Multivariate Multinomial Logistic Regression Analysis Research Articles

Is sleep associated with BMI, waist circumference, and diet among long-term colorectal cancer survivors? Results from the population-based PROFILES registry.

In the general population, poor sleep quality and short sleep duration are associated with a higher body mass index (BMI) and waist circumference (WC), and an unhealthy diet. The aim of this study was to assess if the association between sleep quality and duration and BMI, WC, and diet quality also exists among colorectal cancer (CRC) survivors, as many CRC survivors have an unhealthy weight and diet. Cross-sectional data from a longitudinal CRC cohort were used. In this study, survivors were 4-13years post diagnosis. The Pittsburgh Sleep Quality Index (PSQI) was used to assess both sleep quality and sleep duration. Diet quality was assessed by scoring adherence (low, moderate, high) to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations of five food groups and nutrients: fruit and vegetables, dietary fiber, red and processed meat, alcoholic beverages, and sugary drinks, using a brief diet screener. BMI and WC were self-measured. Associations were analyzed by multivariable linear and multinomial logistic regression analyses. Among 1002 CRC survivors, 23% reported poor sleep quality (PSQI score ≥ 8) and 24% reported short sleep duration (≤ 6h). No associations between sleep and BMI, WC, and diet quality were found. Sleep problems are common in long-term CRC survivors; however, sleep quality and duration was not associated with BMI, WC, and diet quality in this population. It is unknown why the results differ from findings in the general population.

Clinical Outcomes of Patients Attending a Flu Clinic at a Tertiary Health-Care Facility in India during the COVID-19 Pandemic

Purpose: In response to ongoing coronavirus disease (COVID)-19 pandemic, flu clinics were set by most of the hospitals all over India to screen patients for the disease. The study aimed to find out treatment outcome of patients attending a flu clinic at a tertiary health-care facility. Methods: It is an observational study, cross-sectional in design. The study used data routinely collected at the flu clinic of a selected tertiary health-care facility of a selected state of India. Data collected between March 22, 2020, and May 31, 2020 were used for the study. Results: Among 3873 study participants, 364 (9.4%) required admission in COVID-19 isolation ward for testing, while 1536 (39.6%) were referred for further management and the rest being symptomatically managed or home quarantined. In multivariate multinomial logistic regression analysis, females, lockdown phases, symptomatic, severe acute respiratory illness patients, those with contact history with a COVID-19 case, chronic comorbidities, and health worker had significantly higher odds of being admitted in COVID-19 isolation ward compared to others. Those who belonged to the age group of 16–30 years had significantly lower odds of admission. On the other hand, age, sex, lockdown phases, native district COVID-19 risk category, symptom status, chronic comorbidity, contact history, travel history. and profession were significant predictors of referral for further management. Conclusion: Half of the study participants were home quarantined or symptomatically managed. Age, sex, symptom status, contact history, travel history, chronic comorbidity, and profession were significant predictors for their treatment outcome.

The association between adherence to a dietary approaches to stop hypertension (DASH) diet and neuro-psychological function in young women

BackgroundThe adherence to a Dietary Approaches to Stop Hypertension (DASH) diet may have a bidirectional relationship with mental wellbeing. We aimed to evaluate the association between compliance with a DASH diet and neuro-psychological function in young women.MethodsIn this cross-sectional study, a total of 181 girls aged between 18 and 25 years were recruited. The dietary intakes of study participants were evaluated using a valid and reliable food frequency questionnaire (FFQ) containing 65 food items. Neuropsychological function of participants was evaluated using standard questionnaires.ResultsAs may be expected, individuals in the highest tertile (T3) of adherence to DASH diet (highest adherence) were found to consume more folate, fruits, vegetables, low fat dairy, nuts, legume, and seed, less sweetened beverage and sodium, compared to the participants in the lowest tertile (T1, lowest adherence). There was a significant negative correlation between cognitive function and consumption of red and processed meat (r = − 0.168; p < 0.05); quality of life score with dietary sodium (r = − 0.151; p < 0.01) and depression score with dietary vegetables (r = − 0.174; p < 0.05). In multivariate multinomial logistic regression analyses adjusted for age, BMI and energy intake, adherence to a DASH-style diet was associated with a lower stress score (OR = 0.70; 95%CI: 0.34–1.47, P = 0.067; T3 vs. T1) and difficulty with sleep initiation (OR = 0.46; 95%CI: 0.21–1.00, P = 0.017; T3 vs. T1).ConclusionAdherence to a DASH diet may be associated with reduced stress and difficulty with initiating sleep.

