Multiple Variable Logistic Regression Models Research Articles

Early therapeutic drug monitoring of methotrexate and its association with acute kidney injury: A retrospective cohort study.

High-dose methotrexate (HDMTX) use can be limited by the development of acute kidney injury (AKI). Early AKI detection is paramount to prevent further renal injury and irreversible toxicities. This study sought to determine whether early elimination patterns of MTX would be useful as a biomarker of AKI in HDMTX treatment. This retrospective cohort study included two sites that collected ≥2 MTX levels within 16 h from completion of MTX infusion. Early levels were tagged and MTX elimination half-life (t½) were calculated from combinations of two of three different early time periods. Receiver operating characteristic (ROC) curves were synthesized for each elimination t½ (biomarker) with respect to AKI and delayed methotrexate elimination (DME); the biomarker with the highest area under the ROC curve (AUC) was tested in a multiple variable logistic regression model. Data from 169 patients who received a total of 556 courses of HDMTX were analyzed. ROC analysis revealed MTX elimination t½ calculated from the second and third time periods had the highest AUC for AKI at 0.62 (interquartile range [IQR] 0.56-0.69) and DME at 0.86 (IQR 0.73-1.00). After adjusting for age, sex, dose (mg/m2), infusion duration, HDMTX course, and baseline estimated glomerular filtration rate, it remained significant for AKI with an OR of 1.29 and 95% confidence interval of 1.03-1.65. Early MTX elimination t½ measured within 16 h of infusion completion was significantly associated with the development of AKI and serves as an early clearance biomarker that may identify patients who benefit from increased hydration, augmented leucovorin rescue, and glucarpidase administration.

Establishing a novel model to assess exercise capacity in chronic heart failure based on stress echocardiography.

The aim of this study was to develop a simple, fast and efficient clinical diagnostic model, composed of exercise stress echocardiography (ESE) indicators, of the exercise capacity of patients with chronic heart failure (CHF) by comparing the effectiveness of different classifiers. Eighty patients with CHF (aged 60±11years; 78% male) were prospectively enrolled in this study. All patients underwent both cardiopulmonary exercise test (CPET) and ESE and were divided into two groups according to the VE/VCO2 slope: 30 patients with VE/VCO2 slope ventilation classification (VC)1 (i.e., VE/VCO2 slope<30) and 50 patients with VC2 (i.e., VE/VCO2 slope≥30). The analytical features of all patients in the four phases (rest, warm-up, peak and recovery phases) of ESE included the following parameters: left ventricular (LV) systolic function, LV systolic function reserve, LV diastolic function, LV diastolic function reserve and right ventricular function. Logistic regression (LR), extreme gradient boosting trees (XGBT), classification regression tree (CART) and random forest (RF) classifiers were implemented in a K-fold cross-validation model to distinguish VC1 from VC2 (LVEF in VC1 vs. VC2: 44±8% vs. 43±11%, P=0.617). Among the four models, the LR model had the largest area under the curve (AUC) (0.82; 95% confidence interval [CI]: 0.73 to 0.92). In the multiple-variable LR model, the differences between the peak-exercise-phase and resting-phase values of E (ΔE), s'peak and sex were strong independent predictors of a VE/VCO2 slope≥30 (P value: ΔE=0.002, s'peak=0.005, sex=0.020). E/e'peak, ΔLVEF, ΔLV global longitudinal strain and Δstroke volume were not predictors of VC in the multivariate LR model (P>0.05 for the above). Compared with the LR, XGBT, CART and RF models, the LR model performed best at predicting the VE/VCO2 slope category of CHF patients. A score chart was created to predict VE/VCO2 slopes≥30. ΔE, s'peak and sex are independent predictors of exercise capacity in CHF patients.

DO seniors and IMGs have lower match probabilities than MD seniors after adjusting for specialty choice and USMLE Step 1 score.

