Non-significant Increase In Odds Research Articles

The Impact of Hearing Impairment on Health Indicators in a Multiethnic Population of Older Adults in Singapore.

To determine the impact of hearing impairment (HI) on health indicators in a multiethnic Singaporean population of older adults. In this cross-sectional, population-based study, pure-tone averages of air-conduction thresholds at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz were calculated for each ear. Eight categories of HI were defined ranging from: 1: No HI to 8: Bilateral severe HI. Health indicators included hearing-related quality of life (H-QoL), depressive symptoms, frailty, gait speed, instrumental activities of daily living, sarcopenia, and cognitive impairment. Multivariable regression models determined the independent associations between HI and outcomes. A total of 2,503 older adults (mean age ± SD 73.4 ± 8.4; 55.2% female participants) were enrolled. Of these, 289 (11.6%), 259 (10.4%), 798 (31.9%), 303 (12.1%), 515 (20.6%), 52 (2.1%), 155 (6.2%), and 115 (4.6%) had hearing levels in Cats 1 to 8, respectively; and 20 (0.8%) used a hearing aid. Compared to those with no HI, participants with unilateral mild HI (Cat 2) had a 107% reduction in H-QoL (β: 0.63; CI: 0.18, 1.09, p = .006), increasing to a 2,816% reduction (β: 16.78; CI: 13.25, 20.31, p < .001) in those with bilateral severe HI-Cat 8 (p-trend < .001). Those with Cat 8 also had lower gait speed and we observed a nonsignificant increase in odds of frailty as HI worsened. H-QoL is affected across the spectrum of severity and laterality of HI. Interventions to alleviate the effects of HI and provision of QoL support are warranted. Other health indicators were only affected in late stages, suggesting that slowing disease progression is crucial in clinical management.

The association between quality of contraceptive counseling and selection of contraceptive method post-counseling among women in Ethiopia

ObjectivesTo better understand the relationship between high-quality contraceptive counseling and met family planning needs, we examined the association between quality of counseling and selection of a method postvisit among women requesting contraception in Ethiopia. Study designWe used post-counseling survey data from women receiving care in public health centers and nongovernmental clinics in three regions in Ethiopia. Among women whose reason for visit was requesting a contraceptive method, we examined the association between scores on the validated quality of contraceptive counseling (QCC) scale and subscales and selection of a method post-counseling (primary analysis) and type of method selected (secondary analysis). We conducted mixed-effects multivariable logistic regression for the primary analysis and multinomial regression for the secondary analysis. ResultsThere was a nonsignificant increase in odds of selecting contraception with increasing total QCC scale scores (adjusted odds ratio [aOR] 2.35, 0.43–12.95). However, among women experiencing no disrespect and abuse, there was increasing odds of selecting contraception (aOR 3.46, 95% CI 1.09–10.99) and likelihood of selecting injectable contraception (adjusted relative risk ratio 4.27, 95% CI 1.34–13.60) compared to women experiencing disrespect and abuse. Additionally, 168 (32.1%) of women felt pressured by their provider to use a certain method of which>50% selected long-acting reversible contraception. ConclusionsIncreasing QCC is associated with selecting contraception among women requesting contraception. Additionally, probing for negative experiences can reveal feelings of disrespect and abuse that could lead women to avoid selecting contraception or feeling pressured to use methods heavily promoted by providers. ImplicationsOur study assesses contraceptive counseling quality using a validated tool with items on provider pressure and other forms of disrespect and abuse; findings highlight the importance of respectful treatment in meeting women’s needs and the potential influence of disrespect on decision to select contraception and type of method selected.

