Multivariate Poisson Regression Analysis Research Articles

Obstetric Outcomes by Hospital Volume of Operative Vaginal Delivery

Characterizing hospital-level factors associated with adverse outcomes following operative vaginal delivery (OVD) is crucial for optimizing obstetric care. To assess the association between hospital OVD volume and adverse outcomes. This was a retrospective cohort study of OVDs in California between 2008 and 2020. OVD was determined using birth certificate and International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. This study used linked vital statistics and hospital discharge data from California. The study included singleton, nonanomalous, full-term deliveries with vertex presentation. Data analysis was performed between June 10 and October 23, 2024. Hospital OVD volume was categorized by the proportion of OVDs performed among all deliveries, grouped into low (<5.2%), medium (5.2%-7.4%), and high (≥7.4%) volume. Adverse outcomes for birthing individuals included obstetric anal sphincter injuries, cervical lacerations, and postpartum hemorrhage. Neonatal outcomes included shoulder dystocia, subgaleal hemorrhage, intracranial hemorrhage, facial nerve injury, and brachial plexus injury (BPI). χ2 and multivariable Poisson regression analyses were used to assess the association between hospital OVD volume and outcomes. Among 306 818 OVDs (mean [SD] birthing parent's age, 28.5 [6.2] years; 155 157 patients with public insurance [50.6%]), hospitals with low OVD volume had an increased proportion of obstetric anal sphincter injury compared with hospitals with medium and high volumes (12.16% [7444 patients] vs 11.07% [10 709 patients] vs 9.45% [14 064 patients]). Hospitals with low volume also had a higher proportion of adverse neonatal outcomes, including shoulder dystocia (3.84% [2351 patients] vs 3.50% [3386 patients] vs 2.80% [4160 patients]), subgaleal hemorrhage (0.27% [165 patients] vs 0.18% [172 patients] vs 0.10% [144 patients]), and BPI (0.41% [251 patients] vs 0.30% [291 patients] vs 0.20% [301 patients]) compared with hospitals with medium and high volume. In multivariable analyses, low OVD volume remained associated with increased risk of obstetric anal sphincter injury (adjusted risk ratio [aRR], 1.36; 95% CI, 1.14-1.62), shoulder dystocia (aRR, 1.30; 95% CI, 1.10-1.52), subgaleal hemorrhage (aRR, 2.57; 95% CI, 1.55-4.24), and BPI (aRR, 1.73; 95% CI, 1.30-2.2.29) compared with hospitals with high OVD volume. After multivariable analysis, medium OVD volume remained associated with increased risk of subgaleal hemorrhage (aRR, 1.72; 95% CI, 1.04-2.86) and BPI (aRR, 1.35; 95% CI, 1.02-1.79) compared with high OVD volume. This study found that undergoing OVD at hospitals with low OVD volume was associated with adverse perinatal outcomes compared with hospitals with medium and high OVD volumes. Further exploration of the reasons for these differences and prevention of these differences is needed to improve obstetric outcomes.

Investigating dosage effects of ovulation inhibitors on oocyte maturation in assisted reproductive technology: A retrospective study among patients with normal ovarian reserve.

The judicious selection of ovulation inhibitors in ovarian stimulation protocols is crucial for the success of assisted reproductive technology (ART). Herein, we investigate the dose-dependent effects of chlormadinone acetate (CMA) and cetrorelix, two distinct ovulation inhibitors, on oocyte maturation in patients with normal ovarian reserve, using univariable and multivariable Poisson regression analyses. Patients undergoing progestin-primed ovarian stimulation (PPOS) with CMA (n = 299) or gonadotropin-releasing hormone antagonist (GnRH-ant) with cetrorelix (n = 605) during their initial in vitro fertilization cycle were enrolled at our center from March 2018 to October 2020 (N = 904). The primary and secondary outcomes were the oocyte maturation and fertilization rates, respectively. After adjusting for several covariates including age, anti-Müllerian hormone levels, total gonadotropin dose, and type of trigger, we calculated the dose-dependent adjusted relative risk (aRR) and 95% confidence interval (CI) for 1 mg of CMA or 0.25 mg of cetrorelix. In the PPOS group, the median age was 34.0 years, and the median total CMA dosage was 22 mg (interquartile range [IQR]: 18.0-32.0). In the GnRH-ant group, the median age was 35.0 years, and the median total cetrorelix dosage was 0.5 mg (IQR 0.5-0.5). The aRR of the maturation rate was 1.003 (95% CI: 0.999-1.007) with PPOS (p = 0.194) and 1.009 (95% CI: 0.962-1.059) with GnRH-ant (p = 0.717). The aRR of the fertilization rate was 1.002 (95% CI: 0.985-1.020) with PPOS (p = 0.783) and 1.022 (95% CI: 0.839-1.246) with GnRH-ant (p = 0.829). Collectively, these findings indicate that within the applied dosages, ovulation inhibitors do not significantly impact oocyte maturation or fertilization rates in patients with normal ovarian reserve. These valuable insights can be applied when designing ART protocols and may guide clinicians in optimizing infertility treatments.

