Poisson Log-linear Regression Models Research Articles

COVID-19 and sepsis-related excess mortality in the US during the first three years: A national-wide time series study.

The COVID-19 pandemic's global impact has been devastating, causing millions of deaths. Our study investigates excess sepsis-related mortality trends over three years during the pandemic. Using CDC's National Vital Statistics System data from January 2018 to March 2023, we projected sepsis-related deaths during the pandemic using a Poisson log-linear regression model. We compared observed versus predicted deaths and analyzed temporal trends by demographics and regions. Among the 753,160 deaths documented between March 2020 and March 2023, a significant downward trend was noted in sepsis-related mortality rates from March 2022 to March 2023, coinciding with the surge of the Omicron variant. The excess mortality rates were 170.6 per million persons (95% CI: 168.2-172.6), 167.5 per million persons (95% CI: 163.6-170.9), and 73.3 per million persons (95% CI: 69.4-76.6) in the first, second, and third years, respectively. Increased sepsis-related mortality was observed across all age subgroups, with the greatest increase noted in those aged 85 years and above compared to middle- and young-aged decedents. Disparities were also observed across racial/ethnic, sex/gender subgroups, and geographic regions. This study highlights the effectiveness of current policies and prevention measures in response to the long-term circulating of SARS-CoV-2 in the community.

Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP). Subjects and Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age. Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73–1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45–0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49–0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58–0.98). Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.

Infant mortality in Italy: large geographic and ethnic inequalities

BackgroundNeonatal and infant mortality rates are among the most significant indicators for assessing a country's healthcare and social development.This study examined the trends in neonatal, post-neonatal, and infant mortality in Italy from 2016 to 2020 and analysed differences between children of Italian and foreign parents based on areas of residence, as well as the leading causes of death. Special attention was given to the analysis of mortality in 2020, the first year of the Covid-19 pandemic, and its comparison with previous years.MethodsData from 2016 to 2020 were collected by the Italian National Institute of Statistics and extracted from two national databases, the Causes of Death register and Live births registered in the population register. Neonatal, post-neonatal, and infant mortality rates were calculated using conventional definitions. The main analyses were conducted by comparing Italian citizens to foreigners and contrasting residents of the North with those of the South. Group comparisons were made using mortality rate ratios. The main causes of death were examined, and Poisson log-linear regression models were employed to investigate the relationships between mortality rate ratios for each cause of death and citizenship, place of residence and calendar year.ResultsIn Italy, in 2020, the neonatal mortality rate was 1.76 deaths per thousand live births and it was 55% higher in foreign children than in Italian children. Foreign children had a higher mortality rate than Italians for almost all significant causes of death. Children born in the South of Italy, both Italian and foreign, had an infant mortality rate about 70% higher than residents in the North. Regions with higher infant mortality were Calabria, Sicily, Campania, and Apulia. In the South, mortality from neonatal respiratory distress and prematurity was higher.In the first months of 2020, between March and June, the first Covid-19 wave, Italy experienced an increase in neonatal and infant mortality compared to the same period in 2016–2019, not directly related to SARS-CoV-19 infection. The primary cause was neonatal respiratory distress.ConclusionsThe neonatal and infant mortality rates indicate the persistence of profound inequalities in Italy between the North and the South and between Italian and foreign children.

Generalization and Maintenance of Participation in Parkour and Team Handball Recess in Elementary Schools

Purpose: We investigated elementary school children’s voluntary participation in parkour and team handball recess during generalization and maintenance by skill level and sex. Methods: In six schools, 45 girls and 68 boys from different classes received a 10-lesson sport education parkour (second grade) and team handball (third grade) season in physical education. Children’s participation in parkour and team handball recess during (generalization) and after the sport education season concluded (maintenance) was recorded and analyzed using the Poisson loglinear regression model to investigate the effects of skill level and sex. Results: Children’s participation in parkour (72%) was higher than team handball recess (47%) during generalization, p < .001. During maintenance, children’s participation in parkour (44%) was lower than team handball recess (49%), p < .001. Effects of skill level and sex were found in both phases. Conclusions: Coordinating physical education with recess can promote children’s participation in physical activity during recess.

