Multivariate Conditional Logistic Regression Analysis Research Articles

Determinants of second-dose measles vaccination dropout in Ethiopia: A community-based matched case-control study

BackgroundMeasles vaccination is the most important public health intervention and a cost-effective strategy to reduce morbidity and mortality in under-five children. Although Ethiopia's government developed a measles elimination strategic plan by 2020, the full coverage of immunization was 43 %. Therefore, this study aimed to identify determinants of second-dose measles vaccination (MCV2) dropout among children aged 24–35 months in East Bale Zone, Ethiopia. MethodA community-based matched case-control study was conducted among 351 children (117 cases and 234 controls). Children who received the first dose of measles vaccine but did not receive the second dose were cases, and children who received both doses of measles vaccine were control. The matches were based on age and residence. The data were collected using a structured questionnaire, entered into Epi Data 3.1, cleaned, exported, and analyzed using Stata version 16.1. A multivariable conditional logistic regression analysis was performed. Variables with a P value of <0.05 were considered significant determinants of the dependent variable at the 95 % confidence level. ResultsMothers who were unable to read and write (mAOR: 4.0; 95 % CI: 1.59–10.2), did not receive counseling (mAOR: 3.19; 95 % CI: 1.62–6.27), spent ≥30 min to reach health facilities (mAOR; 2.76, 95 % CI: 1.25–6.1), and did not attend postnatal care (mAOR; 3.46, 95 % CI: 1.58–7.57) were significantly and positively associated with second-dose measles vaccination dropout. In addition, mothers who had poor knowledge of second-dose measles vaccination (mAOR; 3.20, 95 % CI: 1.50–6.70) and waited more than an hour for measles vaccination at health facilities (mAOR; 2.61, 95 % CI: 1.0–6.20) were significantly more likely to experience second-dose measles vaccine dropout. ConclusionsThe key factors associated with second-dose measles vaccination dropout are maternal illiteracy, lack of PNC, inadequate maternal knowledge and poor counseling about MCV2 vaccination, long distances travel to healthcare facilities and extended waiting times at vaccination providing sites. Health extension workers emphasize strengthening home visit programs in catchment households to improve mothers' awareness of measles vaccination.

Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study

ObjectivesIt is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. MethodsRetrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15–55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. ResultsWe matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20–1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03,;95% CI 1–1.07). ConclusionsThe higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.

Risk factors associated with Severe Acute Malnutrition (SAM) in children aged 6 – 59 months in the Mokolo Health District, Far North region of Cameroon

Background: Childhood malnutrition remains a pressing public health concern in Cameroon particularly in the Far North region, where 5.2% of children under the age of five suffer from severe acute malnutrition (SAM), and 38.2% experience stunted growth. Chronic poverty, household food insecurity, lack of education and inadequate healthcare infrastructure contribute significantly to this alarming prevalence. This study aims to contribute to the mitigation of malnutrition in the Far North Region of Cameroon by identifying specific risk factors associated with SAM among children aged 6 – 59 months in the Mokolo health district. Subjects and Methods: A cross-sectional descriptive study enrolled 150 participants who met the inclusion criteria, employing consecutive sampling methodology. Data were collected through a face-to-face interview with participants, supplemented by a comprehensive assessment of hygienic practices and food security within the community. Bivariate and multivariate conditional logistic regression analysis were utilized to explore determinants of SAM. Independent variables with p values ≤ 0.05 were considered significantly associated with the nutritional status of children. Results: Gastroenteritis, Adjusted Odd Ration (AOR) = 12.3 (5.5 – 27.5, p &lt; 0.001), malaria AOR = 6.2 (2.8 – 13.8, p &lt; 0.006) and pneumonia AOR = 6.7 (1.3 – 34.4, p = 0.01) emerged as specific comorbidities associated with SAM. Moreover, late introduction of complementary feeding AOR = 2.98 (1.36 – 6.53, p = 0.014), low food diversification AOR = 5.3 (2.5 – 11.8, p &lt; 0.001) and the use of unhygienic traditional concoctions AOR = 2.8 (1.4 – 5.6, p = 0.004) were identified as significant risk factors. Furthermore, 63.3% of the participants reported inadequate access to safe drinking water (e.g., boreholes, wells, and streams) and 46.7% of caretakers had no formal education. Conclusion: In addition to malaria, pneumonia and gastroenteritis, poor nutritional and hygienic practices serve as specific determinants of SAM. Addressing these challenges requires urgent attention to improve the nutritional status of children aged 6 – 59 months emphasizing nutrition education alongside comprehensive multi-sectorial interventions. Key words: Risk factors, Severe Acute Malnutrition, Children aged 6-59 months, Mokolo, Far-North Cameroon.

