Multivariate Logistic Regression Model Analysis Research Articles

Epidemiology of cutaneous leishmaniasis in children of Khyber Pakhtunkhwa, Pakistan.

In Pakistan, cutaneous leishmaniasis is an emerging tropical disease and a very high number (>70%) of children are afflicted by this marring infection. This study aimed to scrutinise the prevalence, spatial distribution and socio-demographic and behavioural risk factors associated with cutaneous leishmaniasis in children aged <5-15 years in Khyber Pakhtunkhwa. A total of 1, 559 clinically confirmed records of children diagnosed with cutaneous leishmaniasis (January-December) from 2020 and 2022 were obtained from selected district hospitals. In addition, a risk factors-related questionnaire was administered to 1, 011 households (400 in 2020 and 611 in 2022) in nine districts during a household survey. The maximum number of cutaneous leishmaniasis cases was recorded in 2022 (n = 877, 56.25%) as compared to 2020 (n = 682, 43.75%). The hospital records showed a greater number of male patients in the 2022 cohort (n = 603, 68.76%). The highest number of cases were observed in children aged 5-9 years in 2022 (n = 282, 32.16%) and 2020 (n = 255, 37.39%). In 2020 and 2022, cutaneous leishmaniasis cases showed peak aggregation in March (n = 118, 17.3%) and January (n = 322, 36.72%). From a spatial analysis, the maximum number of cutaneous leishmaniasis cases was recorded at 59-1700 m elevation in various land-use/land-cover and climatic regions with quaternary alluvium rock formations. A multivariate logistic regression model analysis of risk factors from the households survey suggested that age group, socio-economic status, construction materials of the house, use of insect repellents, Afghan refugee camps in the village/district, knowledge and biting times of sand flies, frequent use of mosquito bed nets, presence of domestic animals in the house, knowledge of the transmission period and peak month of leishmaniasis infection increased the risk of acquiring cutaneous leishmaniasis (p value < 0.05). Our analysis demonstrated that cutaneous leishmaniasis in children is influenced by a variety of environmental, socio-demographic and behavioural risk factors in Khyber Pakhtunkhwa. The increase in recorded cases of cutaneous leishmaniasis in children in 2022 compared to 2020 suggests that the infection likely extended to new foci in the province.

The relationship between QRS-T angle and left ventricular global longitudinal strain in prehypertensive patients

Background and aimThis study aims to examine the relationship between the QRS-T angle (QRS-Ta) detected on electrocardiography and left ventricular global longitudinal strain (LV-GLS) calculated on echocardiography in prehypertensive patients. Materials and methodsA total of 300 patients were included in our study, and the median value of QRS-Ta of the entire population was 27.The patients were divided into two groups (supramedian 148 patients, inframedian 152 patients) according to the median value. Statistical analysis was performed between the two groups. ResultsLV-GLS was lower in the supramedian QRS-Ta group [20 (16–26) vs. 21 (16–27); p < 0.001]. A statistical difference was found between the two groups in age (p < 0.001), BMI (p < 0.001), Hs-troponin I (p < 0.001), aortic velocity (p = 0.023) and TAPSE (p = 0.005) parameters except for LV-GLS.The correlation between QRS-Ta and LV-GLS was determined by Spearman's correlation test (p < 0.001).In the multivariable logistic regression analysis model, LV-GLS (OR: 0.365, 95%CI 0.171–0.780, p = 0.009) was one of the independent predictors for increased QRS-Ta. Others were determined as age (p < 0.001) and TAPSE (p = 0.015). ConclusionsIn this study, a strong relationship was found between QRS-Ta, which is easily calculated by ECG, and LV-GLS, which is an advanced echocardiographic examination, in prehypertensive patients.

Knowledge, Attitude, and Prevention Practices towards Common Zoonotic Diseases in and around Bahir Dar City, North Western Ethiopia

The problem of zoonoses diseases is a global public and veterinary health concern. Globally coordinated and well-established research efforts are essential to successfully fighting and reducing the health burden of zoonoses. In our study area, the interplay of intense livestock animals, agricultural activities, and poor health services characterized the high risks of zoonotic diseases. Thus, people suffer from easily preventable diseases with hygiene and good-quality food. The main objectives of this study were to: (i) evaluate the knowledge, attitude, and prevention practices of people handling farm animals and their products toward common zoonotic diseases; and (ii) estimate the associated risk factors influencing their knowledge, attitude, and prevention practices. A questionnaire-based cross-sectional study was conducted from December 2021 to August 2022. A simple random sampling technique was followed to select respondents. Multivariable logistic regression model analysis was conducted using STATA version 14. The overall level of knowledge, attitude, and prevention practice for the major zoonotic disease was 52.5%, 68.6%, and 39.4%, respectively. Rabies, tuberculosis, taeniasis, anthrax, and brucellosis were the major zoonotic diseases selected by respondents in the study areas. The age of respondents, training status, educational status, and farm location were significantly (P &lt;0.05) associated with the level of knowledge and prevention practice against zoonotic diseases. This study revealed that the level of knowledge, attitude, and prevention practices for major zoonotic diseases in Bahir Dar City were relatively poor. Therefore, a concerted effort among various government and nongovernment stakeholders, including veterinarians, public health officials, and environmental experts, is needed to create and raise awareness among livestock producers about the transmission and control methods and the economic and public health importance of zoonotic diseases.

