Pearson Chi Test Research Articles

Geographical Determinants of the Prevalence of Gestational Diabetes in North and South Kivu in the Democratic Republic of Congo

Objectives: To explore the geographic determinants of gestational diabetes in eastern DRC and to seek confounding factors. Methods: Cross-sectional descriptive study with a multicenter analytical aim conducted in the hot and cold season from April 2019 to February 2021. Included were 392 pregnant women at 24-28 weeks of amenorrhea. Blood glucose, cortisol, SO2, anthropometric measurements, 30 previous day’s temperature, altitude and atmospheric pressure (atm) were examined. The glycaemia ≥92mg/dL was pathological, in which case cortisolaemia was measured after matching with normal glycaemia. Data were analyzed using SPSS version 23 by calculating median, proportion, ANOVA, Pearson's Chi2 or Fisher's exact test, Wilcoxon -Mann–Whitney test. Results: The proportion of 23.8%, 37.4%, 13.8% and 25.0% of 392 pregnant women lived respectively at the altitude of 1400 m, 1500m, 1700m and 2419m. Pathological glycaemia was twice higher at < 1700 m = atm > 82% [32.9% (n = 295)] Vs ≥ 1700 m [15.0% (n = 295)] [OR 2.2 95% CI (1.5- 3.2)] (p<0.001)] and at SO2 > 95% [30.8% (n= 331)] Vs SO2 ≤ 95% [15.3% (n= 144)] [OR 2.0 95% CI (1.3 - 3.1)] (p < 0.001). Cases with pathological glycaemia had elevated cortisol [281.1 nmol/L (87.6)] (n=118) Vs normal glycaemia [261.1 nmol/L (71.1)] (n= 156)] (p= 0.024). Conclusion: The prevalence of pathological glycaemia was higher at <1700 m altitude corresponding to the atm > 82% and when the SO2 was >95%. After adjustment, blood glucose was no longer correlated with temperature.

Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study

BackgroundTreating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat.ObjectiveThe PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia.MethodsPROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group.Results107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402).ConclusionAlthough, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation.Trial registrationNCT02173613. This study was first registered on 25/06/2014.

Tuberculosis in Vaccinated versus Unvaccinated Children with BCG Vaccine in Niamey: Epidemiological, Diagnostic and Outcome Aspects

Introduction: Tuberculosis remains a public health problem worldwide. The BCG vaccination is one of the response means. The objective of this work was to study the impact of BCG vaccination on morbidity and mortality related to childhood tuberculosis in Niamey. Patients and methods: It was a multicenter prospective and comparative study from January to September 2017 in two-referral hospital centers of Niamey and the National Anti-Tuberculosis Center. The study population consisted exclusively of children aged 0 to 15 years old suffering from tuberculosis. Epidemiological, diagnostic, and evolving aspects in vaccinated and unvaccinated children were studied. Statistical tests used were Pearson's Chi² and Fisher's exact test (p <0.05). Results: Ninety-one children were studied. The BCG vaccination rate was 60.4%. The mean age of children was 6 years 11 months [3 months-15 years]. Children under 2 years of age were less affected (11%) in vaccinated children than in unvaccinated children (3.2%). No association was found between the duration of tuberculosis signs (p = 0.37), expression of tuberculin skin test (p = 0.43), and the children's BCG vaccination status. On the other hand, there was a significant link between vaccination status and the occurrence of complications (p = 0.014), and death risk (p = 0.003). Conclusion: This study shows that children’s BCG vaccination status correlates with some aspects of tuberculosis. Unvaccinated children have a significantly higher risk of complications and death from TB.

Utilisation de l’application mobile TestObs pour l’évaluation de l’observance thérapeutique dans une population d’hémodialysés chroniques : modèle de monitoring technologique de l’adhérence au traitement et ses facteurs déterminants

