improve medical outcome. Expression of miR-21 and miR-223-3p in saliva together with clinical and demographic features, appears promising in screening for GC.

Indian Hedgehog (IHh) Protein and COX-2 as Biomarkers to Define the Mechanism of Epilepsy and Gastrointestinal Problems as Comorbid Medical Illnesses in Autism Spectrum Disorder: Combining ROC Curves to Improve Diagnostic Values

Background/Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is increasing throughout the world. Nevertheless, no specific diagnostic or even risk assessment marker is available. Combining more than one marker can improve the diagnostic value of each marker alone and maximize the AUC for ROC curve. Hedgehog (Hh) signaling modulates both intestinal inflammation and immunity. Cyclooxygenase-2 (COX-2) is required for inflammation, and it has been related to epileptic seizures. COX-2 generates prostaglandins-EP2 (PGE2) in the brain, which plays a major role in neuropathology and epilepsy. This study aims to understand the pathophysiology of ASD by investigating the diagnostic value of COX-2 and IHh using independent and combined ROC curves. Methods: COX-2 and IHh were measured in 40 children with ASD and 41 age and sex-matched controls using ELISA. Statistical analyses were performed using ROC curves, odds ratios, and multiple logistic regression models. Results: Higher levels of COX-2 and IHh were observed in the plasma of patients with autism than in controls. The ROC curve of HIh and COX-2 independently showed poor and fair AUCs of 0.662 and 0.776, respectively, while the combined ROC for both variables in relation to the control group increased the AUC = 0.831 significantly (p &lt; 0.001). Conclusions: Thus, combining these variables could be a useful diagnostic marker for ASD.

Oxidative stress mediates the association of organophosphate flame retardants with metabolic obesity in U.S. adults: A combined epidemiologic and bioinformatic study

Obesity is a global public health issue, with limited epidemiologic studies on the relationship and mechanisms between organophosphate flame retardants (OPFRs) and metabolic obesity phenotypes (MOPs). We aimed to explore the link between OPFRs metabolite (m-OPFRs) and MOPs using a combined epidemiologic and bioinformatic approach. We used cross-sectional survey data from the U.S. National Health and Nutrition Examination Survey (2011–2018) to analyze the relationship between m-OPFRs and metabolic health obesity (MHO), as well as metabolic unhealthy obesity (MUO). The dataset encompasses eligible adults to assess the impact of individual, mixed, and mediated effects on the outcome variables through multivariate logistic regression, Bayesian kernel machine regression (BKMR), and mediation analysis. Multiple logistic regression models, stratified by tertiles of exposure showed that bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) levels in the body significantly increased the risk of MHO, with OR and 95%CI of 1.454 (1.082, 1.953) for the second tertile (T2) and 1.598 (1.126, 2.268) for the third tertile (T3), compared to the first tertile (T1). Increased levels of BDCIPP in T3 (1.452(1.013, 2.081)) are associated with MUO, compared to T1. Mixed m-OPFRs and MHO risk in BMKR were positively correlated, with BDCIPP being the primary contributor. We found that the serum uric acid (SUA) and white blood cell count (WBC) indicators significantly mediated the association between BDCIPP and MHO (P < 0.05). Our study suggests that OPFRs, either individual or mixed, are associated with two distinct MOPs, with oxidative stress playing an important role. In addition, in silico analysis was used to screen for shared genes, and eight shared genes and eleven biological pathways identified during the screening process were used to construct the adverse outcome pathway, which suggests that exposure to OPFRs may activate the peroxisome proliferator-activated receptor (PPAR) pathway, thereby increasing the risk of obesity. Further studies are needed to validate our findings.