Diagnostic Efficiency of ACR-TIRADS Score for Differentiating Benign and Malignant Thyroid Nodules of Various Pathological Types.

BACKGROUND Thyroid nodule prevalence reaches 65% in the general population. Hence, appropriate ultrasonic examination is key in disease monitoring and management. We investigated the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) score for diagnosis of benign and malignant thyroid nodules and pathological types. MATERIAL AND METHODS A retrospective study was conducted. According to ultrasound images, ultrasonic characteristics of benign and malignant thyroid nodules and different pathological types were analyzed using ACR-TIRADS score, and diagnostic value was determined. AUCs were compared for tumor diagnosis and differentiation. RESULTS Overall, 1675 thyroid nodules from 1614 patients were included. AUC value of papillary thyroid carcinoma (PTC) diagnosed with ACR-TIRADS was highest (0.955 [95% CI=0.946-0.965]), while that of follicular thyroid carcinoma (FTC) was lowest (0.877 [95% CI=0.843-0.912]). FTC had the highest sensitivity (95.1%) and lowest specificity (64.8%). When the cut-off value was 5.5 points, accuracy of diagnosing PTC and anaplastic thyroid carcinoma (ATC) was highest, 80.5% and 78.7% respectively. Comparison of the multi-index prediction model constructed by multivariable logistic regression analysis and prediction model constructed by ACR-TIRADS score showed, when evaluating PTC and ATC, the multi-index model was better: AUCs of PTC were 0.966 vs 0.955, and AUCs of ATC were 0.982 vs 0.952, respectively, (P<0.05). CONCLUSIONS ACR-TIRADS score-based ultrasound examination of thyroid nodules aids diagnosis of benign and malignant thyroid nodules. TIRADS criteria favor diagnosis of PTC (and ATC) over FTC. ACR-TIRADS score can help clinicians diagnose thyroid nodules quickly and earlier, exhibits good clinical value, and can prevent missed diagnoses.

Association of the metabolic score for insulin resistance with cardiovascular diseases, cardiovascular and all-cause mortality in Chinese hypertensive population.

Little is known about the relationship between the metabolic score for insulin resistance (METS-IR) and the prognosis of hypertensive patients in China. To investigate the association between the novel non-insulin-based METS-IR index and the cardiovascular composite endpoints and all-cause mortality in Chinese hypertensive participants. This cohort study used data from the China H-Type Hypertension Project, a long-term prospective cohort consisting of 14234 hypertensive patients in southern China, with a baseline from March to August 2018. The median follow-up period for participants was 3.94 years, as of 2022. The data analysis period is from July 2023 to September 2023. METS-IR index of participants in the Chinese H-type hypertension project. The calculation formula for METS-IR is (Ln (2 × FPG) +TG) × BMI/Ln (HDL-C). Cardiovascular events and cardiovascular, all-cause mortality were identified by linking the cohort database with the health care system through October, 2023. A total of 14220 participants were included in this study. The prevalence rates of cardiovascular disease (CVD), cardiovascular death, and all-cause death were 2.59% (369/14220), 2.79% (397/14220), and 5.66% (805/14220), respectively. After adjusting for confounding factors in the multivariate logistic regression analysis models, the METS-IR index was significantly positively correlated with CVD, and cardiovascular, all-cause mortality, whether as a categorical or continuous variable. Layered analysis showed that the METS-IR index of hypertensive participants in different subgroups was positively correlated with the endpoint event. This large, prospective cohort study demonstrated that the METS-IR index, a new IR evaluation index, were independently associated with a higher risk of the cardiovascular composite endpoint and all-cause mortality among Chinese hypertensive population. Importantly, our finding provides an independent indicator for evaluating the prognosis of hypertensive patients.

Association between handgrip strength and depressive symptoms in patients undergoing hemodialysis: a cross-sectional study from a single Chinese center

BackgroundThe relationship between handgrip strength (HGS) and depression in patients undergoing hemodialysis (HD) was unknown. Therefore, we aimed to clarify this association in a cohort of patients.MethodsHGS was used as a representative indicator of muscle strength and was measured with a handheld dynamometer. Depressive symptoms were assessed with the self-reported Patient Health Questionnaire-9. A multivariable logistic regression model and restricted cubic spline analysis were used to assess the relationship between HGS and depression.ResultsThe prevalence of depression in our study was 34% in 568 Chinese patients undergoing HD. Compared with patients in the lowest tertiles of absolute and weighted HGS, patients in the highest tertiles of HGS had an approximately 59% lower [odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.24–0.68; OR = 0.41, 95%CI = (0.24–0.69)] prevalence of depressive symptoms after multivariate adjustments. Besides, the risk of depression in hemodialysis patients decreased by 33% (OR = 0.67, 95%CI = 0.53–0.85) and 32% (OR = 0.68, 95%CI = 0.54–0.85) for each standard deviation increase in absolute HGS and weighted HGS, respectively. The prevalence of depressive symptoms decreased with both increasing absolute HGS and weighted HGS after multivariate adjustments (p for trend < 0.05). Furthermore, a linear dose-response relationship was observed between absolute HGS and weighted HGS and the prevalence of depressive symptoms (pnonlinearity>0.05).ConclusionsThis study suggests that lower handgrip strength, a simple and modifiable parameter, is associated with a higher prevalence of depression in Chinese patients undergoing HD. Considering that depression is often unrecognized or underdiagnosed in HD patients, lowered muscle strength should be an important indicator and incentive for medical staff to screen for depression.