Abstract A091: County-level analysis of the link between historical slavery and prostate cancer incidence

Abstract Background: Black individuals with prostate cancer in the US experience the widest racial disparity in both cancer incidence and mortality when compared to the average population. These differences are driven by the intersection of race and a wide range of structural and social determinants of health and equity. Structural and social inequities can drive disproportionate and adverse exposure to violence, poverty, and physical and emotional stress—among other exposures—which may impact biologic risk, health behaviors, and healthcare access. We hypothesize that the impacts of these structural and social determinants are rooted in historical events that continue to inform present day prostate cancer events and outcomes. Methods: This is an ecological study assessing county-level data from 13 states in the Southeastern US. Data on prostate cancer incidence and mortality (NCI: 2018), population estimates (CDC: 2015-2019), structural and social determinants (AHRQ: 2018), and the percentage enslaved individuals (NHGIS: 1860) were obtained. County data were linked across datasets using federal identifiers. Our primary exposure was the legacy of US slavery represented by the percentage of enslaved individuals by county. Random variables such as water access and rail transport (NHGIS: 1860) were used as controls. Variable selection for our multivariable model was informed by a directed acyclical graph that defined the causal relationship between historical slavery and present-day prostate cancer outcomes. Our primary dependent variable was prostate cancer counts per 100,000. We utilized Poisson log-linear regression models to estimate the difference in cancer counts by 10% increase of slave population by county (NHGIS: 1860). Results: Our data included over 3000 counties. In our fully adjusted model, a 10% increase in county slave population was associated with a 1.5% increase in prostate cancer incidence (p<0.001). In this same model, Black race, and age (> 50 years) were associated with a 77% and over 300% increase in cancer incidence (p<0.001). Among Black men, every 10% increase in county slave population was associated with a 1.1% increase in cancer incidence (p < 0.05). Among White men, every 10% increase in county slave population was associated with a 1.5% increase in cancer incidence (p<0.0001). Our adjusted models demonstrated significant increased associations between prostate cancer incidence and education, access to food, segregation index, and social vulnerability index. Conclusions: Our results indicate that a history of slavery is significantly associated with increased county-level prostate cancer incidence for all men in the US, irrespective of their race/ethnicity. The effect of historic slavery persists even after adjusting for present day structural/social determinants of equity and health. These findings demonstrate the importance in acknowledging and incorporating historical inequities and context in evaluating present days inequities in prostate cancer risk, care, and outcomes. Citation Format: Maheetha C. Bharadwaj, Sarah C. Holt, Hari Iyer, John Gore, Tim Rebbeck, Yaw Nyame. County-level analysis of the link between historical slavery and prostate cancer incidence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A091.

US air pollution is associated with increased incidence of non-syndromic cleft lip/palate

The incidence of NSCLP and NSCP per 1000 live births from 2016 to 2020 was extracted from the Centers for Disease Control and Prevention Vital Statistics Database and merged with national reports on air pollution using the Environmental Protection Agency Air Quality Systems annual data. The most commonly reported pollutants were analyzed including benzene, sulfur dioxide (SO2), particulate matter (PM) 2.5, PM 10, ozone (O3), and carbon monoxide (CO). Multivariable negative binomial and Poisson log-linear regression models evaluated the incidence of NSCLP and NSCP as a function of the pollutants, adjusting for race. All p-values are reported with Bonferroni correction. The median NSCLP incidence was 0.22/1000 births, and isolated NSCP incidence was 0.18/1000 births. For NSCLP, SO2 had a coefficient estimate (CE) of 0.60 (95% CI [0.23, 0.98], p<0.007) and PM 2.5 had a CE of 0.20 (95% CI [0.10, 0.31], p<0.005). Among isolated NSCP, no pollutants were found to be significantly associated. SO2 and PM 2.5 were significantly correlated with increased incidence of NSCLP. The American people and perinatal practitioners should be aware of the connection to allow for risk reduction and in utero screening.