COVID-19 pandemic: mental health (distress as depression) in orthodontists

ABSTRACT Objectives For health professionals, pandemic conditions impacted all societal aspects, including economic, wellness, and mental health. This study analysed sociodemographic factors, post-traumatic stress disorder symptoms (PTSD), and depression levels caused by the coronavirus disease 2019 (COVID-19) pandemic in orthodontists. Materials and Methods A sociodemographic questionnaire, the Impact of Event Scale (IES), and the Patient Health Questionnaire (PHQ-9) were used. Following data collection, multiple statistical analyses were applied: scores were compared using the Mann-Whitney and Kruskal-Wallis tests, followed by Dunnett's multiple comparisons. The association between variables was verified using Chi-square or likelihood ratio tests. Multiple logistic regression models were estimated after bivariate logistic regression tests (p < 0.10). The final models using the Stepwise backward selection method were assessed for variables at 5%. Results Of the respondents, 69.3% were women, and their mental health questionnaire scores were significantly higher (p < 0.001). The IES avoidance and PHQ-9 scores were statistically different between the age groups (p = 0.040 and p < 0.001, respectively). Subjective distress was associated with years of practice, monthly income, fear of contracting COVID-19 during dental care, transmitting COVID-19 to patients, and thinking about the future (p < 0.05). Depression was significantly associated with orthodontic practice type, self-confidence in providing dental care, pandemic impact on dental practice, remote care, monthly income, changes in financial expenses, fear of contracting COVID-19 and thinking about the future (p < 0.05). Conclusion Over half of the orthodontists experienced moderate-to-severe mental distress, and the same number suffered from mild-to-severe depression during the pandemic. Registration: Ethics and Research Committee (CEP) of the Faculty of Dentistry of the University of São Paulo (FOUSP): CAAE: 34223720.1.0000.0075 Protocol: 4.191.353

The relationship between comorbidity factors and in-hospital mortality in patients with carbapenem-resistant Klebsiella pneumoniae pneumonia

This study aimed to explore the relationship between comorbidity factors and in-hospital mortality related to factors in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) pneumonia. This study collected clinical data from 218 patients with CRKP pneumonia in Beijing hospital from November 2011 to December 2023, analyzed the number of comorbidities carried by CRKP pneumonia patients, comorbidity patterns, Charlson Comorbidity Index (CCI) scores, and comorbidity of underlying diseases, and explored the relationship between various indicators and comorbidity factors and in-hospital mortality in CRKP pneumonia patients. The Ward.D cluster analysis was performed on the comorbidities of patients and used to draw heatmaps. Using a multiple logistic regression model, a nomogram model was constructed to predict in-hospital mortality in patients with CRKP pneumonia. This study included 218 patients with CRKP pneumonia. The results showed that there were significant differences in the age (P=0.003), comorbidities such as heart failure (P<0.001), arrhythmia (P=0.002), chronic liver disease (P=0.003), chronic kidney disease (P=0.002), CCI score (P=0.007), total number of comorbidities (P<0.001), and comorbidity patterns (respiratory/immune/psychiatric disease patterns and cardiovascular/tumor/metabolic disease patterns, P=0.003) between the survival and death groups of CRKP pneumonia patients. The multiple logistic regression showed that cardiovascular/tumor/metabolic disease patterns (P=0.030), CCI score (P=0.040), concomitant heart failure (P=0.011), and concomitant arrhythmia (P=0.025) were independent risk factors for in-hospital mortality in patients with CRKP pneumonia. The nomogram model for predicting the risk of in-hospital mortality in patients with CRKP pneumonia, constructed based on the identified risk factors, had an area under the ROC curve of 0.758. Both the ROC curve and validation curve indicated that the nomogram model had stable performance in predicting in-hospital mortality in patients with CRKP pneumonia. In summary, comorbidity factors are risk factors for predicting in-hospital mortality in patients with CRKP pneumonia, and the role of comorbidity factors in in-hospital mortality in patients with CRKP pneumonia should be taken seriously.

Cross-sectional analysis of the association between information and communication technology and mental health among Korean workers.