It is unknown if US residency applicants of different educational backgrounds (US allopathic [MD], Doctor of Osteopathic Medicine [DO], and international medical graduates [IMG]) but comparable academic performance have similar match success. Our objective was to compare match probabilities between applicant types after adjusting for specialty choice and United States Medical Licensing Examination (USMLE) Step 1 scores. We performed a secondary analysis of published data in National Resident Matching Program (NRMP) reports from 2016, 2018, 2020, and 2022 for US MD seniors, DO seniors, and IMGs (US citizens and non-US citizens). We examined the 10 specialties with the most available spots in 2022. Average marginal effects from a multiple variable logistic regression model were utilized to estimate each non-MD senior applicant type's probability of matching into their preferred specialty compared to MD seniors adjusting for specialty choice, Step 1 score, and match year. Each non-MD applicant type had a lower adjusted percent difference in matching to their preferred specialty than MD seniors,-7.1 % (95 % confidence interval [CI],-11.3 to-2.9) for DO seniors,-45.6 % (-50.6 to-40.5) for US IMGs, and-56.6 % (-61.5 to-51.6) for non-US IMGs. Similarly, each non-MD applicant type had a lower adjusted percent difference in matching than MD seniors across almost all Step 1 score ranges, except for DO seniors with Step 1 scores <200 (-2.0 % [-9.5 to 5.5]). After adjusting for specialty choice, Step 1 score, and match year, non-US MD applicants had lower probabilities of matching into their preferred specialties than their US MD colleagues.

Prevalence and Associated Factors of Hyperbilirubinemia Among Neonates Admitted to Neonatal Intensive Care Unit of Saint Peter Specialized Hospital, Addis Ababa, Ethiopia

<i>Introduction</i>: Neonatal hyperbilirubinemia is a widespread and significant clinical problem among neonates worldwide. Globally, every year about 1.1 million babies develop it and the vast majority resides in developing countries like Ethiopia. It is a major cause of hospital neonatal intensive care unit admission and readmissions during the neonatal period. As far as our knowledge is concerned there is no such study conducted in St. peter specialized hospital so far. Hence the objective of this study is to determine Prevalence and associated factors of hyperbilirubinemia among neonates admitted to neonatal intensive care unit of Saint Peter Specialized Hospital, Addis Ababa, Ethiopia from January, 1/2022 to January 1, 2023. <i>Methods</i>: A Facility based Retrospective cross sectional study was conducted among one hundred forty two (142) neonates admitted at St. peter specialized hospital by using systematic random sampling technique. Data on socio-demographic characteristics and, potential associated factors for hyperbilirubinemia were collected by a structured data extraction checklist. For this study, a total serum bilirubin level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia. Data entry was done by EPI info version 7, and analyzed using SPSS version 23.0. Binary logistic and multiple variable logistic regression models were used to identify associated factors. Association between were considered statistically significant only if A two-sided P-value <0.05 at 95% confidence level. <i>Result</i>: A total of 142 neonates were included in the study making response rate 100%. The overall prevalence of neonatal hyperbilirubinemia was 35 (24.6 %) with (95% CI: 17.6-31.7). Among several possible factors: Being male sex [AOR]:7.7, 95%CI (1.88, 32.1)], Birth trauma [AOR]: 17, 95%CI (3.8, 76.6), neonatal sepsis [AOR]: 10.9, 95%CI (2.9, 41.79)] and ABO incompatibility [AOR]: 22, 95%CI (4.7, 102.05)] were independent determinants of neonatal hyperbilirubinemia. <i>Conclusion and recommendation</i>: The prevalence of Neonatal Hyperbilirubinemia was quite high. Among identified associated factors for hyperbilirubinemia in this study: neonatal sex, Birth trauma, Sepsis and ABO incompatibility were the leading cause. Hence Health care provider working at NICU should undergo routine screening and investigations for TSB are imperative for early detection and timely intervention.

Association Between Fuchs Endothelial Corneal Dystrophy, Diabetes Mellitus, and Multimorbidity.