The impact of obesity on ventilator-associated pneumonia, a US nationwide study

BackgroundVentilator-associated pneumonia (VAP) is one of the leading causes of mortality in patients with critical care illness. Since obesity is highly prevalent, we wanted to study its impact on the outcomes of patients who develop VAP.MethodsUsing the National Inpatient Sample (NIS) database from 2017 to 2020, we conducted a retrospective study of adult patients with a principal diagnosis of VAP with a secondary diagnosis with or without obesity according to 10th revision of the International Statistical Classification of Diseases (ICD-10) codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included tracheostomy, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p-value less than 0.05 considered statistically significant.ResultsThe study included 3832 patients with VAP, 395 of whom had obesity. The mean age in both groups was around 58 years, and 68% of the group with obesity were females compared to 40% in females in the group without obesity. Statistically significant comorbidities in the obesity group included a Charlson Comorbidity Index score of three and above, diabetes mellitus, hypertension, chronic kidney disease, and sleep apnea. Rates and odds of mortality were not significantly higher in the collective obesity group 39 (10%) vs. 336 (8.5%), p-value 0.62, adjusted odds ratio 1.2, p-value 0.61). The rates and odds of tracheostomy were higher in the obesity group but not statistically significant. Obese patients were also found to have a longer hospitalization. Upon subanalysis of the data, no evidence of racial disparities was found in the care of VAP for both the obese and control groups.ConclusionsObesity was not found to be an independent risk factor for worse outcomes in patients who develop VAP in the intensive care unit.

Analysis of Dietary and Nutritional Status of Tuberculosis Patients in Hulunbuir Region.

Tuberculosis (TB) is a major public health problem that affects millions of people worldwide. Malnutrition is a common complication of TB and can worsen the disease outcome. The purpose of this study was to investigate the dietary and nutritional status, as well as the dietary structure, of TB patients in Hulunbuir City, Inner Mongolia, China. Additionally, the study aimed to analyze the factors that influence the nutritional status in order to provide a theoretical foundation for the prevention and treatment of TB and related issues. A cross-sectional study was conducted on 334 randomly selected TB patients from Hulunbuir City Second Hospital. A questionnaire survey was administered to collect information on demographic characteristics, dietary habits, and food intake. Nutritional status was assessed by body mass index (BMI). Dietary diversity score (DDS) was calculated based on the number of food groups consumed in the previous 24 hours. Statistical analysis was performed using SPSS 20.0 software. Descriptive statistics employed rates and composition ratios, and categorical data was represented using frequencies and percentages. The chi-square test was used to analyze the association between nutritional status and other variables, with a significance level set at α=0.05. Multivariable ordinal logistic regression analysis was performed to identify the independent factors affecting the nutritional status of TB patients. The univariate analysis revealed statistically significant differences (P < 0.05) in the nutritional status (as measured by BMI) among tuberculosis patients, considering ethnicity, educational level, smoking, meat-based diet, vegetable consumption, and DDS grading. No statistically significant differences were found regarding gender, age, marital status, occupation, sleep duration, alcohol consumption, and consumption of rice and flour dishes. Statistically significant variables from the univariate analysis were included in a multivariable ordinal logistic regression analysis model. The findings highlighted that educational level (high school or below), smoking, meat-based diet, DDS scores of 1-3, and a primarily vegetable-based diet had independent effects on the nutritional status of tuberculosis patients (all P < 0.05). No significant difference was found in nutritional status between the Han ethnic group and other ethnicities. The study revealed that the dietary and nutritional status of TB patients in Hulunbuir City was suboptimal and influenced by several factors. Smoking, meat-based diet, and low dietary diversity score were the primary risk factors for malnutrition among TB patients. The study suggests that nutritional education and intervention programs should be implemented for TB patients to improve their dietary quality and nutritional status.

Immune function status of postoperative patients with colon cancer for predicting liver metastasis.