Effect of Statins for Primary Prevention of Cardiovascular Disease According to the Fatty Liver Index.

Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease (CVD). We investigated the primary preventive effect of statins on CVD according to the level of fatty liver index (FLI), which is a marker of NAFLD. We conducted a nested case-control study on the basis of a nationwide health screening cohort in Korea. The participants were divided into tertiles (T1, T2, and T3) according to their FLI score. Cases were defined as individuals who developed CVD (composite of myocardial infarction and stroke). Three controls were matched to each case and multivariable conditional logistic regression analysis was performed. Within a cohort of 206,263 participants without prior CVD, 7044 individuals suffered the primary outcome. For the nested case-control study, we selected these 7044 cases along with their corresponding 20,641 matched controls. Individuals in the T3 tertiles of FLI had a higher risk of CVD than those in the T1 tertile [adjusted odds ratio (OR) 1.30; 95% confidence interval (CI) 1.20-1.40, P < 0.001]. In sub-analyses based on FLI tertiles, statin therapy was associated with a lower risk of CVD (adjusted OR 0.72; 95% CI 0.61-0.85, P < 0.001) in the T3 tertile but not in the T1 and T2 tertiles. Statin therapy was associated with a reduced risk of CVD in individuals with high FLI but not in those with low FLI. Further research is needed to determine the pathophysiologic mechanism between statin and NAFLD.

Factors associated with the introduction of visiting-pharmacist services in older adults in Japan: A nested case-control study.

To investigate the factors associated with introducing visiting-pharmacist services for community-dwelling older adults in Japan. We conducted a nested case-control study using claims data in a cohort from a city in Tokyo. Patients aged ≥65 years who received visiting-pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month-year. Medical and long-term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long-term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting-pharmacist service introduction. A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98-31.80) for physicians' home visits, 5.83 (5.08-6.70) for hospitalization, and 4.97 (4.16-5.95) for designated-facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated. This study provides insights into the introduction of visiting-pharmacist services for older adults in Japan. Geriatr Gerontol Int 2024; 24: 344-351.

Early double-balloon enteroscopy was not related to better clinical outcomes in patients with suspected overt small bowel bleeding.

Device-assisted enteroscopy has been used for over 20 years for the management of patients with suspected small bowel bleeding. Unlike esophagogastroduodenoscopy and colonoscopy, the appropriate timing of enteroscopy is still unknown. In recent guidelines, early enteroscopy is suggested to maximize diagnostic yield and therapeutic yield in patients with suspected small bowel bleeding. However, few studies have identified its influence on clinical outcomes, including mortality or rebleeding rate. We conducted this study to evaluate the influence of the timing of double-balloon enteroscopy on clinical outcomes in patients with suspected small bowel bleeding. Patients with overt small bowel bleeding who underwent double-balloon enteroscopy from January 2013 to February 2021 were retrospectively reviewed. Patients were categorized into an early enteroscopy group (≤14 days) and a nonearly enteroscopy group (>14 days). Clinical outcomes, including short-term mortality and rebleeding rate, long-term mortality and rebleeding rate, diagnostic yield, and therapeutic yield, were analyzed. A total of 100 patients (mean age, 66.2 years; 53% male) were included, and 44 patients were stratified into the early enteroscopy group. The diagnostic yield, therapeutic yield, mortality, and rebleeding rate were similar between two groups. In multivariate conditional logistic regression analysis, there were no significant differences between two groups regarding the 30-day rebleeding rate (adjusted odds ratio [aOR], 1.43; 95% CI, 0.47-4.33), 90-day rebleeding rate (aOR, 1.18; 95% CI, 0.47-2.94), 30-day mortality rate (aOR, 1.29; 95% CI, 0.21-8.13), 90-day mortality rate (aOR, 1.94; 95% CI, 0.48-7.87), and 90-day bleeding-related mortality (aOR, 2.18; 95% CI, 0.24-19.52). The Kaplan-Meier survival curve analysis showed that the timing of DBE was not associated with the long-term rebleeding rate or mortality rate ( p = 0.57 and 0.83, respectively). The timing of enteroscopy did not influence the clinical outcomes, including the short-term mortality rate, short-term rebleeding rate, long-term mortality rate, and rebleeding rate, in patients with suspected overt small bowel bleeding.

Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis.

Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.

Maternal autoimmune disease and its association with childhood cancer: A population-based case-control study in Denmark

BackgroundAutoimmune diseases have been linked to an increased risk of pregnancy-related complications. A family history of autoimmune diseases may be related to the risk of childhood cancer based on similar histocompatibility antigens. We utilized data from national registries in Denmark to examine associations between maternal autoimmune disease and cancer in their offspring. MethodsWe linked data from several national registries in Denmark to identify childhood cancer cases in children <20 years diagnosed between 1977 to 2016. Controls were selected from the Central Population Register and matched to cases by birth year and sex (25:1). Mothers with autoimmune disease diagnosed in pregnancy or prior were identified from the National Patient Register. Multivariable conditional logistic regression analyses were used to estimate associations between maternal autoimmune diseases and childhood cancer in offspring. ResultsAutoimmune diseases (all types) were positively associated with all childhood cancers combined (Odds Ratio (OR) = 1.25, 95% CI 1.06, 1.47), acute lymphoblastic leukemia (OR =1.52, 95% CI 1.09, 2.13), Burkitt lymphoma (OR = 2.69, 95% CI 1.04, 6.97), and central nervous system tumors (OR = 1.45, 95% CI 1.06, 1.99), especially astrocytoma (OR = 2.27, 95% CI 1.36, 3.77) and glioma (OR = 1.75, 95% CI 1.13, 2.73). When we examined mothers with rheumatoid arthritis, we observed an increased association for all cancers (OR = 2.15, 95% CI 1.40, 3.30), acute lymphoblastic leukemia (OR = 3.55, 95% CI 1.69, 7.47), and central nervous system tumors (OR = 2.91, 95% CI 1.46, 5.82), especially glioma (OR = 3.58, 95% CI 1.40, 9.18) in offspring. ConclusionThere is a positive association between maternal autoimmune disease and childhood cancer. This association is especially prominent in the offspring of women with rheumatoid arthritis.

Effect of nutrition education on improving dietary diversity of children aged 6–23 months in Horo district, Oromia region, Ethiopia

BackgroundUnmet minimum dietary diversity (MDD) feeding practices in poor nations place children at high risk of undernutrition and its related effects, which are far-reaching and difficult to correct later in life. ObjectiveThis study aimed to assess the effect of maternal nutrition education and another determinant on the dietary diversity of children aged 6–23 months. MethodsA community-based cluster randomized trial study design was conducted from July 2019 to January 2020 in the Horo district. Twenty-three kebeles were assigned to two clusters. From two clusters, two kebeles were selected by simple random sampling. Two kebeles were assigned as intervention (150) and control (150) groups by the lottery method, at the end of the line as intervention (139) and control (137) groups. Simple random sampling techniques were used to select the study subjects. The nutrition education intervention, which lasted three months and consisted of eight sessions, was given to the intervention group, which was made up of mothers and other caregivers of children aged 6–23 months.Data entry into Epi-data and analysis were done using IBM SPSS version 26 computer software. At a 95% confidence level, values with P ≤ 0.05 were considered statistically significant. B-ivariable and multivariable conditional fixed-effect logistic regression analyses were done to identify the determinants of the dietary diversity score. Variables with a p-value of less than 0.05 were considered statistically significant. The crude odds ratio (COR) and adjusted odds ratio (AOR) were used to describe the strength and direction of the association. ResultThe result was that the proportion of children with a good dietary diversity score was 52 (34.7%) and 40 (26.7%) in the control group and intervention groups at baseline, respectively. Household food security [AOR = 4.06, 95% CI: (2.45, 6.73] and being in the intervention group [AOR = 1.90, 95% CI: (1.10, 3.29] were both positive predictors of the dietary diversity score, while maternal age (35–45 years) was a negative predictor. ConclusionAt baseline, a high proportion of children aged 6–23 months did not receive the World Health Organization's minimum dietary diversity recommendation for both groups. The consumption of animal sources and vitamin-A-rich fruits and vegetables was poor among both groups. At the end of the day, after nutrition education, the dietary diversity score improved in the intervention groups but not in the control groups. New strategies and programs should be made at all levels to improve childhood nutritional status. This includes providing nutrition education for mothers aged between 35 and 45 years old.