The aim of this study was to assess risk for demographic variables and other health conditions that are associated with Fuchs endothelial corneal dystrophy (FECD). We developed a FECD case-control algorithm based on structured electronic health record data and confirmed accuracy by individual review of charts at 3 Veterans Affairs (VA) Medical Centers. This algorithm was applied to the Department of VA Million Veteran Program cohort from whom sex, genetic ancestry, comorbidities, diagnostic phecodes, and laboratory values were extracted. Single-variable and multiple variable logistic regression models were used to determine the association of these risk factors with FECD diagnosis. Being a FECD case was associated with female sex, European genetic ancestry, and a greater number of comorbidities. Of 1417 diagnostic phecodes evaluated, 213 had a significant association with FECD, falling in both ocular and nonocular conditions, including diabetes mellitus (DM). Five of 69 laboratory values were associated with FECD, with the direction of change for 4 being consistent with DM. Insulin dependency and type 1 DM raised risk to a greater degree than type 2 DM, like other microvascular diabetic complications. Female sex, European ancestry, and multimorbidity increased FECD risk. Endocrine/metabolic clinic encounter codes and altered patterns of laboratory values support DM increasing FECD risk. Our results evoke a threshold model in which the FECD phenotype is intensified by DM and potentially other health conditions that alter corneal physiology. Further studies to better understand the relationship between FECD and DM are indicated and may help identify opportunities for slowing FECD progression.

FACTORS IMPACTING SUCCESSFUL REHABILITATION OF BIG BROWN BATS (EPTESICUS FUSCUS) IN A WISCONSIN WILDLIFE REHABILITATION CENTER: A 5-YEAR RETROSPECTIVE.

The big brown bat (Eptesicus fuscus; EPFU) is widely distributed throughout the Americas and plays critical roles in sustaining cave ecosystems and abating agricultural pests. In Wisconsin, EPFU is a threatened species with declining populations due to hibernacula disturbances, wind turbines, and habitat destruction. Due to their ecological and economic value, it is important to be able to release EPFU that enter wildlife rehabilitation centers back to the wild. This study evaluated the medical records of 454 EPFU (275 male, 179 female) admitted to a wildlife rehabilitation center in Wisconsin from 2015 to 2020. For each bat, the season at intake, examination findings, length of time in rehabilitation, and final outcome (released or not released) were recorded. Using a multiple variable logistic regression model, there was a statistically significant positive association between length of time in the rehabilitation center and likelihood of release (odds ratio [OR] 1.08; 95% CI 1.06-1.12); this association can be explained by the need to overwinter some otherwise healthy bats in rehabilitation during hibernation. The following examination findings were associated with a significantly lower likelihood of release: wing injury (OR 0.32; 95% CI 0.10-0.89) and decreased body condition (OR 0.29; 95% CI 0.12-0.64). When corrected for time spent in rehabilitation (potentially artificially lengthened due to hibernation), patients admitted in the summer and fall were less likely to be released than those admitted in the winter (OR 0.93; 95% CI 0.90-0.96 and OR 0.95; 95% CI 0.92-0.97, respectively). The results of this study can be used to help veterinarians and licensed rehabilitators better triage EPFU during admission to wildlife rehabilitation centers in order to improve management and promote successful release back to the wild.

Does obesity related eating behaviors only affect chronic diseases? A nationwide study of university students in China

The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.

Circulating plasma phospholipid fatty acid levels and breast cancer risk in the Cancer Prevention Study-II Nutrition Cohort.

Prospective studies that objectively measure circulating levels of fatty acids are needed to clarify their role in the etiology of breast cancer. Thirty-eight phospholipid fatty acids were measured using gas chromatograph in the plasma fraction of blood samples collected prospectively from 2718 postmenopausal women (905 breast cancer cases) enrolled in the Cancer Prevention Study II Nutrition Cohort. Associations of 28 fatty acids that passed quality control metrics (modeled as per 1-SD increase) with breast cancer risk were assessed using multiple variable conditional logistic regression models to compute odds ratios (OR) and 95% confidence intervals (CI). The false discovery rate (q value) was computed to account for multiple comparisons. Myristic acid levels were positively associated with breast cancer risk (OR, 1.17, 95% CI: 1.07-1.28; q value=0.03). Borderline associations were also found for palmitoleic acid (OR, 1.14, 95% CI: 1.04-1.24) and desaturation index16 (OR, 1.10, 95% CI: 1.01-1.20) at nominal P values (<.03) (q values>0.05). These findings suggest that higher circulating levels of myristic acid, sourced from dietary intake of palm kernel oils along with increased de novo synthesis of fatty acids, may increase breast cancer risk. Additional studies are needed to investigate de novo synthesis of fatty acid in breast cancer tissues.

Patient Personality and Illness Perceptions in Relation to Follow-Up Appointment Adherence in Neuro-Ophthalmology.