Examining the effect of information channel on COVID-19 vaccine acceptance.

Hesitancy towards the COVID-19 vaccine remains high among the US population. Now that the vaccine is available to priority populations, it is critical to convince those that are hesitant to take the vaccine. Public health communication about the vaccine as well as misinformation on the vaccine occurs through a variety of different information channels. Some channels of information are more commonly found to spread misinformation. Given the expansive information environment, we sought to characterize the use of different media channels for COVID-19 vaccine information and determine the relationship between information channel and vaccine acceptance. We used quota sampling of vaccine priority groups [N = 2,650] between December 13 and 23, 2020 and conducted bivariate chi-squared tests and multivariable multinomial logistic regression analyses to determine the relative impact of channels of information on vaccine acceptance. We found traditional channels of information, especially National TV, National newspapers, and local newspapers increased the likelihood of vaccine acceptance. Individuals who received information from traditional media compared to social media or both traditional and social media were most likely to accept the vaccine. The implications of this study suggest social media channels have a role to play in educating the hesitant to accept the vaccine, while traditional media channels should continue to promote data-driven and informed vaccine content to their viewers.

Lifestyle changes associated with COVID-19 quarantine among young Saudi women: A prospective study.

BackgroundNegative lifestyle behaviors are associated with an increased risk of adverse outcomes from coronavirus disease (COVID-19). This study aimed to assess lifestyle changes affecting weight, sleep, mental health, physical activity, and dietary habits prospectively from before COVID-19 to during lockdown.MethodsA total of 297 Saudi women, aged 19–30 years (mean age, 20.7 ± 1.4 years), were interviewed at two time points, before and during the quarantine. The data collected included anthropometrics, sociodemographic data, clinical history, food frequency questionnaire responses, Pittsburgh Sleep Quality Index scores, Global Physical Activity Questionnaire (GPAQ) responses, and Perceived Stress Scale measures. In addition, during quarantine, COVID-19 and nutrition-related information and Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores were collected. Multivariate multinomial logistic regression analysis was used to examine the indicators of weight gain and loss from before COVID-19 (baseline) until during lockdown.ResultsAlthough approximately half of the participants did not report a weight change, 30% revealed weight loss and 18%, weight gain. The variables associated with increased weight gain were self-quarantine since COVID-19 started (OR: 5.17, 95% CI: 1.57–17.01, p = 0.007), age (OR: 1.53, 1.03–2.28, p = 0.04), and stress at baseline and during lockdown (OR: 1.15, 1.03–1.29, p = 0.01; OR: 1.10, 1.01–1.19, p = 0.03, respectively). The variables associated with a reduced risk of weight gain were the GPAQ score during lockdown (OR: 0.16, 0.04–0.66, p = 0.01), coffee consumption (OR: 0.36, 0.19–0.67, p = 0.01), and total sleep time (OR: 0.70, 0.51–0.97, p = 0.03).ConclusionWhile most young Saudi women experienced no weight change during the COVID-19 lockdown, one-third lost weight and a significant proportion gained weight. Factors associated with weight, such as stress, sleep hours, physical activity, and coffee consumption, highlight the need to carefully consider those at risk during future circumstances that may require lockdowns. These factors could also aid in implementing policies for future lockdowns and support those most at risk of gaining weight.

Exploring the relationship among dental caries, nutritional habits, and peri-implantitis.

A study was made of the prevalence, co-occurrence and association among caries, nutritional habits, and peri-implant disease, with an analysis of the influence of other patient and implant factors upon peri-implant disease. The included subjects underwent a clinical examination and were asked to complete a questionnaire. Demographic data and potential lifestyle/behavioral variables were collected. Clinical and radiographic assessment allowed calculation of the decayed, missing and filled teeth (DMFT) index and peri-implant diagnosis. Uni- and multivariate multinomial logistic regression analyses were applied to identify predictors of peri-implant disease. A total of 169 patients with 311 implants were studied. At patient level, 92.2% of the subjects presented at least one carious lesion, whereas 22.5% and 56.2% were diagnosed with peri-implantitis and mucositis, respectively. Those patients with more than two caries had a higher risk of mucositis (OR=3.33). Statistically significant associations for peri-implantitis included full mouth periodontal indexes, sugar-rich diets, keratinized mucosa width, number of missing teeth and interproximal untreated caries or fillings adjacent to implants. High caries risk profiles and mucositis/peri-implantitis tended to accumulate within subjects. A sugar-enriched diet and untreated caries or fillings adjacent to implant sites may be further considered as risk indicators of peri-implantitis.