Factors associated with death, hospitalization, resignation, and sick leave from work among patients with schizophrenia in Japan: a nested case–control study using a large claims database

BackgroundPremature mortality, frequent relapse that easily leads to hospitalization, and discontinuous employment are key challenges for the treatment of schizophrenia. We evaluated risk factors for important clinical outcomes (death, hospitalization, resignation, and sick leave from work) in patients with schizophrenia in Japan.MethodsA nested case–control study was conducted for patients with schizophrenia identified in a Japanese claims database. For each outcome, the case was matched with up to four controls of the same age, sex, index year, and enrollment status (employee or dependent family). Potential risk factors were defined by prescriptions or diagnoses within 3 months prior to or in the month of the event. The association among potential risk factors and each outcome was evaluated using multivariable conditional logistic regression analysis with stepwise variable selection.ResultsThe number of cases and eligible patients for each outcome were 144 and 38,451 (death), 1,520 and 35,225 (hospitalization), 811 and 18,770 (resignation), and 4,590 and 18,770 (sick leave), respectively. Depression was a risk factor for death (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.12, 3.29), hospitalization (OR: 1.22; 95% CI: 1.05, 1.42), and sick leave from work (OR: 1.46; 95% CI: 1.36, 1.57). Other risk factors for death were hospitalization history, Charlson Comorbidity Index (CCI) score, and prescription for laxatives. Prescriptions for hypnotics, laxatives, and anticholinergics were risk factors for hospitalization. Prescriptions for hypnotics and anticholinergics were risk factors for resignation. CCI score, prescription for hypnotics, laxatives, and antidiabetics were risk factors for sick leave from work.ConclusionsOur findings suggest that depression and some physical symptoms, such as constipation and extrapyramidal symptoms, are risk factors for important clinical outcomes in patients with schizophrenia. Attention should be paid to both depression and physical symptoms for the treatment of schizophrenia.

Risk factors for parapharyngeal and retropharyngeal metastases in papillary thyroid cancer: a matched case-control study.

To analyze risk factors for parapharyngeal (PP) and retropharyngeal (RP) metastases in papillary thyroid cancer (PTC). A matched case-control study was conducted, comprising 130 age- and sex-matched cases of PTC. Among these cases, 50 had PP/RP metastases, 50 had central and/or lateral neck lymph node metastases, and 30 showed no lymph node metastases. Preoperative thyroid function test, computed tomography images, and postoperative pathological findings were collected. Associations between cases were assessed using univariate conditional logistic regression analysis, followed by multivariate conditional logistic regression analysis, and backward stepwise selection to predict risk factors for PP/RP metastases. The study found that thyroglobulin was significantly associated with the development of PP/RP metastases [136.10(16.55-312.60) vs. 27.60(10.28-55.62) vs. 8.74(6.35-21.10) P < 0.001]. The study concludes that thyroglobulin is a significant risk factor for PP/RP metastases in PTC. This finding emphasizes the importance of monitoring thyroglobulin levels in PTC patients to identify those at risk of developing PP/RP metastases.

Family history, socioeconomic factors, comorbidities, health behaviors, and the risk of sudden cardiac arrest

Genetic, environment, and behaviour factors have a role in causing sudden cardiac arrest (SCA). We aimed to determine the strength of the association between various risk factors and SCA incidence. We conducted a multicentre case-control study at 17 hospitals in Korea from September 2017 to December 2020. The cases included out-of-hospital cardiac arrest aged 19–79 years with presumed cardiac aetiology. Community-based controls were recruited at a 1:1 ratio after matching for age, sex, and urban residence level. Multivariable conditional logistic regression analysis was conducted. Among the 1016 cases and 1731 controls, 948 cases and 948 controls were analysed. A parental history of SCA, low educational level, own heart disease, current smoking, and non-regular exercise were associated with SCA incidence (Adjusted odds ratio [95% confidence interval]: 2.51 [1.48–4.28] for parental history of SCA, 1.37 [1.38–2.25] for low edication level, 3.77 [2.38–5.90] for non-coronary artery heart disease, 4.47 [2.84–7.03] for coronary artery disease, 1.39 [1.08–1.79] for current smoking, and 4.06 [3.29–5.02] for non-regular exercise). Various risk factors related to genetics, environment, and behaviour were independently associated with the incidence of SCA. Establishing individualised SCA prevention strategies in addition to general prevention strategies is warranted.