The adoption of information and communication technology (ICT) has been the fastest and most widespread in the South Korean workplace. While ICT has several advantages, it can also cause stress among workers. However, the relationship between the introduction of ICT in the workplace and mental health problems among Korean workers remains unclear. We conducted a cross-sectional analysis of data obtained from the sixth Korean Working Conditions Survey (KWCS). In total, 40,019 participants answered a question about whether ICT had been introduced in their workplace. Among these, we compared the rate of complaints of mental health disorders between those who answered "yes" (n = 3,250) and those who answered "no" (n = 36,769). We analyzed the data using the SAS statistical software and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) for anxiety, insomnia, and depression using multiple logistic regression models. We also stratified the data on Korean workers to assess the impact of ICT on subgroups. In our nationally representative cohort, on experiencing ICT incorporation at work, 384 participants (11.8%) reported anxiety, 138 (4.2%) reported insomnia, and 296 (9.1%) reported depression. In contrast, among participants who did not have access to ICT, 1,929 (5.2%) reported anxiety, 702 (1.9%) reported insomnia, and 4,404 (12.0%) reported depression. The ORs (95% CIs) for anxiety and insomnia complaint rates were 2.47 (2.19-2.79) and 2.55 (2.10-3.10), respectively, among workers who experienced new ICT adaptations in comparison with those who did not. However, no significant relationship was observed between ICT adoption and depression. The causes of mental health problems in the workplace should be identified and addressed. We found that the introduction of ICT in the workplace was significantly related to anxiety and insomnia symptoms among Korean workers, after controlling for the selected covariates. This information can be used to identify subgroups in the workplace that are vulnerable to ICT changes and tailor interventions to their social and demographic profiles.

Effectiveness of synchronous teledentistry consultations in facilitating treatment compliance of rural pediatric patients

BackgroundLimited access to pediatric oral health care in rural US areas is a substantial dental public health problem. In 2010, the Eastman Institute for Oral Health at the University of Rochester, initiated a synchronous teledentistry program to enhance oral health screenings, treatment planning, and treatment completion for rural pediatric patients who reside in the Western region of New York. MethodsData from dental records of all pediatric patients who were participants in the teledentistry program from its inception on April 13, 2010 through December 31, 2022, were reviewed. Multiple logistic regression models were used to study the association between treatment compliance rate and age, sex, treatment modality, and impact of the COVID-19 pandemic. ResultsData from the dental records of 1,168 children were reviewed. Nine hundred fifty-four children (81.6%) completed the recommended treatment within 6 months of synchronous teledentistry consultation. Treatment completion rates varied significantly according to treatment modality. In-office consultation had the highest rate (96.8%), followed by oral sedation (89.7%) and operating room treatment (89.5%). Nitrous oxide (66.7%) had the lowest rate (P < .0001). Children recommended for nitrous oxide anxiolysis had the lowest odds of completing treatment (odds ratio, 0.25; 95% CI, 0.18 to 0.36; P < .0001) compared with other treatment modalities. Being older decreased the likelihood of completing treatment (odds ratio, 0.92; 95% CI, 0.85 to 0.99; P = .02). The COVID-19 pandemic did not significantly affect compliance rates. ConclusionsSynchronous teledentistry consultations with rural pediatric patients and their guardians or caregivers can effectively facilitate treatment completion for children with complex treatment needs in underserved areas. Practical ImplicationsSynchronous teledentistry is a practical adjunct tool to be considered in dental offices.

Serum Low-Density Lipoprotein Cholesterol Levels are Associated with Relapse in Neuromyelitis Optica Spectrum Disorder.