Improving patient attendance at medical follow-up visits may have a notable impact on disease and overall health outcomes. Understanding factors contributing to poor attendance is important for identifying at-risk patients and designing interventions to improve clinical outcomes. Our objective was to identify personality and illness perception factors associated with attendance at recommended follow-up visits in a neuro-ophthalmology practice. New or established patients (≥18 years) with scheduled neuro-ophthalmology (study) or glaucoma (comparison) appointments at a tertiary care academic medical center completed the Brief Illness Perception Questionnaire and Ten-Item Personality Inventory. Physician recommendations made during the visit were recorded (medications, referrals, follow-up, testing, and procedures). A chart review was performed 18 months after enrollment to assess attendance at follow-up appointment and adherence with other physician recommendations. Multiple variable logistic regression models studied associations between follow-up appointment attendance and demographic factors, appointment factors, and survey responses. Among 152 respondents (97% response rate (152 of 157), aged 19-97 years, 58% female, 34% new, 80 neuro-ophthalmology, 72 glaucoma), neuro-ophthalmology subjects were younger, more likely to be White, non-Hispanic, female and new to the practice than subjects with glaucoma. They reported higher emotional impact, identity, and consequences related to their illness (P = 0.001-0.03). Neuro-ophthalmology physician recommendations included more referrals to other services (17.5% vs 1.4%, P = 0.001, chi-square) and more radiology studies (15% vs 0%, P = 0.001, chi-square), but fewer follow-up visits (75% vs 97%, P < 0.0005, chi-square). Among those with recommended follow-up visits, neuro-ophthalmology subjects had lower rates of on-time appointment attendance (55% vs 77%, P = 0.009, chi-square). In a multiple variable model, on-time follow-up attendance was associated with shorter recommended follow-up interval (≤90 days, P < 0.0005), established (vs new) patient status at enrollment visit (P = 0.04), and glaucoma (P = 0.08), but not subject demographics, illness perception, or personality factors. Patient demographics, illness perception, and personality traits were not associated with follow-up appointment attendance and therefore unlikely to be useful for identifying patients at risk of being lost to follow-up. New neuro-ophthalmology patients with a follow-up recommended ≥90 days in advance may benefit from targeted interventions to improve follow-up appointment adherence.

SARS-CoV-2 infection in public hospital medical doctors in an Eastern Cape metro.

BackgroundEvidence-based Infection Prevention and Control (IPC) measures are critical in protecting medical doctors from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Concerns surrounding access to personal protective equipment (PPE), compliance with IPC measures and the quality of available PPE have been raised as possible causes for high rates of SARS-CoV-2 infection in medical doctors in high transmission settings. This study aimed to determine the prevalence of SARS-CoV-2 infection and the risk factors for occupational infection in doctors in the hospitals in Nelson Mandela Bay (NMB).MethodsWe conducted a cross-sectional study wherein we electronically surveyed medical doctors in public-sector NMB hospitals from 01 March 2020 to 31 December 2020. We collected demographic, health, occupational and SARS-CoV-2 infection and exposure data. Categorical data were described as proportions and a multiple variable logistic regression model was used to identify risk factors for SARS-CoV-2 infection.ResultsThe survey was distributed amongst 498 doctors, 141 (28%) of whom replied. Forty-three (31%) participants reported that they had tested positive for SARS-CoV-2 during the study period. Eighty-nine participants (64%) reported inadequate access to PPE whilst only 68 (49%) participants adhered to PPE recommendations when interacting with patients with confirmed or suspected SARS-CoV-2 infection. We were unable to identify any significant predictors of SARS-CoV-2 infection.ConclusionThis study demonstrates a high prevalence of SARS-CoV-2 infection in public hospital doctors in NMB. Most participants reported inadequate access to PPE and poor compliance with IPC protocols. These findings suggest an urgent need for the improved implementation of IPC measures to protect doctors from SARS-CoV-2 infection.