A Protective Fluid Resuscitation Strategy In HF Patients With Sepsis Does Not Significantly Influence Mortality

<h3>Objective</h3> : Administration of at least 30mL/kg of IV crystalloids within the first 3 hours of recognition of sepsis is the current fluid resuscitation goal per the 2018 Surviving Sepsis Campaign update. However, sepsis and concomitant heart failure create a challenging clinical scenario due to fear of volume overload. Our meta-analysis sought to determine if this strategy vs. lower infusion rates influences in-hospital mortality for heart failure patients with sepsis. <h3>Methods</h3> : The terms "heart failure" and "sepsis" or "septic shock" and "fluid bolus" or "fluid administration" were used in Embase and Pubmed. Studies were included if they had: sepsis patients with heart failure, or a subgroup of patients with heart failure, and mortality data on these patients that did or did not meet the 30mL/kg-by-3 hour (30 × 3) goal. Five eligible studies were found. The odds ratio and 95% confidence interval for mortality among HF patients with sepsis who received <30 × 3 vs. at least 30 × 3 were calculated for the five studies using their mortality data. The mortality data from the five studies were totaled to calculate a total odds ratio and 95% CI. <h3>Results</h3> : One study demonstrated a statistically significant increase in the odds ratio for in-hospital mortality when comparing the <30 × 3 vs. the 30 × 3 group (OR 2.96; 95% CI 1.18-7.41) (Table 1 and Figure 1). All other studies demonstrated a non-significant increase in odds of in-hospital mortality. Totaling the data from these studies resulted in 616 patients with HF and sepsis. 78 of the 281 in the <30 × 3 group died and 84 of the 335 in the 30 × 3 group died (OR=1.14; 95% CI 0.84-1.64). <b>Conclusions</b>: Our meta-analysis shows a non-significant increase in odds of in-hospital mortality among hospitalized HF patients with sepsis/septic shock who received a restrictive resuscitation strategy compared to those who met the 30 × 3 goal. This study highlights the need for larger prospective trials to study this interaction further. Limitations include the retrospective nature of the studies. Additional work is needed to account for the influence of systolic vs. diastolic heart failure history, sepsis severity, pressor requirement, ICU vs. non-ICU level of care, and use of invasive hemodynamic monitoring to guide resuscitation.

Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis

IntroductionThe outcomes of large-volume IVF administration to septic shock patients with comorbid congestive heart failure (CHF) and/or end-stage renal disease (ESRD) are uncertain and widely debated in the existing literature. Despite this uncertainty, CMS continues to recommend that 30 ml/kg of an intravenous crystalloid solution be administered to patients in septic shock starting within 3 h of presentation. We performed a systematic review and meta-analysis to assess the relationship between adherence to this guideline and outcomes among patients whose underlying comorbidities present a risk of fluid overload. MethodsOur search was conducted on PubMed and Scopus through November 5, 2021 to identify studies that evaluated clinical outcomes among septic patients with CHF/ESRD based on volume of fluid administered. The primary outcome measured was mortality at 30 days post-hospital discharge. Other outcomes included the rates of vasopressor requirements, invasive mechanical ventilation during hospitalization, as well as length of stay in the intensive care unit and/or hospital. We used random effects meta-analysis when two or more studies reported the same outcome. ResultsWe included five studies in the final meta-analysis, which comprised 5804 patients, 5260 (91%) of whom received non-aggressive fluid resuscitation, as defined by the studies' authors. Random-effects meta-analysis for all-cause mortality showed that aggressive fluid resuscitation was associated with statistically non-significant increased odds of mortality (OR 1.42, 95% CI 0.88–2.3, P = 0.15, I2 = 35%). There was no statistical association between volume of IVF administration and other outcomes evaluated. ConclusionAmong septic shock patients with CHF and/or ESRD, administration of greater than or equal to 30 ml/kg IVF was associated with a non-significant increase in odds of mortality. All other outcomes measured were found to be non-significant, although there was a trend toward better outcomes among patients in the restricted-volume compared to the standard-volume IVF groups. Since this meta-analysis only included five observational studies, more studies are needed to guide an optimal volume and rate of fluid administration in this patient population.

