Odds Ratio Research Articles

Respiratory viruses associated with severe acute respiratory infection in children aged

With the increased availability of licensed vaccines for respiratory viruses such as severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus (RSV), and influenza virus, a better understanding of the viral aetiology of severe acute respiratory infections (SARI) among children could help in optimising the use of these vaccines. We conducted a study among children aged <5 years hospitalised with SARI at a tertiary care children's hospital in north India and tested for common respiratory pathogens. We randomly enrolled eligible SARI cases aged <5 years from August 2013 to July 2015. SARI cases were defined as either <7-day history of fever with cough or in children aged eight days to three months, a physician diagnosis of acute lower respiratory infection requiring hospitalisation. We also enrolled an age-group matched control without any acute illness in a 2:1 ratio from the outpatient clinic within 24 hours of case enrolment. Nasopharyngeal and/or oropharyngeal swabs were collected and tested using TaqMan Array Cards, a real-time reverse transcription polymerase chain reaction-based multi-pathogen testing platform for selected respiratory viruses among the enrolled cases and controls. We compared the prevalence of each pathogen among cases and controls using the χ2 (χ2) or Fisher exact test (P < 0.05). We used logistic regression to estimate adjusted odds ratios (aORs) which were then used to calculate aetiologic fractions (EFs). We enrolled 840 cases and 419 outpatient controls. Almost half of the individuals in the whole sample were aged <6 months (n = 521, 41.4%). Females made up 33.7% of cases and 37.2% of controls. Viral detections were more common among cases (69%, 95% confidence interval (CI) = 66, 73) compared to controls (33%; 95% CI = 29, 38) (P < 0.01). RSV (n = 257, 31%; 95% CI = 28, 34%) was the most common virus detected among cases. Influenza A was detected among 24 (3%; 95% CI = 2, 4%), and influenza B among 5 (1%; 95% CI = 0, 1%) cases. The association between the virus and SARI was strongest for RSV (aOR = 23; 95% CI = 12, 47; EF = 96%). Antivirals were administered to 1% of SARI cases while 78% received antibiotics. Using a multi-pathogen molecular detection method, we detected respiratory viruses among more than two-thirds of children aged <5 years admitted with SARI in the Delhi tertiary care children's hospital. The guidelines for preventing and managing SARI cases among children could be optimised further with the improved availability of antivirals and vaccines.

Postoperative pain management practice and associated factors among nurses working at public hospitals, in Oromia region, Ethiopia, 2021: an institution-based cross-sectional study

BackgroundManagement of postoperative pain leads to positive patient progress and shortens the duration of hospital stay. There is a lack of information on nurse’s postoperative pain management practice and its...

Diagnostic uncertainties in patients with bacteraemia: impact on antibiotic prescriptions and outcome.

To establish a formal diagnosis in infectious disease is not an easy task. Our aim was to characterize diagnostic uncertainty (DU) in patients for whom blood cultures were positive (PBC) and to determine its impact on both the antibiotic therapy and the outcome. This was a prospective multicentre study including PBC for 6 months. The laboratory gave the PBC result to the infectious disease (ID) specialists in real time (24/7). The latter analysed all data from electronic patient charts and gave therapeutic advice to the physicians in charge of the patient to either initiate an antibiotic therapy, or to modify or to pursue continuing antimicrobial treatment. A DU was defined as no diagnosis of ID after thorough reading of the patient's chart, or more than two diagnoses despite two medical opinions obtained before PBC. An unfavourable outcome was defined by the occurrence of death during hospitalization. One hundred and nighty-nine PBCs were communicated to ID specialists, including 93 DUs (47%). In multivariate analysis, DU was associated with hospitalization in medical wards: [adjusted odds ratio (AOR) (95% CI): 6.94 (3.41-14.28)], the advice to initiate an antibiotic treatment: [3.89 (1.56-9.70)] and piperacillin-tazobactam use [3.75 (1.56-9.00)]; ICU requirement at initiation of care was a protective factor [0.38 (0.17-0.84)]. An unfavourable outcome was observed in 22 cases, and in a second logistic regression showed that DU was associated with the latter [AOR (95% CI): 5.07 (1.60-16.12)]. DUs were frequent during infections proved by PBC, and were associated with admission in medical wards, broad-spectrum antibiotic use and a high rate of unfavourable outcomes.

Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease.

To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD). This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications. Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%). CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.

Maternal and neonatal risks and outcomes after bariatric surgery: a comparative population based study across BMI categories in Qatar

The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18–2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06–2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33–15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153–2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09–2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23–2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women.

Prevalence and associated factors of intimate partner violence against pregnant women who attend antenatal care in Denmark and Spain: A digital screening approach.

Intimate partner violence against women is a global health issue. Exposure to intimate partner violence during pregnancy leads to health-related problems for both the mother and the newborn. However, current knowledge on its occurrence varies widely and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital screening tools. A cross-sectional design was used to systematically screen for intimate partner violence among pregnant women attending antenatal care by using standardized digital screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen. A total of 17 220 pregnant women in Denmark and 2222 pregnant women in Spain were invited to participate. The response rate was high in both countries (77.3% and 92.5%, respectively). Overall, 6.9% (n = 913) and 13.7% (n = 282) screened positive in Denmark and Spain, respectively. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and intimate partner violence. In both countries, being unmarried and lacking social support were risk factors of intimate partner violence. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, not having a partner at the time of questionnaire completion and having at least one child prior to the current pregnancy were risk factors of intimate partner violence. Prevalence results and found associated factors contribute to a more comprehensive understanding of the occurrence of intimate partner violence during pregnancy in Denmark and Spain, while highlighting the feasibility of digital systematic screening in antenatal settings.

Dental Health Adjuncts and Care: Exploring Access Among Asylum Seekers and Refugees in London, United Kingdom.

This work examines and describes dental health among people seeking asylum and refugees (PSAR) who are evaluated by the Respond service. This includes access to and use of oral health products, access to dental care, and experience of dental pain. The Respond service pilot offered holistic health assessments to PSAR in temporary accommodation within North Central London between July 2021 and March 2023. Relevant data were extracted from anonymized health records of individuals seen by Respond. Data were analyzed with SPSS (version 28.0.0.0; IBM) to produce descriptive statistics and regression models. An overall 1,390 PSAR were included; 78.7% were male. The mean ages of adults and children were 31.6 and 6.8 y. Seventy-seven countries of birth were reported, most commonly Iran (23.1%). Over two-thirds (67.1%) of PSAR were not accompanied by family members; only 17.2% had UK family links. The mean travel duration was 769.3 days; migration reasons were multifactorial, including persecution (31.2%) and conflict (20.5%). In addition, 77.3% of PSAR reported having access to a toothbrush; only 50.8% indicated routinely brushing their teeth, with 38.9% having seen a dentist in <36 mo. Dental pain was common (28.8%). Only 45.8% of children (<16 y) had access to a toothbrush, 32.3% were brushing their teeth twice daily, and 9.7% cited dental pain. Logistic regression identified significant predictors of routine toothbrushing, access to dental care, and dental pain. Female PSAR were more likely to routinely brush their teeth (adjusted odds ratio [OR], 3.19; P < 0.001) and access dental care (adjusted OR, 0.57; P < 0.05). PSAR aged 30 to 39 y (adjusted OR, 1.97; P < 0.05) and those with informal travel modes (adjusted OR, 1.82; P < 0.001) were more likely to experience pain. There is variation in the dental experience of PSAR, but a significant proportion are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.Knowledge Transfer Statement: The results of this analysis suggest that there is variation in the dental experience of people seeking asylum and refugees, but many are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.