SKILLED BIRTH CARE UPTAKE AMONG WOMEN FROM SOCIALLY MARGINALIZED MINORITIES IN THE KAMBATA-TAMBARO ZONE, SOUTHERN ETHIOPIA

Globally in 2019, it was reported that 295,000 women die during pregnancy and childbirth every year. Women from disadvantaged minorties were vulnerable to poor health care and skilled birth care service uptake was low. Thus, this study aimed to assess the prevalence of skilled birth care uptake, and associated factors among women from socially disadvantaged minorities in the Kambeta-Temabaro Zone, Southern Ethiopia. A multistage sampling procedure was employed to enroll 521 study participants. Data were entered using EPI- INFO and SPSS-21 for analysis. Both bivariate and multiple variable logistic regression analyses were applied to determine the association of independent variables with skilled birth care uptake. Those variables with p&lt;0.25 at bivariate logistic regression were booked into the multiple variable logistic regression model. The degree of association between independents and outcome variable was assessed using odds ratios with 95% confidence intervals and variables with a p-value &lt;0.05 were declared statistically significant. The prevalence of skilled birth care service uptake among women from socially disadvantaged minorities was 19%. Maternal education, occupation, awareness of skilled birth care, pregnancy plan, number of births, mothers’ lifestyle, and social subordination were significantly associated with skilled birth care service uptake in the study area. The prevalence of skilled birth service utilization among women from socially disadvantaged minorities was low [19%]. Thus, awareness creation on skilled birth, improving access to education for women, increasing the employability of women, and conducting community forums to avoid social discrimination against minorities are highly recommended.

Hypomineralized Primary Teeth in Preterm Low Birth Weight Children and Its Association with Molar Incisor Hypomineralization-A 3-Year-Prospective Study.

The present prospective study was conducted to assess the prevalence of enamel hypomineralization (EH) in primary dentition among preterm low birth weight (PT-LBW) children, incidence of molar incisor hypomineralization (MIH) in the same cohorts, and to determine associations between PT-LBW, hypomineralization in primary second molars, and MIH. A total of 287 PTLBW study subjects and 290 control full-term normal birth weight subjects were followed up for 36 months. Enamel defects were recorded at baseline. The same cohorts were examined after 3 years for MIH using the European Academy of Paediatric Dentistry (EAPD) criteria. Multiple variable logistic regression models were developed. A total of 279 children (48.4%) presented with EH in primary dentition and 207 (35.9%) children presented with MIH. Children with primary second molar hypomineralization had 2.13 (R2 = 0.19, 95% CI = 0.98–4.19, p = 0.005) times higher frequency of MIH. Children with PT-LBW had 3.02 times (R2 = 0.31, 95% CI = 1.01–5.94, p = 0.005) higher frequency of MIH incidence after adjusting for childhood infection, prenatal history, and presence of hypomineralized primary second molars. To conclude, the present study showed significant association between PT-LBW, hypomineralized second primary molars, and incidence of MIH.

Incidence and predictors of surgical site infection in women who are obese and give birth by elective caesarean section: A secondary analysis.

Surgical site infection (SSI) after a caesarean section is of concern (CS) is of concern to both clinicians and women themselves. The aim of this study is to identify the cumulative incidence and predictors of SSI in women who are obese and give birth by elective CS. The method used was planned secondary analysis of data from women with a pre-pregnancy body mass index (BMI) ≥30kg/m2 giving birth by elective CS in a multicentre randomised controlled trial of a prophylactic closed-incision negative pressure wound therapy dressing. Data were collected from medical records, direct observations of the surgical site and self-reported signs and symptoms from October 2015 to December 2019. The Centers for Disease Control and Prevention definition was used to identify SSI. Women were followed up once in hospital just before discharge and then weekly for fourweeks after discharge. Blinded outcome assessors determined SSI. After the cumulative incidence of SSI was calculated, multiple variable logistic regression models were used to identify independent risk factors for SSI. SSI incidence in 1459 women was 8.4% (122/1459). Multiple variable-adjusted odds ratios (OR) for SSI were BMI ≥40kg/m2 (OR 1.55, 95% confidence interval (CI) 1.30-1.86) as compared to BMI 30-34.9 0kg/m2 , ≥2 previous pregnancies (OR 1.38, 95% CI 1.00-1.80) as compared to no previous pregnancies and pre-CS vaginal cleansing (OR 0.55, 95% CI 0.33-0.99). Our findings may inform preoperative counselling and shared decision-making regarding planned elective CS for women with pre-pregnancy BMI ≥30kg/m2 .

Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay

BackgroundThe COVID-19 pandemic has put considerable strain on healthcare systems.AimTo investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care.MethodsWe compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002–2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression.ResultsThere were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016–2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)—OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor—OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved—OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased.ConclusionA diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.

Assessment for Septic Arthritis in Immunocompetent and Immunocompromised Patients: A Single-Institution Study.

Prompt diagnosis of septic arthritis is imperative to prevent irreversible joint damage. Immunocompromised patients are at an increased risk of septic arthritis as well as secondary systemic infection. Our aims were to identify features predictive of septic arthritis and to determine whether these features differed between immunocompetent and immunocompromised patients. A single institution retrospective cohort study was performed of 173 immunocompetent and 70 immunocompromised patients who underwent aspiration or arthrotomy for suspected septic arthritis from 2010 to 2018. Demographic data, symptoms, laboratory values, and imaging findings were recorded. Multiple variable logistic regression models were used to assess for predictive factors for septic arthritis in both cohorts. Results were reported as odds ratios, 95% confidence intervals, and P values. In the regression analysis, independent predictive factors for septic arthritis in immunocompetent patients were younger age (P = 0.004), presence of radiographic abnormalities (P = 0.006), and C-reactive protein (CRP) (P < 0.001). For immunocompromised patients, only CRP was an independent continuous predictive factor (P = 0.008) for septic arthritis. A risk stratification tool for predicting septic arthritis in immunocompetent patients using age <55 years, CRP >100 mg/dL, and presence of radiographic abnormalities was developed. A similar tool was created using CRP >180 mg/dL and radiographic abnormalities in immunocompromised patients. Differences in predictive factors for septic arthritis between immunocompromised and immunocompetent patients suggest dissimilar clinical presentations. The developed risk stratification tools allow one to predict the likelihood of septic arthritis in both groups. This may permit more accurate selection of patients for surgical intervention in the setting of insufficient data from synovial aspiration.

Bone characteristics and metabolic phenotypes of obesity in an Iranian Elderly population: Bushehr Elderly Health Program (BEHP).

Obesity and osteoporosis are health problems with high impact on the morbidity and mortality rate. While the association between BMI and bone density is known, the combined effects of obesity and metabolic components on bone health have not yet been revealed. The objectives of this study were to determine the association between bone health and different phenotypes of obesity in an elderly population. This cross-sectional study was conducted on the data collected in the Bushehr Elderly Health Program (BEHP). The participants were classified in four groups based on the metabolic phenotypes of obesity (metabolic healthy obese (MHO), metabolic non-healthy non-obese (MNHNO), metabolic non-healthy obese (MNHO), and metabolic healthy non-obese (MHNO)). The association between osteoporosis and TBS and the metabolic phenotypes of obesity were assessed using multiple variable logistic regression models. Totally, 2378 people (1227 women) were considered for analyses. The prevalence of MHNO, MHO, MNHNO, and MNHO were 902 (39.9%), 138 (6.1%), 758 (33.5%), and 464 (20.5%), respectively. In the multivariate logistic regression models, those with MHO (OR 0.22; 95% CI 0.12-0.36), MNHNO (OR 0.52; 95% CI 0.4-0.66), and MNHO phenotypes (OR 0.22; 95% CI 0.16-0.3) had a significantly lower risk of osteoporosis. Likewise, those having MHO (OR 2.38; 95% CI 1.51-3.76), MNHNO (OR 1.49; 95% CI 1.11-2), and MNHO (OR 2.50; 95% CI 1.82-3.42) phenotypes were found to had higher risk of low bone quality as confirmed by TBS. The obese subjects have lower bone quality, regardless of their obesity phenotype.