IntroductionNon-adherence behaviors are very common in chronic hemodialysis patients, it is estimated that only one patient out of two complies with medical prescriptions, these behaviors are associated with a higher risk of morbidity and adverse events as well as increased expenses for health systems. The aim of our study was to assess adherence to long-term prescribed medications in chronic hemodialysis patients, using a mobile application named TestObs, as well as to determine the main factors influencing medication adherence. MethodsWe conducted a prospective descriptive study, between January and June 2019. We developed a mobile application named TestObs, downloadable on playstore for android devices, which assesses with the Girerd questionnaire, the adherence to the main medications taken by chronic hemodialysis patients. We included adult patients, with a duration of dialysis of more than 6 months, all patients who downloaded TestObs, tested their adherence to their medication by answering the questionnaire. We created a web-based platform, where data was collected from the application and then analyzed and tabulated. Regarding the statistical analysis, the normal distribution of the variables was studied by the Kolmogorov-Smirnov test, the analysis of the qualitative variables used the Pearson's Chi2 and Fisher's statistical test, the Hosmer Lemeshow test was used to examine the quality of the final logistic regression model. ResultsWe collected 90 adult chronic hemodialysis patients, 51 of them (56%) were selected to enter the study. We found good compliance in 46.15% of patients, minor noncompliance in 32.87%, and noncompliance in 20.98%. In multivariate analysis, the factors influencing adherence were the presence of other comorbidities (diabetes and vision problems) and the number of pills per day. DiscussionIn this study, we report treatment adherence problems in 53.85% of patients, our results are close to the data reported in hemodialysis patients in the literature, different factors influence the quality of treatment adherence, in our study poly-medication and the presence of other comorbidities were the statistically significant determinants. The new technology assessment instruments were used in hemodialysis patients and were able to provide real-time monitoring of adherence behaviors. ConclusionWe believe that mobile health technologies hold promise for assessing and improving medication adherence in hemodialysis patients, so we suggest that TestObs represents an accessible and free of charge tool, based on a validated questionnaire, that can allow patients to benefit from new technologies for medical monitoring, and may eventually constitute an interventional program to improve medication adherence; however, this technological tool should not replace traditional therapeutic education; prior targeting of non-adherent patients and an optimal combination of several tools can help improve adherence in these patients.

Feeding preterm infants with breast milk – the role of maternal pressure

Abstract Background Motheŕs own milk (MOM) is the best nutrition for preterm infants because of its preventive effects. Nevertheless, current research shows that mothers have problems getting into continuous lactation, especially after preterm birth. Breastfeeding-related pressure after prematurity has not been measured yet. It's relevance for the lactation is thus unclear, as well as the role of the NICU staff's attitudes. The aim of this study is to gain more knowledge about breastfeeding-related pressure in order to enable mothers to have a positive breastfeeding experience and to sensitise NICU staff about this topic. Methods The written survey included mothers of preterm infants with a birth weight under 1500g and an age from 6 to 24 months at the time of the survey. Descriptive and bivariate testing was used for analyses. Results Data of 506 mothers was included (32% response rate). One third totally agreed to perceive pressure regarding breastfeeding their child with MOM (36%). A milk volume over 500ml/day 14 days post-partum was reported in 60%. That the nutrition with MOM was promoted by the physicians in the NICU was totally agreed by 44% of the mothers. To the promotion by nurses, 50% totally agreed. Pearson Chi2-Test showed a significant correlation between milk volume and breastfeeding-related pressure (p = 0.005). Spearman’s correlation test showed a significant correlation between a high promotion of MOM by physicians (Spearman’s rho: -0.1150, p = 0.0109) and nurses (Spearman’s rho: -0.0949, p = 0.0362) and lower breastfeeding-related pressure. Conclusions Our findings indicate that breastfeeding-related pressure seems to affect most of the mothers of preterm infants and correlates with lactation, even if no direction of effect can be stated. A more breastfeeding promoting NICU staff is related to lower breastfeeding-related pressure. Therefore, NICU staff should be sensitised to breastfeeding-related pressure with regard to communication with mothers. Key messages • Noticing breastfeeding-related pressure as an important factor for mothers within their lactation process may have the potential to enhance mothers to achieve their breastfeeding goals. • NICU staff should be aware of breastfeeding-related pressure to enable more mothers to have a positive breastfeeding experience.

Financial toxicity of patients with lung cancer in China: Results from a National Survey Study.