Cystic echinococcosis in humans and ruminants in Portugal: a one health approach

Abstract Background Cystic echinococcosis or hydatid disease is an important parasitic zoonosis for public health, although neglected. Despite being a mandatory notification disease both in humans and animals, data in Portugal are almost absent. A collaborative One Health retrospective nationwide study was conducted, bringing together the expertise of public health doctors, veterinarians and epidemiologists. Methods Human hospitalizations caused by cystic echinococcosis and slaughterhouse records of echinococcosis from bovine, ovine and caprine species were obtained. Poisson loglinear regression model was used. Occurrence maps were generated combining animal and human cases. Results From 2008 to 2022, 298 cases of echinococcosis were identified in post-mortem inspection in Portuguese slaughterhouses (bovines n = 125, ovines=288 cases, caprines n = 14). Between 2008 and 2018, cystic echinococcosis caused 582 hospitalizations in Portuguese public hospital, with an average length of 11 (± 15.66) days, resulting in 13 deaths (2.23%). Alentejo was the region with the highest hospitalizations. For every infected animal, a 7% increase in the incidence rate of human hospitalization was found (p = 0.002, Exp(B)=1.070, 95% CI: 1.025 - 1.117). Residing in the Alentejo increased the incidence rate of human hospitalizations by 5.3 times when compared to other regions (p = 0.000, Exp(B)=5.290, 95% CI: 3.835 - 7.296). For every 100,000 person-years, there was a total of 0.528 hospitalizations and the risk of death from echinococcosis was 8 times higher for those living in the Alentejo (p &amp;lt; 0.001, Exp(B)=8.259, 95% CI: 2.427 - 28.106). Conclusions Living in the Alentejo region has shown to be a high-risk factor for echinococcosis. This work gives an accurate recognition of the situation in Portugal, allowing the development of effective health control and education programs to face an important but neglected zoonotic disease under a One Health approach. Key messages • Considering that echinococcosis is still one of the 20 neglected tropical diseases of global health importance, is critical to map and monitor its prevalence and trends. • This study highlights the impact of this neglected zoonosis in humans and livestock, allowing the identification of the most problematic areas for echinococcosis in Portugal.

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients.

Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. 4 Laryngoscope, 134:1581-1590, 2024.

MP61-11 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY AFTER PREVIOUS TRANS-URETHRAL RESECTION OF THE PROSTATE: ASSESSMENT OF FUNCTIONAL AND ONCOLOGICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP61-11 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY AFTER PREVIOUS TRANS-URETHRAL RESECTION OF THE PROSTATE: ASSESSMENT OF FUNCTIONAL AND ONCOLOGICAL OUTCOMES Stefano Tappero, Enrico Vecchio, Erika Palagonia, Giorgia Granelli, Marco Martiriggiano, Ofir Maltzman, Alberto Olivero, Silvia Secco, Aldo Massimo Bocciardi, Antonio Galfano, and Paolo Dell'oglio Stefano TapperoStefano Tappero More articles by this author , Enrico VecchioEnrico Vecchio More articles by this author , Erika PalagoniaErika Palagonia More articles by this author , Giorgia GranelliGiorgia Granelli More articles by this author , Marco MartiriggianoMarco Martiriggiano More articles by this author , Ofir MaltzmanOfir Maltzman More articles by this author , Alberto OliveroAlberto Olivero More articles by this author , Silvia SeccoSilvia Secco More articles by this author , Aldo Massimo BocciardiAldo Massimo Bocciardi More articles by this author , Antonio GalfanoAntonio Galfano More articles by this author , and Paolo Dell'oglioPaolo Dell'oglio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To date, no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in patients previously treated with trans-urethral resection of the prostate (p-TURP) for benign prostate obstruction. The current study aimed to address the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as perioperative outcomes and surgical margins after RS-RARP. METHODS: Patients treated with RS-RARP for prostate cancer at a single high-volume European institution were identified and stratified according to p-TURP. Intraoperative and postoperative complications were reported according to EAU guidelines standardized methodology. Univariable and multivariable logistic, Poisson log-linear and Cox regression models were performed. RESULTS: Of 1,386 RS-RARP patients, 99 (7%) had history of p-TURP. According to EAU intraoperative adverse events classification (EAUiaiC), the most common intraoperative complications were EAUiaiC grade 1 (n=26/31, 84%). The most common postoperative complications were Clavien-Dindo grade 2 (n=67/174, 39%), and the most common reason of readmission was infected lymphocele (n=8/16, 50%). Between p-TURP and no-TURP patients no differences were detected in terms of rates of intraoperative complications (2 vs 2%), in-hospital postoperative complications (12 vs 11%), and readmissions (1 vs 1%; all p values≥0.8). At catheter removal, the rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p<0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p<0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p<0.001) and 12-months UCR (hazard ratio: 0.54, p<0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p<0.001) but not longer length of stay or time to catheter removal (p values>0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p=0.1), which translated in a non significant multivariable OR of 1.14 (p=0.58). CONCLUSIONS: RS-RARP in patients with history of TURP for BPO may be longer and associated with worse urinary continence recovery both at bladder catheter removal and at subsequent time-points. In the current series, p-TURP patients harbored low complication rates, and surgical margins rates comparable to their no-TURP counterparts. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefano Tappero More articles by this author Enrico Vecchio More articles by this author Erika Palagonia More articles by this author Giorgia Granelli More articles by this author Marco Martiriggiano More articles by this author Ofir Maltzman More articles by this author Alberto Olivero More articles by this author Silvia Secco More articles by this author Aldo Massimo Bocciardi More articles by this author Antonio Galfano More articles by this author Paolo Dell'oglio More articles by this author Expand All Advertisement PDF downloadLoading ...