The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19

Rationale and ObjectivesCardiac indices can predict disease severity and survival in a multitude of respiratory and cardiovascular diseases. Herein, we hypothesized that CT-measured cardiac indices are correlated with severity of lung involvement and can predict survival in patients with COVID-19.Materials and MethodsEighty-seven patients with confirmed COVID-19 who underwent chest CT were enrolled. Cardiac indices including pulmonary artery-to-aorta ratio (PA/A), cardiothoracic ratio (CTR), epicardial adipose tissue (EAT) thickness and EAT density, inferior vena cava diameter, and transverse-to-anteroposterior trachea ratio were measured by non-enhanced CT. Logistic regression and Cox-regression analyses evaluated the association of cardiac indices with patients' outcome (death vs discharge). Linear regression analysis was used to assess the relationship between the extent of lung involvement (based on CT score) and cardiac indices.ResultsMean (±SD) age of patients was 54.55 (±15.3) years old; 65.5% were male. Increased CTR (>0.49) was seen in 52.9% of patients and was significantly associated with increased odds and hazard of death (odds ratio [OR] = 12.5, p = 0.005; hazard ratio = 11.4, p = 0.006). PA/A >1 was present in 20.7% of patients and displayed a nonsignificant increase in odds of death (OR = 1.9, p = 0.36). Furthermore, extensive lung involvement was positively associated with elevated CTR and increased PA/A (p = 0.001).ConclusionCT-measured cardiac indices might have predictive value regarding survival and extent of lung involvement in hospitalized patients with COVID-19 and could possibly be used for the risk stratification of these patients and for guiding therapy decision-making. In particular, increased CTR is prevalent in patients with COVID-19 and is a powerful predictor of mortality.

Rhythm-centred music making in community living elderly: a randomized pilot study

BackgroundQuality of life has become an important aspect in the measurement of the health of an individual as the population ages. Rhythm-centred music making (RMM) has been shown to improve physical, psychological and social health. The purpose of this study was to explore the effects of RMM on quality of life, depressive mood, sleep quality and social isolation in the elderly.MethodsA randomised controlled trial with cross over was conducted. 54 participants were recruited with 27 participants in each arm. In phase 1, group A underwent the intervention with group B as the control. In phase 2, group B underwent the intervention with group A as the control. The intervention involved 10 weekly RMM sessions. Patient related outcome data which included European Quality of Life-5 Dimensions (EQ5D), Geriatric Depression Scale (GDS), Pittsburg Sleep Quality Index (PSQI) and Lubben Social Network Scale (LSNS) scores were collected before the intervention, at 11th and at the 22nd week.ResultsA total of 31 participants were analyzed at the end of the study. The mean age was 74.65 ± 6.40 years. In analysing the change in patient related outcome variables as a continuous measure, participation in RMM resulted in a non-significant reduction in EQ5D by 0.004 (95% CI: -0.097,0.105), GDS score by 0.479 (95% CI:-0.329,1.287), PSQI score by 0.929 (95% CI:- 0.523,2.381) and an improvement in LSNS by 1.125 (95% CI:-2.381,0.523). In binary analysis, participation in RMM resulted in a 37% (OR = 1.370, 95% CI: 0.355,5.290), 55.3% (OR = 1.553, 95% CI: 0.438,5.501), 124.1% (OR = 2.241, 95% CI = 0.677,7.419) and 14.5% (OR = 1.145, 95% CI = 0.331,3.963) non-significant increase in odds of improvement in EQ5D, GDS, PSQI and LSNS scores respectively.ConclusionParticipation in RMM did not show any statistically significant difference in the quality of life of the participants. It is however, an interesting alternative tool to use in the field of integrative medicine. Moving forward, a larger study could be performed to investigate the effects of RMM on the elderly with an inclusion of a qualitative component to evaluate effects of RMM that were not captured by quantitative indicators.Trial registrationThis trial was retrospectively registered. This trial was registered in the Australian New Zealand Clinical Trials Registry under trial number ACTRN12616001281482 on 12 September 2016.

Does stage of labor at time of cesarean delivery affect risk of subsequent preterm birth?