Social disparities in the diagnosis and management of bladder cancer.

403 Background: The socioeconomic characteristics associated with the diagnosis and management of bladder cancer are not well described. Methods: We utilized the National Cancer Database (NCDB) to stratify cases of urothelial cell carcinoma of the bladder by the National Comprehensive Cancer Network (NCCCN) guidelines: early (Tis, Ta, T1), muscle invasive (T2-T3, N0), locally advanced (T4, N1-3), and metastatic. We then used multivariate binomial and multinomial logistic regression analyses to identify demographic characteristics associated with stage at diagnosis and receipt of cancer-directed therapies. Hazard ratios (HR) are reported with 95% confidence intervals. Results: After exclusions, we identified 331,714 early, 72,154 muscle invasive, 15,579 locally advanced, and 15,161 metastatic cases. Relative to diagnosis at early stage, the two strongest independent predictors of diagnosis at muscle invasive, locally advanced, and metastatic disease included black race (HR = 1.19 [1.15-1.23], HR = 1.49 [1.40-1.59], HR = 1.66 [1.56-1.76], respectively), and female gender (HR = 1.21 [1.18-1.21], HR = 1.16 [1.12-1.20], and HR = 1.34 [1.29-1.38], respectively). Additional demographic factors associated with diagnosis at a more advanced stage on multivariable analysis included older age, treatment at an academic center (except for metastasis), Medicaid insurance, and patients from lower income/ less educated/more rural areas (all p &lt; 0.01). The following demographic factors were less likely to receive cancer-directed therapies, signified by odds ratios, per multivariable binomial regression analysis: Additionalyl, female patients (HR = 1.03, 1.02-1.05) and black patients (HR = 1.13, 1.11-1.16) were the only demographic correlates of reduced survival in the entire cohort with multivariable cox regression analysis. Conclusions: In the largest study of its kind, we report that several socioeconomic, racial, and gender factors are associated with the diagnosis of bladder cancer at a later stage, as well as the use of less cancer-directed treatments. Further investigation is warranted to better characterize, and ultimately improve upon, health disparities in bladder cancer. Research Sponsor: None[Table: see text]

Polysubstance use among adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2017.

Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. This study aimed to determine the prevalence of single substance users and polysubstance users and 'their associated factors among adolescents in Malaysia. This study was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2017, a cross-sectional survey conducted among Malaysian school-going adolescents aged 13 to 17. The NHMS utilised a two-stage stratified cluster sampling. Multivariate Multinomial Logistic Regression analysis was applied. The overall prevalence of single substance use and polysubstance use among adolescents were 17.2% and 5.1% respectively. The multinomial model showed a higher likelihood of being single or polysubstance user among male (single user OR = 3.0, poly user OR = 4.6), others Bumiputeras vs Malay (single user OR = 1.7, poly user OR = 5.3), those who live with a single parent (single user OR = 1.2, poly user OR = 1.4), involved in truancy (single user OR = 1.7, poly user OR = 3.6) and being bullied (single user OR = 1.3, poly user OR = 3.4), those who had lack of peer support (single user OR = 1.3, poly user OR = 1.4), poor parental bonding (single user OR = 1.4, poly user OR = 1.8), depression (single user OR = 1.4, poly user OR = 3.2) and those who had no close friend (single user OR = 1.3, poly user OR = 2.7). Our study highlighted multiple significant associated factors of single and polysubstance use among adolescents in Malaysia. This result can assist in the development of specific intervention and prevention programs targeting high-risk groups.

