Multivariate Binary Logistic Model Research Articles

Acute stress disorder and associated factors among adult trauma patients in Ethiopia: a multi-institutional study

IntroductionAcute stress disorder (ASD) is a mental disorder that happens after someone experienced traumatic event within duration of less than a month. Other studies conducted in different countries revealed that adults with a trauma had experienced acute stress disorder. This results in substantial distress and interferes with social and day to day activities. Despite the high burden of this problem, very little is known about the prevalence and risk factors for acute stress disorder in adults with traumatic injuries in Ethiopia.ObjectiveThis study was aimed to assess the prevalence of acute stress disorder and associated factors among adult trauma patients attending in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia 2022.MethodsAn institutional based cross-sectional study design was employed among 422 adult trauma patients from May– June 2022. Systematic sampling technique was applied to recruit study participants. Data were collected through interviewer administered questionnaires using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, acute stress disorder measurement tools. Then, it was entered into Epi-Data version 4 and exported to STATA version 14 for analysis. Bivariate and multivariable binary logistic regressions model were carried out to identify factors significantly associated acute stress disorder.ResultThe prevalence of acute stress disorder among adult trauma patients in northwest Amhara comprehensive specialized hospitals was found to be 44.15% (95% CI: 39.4%, 49.0%) with 99% of response rate. In multivariate logistic analysis younger age (21–29) (AOR = 0.33 95% CI: 0.14–0.77), (30–39) (AOR = 0.35 95% CI: 0.15–0.85), (40–49) (AOR = 0.28 95% CI: 0.10–0.76) respectively, presence of complication (AOR = 2.22 95% CI: 1.36–3.60), prolonged length of hospital stay (AOR = 1.89 95% CI: 1.21–2.95) and having low (AOR = 3.21, 95% CI: 1.66–6.19) and moderate (AOR = 1.99, 95%, CI: 1.14–3.48) social support were factors significantly associated with acute stress disorder.Conclusion and recommendationThis study showed that the prevalence of acute stress disorder among the adult study participants who experienced traumatic events was high as compared to other literatures. Age, complication, prolonged hospital stay and social support were factors significantly associated with ASD at p-value < 0.05. This indicates the need for early identification and interventions or ASD care services from health workers of psychiatric ward.

A re-evaluation of the Endoscopic Third Ventriculostomy Success Score: a Hydrocephalus Clinical Research Network study.

The Hydrocephalus Clinical Research Network (HCRN) conducted a prospective study 1) to determine if a new, better-performing version of the Endoscopic Third Ventriculostomy Success Score (ETVSS) could be developed, 2) to explore the performance characteristics of the original ETVSS in a modern endoscopic third ventriculostomy (ETV) cohort, and 3) to determine if the addition of radiological variables to the ETVSS improved its predictive abilities. From April 2008 to August 2019, children (corrected age ≤ 17.5 years) who underwent a first-time ETV for hydrocephalus were included in a prospective multicenter HCRN study. All children had at least 6 months of clinical follow-up and were followed since the index ETV in the HCRN Core Data Registry. Children who underwent choroid plexus cauterization were excluded. Outcome (ETV success) was defined as the lack of ETV failure within 6 months of the index procedure. Kaplan-Meier curves were constructed to evaluate time-dependent variables. Multivariable binary logistic models were built to evaluate predictors of ETV success. Model performance was evaluated with Hosmer-Lemeshow and Harrell's C statistics. Seven hundred sixty-one children underwent a first-time ETV. The rate of 6-month ETV success was 76%. The Hosmer-Lemeshow and Harrell's C statistics of the logistic model containing more granular age and etiology categorizations did not differ significantly from a model containing the ETVSS categories. In children ≥ 12 months of age with ETVSSs of 50 or 60, the original ETVSS underestimated success, but this analysis was limited by a small sample size. Fronto-occipital horn ratio (p = 0.37), maximum width of the third ventricle (p = 0.39), and downward concavity of the floor of the third ventricle (p = 0.63) did not predict ETV success. A possible association between the degree of prepontine adhesions on preoperative MRI and ETV success was detected, but this did not reach statistical significance. This modern, multicenter study of ETV success shows that the original ETVSS continues to demonstrate good predictive ability, which was not substantially improved with a new success score. There might be an association between preoperative prepontine adhesions and ETV success, and this needs to be evaluated in a future large prospective study.