Dental trainees’ mental health and intention to leave their programs during the COVID-19 pandemic

BackgroundDental trainees (dental students, graduate students, and postdoctoral residents) are at increased risk of experiencing poor mental health, which can lead to intentions to leave their program, especially during the COVID-19 pandemic. MethodsThe authors invited 355 dental trainees at the University of Washington School of Dentistry to complete an 83-item questionnaire in August and September 2020. The outcome analyzed was intention to leave their programs. There were 4 self-reported predictors: anxiety, burnout, depression, and COVID-19 impact on overall mental health. The authors ran multiple variable logistic regression models to evaluate relationships between each predictor and outcome (α = .05) and reported odds ratios (ORs) and 95% CIs. ResultsThe survey response rate was 35.5%. Overall, 12.7% of participants reported any intention to leave. In total, 22.2% and 16.7% of participants endorsed clinically significant anxiety or depression symptomatology, respectively; 28.6% reported 1 or more burnout symptoms; and 69.0% reported that COVID-19 affected their overall mental health. Participants reporting anxiety (OR, 8.87; 95% CI, 1.80 to 43.57; P = .007), depression (OR, 11.18; 95% CI, 1.84 to 67.74; P = .009), or burnout (OR, 8.14; 95% CI, 1.73 to 38.23; P = .008) were significantly more likely to report intention to leave than those not reporting mental health problems. All participants reporting that the COVID-19 pandemic impacted their mental health expressed intention to leave. ConclusionsPoor mental health is common among dental trainees and is associated with intention to leave their program. Practical ImplicationsCOVID-19 has exacerbated the prevalence and consequences of poor mental health among dental students, highlighting the importance of providing wellness resources.

Abstract PD4-07: Contemporary practice patterns for the use of regional nodal irradiation during post-lumpectomy radiotherapy for patients with N0/N1 breast cancer

Abstract BACKGROUND: Current national guidelines encourage consideration for treating the at-risk regional nodes (axillary, supraclavicular, and/or internal mammary) with directed regional nodal irradiation (RNI) during post-lumpectomy radiotherapy for high risk N0 (node negative) and N1 (1-3 nodes positive) breast cancer patients. This recommendation is based on the results of several randomized trials published over the last decade. Evidence regarding translation of these trials into clinical practice in the United States has been limited to date. In this study, we sought to characterize the temporal changes in and clinical factors associated with the utilization of RNI during post-lumpectomy radiotherapy for N0-N1 breast cancer across a contemporary, statewide consortium of radiation oncology practices. METHODS: Within a statewide radiation oncology quality consortium, 12,170 breast cancer patients were consecutively enrolled between 1/1/2013 and 10/31/2019 in both academic (teaching) and community (non-teaching) facilities. Data on receptor status, adjuvant systemic therapy, age, TNM stage, extent of axillary surgery, race, body mass index (BMI), type of treating facility, and year completing radiotherapy (RT) were collected. Eligibility for the present analysis was limited to patients with N0 and N1 disease not receiving neoadjuvant systemic therapy and receiving adjuvant radiotherapy after lumpectomy for non-metastatic breast cancer. Multiple variable logistic regression models were separately fit to explain the use of directed RNI (to the axilla, supraclavicular region, and/or internal mammary region) for the N0 and N1 populations separately and described using odds ratios (OR), with significant ORs (p&amp;lt;0.05) reported. RESULTS: A total of 8,468 patients from 29 treating facilities met the inclusion criteria: 6,929 (81.8%) with N0 and 1,539 (18.2%) N1 disease. RNI was performed in addition to whole breast radiation in 95 (1.4%) and 908 (59%) patients in the N0 and N1 cohorts respectively. For the N0 cohort, significant correlates of RNI on multivariable analysis (MVA) were receipt of adjuvant chemotherapy (OR 2.7), higher T-stage (OR 1.9 for T2 vs T1 and 27.3 for T3/T4 vs T1), axillary surgery [compared to sentinel node biopsy (SLN) alone : no axillary surgery (OR 14.5), axillary lymph node dissection (ALND) with 10+ nodes removed (OR 15.1) ALND after SLN (OR 2.7)], and underweight BMI (OR 4.9 compared to overweight, which was the reference as the largest BMI category). For the N1 cohort, MVA suggested adjuvant chemotherapy (OR 1.8) and larger tumors (OR 1.6 [T2 vs T1]) were significantly associated with use of RNI. The year completing RT was also significantly associated with RNI use, with 22% and 15% increases per year from 2013 to 2019 in the N0 and N1 cohorts, respectively. Lastly, receiving treatment in an academic facility compared to a community facility was significantly associated with receipt of RNI in both the N0 (OR 1.8) and N1 (OR 2.2) cohorts. CONCLUSION: In this large cohort, selective use of RNI added to post-lumpectomy whole breast radiotherapy is estimated to have increased over time, suggesting growing implementation of recent trial data and current clinical practice guidelines. Patient, treatment, and tumor characteristics appear to factor into the decision to treat with RNI, but differences in use between academic and community practices suggest opportunities for improving the consistency of care across care delivery settings. Ongoing trials seeking to identify subgroups of N1 patients in whom RNI can safely be omitted may be especially important to inform decisions, given the almost even split (59% receiving, 41% not) in practice observed in this large American cohort. Citation Format: Derek Bergsma, Kent Griffith, Reshma Jagsi, Michael Dominello, Thomas Boike, Joshua Dilworth, Amit Bhatt, Frank Vicini, Maggie Grubb, Jean Moran, James Hayman, Lori Pierce, on behalf of MROQC, the Michigan Radiation Oncology Quality Consortium. Contemporary practice patterns for the use of regional nodal irradiation during post-lumpectomy radiotherapy for patients with N0/N1 breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD4-07.