Metabolic syndrome and masticatory hypofunction: a cross-sectional study

The objective of this paper is to clarify the rate of abdominal obesity (AO), waist-to-height ratio (WHtR), metabolic syndrome (MetS) and determine the relationship with the masticatory capacity (MC) in terms of total functional tooth units (t-FTU) in a representative sample of older Spanish adults. This cross-sectional study included 544 adult subjects aged 50 or over, who were prospectively selected and who had participated in a survey conducted in a primary dental care service in a Public Oral Health Service in Spain. Anthropometric, clinical variables and t-FTUs were obtained through a calibrated and well-established protocol. Univariate and multivariate binary and multinomial logistic regression analyses were developed. With regards to the t-FTU or MC, it was poor in 60.3%, good in 17.6%, and complete in 22.1% of the sample. The univariate odss ratio (OR) for MetS and AO increased as the MC decreased and as the age group increased. With regards to gender, women presented with an OR of 5.56 (CI 95% 3.70-8.38). With regards to the WHtR-a3 (WHtR grouped into three categories), the univariate ORs were all significant for morbid obesity compared to the healthy group, with a risk of 6.86 (CI 95% 3.23-14.58) for patients with poor MC compared to those with complete MC. Masticatory hypofunctionality could be associated with the presence of MetS. Clinical relevance: The number of t-FTUs is directly related to AO.

The Use of Point-of-care Ultrasound in Emergency Medical Centers in Korea: a National Cross-sectional Survey.

BackgroundPoint-of-care ultrasound (POCUS) is an essential tool in emergency medicine (EM). We aimed to investigate the current status and perception of POCUS use in emergency medical centers in Korea.MethodsA cross-sectional, nationwide survey was conducted using a mobile survey of physicians at emergency medical centers in Korea. The first message was sent on November 27, 2020, and the second message was sent on December 3, 2020 to the non-responders. The questionnaire comprised 6 categories and 24 questionnaires on demographics, current practice, education, perception, and barriers to the use of POCUS.ResultsA total of 467 physicians participated in the survey (a response rate of 32% among 1,458 target physicians), of which 43% were residents and 57% were EM specialists. Most of the respondents (96%) answered that they use POCUS, of which 89% reported using it at least once a week. The most frequently used types of POCUS were focused assessment with sonography for trauma (68%) and echocardiography (66%). Musculoskeletal, male genital, and pediatric scans were rarely performed tests but ranked as of the scans physicians most wanted to learn. About 73% of the respondents received ultrasound education, and 41% received ultrasound education at their own institutions. Nevertheless, education-related barriers are still the biggest deterrent to POCUS use (60%). In addition, multivariate multinomial logistic regression analysis revealed that the greater the number of ultrasound devices and the total number of physicians in the emergency center, the more likely they were to use POCUS every day.ConclusionThis study found that most physicians currently working in emergency medical centers in Korea more frequently perform various types of ultrasound scans compared to those 10 years prior. To further promote the use of POCUS, it is important to have an appropriate number of ultrasound devices and physicians in the emergency center along with systematic POCUS education.

Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort

AimTo describe the prevalence and characteristics of polypharmacy in a Dutch cohort of individuals with type 2 diabetes.MethodsWe included people with type 2 diabetes from the Diabetes Pearl cohort, of whom 3886 were treated in primary care and 2873 in academic care (secondary/tertiary). With multivariable multinomial logistic regression analyses stratified for line of care, we assessed which sociodemographic, lifestyle and cardiometabolic characteristics were associated with moderate (5–9 medications) and severe polypharmacy (≥10 medications) compared with no polypharmacy (0–4 medications).ResultsMean age was 63 ± 10 years, and 40% were women. The median number of daily medications was 5 (IQR 3–7) in primary care and 7 (IQR 5–10) in academic care. The prevalence of moderate and severe polypharmacy was 44% and 10% in primary care, and 53% and 29% in academic care respectively. Glucose‐lowering and lipid‐modifying medications were most prevalent. People with severe polypharmacy used a relatively large amount of other (i.e. non‐cardiovascular and non‐glucose‐lowering) medication. Moderate and severe polypharmacy across all lines of care were associated with higher age, low educational level, more smoking, longer diabetes duration, higher BMI and more cardiovascular disease.ConclusionsSevere and moderate polypharmacy are prevalent in over half of people with type 2 diabetes in primary care, and even more in academic care. People with polypharmacy are characterized by poorer cardiometabolic status. These results highlight the significance of polypharmacy in type 2 diabetes.

