Multivariable Random-effects Logistic Regression Research Articles

Predictors of accessing seasonal malaria chemoprevention medicines through non-door-to-door distribution in Nigeria

BackgroundIn Nigeria, seasonal malaria chemoprevention (SMC) is typically administered door-to-door to children under five by community medicine distributors during high transmission seasons. While door-to-door distribution (DDD) is exclusively employed in Nigeria as part of standard operating procedures of SMC programmes, some households access SMC through non-DDD channels, such as fixed-point distributions, health facilities, and private purchase. However, analysis of access to SMC medicines through non-DDD has been limited, with little evidence of its outcomes on adherence to the three-day complete course of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines.MethodsData were obtained from SMC end-of-round coverage surveys conducted in Nigeria in 2021 and 2022, including 25,278 households for the analysis. The proportion of households accessing SMC medicine through non-DDD and the distribution of various non-DDD sources of SMC medicines were described. Multivariate random-effects logistic regression models were performed to identify predictors of accessing SMC medicines through non-DDD. The associations between non-DDD, and caregiver-reporting of adherence to complete administration of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines were also assessed.ResultsLess than 2% (314/24003) of households accessed SMC medicines through non-DDD in the states surveyed. Over 60% of non-DDD access was via health facility personnel and community medicine distributors from different locations. Variables associated with non-DDD access included heads of household being born in the local state (OR = 0.68, 95% CI 0.47 to 0.90), households residing in the study state since the first cycle of the SMC round (OR = 0.39, 95% CI 0.17 to 0.88), households with high wealth index (OR = 1.36, 95% CI 1.01 to 1.82), and caregivers hearing about date of SMC delivery in the previous cycle (OR = 0.18, 95%CI 0.14 to 0.24). Furthermore, non-DDD was associated with reduced SMC adherence and higher caregiver non-reporting of adverse reactions to SMC medicines in children compared with DDD.ConclusionThis study provides evidence on the characteristics of households accessing SMC medicines through non-DDD and its potential negative outcomes on adherence to SMC medicine and adverse reaction reporting, underscoring potential implementation issues that may arise if non-DDD delivery models are adopted in SMC, particularly in places where DDD had been firstly used.

Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria.

To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. Retrospective observational study. A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria. Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50-2.75), who lacked formal education (OR 1.88, 95% CI 1.55-2.30), were unemployed (OR 1.94, 95% CI 1.57-2.41), were nulliparous (OR 2.11, 95% CI 1.83-2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53-4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41-15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions.

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies

Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023. Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more. The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix. In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement. In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.

Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal.

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

Health status of honeybee colonies (Apis mellifera) and disease-associated risk factors in different agroecological zones of Southwest Ethiopia

A cross-sectional study design was conducted in different agroecological zones of southwest Ethiopia from October 2019 to October 2021. The study aimed to determine the prevalence and associated risk factors for honeybee diseases and pests, as well as the impact of these issues on honeybee colonies and their products. To identify potential risk factors for honeybee disease and pests, a multivariate random effects logistic regression analysis was used. Adult honeybee and brood samples from a total of 384 honeybee colonies were collected and tested using standard laboratory diagnostic methods. The highest prevalence (55.8%) of ants was recorded, followed by wax moths (22.5%) and hive beetles (23.3%). In the current study, the main honeybee diseases observed in the study areas were varroosis (36.5%), bee lice (5.2%), nosemosis (39.6%), amoeba (56%), and chalkbrood (4.5%). However, tracheal mites, sachbrood, and American and European foul brood, were not detected. The agroecological zone (OR = 5.2, 95% CI: 1.75–14.85), type of hive (OR = 2.9, 95% CI: 1.17–17.03), management system (OR = 4.3, 95% CI: 1.23–14.70), and the management of the colony (OR = 3.5, 95% CI: 1.31–9.14) were identified as risk factors for varroosis in these areas. The occurrence of nosemosis in colonies was also influenced by the agroecological zone (OR = 12.2, 95% CI: 3.06–48.54) and colony management (OR = 3.4, 95% CI: 1.59–7.23). The agroecological zone (OR = 10.5, 95% CI: 12.76–22.63) and hive type (OR = 3.0, 95% CI: 1.39–6.36) were the primary risk factors for the occurrence of amoeba in honeybee colonies. However, the occurrence of bee lice (OR = 34.7, 95% CI: 3.96–104.93) and chalkbrood (OR = 4.8, 95% CI: 1.44–13.16) in honeybee colonies was only influenced by the agroecological zone in the study areas. This study demonstrated that losses in honey production in the area are significantly attributed to honeybee disease and pests. Therefore, it is essential to increase public awareness of how honeybee diseases and pests affect honey production and to develop and implement appropriate control measures for these diseases and pests. Furthermore, more studies should be conducted to characterize and isolate other causes of honeybee diseases and pests in various locations.