Comparative analysis of pregnancy outcomes in different time intervals following GnRH antagonist stimulation and modified natural frozen-thawed embryo transfers

To evaluate whether the interval between oocyte retrieval and frozen-thawed embryo transfer (FET) affects clinical outcomes using modified natural cycle (mNC) regimen following freeze-all GnRH antagonist stimulation. A total of 542 patients underwent first mNC-FET were divided into two groups: immediate (FET conducted in the first menstrual cycle after freeze-all) and delayed (FET performed in the second or subsequent menstrual cycle) groups. The immediate group was associated with a notably reduced duration between oocyte retrieval and transfer day (35.5 ± 5.8 vs. 88.7 ± 35.5 d, P < 0.001). Regarding pregnancy results, the immediate cycles resulted in comparable implantation rate (55.3% vs. 57.2%, P = 0.624), clinical pregnancy rate (66.9% vs. 72.2%, P = 0.236), abortion rate (16.1% vs. 12.7%, P = 0.402), ongoing pregnancy rate (59.0% vs. 65.0%, P = 0.204), and live birth rate (56.1% vs. 63.0%, P = 0.149) with the delayed cycles. After the multivariable logistic regression analysis, the difference in live birth outcome between the two regimens remained insignificant (immediate vs. delayed protocol: adjusted odds ratio = 0.87, 95% confidence interval= 0.56–1.33). Immediate mNC-FET following a freeze-all antagonist cycle displayed promising clinical outcomes and significantly shortened the time to conception compared to delayed FET.

Impact of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal - the VALID randomized controlled trial

IntroductionCounseling, together with iron and folic acid supplements, can improve hemoglobin levels in pregnant women, but few interventions have tested a virtual method of delivering counseling. We hypothesized that a virtual counseling intervention delivered via a mobile device (mHealth) would prevent and treat anemia, compared with routine antenatal care (ANC).MethodsVirtual antenatal intervention for improved diet and iron intake (VALID) was a non-blinded parallel group two-arm, individually randomized superiority trial (1:1 allocation). Participants were pregnant women who were married, aged 13–49 years, able to answer questions, 12–28 weeks’ gestation and living in Kapilvastu district, Nepal. Women were randomized to receive routine ANC (control arm), or ANC plus a virtual antenatal intervention of two problem-solving counseling sessions via video call. The primary outcome was iron folic acid (IFA) tablet compliance (consumption on 12 or more days of the previous 14 days). Secondary outcomes were dietary diversity, promoted food consumption, iron bioavailability enhancement, and knowledge of iron-rich foods. Primary logistic regression analysis was by intention-to-treat, adjusting for baseline values.ResultsWe enrolled 319 pregnant women (161 control, 158 intervention) from 23 January 2022 to 6 May 2022 and analyzed outcomes in 144 control and 127 intervention women. Compliance with IFA increased in both arms. In the intervention arm, compliance increased by 29.7 percentage points (pp) (49.0–78.7%) and 19.8 pp. in the control arm (53.8–73.6%). Despite the more significant increase in the intervention arm, we found no intervention effect upon IFA compliance (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI]: 0.75, 2.35; p = 0.334), dietary diversity, or ANC visits. The intervention increased knowledge of iron-rich foods (coefficient 0.96; 95% CI: 0.50, 1.41; p &amp;lt; 0.001), consumption of promoted foods (aOR: 1.81; 95% CI: 1.08, 3.02; p = 0.023), behavior to enhance iron bioavailability (aOR: 4.41; 95% CI: 1.23, 15.83; p = 0.023), and coronavirus disease 2019 (COVID-19) knowledge (aOR: 4.06; 95% CI: 1.56, 10.54; p = 0.004). The total intervention cost was US$35,193, and the cost per pregnant woman receiving two virtual counseling sessions was US$277.ConclusionVirtual counseling can improve antenatal health behaviors, such as the consumption of promoted foods and methods to enhance bioavailability. Improved IFA consumption and ANC attendance may require additional family/community support.Clinical trial registrationhttps://www.isrctn.com/ISRCTN17842200, identifier ISRCTN17842200.

Endovascular Treatment of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score.

Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large-vessel occlusion with tandem lesions, stratified by baseline ASPECTS. We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age ≥18 years, anterior circulation tandem lesions, endovascular thrombectomy <24 hours of symptom onset, and ≥70% internal carotid artery stenosis/occlusion. Patients were categorized into low (0-5) and high (6-10) ASPECTS. Inverse probability of treatment weighting matching was used to balance the groups. Primary outcomes included the following: 90-day modified Rankin Scale (mRS) score 0 to 2 and symptomatic intracranial hemorrhage. Secondary outcomes included the following: ordinal mRS, mRS 0 to 3, modified Thrombolysis in Cerebral Infarction ≥2b and 2c-3, petechial hemorrhage, parenchymal hematoma (1/2), early neurologic improvement, and mortality. Of 691 patients, 44 had ASPECTS 0 to 5 and 505 had ASPECTS 6 to 10. Patients with low ASPECTS had lower odds of 90-day mRS 0 to 2 (adjusted odds ratio [OR], 0.48; P=0.036) and higher odds of symptomatic intracranial hemorrhage (adjusted OR, 3.78; P=0.014). Additional significant differences were found in mRS shift, mRS 0 to 3, parenchymal hematoma 2, and mortality. In interaction analysis, the association between low ASPECTS and functional outcome persisted only in the internal carotid artery occlusion subgroup, with no significant interaction indicating no reason to suppose a difference between the effect of both subgroups. Endovascular thrombectomy in patients with tandem lesions with low ASPECTS is associated with reduced odds of functional recovery and increased symptomatic intracranial hemorrhage risk, when compared with patients with high ASPECTS. However, 30% of patients with low ASPECTS achieved 90-day functional independence, suggesting potential benefit for a nonnegligible proportion of patients.

WHO/INRUD prescribing indicators with a focus on antibiotics utilization patterns at outpatient department of Adigrat general hospital, Tigrai, Ethiopia: a retrospective cross-sectional study

BackgroundThe World Health Organization (WHO) defines rational use of drug as a state in which medications are received by patients appropriately according to their clinical needs and individual requirement, for adequate period and at the right cost. More than 50% of all medicines are prescribed, dispensed, or sold inappropriately worldwide. This study aimed to evaluate the prescribing patterns in Adigrat general hospital, Tigrai, Ethiopia.MethodsA retrospective cross-sectional study was done to evaluate prescription patterns. A systematic random sampling technique was used to select 600 prescriptions and the prescriptions were reviewed using WHO/International Network of Rational Use of Drugs prescribing indicators. Data was collected from prescriptions dispensed from 01 March 2023 to 30 March 2024 at outpatient pharmacy of Adigrat general hospital. Data was analyzed using SPSS version 21 and a p-value < 0.05 was declared statistically significant.ResultsA total of 1088 medicines were prescribed in 600 prescription encounters, giving an average number of 1.8 (± 0.83) medicines per encounter. The percentage of medicines prescribed by generic name was 91.5% while 98.7% of the medicines were prescribed from essential medicine list (EML). Besides, the percentages of encounters containing at least one antibiotic and one injection were 44.5% and 7.2%, respectively. A total of 340 antibiotics were prescribed in 267 encounters. Penicillins (34.4%), macrolides (23.8%) and fluoroquinolones (17.1%) were the most prevalent antibiotics classes. The “Access” and “Watch” groups covered 54.4% and 45.6% of the total antibiotics prescribed, respectively. Being under 18 years old [Adjusted Odds Ratio (AOR): 9.830, CI: 4.062–23.786], being prescribed with three medicines (AOR: 3.247, CI: 1.571–6.708) and certain diagnosis like diseases of the respiratory system (AOR: 3.750, CI: 2.136–6.584) were significantly associated with antibiotic prescribing.ConclusionThis study showed deviations of prescribing patterns from WHO standards. The percentage of prescriptions with antibiotic was far from WHO optimal value. The use of antibiotics from “Access” group was below WHO standard. The percentage of medicines prescribed by generic name and the percentage of encounters with injection also deviated from WHO standard. Antibiotics prescribing showed significantly association with age, number of medicines and certain diseases.

Impact of patient education by nurse case managers on decision making for out-of-pocket anti-osteoporotic pharmaceutical therapy: a single-center retrospective study.