Temporal variation of excess deaths from diabetes during the COVID-19 pandemic in the United States

BackgroundAlthough the COVID-19 pandemic has persisted for more than two years with the evident excess mortality from diabetes, few studies have investigated its temporal patterns. This study aims to estimate the excess deaths from diabetes in the United States (US) during the COVID-19 pandemic and evaluate the excess deaths by spatiotemporal pattern, age groups, sex, and race/ethnicity. MethodsDiabetes as one of multiple causes of death or an underlying cause of death were both considered into analyses. The Poisson log-linear regression model was used to estimate weekly expected counts of deaths during the pandemic with adjustments for long-term trend and seasonality. Excess deaths were measured by the difference between observed and expected death counts, including weekly average excess deaths, excess death rate, and excess risk. We calculated the excess estimates by pandemic wave, US state, and demographic characteristic. ResultsFrom March 2020 to March 2022, deaths that diabetes as one of multiple causes of death and an underlying cause of death were about 47.6 % and 18.4 % higher than the expected. The excess deaths of diabetes had evident temporal patterns with two large percentage increases observed during March 2020, to June 2020, and June 2021 to November 2021. The regional heterogeneity and underlying age and racial/ethnic disparities of the excess deaths were also clearly observed. ConclusionsThis study highlighted the increased risks of diabetes mortality, heterogeneous spatiotemporal patterns, and associated demographic disparities during the pandemic. Practical actions are warranted to monitor disease progression, and lessen health disparities in patients with diabetes during the COVID-19 pandemic.

Extension of generalized Poisson log-linear regression models for analysing three-way contingency table: Application to malaria data

This study presents the extension of generalized Poisson (GP-1 and GP-2) models for three-way contingency table. We assume a mixed systematic component of the log-linear models for contingency tables to produce a linear transformation for the link function of Generalized Linear Models (GLMs). Maximum likelihood estimation method was derived for the parameters estimates of the models. An over-dispersed malaria data of 2019 was considered for the study. The GP-1 and GP-2 models for three-way contingency table was used to model the data. Based on Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC) goodness-of-fits measures, the GP-2 model outperformed the GP-1 model for three-way contingency table on malaria data. We found that some parameters of the full model were statistically significant as; malaria cases was sensitive to all ages considered in the study, and people were more infected with malaria in the month of April, June, and July 2019.

Miniscrews for orthodontic anchorage: analysis of risk factors correlated with the progressive susceptibility to failure