Contraceptive use, prevalence and incidence of pregnancy and associated factors among women participating in a vaccine preparedness cohort study in Masaka, Uganda, a retrospective secondary analysis

BackgroundHIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda.MethodsHIV sero-negative women (18–45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited between July 2018 and October 2022. Study procedures included collection of baseline socio-demographics and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Multivariable Logistic and Poisson regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy.Results652 (73%) of 891 women reported contraceptive use at baseline. Contraceptive use was higher in women who were in a relationship/married/cohabiting [adjusted odds ratio (aOR) = 1.60; 95% confidence interval (CI) 1.07–2.40] or divorced/separated/widowed [aOR = 1.86; 95% CI 1.24–2.79] versus those that were single, and among women reporting transactional sex [aOR = 2.10; 95% CI 1.16–3.80] versus those who did not. Baseline pregnancy prevalence was 4% (95% CI 3–6%) and lower in women who reported using long-acting contraceptive methods (aOR = 0.17; 95% CI 0.07–0.39) versus women who did not use these methods. A total of 65 pregnancies over 301.3 person-years of observation (PYO), an incidence rate of 21.6/100 (95% CI 16.9–27.5) PYO, higher among younger women (≤ 24 versus 25 + years, adjusted incidence rate ratio = 1.97; 95% CI 1.15–3.40).ConclusionWe observed a high pregnancy incidence in this cohort. Innovative strategies that promote sustained and consistent use of highly effective contraceptive methods especially for young women will be critical to the success of HIV prevention trials in this and similar populations.

Clinical Outcomes in Non-Obese Caucasian and Hispanic Populations with DM, a Nation-Wide Study

The global prevalence of DM is approximately 10.5% and is expected to rise in the next few years. There is limited data on its outcomes stratified by race. Controlling DM will mitigate the risks of atherosclerotic cardiovascular disease. The purpose of this study is to compare differences in clinical outcomes in non-obese Caucasian and Hispanic populations with DM. Conducted as an observational study, it utilized data from the National Inpatient Sample from 2017 to 2020 focusing on non-obese adults over 18 years, with a BMI <30 kg/m^2, and DM diagnosis, excluding those under 18, obese or without DM. Primary outcome was in-hospital mortality. Secondary outcomes were cardiogenic shock, cardiac arrest, GIB, mechanical ventilation, length of stay, and total cost. Multivariable logistic and Poisson regression analyses determined the clinical outcomes, considering a p-value <0.05 significant. Among 22,300,000 non-obese adults with DM, 64.2% were Caucasians, 13.3% were Hispanics, 3.5% were Asians, 18.8% were AA, and the remaining population belonged to other ethnicities. This study revealed higher rates in the Caucasians for conditions like metabolic syndrome, dyslipidemia, HTN, pHTN, HF, PVD, A.fib, ACS, AKI, stroke, PE, and COPD. The Hispanics were seen to have a higher incidence of anemia, CKD, and severe sepsis. In terms of primary and secondary outcomes, Hispanics were higher. The findings undermine the importance of racial differences in such conditions and more in-depth studies are needed to extrapolate the gaps in care.

Association between sleep quality and weight gain in pregnancy: a cross-sectional study

IntroductionThere are grounds for the hypothesis that poor sleep quality, regardless of the pre-gestational nutritional status, is a risk factor for inadequate gestational weight gain.ObjectiveTo investigate the association between sleep quality and insufficient or excessive gestational weight gain in Brazilian pregnant women without gestational complications and monitored in public prenatal care units.MethodsThis is a cross-sectional study nested within a cohort study that reviewed pregnant women’s mental health, sleep, and nutritional outcome. Data collection was carried out from May 2018 to June 2019 through face-to-face and telephone interviews and consultation of pregnant women’s medical records. Sleep quality was assessed using the Mini-sleep Questionnaire. The pregnancy weight gain was measured based on the Institute of Medicine’s recommendations. Univariate and multivariate Poisson regression analysis was used for the two outcomes: insufficient or excessive weight gain, using pregnant women with adequate weight gain as the reference category. Associations were considered significant when p < 0.05.ResultsThe prevalence of severe sleep disorders was high: 63.4% of pregnant women experienced this condition. Severe sleep disorders enhanced independently the risk of insufficient gestational weight gain (PR = 2.40; 95% CI = 1.06–5.42, p = 0.035). There was no association between sleep disorders and excessive gestational weight gain.ConclusionThe hypothesis that poor sleep quality influences gestational weight gain was confirmed. Severe sleep disorders, a highly prevalent condition, significantly increased the prevalence of insufficient gestational weight gain, yet it was not associated with excessive weight gain. Thus, educational actions should be included in the preconception and prenatal periods, in order to encourage the adoption of habits that favor sleep quality, an intervention that may have positive effects in reducing insufficient gestational weight gain.