Differential diagnosis in acute inflammatory myelitis

IntroductionEstablishing differential diagnosis between different inflammatory causes of acute transverse myelitis (ATM) can be difficult. The objective of this study was to see which clinical, imaging or laboratory findings best contribute to confirm ATM etiology. MethodsWe reviewed clinical history, MRI images, CSF and serum laboratory tests in a retrospective study of patients presenting ATM. Univariate and multivariate multinomial logistic regression analysis was performed for each of the items listed above. ResultsOne hundred and seventy-two patients were analyzed in the study: 68 with multiple sclerosis (MS), 67 presenting idiopathic myelitis (IM; 23 of which were recurrent), 21 who developed positive systemic-antibodies associated myelitis (SAb-M) and 16 with neuromyelitis optica spectrum disorders (NMOSD). The following factors were associated with increased risk of developing MS: lower values in the modified Rankin scale at admission; positive oligoclonal bands (OCB); higher spinal cord lesion load; presence of brain demyelinating lesions; and disease recurrence. Longitudinally extended (LE) lesions, brain demyelinating lesions, and recurrences also contributed to final diagnosis of NMOSD. Multivariate multinomial logistic regression analysis showed presence of LE lesions increased risk of NMOSD and recurrence of ATM. Whereas, brain demyelinating lesions, and presence of OCB increased risk of MS. ConclusionsATM etiology may be clarified on the basis of spinal cord and brain MRI findings, together with CSF biochemistry and serum laboratory test results, allowing more timely and exact diagnosis as well as specific therapy for cases of uncertain origin.

Assessment of Epidemiological Determinants of COVID-19 Pandemic Related to Social and Economic Factors Globally

The COVID-19 pandemic has manifested more than a health crisis and has severely impacted on social, economic, and development crises in the world. The relationship of COVID-19 with countries’ economic and other demographic statuses is an important criterion with which to assess the impact of this current outbreak. Based on available data from the online platform, we tested the hypotheses of a country’s economic status, population density, the median age of the population, and urbanization pattern influence on the test, attack, case fatality, and recovery rates of COVID-19. We performed correlation and multivariate multinomial regression analysis with relative risk ratio (RRR) to test the hypotheses. The correlation analysis showed that population density and test rate had a significantly negative association (r = −0.2384, p = 0.00). In contrast, the median age had a significant positive correlation with recovery rate (r = 0.4654, p = 0.00) and case fatality rate (r = 0.2847, p = 0.00). The urban population rate had a positive significant correlation with recovery rate (r = 0.1610, p = 0.04). Lower-middle-income countries had a negative significant correlation with case fatality rate (r= −0.3310, p = 0.04). The multivariate multinomial logistic regression analysis revealed that low-income countries are more likely to have an increased risk of case fatality rate (RRR = 0.986, 95% Confidence Interval; CI = 0.97−1.00, p &lt; 0.05) and recovery rate (RRR = 0.967, 95% CI = 0.95–0.98, p = 0.00). The lower-income countries are more likely to have a higher risk in case of attack rate (RRR = 0.981, 95% CI = 0.97–0.99, p = 0.00) and recovery rate (RRR = 0.971, 95% CI = 0.96–0.98, p = 0.00). Similarly, upper middle-income countries are more likely to have higher risk in case of attack rate (RRR = 0.988, 95% CI = 0.98–1.0, p = 0.01) and recovery rate (RRR = 0.978, 95% CI = 0.97–0.99, p = 0.00). The low- and lower-middle-income countries should invest more in health care services and implement adequate COVID-19 preventive measures to reduce the risk burden. We recommend a participatory, whole-of-government and whole-of-society approach for responding to the socio-economic challenges of COVID-19 and ensuring more resilient and robust health systems to safeguard against preventable deaths and poverty by improving public health outcomes.

Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment.

Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. This was a cohort study of 656 youth aged 12-25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. With a one-point reduction in PHQ9 at follow-up, there was an estimated 11-18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7-14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.