The phenomenon of orthodontic anchorage miniscrews loosening after being implanted several times happens in daily clinical practice, and the reasons need to be traced. This study aimed to investigate the underlying risk factors influencing the progressive susceptibility of orthodontic miniscrews to failure. Overall, 889 miniscrews were successively inserted into 347 patients because some loosened or fell off once, twice, or more before achieving their purposes. The number of miniscrew failures (ie, once, twice, or more) was defined as progressive susceptibility to failure. The clinical indicators were assessed via univariate analysis, multicollinearity diagnosis, and Poisson log-linear regression model with stepwise calculation to screen out. The progressive susceptibility of miniscrews to failure was proved to be affected by the age of patients, the onset of force application, site of placement, and appliance type. Age and onset of force application presented a negative relationship with susceptibility. Miniscrews inserted in the palatal region appeared to be more stable than the forepart of the arch. In contrast, the retromaxillary and retromandibular areas obtained the lowest stability. The patients with fixed appliances were more unlikely to suffer progressive failure than removable appliances. In addition, the larger number of screws inserted in each patient, the greater probability of failure. Younger people with removable appliances that miniscrews inserted in the retromaxillary or retromandibular regions and earlier onsets of loading had a higher progressive susceptibility to loosening. Meanwhile, the failure rate was elevated with the increasing number of screws per patient received.

Analyzing travel destinations distribution using large-scaled GPS trajectories: A spatio-temporal Log-Gaussian Cox process

Under the increasingly serious city diseases, it is very important to deeply understand the spatio-temporal correlation between travel destination and urban built environment. The spatio-temporal point process has been widely used in many specific fields to explore the evolution of events. We employ a spatio-temporal Log-Gaussian Cox process model (LGCP) to analyze travel destination, which consists of three different components: a spatial component λ(s), a temporal component μ(t), and a separable log-Gaussian stochastic intensity field exp{Υ(s,t)}, to model and predict the destination. The spatial component and temporal component are modeled by the Poisson log linear regression model combined with covariates of interest separately. Spatial covariates including land use, demographics, travel origins and road network, and temporal covariates including the periodic function, weekdays and weekend variation, are selected as influencing factors to analyze the impact of building environment on travel destinations under different combinations of spatial and temporal covariates. Then, an extensible Markov chain Monte Carlo (MCMC) algorithm is applied to simulate Gaussian random field, and the fitted LGCP model can be used to obtain the prediction distribution of Gaussian random field beyond the last time point of data observation. In the experiment, taxi destination data collected in Shenzhen city May 6 to May 23, 2019 are used to validate modeling performance. The results in experiment shows the space–time positions of destination simulated by LGCP model are very similar to those observed. This study can provide strategy for urban planners and transportation administration to conduct reasonable policy to balance travel demand and public resources.

Gang Graffiti, Group Process, and Gang Violence

Examines the neighborhood-level relationship between gang graffiti and gang violence in a large city in the western region of the US during a peak period of local gang feuds in 2014–15. Bayesian Poisson log-linear mixed regression models with a spatio-temporal autoregressive process are estimated using a combination of data for N = 42,276 space–time units. Consistent with the view of graffiti an important means of street-level communication between gangs and an integral part of group processes associated with violence escalation and contagion, results reveal a roughly 40 to 60% increase in the expected rate of gang homicides, gang assaults, and gang firearm offenses (but not gang robberies) for each unit increase in neighborhood density of gang graffiti. Somewhat unexpectedly, the relationship with both gang homicide and gang assault was stronger for non-threatening gang graffiti than gang graffiti involving explicit threats or disrespect. Findings suggest gang graffiti provides clear clues about local “staging grounds,” where gang status is on the line and violence is expected and easily provoked. Thus, while gangs increasingly are dissing rivals and airing beefs through music (e.g., “diss tracks”) and in cyberspace, many still occupy and defend turf and write graffiti that communicates threats to other gangs and feeds into group processes associated with violence escalation and contagion.

Lessons Learned From Decentralization of an Elective Surgery Medical-Surgical Unit.

The objective of this study was to examine changes in healthcare practitioners' perception of supportiveness of their physical work environment, and trend in patient fall, when moving from a centralized to a decentralized unit configuration. Previous studies on decentralization have not uniformly provided findings consistent with desired outcome. A pretest-posttest study was conducted in an elective surgery medical-surgical unit in the mid-Atlantic region of the United States. The independent variable was the physical design supporting centralized versus decentralized nursing models. Data were collected from healthcare staff with a self-report survey "before" (September 2017; n = 42) and "after" (June 2019; n = 22), and interviews. Before-after data were analyzed using both parametric and nonparametric tests to identify significant differences. Qualitative responses were analyzed to identify triangulating evidences. Monthly patient fall data were collected for a 3-year period and analyzed using log-linear Poisson Regression model. Results show favorable assessments in the areas of overall supportiveness of design, equipment and soiled utility location, peer support, process flow visualization, and overall satisfaction. A reduction in patient falls was observed. Unfavorable outcomes were found in the contexts of walking distance, multidisciplinary collaboration, alarm audibility, nurse station size, and PPE location. This study underscores that the success of a unit cannot be achieved without coordinated and successful interventions in the areas of operations, processes, policies, culture, and the physical design.