Effect of nutrition education integrating the health belief model and theory of planned behavior on dietary diversity of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial

BackgroundMaternal anemia, miscarriage, low birth weight (LBW), preterm birth (PTB), intrauterine growth restriction (IUGR), prenatal and infant mortality, morbidity, and the risk of chronic disease later in life are all increased by a lack of dietary diversity during pregnancy. However, evidence for the effect of nutrition education on the dietary diversity score (DDS) among pregnant women was sparse in Ethiopia, particularly in the study areas. This study aimed to assess the effect of nutrition education on dietary diversity among pregnant women in urban settings in Southeast Ethiopia.MethodsA community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention group and 223 control group) at health facilities from February to December 2021. A multistage cluster sampling technique, followed by systematic sampling, was used to select the pregnant women. Pregnant women who participated in the interventions were given nutrition education starting at 16 weeks of gestation and continuing for 6 months. We used a pre-tested, interviewer-administered, structured questionnaire to collect the data. A 24-hour qualitative dietary recall was used to calculate the dietary diversity score (DDS). A multivariable generalized estimating equation (GEE) model was conducted to evaluate the intervention effect.ResultsAfter the intervention, the proportion of adequate dietary diversity was 14.15% higher in the intervention arm compared to the control group (45.09% versus 30.94%, P = 0.002). The overall difference in adequate dietary diversity between the two groups was 8.5%. After adjusting for background characteristics, the multivariable GEE binary logistic model revealed that having received intervention [(AOR = 1.89, 95% CI: 1.27, 2.79)], being literate [(AOR = 3.41, 95% CI: 1.13, 10.23)], and having high wealth [(AOR = 1.60, 95% CI: 1.09, 2.35)] significantly improved adequate dietary diversity.ConclusionThe findings indicated that having received the intervention, being literate, and having a high level of wealth significantly improved maternal dietary diversity. Efforts should be made to increase nutrition education using the health belief model (HBM) and the theory of planned behavior (TPB). Moreover, there is a need to improve literacy and economic empowerment through income-generating activities to enhance adequate dietary diversification during pregnancy.Trial registrationClinicaltrials.gov (PACTR202201731802989, Retrospectively registered on 24 January 2022).

Use of Computed Tomography-Based Texture Analysis to Differentiate Benign From Malignant Salivary Gland Lesions.

Salivary gland lesions show overlapping morphological findings and types of time/intensity curves. This research aimed to evaluate the role of 2-phase multislice spiral computed tomography (MSCT) texture analysis in differentiating between benign and malignant salivary gland lesions. In this prospective study, MSCT was carried out on 90 patients. Each lesion was segmented on axial computed tomography (CT) images manually, and 33 texture features and morphological CT features were assessed. Logistic regression analysis was used to confirm predictors of malignancy ( P < 0.05 was considered to be statistically significant), followed by receiver operating characteristics analysis to assess the diagnostic performance. Univariate logistic regression analysis revealed that morphological CT features (shape, size, and invasion of adjacent tissues) and 17 CT texture parameters had significant differences between benign and malignant lesions ( P < 0.05). Multivariate binary logistic regression demonstrated that shape, invasion of adjacent tissues, entropy, and inverse difference moment were independent factors for malignant tumors. The diagnostic accuracy values of multivariate binary logistic models based on morphological parameters, CT texture features, and a combination of both were 87.8%, 90%, and 93.3%, respectively. Two-phase MSCT texture analysis was conducive to differentiating between malignant and benign neoplasms in the salivary gland, especially when combined with morphological CT features.

Synthesizing the risk of morbidities and lifestyle factors on insomnia symptoms among middle-aged and older adult persons in India

PurposeMost of the time increasing age and improper lifestyle enhance the burgeoning health challenge for middle-aged and older adult persons. In this way, the present study seeks to know the association of morbidity, lifestyle parameters, and background characteristics with insomnia symptoms among middle-aged and older adults in India.MethodsThe study utilizes a sample of 46,462 older individuals aged 45 years and above from LASI wave-1. Multivariate binary logistic models were applied to acquire the results.ResultInsomnia symptom was closely linked with hypertension [AOR: 1.33; 1.27–1.39], heart diseases [AOR: 1.37; 1.23–1.53], the neurological problem [AOR: 1.67; 1.46–1.91], as compared to older adults who did not suffer from any morbidity. The likelihood of insomnia symptoms was also higher among older individuals who reported following an accustomed lifestyle i.e., no reading habit [AOR: 1.35; 1.26–1.45], never going to the park for relaxing leisure hours [AOR: 1.38; 1.01–1.73]. Moreover, insomnia increases with age, and among elder women.ConclusionThe encouragement of remedies for morbidity and improper lifestyle practices could be considered as part of a plan to decrease insomnia symptoms. As well as the detection of early stages of insomnia by health professionals and intervention of public health services is necessary.