Bias Against Complex Lung Cancer Surgery

BackgroundLung cancer remains a major public health problem. There remain differences in mortality among socioeconomic and racial groups. Using The Society of Thoracic Surgeons General Thoracic Surgery database, we attempted to determine whether there were differences in treatment choices by thoracic surgeons based on patients’ race or insurance. MethodsUsing data from 2012 to 2017, we analyzed data from 75,774 patients with a diagnosis of lung cancer for whom complete information on race, insurance, or both was available, and who had undergone a pulmonary resection. We categorized 66,614 operations (87.9%) into standard (lobectomy, bilobectomy, or wedge excision) and 9160 (12.1%) into complex (pneumonectomy, sleeve or bronchoplastic resection, segmentectomy, or Pancoast resection) operations. Univariate and multiple variable logistic regression models were used to assess associations with receipt of a complex operation. ResultsPatients with private insurance had a higher incidence of complex operations (14.4%) compared with patients with government insurance (11.6%) (P < .0001). We also found a higher incidence of complex operations in White patients (12.2%) compared with Nonwhite patients (11.3%; P = .0054). On multivariate analysis, patients with private insurance were significantly more likely to have a complex operation (odds ratio = 1.08; P < .03) and Nonwhite patients were less likely to have a complex operation (odds ratio = 0.93; P = .04) respectively. ConclusionsIn this cohort of patients from The Society of Thoracic Surgeons General Thoracic Surgery database, White patients and those with private insurance had a higher incidence of complex operations. Many factors affect the decision to proceed with a complex thoracic surgical operation; type of medical insurance and race may represent 2 of them.

Factors affecting patient adherence to lung cancer screening: A multisite analysis.

To identify factors associated with delayed adherence to follow-up in lung cancer screening. Utilizing a data warehouse and lung cancer screening registry, variables were collected from a referred sample of 3110 unique participants with follow-up CT during the study period (1 January 2016 to 17 October 2018). Adherence was defined as undergoing chest CT within 90 days and 30 days of the recommended time for follow-up and was determined using proportions and multiple variable logistic regression models across the American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS®) categories. Of 1954 lung cancer screening participants (51.9% (1014/1954) males, 48.1% (940/1954) female; mean age 65.7 (range 45-87), smoking history median 40 pack-years, 60.2% and 44.5% did not follow-up within 30 and 90 days, respectively. Participants receiving Lung-RADS® category 1 or 2 presented later than those with Lung-RADS® category 3 at 90 days (coefficient -27.24, 95% CI -51.31, -3.16, p = 0.027). Participants with Lung-RADS® category 1 presented later than those with Lung-RADS® category 2 at both 90- and 30-days past due (OR 0.76 95% CI [0.59-0.97], p = 0.029 and OR 0.63 95% CI [0.48-0.83], p = 0.001, respectively). Adherence to follow-up was higher among participants receiving more suspicious Lung-RADS® results at index screening CT and among those who had undergone more non-lung cancer screening imaging examinations prior to index lung cancer screening CT. These observations may inform strategies aimed at prospectively identifying participants at risk for delayed or nonadherence to prevent potential morbidity and mortality from incident lung cancers.