The relationship between serum low-density lipoprotein cholesterol (LDL-C) and the risk of relapse in neuromyelitis optica spectrum disorder (NMOSD) remains uncertain. We aimed to examine the association between serum LDL-C level and relapse in NMOSD patients. We conducted an analysis of the prospective observational NMOSD cohort study with consecutive 184hospitalized NMOSD patients from department of neurology. Blood samples were collected to measure LDL-C level upon admission. Primary and relapse were evaluated during hospitalization. The relationship between serum LDL-C level and relapse were analyzed by linear curve fitting analyses. Crude and adjusted odds ratios (OR) of LDL-C for relapse with 95% confidence intervals were analyzed using multiple logistic regression models. ROC curve analysis was used to identify the target lipid-lowering value of LDL-C and the probability of relapse was evaluated by the Kaplan-Meier Plot. Over a mean disease course of 100±87 days, 59.24% (n=109) participants developed relapse with higher LDL-C than the primary group (n=75) (p<0.001). Adjusted smoothed plots suggested that there were linear relationships between serum LDL-C level and relapse (p< 0.001). The OR (95% CI) between serum LDL-C level and relapse were 2.67 (1.76-4.04, p<0.001), and 2.38 (1.48-3.83, p<0.001) respectively in NMOSD patients before and after adjusting for potential confounders. The target LDL-C lowering values were 2.795mmol/L with potential benefits to prevent relapse in NMOSD. In this sample of NMOSD patients, we found that the elevated serum LDL-C was independently and positively associated with the relapse, and serum LDL-C should be well-controlled to prevent the relapse of NMOSD.

Comparing methods for risk prediction of multicategory outcomes: dichotomized logistic regression vs. multinomial logit regression

BackgroundMedical outcomes of interest to clinicians may have multiple categories. Researchers face several options for risk prediction of such outcomes, including dichotomized logistic regression and multinomial logit regression modeling. We aimed to compare these methods and provide guidance needed for practice.MethodsWe described dichotomized logistic regression, multinomial continuation-ratio logit regression, which is an alternative to standard multinomial logit regression for ordinal outcomes, and logistic competing risks regression. We then applied these methods to develop prediction models of survival and neurodevelopmental outcomes based on the NICHD Extremely Preterm Birth Outcome Tool model. The statistical and practical advantages and flaws of these methods were examined. Both discrimination and calibration of the estimated logistic models of dichotomized outcomes and continuation-ratio logit model were assessed.ResultsThe dichotomized logistic models and multinomial continuation-ratio logit model had similar discrimination and calibration in predicting death and survival without neurodevelopmental impairment. But the continuation-ratio logit model had better discrimination and calibration in predicting neurodevelopmental impairment. The sum of predicted probabilities of outcome categories from the dichotomized logistic models could deviate from 100% substantially, ranging from 87.7 to 124.0%, and the dichotomized logistic model of neurodevelopmental impairment greatly overpredicted low risks and underpredicted high risks.ConclusionsEstimating multiple logistic regression models of dichotomized outcomes may result in poorly calibrated predictions for an outcome with multiple ordinal categories. Multinomial continuation-ratio logit regression produces better calibrated predictions, constrains the sum of predicted probabilities to 100%, and has the advantages of simplicity in model interpretation, flexibility to include outcome category-specific predictors and random-effect terms for patient heterogeneity by hospital. It also accounts for mutual dependence among multiple categories and accommodates competing risks.

Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden.

Physical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day). A cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time. The study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time. In this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA.

Investigating the Risk Factors Associated With Acute Neurologic Dysfunction in Pediatric Hyperglycemic Emergencies on Transport.