Sarcopenia in the Oldest-Old Adults in the Capital of Brazil: Prevalence and Its Associated Risk Factors.

In light of the demographic context in which the older adult population is prominent, sarcopenia emerges as a significant concern for the health of these individuals. To assess the frequency of sarcopenia and severe sarcopenia and the associated risk factors in the oldest adults living in the community. There were 399 participants aged 80 or older, of both sexes, using primary health care services in the metropolitan area of Brasília, Brazil. Sarcopenia was evaluated based on European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Muscle mass was measured by calf circumference, muscle function by handgrip strength, and muscle performance by gait speed. Clinical and socioeconomic variables, comorbidities, falls, and urinary incontinence were collected. The prevalence of sarcopenia was calculated with a 95% (IC) prevalence. Multivariate Poisson regression analysis was performed in Stata, with p < 5%. Among participants, 78.2% were women. Prevalence of pre-sarcopenia was 31.8%, sarcopenia 3.3%, and severe sarcopenia 25.1%. After multivariate regression, sarcopenia was associated with the female sex, low weight, and a dependency for activities of daily living (ADLs). Similarly, severe sarcopenia remained associated with female sex, low weight, and an ADLs dependency. Sarcopenia and severe sarcopenia were not associated with the level of education, marital status, income, physical activity, medications, falls, nor comorbidities. A quarter of older adults had severe sarcopenia. Sarcopenia and severe sarcopenia were associated with being a woman, being low weight, and have an ADLs dependence.

Clinical factors associated with hospital mortality in critically ill adult COVID-19 patients with AKI requiring CRRT: A multicenter study.

Acute kidney injury (AKI) is a common complication of critically ill COVID-19 patients which is associated with adverse outcomes. We examined clinical factors associated with hospital mortality in critically ill adult COVID-19 patients with AKI who required continuous renal replacement therapy (CRRT). We conducted a multicenter retrospective cohort study including data from two large academic medical centers. Adult (age ≥ 18 years) patients with AKI and requiring CRRT admitted from March 2020 to April 2021 were included in the study. Patients with end-stage kidney disease or renal transplantation were excluded. Multivariable Poisson regression analyses were used to identify clinical predictors of hospital mortality. A total of 178 patients were included. Patients were predominantly men (68.2%), 13.1% were Black, and 57.9% White. Median hospital and ICU length of stay were 20 days and 14 days, respectively. Mechanical ventilation and extracorporeal membrane oxygenation were utilized in 97.2% and 17.4% of patients, respectively. Overall, 130 (73.0%) patients died in the hospital (mortality rate of 2.7 per 100 person-days). In multivariable analyses, SOFA score ≥ 12 at ICU admission (MRRadj = 1.88; 95% CI 1.17 - 3.01) was associated with increased risk of mortality, while Black race (MRRadj = 0.56; 95% CI 0.31 - 1.01) was associated with a decreased risk of mortality. More than two-thirds of critically ill adult COVID-19 patients with AKI requiring CRRT died during hospitalization. SOFA score ≥ 12 at ICU admission was an independent predictor of hospital mortality, and Black patients had a lower risk of mortality.

Exploring relationships between dating app use and sexual activity among young adult college students.