To develop a comprehensive understanding of financial toxicity (FT) among patients with lung cancer in China and the major factors affecting FT. Drawing from a national cross-sectional survey, which used the validated comprehensive score for financial toxicity (COST) questionnaire, we estimated the prevalence and degree of FT. Patient coping actions were investigated. Pearson's chi tests and multinomial logistic regression were used to evaluate the predictors of FT in patients with lung cancer. The median score of FT was 20 (scored on a range of 0-44, with lower scores indicating more severe toxicity). Altogether, 77% of the sample patients had FT (COST <26), 54.5% had mild FT (COST 14-25), and 22.5% had moderate and severe FT (COST 0-13). Living in the less-developed western region of China, being male, having a lower educational level, lower annual family income, and advanced stage or worse self-reported health status were significantly related to higher FT than their counterparts (p< 0.05). Patients with higher FT tended to have a lower level of medical compliance, a higher risk of incurring debts, and reduced living expenditures relative to those with lower FT. Despite China's remarkable progress in the past two decades with regard to Universal Healthcare Coverage, FT still presents a serious challenge for patients with lung cancer. Keen attention must be paid to reducing the disproportionate high financial risks of patients with low socioeconomic status.

Tuberculosis in Vaccinated versus Unvaccinated Children with BCG Vaccine in Niamey: Epidemiological, Diagnostic and Outcome Aspects

Introduction: Tuberculosis remains a public health problem worldwide. The BCG vaccination is one of response means. The objective of this work was to study impact of BCG vaccination on morbidity and mortality related to childhood tuberculosis in Niamey. Patients and methods: It was a multicenter prospective and comparative study from January to September 2017 in two-referral hospital centers of Niamey and the National Anti-Tuberculosis Center. The study population consisted exhaustively of children aged 0 to 15 years old suffering from tuberculosis. Epidemiological, diagnostic and evolving aspects in vaccinated and unvaccinated children were studied. Statistical tests used were Pearson's Chi² and Fisher's exact test (p &lt;0.05). Results: Ninety-one children were studied. The BCG vaccination rate was 60.4%. The mean age of children was 6 years 11 months [3 months-15 years]. Children under 2 years of age were less affected (11%) in vaccinated children than in unvaccinated children (3.2%). No association was found between duration of tuberculosis signs (p = 0.37), expression of tuberculin skin test (p = 0.43), and the children's BCG vaccination status. On the other hand, there was a significant link between vaccination status and the results of microscopic examination of sputum or gastric fluid (p = 0.02), occurrence of complications (p = 0.014) and death risk (p = 0.003). Conclusion: This study shows that children’s BCG vaccination status interferes with some aspects of tuberculosis. Therefore, fighting against tuberculosis must be intensified, through combination of many strategies including vaccination.

Vaccination against COVID-19: Surveillance of Adverse Events in Brazzaville

Introduction: All countries have embarked on vaccinating populations against COVID-19 to reduce the incidence and severe forms of this disease. Several vaccines are used and the risk of occurrence of Adverse Events Following Immunization (AEFI) is not to be neglected. The objective of this study is to describe the AEFI of COVID-19 vaccination in Brazzaville. Population and Method: This was a descriptive cross-sectional study conducted in Brazzaville at all AEFI reporting points of the Expanded Programme on Immunization in the period from March 25th to October 15th 2021. A standardized notification sheet of AEFI cases occurring after vaccination against COVID-19, validated by the WHO, collected the data. These have been analyzed with R Studio software version 4.0.3. Qualitative variables were expressed in numbers and percentages. Quantitative variables were expressed as average, standard deviation, maximum and minimum. Pearson's Chi-2 test and ANOVA's were used to compare variables. Results: The average age of people with AEFI was 46 years ± 12.6 years; men were more affected than women non-significantly (p-value=0.063). AEFI frequencies were 56 per 10,000 people vaccinated. Mild AEFI such as joint and muscle pain (63.07%), headache (59.70%) fever (55.84%) were the most recorded while severe forms were rare. These AEFI appeared most often in the first week of administration of the COVID-19 vaccine and had a favorable evolution in 90.69% of cases. Conclusion: This study revealed that vaccination against COVID-19, can cause AEFI. These are infrequent and in most cases they are mild forms. High vaccination coverage must be a priority objective to better counter the COVID-19 pandemic.