Osteoporosis is a common condition that increases the risk of fracture and mortality. In Taiwan, clinical guidelines recommend pharmaceutical therapy for patients with a T-score of ≤ - 2.5; however, Taiwan's National Health Insurance (NHI) only covers these medications for those with a history of fragility fractures. This gap in coverage necessitates a discussion of out-of-pocket treatment options. To address this, we provided an integrated care program with patient education and shared decision-making by nurse case managers specializing in osteoporosis. We evaluated whether education by nurse case managers influences patients with a T-score ≤ - 2.5, who are not covered by the NHI, to choose out-of-pocket pharmaceutical therapy. We retrospectively reviewed medical records of patients who underwent bone density scanning at our hospital between January 2014 and December 2021. We identified 4,462 patients with a T-score of ≤ - 2.5 who were ineligible for NHI-covered anti-osteoporotic therapy and analyzed trends in out-of-pocket medication use. Since the integrated care program began in 2018, we evaluated whether education by nurse case managers between 2018 and 2021 influenced patients' decisions to pay out-of-pocket for therapy. After the implementation of the integrated care program, we identified 2,910 patients with a T-score ≤ -2.5 who were ineligible for NHI-covered anti-osteoporotic therapy. Of these, 640 opted for out-of-pocket treatment, while 2,270 chose conservative care. After a 1:1 propensity score match based on age and sex, logistic regression was used to analyze the impact of nurse case manager education on these decisions. Between 2014 and 2021, 888 of the 4,462 patients chose out-of-pocket pharmaceutical therapy. Before the implementation of the integrated care program and patient education by nurse case managers (2014-2017), 16% of the patients opted to pay out-of-pocket for anti-osteoporotic therapy. After the program was implemented (2018-2021), the rate increased significantly to 22% (P < 0.001). A multivariate logistic regression model showed that a history of osteoarthritis (adjusted odds ratio = 1.576; P = 0.009) and education provided by the nurse case managers (adjusted odds ratio = 5.044; P < 0.001) were significantly associated with choosing out-of-pocket therapy. Education from nurse case managers significantly increased the likelihood of patients choosing out-of-pocket anti-osteoporotic therapy in our hospital, thereby bridging the gap between clinical guidelines and NHI reimbursement criteria.

Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma.

International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

Attitudes of Health Professionals Toward Digital Health Data Security in Northwest Ethiopia: Cross-Sectional Study.

Digital health is a new health field initiative. Health professionals require security in digital places because cybercriminals target health care professionals. Therefore, millions of medical records have been breached for money. Regarding digital security, there is a gap in studies in limited-resource countries. Therefore, surveying health professionals' attitudes toward digital health data security has a significant purpose for interventions. This study aimed to assess the attitudes of health professionals toward digital health data security and their associated factors in a resource-limited country. A cross-sectional study was conducted to measure health professionals' attitudes toward digital health data security. The sample size was calculated using a single population. A pretest was conducted to measure consistency. Binary logistic regression was used to identify associated factors. For multivariable logistic analysis, a P value ≤.20 was selected using Stata software (version 16; StataCorp LP). Of the total sample, 95% (402/423) of health professionals participated in the study. Of all participants, 63.2% (254/402) were male, and the mean age of the respondents was 34.5 (SD 5.87) years. The proportion of health professionals who had a favorable attitude toward digital health data security at specialized teaching hospitals was 60.9% (95% CI 56.0%-65.6%). Educational status (adjusted odds ratio [AOR] 3.292, 95% CI 1.16-9.34), basic computer skills (AOR 1.807, 95% CI 1.11-2.938), knowledge (AOR 3.238, 95% CI 2.0-5.218), and perceived usefulness (AOR 1.965, 95% CI 1.063-3.632) were factors associated with attitudes toward digital health data security. This study aimed to assess health professionals' attitudes toward digital health data security. Interventions on educational status, basic computer skills, knowledge, and perceived usefulness are important for improving health professionals' attitudes. Improving the attitudes of health professionals related to digital data security is necessary for digitalization in the health care arena.