Toothache and its Determinants in 12-Year-Old Iranian Children: A Cross-sectional Study

Background: Toothache is a common condition among children that often leads to school absenteeism. However, there is limited information on the prevalence of toothache and its associated factors in Iranian children. Objectives: This study aimed to assess the prevalence of toothache and related factors in 12-year-old Iranian children. Methods: This was a cross-sectional population-based study. Multistage cluster sampling was used to recruit the participants from three provinces (Tehran, Kerman, and Fars). Parents of 1,468 students aged 12 years completed a valid questionnaire that assessed their socioeconomic status and the children’s oral hygiene behavior, toothache, and absenteeism in the last 6 months. A multivariate random effects logistic regression model was adopted to analyze the effect of demographic, geographic, and oral hygiene practice factors on toothache prevalence. Results: The prevalence of toothache in children was high, with 41% (95% CI = 38.4, 43.5) of the children reporting toothache. Of the children who had a toothache, 12.8% missed 1 to 7 school days. The prevalence of toothache was significantly higher in children living in cities compared to those living in towns (P < 0.001). Additionally, toothache prevalence had a significant association with the fathers’ educational level (P = 0.003) and the children’s toothbrushing and flossing practices (P < 0.001). Conclusions: The high prevalence of toothache among Iranian children highlights the need for effective health interventions to control this condition. These interventions can focus on improving oral hygiene practices and increasing access to dental care in both urban and rural areas. Moreover, targeting families with lower educational levels could be an effective approach to reducing the prevalence of toothache in children.

Herd and animal level seroprevalence and associated risk factors of bovine brucellosis in different agro-ecologies of southwest Ethiopia

Brucellosis is a zoonotic infection that commonly affects cattle in Ethiopia, causing significant negative economic impact. A cross-sectional study was carried out between November 2020 and November 2021 in southwest Ethiopia to determine the seroprevalence of brucellosis and its associated risk factors in cattle herds. Blood samples were taken from 461 randomly selected cattle to test for the presence of Brucella antibodies using the Rose Bengal Plate test, with positive serum confirmed through the complement fixation test. A multivariable random effect logistic regression analysis was used to identify potential risk factors for Brucella seropositivity. The study found 7.14% (95% CI: 4.44–9.01) seroprevalence at the animal level and 12.23% (95% CI: 6.52–16.05) at the herd level based on the complement fixation test. Age (OR = 6.9, 95%CI: 1.83–15.97), herd size (OR = 3.66, 95%CI: 1.39–9.61), introducing new animals (OR = 2.72, 95%CI: 1.17–6.29), management system (OR = 12.2, 95%CI: 1.53–26.80), species composition (OR = 4.24, 95%CI: 1.51–11.91), and abortion (OR = 7.1, 95%CI: 1.93–15.39) were found to be associated with Brucella seropositivity. The analysis also revealed two risk factors for Brucella infection at the herd level, including herd size (OR = 3.4, 95% CI: 1.05–10.68) and species composition (OR = 3.1, 95% CI: 1.20–7.88). The presence of Brucella antibodies in cattle highlights the need for increased awareness and measures to mitigate the identified risk factors of the disease to prevent its spread. Furthermore, further studies are necessary to investigate the zoonotic transmission of brucellosis to humans and its role in cattle reproduction disorders in the study area.