Obstetrical specificities of Ivorian adolescent mothers on a single-center hospital series of 1040 cases

Overview and aimThe precocity of sexual intercourse among adolescent girls is a prominent source of unwanted pregnancy. Here, we aim to survey the past issues relating to the pregnancy, childbirth, and materno-fetal prognosis of Ivorian adolescent women. MethodsWe conducted a retrospsective study with adolescent group (n ​= ​1040) versus young adult group aged 20 to 24 (n ​= ​736) over three years from1st January 2016 to 31rd December 2018 ​at the Department of Obstetrics and Gynecology at the University of Abidjan-Yopougon Hospital. Maternal and fetal outcomes of the two groups were analyzed and compared by using Pearson's Chi2 tests and Fisher's exact tests, followed by multivariate analysis and logistic regression using Stata software version 20. ResultsThe average age of adolescent girls in our study was 17.45 years (SD ​= ​1.39) and a minimum of 12 years. Adolescents consulted less (P ​< ​0.0001) and later (P ​< ​0.0001) versus young adults aged 20 to 24. The proportion of adolescent girls (47.6%) versus young adults (39.1%) who had underwent caesarean section was significantly higher (P ​= ​0.0004). These adolescents were 3.5-fold more likely to develop hypertension and its complications in the postpartum period and 2.5-fold more likely to contract a postpartum infection. Maternal mortality was not significantly associated with adolescence (OR ​= ​0.52 (95%CI: 0.22–1.19; P ​= ​0.0891). The risk of prematurity, early neonatal death, and neonatal admission were 2.02 (95%CI: 1.56–2.63; P ​< ​0.0001), 1.55 (95%CI: 1.14–2.13; P ​= ​0.0040), and 1.73 (95%CI:1.12–2.71; P ​= ​0.0097) in adolescence, respectively. ConclusionAdolescent childbirth remains associated with a poor prognosis.

The Role of the Educational Programs in the Improving of Confidence in Vaccination against Pneumococcal Infection among Population

Relevance . Pneumococcal disease is a common cause of morbidity and mortality in adults and children worldwide. Vaccination against pneumococcal infection was included in the National Immunization Schedule in the Russian Federation in 2014. But despite the progress made, the proportion of children who received a completed course of vaccination remains insufficient. Coverage of the adult population remains low. A significant role in this is played by confidence of the population to vaccination against pneumococcal infection. In this regard, we conducted a study to assess the effectiveness of the educational programs in the improving of confidence in vaccination against pneumococcal infection among various target groups of population. Materials and methods . The results of the developed and conducted educational campaigns, consisting of two stages, were used as material: a series of face-to-face events for young people (students of non-medical universities in Moscow) and a series of webinars for medical professionals of various specialties. In the first stage of the educational component, the total coverage of the target audience («future parents») amounted to 650 people. Face-to-face events were held with the participation of students from Sechenov University using the peer-to-peer approach. The total audience of the second phase of the educational component (a series of 5 webinars for health professionals) was more than 3,000 people (2,902 connections, some of them group). Online events for medical workers were held by leading experts in the field of epidemiology and vaccine prevention, psychology. Evaluation of the effectiveness of the campaign was carried out through measurements (surveys before and after the event). To assess the statistical significance of differences, Pearson's Chi2 test was used at the accepted level of statistical significance p &lt; 0.05. Qualitative variables are presented as proportion and 95% confidence interval of the proportion. Statistical processing was performed using IBM SPSS Statistics v.20.0, data visualization – Microsoft Excel 2016. Results . The proportion of students who have a positive attitude towards vaccination increased by 16% – from 41.0±5.6% to 57.0±6.0%, p&lt;0.05. The level of awareness about the availability of vaccination against pneumococcal infection increased by 75.9% – from 21.2 ± 4.5% in the initial survey to 97.1 ± 2.0% in the final one (p &lt; 0.001). Awareness about contingents subject to vaccination against pneumococcal infection increased by 78% (the proportion of respondents who initially found it difficult to answer this question decreased from 85.3 ± 3.9% to 7.2 ± 3.1% (p &lt; 0.001). The total audience of the second stage of the educational component (a series of 5 webinars for medical professionals) amounted to more than 3000 people (2902 connections, some of them were group). The proportion of doctors willing to recommend vaccination against pneumococcal infection increased from 82.1 ± 1.4% to 97.0 ± 0.6%, p &lt; 0.001. Conclusion . Educational programs plays important role in the improving confidence in vaccination both among medical workers and among the population. Short-term indicators of the effectiveness of the event can be reflected in the increased awareness of participants in the issues of vaccination and infectious diseases. At the same time, a significant change in the indicator of attitudes towards vaccination should be expected when conducting a series of educational events using various formats – lectures, conversations, discussions, interactive games.