University campus clinics provide crucial sexual health services to students, including STI/HIV screening, testing, contraception, and counseling. These clinics are essential for engaging young adults who may lack access to primary care or have difficulty reaching off-campus services. Dating apps are widely used by young adults, yet there is a lack of studies on how they affect sexual practices. This study aimed to evaluate the use of dating apps, engagement in condomless sexual activity, and the prevalence of STIs among young adult college students in Northern Texas. A cross-sectional survey was conducted from August to December 2022 among undergraduate and graduate students aged 18-35 at a large university in Northern Texas. A total of 122 eligible participants completed the survey, which assessed demographics, sexual behaviors, dating app use, and STI/HIV testing practices. Descriptive statistics, bivariate analyses, and multivariate Poisson regression analyses with robust variance were performed to identify factors associated with dating app use and condomless sexual activity. Two-thirds of participants reported using dating apps. Significant differences were found between app users and non-users regarding demographic factors and unprotected sexual behaviors. Dating app users were more likely to report multiple sexual partners, inconsistent condom use, and a higher likelihood of engaging in unprotected sex. Poisson regression analysis indicated that app use was associated with residing in large urban areas, frequent use of campus STI/HIV screening services, and having multiple sexual partners (p < 0.05). The study highlights a significant association between dating app use and engagement in condomless sexual activity among college students. University health clinics play a critical role in providing sexual health services and can enhance their impact by expanding access to testing, contraception, and inclusive, sex-positive education. Future research should explore the long-term effects of dating app use on sexual health and evaluate the effectiveness of app-based interventions in promoting safer sexual practices.

Relationship between bullying victimization and murderous behaviors and impulsivity's mediating role: Evidence from Chinese early adolescents.

Evidence suggests a robust relationship between experiencing bullying victimization (BV) and engaging in murderous behaviors among adolescents. However, the potential mediating effect of impulsivity on the relationship between BV and murderous behaviors in early adolescents remains underexplored. A total of 5724 adolescents, with a mean age of 13.5years, were enrolled from three middle schools in Anhui Province, China. Participants completed self-report questionnaires detailing their experiences with bullying, impulsiveness, and murderous behaviors. To assess the relationship between BV and murderous behaviors, multivariate logistic regression and Poisson regression analyses were conducted. Mediation analysis was performed using structural equation modeling. After controlling for confounding factors, a positive association was found between experiencing BV and engaging in murderous behaviors (p<0.05). Mediation analysis revealed a significant indirect effect of BV on the occurrence of murderous behaviors through impulsivity (indirect effect=0.027, 95% CI: 0.021, 0.033). BV appears to heighten levels of impulsivity, which in turn increases the likelihood of murderous behaviors. Additionally, sex-specific analysis indicated that impulsivity played a greater mediating role in the link between verbal and relational BV and murderous behaviors in females, while physical and cyber BV were more significant in males. Our findings underscore the necessity of early targeted interventions for adolescents experiencing BV and exhibiting high levels of impulsivity to mitigate their risk of engaging in murderous behaviors.

Stressful Events and Oral Health Related Quality of Life Aboard: A Longitudinal Study

Stressful events may affect self-perceived general and oral health. While the working environment is known to expose military personnel to chronic stress, oral health reports in these populations is limited. This longitudinal study aimed to investigate the association of Oral Health Related Quality of Life (OHRQL) and stress in the military population aboard a training ship for 6 months. Three hundred and twenty-eight individuals were enrolled at baseline and three hundred and one at follow-up (six-month later). Completed questionnaires on Oral Health Impact Profile (OHIP-14) and Perceived Stress Scale (PSS-14) were assessed for analysis. Socio-demographic characteristics were also obtained. Multivariate Poisson regression analysis showed that PSS-14 predicted higher OHIP-14 scores at baseline and follow-up. At follow-up, besides PSS-14 (RR: 2.03; 1.42-2.90), being part of the crew group represented an increase of 87% on the OHIP-14 scores (RR:1.87; 1.27-2.74). Older individuals were 24% less likely to present higher OHIP-14 scores (RR:0.76; 0.58-0.99) than younger ones. OHRQL has worsened over time in this military population aboard (4.41±5.76 versus 5.95±6.88) and stress was an associated factor of that. The need to adjust management styles was highlighted as well as the need to prepare the staff to navigate stressful situations more effectively.

Cross-sectional study of factors related to declining participation in community gathering places providing communal meals: A social marketing framework