This study aims to identify key characteristics of hyperglycemic emergencies in pediatric patients and those at risk for acute neurologic dysfunction during transport. We conducted a retrospective chart review of pediatric patients during interfacility transport by Ornge, Ontario's critical care transport service, from January 1, 2009, to December 31, 2019. Data were extracted from electronic patient care records and included demographic, clinical, and transport-specific variables. Two multiple logistic regression models were utilized to analyze associations between predictor variables and neurologic dysfunction (GCS, <14). Of the 399 patients included, 24% (n = 95) had a GCS score of <14. Patients with a GCS score of <14 were more acidotic compared with those with a GCS score of ≥14 (median pH, 6.9 [IQR, 6.8-7.1] vs median, pH 7.0 [IQR, 1.0-7.2]; P < 0.001). Higher median corrected sodium for glucose values were observed in patients with a GCS score of <14 compared to those with a GCS score of ≥14 (145.7 mmol/L [IQR, 140.6-149.9 mmol/L] vs 141.7 mmol/L [IQR, 138.3-146.4 mmol/L]; P < 0.001). Multiple logistic regression identified younger age (aOR, 0.91; 95% CI, 0.84-0.98; P = 0.01), severe acidosis (pH <7.10; aOR, 3.56; 95% CI, 1.33-11.62; P = 0.02), and higher creatinine (aOR, 1.01; 95% CI, 1.01-1.02; P < 0.001) as risk factors for acute neurologic dysfunction. Our findings reveal associations between acute neurologic dysfunction, younger age, severe acidosis, and elevated corrected sodium for glucose values in pediatric hyperglycemic emergencies during transport. Education and adherence to guidelines are recommended to improve outcomes in this population.

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.

Association of body roundness index with female infertility: 2013-2018 NHANES.

This study aims to understand the association between body roundness index (BRI) and female infertility prevalence. Infertility is a public health concern with significant implications for individuals' well-being and rights. All individuals who completed the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018 were initially included in this cross-sectional study. Following the screening, 2,777 eligible participants were selected for analysis from the original pool of 10,375 participants. Trained operators conducted anthropometric measurements, including height, weight, and waist circumference. The BRI was then calculated based on established research. Data from infertility status questionnaires were gathered from the NHANES database for all participants, with self-reported infertility serving as the study outcome. Multivariable logistic regression and restricted cubic splines (RCS) were employed to investigate the relationship between BRI and infertility. Subgroup analyses were also conducted to further explore the association between BRI and infertility. Upon analyzing the baseline characteristics of all women in the study, notable distinctions were identified in the clinical and demographic features between fertile and infertile women. Our investigation revealed a positive correlation between BRI and the likelihood of infertility in both weighted and unweighted multiple logistic regression models. Additionally, BRI exhibited a significant association with infertility in both continuous and categorical forms. Utilizing RCS curves, we noted a linear escalation in the prevalence of infertility with rising BRI values. Subgroup analyses provided further clarity on these observations. Our study demonstrates a statistically significant positive correlation between BRI and the prevalence of infertility across diverse populations, suggesting potential implications for infertility prevention and treatment. Future prospective cohort studies will explore this association and understand the underlying mechanisms.

Heart Rate Variability and Cerebral Autoregulation in Patients with Traumatic Brain Injury with Paroxysmal Sympathetic Hyperactivity Syndrome.

Severe traumatic brain injury (TBI) can lead to transient changes in autonomic nervous system (ANS) functioning and development of paroxysmal sympathetic hyperactivity (PSH) syndrome. Clinical manifestation of ANS disorders may be obscured by therapeutic interventions in TBI. This study aims to analyze ANS metrics and cerebral autoregulation in patients with PSH syndrome to determine their significance in early prognostication. This single-center retrospective study investigated the relationship between changes in ANS metrics, cerebral autoregulation, and PSH syndrome. Arterial blood pressure and intracranial pressure signals were monitored for 5 days post TBI. ANS metrics included time and frequency domain heart rate variability (HRV) metrics. Cerebral autoregulation was assessed using the pressure reactivity index. Sixty-six patients with severe TBI (median age 33 [interquartile range 26-50] years) were analyzed, and PSH was confirmed in nine cases. Impairment of cerebral autoregulation was observed in 67% of patients with PSH and 72% without the syndrome. Patients with PSH had higher HRV in the low-frequency range (LF; 253 ± 178 vs. 176 ± 227 ms2; p = 0.035) and lower heart rates (HRs; 70 ± 7 vs. 78 ± 19 bpm; p = 0.027) compared to those without PSH. A receiver operating characteristic curve analysis indicated that HR (area under the curve(AUC) = 0.73, p = 0.006) and HRV in the LF (AUC = 0.70, p = 0.009) are moderate predictors of PSH. In the multiple logistic regression model for PSH, diffuse axonal trauma (odds ratio(OR) = 10.82, 95% confidence interval(CI) = 1.70-68.98, p = 0.012) and HR (OR =0.91, 95% CI 0.84-0.98, p = 0.021) were significant factors. Elevated HRV in the LF and decreased HR may serve as early predictors of PSH syndrome development, particularly in patients with diffuse axonal trauma. Further research is needed to investigate the utility of the cerebral autoregulation-ANS relationship in PSH prognostication.

