Propensity Score Matching Model Research Articles

Preoperative Cannabis Use Did Not Increase Opioid Utilization After Primary Total Knee Arthroplasty in a Propensity Score–Matched Model

Background: Recreational and medicinal cannabis use is becoming increasingly popular, but there are little data on its effect on postoperative pain and opioid consumption after primary total knee arthroplasty (TKA). Purpose: We sought to evaluate the relationship between self-reported preoperative cannabis use and postoperative opioid consumption and post-discharge opioid prescriptions following elective primary TKA. Methods: We identified all patients who underwent unilateral, primary TKA for a diagnosis of osteoarthritis at a single institution between February 1, 2019, and April 30, 2021, and subdivided them into current cannabis users and non-users based on self-reported data. Regular users were propensity score-matched 1:6 with non-users using logistic regression on age, sex, body mass index (BMI), history of chronic pain, smoking status, history of anxiety/depression, American Society of Anesthesiology (ASA) classification, and type of anesthesia. Outcomes of interest included median inpatient (total, daily, and hourly) morphine milligram equivalents (MMEs), discharge MMEs, and outpatient MMEs within 90 days after surgery. Results: A cohort of 70 current cannabis users was matched with 420 non-users. There were no significant differences in opioid use in inpatient MMEs (hourly, daily, or total), discharge MMEs, or outpatient MMEs between cohorts. Also, there was no significant difference in hospital stay between cohorts. Conclusion: In this retrospective propensity score–matched model, preoperative cannabis use did not independently increase opioid use post-TKA in the inpatient or outpatient setting when compared with non-use. More rigorous, prospective study is warranted.

Examining the Impact of the Separation of Ownership from Management on the Performance of Small and Medium Poultry Agribusinesses in Ghana

ABSTRACT This study aimed to examine the relationship between the Separation of Ownership and Management (SOM) and the performance of poultry farms in Ghana. Binary Probit regression was used to examine the factors influencing SOM and the owner’s willingness to separate management from ownership. The Propensity Score Matching (PSM) model and Instrumental Variable Tobit Regression were used to analyze the impact of SOM on financial and non-financial performances. The results revealed that most farms studied had separate ownership and management roles, but owners still exerted the same amount of control over farm operations. SOM was determined to significantly impact the financial performance variable of total assets but did not impact total sales revenue and non-financial performance variables of employee satisfaction or corporate social responsibility. Owner’s demographics, perception and control variables, and farm characteristics have varying influences on the separation of ownership and management and the willingness to undertake the same.

Impact of Soil and Water Conservation on Household Income in East Shoa Zone of Oromia

This study was conducted to assess the impact of Soil and Water Conservation (SWC) intervention on the livelihood of smallholder farm households in terms household income and productivity. To meet this objective primary data was gathered in 2010 from 120 sample respondents (50 SWC program participants and 70 non-participants). Descriptive and inferential statistics (Logistic regression) and propensity score matching (PSM) models were used to address the stated objectives. The analysis of mean difference in outcome variables before matching result indicated that the mean total crop yield for SWC practiced respondent households is 29.10 and 27.80 quintal/ha having 1.30 quintal difference in the study. In the meantime total annual crop income of households who participated in SWC program was 33,903 and 33,808.40 birr. Except sex of the household, Market information, amount of land cultivated, Education and farm experience influenced the probability of HH participation in SWC positively and significantly at 10% expect land cultivated at 5% level. Nominal results of analysis of treatment effects indicate that there was a sign of positive impact on both of the variables considered due to SWC program. However, the changes in crop productivity and gross household income could not be statistically justified as there was no statistically significant difference between the two groups in terms of these variables. The possible reason could be that SWC programs are not short-term nature and impacts are to be realized gradually with increased adoption and intensification of activities.

Uptake of postplacental intrauterine device placement at cesarean delivery

Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.

The role of radiotherapy in HER2+ early-stage breast cancer patients after breast-conserving surgery.