Changing profile of encephalitis: Results of a 4-year study in France

ContextIn 2007, we performed a nationwide prospective study to assess the epidemiology of encephalitis in France. We aimed to evaluate epidemiological changes 10years later. MethodsWe performed a 4-year prospective cohort study in France (ENCEIF) from 2016 to 2019. Medical history, comorbidities, as well as clinical, biological, imaging, and demographic data were collected. For the comparison analysis, we selected similar data from adult patients enrolled in the 2007 study. We used Stata statistical software, version 15 (Stata Corp). Indicative variable distributions were compared using Pearson's Chi2 test, and means were compared using Student's t-test for continuous variables. ResultsWe analyzed 494 cases from 62 hospitals. A causative agent was identified in 65.7% of cases. Viruses represented 81.8% of causative agents, Herpesviridae being the most frequent (63.6%). Arboviruses accounted for 10.8%. Bacteria and parasites were responsible for respectively 14.8% and 1.2% of documented cases. Zoonotic infections represented 21% of cases. When comparing ENCEIF with the 2007 cohort (222 adults patients from 59 hospitals), a higher proportion of etiologies were obtained in 2016–2019 (66% vs. 53%). Between 2007 and 2016–2019, the proportions of Herpes simplex virus and Listeria encephalitis cases remained similar, but the proportion of tuberculosis cases decreased (P=0.0001), while tick-borne encephalitis virus (P=0.01) and VZV cases (P=0.03) increased. In the 2016–2019 study, 32 causative agents were identified, whereas only 17 were identified in the 2007 study. ConclusionOur results emphasize the need to regularly perform such studies to monitor the evolution of infectious encephalitis and to adapt guidelines.

A mixed-method service evaluation of health information exchange in England: technology acceptance and barriers and facilitators to adoption

BackgroundThe need for information exchange and integrated care has stimulated the development of interoperability solutions that bring together patient data across the health and care system to enable effective information sharing. Health Information Exchange (HIE) solutions have been shown to be effective in supporting patient care, however, user adoption often varies among users and care settings. This service evaluation aimed to measure user acceptance of HIE and explore barriers and facilitators to its wider uptake.MethodsA mixed-method study design was used. A questionnaire was developed using the Unified Theory of Acceptance and Use of Technology and administered to HIE users to assess technology acceptance. Pearson Chi2 tests were used to examine differences in acceptance between user groups and care settings. Web-based, semi-structured interviews were conducted drawing on the Normalisation Process Theory to explore barriers and facilitators to adoption. Interview data were analysed thematically using the Framework Approach.ResultsA total of 105 HIE users completed the survey and another 12 participated in the interviews. Significant differences were found in HIE acceptance between users groups and care settings, with high adopters demonstrating higher acceptance and social care users showing lower acceptance. Participants identified several drivers to adoption, including increased information accessibility, better care coordination, informed decision-making, improved patient care, reduced duplication of procedures, and time and cost savings. However, they also highlighted a number of barriers, such as lack of awareness about the solution and its value, suboptimal communication strategies, inadequate training and lack of resources for knowledge dissemination, absence of champions to support the implementation, lack of end-user involvement in the implementation and evaluation of HIE, unclear accountability and responsibility for the overall success of the programme, and patient confidentiality concerns.ConclusionsWorking to better engage stakeholders, considering the needs of users from different care settings, providing users with training resources and support to increase their knowledge and confidence in using the system, developing implementation strategies to seek user feedback and monitor performance, and using communication strategies to increase awareness of the product and its value, can help improve uptake and adoption of HIE.

Factors associated with the use of tumor necrosis factor alpha inhibitors in a population of Colombian patients with spondyloarthritis

IntroductionThe use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use. ObjectiveTo determine factors that better explain the indication of TNFi in the study population. Material and methodsThe association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < .25 were entered into univariate models of explanatory logistic regression to construct crude ORs, and those with P < .25 were included in the multivariate model to construct adjusted ORs. Results and discussionThe study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX2 inhibitors, evolution time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = .036), inflammatory back pain (P = .026), sacroiliitis (P = .045), use of coxibs (P = .001) and the maximum score of BASDAI (P = .022, P = 006) were independently associated with the use of TNFi. The use of coxibs was associated with the indication of using TNFi in both patients with axial (P = .001) and peripheral spondyloarthritis (P < .001). ConclusionsThe onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.