Abstract D085: Differences in the use of proton beam therapy among patients diagnosed with American Society for Radiation Oncology Group 1 proton beam therapy indication cancer types in the United States

Abstract Purpose: To examine the extent of racial/ethnic and geographic differences in the use of proton beam therapy (PBT) among newly diagnosed cancer patients in the United States. Methods: We included all patients diagnosed from 2009 to 2016 with invasive single or first primary cancer categorized as Group 1 indication (recommended) for PBT by the American Society for Radiation Oncology. We conducted descriptive and multivariable multinomial logistic regression analyses to assess patient and facility characteristics associated with receipt of PBT. Results: Of the total 246,932 patients diagnosed with Group 1 indication cancer types, 0.6% received PBT. PBT use was lower in non-Hispanic (NH) blacks compared with NH whites (0.3% vs 0.6%). Patients who were older, uninsured, with low median income, higher comorbidity score, treated at low volume or community programs or at facilities located in the south, and residing in rural areas had the lowest PBT use. There was a 46% relative difference in PBT use between NH blacks and NH whites, with marked variation by geographic region of facility. NH black had 37% lower odds of receiving PBT compared with NH whites (odds ratio, 0.63; 95% confidence interval, 0.50-0.79), which became nonsignificant after accounting for difference in cancer type. Further, minority race/ethnicity, older age, high comorbidity score, uninsurance/non-private insurance, treatment out of NCI-designated center, and treatment out of facilities in the northeast region were significantly associated with lower odds of PBT use versus no radiation treatment. Conclusions: Despite very low overall PBT use in the United States, there were marked differences in PBT use among patients diagnosed with Group 1 indication cancer types by race/ethnicity and geographic region of treatment facility. Citation Format: Helmneh M. Sineshaw, K. Robin Yabroff, Ahmedin Jemal, Leticia M. Nogueira, Jason A. Efstathiou. Differences in the use of proton beam therapy among patients diagnosed with American Society for Radiation Oncology Group 1 proton beam therapy indication cancer types in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D085.

Determinants of modern contraceptive use among sexually active men in Ethiopia; using EDHS 2016 national survey

BackgroundRecently, the focus of family planning programs has changed from female oriented to men oriented, or both partner oriented to have effective outcomes. Although, contraceptive use among sexually active women was exhaustively researched; there is still a huge gap on modern contraceptive use and its determinants among sexually active men in Ethiopia.ObjectivesWe assessed the determinants of contraceptive use among sexually active men in Ethiopia using national survey data.MethodThe data source for this study was the 2016’s Ethiopian Demographic and Health Survey of men aged above 15–59 years. We analyzed data of 12, 688 sexually active men in the past 12 months prior to the survey using STATA version 14.1. Bivariate and multivariable multinomial logistic regression analysis was conducted and statistical significance was set at p value < 0.05.ResultFrom a total of 12, 688 sexually active men in Ethiopia, 9378 (73.9%) didn’t use any modern contraception or use traditional methods, 2394 (18.9%) use partner methods for those who reported using a method through their partner (such as pill, IUD, injections, female sterilization and Norplant) and the rest 916 (7.2%) used male methods for those who reported using male only methods (such as condoms and male sterilization). In the adjusted multinomial logistic regression model, men’s age categories 25–34 years (AOR:2.0; 95%CI = 1.5–2.5), 35–44 (AOR: 2.8; 95%CI = (2.0–3.8), and 45+ years (AOR: 1.5; 95%CI = 1.0–2.6), being rural resident (AOR: 1.60; (95%CI = 1.3–2.2), married and living with partner (AOR: 0.03; (95%CI = 0.01–0.06), who attended secondary (AOR:1.2; (95%CI = 0.8–1.9) and higher (AOR: 1.4; (95%CI = 1.2–2.5) education, whose partner was working (AOR: 1.6; (95%CI = 1.3–2.2), having three and above children (AOR: 0.5; (95%CI = 0.3–0.8), reading newspaper/magazines at least once a week or less than once a week, listening to radio at least once a week, watching television at least once a week and watching television less than once a week were significantly associated with use of male method than traditional/no method as compared to their respective references.ConclusionModern contraceptive use among sexually active men in Ethiopia is low and multiple factors determined it. Close monitoring and supporting of sexually active men with age above 25 years, rural background, higher educational level, whose partner was working, having three and more children and little exposure to media may increase men’s use of modern contraceptives.