Due to radioresistance, some HER2+ patients may gain limited benefit from radiotherapy (RT) after breast-conserving surgery (BCS). This study aimed to develop an individualized nomogram to identify early-stage HER2+ patients who could omit RT after BCS. The data of HER2+ patients with T0-2N0M0 breast cancer after BCS between 2010 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER). Based on the independent prognostic factors determined by the Cox analysis in patients without RT after propensity score matching (PSM), the nomogram and risk stratification model were constructed, and then the prognosis of patients with and without RT was compared in each stratified group. A total of 10799 early-stage HER2+ patients after BCS were included. Baseline characteristics were similar between groups after PSM. Multivariate Cox analysis indicated that RT could improve overall survival (OS) (HR: 0.45, P<0.001) and breast cancer-specific survival (BCSS) (HR: 0.53, P<0.001). Age, marital status, tumor location, tumor size, and chemotherapy were identified by multivariate Cox analysis in patients without RT and were incorporated into a well-validated nomogram. The risk stratification model based on the nomogram indicated that RT was associated with improved OS (HR 0.40, P< 0.001) and BCSS (HR 0.39, P< 0.001) in the high-risk group but not in the low-risk group [OS: HR 1.04, P = 0.94; BCSS: HR 1.06, P = 0.93]. RT could significantly improve the OS and BCSS of HER2+ early-stage breast cancer patients after BCS on the whole. For high-risk patients, RT is an essential component of cancer therapy. However, the omission of radiotherapy may be considered for low-risk HER2+ early-stage patients. Further validation and improvement of the nomogram by prospective study or randomized controlled trials are warranted.

Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model.

The management of severe COVID-19-induced acute respiratory distress syndrome (C-ARDS) often involves deep sedation. This study evaluated the efficacy of sevoflurane, a volatile anesthetic, as an alternative to traditional intravenous sedation in this patient population. This single-center, retrospective cohort study enrolled 112 patients with C-ARDS requiring invasive mechanical ventilation. A propensity score matching model was utilized to pair 56 patients receiving sevoflurane sedation with 56 patients receiving intravenous sedation. The primary outcome was mortality, with secondary outcomes being changes in oxygenation (PaO2/FiO2 ratio), pulmonary compliance, and levels of D-Dimer, CRP, and creatinine. The use of sevoflurane was associated with a statistically significant reduction in mortality (OR 0.40, 95% CI 0.18-0.87, beta = -0.9, p = 0.02). In terms of secondary outcomes, an increase in the PaO2/FiO2 ratio and pulmonary static compliance was observed, although the results were not statistically significant. No significant differences were noted in the levels of D-Dimer, CRP, and creatinine between the two groups. Our findings suggest an association between the use of sevoflurane and improved outcomes in C-ARDS patients requiring invasive mechanical ventilation. However, due to the single-center, retrospective design of the study, caution should be taken in interpreting these results, and further research is needed to corroborate these findings. The study offers promising insights into potential alternative sedation strategies in the management of severe C-ARDS.

Association between early vasopressor administration and in-hospital mortality in critically ill patients with acute pancreatitis: A cohort study from the MIMIC-IV database.

This study aims to explore the association between early administration of vasopressors and in-hospital mortality in acute pancreatitis (AP) patients admitted to the ICU. The MIMIC-IV database was used to identify AP patients who had and had not received vasopressors. Univariate and multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used for statistical analysis. A total of 894 AP patients admitted to the ICU were included in the study. Among them, AP patients who received vasopressors were associated with an increased risk of in-hospital mortality in the unadjusted model (OR: 7.77, 95% CI 4.92-12.61, p<0.001), multivariable-adjusted model (OR: 2.51,95% CI 1.1-5.76, p<0.05), PSM model (OR: 2.58, 95% CI 1.03-6.85, p<0.05) and IPTW model (OR: 1.82, 95% CI 1.06-3.15, p<0.05) compared with patients who did not receive vasopressors. In the subgroup analysis, age (≥ 65 years old: OR: 2.5, 95% CI 0.82-7.91; <65 years old: OR: 4.63, 95% CI 0.84-26.41), male (OR: 1.19, 95% CI 0.35-4.03), ethnicity (white: OR: 2.49, 95% CI 0.81-7.62; non-white: OR: 4.28, 95% CI 0.85-23.7), usage of norepinephrine (OR: 2.29, 95% CI 0.91-5.78), and single-use of vasopressor (OR: 1.48, 95% CI 0.43-4.95) were not associated with in-hospital mortality in patients with AP, whereas vasopressin (OR: 4.27, 95% CI 1.24-15.13; p<0.05) and phenylephrine usage (OR: 4.75, 95% CI 1.66-13.95; p<0.05), combined vasopressor usage (OR: 4.41, 95% CI 1.55-12.96; p<0.01), and female usage (OR: 7.89, 95% CI 2.03-34.2; p<0.01) were associated with in-hospital mortality. Early vasopressor use is significantly associated with increased in-hospital mortality among critically ill AP patients. This association might be greater in females, vasopressin, phenylephrine, and combined vasopressor users. Our results may benefit clinicians as they can guide the rational use of vasopressors in critically ill AP patients admitted to the ICU.