The effect of a cesarean delivery in different stages of labor on spontaneous preterm birth (sPTB) in a subsequent pregnancy has not been studied extensively. The objective of the study was to evaluate the risk of subsequent sPTB after a first-stage or second-stage cesarean delivery compared with a vaginal delivery. This was a planned secondary analysis of a large retrospective cohort study of women with 2 consecutive deliveries from 2005-2010. Women with a previous sPTB were excluded. First-stage (<10 cm) and second-stage (≥10 cm) cesarean deliveries were compared with vaginal deliveries. Data were obtained through chart abstraction. The primary outcome was sPTB (<37 wk) in a subsequent pregnancy. Categoric variables were compared with the use of χ(2) analyses, and logistic regression was used to calculate odds and control for confounders. Eight hundred eighty-seven women were included (721 vaginal deliveries; 129 first-stage and 37 second-stage cesarean deliveries). The sPTB rate varied between groups (7.8%, 2.3%, and 13.5%, respectively; P = .03). When compared with women with a vaginal delivery, women with a first-stage cesarean delivery had a decreased risk of sPTB, which remained after adjustment for confounders (adjusted odds ratio, 0.30; 95% confidence interval, 0.09-0.99; P = .049). There was a nonsignificant increase in odds of sPTB after a second-stage cesarean delivery compared with a vaginal delivery (adjusted odds ratio, 2.4; 95% confidence interval, 0.77-7.43; P = .13). Women with a second-stage cesarean delivery had a 6-fold higher odds of sPTB compared with women with a first-stage cesarean delivery, which remained after adjustment for confounders (adjusted odds ratio, 5.8; 95% confidence interval, 1.08-30.8; P = .04). Women with a full-term second-stage cesarean delivery have a significantly higher than expected rate of subsequent sPTB (13.5%) compared with both the overall national sPTB rate (7-8%) and to a first-stage cesarean delivery (2.3%). As the cesarean delivery rate continues to rise, this potential impact on pregnancy outcomes cannot be ignored.

Association of copayment with likelihood and level of adherence in new users of statins: a retrospective cohort study.

Statins remain a fundamental component of pharmacologic therapy for hyperlipidemia. Health benefits of statin therapy are jeopardized when adherence is reduced. To (a) assess the association between copayment and copayment type on statin adherence using 2 different thresholds of adherence and (b) identify the incremental change in statin adherence associated with presence of copayment and copayment type. We executed a retrospective cohort study of new users of statins with dyslipidemia from the Veterans Health Administration (VHA) within the Veterans Integrated Service Network 22 who initiated a statin between November 30, 2006, and December 2, 2007. We used exposure categories of Any Copayment versus No Copayment, indicating a patient had a copayment or had no copayment in order to obtain medications, respectively. As a separate analysis, we varied the exposures to the standard VHA copayment categories: (a) Service-Connected (SC) Copayment (patients with service-related injury), (b) Non-Service-Connected (NSC) Copayment (patients without a service-related injury), and (c) No Copayment. Using each set of exposures, we conducted separate multiple logistic regression analyses using 2 different adherence outcomes based on medication possession ratio (MPR) threshold: (1) adherence defined as MPR ≥ 0.8 and (2) adherence defined as MPR ≥ 0.9. We then proceeded with multiple linear regression models to determine the incremental change in MPR associated with the 2 sets of exposures. Subjects were required to be enrolled in VHA services for at least 2 years prior to index date and throughout the 1-year study period. A total of 4,886 subjects were identified for analysis based on the inclusion and exclusion criteria. Patients who did not pay a copayment for their statin medications were more likely to have adherence rates of ≥ 0.8 MPR and ≥ 0.9 MPR relative to the No Copayment Group with odds ratios (OR) of 1.19 (95% CI = 1.03-1.37) and 1.28 (95% CI = 1.11-1.48), respectively. The second analysis applied the VHA exposure categories of SC Copayment, NSC Copayment, and No Copayment. Using the 0.8 MPR or greater adherence threshold, the No Copayment group was associated with an increased likelihood of adherence versus the SC Copayment category as reference group with an OR of 1.31 (95% CI = 1.10-1.58). The NSC Copayment was associated with a nonsignificant increase in odds of adherence at the 0.8 MPR level or greater with OR of 1.12 (95% CI = 0.98-1.39). Using the 0.9 MPR level or greater, adherence threshold findings were similar. The No Copayment group produced an OR of 1.42 (95% CI = 1.17-1.71) compared with the SC Copayment group. The NSC Copayment group was associated with a nonsignificant increase in odds of adherence at the 0.9 MPR level or greater with an OR of 1.12 (95% CI = 0.97-1.38).The No Copayment group was associated with an increase in MPR of 0.02 (95% CI = 0.002-0.035) versus the Any Copayment category. Using the VHA copayment categories, we observed an increase in MPR for the No Copayment group versus the SC Copayment group of 0.03 (95% CI = 0.01-0.05). The NSC Copayment group was associated with a nonsignificant increase in MPR versus the SC Copayment group of 0.02 (95% CI = -0.003-0.036). Patients without out-of-pocket payments for their statins were more likely to adhere to therapy. Patients who pay a copayment for their statin medications were also compared with each other based on whether they (a) received any of their nonstatin prescriptions without a copayment or (b) paid a copayment on all of their prescriptions including statins. Our findings suggest that, among those that pay for their statins, patients are less adherent to their statins if other medications they are prescribed are copayment free. Thus, patient consumption behavior may be influenced by the relative cost of medications in patient prescription lists. Additional counseling on the necessity of adherence should be given to patients paying a copayment for their statin prescriptions.