Mortality and cause of death during inpatient psychiatric care in New South Wales, Australia: A retrospective linked data study

BackgroundPremature mortality in people with mental illness is well-documented, yet deaths during inpatient psychiatric care have received little research attention. This study investigates mortality rates and causes of death during inpatient psychiatric care in New South Wales (NSW), Australia. Risk factors for inpatient death were also explored. MethodsA retrospective cohort study using linked administrative datasets with complete capture of psychiatric admissions in NSW from 2002 to 2012 (n = 421,580) was conducted. Univariate and multivariate random-effects logistic regression analyses were used to explore risk factors for inpatient death. ResultsThe mortality rate during inpatient psychiatric care was 1.12 deaths per 1000 episodes of care and appeared to decline over the study period. Suicide accounted for 17% of inpatient deaths, while physical health causes accounted for 75% of all deaths. Thirty percent of these deaths were considered potentially avoidable. In the multivariate model, male sex, unknown address and several physical health diagnoses were associated with increased deaths. ConclusionsThe mortality rate and number of avoidable deaths during inpatient psychiatric care were substantial and warrant further systemic investigation. This was driven by a dual burden of physical health conditions and suicide. Strategies to improve access to physical health care on psychiatric inpatient wards and prevent inpatient suicide are necessary. A coordinated approach to monitoring psychiatric inpatient deaths in Australia is not currently available and much needed.

Neglected zoonotic bacteria causes and associated risk factors of cattle abortion in different agro-ecological zones of southwest Ethiopia

Three zoonotic bacteria, Coxiella burnetii, Leptospira spp, and Brucella spp, cause cattle abortion and significant losses in the livestock sector. However, these infections were neglected diseases in Ethiopia. Between October 2020 and October 2021, a cross-sectional study was carried out in southwest Ethiopia to determine the prevalence of abortion and identify the major zoonotic bacterial causes and risk factors that contribute to abortion. Using an indirect ELISA, antibodies to Brucella abortus, Leptospira Hardjo, and Coxiella burnetii were detected in serum samples taken from 461 cattle. Potential risk factors for cattle abortion were found using a multivariable random effect logistic regression analysis. The prevalence of cattle abortion was found to be 22.56 % (95 % CI: 18.74–26.38) in the study areas. Leptospira Hardjo (OR=1.8, 95% CI: 1.04–3.00), Coxiella burnetii (OR=2.7, 95 % CI: 1.26–5.62), and Brucella abortus (OR=9.8, 95 % CI: 1.27–17.15) were all associated with the occurrence of abortion in cattle, as were their co-infections (OR=8.1, 95 % CI: 1.28–39.33). Other risk factors for cattle abortion included breed (OR=16.7, 95 % CI: 2.20–26.77), herd size (OR=2.5, 95 % CI: 1.16–4.68), breeding method (OR=2.3, 95 % CI: 1.33–3.90), and contact with dogs (OR=2.2, 95 % CI: 1.34–3.53). According to the findings of this study, Brucella abortus, Coxiella burnetii, and Leptospira Hardjo are serious zoonoses that cause significant production loss in cattle due to abortion. To prevent transmission of these zoonotic diseases, it is crucial to implement effective control measures and increase public awareness. The causes of cattle abortion in the study areas should also be isolated and characterized.