Factors influencing micro-entrepreneurship among women SHG members of Sikkim: a propensity score matching approach

PurposeThe paper identifies the influence of socio-economic factors and livelihood training in stimulating micro-entrepreneurship among women self-help group (SHG) members.Design/methodology/approachThe study is based on a sample of 416 women SHG members drawn from all the four districts of Sikkim using cluster sampling procedure. A multivariate binary logistic model is used to find the impact of socio-economic factors, and a Poisson regression has been used to find the impact of training on fostering micro-entrepreneurship. The result is validated using a propensity score matching approach which corrects for the potential self-selection bias in the sample. Subsequently, a covariate adjustment estimator verifies the robustness of the approach.FindingsThe study finds that “size of landownership”, “amount of loan borrowed”, “member's age”, “number of earning and dependent members”, “number of years of SHG enrolment” as well as the “district to which the member belongs to” have a statistically significant influence on the graduation of SHG members to micro-entrepreneurs. Furthermore, it is found that members attending the livelihood training programmes had a significantly higher number of microenterprises.Originality/valueThe study differentiates itself by providing empirical evidence on how socio-economic factors and livelihood training stimulate micro-entrepreneurship among SHG women of Sikkim, which has so far remained unexplored. Moreover, advanced econometric method has been used to eliminate the possible self-selection bias involved with training participation and thereby provides reliable and robust results.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0070

Spinal disease in a captive population of Panthera species: Review of 86 cases (2003-2021).

This retrospective study aimed to characterize and determine the prevalence of spinal disease in nondomestic felids within a sanctuary population. A review of 304 postmortem examination reports in Panthera species from 2003 to 2021 revealed that 86/304 (28%) were diagnosed with spinal disease. Spinal lesions were categorized according to pathologic process: degenerative (78/86, 91%), developmental (8/86, 9%), inflammatory (6/86, 7%), or neoplastic (8/86, 9%). Degenerative lesions included intervertebral disk disease (IVDD; 66/78, 85%), spondylosis without concurrent IVDD (4/78, 5%), and idiopathic (noncompressive) degenerative myelopathies (8/78, 10%). Fourteen individuals had lesions in more than 1 category. Developmental cases were vertebral (4/8) or spinal cord (3/8) malformations or both (1/8). Inflammatory lesions included meningitis (4/6) and meningomyelitis (2/6). Neoplasia included vertebral multiple myeloma (4/8) and others (4/8). IVDD often involved multiple disks but primarily affected the cervical (41/66, 62%) and thoracic spine (32/66, 48%). A multivariate binary logistic model predicted the diagnosis of IVDD at postmortem examination, where odds of being affected were highest for males, lions (Panthera leo), and geriatric age group (>14 years). The spinal lesions documented in this study provide insight into high-risk signalment categories and predominant associated lesions affecting captive Panthera populations. Specifically, spinal disease, especially cervical IVDD, is common among Panthera species, and lions, males, and older felids are at increased risk.

Serum antioxidant enzymes in spinal stenosis patients with lumbar disc herniation: correlation with degeneration severity and spinal fusion rate