Generalized quasi-likelihood estimation procedure for non-stationary over-dispersed longitudinal counts

Poisson log-linear regression model is commonly used for analysing count data. Valid inference based on this model can be drawn when the mean and variance of the data are equal. However, in practice variance of responses is often much greater than the mean of the responses, known as over-dispersion. Also, non-stationarity, i.e. non-constant mean, or/and non-constant variance, and/or covariance that is not solely the function of elapsed time between responses over the period of study, is another issue in the longitudinal study. It has been found that ignoring such departures may arise bias and provide misleading conclusions. As a remedy, negative binomial (NB) regression was suggested by the researcher for modelling longitudinal count. For longitudinal non-stationary count with over-dispersion, there is no established observation-driven model in the literature. Although there exists a non-stationary NB type model in the time series context, this type of observation-driven model has never been used in longitudinal data. In this paper, we have extended the non-stationary model to the longitudinal set-up and proposed a GQL estimation procedure for estimating regression parameters. An extensive simulation study has been carried out through which it has been shown that GQL provides unbiased estimates of the regression parameters. Performance of the method of moment approach for estimating correlation and over-dispersion parameter has also found to be consistent. The proposed model and estimation technique, thereafter, was applied to analyse longitudinal epileptic seizure count data.

Effect of NOx and NO2 Concentration Increase in Ambient Air to Daily Bronchitis and Asthma Exacerbation, Silesian Voivodeship in Poland.

There is a discussion in Europe about the dominant role of air pollution for health effects, most researchers claim that the particulate matter is responsible for inflammatory processes in the respiratory system, while others underline the role of nitrogen dioxide. The aim of the study was to assess the risk related to NOx, NO2 and PM2.5 concentration increase and daily outpatient visits or hospitalization due to bronchitis and asthma exacerbation in the entire population of Silesian Voivodeship, Poland. To assess the relationship between daily pollutants concentrations and the number of outpatient visits or hospitalizations due to bronchitis and asthma (available in the regional registry), the multivariable log-linear Poisson regression model was used. Results were presented by relative risk (RR) of health outcomes related to the increase in pollutant concentration by unit (interquartile range). Obtained results confirmed a statistically significant association between outpatient visits and hospitalizations due to bronchitis and asthma exacerbation and daily nitrogen oxides concentrations in Silesian voivodeship, Poland. The strongest relationship was observed in the case of NO2 and outpatient visits due to bronchitis, e.g., RR = 1.434 (1.308–1.571) for exposure expressed by the 50-day moving average concentration. In the case of hospitalizations, the health effect was lagged a few days in relation to the increase in exposure.

Effectiveness of 23-valent pneumococcal polysaccharide vaccine on elderly patients with colorectal cancer: A population-based propensity score-matched cohort study.