Why does knee flexion in the standing position occur? Spinal deformity or knee osteoarthritis.

Background: The interaction between knee osteoarthritis and spinal deformity and knee flexion (KF) remains unclear. We aimed to clarify the relationship between KF in the standing position and the severity of spinal deformity and knee osteoarthritis. Methods: We analyzed older volunteers aged over 60 years who participated in the musculoskeletal screening program. The participant's characteristics and standing radiographic parameters were assessed. After a preliminary analysis, a propensity score-matched model was established with adjustments for age, sex, and body mass index (BMI). Cases were divided into KF (knee angle [KA] ≥10°) and non-KF (KA <10°) groups. Results: In a preliminary analysis of 252 cases (42KF and 210 non-KF), there were significant differences in age and BMI between the KF and non-KF groups (all p < 0.05). Using a one-to-one propensity score-matched analysis, 38 pairs of cases were selected. There were significantly higher values of C7 sagittal vertical axis, T1 pelvic angle, pelvic tilt, pelvic incidence minus lumbar lordosis, KA, ankle angle, and pelvic shift in the KF group than in the non-KF group (all p < 0.05). In the KF group, 71.1% of the cases had severe spinal deformity (defined as marked deformity by the SRS-Schwab classification), and 31.6% had severe knee osteoarthritis (defined as a Kellgren Lawrence grade ≥3). Of the 31.6%, 7.9% were attributable to knee osteoarthritis alone, and 23.7% to both knee osteoarthritis and spinal deformity. Conclusions: This study clarified that compensatory changes due to spinopelvic malalignment, not due to knee osteoarthritis alone, mainly affected KF in the standing position.

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

ObjectiveTo find out the effect of different oral anticoagulation therapies (OAC) on mortality rate in patients with acute kidney injury (AKI) and atrial fibrillation (AF).DesignA retrospective study.SettingThis study was conducted...

Farmers′ use of climate change adaptation strategies and their impacts on food security in Kenya

Climate change threatens the sustainability of food production among farmers in Kenya who depend on rain‐fed agriculture. To minimize the negative impacts of climate change, farmers have sought to adopt different adaptation strategies. This study investigates factors influencing farmers’ choice of climate change adaptation strategies and associated effects on their food security in Kenya using data collected from 540 farmers from six counties. A multivariate probit, censored least absolute deviation (CLAD), and propensity score matching (PSM) models were employed to identify the determinants in the farmers’ choice of climate change adaptation strategies, the number of adaptation strategies adopted, and the effect of climate change adaptation strategies on their food security, respectively. Results show that planting drought-tolerant crop varieties (55%), growing diversified crops (34%), growing early maturing crops (22%), and diversifying the sources of household income (18%) were the four major adaptation strategies used by the farmers in the study area. Younger farmers and those with higher education levels are more likely to use these climate change adaptation practices. The number of adaptation strategies used was positively associated with male farmers, education level, family size, land size, farm income, extension contact, training, and information access. The farmers who adopt one adaptation strategy have higher food security status (approximately 7–11%) than those who do not. If they adopt two adaptation strategies, their food security status increases by approximately 11–14%; if they adopt three adaptation strategies, their food security status increases by nearly 12–15%; and if they adopt four adaptation practices, their food security status increases by about 14–18%, compared to those who do not adopt any strategy. Thus, the farmers’ climate change adaptation practices have positive food security effects in Kenya according to the number of adaptation strategies adopted.