ObjectiveTo determine whether superoxide dismutase (SOD) and glutathione reductase (GR) correlated with the intervertebral disc degeneration (IDD) severity and the postoperative spinal fusion rate in lumbar spinal stenosis patients accompanied with lumbar disc herniation.MethodsThis retrospective study investigated 310 cases of posterior lumbar decompression and fusion. The cumulative grade was calculated by adding the pfirrmann grades of all the lumbar discs. Subjects were grouped based on the median cumulative grade. Logistic regression was used to determine the associations among the demographical, clinical, and laboratory indexes and severe degeneration and fusion. The receiver operating characteristic (ROC) curve was performed to measure model discrimination, and Hosmer-Lemeshow (H-L) test was used to measure calibration.ResultsSOD and GR levels were significantly lower in the severe degeneration group (cumulative grade > 18) than in the mild to moderate degeneration group (cumulative grade ≤ 18). Furthermore, the SOD and GR concentrations of the fusion group were significantly higher than that of the non-fusion group (p < 0.001 and p = 0.006). The multivariate binary logistic models revealed that SOD and GR were independently influencing factors of the severe degeneration (OR: 0.966, 95%CI: 0.950–0.982, and OR: 0.946, 95%CI: 0.915–0.978, respectively) and non-fusion (OR: 0.962; 95% CI: 0.947–0.978; OR: 0.963; 95% CI: 0.933–0.994). The models showed excellent discrimination and calibration. Trend analysis indicated that the levels of SOD and GR tended to decrease with increasing severity (p for trend < 0.001 and 0.003). In addition, it also revealed that SOD provided protection from non-fusion in a concentration-dependent manner (p for trend < 0.001). However, GR concentration-dependent effects were not apparent (p for trend = 0.301).ConclusionHigh serum SOD and GR levels are associated with a better fusion prognosis and a relief in degeneration severity.

Influence of Salt Intake on Segmental Lesions of Patients with Ischaemic Heart Disease in Sri Lanka: A Cross-sectional Study

Background: Sodium assists in maintaining body fluid balance. Excess sodium intake increases the risk of ischaemic heart disease (IHD) adding to global and local mortality due to non-communicable diseases. Aim: To determine the salt intake levels of patients having coronary artery bypass grafting (CABG) and to explain the relationship between salt consumption and atheroma development. This study used an adapted cross-sectional design with 233 patients admitted to Sri Jayewardenepura General Hospital with acute heart diseases. Method: Demographic and lifestyle-related data, medical history and food intake data were collected. Salt intake was calculated based on the consumption of salt used per month at household level, salt added to food – including in restaurants. Salt content was determined using web-based applications and food tables. Multivariate logistic regression was used to identify variables significantly associated with IHD. Results: In this study, the daily intake of sodium per person was 6,176 mg. This was much higher than WHO’s recommended level of 2,000 mg/day, demonstrating a significant relationship between segmental lesions and sodium intake (p&lt;0.01). The multivariate binary logistic model demonstrated that high salt intake (OR 8.54; 95% CI [4.545–16.734]) and the presence of diabetes (OR 2.23; 95% CI [1.206–4.238]), contributed to the high number of segmental lesions (p&lt;0.01). Conclusion: A high daily intake of sodium increases the risk of atheroma formation in more coronary segments, regardless of age, sex, several known disease conditions and risk factors.

A pre-transplantation risk assessment tool for graft survival in Dutch pediatric kidney recipients.

A prediction model for graft survival including donor and recipient characteristics could help clinical decision-making and optimize outcomes. The aim of this study was to develop a risk assessment tool for graft survival based on essential pre-transplantation parameters. The data originated from the national Dutch registry (NOTR; Nederlandse OrgaanTransplantatie Registratie). A multivariable binary logistic model was used to predict graft survival, corrected for the transplantation era and time after transplantation. Subsequently, a prediction score was calculated from the β-coefficients. For internal validation, derivation (80%) and validation (20%) cohorts were defined. Model performance was assessed with the area under the curve (AUC) of the receiver operating characteristics curve, Hosmer-Lemeshow test and calibration plots. In total, 1428 transplantations were performed. Ten-year graft survival was 42% for transplantations before 1990, which has improved to the current value of 92%. Over time, significantly more living and pre-emptive transplantations have been performed and overall donor age has increased (P<.05).The prediction model included 71829 observations of 554 transplantations between 1990 and 2021. Other variables incorporated in the model were recipient age, re-transplantation, number of human leucocyte antigen (HLA) mismatches and cause of kidney failure. The predictive capacity of this model had AUCs of 0.89, 0.79, 0.76 and 0.74 after 1, 5, 10 and 20years, respectively (P<.01). Calibration plots showed an excellent fit. This pediatric pre-transplantation risk assessment tool exhibits good performance for predicting graft survival within the Dutch pediatric population. This model might support decision-making regarding donor selection to optimize graft outcomes. ClinicalTrials.gov Identifier: NCT05388955.