Association of fear of falling and low physical activity with fall risk among older Taiwanese community-dwellers

Background and purposeFear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation.MethodsOur study involved 600 individuals aged 70.8–96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high).ResultsFalls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12–4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified.ConclusionFear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither.

Decadal changes in nocturia among American middle-aged and older men.

To estimate the prevalence of nocturia in middle-aged and elderly men and evaluate its associated factors and changes over time. Data of middle-aged and older men aged ≥40 years from the 2007-2008 and 2017-2020 cycles of the National Health and Nutrition Examination Survey were retrospectively analyzed. The prevalence of nocturia was estimated using participant questionnaires on nocturia, lifestyle-related factors, and health factors, and its decadal changes were examined using multivariate logistic regression analysis to determine related factors associated with the prevalence of nocturia. The prevalence of nocturia was 38.0% in 2007-2008 and 39.6% in 2017-2020, with no significant increase observed (P = 0.3989). Being a non-Hispanic black was positively correlated with nocturia (adjusted odds ratio [AOR] = 1.54, 1.22-1.93, P < 0.001), whereas the correlation with being a Mexican American disappeared (AOR = 1.25, 0.90-1.73, P = 0.187). Diabetes (AOR = 1.32, 1.07-1.64, P = 0.010) and sleep disorders (AOR = 1.31, 1.07-1.60, P = 0.008) showed a statistically significant positive correlation with nocturia, whereas a significant negative correlation was observed between employment (AOR = 0.66, 0.54-0.82, P < 0.001) and nocturia. Above-high-school education (AOR = 0.60, 0.47-0.76, P < 0.001) showed a constant trend toward a negative correlation with nocturia. The correlation between high school education or general educational development and nocturia disappeared (AOR = 0.81, 0.62-1.05, P = 0.112). Diabetes and sleep disorders contribute to the development of nocturia, while work and high educational attainment can actively combat nocturia. Geriatr Gerontol Int 2024; ••: ••-••.

Decision Support Intervention and Anticoagulation for Emergency Department Atrial Fibrillation

Oral anticoagulation for adults with atrial fibrillation or atrial flutter (AFF) who are at elevated stroke risk reduces the incidence of ischemic stroke but remains underused. Efforts to increase anticoagulation initiation on emergency department (ED) discharge have yielded conflicting results. To evaluate the effectiveness of a multipronged intervention supporting anticoagulation initiation for eligible adult ED patients. The Clinical Decision Support to Optimize Care of Patients With Atrial Fibrillation or Flutter in the Emergency Department (O'CAFÉ) pragmatic, stepped-wedge cluster randomized clinical trial was conducted from July 1, 2021, through April 30, 2023, at 13 community medical centers (in 9 clusters) of an integrated health system in Northern California. The study included adult ED patients with primary AFF eligible for anticoagulation initiation when discharged home. Clusters were randomly assigned to staggered dates for 1-way crossover from the control phase (usual care) to the intervention phase. Physician education, facility-specific audit and feedback, and access to decision support, which identified eligible patients and recommended shared decision-making, anticoagulation initiation (if suitable), and timely follow-up. The main outcome was a composite of anticoagulation on discharge or within 30 days. A primary intention-to-treat analysis (decision support access regardless of use) and a secondary per-protocol analysis (decision support use) were performed. Multivariable analyses adjusted for intervention and exposure months with random effects, accounting for clustering by facility and patient. A total of 3388 eligible patients with atrial fibrillation were discharged home: 2185 (64.5%) were receiving pre-ED arrival anticoagulation and 1203 (35.5%) were eligible for anticoagulation. Among the 1203 patients with an initiation-eligible encounter, the median age was 74.0 (IQR, 68.0-82.0) years and approximately half (618 [51.4%]) were men. Among the 387 patients with an initiation-eligible control encounter, 244 (63.0%) received anticoagulation (190 [49.0%] at discharge and 54 [14.0%] within 30 days). Among the 816 patients with an initiation-eligible intervention encounter, 558 (68.4%) received anticoagulation (428 [52.5%] on discharge and 130 [15.9%] within 30 days). There was no statistically significant change in initiation of anticoagulation associated with the intervention (adjusted odds ratio, 1.33 [95% CI, 0.75-2.35]; P = .13). Decision support was used for 217 eligible case patients (26.6%) (per protocol) and was associated with a statistically significant change in anticoagulation initiation when compared with 599 patients for whom decision support was not used (164 [75.6%] vs 394 [65.8%]; P = .008). In this trial, a multipronged intervention to facilitate thromboprophylaxis among eligible ED patients with AFF did not significantly increase anticoagulation initiation. Opportunities exist to further improve stroke prevention among ED patients with primary AFF. ClinicalTrials.gov Identifier: NCT05009225.