Impact of collective marketing participation on farmers' income: Evidence from smallholder avocado farmers of Murang'a County, Kenya

Avocado (Persea Americana) is a major crop in Kenya but its potential to generate income is limited by challenges associated with production and marketing. The objective of this study was to assess the impact of participation in collective marketing on the incomes of smallholder avocado farmers in Kigumo Sub-County, Murang'a County, Kenya. Data was collected from 300 randomly selected households comprising of 150 participants and 150 non-participants of collective marketing. Data collected included demographic characteristics, socio-economic and institutional factors, farmers' income, and market information. Propensity Score Matching (PSM) models were employed to estimate the impact of participation in collective marketing on incomes. Results showed that farmers who participated in collective marketing benefitted from increased production and better sales. Participation in avocado collective marketing increased farmers' incomes by an average of 32.95% during the three consecutive years considered (2018, 2019, and 2020). Participants produced significantly higher avocado fruits (1251.3 kg) compared to non-participants (889.7 kg) in 2020. Participants also fetched better prices of 7.5Ksh per fruit compared to non-participants who sold their fruits at 5Ksh. Based on our findings, we recommend that farmers should participate more in collective marketing so as to improve the incomes from their avocado production. Policymakers should also promote a collective marketing strategy through interventions such as improving access to avocado collection centers and provision of market infrastructures.

Routine nasogastric tube placement in patients with small esophageal perforation after endoscopic foreign body removal may be unnecessary: a propensity score matching analysis.

Nasogastric tube (NGT) placement is part of the post-operative management of upper gastrointestinal perforation, but its routine use in esophageal perforation (EP) caused by foreign bodies remains unclear. The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal. A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study. Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed. The perforation healing rate, post-operative adverse events, hospital stay, and death rate were analysed using a 1:1 propensity score matching model. Before matching, there were 263 patients in the NGT group and 60 patients in the non-NGT group. There were significant differences in the time to treatment, infection, albumin, and types of endoscopy between the two groups, while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group. After 1:1 propensity score matching, 48 pairs of patients were matched between the two groups. The perforation healing rate, post-operative adverse events, length of hospital stay, and death rate did not show significant differences between the two groups. For patients with small EP caused by foreign bodies, routine NGT placement after endoscopic foreign body removal may be unnecessary.

The Impact of the Belt and Road Initiative on Corporate Excessive Debt Mechanism: Evidence from Difference-in-Difference Equation Model

This paper uses the difference in difference (DID) model to explore the impact of the “Belt and Road” Initiative (BRI) on the level of corporate debt and its mechanism based on quasi-natural experiment of the promulgation and implementation. The results indicate that the excessive debt level of enterprises has a hump trend after the implementation of the BRI. The excessive debt level of enterprises shows a hump trend—that is, although the excessive debt level of enterprises in the initial stage of the implementation of the BRI increases to a certain extent, showing a significant downward trend in the middle and later stages. By using the placebo test and DID propensity score matching model to alleviate the possible endogeneity problem, the above conclusion is still robust. The mechanism analysis shows that: during the implementation of the BRI, the government, and financial institutions have increased tax support for companies participating in the BRI, expanded corporate financing sources, reduce corporate financing costs, and increase companies’ demand for funds. As a result, the level of corporate debt has been increases. The conclusions of this paper not only provide micro-evidence for the interaction between the BRI and the micro-behavior of enterprises, but also have certain implications for evaluating the implementation effect of the BRI and subsequent reforms and refuting the “debt trap” of the “Belt and Road” construction from a microscopic perspective.

Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer

Radical cystectomy (RC) with neoadjuvant chemotherapy is the most commonly recommended treatment for muscle-invasive bladder cancer (MIBC), yet RC with urinary diversion remains an invasive treatment. Although some patients with MIBC gain good cancer control with radiation therapy (RT), its effectiveness remains under discussion. Therefore, we aimed to reveal the effectiveness of RT compared with RC for MIBC. Using cancer registry and administrative data from 31 hospitals in our prefecture, we recruited patients with bladder cancer (BC) initially registered between January 2013 and December 2015. All patients received RC or RT, and none had metastases. Prognostic factors for overall survival (OS) were analyzed by Cox proportional hazards model and log-rank test. Propensity score matching between the RC and RT groups was performed to examine the association of each factor with OS. Among the patients with BC, 241 received RC and 92 received RT. Median ages of the patients receiving RC and RT were 71.0 and 76.5 years, respectively. Five-year OS rates were 44.8% for patients receiving RC and 27.6% for patients receiving RT (P < .001). Multivariate analysis for OS showed that older age, poorer functional disability, clinical node positive, and pathology of nonurothelial carcinoma were significantly associated with worse prognosis. A propensity score-matching model identified 77 patients with RC and 77 with RT. In this arranged cohort, there were no significant differences in OS between the RC and RT groups (P=.982). Prognostic analysis with matched characteristics showed that patients with BC receiving RT were not significantly different from those receiving RC. These findings could contribute to proper treatment strategies for MIBC.

Associations of Osteoarthritis With Thrombectomy Utilization and Outcomes for Large Vessel Acute Ischemic Stroke.

Osteoarthritis and other musculoskeletal disorders are the leading causes of disability in the United States. While osteoarthritis is not a direct risk factor for stroke, osteoarthritis may impact patient selection for endovascular thrombectomy (EVT) due to prestroke disability. This study investigates associations of osteoarthritis with EVT utilization and outcomes. This was a large-scale cross-sectional study of the 2016 to 2019 National Inpatient Sample database. Adult patients with anterior large vessel ischemic strokes were identified. Patient demographics, stroke risk factors, stroke etiology, presence of osteoarthritis, medical comorbidities, EVT, intravenous thrombolysis treatments, and discharge destinations were recorded. Primary outcome was the rate of EVT treatment. Secondary outcomes include rates of discharge to home and in-hospital mortality. Propensity score matching and multivariable logistic regression models were used to account for possible confounders. Two hundred fifty-two thousand five hundred five patients were identified, of whom 8.5% (21 500 patients) had osteoarthritis. After propensity score matching for 32 clinical variables, osteoarthritis patients were found to be 17.3% less likely to receive EVT than non-osteoarthritis patients (14.4% versus 17.3%, respectively; P<0.001). In multivariable logistic regression analysis, osteoarthritis was associated with 22.6% lower odds of receiving EVT (OR, 0.77 [95% CI, 0.70-0.86]; P<0.001), an effect size larger than any medical comorbidity captured in this study other than dementia and nonstroke neurological disease. Among those treated with EVT, multivariable logistic regression models showed that osteoarthritis was not associated with different odds of being discharged home (OR, 0.99 [95% CI, 0.81-1.21]; P=0.93); however, osteoarthritis was marginally associated with lower odds of in-hospital mortality (OR, 0.74 [95% CI, 0.54-1.01]; P=0.054). Large vessel ischemic stroke patients with osteoarthritis were significantly less likely to receive EVT therapy despite similar post-EVT outcomes. These results warrant further investigation and prompt a critical review of current patient selection practices for stroke EVT therapy, specifically for patients with baseline disability due to musculoskeletal conditions such as osteoarthritis.

Chronic diseases and productivity loss among middle-aged and elderly in India

ContextChronic diseases are growing in India and largely affecting the middle-aged and elderly population; many of them are in working age. Though a large number of studies estimated the out-of-pocket payment and financial catastrophe due to this condition, there are no nationally representative studies on productivity loss due to health problems. This paper examined the pattern and prevalence of productivity loss, due to chronic diseases among middle-aged and elderly in India.MethodsWe have used a total of 72,250 respondents from the first wave of Longitudinal Ageing Study in India (LASI), conducted in 2017-18. We have used two dependent variables, limiting paid work and ever stopped work due to ill health. We have estimated the age-sex adjusted prevalence of ever stopped working due to ill health and limiting paid work across MPCE quintile and socio- demographic characteristics. Propensity Score Matching (PSM) and logistic regression was used to examine the effect of chronic diseases on both these variables. FindingsWe estimated that among middle aged adults in 45–64 years, 3,213 individuals accounting to 6.9% (95%CI:6.46–7.24) had ever-stopped work and 6,300 individuals accounting to 22.7% (95% CI: 21.49–23.95) had limiting paid work in India. The proportion of ever-stopped and limiting work due to health problem increased significantly with age and the number of chronic diseases. Limiting paid work is higher among females (25.1%), and in urban areas (24%) whereas ever-stopped is lower among female (5.7%) (95% CI:5.16–6.25 ) and in urban areas (4.9%) (95% CI: 4.20–5.69). The study also found that stroke (21.1%) and neurological or psychiatric problems (18%) were significantly associated with both ever stopped work and limiting paid work. PSM model shows that, those with chronic diseases are 4% and 11% more likely to stop and limit their work respectively. Regression model reveals that more than one chronic conditions had a consistent and significant positive impact on stopping work for over a year (increasing productivity loss) across all three models.ConclusionIndividuals having any chronic disease has higher likelihood of ever stopped work and limiting paid work. Promoting awareness, screening and treatment at workplace is recommended to reduce adverse consequences of chronic disease in India.