The effect of maternal alcohol consumption on fetal growth and preterm birth

To investigate the relationship between prenatal alcohol exposure and fetal growth and preterm birth and to estimate the effect of dose and timing of alcohol exposure in pregnancy. A population-based cohort study linked to birth information on the Western Australian Midwives Notification System. Western Australia. A 10% random sample of births restricted to nonindigenous women who had delivered a singleton infant (n= 4719) in 1995-1997. The impact of alcohol consumption in pregnancy on fetal growth (small-for-gestational-age [SGA] and large-for-gestational-age infants [LGA]) and preterm birth (<37 weeks of gestation) was assessed using multivariate logistic regression analysis and adjusting for confounding factors. Odds ratios and 95% CI, attributable risk, and population attributable risk were calculated. The percentage of SGA infants and preterm birth increased with higher levels of prenatal alcohol exposure; however, the association between alcohol intake and SGA infants was attenuated after adjustment for maternal smoking. Low levels of prenatal alcohol were not associated with preterm birth; however, binge drinking resulted in a nonsignificant increase in odds. Preterm birth was associated with moderate and higher levels of prenatal alcohol consumption for the group of women who ceased drinking before the second trimester. This group of women was significantly more likely to deliver a preterm infant than women who abstained from alcohol (adjusted OR 1.73 [95% CI 1.01-3.14]). Alcohol intake at higher levels, particularly heavy and binge drinking patterns, is associated with increased risk of preterm birth even when drinking is ceased before the second trimester. This finding, however, is based on small numbers and needs further investigation. Dose and timing of prenatal alcohol exposure appears to affect preterm delivery and should be considered in future research and health education.

Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials.

The surgical treatment of primary intracerebral hemorrhage (PICH) varies throughout the world, mainly because of the lack of evidence of its safety and effectiveness. This study compares the outcome of patients with PICH who are treated surgically with those who are not. We conducted a systematic overview (meta-analysis) of all studies of the outcome of surgery for PICH by means of a Medline search of relevant randomized trials and case series published since 1966. Cited references and presentations were also reviewed. The 15 case series of surgery for PICH involving a total of 1524 patients (654 treated surgically) are potentially confounded and the results inconclusive. The pooled results of the three randomized controlled trials of open craniotomy and one trial of endoscopic evacuation for supratentorial PICH in a total of 349 patients (173 treated surgically) indicate a nonsignificant increase in odds of death and dependency at 6 months for patients treated surgically (odds ratio, 1.23; 95% confidence interval, 0.77 to 1.98). The odds of death or dependency at 6 months were 2.1 (1.1 to 4.1) for patients undergoing craniotomy and 0.45 (0.2 to 1.0) for endoscopic evacuation. There is insufficient evidence of the risks and benefits of surgery for PICH. Further randomized trials are needed to identify whether there is a favorable treatment effect of surgery, the types of PICH and patients who are likely to benefit and not benefit, and the safety and effectiveness of the different surgical interventions.