Impact of renal impairment on early development of severe neutropenia with trifluridine/tipiracil treatment for metastatic colorectal cancer.

Trifluridine/tipiracil (FTD/TPI) with or without bevacizumab is an effective treatment for metastatic colorectal cancer (mCRC). As this agent is mainly excreted via the kidney, we aimed to evaluate the impact of renal impairment (RI) on the early development of severe neutropenia, a dose-limiting toxicity and whose development reflects better treatment outcomes, in patients with mCRC treated with FTD/TPI. Patients with mCRC receiving FTD/TPI ± bevacizumab (n = 100) were divided into the RI group (creatinine clearance [CCr] < 90 mL/min) or control group (CCr ≥ 90 mL/min), and retrospectively evaluated. Severe neutropenia during the first two cycles occurred in 57.6% and 34.2% of patients in the RI and control groups, respectively, which was significantly different (P = 0.03) and met our primary endpoint. Furthermore, the incidence during the first cycle also differed significantly (52.5% in the RI group and 17.1% in the control group, P = 0.0004). Multivariate logistic regression analysis suggested that baseline RI and neutropenia were significant risk factors for early severe neutropenia (adjusted odds ratio and 95% confidence interval: 3.07, 1.24-7.59, P = 0.02 for RI, and 9.76, 1.08-88.11, P = 0.04 for neutropenia). In conclusion, our study suggested that patients with RI can exhibit early severe neutropenia during real-world FTD/TPI treatment for mCRC.

Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study

Background and Objectives: Hypertensive patients’ knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill–Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill–Bone Medication Adherence Scale scores (Spearman’s rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18–3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85–5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36–4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.

Work-Related Stress Is Associated With Unfavorable Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis.

Work-related stress is a psychosocial risk factor linked to a higher risk of cardiovascular disease. However, the association between work-related stress and cardiovascular health (CVH) is not well established. We estimated the association between work-related stress and CVH in a multiethnic sample of adults free of cardiovascular disease at baseline. We performed a cross-sectional analysis of 3579 community-based men and women, aged 45 to 84 years, of the Multi-Ethnic Study of Atherosclerosis from data collected between 2000 and 2002. Work-related stress (yes/no) was assessed by a self-administered questionnaire. CVH was measured by the American Heart Association's Life's Simple 7 metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose). Each metric contributed 0, 1, or 2 points if in the poor, intermediate, or ideal range, respectively. The aggregated CVH score was 0 to 14 points and categorized as inadequate (0-8 points), average (9-10 points), and optimal (11-14 points). Polytomous logistic regression was used to estimate the association between work-related stress and CVH, adjusting for sociodemographic factors. The mean±SD age was 57±8 years, and 48% were women. Work-related stress was reported by 20% of participants. In fully adjusted models, participants with work-related stress had lower odds of having average (adjusted odds ratio [OR], 0.75 [95% CI, 0.62-0.92]) and optimal (adjusted OR, 0.73 [95% CI, 0.58-0.92]) CVH scores compared with participants without work-related stress. Work-related stress was associated with unfavorable CVH. These findings underscore the importance of workplace psychological well-being and suggest the need for studies on interventions that may reduce work-related stress and promote CVH.