Objectives While Community gathering places known as "kayoi-no-ba" providing communal meals play a crucial role in promoting the health of older adults, the researches supporting their operations and maintenance is limited. Social marketing has been successful in implementing strategic public health programs. This study aimed to identify factors associated with declining participation in kayoi-no-ba providing communal meals using a social marketing framework based on the 4Ps marketing mix (product, promotion, place, and price).Methods In November 2019, this cross-sectional study surveyed kayoi-no-ba providing communal meals nationwide via a mail. A total of 580 kayoi-no-ba organizers with complete data participated. Changes in the number of participants were assessed using a questionnaire in order to determine the decrease since their establishment. Survey items were organized based on the 4Ps marketing mix framework and treated as independent variables. Multivariate Poisson regression analysis was conducted with participant decrease as the dependent variable, and prevalence ratios (PR) were calculated. The opening period and the number of participants at the time of the survey were included as covariates.Results A total of 154 kayoi-no-ba experienced the decline in participants (26.6%). Multivariate analysis revealed the following. For product variables, a high frequency of monthly events was significantly associated with a lower PR for participant decrease (0.92). Among promotion variables, kayoi-no-ba with a registration system had a significantly higher PR for participant decrease (1.49). For place variables, a higher population density in the region was significantly associated with a lower PR (0.90), whereas a higher ratio of the population aged 65 years and older was significantly associated with a higher PR (1.05). The price variables did not show a significant association with the decrease in participants.Conclusions Except price, the other three marketing 4Ps were significantly associated with decreases in participants at kayoi-no-ba providing communal meals. Future efforts should focus on developing and evaluating kayoi-no-ba strategies to ensure sustained participant engagement and promote the health of older adults through communal meals.

Healthcare-seeking behavior for diarrhea in under-five children and associated factors in sub-Saharan Africa: a multilevel robust Poisson regression model.

Diarrhea is one of the leading causes of child death in sub-Saharan Africa (SSA). Children with diarrhea who do not receive medical advice or treatment are at high risk of poor health outcomes and increased mortality. Prompt and adequate treatment is essential to mitigate these risks. However, studies that have been conducted on the factors influencing healthcare-seeking behavior (HSB) for diarrhea in under-five children in SSA are scarce. Therefore, the purpose of this research was to determine the variables related to HSB for diarrhea in children under the age of five. A secondary data analysis was conducted on the most recent data from the Demographic and Health Surveys in 35 SSA countries. The study included a total weighted sample of 51,791 children under the age of five with diarrhea. We presented the adjusted prevalence ratio and the 95% confidence interval in the multivariable multilevel robust Poisson regression analysis to show the statistical significance and strength of the association between HSB and its determinants. The pooled prevalence of HSB for diarrhea in under-five children was 58.71% (95%CI: 55.39 to 62.04). Factors found to be associated with HSB included maternal age, education and working status, antenatal care visits, postnatal checkups for the child, wasting, distance to a health facility, SSA region, and country income level. More than 40% of under-five children with diarrhea in SSA did not receive medical advice or treatment. To improve healthcare-seeking behavior, effective health policy interventions are necessary. These include enhancing the education and employment status of mothers, promoting regular antenatal and postnatal care visits, building health facilities in close proximity, and raising awareness in the community about the importance of seeking healthcare services for malnourished children.

Trends in case detection rate for leprosy and factors associated with disability among registered patients in Zanzibar, 2018–2021

BackgroundLeprosy is still a disease of public health concern. Globally, 2–3 million people are thought to be affected by leprosy’s disease-related disabilities. Regarding leprosy status in Zanzibar, limited information is available. Determining changes in detection rates and factors associated with disability is crucial for treatment and preventative strategies for this debilitating disease. This study aimed to determine trends in case detection rate for leprosy and risk factors for disability among registered patients in Zanzibar, from 2018 to 2021. The study included all leprosy patients who received treatment in Zanzibar's 11 districts between 2018 and 2021. The study design used was an analytical cross-sectional. Prevalence and new case detection rate (NCDR) were calculated. Multivariable Poisson regression analyses were used to identify factors associated with leprosy disability. Crude and adjusted prevalence ratios (APR) and their respective 95% confidence intervals (CI) were reported. P-values ≤ 0.05 were considered significant.ResultsOf the 490 leprosy cases reported between 2018 and 2021, 469 (95.7%) were new patients, and 349 (71.2%) were multi-bacillary. The disease was found to be more common in males 296 (60.4%). The average prevalence was 7/100,000 population, while the average NCDR was 7/100,000 from 2018 to 2021. There was a significant decrease in disability grades from diagnosis to the end of treatment over 4 years (P < 0.001). Male sex (APR 1.55; 95% CI 1.18–2.04), advanced age (APR 5.01; 95% CI 1.91–13.17), multi-bacillary (APR 6.99; 95% CI 3.16–15.44) and HIV negative patients (APR 1.51; 95% CI 1.11–2.06) were more likely to develop physical disability.ConclusionThis study found that leprosy disability grades at diagnosis compared to the end of treatment declined during 4 years. There was no significant change in point prevalence and NCDR during the 4-year study period. Disability was associated with male sex, advanced age, multi-bacillary, and HIV-negative patients. To prevent leprosy-related disability and transmission, health education, early case detection, and adequate multidrug therapy should be prioritized.