Analysis of risk factors for community-acquired Clostridioides difficile diarrhea in children: a case-control study in Chenzhou, China.

Most previous studies on Clostridium difficile infection (CDI) mainly focused on adults with underlying diseases or critical illnesses. However, the number of CDI cases in children has also significantly increased, especially the growth of community-acquired CDI, which has attracted attention. This study was conducted to examine the toxin gene characteristics and the risk factors associated with community-acquired CDI (CA-CDI) in children with diarrhea. Children with diarrhea before admission or within 48 hours of hospitalization were included in the study. Stool samples were collected from children with community-acquired diarrhea who were treated at the Children's Hospital of the First People's Hospital of Chenzhou, China from June of 2021 to June of 2022. Fluorescence real-time polymerase chain reaction was utilized to detect Clostridioides difficile (CD) toxins A (tcdA) and B (tcdB) genes as well as binary toxin gene A (cdtA) and B (cdtB) in the specimens cultured for CD. Each child with CA-CDI was matched with four control children of the same sex, age, and place of residence. Necessary clinical data were extracted from the hospital's electronic medical record system. Then, a multivariate conditional logistic regression analysis was applied to identify potential risk factors for CA-CDI. Sixteen (8.3%) of the 193 stool specimens who tested positive for CD were selected for the case group, and their matching 64 control patients were in the study cohort. The breakdown of the CD genotypes of the 16 positive cases were follows: 14 (tcdA+ and tcdB+) (7.25%) and 2 (tcdA+ and tcdB-) (1.04%). The cdtA and cdtB binary toxin genes were negative in all. The results of multivariate conditional logistic regression analysis identified antibiotic use within the previous month [odds ratio (OR) =5.13; 95% confidence interval (CI): 1.65-15.91] and non-breastfeeding (OR =4.89; 95% CI: 1.11-21.53) as independent risk factors for CDI in pediatric patients experiencing community-acquired diarrhea. Children who had been treated with antibiotics and not breastfed were more susceptible to CDI. Therefore, in order to prevent and to control the spread of CD infection, being prudent to the aforementioned high-risk factors is strongly advocated in clinical practice.

The Time-Effect Relationship between Time to Surgery and In-Hospital Postoperative Pneumonia in Older Patients with Hip Fracture

Introduction: Pneumonia is a common and devastating complication following hip fracture surgery in older patients. Time to surgery is a potentially modifiable factor associated with improved prognosis, and we aim to quantify the time-effect relationship between time to surgery and in-hospital postoperative pneumonia (IHPOP) and identify the effect of delayed surgery on the risk of IHPOP. Methods: We analyzed clinical data of older hip fracture patients (≥60 years) undergoing surgical treatments at a tertiary referral trauma center between 2015 and 2020. Restricted cubic spline (RCS) was used to fit the time-effect relationship between time to surgery and IHPOP. Based on the results of RCS, we divided patients into two groups of “early surgery” and “delayed surgery.” A 1:1 propensity score matching (PSM) analysis and multivariate conditional logistic regression analysis were performed to minimize the selection bias and determine the association magnitude. Subgroup analysis was conducted to assess potential interaction effects between delayed surgery and common risk factors for IHPOP. Results: 3,118 eligible patients were included. The RCS curve showed an inverse S-shape trend and the relative risk of IHPOP decreased in the range of days 2–3 and increased on day 1 and day 3 or more post-injury, with the lowest point on day 3. PSM yielded 1,870 matched patients and delayed surgery (>3 days) was identified to be independently associated with IHPOP (relative ratio, 1.66; 95% confidence interval, 1.12–2.46; p value, 0.011). We observed positive interaction effects between delayed surgery and age of 80 years or more, female gender, COPD, heart disease, ASA score ≥3, anemia, and hypoproteinemia. Conclusion: The relative risk of IHPOP decreased in the range of 2–3 days and increased on day 1 and day 3 or more post-injury. Delayed surgery (>3 days) was identified to be independently associated with a 1.66-fold increased risk of IHPOP.