Colon cancer (CC) has a high incidence rate. Radical resection is the main treatment method for CC; however, liver metastasis (LM) often occurs post-surgery. The liver contains both innate and adaptive immune cells that monitor and remove abnormal cells and pathogens. Before LM, tumor cells secrete cytokines and exosomes to adjust the immune microenvironment of the liver, thus forming an inhibitory immune microenvironment for colonization by circulating tumor cells. This indicates that the immune state of patients with CC plays a crucial role in the occurrence and progression of LM. To observe and analyze the relationship between immune status and expression of tumor factors in patients with LM of CC, and to provide a scientific intervention method for promoting the patient prognosis. A retrospective analysis was performed. The baseline data of 100 patients with CC and 100 patients with CC who suffered from postoperative LM and were admitted to our hospital from May 2021 to May 2023 were included in the non-occurrence and occurrence groups, respectively. The immune status of the patients and the expression of tumor factor-related indicators in the two groups were compared, and the predictive value of the indicators for postoperative LM in patients with CC was analyzed. Compared with the non-occurrence group, the expression of serum carcinoembryonic antigen (CEA), CA19-9, CA242, CA72-4 and CA50 in patients in the occurrence group were significantly higher, while the expression of CD3+, CD4+, CD8+, natural killer (NK) and CD4+/CD25 in patients in the occurrence group were significantly lower (P < 0.05). No significant difference was observed in other baseline data between groups (P > 0.05). Multivariate logistic regression model analysis revealed that the expressions of CEA, CA19-9, CA242, CA72-4, CA50, CD3+, CD4+, CD8+, NK, and CD4+/CD25 were associated with the LM in patients with CC. High expressions of serum CEA, CA19-9, CA242, CA72-4 and CA50, and low expressions of CD3+, CD4+, CD8+, NK, and CD4+/CD25 in patients with CC were risk factors for LM (OR > 1, P < 0.05). The receiver operating characteristic curve showed that the area under curve for CEA, CA19-9, CA242, CA72-4, CA50, CD3+, CD4+, CD8+, NK, and CD4+/CD25 in the prediction of LM in patients with CC were all > 0.80, with a high predictive value. The expression of tumor factors and immune state-related indices in patients with CC is closely associated with the occurrence of LM.

Prevalence of vitamin D deficiency and its association with cardiometabolic risk factors among healthcare workers in the Eastern Cape province, South Africa; cross-sectional study

This study assesses the prevalence of Vitamin D deficiency and its potential association with cardiometabolic risk factors among South African adults residing in the Eastern Cape province. In this cross-sectional study, 1244 healthcare workers (HCWs) completed a self-administered questionnaire and venous blood samples were drawn at two academic hospitals in the Eastern Cape. History of hypertension and diabetes mellitus were self-reported. Participants were categorised as obese if their body mass index (BMI) ≥ 30 kg/m2. Participants were classified as having metabolic syndrome if they had hypertension, diabetes mellitus and obesity. Vitamin D [25(OH)D] deficiency was defined as venous blood concentrations < 50 nmol/L. Associations between vitamin D deficiency and participants’ characteristics were assessed using multivariate logistic regression model analysis. The prevalence of vitamin D deficiency was 28.5% (n = 355), of whom 292 were female. Among the participants who were deficient in vitamin D, the prevalence of obesity, diabetes mellitus, hypertension, chronic kidney disease, and metabolic syndrome was 64.9% (n = 230), 9% (n = 32), 16.6% (n = 59), 2.3% (n = 8) and 18% (n = 64), respectively. In the adjusted multivariate logistic regression model, black Africans (AOR = 2.87; 95% CI 1.52–5.43) and individuals ≥ 42 years (AOR = 1.37; 95% CI 1.07–1.77) were more likely to exhibit vitamin D deficiency. However, there was no significant association by age, sex, and cardiometabolic markers. More than one in four healthcare workers was deficient in vitamin D among the study sample, especially the black Africans and older individuals. Further studies are needed at the population level to elucidate on the vitamin D status in the region.

Effect of repeated vitrification of human embryos on pregnancy and neonatal outcomes

BackgroundRepeated cryopreservation of embryos should occasionally be considered when embryos were not suitable for transfer. The effect of re-cryopreservation on embryos remains contentious.MethodsThis retrospective cohort study aimed to evaluate the pregnancy and neonatal outcomes of twice vitrificated blastocyst derived from once vitrified embryos. Total 410 vitrified-warmed blastocyst transfer cycles were divided into two groups according to the times of embryo vitrification: (1) vitrified blastocysts derived from fresh blastocysts (control group, n = 337); (2) twice vitrified blastocysts derived from once vitrified embryos (n = 73). The primary outcome was live birth rate. Multivariable logistic or linear regression analysis model was performed to describe the association between embryo cryopreservation times and clinical outcomes.ResultsNo difference was observed in female age at retrieval and transfer, infertility period, body mass index (BMI), infertility type, endometrial thickness, and embryo transfer numbers between the two groups. The pregnancy outcomes of embryos in repeated cryopreservation group were comparable to those of embryos in control group, including implantation rate, clinical pregnancy rate, and live birth rate. In multivariate logistic regression analysis, the cryopreservation times did not affect the outcomes of biochemical pregnancy, clinical pregnancy, and live birth. Moreover, there was no difference in gestational age, birthweight and sex ratio of singleton newborns between groups. After correcting several possible confounding variables, no significant association was observed between cryopreservation times and neonatal birthweight.ConclusionIn conclusion, pregnancy and neonatal outcomes achieved with twice vitrified blastocyst transfer were comparable to those achieved with vitrified blastocyst transfer in control group.