203 Patient Engagement in Diabetes Care: Missed Appointments Among Adults Living with Type 2 Diabetes

OBJECTIVES/GOALS: Missed appointments (MAs) negatively impact the health outcomes of adults living with type 2 diabetes mellitus (T2DM), causing disruptions in clinic operation and added financial cost to healthcare providers and systems. This study aimed to identify risk factors for MAs in both in-person and telehealth settings among adults living with T2DM. METHODS/STUDY POPULATION: Using a sequential multi-method design guided by the modified Quality-Caring Model, the quantitative phase of this study used electronic health records (EHR) data in Calendar Years 2019 and 2020 with 7,276 encounters made by 2,235 patients with T2DM from four diabetes clinics within a tertiary academic medical center in Baltimore, MD. Multivariable random effect logistic regression were used to examine the association between MAs and included predictors (i.e., patient characteristics [e.g., age, race, health status], health provider factors [e.g., types of provider], and health system factors [e.g., scheduling lag]). Based on the results of the quantitative phase, a purposive sample of 23 adults with T2DM and 10 providers were then interviewed individually via phone or zoom. RESULTS/ANTICIPATED RESULTS: The EHR data found that the following variables decreased the odds of MAs: having an activated patient portal account, patients with age over 46 or with white race. Telehealth was associated with 50% decreased odds of MAs during COVID (after 3/23/2020). On the other hand, longer scheduling lag increased the odds of MAs. Qualitative interviews revealed that MAs were often related to social needs, such as lack of/limited health-related transportation and its associated financial burden. Telehealth helped break these barriers for some adults with T2DM, but technical challenges in telehealth persisted for those with low digital health literacy and people who did not have a digital device and/or with unstable internet connection. Providers worried that these challenges might undermine the quality of diabetes care. DISCUSSION/SIGNIFICANCE: Disparities in MAs by age and race were noted, which might reflect the impact of unmeasured social needs in EHR. Perceived convenient telehealth may reduce MAs in T2DM care. However, the persistent technical challenges of telehealth should be addressed to optimize the quality of diabetes care and to promote care continuity for underserved populations.

MP53-15 AFTER ADJUSTING FOR CLINICAL COMPLEXITY AND SOCIAL DETERMINANTS OF HEALTH, STATE OF RESIDENCE ONLY FACTOR ASSOCIATED WITH HOSPITAL ADMISSIONS AMONG CHILDREN WITH SPINA BIFIDA PRESENTING TO THE EMERGENCY DEPARTMENT

You have accessJournal of UrologyCME1 Apr 2023MP53-15 AFTER ADJUSTING FOR CLINICAL COMPLEXITY AND SOCIAL DETERMINANTS OF HEALTH, STATE OF RESIDENCE ONLY FACTOR ASSOCIATED WITH HOSPITAL ADMISSIONS AMONG CHILDREN WITH SPINA BIFIDA PRESENTING TO THE EMERGENCY DEPARTMENT Patrice Basada, Victor M. Kucherov, Teresa L. Russell, Jacob C. Smith, Sally Zimmermann, Elena K. Johnston, M. Sohel Rana, Elaise Hill, Christina P. Ho, Hans G. Pohl, and Briony K. Varda Patrice BasadaPatrice Basada More articles by this author , Victor M. KucherovVictor M. Kucherov More articles by this author , Teresa L. RussellTeresa L. Russell More articles by this author , Jacob C. SmithJacob C. Smith More articles by this author , Sally ZimmermannSally Zimmermann More articles by this author , Elena K. JohnstonElena K. Johnston More articles by this author , M. Sohel RanaM. Sohel Rana More articles by this author , Elaise HillElaise Hill More articles by this author , Christina P. HoChristina P. Ho More articles by this author , Hans G. PohlHans G. Pohl More articles by this author , and Briony K. VardaBriony K. Varda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: ED use and admissions among children with Spina Bifida (SB) may be influenced by social determinants of health (SDoH). Childhood opportunity index is a validated proxy measure of SDoH. Our aim was to determine whether or not there is an association between COI level and admission rates among children with SB presenting at our institution’s ED between 2016-2020 and determine clinical and non-clinical factors associated with ED admissions. METHODS: A retrospective single-institution study of children (age <18 years) with SB presenting to the ED between 2016-2020 was performed. Only encounters for SB-related conditions were included. The primary outcome was hospital admission from the ED. Baseline patient factors (sex, age, race/ethnicity, language, insurance, location of residence, distance from the ED, and COI level) and markers of clinical complexity (SB lesion type, lesion functional level, community ambulation status, and ventricular shunt [VS] status) were collected. Our primary exposure was COI level (high vs. low). We performed descriptive statistics and a random intercept mixed effects multivariable logistic regression (to adjust for patient clustering) to determine factors associated with ED admissions. RESULTS: A total of 165 patients accounted for 598 ED encounters between 2016-2020. Nearly a third of encounters (28%) led to admission; 66% of high COI patients were admitted, while 34% of low COI patients were admitted (p=0.2). COI level was not significantly associated with admission on adjusted analysis (0.9 [0.5-1.6], p=0.7). Factors that were associated with admission on unadjusted analysis included age, race/ethnicity, language, insurance, location of residence, community ambulation, and VS status. However, on adjusted analysis, only location of residence was significant for admission. Those with a residence outside of the District of Columbia and Maryland areas were significantly more likely to be admitted (Virginia [VA] OR=3.7, p<0.01 and West VA/Pennsylvania/New Jersey/military [OR=9.6, p=0.049]). CONCLUSIONS: At our institution, approximately one-third of ED visits led to hospital admissions. COI level was not found to be associated with hospital admissions. Location of residence was the only factor significantly associated. This finding may suggest the need for better access to local care and community partnerships with the Spina Bifida program. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e718 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrice Basada More articles by this author Victor M. Kucherov More articles by this author Teresa L. Russell More articles by this author Jacob C. Smith More articles by this author Sally Zimmermann More articles by this author Elena K. Johnston More articles by this author M. Sohel Rana More articles by this author Elaise Hill More articles by this author Christina P. Ho More articles by this author Hans G. Pohl More articles by this author Briony K. Varda More articles by this author Expand All Advertisement PDF downloadLoading ...