Risk of peri‑implant femoral fracture after cephalomedullary nailing in older patients with trochanteric fractures

IntroductionDespite the recent increase in the use of cephalomedullary nails for trochanteric hip fractures, factors that may be associated with peri‑implant femoral fracture (PIFF) after cephalomedullary nailing for trochanteric fractures remain unknown. We investigated the factors associated with PIFF after cephalomedullary nailing of trochanteric hip fractures in older patients. MethodsA nested case–control study was conducted using a database of patients aged ≥65 years who underwent surgery with cephalomedullary nails for trochanteric fractures caused by low-energy trauma during 2005–2021. The cases were defined as patients who developed PIFF after surgery, while controls were patients who did not develop PIFF and who were followed up for ≥3 years after surgery. Four controls were randomly matched to each case for sex and age. First, potential factors associated with PIFF were compared between cases and controls. Second, multivariable conditional logistic regression analysis was employed to assess factors possibly associated with PIFF, controlling for potential confounding factors. ResultsOf 1531 patients who underwent surgery with cephalomedullary nails because of trochanteric fractures, we assessed 34 cases and 136 controls (N = 170; mean age 85.7 ± 7 years; and females, 94 %). PIFF was significantly associated with patients having undergone total knee arthroplasty (adjusted odds ratios [95 % confidence intervals], 4.41 [1.16–16.8]) and those with AO/OTA classification 31A3 fracture (A3 fracture) (2.3 [1.12–4.76]), after adjusting for potential confounding factors. ConclusionsOur results showed that PIFF was more likely to develop among older patients with a clinical history of total knee arthroplasty and A3 fracture. These findings suggest that such patients may require careful follow-up with rigorous assessments after cephalomedullary nailing for trochanteric fractures.

Trends in teicoplanin loading dose implementation from 2010 to 2019 and evaluation of safety and efficacy factors: a retrospective cohort study based on a Japanese administrative claims database

BackgroundThe loading dose of teicoplanin (TEIC) is recommended for implementation. However, there is significant discrepancy between the dose settings in the package insert and, in the guidelines, and the actual status of loading doses in Japan is unclear. Furthermore, TEIC causes liver injury as side effect. Although the risk of developing liver injury has not been reported to be increased following a loading dose based on the guidelines, there is a lack of reports in large populations. Therefore, we evaluated the trend in the loading dose and factors affecting the efficacy and safety of TEIC administration.MethodsA Japanese administrative claims database was used in this study. Trends in loading doses were evaluated in target populations administered TEIC between 2010 and 2019. Patient characteristics were adjusted by propensity score matching based on the guideline group (total dose of 3 days > 1,600 mg) and non-guideline group (≤ 1,600 mg) of the loading dose. Finally, univariable and multivariable conditional logistic regression analysis was performed to evaluate factors affecting 30-day mortality and liver injury.ResultsA total of 10,030 patients were selected based on these criteria. The proportion of loading doses based on the recommended guidelines showed an increase over time, regardless of the implementation of therapeutic drug monitoring (TDM), but especially so in cases where TDM was implemented, the loading doses were administered in accordance with the recommendations of the guidelines. Conditional logistic regression analysis showed a relationship between drug management and guidance fees (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.36‒0.55), a reimbursement indicating pharmacist intervention, and a reduction in 30-day mortality. In addition, loading doses based on the recommended guidelines had no influence on liver injury, and other factors were not significantly associated with increased incidence of liver injury.ConclusionThus, this study implies the benefits of pharmacological management as indicated by drug management and guidance fee and supports the implementation of loading doses based on the guideline on TEIC administration.

Effect of Smoking Cessation on the Risk of Subarachnoid Hemorrhage: A Nested Case-Control Study in Korean Men.