Association Between Serum Anion Gap and Mortality in Critically Ill Patients with COPD in ICU: Data from the MIMIC IV Database.

Serum anion gap (AG) has been proven to be associated with prognosis in critically ill patients. However, few studies have investigated the association between AG and all-cause mortality in critically ill patients with chronic obstructive pulmonary disease (COPD). We hypothesized that the initial AG level would predict the mortality risk in critically ill patients with COPD. This retrospective cohort study was based on the Medical Information Mart for Intensive Care (MIMIC) IV database. We extracted demographics, vital signs, laboratory tests, comorbidity, and scoring systems from the first 24 hours after patient ICU admission. Multivariable logistic regression analysis models were used to explore the association between serum AG levels and mortality. Interaction and stratified analyses were conducted including age, gender and comorbidity. A total of 5531 critically ill patients with COPD were enrolled, composed of 53.6% male and 46.4% female with a median age of 73 years. The all-cause mortality of these patients during ICU hospitalization was 13.7%. The risk of all-cause mortality increased as the AG level increased in the univariate logistic regression analysis (OR=1.13, 95% CI: 1.11-1.15, p<0.01). After adjusting for all the covariates in multivariate logistic regression analysis, the odds ratio was 1.06 (95% CI: 1.04-1.09, p<0.01). Compared with the lowest AG group Q1 (≤11mmol/L), the adjusted OR value for AG and mortality in Q2 (12-13mmol/L) was 0.89 (95% CI: 0.63-1.25, p=0.502), Q3 (14-15mmol/L) was 0.95 (95% CI: 0.68-1.34, p=0.788), and Q4 (≥16mmol/L) was 1.49 (95% CI: 1.10-2.02, p=0.009) respectively. In addition, the results of the subgroup and stratified analyses were robust. AG is positively related to all-cause mortality in critically ill patients with COPD.

Clinical practice competence and associated factors among undergraduate midwifery and nursing sciences students at Bahir Dar city, Northwest Ethiopia

Background: Competence describes actions that will be demonstrated or observed and assessed while competency refers to the skill itself. Following appropriate theoretical and practical training, clinical experience is required to achieve the highest level of clinical competence. It is estimated that many women and newborns die each year due to a lack of qualified health professional around the world. As a result, the purpose of this study was to determine the prevalence and factors influencing clinical competency in the study area. Methods: An Institutional-based cross-sectional study was conducted from 12 August to 12 September 2022, among 403 undergraduate health sciences students of Bahir Dar University. Participants were approached through simple random sampling technique. Data were collected using a pre-tested structured questionnaire through a face-to-face interview, and entered into Epidata version 3.1 and analyzed using SPSS version 22. The prevalence was reported using proportion with 95% CI and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio (AOR) with 95% CI. Statistical significance was declared at P value less than 0.05. Results: Overall, the prevalence of clinical practice competency was 36.5% [95% CI; 33.5, 39.1]. Students who were provided a logbook (AOR=5.40, 95% CI 2.91, 10.02), adequate clinical cases in the clinical practice placement (AOR=2.72, 95% CI 1.60, 4.60), preceptor show different procedures (AOR=2.50, 95% CI 1.33, 4.71), student’s confidence during conducting procedure (AOR=4.16, 95% CI 1.67, 10.35) and the suitability of the way of teaching to the learning styles of students during skills demonstration (AOR=2.10, 95% CI 1.00, 4.40) were factors statistically associated with clinical practice competence. Conclusions: According to this study, more than three out of every five participants were found to be clinically incompetent. Providing logbooks, adequate clinical cases, preceptors showing different procedures, students’ confidence, and suitability of the way of teaching to the learning styles of students were significantly associated with clinical practice competence. Implementing logbooks, selecting clinical sites, enhancing the confidence of students, preferred teaching/learning styles, and clinical preceptor support were important to improve the clinical competence of students.

Higher pre-pregnancy body mass index was associated with adverse pregnancy and perinatal outcomes in women with polycystic ovary syndrome after a freeze-all strategy: Ahistorical cohort study.

Previous studies have demonstrated that abnormal body mass index (BMI) is associated with adverse pregnancy outcomes in frozen-thawed embryo transfer cycles. However, the relationship between BMI and pregnancy and perinatal outcomes in patients with polycystic ovary syndrome (PCOS) remains unclear. Furthermore, whether a diagnosis of PCOS could result in adverse pregnancy and perinatal outcomes in women with different BMIs remains unknown. A historical cohort study included 1667 women with PCOS and 12 256 women without PCOS after a freeze-all policy between January 2016 and December 2020. The outcomes encompassed both pregnancy and perinatal outcomes. Multivariate logistic regression analysis and restricted cubic spline models were performed to eliminate confounding factors when investigating the relationship between BMI and different outcomes. After controlling for covariates, pregnancy outcomes were comparable between underweight women with PCOS and normal weight women with PCOS. However, overweight patients had a lower clinical pregnancy rate and an overall live birth rate. Furthermore, patients with obesity had a lower rate of multiple pregnancies but a higher rate of biochemical pregnancy than in the normal BMI group. Additionally, the restricted cubic spline models showed that as maternal BMI increased to 32 kg/m2, the clinical pregnancy rate and live birth rate after blastocyst transfer decreased, but the risks of preterm birth, gestational diabetes mellitus, macrosomia, large-for-gestational age (LGA) and very LGA increased in patients with PCOS after a freeze-all strategy. Moreover, a diagnosis of PCOS resulted in a higher clinical pregnancy rate and live birth rate and a higher risk of small-for-gestational age in the normal weight group. However, women with PCOS in the overweight group exhibited higher risks of very preterm birth and gestational diabetes mellitus compared with women without PCOS. This study showed that a higher BMI had a detrimental impact on the pregnancy and perinatal outcomes of PCOS patients undergoing a freeze-all strategy. However, it was only statistically significant in the overweight group. A diagnosis of PCOS had a higher clinical pregnancy rate and live birth rate in normal weight women but higher risks of perinatal complications in normal weight and overweight women.