Perda de peso em pacientes oncológicos: prevalência e prognóstico relacionados a sexo, idade, localização do tumor e sintomas de impacto nutricional

ABSTRACT Introduction: Cancer causes an increase in nutritional demands and the presence of of nutritional impact symptoms (NIS) contributes to reduction of nutrient intake and absorption, leading to weight loss, malnutrition and predicting overall survival. Assess the prevalence and predict the weight loss related to cancer, the Grade Scheme and the NIS. Methods: Data were collected from 2012 to 2018 from the first nutritional consultation of cancer patients in a clinic linked to SUS in the city of Guarapuava-PR. The primary outcome was to determine the % of weight loss (% WL), NIS and by the Grade Scheme proposed by Martin et. al (2015) the prognosis was determined by univariate and multivariate Multinomial Logistic Regression (MLR) analysis (adjusted for age, sex and tumor location). Results: 1164 patients aged 56.9 years. In the first consultation, a 6.7 %WL was observed, and it was observed that 21.6% of the patients were underweight. The main sites and %WL were, respectively: Lung 140 (12.0%) and 9.4 %WL, Head and Neck 113 (9.7%) and 10.5 %WL, Colorectal 84 (7.2%) and 10.3 %WL, Stomach 90 (7.7%) and 13.7 %WL, Esophagus 85 (7.3%) and 14.0 %WL, Pancreas 24 (2.1%) and 16.1 %WL. The main NIS were: dry mouth (51.0%), abdominal pain (23.0%), constipation (21.7%), nausea (15.3%) and altered taste (10.5%). In the RML for univariate analysis, age, sex, cancer site and SIN and for multivariate analysis, all cancer locations showed significant OR to be classified in grades 3 and 4. Conclusion: Before chemotherapy, weight loss and malnutrition are present. The cancer site and SIN increase the chance of the patient being classified in grades 3 and 4, leading these patients to a worse nutritional status and contributing to adverse results.

Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients.

Total knee arthroplasty (TKA) is usually effective, although not all patients have satisfactory outcomes. This assumes distinct recovery patterns might exist. Little attention has been paid to determine which patients have worse outcomes. This study attempts to distinguish specific recovery patterns using the Oxford knee score (OKS) during the first postoperative year. The secondary aim was to explore predictors of less favourable recovery patterns. Analysis of patients in the Dutch Arthroplasty Register (LROI) with unilateral primary TKA. Data collected up to one year postoperative was used. To identify subgroups of patients based on OKS, latent class growth modeling (LCGM) was used. Moreover, multivariable multinomial logistic regression analysis was used to explore predictors of class membership. 809 Patients completed three OKS during the first year postoperative and were included. LCGM identified 3 groups of patients; 'high risers' (most improvement during first 6-months, good 12-month scores 77%), 'gradual progressors' (continuous improvement during the first year 13%) and 'non responders' (initial improvement and subsequent deterioration to baseline score 10%). Predictors of least favourable class membership (OR, 95%CI) are EQ-5D items: VAS health score (0.83, 0.73-0.95), selfcare (2.22, 1.09-4.54) and anxiety/depression (2.45, 1.33-4.52). Three recovery patterns after TKA were distinguished; 'high risers', 'gradual progressors' and 'non responders'. Worse score on EQ-5D items VAS health, selfcare, and anxiety/depression were correlated with the least favourable 'non responders' recovery pattern.

The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria.

In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.

Association between dental consultation and oral health status among male Japanese employees

ObjectiveTo investigate the association between dental consultation and oral health status among male Japanese employees.MethodsThe participants were 3351 male employees who received a workplace oral health examination conducted at the ages of 35, 40, 45, 50, 55, and 59 years before retirement in conjunction with an annual health checkup. Data on dental expenditures were collected from health insurance claims. The number of dental visits and dental care expenses, alone or in combination, were used as indices of the dental consultation status for the analyses. The effects of dental consultation status on oral health status (number of total teeth, number of decayed teeth, and periodontal status) were analyzed using multivariate multinomial logistic regression analyses adjusted for confounders.ResultsMultivariate analyses revealed that the odds ratio (OR) for 20‐27 teeth (losing 1‐8 teeth) was significantly higher (OR 1.4, 95% confidence interval (CI) 1.1‐1.7) in those who had a high number of dental visits and high dental care expenses than in those who did not have a dental visit. By contrast, the ORs for ≤19 teeth (losing ≥9 teeth), having ≥3 decayed teeth, or having a periodontal pocket ≥6 mm were significantly lower (OR 0.2, 95% CI 0.1‐0.6; OR 0.5, 95% CI 0.3‐0.6; OR 0.7, 95% CI 0.5‐1.0, respectively) in those who had fewer dental visits and lower dental care expenses.ConclusionsThese results imply that the dental consultation status is associated with oral health status among male employees.