Chemsex Session Typologies and Associated Sociodemographic Factors in Sexual Minority Men: Latent Class Analysis From a Cultural Perspective Using a Cross-Sectional Survey.

Chemsex prevalence is still not well known, and both the lack of homogeneity and cultural component of chemsex practices are usually overlooked. This study aims to estimate the proportion of sexual minority men (SMM) engaging in chemsex sessions, while understanding the cultural dimension of chemsex, and to analyze distinct session typologies with potential risk differences and the sociodemographic factors associated with engaging in them. A total of 5711 SMM residing throughout Spain participated in an anonymous web-based survey that assessed chemsex session engagement and characteristics, drug use, and sociodemographic variables. We measured the association of sociodemographic factors with engaging in chemsex sessions by calculating adjusted prevalence ratios, using multivariate Poisson regression analysis. Chemsex typologies were analyzed using latent class analysis, and sociodemographic factors were associated with the different risk classes. Our results determined that 21.1% (1205/5711; 95% CI 20.0%-22.1%) of SMM engaged in chemsex sessions during their lifetime. Participating in sessions was significantly associated with being a migrant, not having a comfortable financial situation, openly living their sexuality, residing in bigger municipalities, older age, using steroids, and living with HIV (adjusted prevalence ratio: range 1.17-2.01; all P values <.05). Three typologies of sessions with different risks were identified with latent class analysis, with 23.2% of SMM engaging in sessions taking part in higher-risk ones, which was associated with younger age, using steroids, living in bigger municipalities, openly living their sexuality, and living with HIV, compared to SMM engaging in lower-risk sessions (odds ratio: range 2.75-4.99). Chemsex is relatively common among SMM in Spain, but it is important to differentiate typologies of sessions with varying risks, and the proportion of SMM engaging in high-risk sessions is low. Chemsex is highly associated with sociodemographic factors. Chemsex should be prioritized in public health programs, which should consider the different forms of sessions with their varying risks and prevalence, while also considering the cultural dimension inherent to chemsex.

A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery.

Perme intensive care unit (ICU) mobility score is a comprehensive mobility assessment tool; however, its usefulness and validity for patients after cardiovascular surgery remain unclear. We investigated the association between the Perme Score and clinical outcomes after cardiovascular surgery. We retrospectively enrolled 249 consecutive patients admitted to the ICU after cardiac and/or major vascular surgery. The Perme Score contains categories on mental status, potential mobility barriers, muscle strength and mobility level and was assessed within 2days after surgery. The outcomes of physical recovery were the number of days until 100-m ambulation achievement and 6-min walk distance (6MWD) at hospital discharge. The endpoint was a composite outcome of all-cause mortality and/or all-cause unplanned readmission. We analyzed the associations of the Perme Score with physical recovery and the incidence of clinical events. After adjusting for clinical confounding factors, a higher Perme Score was an independent factor of earlier achievement of 100-m ambulation (hazard ratio: 1.039, 95% confidence interval [CI]: 1.012-1.066) and higher 6MWD (β: 0.293, P = .001). During the median follow-up period of 1.1years, we observed an incidence rate of 19.4/100 person-years. In the multivariate Poisson regression analysis, a higher Perme Score was significantly and independently associated with lower rates of all-cause death/readmission (incident rate ratio: 0.961, 95% CI: 0.930-0.992). The Perme Score within 2days after cardiovascular surgery was associated with physical recovery during hospitalization and clinical events after discharge. Thus, it may be useful for predicting clinical outcomes.

Assessing the impact of Delta and Omicron in German intensive care units: a retrospective, nationwide multistate analysis

BackgroundThe spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.MethodsA retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany. A multivariable Poisson regression analysis was performed to estimate the incidence rate ratios (IRRs) of transfer (to another hospital during inpatient care), discharge (alive) and death of COVID-19 intensive care patients associated with Delta or Omicron, adjusted for age group and sex. In addition, a multistate approach was used for the clinical trajectories of COVID-19 intensive care patients to estimate their competing risk of transfer, discharge or death associated with Delta or Omicron, specifically concerning patient age.ResultsA total of 6046 transfers, 33256 discharges, and 12114 deaths were included. Poisson regression analysis comparing Omicron versus Delta yielded an estimated adjusted IRR of 1.23 (95% CI 1.16–1.30) for transfers, 2.27 (95% CI 2.20–2.34) for discharges and 0.98 (95% CI 0.94–1.02) for deaths. For ICU deaths in particular, the estimated adjusted IRR increased from 0.14 (95% CI 0.08–0.22) for the 0–9 age group to 4.09 (95% CI 3.74–4.47) for those aged 90 and older compared to the reference group of 60-69-year-olds. Multistate analysis revealed that Omicron was associated with a higher estimated risk of discharge for COVID-19 intensive care patients across all ages, while Delta infection was associated with a higher estimated risk of transfer and death.ConclusionsRetrospective, nationwide comparisons of transfers, discharges and deaths of COVID-19 intensive care patients during Delta- and Omicron-dominated periods in Germany suggested overall less severe clinical trajectories associated with Omicron. Age was confirmed to be an important determinant of fatal clinical outcomes in COVID-19 intensive care patients, necessitating close therapeutic care for elderly people and appropriate public health control measures.