Analysis of clinical characteristics and risk factors of postoperative complications in infants with early-onset necrotizing enterocolitis after enterostomy

Objective: To investigate the clinical characteristics of children with early-onset necrotizing enterocolitis (NEC) undergoing enterostomy and analyze the risk factors for postoperative complications. Methods: Retrospective analysis was conducted on the clinical data (perinatal conditions, clinical characteristics, clinical outcomes, etc.) of NEC patients who underwent enterostomy at Beijing Children's Hospital from May 2016 to May 2023. The patients were divided into two groups based on the age of onset: an early-onset enterostomy group (<14 days) and a late-onset enterostomy group (≥14 days). Furthermore, the children with NEC were categorized into complication group and non-complication group based on whether there were complications after enterostomy. The differences in clinical data between these groups were analyzed, and the clinical characteristics of children with early-onset NEC and enterostomy were summarized. Multivariate logistic regression model was employed to analyze the risk factors for postoperative complications in NEC children with enterostomy. Results: A total of 68 cases were enrolled, including 43 cases in the early-onset enterostomy group [26 males and 17 females, aged (6.5±3.0) days] and 25 cases in the late-onset enterostomy group [15 males and 10 females, aged (21.0±3.0) days]. There were 28 cases (17 males and 11 females), age [M (Q1, Q3)] 9 (5, 14) days in the complication group and 33 cases (22 males and 11 females), aged of 14 (6, 21) days in the non-complication group. Compared to the late-onset enterostomy group, the early-onset enterostomy group had significantly higher rates of intraventricular hemorrhage [30.2% (13/43) vs 8.0% (2/25)], hemodynamically significant patent ductus arteriosus [37.2% (16/43) vs 12.0% (3/25)], mechanical ventilation≥72 hours after birth [39.5% (17/43) vs 16.0% (4/25)], stage Ⅲ NEC [(69.8% (30/43) vs 40.0% (10/25)], extensive NEC [27.9% (12/43) vs 8.0% (2/25)], and short-term postoperative complications [56.8% (21/37) vs 29.2% (7/24)] (all P<0.05).Multivariate logistic regression model analysis revealed that residual length of proximal small intestine was a protective factor for postoperative complications after enterostomy in NEC infants (OR=0.764, 95%CI: 0.648-0.901, P=0.001), but stage Ⅲ NEC was a risk factor (OR=1.042, 95%CI: 1.004-5.585, P=0.017). Conclusions: The incidence of postoperative complications is high, and the prognosis is poor in children with early-onset NEC enterostomy. The residual length of proximal enterostomy is a protective factor for postoperative complications of NEC enterostomy, but stage Ⅲ NEC is a risk factor.

Two out of every three pregnant women who gave birth in public health facilities of Tullo Woreda were dissatisfied with deliveries services, Eastern Ethiopia.

The level of maternal satisfaction with delivery services significantly affects health service utilization among women. Ethiopia's healthcare system and health facilities' quality have not much improved, which may contribute to women's generally poor levels of satisfaction and there was a limited study about client satisfaction on delivery services in the study area. Thus, the purpose of this study was to assess level of maternal satisfaction with delivery service and its associated factors among women who gave birth in Tullo Woreda public health facilities, Eastern Ethiopia. A facility-based cross-sectional study was conducted from 1 to 30 September 2020 among 355 women who gave birth in Tullo Woreda public health facilities, Eastern Ethiopia Data were collected using a pretested structured questionnaire through a face-to-face interview and entered into Epidata version 3.1 and analyzed using statistical package for the social sciences (SPSS) version 25. The prevalence was reported using a 95% confidence interval and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at a p-value of <0.05. The overall satisfaction of mothers on delivery service was 33.5% (95% CI: 27.81, 39.13). Factors such as having no antenatal care (ANC) for the index pregnancy (AOR = 0.33; 95% CI: 0.19, 0.56), women who came to health centers on foot (AOR = 0.17; CI: 0.04, 0.74) and by auto-rickshaw (AOR = 0.16; 95 % CI: 0.04, 0.64), mothers who did not satisfied with toilet service at the delivery room (AOR = 0.49; 95% CI: 0.12, 0.86) and who were not satisfied with maternal drugs availability (AOR = 0.65; 95% CI: 0.11, 0.95) were predictors of maternal satisfaction. This study pointed out that only 33.5% of women were satisfied with delivery care services provided in public health facilities of the study area. Factors such as not having ANC, using foot and auto-rickshaw as means of transportation, availability of drugs, and toilets were predictor of maternal satisfactions. Awareness creation for the benefit of ANC follow-up and delivery in the health facilities and providing safe transportation during referral time may help mothers get a timely healthcare service, which may increase client satisfaction. The concerned entities must pay attention in timely availability of drugs and improving the toiles, which play a role in shaping and molding level of satisfaction of women.