A Teaching Strategy Based Upon a Model of Agentic Learning

ICT integration in educational pedagogy enhances teachers’ content delivery alongside heightening the levels of education. This study was carried out in Machakos County, Kenya to investigate the influence of ICT integration on content delivery by ICT and Non-ICT trained teachers in secondary schools. The study was guided by two objectives; to establish the status of teachers’ integration of ICT in content delivery and to determine the influence of ICT integration on content delivery by teachers. The study embraced descriptive survey design. Ratio proportionate sampling and equal allocation method were employed to get the sample size. Data was collected using questionnaires for the principals, teachers and the students. Test re-test technique was employed to heighten the instruments reliability. Statistical Package for Social Sciences (SPSS) was used to analyse data. Pearson’s Product Moment determined the level of the relationship between the variables. Pearson chi test was employed to present, interpret inferential data. The study revealed that ICT trained teachers utilized ICT in content presentations which enriched their delivery, while Non-ICT trained teachers applied their general ICT knowledge inhibiting their technology utilization in content delivery. The study concluded that ICT trained teachers’ integration of ICT in content delivery was significantly higher at (p) 0.003 than for Non-ICT trained teachers at (p) 0.047. Hence the null hypothesis was rejected. The study recommended that the Ministry of Education (MOE) should incorporate ICT training in teacher training institutions for application of technology in content delivery.

Predictive Factors to Assess the Difficulty to Extract Retained Lower Third Molars

Background: Third molar eruption occurs in a very limited space. Several difficulty scales have been used to determine the complexity when extracting retained molars, which are key for surgical planning and prediction. A scale including indicators such as quality of mucosa and bone, as well as shape and number of roots is introduced. Purpose: Evaluate the difficulty in extracting retained lower third molars, using the scale proposed by Romero-Ruiz, and thus estimate the presence of intraoperative complications and surgical time. Methods: An observational descriptive cross-sectional study was carried out, with a sample of 100 extractions of retained lower third molars in patients between 16 and 40 years of age. The following variables were evaluated: spatial relationship, depth, relationship with mandible ramus/space, integrity of bone and mucosa, roots, dental follicle, and surgical time. The data were summarized in absolute frequency tables and analyzed with Pearson's Chi2 test (p &lt; 0.05). Results: 71 % of third molars were classified as “difficult” on the scale. There were significant differences in terms of surgical time-age (p = 0.002), presence of complications-location of the third molar (p = 0.015), presence of complications-follicle size (p = 0.022), difficulty-sex (p = 0.011 ), difficulty-age (p = 0.068). Conclusions: This scale can be used to plan extraction treatments for retained lower third molars to reduce surgical times and anticipate complications.

Sexual Behaviours at Risk of HIV Infection among Male to Female Transgender People in Benin

Transgender people are a population vulnerable to the human immunodeficiency virus (HIV) due to frequent adoption of risky sexual behaviours. To reorient prevention interventions in this population, this study aims to identify factors associated with high-risk sexual behaviours. It's a cross-sectional study. The subjects were recruited by driven respondents sampling throughout the country in December 2017. They included subjects who identified themselves as Male to Female transgender and who adopted such an image. The data were collected by questionnaire. The variables were multi-partnership and condom use during sex. Proportion comparisons were made with Pearson's Chi2 test and multiple logistic modeling was performed. The prevalence of multipartnership was 83.85% and the prevalence of condom use during last intercourse was 92.41%. Sexual risk behaviours were associated with age (P = 0.004), occupation (P = 0.000), education level (P = 0.025), family and friends' attitudes towards transgender status (P = 0.044) and HIV prevention knowledge level (P < 0.05). The factors identified should be integrated into transgender interventions in Benin with a focus on improving knowledge in HIV prevention.

Factores asociados con el uso de inhibidores del factor de necrosis tumoral alfa en una población de pacientes colombianos con espondiloartritis

IntroductionThe use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use. ObjectiveTo determine factors that better explain the indication of TNFi in the study population. Material and methodsThe association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < 0.25 were entered into univariate models of explanatory logistic regression to construct crude ORs, and those with P < 0.25 were included in the multivariate model to construct adjusted ORs. Results and discussionThe study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX-2 inhibitors, evolution time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = 0.036), inflammatory back pain (P = 0.026), sacroiliitis (P = 0.045), use of coxibs (P = 0.001) and the maximum score of BASDAI (P = 0.022, P = 0.006) were independently associated with the use of TNFi. The use of coxibs was associated with the indication of using TNFi in both patients with axial spondyloarthritis (P = 0.001) and peripheral (P < 0.001). ConclusionsThe onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.