Impact of Statins on Survival and Limb Salvage in Patients Undergoing Peripheral Endovascular Intervention for Chronic Limb-Threatening Ischemia

Statin therapy is recommended in all patients with peripheral arterial disease (PAD). Its impact on reduction in mortality has been well-documented, yet effect on limb-specific outcomes has been less conclusive. Differences among PAD subgroups or variability of statin use may contribute to the inconsistent findings. We evaluated statin use in patients who underwent peripheral endovascular intervention (PVI) for chronic limb-threatening ischemia (CLTI) and its impact on overall survival (OS), amputation-free survival (AFS) and limb salvage (LS). The national Vascular Quality Initiative was queried for the index PVI for CLTI during the period 2010-2016; follow-up (FU) through 2020. Demographics, comorbidities, operative details, and FU status were recorded. Patients were categorized as E-Statin: statin use pre-PVI through discharge (D/C) and FU or N-Statin: No statins pre-PVI, at D/C or any time during FU. The propensity score matched model (PSM) was constructed. Groups were compared using chi-square, Kaplan-Meier survival and Cox regression analysis. There were 9,089 index PVI in 8,402 patients; E-Statin: 7149 index PVI in 6,591 patients; and N-Statin: 1940 index PVI in 1811 patients. The mean age was 69±12years and 58% were male. Statin use was associated with improved 3-year OS-E Statin: 92.9%±0.9 versus N Statin: 91.1%±2.2%; P=0.003; hazard ratio (HR): Exp (B) (95% confidence interval): 0.66 (0.44-0.99); P=0.047 and remained significant following PSM: E Statin: 95.1%±0.2% versus 90.8%±0.3%; P=0.02; HR: 0.50 (0.27-0.92); P=0.025. No significant differences in 3-year LS or AFS were noted between the prematched groups; LS: E Statin: 83.7%±0.8 versus N Statin: 84.0%±1.7%; P=0.89; HR: 1.09 (0.88-1.35); P=0.44; AFS-E Statin: 77.2%±1.1% versus 76.1%±2.5%; P=0.17; HR: 0.97 (0.79-1.18); P=0.74. or following PSM: AFS: 80.2%±2.8% vs. 74.7%±3.9%; P=0.53, HR: 0.92 (0.72-1.19); P=0.54; LS 85.3%±1.9% vs. 83.5%±2.6%; P=0.51, HR: 1.08 (0.83-1.4); P=0.57. Statins significantly improved LS among those with renal failure: 67.8%±2.6% vs. 59.7%±4.4%; P=0.003; HR: 56 (0.40-0.79); P=0.001. Statins are independently associated with improved OS in patients who undergo PVI for CLTI and should be considered for all barring intolerance. Statin use was associated with improved LS in patients with end-stage renal disease. Additional research is needed in this area, particularly, the impact of statin therapy in high-risk CLTI subgroups.