Poor Sleep Quality and Associated Factors among Midlife Women at Dessie Town, Northeast Ethiopia, 2022: A Cross-Sectional Study

Introduction: Poor sleep quality is defined as a lack of restful and restorative sleep, which is a common complaint among midlife women. There aren't enough studies on the prevalence and contributing factors of poor sleep quality among Ethiopian midlife women, even though it affects these women's quality of life. Therefore, this study aimed to determine the prevalence and associated factors of poor sleep quality among midlife women in Dessie town. Methods: A community-based cross-sectional study was conducted from April 01, 2022, to May 01, 2022. A cluster sampling technique was employed. Moreover, data were collected using interviewer-administered pretested questionnaires. Data were entered and analyzed using Epidata version 3.1 and SPSS version 26 respectively. Bivariable and multivariable binary logistic regression analysis models were fitted to find the association of each independent variable with the outcome variable. The strength of the association was computed by using an adjusted odds ratio with a 95% confidence interval. Variables having a P-value ≤0.05 were considered statistically significant. Result: A total of 652 women were included in the study with a response rate of 98.3% and the mean age was 47.6 ±5.81 with the age range of 40-65. The prevalence of poor sleep quality among midlife women in Dessie town was 55.5% (95% CI (=51.9, 59.0)). Women who had no formal education (AOR=2.51, 95%CI(=1.30, 4.86)),being obese (AOR=2.41, 95% CI(=1.10, 5.32)), khat chewing(AOR=2.05, 95% CI(=1.13, 3.74)), hot flashes (AOR=5.58, 95%CI(=3.31, 9.39)), being Diabetics (AOR=3.16, 95% CI(=1.43, 6.94)), having stress (AOR=2.72, 95 % CI (=1.32, 5.59)) were significantly associated with poor sleep quality. Conclusion: More than half of the participant had poor sleep quality. Lack of formal education, khat chewing, being obese, diabetic, and having hot flashes and stress were significantly associated with poor sleep quality. It is recommended to avoid modifiable risk factors.

A randomised control trial to evaluate the effectiveness of a commercial vaccine for pinkeye in Australian beef cattle

Pinkeye (a generic term to describe infectious bovine keratoconjunctivitis) is a significant disease of cattle worldwide, impacting productivity and animal welfare. One commercial pinkeye vaccine, a systematically administered Moraxella bovis bacterin, has been available in Australia since 2007. This is the first field trial of the effectiveness of this vaccine for the prevention of naturally occurring disease in Australia. Extensively run beef herds in southwest Queensland that regularly experienced pinkeye were enrolled in the trial and animals were randomly allocated to vaccinated and control groups in different proportions in each herd. The subsequent incidence of clinical pinkeye between the two groups was compared for animals less than one-year-old. Data were analysed from 649 cattle from five herds over two pinkeye seasons: three herds of 390 calves from 1st November 2019 to 20th January 2020 and two herds of 259 calves from 23rd September 2020 to 21st April 2021. Pinkeye was common with 24% of all calves (156/649) contracting the disease during the trial. Univariable and multivariable binary logistic mixed-effect models were fitted to account for clustered data and potential residual confounding due to sex, weight, breed, coat colour, and periocular pigmentation. The incidence of pinkeye was not significantly different between vaccinated and control groups, both alone (p = 0.67) and after adjusting for sex and weight differences (p = 0.69). The vaccine was not protective against naturally occurring pinkeye under the field conditions.

Depression among middle-aged adults in Japan: The role of the built environment design

There has been considerable interest in the effect of the built environment design on depressive symptoms. However, there are still few empirical studies on this topic, and there is a dearth of evidence among middle-aged adults. The present study examined the associations of urban design attributes with depressive symptoms among a sample of middle-aged adults in Japan. Cross-sectional data from a random sample of residents (40–64 years old) in two cities in Japan were examined. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression (CES-D) questionnaire. Two types of perceived and objective attributes of the built environment were measured. Covariate-adjusted multivariable linear and binary logistic models were used to estimate associations between perceived and objective built environment attributes and depressive symptoms. Among women, higher perceived access to public transport and total perceived walkability was associated with a decrease in depressive symptoms. Furthermore, there was a significant association between higher safety from traffic and lower odds of having mild depressive symptoms (CES-D ≥ 16) in women. Among men, higher safety from crime was associated with a decrease in depressive symptoms and with lower odds of having mild depressive symptoms. Total perceived walkability was also associated with lower odds of having mild depressive symptoms in men. None of the objective built environment attributes were associated with depressive symptoms in women or men. Our findings provide empirical evidence that improving perceptions of neighbourhood walkability and, in particular, enhancing access to public transport and safety from crime and traffic are important for improving depressive symptoms among middle-aged men and women.