Smoking is a well-established risk factor for subarachnoid hemorrhage (SAH), and current smokers have an increased risk of SAH. However, there are insufficient data on whether smoking cessation in current smokers reduces the risk of SAH. A nested case-control study was conducted based on the National Health Insurance Service-National Health Screening Cohort, which comprises nationwide health claims data and a national health screening program in Korea (2002-2019). We constructed a cohort of current male smokers without a history of stroke at the baseline health screening (2002-2003). From this cohort, cases were defined as individuals who experienced a nontraumatic SAH during the follow-up period up to 2019. Five controls were matched to each case using incidence density sampling. Smoking status (continuation or cessation) before the occurrence of SAH was evaluated using the repeated national health screening program. We conducted a multivariable conditional logistic regression analysis, adjusting for alcohol consumption, physical activity, body mass index, systolic blood pressure, and fasting blood glucose levels, to evaluate the association between SAH risk and smoking cessation. At baseline, there were 112 142 current male smokers. After excluding individuals with prior stroke or insufficient data, the cohort consisted of 105 223 eligible participants (mean age, 50.3±8.5 years). Among them, we identified 318 cases of SAH and 1590 matched controls. Those who quit smoking had a significantly lower risk of SAH compared with current smokers (adjusted odds ratio, 0.55 [95% CI, 0.41-0.73]). The risk of SAH decreased with a longer period of smoking cessation. The risk reduction with smoking cessation was consistent even among prior heavy smokers. Smoking cessation in current male smokers reduced the risk of SAH, and the risk reduction was greater as the cessation period increased. These findings warrant intensive efforts to encourage smokers, even heavy smokers, to quit.

Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study.

This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014-2021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age ≥35 years (as compared to ≤18 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15-1.99), along with polydrug use (aOR 1.39, 95% CI 1.22-1.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26-1.64), and the use of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL, aOR 3.08, 95% CI 2.66-3.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74-0.99), cannabis (aOR 0.44, 95% CI 0.37-0.52), heroin (aOR 0.80, 95% CI 0.69-0.93), and amphetamine (aOR 0.65, 95% CI 0.54-0.78), as was the arrival to the ED during the night (8 p.m.-8 a.m., aOR 0.88, 95% CI 0.79-0.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.

Exploring the relationship between intimate partner violence during pregnancy and stillbirths

IntroductionThe relationship between intimate partner violence (IPV) in pregnancy and stillbirths is poorly understood. We aimed to determine if there was any association between stillbirths and IPV during pregnancy. MethodsA community-based, matched, case-control study was conducted in 2014, nested within the Maternal and Newborn Health Registry of the Global Network for Women's and Children's Health Research in Pakistan. Using a WHO questionnaire, IPV in pregnancy was ascertained from 256 cases (women with stillbirths) and 539 controls (women with live births), individually matched on parity. Multivariable conditional logistic regression analysis assessed the association of IPV in pregnancy ending in stillbirths compared to those with live births. ResultsThe effect of physical and psychological IPV was modified by maternal age. Among women 25-34 years old with stillbirths, the odds of experiencing physical IPV in pregnancy were four times greater than those with live births, after controlling for confounders [odds ratio 4.1 (95% CI: 1.5, 11.2)]. A negative association was observed between psychological IPV in pregnancy and stillbirths among women younger than 25 years, and no association was observed between sexual IPV during pregnancy and stillbirths. ConclusionStudy results show that women 25-34 years of age with stillbirths were four times more likely to experience physical IPV during pregnancy. Further studies replicating the effect modification of IPV by maternal age are warranted.

Association between lipoprotein(a) and ischemic stroke: Fibrinogen as a mediator

BackgroundPrevious studies have reported lipoprotein(a) was related to increased risk of ischemic stroke. However, the role of fibrinogen in their associations was not fully elucidated. AimWe aimed to investigate the mediating role of fibrinogen in the association between lipoprotein(a) and risk of ischemic stroke. MethodsA total of 516 patients with ischemic stroke were matched 1:1 to patients without ischemic stroke for age and gender. Serum lipoprotein(a) and plasma fibrinogen levels were collected on the basis of the results of biochemical tests. Multivariate conditional logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for lipoprotein(a) levels and ischemic stroke risk. Mediation analysis were further conducted to evaluate the potential mediating role of fibrinogen in the association between lipoprotein(a) and ischemic stroke risk. ResultsThe lipoprotein(a) level of subjects with ischemic stroke was significantly higher than that of subjects without ischemic stroke (P < 0.001). Each SD increment of lipoprotein(a) was associated with 27% higher odds (OR 1.27, 95%CI: 1.11, 1.45) increment in ORs of ischemic stroke. Furthermore, mediation analyses indicated that fibrinogen mediated 10.15% of the associations between lipoprotein(a) and ischemic stroke. ConclusionsHigher level of lipoprotein(a) was independently associated with increased risk of ischemic stroke and fibrinogen partially mediated the associations of lipoprotein(a) and ischemic stroke risk.