Prevalence, diagnosis, treatment, and associated factors of hepatitis C in the United States from 1999 to 2018: A population-based cross-sectional study

Background and aimHepatitis C virus (HCV) infection is one of the major global health challenges, leading to a significant increase in rates of hepatic fibrosis, cirrhosis and hepatocellular carcinoma. A comprehensive nationwide survey of trends in prevalence and associated factors could facilitate preventive behavioral interventions. Herein, we sought to determine prevalence, diagnosis, treatment, and risk factors for HCV infection in the general United States (US) population. MethodsThis was a secondary analysis of the publicly available data from the US National Health and Nutrition Examination Survey (NHANES). The prevalence of HCV-RNA-positive (HCV-RNA+) was weighted using patient serum sample data collected from 1999 to 2018. A propensity score matching model was used due to the imbalance in the number of HCV-RNA+ and HCV-RNA-negative (HCV-RNA−) patients. Matched variables included gender, age, educational level, marital status, language, household size, alcohol consumption, smoking, number of family members and family income to poverty ratio. ResultsThe weighted prevalence of HCV-RNA+ was 1.11% (95% confidence interval (CI): 1.02–1.20), 1.58% (95% CI: 1.42–1.74) for men and 0.67% (95% CI: 0.57–0.77) for women aged 20 years or older in the US from 1999 to 2018. The weighted prevalence of HCV-RNA+ increased from 0.87% (95% CI: 0.62–1.12) in 2013–2014, 0.95% (95% CI: 0.68–1.22) in 2015–2016 to 1.00% (95% CI: 0.72–1.28) in 2017–2018, respectively. In propensity-matched analysis, patients with HCV-RNA+ were more likely to be non-Hispanic black, and have had drug use and blood transfusions. Meanwhile, the weighted diagnostic and treatment rates were 56.27% (95% CI: 50.90–61.64) and 35.40% (95% CI: 27.64–43.16) from 1999 to 2018, respectively. ConclusionsActive HCV infection rate increased between 2013 and 2018, varied by demographic and risk variables. In the direct-acting antiviral era, affordable treatment and universal screening have the potential to improve overall national health.

Effect of renin–angiotensin system inhibitors in patients with cancer treated with anti-VEGF therapy

BackgroundCancer treatment with vascular endothelial growth factor signalling pathway (VSP) inhibitors frequently causes hypertension. Although previous reports suggested that the antihypertensive drug renin–angiotensin system inhibitor (RASI) may have a positive...

Effects of continuity of maternal health services on immediate newborn care practices, Northwestern Ethiopia: multilevel and propensity score matching (PSM) modeling

BackgroundDespite priority being given to maternal and child health programs in Ethiopia, the reduction of neonatal mortality rate is stagnant, which is more than double the national target. Immediate newborn care and continuity of maternal health services are comprehensive, wide-ranging, and core strategies to overcome neonatal mortality and morbidity. However, the evidence of immediate newborn care practices and the effectiveness of continuity of maternal health services on immediate newborn care practices are scarce. Hence, this study aimed to fill this gap. MethodsA prospective follow-up study was conducted from March 2020 to January 2021, among 2198 pregnant women screened from the study areas. The data were collected using pretested semi-structured questionnaires and a registration logbook. Data were coded, entered, cleaned, and analyzed using STATA software 14. Descriptive statistics, multilevel regression, and propensity score matching (PSM) models were computed. Finally, ICC (ρ), AOR, and coefficient (β) along with 95%CI were calculated and statistical significance was considered at a p-value < 0.05. ResultsThe magnitude of immediate newborn care practice was 50.9% (95%CI: 50.5%, 51.3%). Partner attended primary cycle school (AOR = 2.32), women attended ANC visit ≥4 (AOR = 2.69), initiated 1st ANC visit between 4–6 months of GA (AOR = 0.47), IFA supplementation (AOR = 2.99), women who make a decision (AOR = 2.25), women whose husband make a decision (AOR = 1.66) and immunizing the newborn (AOR = 2.46) were determinant factors of immediate newborn care practices. As treatment effect, completion of COC in MHS via time dimension (β = 0.31; 95%CI: 0.27, 0.35); whole key service MHS (β = 0.43; 95%CI: 0.39, 0.48) and COC via space dimension (β = 0.17; 95%CI: 0.12, 0.21) were significantly increased the likelihood of immediate newborn care practices. ConclusionThe magnitude of optimal immediate newborn care practices was low. Different enabling factors were discovered in the study. Therefore, strengthening those enabling factors such as partner education, immunization program, IFA supplementation, early initiation and receiving ANC services, the decision-making power of women and partners, as well as scaling up a continuum of care in maternal health services are strongly recommended.