Work-related burnout and its associated factors among midwives working at public hospitals in northwest Ethiopia: a multi-centered study.

Work-related burnout (WRB) is defined as the degree of physical and psychological fatigue and exhaustion that is perceived by the person as related to work. Midwives are vulnerable to work-related burnout due to their physically and emotionally demanding nature of their job. It affects the health of professionals and the quality of care provided. However, there is limited evidence on the burden and predictors associated with work-related burnout among midwives in developing countries, including Ethiopia. This study investigated the burden and contributing factors of work-related burnout among midwives in northwest Ethiopia. A facility-based cross-sectional study was conducted from February 7 to April 30, 2022. A simple random sampling method was used to enroll 640 study participants. The Copenhagen burnout inventory tool was used to assess the magnitude of work-related burnout. A self-administered questionnaire was used to collect data, which was then entered into Epi Data 4.6 software and exported to SPSS version 25 for analysis. A multivariable logistic regression analysis model was fitted to identify factors associated with work-related burnout. The Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was reported to declare the factors that are significantly associated with work-related burnout. The prevalence of work-related burnout was found to be 60.47% (95% CI = 56.6-64.2). Workplace violence (AOR = 3.33, CI: 2.02, 5.48), working hours over 60 h a week (AOR = 4.55, CI: 2.78, 7.43), emotional demand of the job (AOR = 8.85, 95% CI: 4.48, 17.47), exposure to blood and body fluids/sharp injuries (AOR = 5.13, CI: 3.12, 7.13), good superior support (AOR = 0.38, CI: 0.23, 0.63), Job rotation of ≤6 months (AOR = 2.30, CI: 1.28, 4.14) and being stressed (AOR = 2.64, CI: 1.63, 4.26) were all found to be strongly linked to work-related burnout. This study found a significant level of work-related burnout among midwives working in public hospitals. Experiencing workplace violence, a job rotation of less than or equals to six months, working hours over 60 h a week, good superior support, exposure to blood and body fluids or needle stick injuries and experiencing stress were significant factors that influenced work-related burnout. Therefore, reducing prolonged working hours, promoting supportive management, creating a safe working environment, and applying effective stress prevention strategies are some of the interventions to prevent or alleviate work-related burnout.

Analysis of the current status and related factors of human papillomavirus infection among community-dwelling women aged 18-24 years without a history of vaccination in Shanghai City

Objective: To understand the status of human papillomavirus (HPV) infection among young women without a history of vaccination in Shanghai, and analyze the related factors of HPV infection in this population. Methods: A total of 2 660 women aged 18-24 years old who had made an appointment for HPV vaccine at 36 community health service centers in Shanghai from July 2022 to February 2023 were selected as the study subjects. Basic information (including demographic characteristics, previous disease history, female menstrual and reproductive history, sexual life history, etc.) was collected by a self-filling electronic questionnaire. Cervical secretions were detected by HPV nucleic acid typing. The multivariate logistic regression model was used to analyze the factors related to high-risk HPV (HR-HPV) infection in the target population. Results: The age of the subjects was (23±1) years old, and the infection rate of HPV was 14.51% (386 cases), among which the infection rates of HR-HPV and low-risk HPV were 13.53% (360 cases) and 1.84% (49 cases), respectively. The main subtypes of HR-HPV infection were HPV52, 16, 58, 39 and 66. The multivariate logistic regression model analysis showed that compared with the control group, the OR (95%CI) values for HR-HPV infection in the group of married, earned less than 2 000 yuan/month, drank alcohol occasionally, gynecological disease history, had two or more sexual partners in the past year, and did not know whether the partners had other sexual partners were 0.41 (0.25-0.66), 0.39 (0.21-0.70), 1.45 (1.13-1.86), 1.29 (1.00-1.66), 2.18-5.18 (1.02-16.05), and 1.82 (1.31-2.54), respectively. Conclusion: The infection rate of HPV among women aged 18-24 years old in Shanghai remains at a high level. The main subtypes of HR-HPV infection are HPV52, 16, 58, 39 and 66. The marital status, economic income level, drinking status, gynecological disease history and sexual life history are related to HR-HPV infection.