The commonly used vaccine for adults with a high risk of pneumonia is 23-valent pneumococcal polysaccharide vaccine (PPSV23). However, its effectiveness in patients with colorectal cancer has not been investigated. This study aimed to investigate the effectiveness of PPSV23 in reducing the risk of pneumonia among elderly patients with colorectal cancer.A total of 120,605 newly diagnosed patients with colorectal cancer were identified from the Taiwan National Health Insurance Research Database between 1996 and 2010. Of these patients, 18,468 were 75 years or older in 2007 to 2010, and 3515 received PPSV23. People aged 75 years or older have been considered eligible for receiving PPSV23 vaccination in Taiwan since 2007. The specific “vaccination period” of October 2008 to December 2008 was used to minimize the potential immortal time bias. Therefore, 893 patients who received PPSV23 outside this vaccination period or died before 2009 and 2960 unvaccinated patients who died before 2009 were excluded. After the propensity score was matched with a 1:3 ratio, 2622 vaccinated patients and 7866 unvaccinated patients were recruited. A multivariate log-linear Poisson regression model was performed and adjusted for potential confounders, including influenza vaccination, vaccination period, cancer treatment modalities, comorbidities, and sociodemographic variables.After 2 years of follow-up, the incidence rate of the pneumonia hospitalization of the vaccinated patients was significantly lower than that of the unvaccinated patients at 85.53 per 1000 person-years (PYs) of the former and 92.38 per 1000 PYs of the latter. The proportions of patients who had 2, 3, and >3 pneumonia hospitalizations per year were consistently lower in the vaccinated group than in the unvaccinated group (1.9% vs 2.0%, 0.5% vs 0.9%, and 0.7% vs 1.1%, respectively). After adjustment for covariates was made, PPSV23 vaccine was significantly associated with a reduced risk of pneumonia hospitalization, with an adjusted incidence rate ratio of 0.88 (P = .040). The overall pneumonia-free survival rate was also significantly higher in the vaccinated patients than in the unvaccinated patients (P = .001).PPSV23 vaccination was associated with a significantly reduced rate of pneumonia hospitalization in elderly patients with colorectal cancer.

Short-term effects of Saharan dust intrusions and biomass combustion on birth outcomes in Spain

The objective of this study is to analyze the short-term effects of atmospheric pollutant concentrations (PM10, NO2 and O3) and heat and cold waves on the number of pre-term births and cases of low birth weight related to Saharan dust advection and biomass combustion. The dependent variables used in this analysis were the total number of births, births with low weight (>2.500 g) and pre-term births (<37 weeks), that occurred at the province level. Data provided by the NSI included: days with Saharan dust intrusion or biomass advection classified in terms of information provided by MITECO for each of the nine regions in Spain. A representative city was selected for reach region in which the registered average daily concentrations of PM10, NO2 and O3 (μg/m3) were used. These were also provided by MITECO. The daily maximum and daily minimum temperature (°C) used was those registered by the meteorological observatory station located in each province capital, provided by AEMET. Using Poisson log linear regression models, the associated relative risks (RR) were measured as well as the population attributable risk (PAR) corresponding to the variables that resulted statistically significant at p < 0.05 for days with and without intrusion of natural particulate matter.The results obtained show that the days with Saharan dust intrusion or advections due to biomass combustion- beyond the impact of PM10, primary pollutants such as NO2 (in Saharan intrusions), heat waves and O3 - are associated with the number of births, low birth weight and pre-term birth. The RR and percent PAR of the pollutants and the heat waves are greater than those obtained for PM10.The results of this study indicate that days with natural particulate matter due to biomass combustion or advection of Saharan dust put pregnant women at risk.

Impact of the subclinical small ruminant lentivirus infection of female goats on the litter size and the birth body weight of kids

A longitudinal study was conducted in a single dairy goat herd to investigate the relationship between subclinical small ruminant lentivirus (SRLV) infection in does and litter size (LS) or birth body weight of kids (BW). Each year kids born to seropositive and seronegative does were weighed before the first consumption of colostrum. LS and BW of each kid were recorded. BW was significantly negatively linked to LS (p = 0.006) – singletons weighed (mean ± SD) 4.20 ± 0.67 kg, twins – 3.75 ± 0.62 kg, and triplets and quadruplets – 3.38 ± 0.47 kg. Male kids were significantly heavier than female kids in twin litters (3.97 ± 0.53 kg vs. 3.52 ± 0.60 kg; p < 0.001) and triplet or quadruplet litters (3.62 ± 0.40 kg vs. 3.17 ± 0.43 kg; p < 0.001). However, BW of male and female kids from singleton litters did not differ (4.31 ± 0.71 kg vs. 4.07 ± 0.65 kg; p = 0.154). Then, two mixed models were developed to assess the relationship between LS (mixed Poisson log linear regression model) or BW (mixed linear model) and SRLV infection in the doe, controlling for potential confounders such as the effect of an individual doe, year in which the parturition took place, parity and kid’s sex. Neither LS nor BW proved to be significantly associated with SRLV infection (p = 0.788 and p = 0.214, respectively). On this basis it was concluded that LS and BW were not affected by the subclinical SRLV infection of a doe.