Association of Body Mass Index With 21-Gene Recurrence Score Among Women With Estrogen Receptor–Positive, ERBB2–Negative Breast Cancer

Body mass index (BMI) may affect the 21-gene recurrence score (RS) in patients with ER-positive, ERBB2-negative breast cancer. If high BMI increases genomic risk in ER-positive, ERBB2-negative breast cancer, weight control will become more important. To assess the association between RS and BMI according to age groups and address BMI as a factor associated with high RS. This cohort study included 2295 patients with ER-positive, ERBB2-negative breast cancer who had undergone a multigene assay between March 29, 2010, and December 31, 2020, in 2 hospitals. All of the study patients were Korean women, and the median follow-up period was 45 months (range, 1-40 months). The correlations between continuous RS and BMI were investigated. A high BMI was defined as a body mass index greater than or equal to 25. In the younger age group (age ≤45 years), a high RS was defined as an RS of greater than 20. Body mass index. The Pearson correlation coefficient was used to estimate the association between RS and BMI. A multivariable binary logistic model was used to identify high RS. Among the 2295 women included (mean [SD] age, 49.8 [4.00] years; range, 22-81 years), 776 were aged 45 years or younger; RS and BMI were weakly correlated (correlation coefficient, 0.119; P < .001) in this younger group. Among them, the proportion of patients with an RS greater than 20 was significantly higher in the high BMI group than in the normal BMI group (45.5% [46 of 101] vs 27.3% [184 of 675]; P < .001). In the multivariable analysis, high BMI was an associated factor for high RS (odds ratio, 2.06; 95% CI, 1.28-3.32; P = .003). The 21-gene multigene assay-guided chemotherapy rate was significantly higher in patients with high BMI (30.7% [31 of 101] vs 20.2% [136 of 674]; P = .02). In this cohort study of women aged 45 years or younger, high BMI was associated with higher RS in those with ER-positive, ERBB2-negative breast cancer; further studies are necessary to examine the underlying mechanisms.

Effect of sagittal screw angle and distance of screw apex to superior endplate on adjacent segment disease after posterolateral lumbar fusion: a retrospective study

BackgroundNumerous complications of lumbar fusion surgery have been reported, with adjacent segment disease (ASD) being one of the most important. Few studies describe the effect of sagittal, horizontal screw angles and distance of pedicle screw apex to superior endplate on the incidence of ASD in lumbar spine. The purpose of this retrospective study is to evaluate the hypothesis that unsatisfactory pedicle screw insertion positions would increase the likelihood of ASD.MethodsOutpatients with lumbar spinal stenosis underwent posterolateral lumbar fusion at L4-S1 with a least 2-year follow-up were studied. ASD at L3–L4 was defined as a condition in which intervertebral disk narrowing, posterior vertebral opening, and vertebral slippage progress at the last follow-up in comparison with the postoperative. Independent t test was performed to compare data between two groups; Spearman analysis was performed to analyze the relationship between two continuous variables. Multivariate binary logistic models were performed to identify the independent risk factors of ASD. The receiver operating characteristic (ROC) curve was performed to measure model discrimination and Hosmer–Lemeshow (H–L) test was used to measure calibration. ROC curve evaluated the discrimination ability of sagittal screw angle and distance in predicting incidence of ASD.ResultsPatients in ASD group exhibit higher incidence of osteoporosis, higher Visual analogue scale (VAS), Oswestry disability index (ODI), bigger sagittal screw angle, shorter distance of pedicle screw apex to superior endplate than those in non-ASD group (p < 0.05). VAS, ODI at the last follow-up were positively correlated with Pfirrmann grade of L3–4 disk and sagittal screw angle, while negatively correlated with distance of screw apex to superior endplate (p < 0.05). Multivariate binary logistic model indicated that follow-up time (odds ratio [OR] 1.637, 95% confidence interval [CI] 1.186–2.260), distance of screw apex to superior endplate (OR 0.150, 95% CI 0.067–0.336), sagittal screw angle (OR 2.404, 95% CI 1.608–3.594) were statistically significant. The models showed great discrimination and calibration. The area under the curve of ASD identified by sagittal angle and distance was 0.895 and the cut-off values were 5.500° and 6.250 mm, respectively.ConclusionSagittal screw angle and distance of screw apex to superior endplate were significantly associated with the risk of ASD.