Association between blood glucose-to-lymphocyte ratio and prognosis of patients with sepsis-associated acute kidney injury

To investigate the association between the glucose-to-lymphocyte ratio (GLR) and prognosis of patients with sepsis-associated acute kidney injury (SA-AKI). Based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV), SA-AKI patients aged ≥ 18 years were selected. According to the tertiles of GLR, the patients were divided into GLR1 group (GLR ≤ 4.97×10-9 mmol), GLR2 group (4.97×10-9 mmol < GLR < 9.75×10-9 mmol) and GLR3 group (GLR ≥ 9.75×10-9 mmol). Patients with SA-AKI were divided into survival group and death group according to whether they survived 28 days after admission. The patient's gender, age, vital signs, laboratory test results, comorbidities, sequential organ failure assessment (SOFA), acute physiology score III (APS III) score and treatment measures were extracted from the database. Kaplan-Meier survival analysis was used to make the survival curves of patients with SA-AKI at 28 days, 90 days, 180 days and 1 year. Multivariate Logistic regression analysis model was used to explore the independent risk factors of 28-day mortality in patients with SA-AKI. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive efficacy of GLR for the prognosis of patients with SA-AKI. A total of 1 524 patients with SA-AKI were included, with a median age of 68.28 (58.96, 77.24) years old, including 612 females (40.16%) and 912 males (59.84%). There were 507 patients in the GLR1 group, 509 patients in the GLR2 group and 508 patients in the GLR3 group. There were 1 181 patients in the 28-day survival group and 343 patients in the death group. Grouping according to GLR tertiles showed that with the increase of GLR, the 28-day, 90-day, 180-day and 1-year mortality of SA-AKI patients gradually increased (28-day mortality were 11.64%, 22.00%, 33.86%, respectively; 90-day mortality were 15.98%, 26.72%, 40.55%, respectively; 180-day mortality were 17.16%, 28.29% and 41.73%, and the 1-year mortality were 17.95%, 29.27% and 42.72%, respectively, all P < 0.01). According to 28-day survival status, the GLR of the death group was significantly higher than that of the survival group [×10-9 mmol: 9.81 (5.75, 20.01) vs. 6.44 (3.64, 10.78), P < 0.01]. Multivariate Logistic regression analysis showed that GLR was an independent risk factor for 28-day mortality in patients with SA-AKI [when GLR was used as a continuous variable: odds ratio (OR) = 1.065, 95% confidence interval (95%CI) was 1.045-1.085, P < 0.001; when GLR was used as a categorical variable, compared with GLR1 group: GLR2 group OR = 1.782, 95%CI was 1.200-2.647, P = 0.004; GLR3 group OR = 2.727, 95%CI was 1.857-4.005, P < 0.001]. ROC curve analysis showed that the area under the ROC curve (AUC) of GLR for predicting 28-day mortality in patients with SA-AKI was 0.674, when the optimal cut-off value was 8.769×10-9 mmol, the sensitivity was 57.1% and the specificity was 67.1%. The predictive performance was improved when GLR was combined with APS III score and SOFA score, and the AUC was 0.806, the sensitivity was 74.6% and the specificity was 71.4%. GLR is an independent risk factor of 28-day mortality in patients with SA-AKI, and high GLR is associated with poor prognosis in patients with SA-AKI.

The Metabolic Score for Insulin Resistance Index is Superior to the Triglyceride and Glucose Index in Identifying Nonalcoholic Fatty Liver Disease in Hyperuricemia Subjects.

Hyperuricemia (HUA) is a recognized risk factor for non-alcoholic fatty liver disease (NAFLD). Early diagnosis and the identification of predictive factors are important for the HUA population. This study aimed to investigate the potential relationship between the metabolic score for insulin resistance (METS-IR) index and the triglyceride and glucose (TyG) index with NAFLD in individuals with HUA. A total of 5537 HUA participants were included in the study. Hepatic ultrasonography was conducted following the latest diagnostic criteria to diagnose NAFLD. The relationship between the TyG and METS-IR index and NAFLD was evaluated by multivariable logistic regression analysis and restricted cubic spline model (RCS). In addition, the area under the curve (AUC), positive likelihood ratio, and negative likelihood ratio were explored to compare the predictive value of IR surrogates for NAFLD with HUA. The AUCs of the two indicators were compared using the DeLong test. Multivariable logistic regression analysis revealed that elevated TyG (OR = 2.285, 95% CI: 1.525, 3.428) and METS-IR (OR = 1.242, 95% CI: 1.219, 1.266) indices significantly increase the risk of NAFLD. Meanwhile, the RCS analysis revealed a -log-shaped nonlinear relationship between NAFLD risk and the METS-IR index (P non-linear < 0.001), contrasting with the linear association observed with the TyG index (P non-linear = 0.763). Notably, the risk of NAFLD demonstrated a significant escalation when the METS-IR index exceeded the threshold of 39.208 (OR=1). Compared to the TyG index (AUC = 0.734, 95% CI: 0.721~0.748), the METS-IR index (AUC = 0.821, 95% CI: 0.810~0.832) demonstrated superior predictive value for NAFLD in individuals with HUA according to the DeLong test. In the HUA population, the METS-IR index has a higher predictive value for NAFLD than the TyG index, contributing to early diagnosis and disease prevention.