Spatial patterns and associated factors of HIV testing and counselling (HTC) as a component of antenatal care services in Ethiopia

Background While HIV testing and counselling play a crucial role in preventing mother-to-child transmission, numerous pregnant women did not receive these services. Understanding the spatial variation of HIV testing and counselling and its associated factors during antenatal care in Ethiopia remains limited. Thus, this study was aimed at assessing the spatial patterns and factors associated with HIV testing and counselling during antenatal care visits in Ethiopia. Methods A cross-sectional study design was employed with a two-stage stratified cluster sampling technique. A total of 2,789 women who gave birth in the two years prior to the survey and had at least one antenatal care visit were included in the study. Stata version 16 and ArcGIS version 10.8 software were used for analysis. A multilevel robust Poisson regression model was fitted to identify significantly associated factors since the prevalence of HIV testing and counselling was higher than 10%. A statistically significant association was declared based on multivariable multilevel robust Poisson regression analysis using an adjusted prevalence ratio with its 95% confidence interval at a p-value &lt; 0.05. Spatial regression analysis was conducted, and the local coefficients of statistically significant spatial covariates were visualised. Results In Ethiopia, the overall prevalence of HIV testing and counselling during antenatal care visits was 29.5% (95% CI: 27.8%, 31.2%). Significant spatial clustering was observed (Global Moran’s I = 0.138, p-value &lt;0.001). In the spatial regression analysis, high and comprehensive knowledge related to HIV, and comprehensive knowledge on the prevention of mother-to-child transmission were significant explanatory variables for the spatial variation of HIV testing and counselling. In the multivariable multilevel robust Poisson regression analysis, education, household wealth, media exposure, number of antenatal care visits, comprehensive knowledge on mother-to-child transmission, comprehensive knowledge on prevention of mother-to-child transmission, and region were significantly associated factors. Conclusion The prevalence of HIV testing and counselling during antenatal care visits was low. Empowering women through education, promoting mass media exposure, increasing numbers of antenatal care visits, and enhancing women’s knowledge related to HIV and mother-to-child transmission by targeting cold spot areas could improve HIV testing and counselling service uptake among pregnant women in Ethiopia.

Predictors of high-flow nasal cannula failure in COVID-19 patients in a northern Peruvian hospital

ObjectivesTo determine predictors of high-flow nasal cannula (HFNC) failure in COVID-19 patients in a hospital in northern Peru.MethodologyA retrospective cohort study was conducted during the months of March and May 2021. Data collection was based on a follow-up of 156 hospitalized patients with a diagnosis of COVID-19 who were users of HFNC. Epidemiological factors and clinical outcomes of treatment were analyzed from medical records. Epidemiological, analytical, and HFNC use-related characteristics were described using measures of absolute and relative frequencies, measures of central tendency, and dispersion. A multivariate Poisson regression analysis with robust variance and a 95% confidence interval was performed.ResultsWe found that age, SpO2/FiO2, work of breathing (WOB scale) at admission, degree of involvement, type of infiltrate on CT scan, lymphocytes, c-reactive protein, and D-dimer were significantly associated with failure of HFNC (p < 0.05). In addition, the WOB scale, PaO2/FiO2, SaO2/FiO2, and ROX index were variables that presented statistical significance (p < 0.0001). In the multivariate analysis model, a risk of failure of HFNC was determined with age > = 60 years [RRa 1.39 (1.05–1.85)] and PaO2/FiO2 score less than 100 [Rra 1.65 (0.99–2.76)].ConclusionsPredictors to failure of HFNC are age older than 60 years and minimally significantly lower PaO2/FiO2 than 100.

Heightened mortality risk after a non-fatal opioid overdose: Risk factors for mortality in the week following emergency treatment.