The Importance of the Thyroid Nodule Location in Determining the Risk of Malignancy: A Retrospective Study.

IntroductionThyroid nodules are very common. However, the majority of thyroid nodules are benign. Ultrasound is the first-line imaging investigation of choice for thyroid nodules. Certain sonographic features are associated with an increased risk of malignancy. Recent studies suggested that the location of the nodule may be associated with the malignancy risk. Hence, this study aims to investigate this association.MethodsAfter obtaining approval from the ethics committee, we conducted a retrospective study that involved all patients who attended our hospital, and who underwent fine-needle aspiration cytology for the evaluation of suspicious thyroid nodules (TR3-5). Electronic medical records were used to obtain data about the ultrasound and cytology reports. A multivariable binary logistic regression analysis model was conducted to identify the independent factors significantly associated with malignant thyroid nodules.ResultsThe study included 366 patients who underwent fine-needle aspiration cytology for suspicious nodules on thyroid ultrasound. In total, 52 (14.2%) nodules were found to be malignant on cytology. By far, the most common thyroid malignancy was papillary carcinoma. The multivariable analysis model revealed that women were 24% less likely to have malignant thyroid nodules compared with men. After adjusting for the age, gender, and Thyroid Imaging Reporting and Data System (TI-RADS) group, the nodules located within the isthmus were four times more likely to be malignant compared to those located in the right or left lobes.ConclusionsThe study demonstrates that the isthmus location of thyroid nodules is associated with a higher risk of malignancy. Physicians should have a lower threshold to biopsy such nodules. Further studies are needed to confirm this interesting finding.

Preoperative Lymphocyte to Monocyte Ratio as a Predictive Biomarker for Disease Severity and Spinal Fusion Failure in Lumbar Degenerative Diseases Patients Undergoing Lumbar Fusion

ObjectiveThis study was designed to determine whether lymphocyte to monocyte ratio (LMR) correlated with the intervertebral disc degeneration (IDD) severity and the postoperative spinal fusion rate in patients with lumbar disc disease.Methods303 patients undergoing posterior lumbar decompression and fusion were retrospectively analyzed. An examination of the blood count was performed before surgery. The cumulative grade was calculated by summing the pfirrmann grades of all lumbar discs. Grouping was based on the 50th percentile of cumulative grade and spinal fusion. The relationship between LMR and IDD severity and spinal fusion was explored using correlation analyses and logistic regression models. The receiver operating characteristic (ROC) curve was performed to measure model discrimination, and Hosmer-Lemeshow (H-L) test was used to measure calibration. Meanwhile, the ROC curve evaluated the discrimination ability of LMR in predicting severe degeneration and fusion failure.ResultsLMR was significantly lower in the severe degeneration group (cumulative grade > 18) than in the mild to moderate degeneration group (cumulative grade ≤ 18). Furthermore, the LMR of the fusion group was significantly higher than that of the non-fusion group. The multivariate binary logistic models revealed that LMR was an independently influencing factor of the severe degeneration and fusion failure (OR: 0.793, 95% CI: 0.638–0.987, p = 0.038; OR: 0.371, 95% CI: 0.258–0.532, p < 0.001). The models showed excellent discrimination and calibration. The area under the curve (AUC) of severe degeneration and fusion failure identified by LMR were 0.635 and 0.643, respectively, and the corresponding cut-off values were 3.16 and 3.90.ConclusionLMR is significantly associated with the risk of severe disc degeneration and spinal fusion failure.

Sleep disturbance and associated factors among Nigerian adults living with HIV in the dolutegravir era