Influence of ICT integration on content preparation by ICT and Non-ICT trained teachers in secondary schools in Machakos County, Kenya

The use of Information Communication Technology (ICT) in teaching and learning has become a necessity and an opportunity for improving and enhancing acquisition of knowledge by learners. The integration of ICT in teachers’ pedagogical practices has the potential to transform the teaching and learning process. ICTs have become vital tools for teachers to enhance learning through the teachers’ pedagogical aspect of content preparation in classroom. The purpose of this study was to investigate the influence of ICT integration on content preparation by ICT and Non-ICT trained teachers in secondary schools. The study’s specific objectives were to assess the status of teachers’ integration of ICT in content preparation and to establish the influence of ICT integration on content preparation by ICT and Non-ICT trained teachers in secondary schools. The hypothesis of the study was; ICT integration does not significantly influence content preparation by ICT and Non-ICT trained teachers in secondary schools in Machakos County, Kenya. The study employed descriptive survey research design. The sample size comprised of 180 principals, 360 teachers and 398 students. Data was collected using questionnaires, observation schedule, and document analysis. Content validity of the research instruments was ascertained through analysis by experts in comparative education and piloting of the research instruments. Reliability was ascertained by testing and re-testing the instruments. Data analysis was done by use of the Statistical Package for Social Sciences (SPSS). Responses from the observation schedule and document analysis guide were organized into themes and integrated with rest of the data for purposes of triangulation. Pearson’s Product Moment correlation coefficient was used to determine the level and strength of the relationship between ICT integration and teachers’ content preparation. Pearson chi test was employed to determine the levels of significance between the variables. The study established that ICT trained teachers profoundly embraced the use of ICT skills to prepare e-based learning activities which enhanced their content preparation leading to more innovative lessons due to the acquisition of pedagogical ICT training. The study concluded that ICT integration significantly influenced teachers’ content preparation by ICT and Non-ICT trained teachers. ICT trained teachers’ integration of ICT in their content preparation was significantly higher at (p) 0.002 than their Non-ICT trained counterparts at (p) 0.045. It was concluded that ICT trained teachers integrated ICT in their content preparation more than Non-ICT trained teachers in secondary schools. Hence the null hypothesis was rejected. Based on the findings and conclusions the study recommended that, The Ministry of Education (MOE) and other ICT training agencies should provide ICT in-service training programs to ensure that all teachers acquire ICT skills to utilize ICT in content preparation for quality education.

COVID-19 Outbreak Perception in Italian Dentists.

The aim of this study is an evaluation of the Italian dentists’ knowledge regarding COVID-19 and their perception of the risks associated with COVID-19, their attitude in resuming their activities, and how they judge the institutional intervention on a health and economic basis. Methods: This research evaluated Italian dentists from 11 to 18 April 2020, using a questionnaire submitted via Google Forms (Alphabet, Mountain View, CA, USA). It consisted of different investigations about sociodemographic aspects, profession-related characteristics, knowledge about COVID-19 infection transmission modalities, symptoms, and attitude in treating potentially infected patients. Statistical analysis was performed using the Pearson chi2 test and Student t-test. The α-level was fixed at p = 0.05. All data were analyzed with STATA 16 (StataCorp LP, College Station, TX, USA). Results: 1500 dentists (664 men and 836 women) completed the questionnaire. The majority of respondents declared having been trained in infection prevention procedures (64.3%) but not specifically to prevent the spread of COVID-19 (48.7%). A total of 57.2% declared that they were not trained sufficiently to restart working after lockdown, with a significantly higher prevalence (Pearson chi2 test, p < 0.001) among women (62.3%) than men (50.9%). Conclusion: Italian dentists were informed correctly on the mode of transmission but partially missed COVID-19 symptoms. Dentists considered the virus infection highly dangerous, and they were not confident in being able to work safely. The lack of precise operating guidelines creates uncertainties on infection control measures and appropriate personal protective equipment (PPE) use. The participants revealed apprehension for their health and the current and future economic situation of their practices.

Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study.

Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.