Geographic variation in kidney failure and transplantation in Aotearoa New Zealand: A population-based data linkage study.

This study aimed to describe the epidemiology of kidney replacement therapy (KRT) in Aotearoa New Zealand and assess the impact of residential location on access to kidney transplantation. AcceSS and Equity in Transplantation (ASSET), a health-linked data platform, was used to identify people commencing KRT in New Zealand from 2006 to 2019 and analyse regional epidemiology. Health services were classified as 'transplanting', 'intermediate' or 'remote' depending on their degree of separation from a transplant centre. Multiple logistic regression modelling was used to assess the predictors of deceased donor waitlisting or living donor transplantation within 6 months after starting KRT. Web-based mapping software was used to develop interactive geospatial maps. The cohort was 7704 people newly starting KRT. Living in an intermediate [odds ratio (OR): 0.73 (95% confidence interval (CI): 0.61-0.88)] or remote [OR: 0.38 (95% CI: 0.27-0.54)) region and Māori (OR: 0.35 (95% CI: 0.28-0.44)], Pacific [OR: 0.32 (95% CI: 0.24-0.42)) and Asian (OR: 0.66 (95% CI: 0.50-0.87)] ethnicity were associated with a decreased likelihood of timely waitlisting or transplantation. Regional maps can be explored here. There is marked geospatial and ethnic variation in the epidemiology of kidney failure and access to kidney transplantation across New Zealand. Geospatial mapping of kidney failure epidemiology and transplantation outcomes can provide opportunities to direct resources towards populations at greatest need.

Food insecurity is associated with poor mental health and health risk behaviors in Czechia

Abstract Background Food insecurity (FI) is one of social determinants of health and a profound public health concern because it leads to malnutrition and hence poor health. COVID-19 impacted people disproportionately and exacerbated preexisting social and health inequalities. The aim of this study was to understand how socioeconomic and health conditions affected one’s FI in Czechia during the pandemic using a representative panel of Czech adults from a longitudinal survey, Life During the Pandemic collected in October 2022 as part of a Czech longitudinal survey. Methods A study sample of 1,499 respondents was included in our multiple logistic regression models. Depressive symptoms and anxiety symptoms were assessed using validated questionnaires PHQ-2 and DAG-2. Results Approximately one third of the study sample (32.4%) reported being food insecure. In the fully-adjusted model, adults with depressive symptoms (OR 2.37, CI 1.49, 5.02), problems with sleeping (OR 2.20, CI 1.64, 2.96), smoking habit (OR 2.27, CI 1.68, 3.07), lower fruit and vegetable consumption (OR 1.50, CI 1.04, 2.17) had greater odds of experiencing FI. The lowest income group was associated with 6.2 times greater odds of reporting FI as compared to the high-income group (CI 3.96, 9.67). Lower education attainment also had higher odds of experiencing FI (OR 2.15, CI 1.40, 3.31). Anxiety was not a significant predictor for FI. Conclusions Our study highlights that food insecurity is associated with depressive symptoms, poor quality of sleep and lower consumption of fruit and vegetables among adults. Food insecurity was also evident among lower income and lower education attainment. Funding source This study was supported by The Charles University Grant Agency (GA UK). Key messages • Our study suggests that adults with poor mental health and diet quality experience food insecurity. • Given the established link between a balanced diet and mental well-being, interventions should encompass not only food security but also the quality of dietary intake.