Sleep disturbance is common among persons living with HIV (PLWH) causing significant health impacts. Nigeria recently switched from efavirenz to dolutegravir (DTG) for first-line antiretroviral therapy (ART). This study aimed to assess the prevalence of sleep disturbance and to determine factors associated with sleep disturbance among treatment-experienced PLWH. Using a cross-sectional study design and systematic random sampling, 300 participants were recruited from the Infectious Diseases Institute, Ibadan, Nigeria (IDI). Interviewer administered questionnaire was used to collect data regarding sociodemographic, sleep disturbance (Pittsburgh Sleep Quality Index; PSQI), depression (Patient Health Questionnaire; PHQ-9), anxiety (Generalized Anxiety Disorder-7; GAD-7), and psychoactive substance use. HIV-specific data were retrieved from IDI's medical records. The relationship between the PSQI score and the scores on the PHQ-9 and GAD-7 were explored with the Pearson correlation coefficient. Chi-square global tests of independence were used to assess factors associated with sleep disturbance and a multivariable binary logistic model was used to determine independent predictors of sleep disturbance. The mean age of the sample was 44.5 ± 11.4 (years), the average duration of HIV diagnosis was 8.13 ± 5.33 (years) and the majority were on DTG-based regimens (95%). Depression and anxiety were present in 14 and 17.3%, respectively. Prevalence of sleep disturbance (PSQI score of 6 or more) was 21.7%. Higher PSQI scores were associated with higher PHQ-9 scores (r = 0.526; p &amp;lt; 0.001) and higher GAD-7 scores (r = 0.529; p &amp;lt; 0.001). Sleep disturbance was associated with age (χ2 = 4.483, p = 0.038), marital status (χ2 = 7.187, p &amp;lt; 0.01), depression (χ2 = 46.589, p &amp;lt; 0.001), and anxiety (χ2 = 38.379, p &amp;lt; 0.001). There was no significant association between sleep disturbance and HIV clinical stage at diagnosis, virological suppression status, and ART regimen type (p &amp;gt; 0.05), whereas tea intake was associated with an absence of sleep disturbance (χ2 = 6.334, p &amp;lt; 0.014). Age (&amp;gt;45 years), depression and anxiety were associated with higher odds of sleep disturbance among PLWH. Sleep disturbance remains common among PLWH in the DTG era. Depression and anxiety are significant factors associated with sleep disturbance. Assessing these factors in future studies may improve the sleep health of PLWH.

Self-care behavior and associated factors among patients with heart failure in public hospitals of Southeast Ethiopia.

ObjectiveThis study was performed to assess self-care behavior and associated factors among patients with heart failure attending public hospitals in Southeast Ethiopia in 2021.MethodsAn institutional-based cross-sectional study was conducted among 420 patients with heart failure from 15 May to 30 June 2021 using a simple random sampling technique. A multivariable binary logistic model was used to identify factors associated with self-care behavior. Statistical significance was declared at p < 0.05.ResultsThe magnitude of good self-care behavior among patients with heart failure was 53.6% [95% confidence interval (CI), 48.9–58.3]. Factors associated with self-care behavior were treatment with a beta blocker [adjusted odds ratio (AOR), 0.49; 95% CI, 0.27–0.89], treatment with digitalis (AOR, 0.11; 95% CI, 0.05–0.24), the level of social support (AOR, 0.07; 95% CI, 0.03–0.15), and the presence of depressive symptoms (AOR, 0.21; 95% CI, 2.70–8.33).ConclusionSlightly more than half of the respondents had good self-care behavior. Attention should be given to enhancing good self-care practice through integration of health education as routine care.

The Prevalence of Food Insecurity and its Association with Non-Communicable Diseases Risk Factors: a Cross-Sectional Study in Alborz Province, Iran

ABSTRACT Food insecurity (FI) is a public health concern that affects health status. In this study, we aimed to investigate the FI status, and the probable link between FI and a number of risk factors related to Non-Communicable Diseases (NCDs) in Alborz Province, Iran. This was a cross-sectional study in which 983 housewives living in Alborz Province, with the age range of 18–65 years were selected randomly using a multi-stage cluster sampling method, between 2018 and 2019. Demographic Questionnaire, Household Food Insecurity Access Scale (HFIAS), International Physical Activity Questionnaire (IPAQ), Anthropometric Measurements (weight, body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and waist, hip, and Neck Circumferences (WC,HC, and NC)), and systolic and diastolic blood pressure (SBP and DBP) were measured. Multivariable binary logistic regressions were used to evaluate the association between mentioned variables and FI status. The prevalence of FI in the study population was 61.24 percent (95 percent CI: 58.11–64.30). In a Multivariable binary logistic regressions model, participants in the highest stages of FI had significantly lower risk of BMI (OR: 0.62 95 percent CI 0.45–1.10) (p .007), NC (OR: 0.51; 95 percent CI 0.28–0.95) (p .03), and WHR (OR: 0.50; 95 percent CI 0.29–0.88) (p .011) in comparison with food secure group. FI was highly prevalent in our study population. Despite the high prevalence of overweight and obesity, there were no significant differences in terms of weight between groups.