To measure all-cause mortality risk after an ambulance-attended non-fatal opioid overdose and associations with number of days following attendance, and individual and clinical characteristics. A prospective observational study. Oslo, Norway. Patients treated with naloxone for opioid overdose by Oslo Emergency Services between 1 June 2014 and 31 December 2018. Medical records were linked to the national Cause of Death Registry (1 June 2014-31 December 2019). Crude mortality rates (CMR) and incidence risk ratios (IRR) with 95% confidence intervals (CI) were estimated for the time periods (0-7days, 8-31 days, 32-91 days, 92-183 days, >183 days) using multivariate Poisson regression analysis. IRR were estimated for sex, age, Glasgow Coma Scale (GCS), respiration rate, place of attendance and non-transportation following treatment. Robust variance estimates applied due to multiple risk periods. Standardized Mortality Rates (SMR) were estimated. Overall, 890 patients treated for 1764 overdoses contributed to a total time at risk of 3142 person-years (PY). Median number of attendances was 1 (range 1-27). The majority were male (75.5%) and the mean age was 37.7 years. In total, 112 (12.6%) died; 5.2% within 183 days and 2.2% between 184 and 365 days. Acute poisoning was the most common single cause of death (52.7%). The CMR was 3.6 (95% CI = 3.0-4.2) per 100-PY. The women had a SMR of 32 (95% CI = 15.8-57.9) and the men 24.9 (95% CI = 17.7-34.2). The CMR (22.2, 95% CI = 10.6-46.8) was particularly high in the first 7days, and significantly higher than in the following periods. However, this finding was only valid for those with severe overdose symptoms (GCS score = 3/15 and/or respiratory rate ≤6/min). Except for increasing age, no other indicators were associated with the mortality risk. Patients treated by Oslo Emergency Services between June 2014 and December 2018 for a non-fatal opioid overdose with severe overdose symptoms at attendance had an overall high mortality risk compared with the general population, but particularly during the first 7 days after attendance.

Identifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis.

Intraoperative events and clinical management of deceased organ donors after brain death are poorly characterized and may consequently vary between hospitals and organ procurement organization (OPO) regions. In a multicenter cohort, we sought to estimate the incidence of hypotension and anesthetic and nonanesthetic medication use during organ recovery procedures. We used data from electronic anesthetic records generated during organ recovery procedures from brain-dead adults across a Multicenter Perioperative Outcomes Group (MPOG) cohort of 14 US hospitals and 4 OPO regions (2014-2020). Hypotension, defined as mean arterial pressure or MAP <60 mm Hg for at least 10 cumulative minutes was the primary outcome of interest. The associations between hypotension and age, sex, race, anesthesia time, OPOs, and OPO case volume were examined using multivariable mixed-effects Poisson regression analyses with robust standard error estimates. We calculated intraclass correlation coefficients (ICCs) to describe the variation between-MPOG centers and the OPO regions in the use of medications, time of the operation, and duration of the operation. We examined 1338 brain-dead adult donors, with a mean age of 42± (standard deviation [SD] 15) years; 60% (n = 801) were males and 67% (n = 891) non-Hispanic White. During the entire intraoperative monitoring period, 321 donors (24%, 95% confidence interval [CI], 22%-26%) had hypotension for a median of 13.8% [quartile1-quartile 3: 9.4%-21%] of the monitoring period and a minimum of 10 minutes to a maximum of 96 minutes [(median: 17, quartile1-quartile 3: 12-24]). The probability having hypotension in donors 35 to 64 years and 65 years and older were approximately 30% less than in donors 18 to 34 years of age (adjusted relative risk ratios, aRR, 0.68, 95% CI, 0.55-0.82, aRR, 0.63, 95% CI, 0.42-0.94, respectively). Donors received intravenous heparin (96.4%, n = 1291), neuromuscular blockers (89.5%, n = 1198), vasoactive medications (82.7%, n = 1108), crystalloids (76.2%, n = 1020), halogenated anesthetic gases (63.5%, n = 850), diuretics (43.8%, n = 587), steroids (16.7%, n = 224), and opioids (23.2%, n = 310). The largest practice heterogeneity observed between the MPOG center and OPO regions was steroids (between-center ICCs = 0.65, 95% CI, 0.62-0.75, between-region ICCs = 0.39, 95% CI, 0.27-0.63) and diuretics (between-center ICCs = 0.44, 95% CI, 0.36-0.6, between-region ICCs = 0.30, 95% CI, 0.22-0.49). Despite guidelines recommending maintenance of MAP >60 mm Hg in adult brain-dead organ donors, hypotension during recovery procedures was common. Future research is needed to clarify the relationship between intraoperative events with donation and transplantation outcomes and to identify best practices for the anesthetic management of brain-dead donors in the operating room.