Back Pain without Disease or Substantial Injury in Children and Adolescents: A Twin Family Study Investigating Genetic Influence and Associations.

This twin family study first aimed to investigate the evidence for genetic factors predicting the risk of lifetime prevalence of non-specific low back pain of at least three months duration (LBP (life)) and one-month current prevalence of thoracolumbar back pain (TLBP (current)) using a study of children, adolescents, and their first-degree relatives. Secondly, the study aimed to identify associations between pain in the back with pain in other regions and also with other conditions of interest. Randomly selected families (n = 2479) with child or adolescent twin pairs and their biological parents and first siblings were approached by Twins Research Australia. There were 651 complete twin pairs aged 6-20 years (response 26%). Casewise concordance, correlation, and odds ratios were compared for monozygous (MZ) and dizygous (DZ) pairs to enable inference about the potential existence of genetic vulnerability. Multivariable random effects logistic regression was used to estimate associations between LBP (life) or TLBP (current) as an outcome with the potentially relevant condition as predictors. The MZ pairs were more similar than the DZ pairs for each of the back pain conditions (all p values < 0.02). Both back pain conditions were associated with pain in multiple sites and with primary pain and other conditions using the combined twin and sibling sample (n = 1382). Data were consistent with the existence of genetic influences on the pain measures under the equal environments assumption of the classic twin model and associations with both categories of back pain were consistent with primary pain conditions and syndromes of childhood and adolescence which has research and clinical implications.

Reproductive Disorders of Cattle in the Tole District of Southwest Ethiopia and Their Prevalence and Associated Risk Factors

Reproduction is a basic requirement for efficient cattle production to continue or cease; whereas, reproductive disorders are the leading cause of economic loss in the cattle industry. To determine the prevalence and associated risk factors of major reproductive disorders in cattle in the Tole district, a cross-sectional study design was conducted from October, 2020, to October, 2021. To identify potential risk factors for cattle reproductive disorders, a multivariable random effect logistic regression analysis was used. A total of 400 randomly selected cows were examined, and 37.8% of them had at least one reproductive disorder. The three main reproductive disorders observed in the study area were abortion (17.8%), stillbirth (4.8%), and dystocia (3.3%). Risk factors for reproductive disorders in the study area included the calving season (OR = 3.7, 95% CL-1.37–7.18) and the accessibility of dogs to cattle (OR = 2.5, 95% CL-1.64–3.85). Accessibility of dogs to cattle in the study areas was also a risk factor for abortion (OR = 7.5, 95% CL-3.59–15.54). The present study also identified parity (OR = 5.2, 95% CL-1.05–26.04) as a risk factor for dystocia in cattle in the study areas. This demonstrated that losses in cattle production in the study areas are significantly attributed to reproductive problems. Hence, it is essential to increase public awareness of how reproductive disorders affect cattle production and to develop and implement appropriate control measures for these disorders. The causes of abortion and dystocia in various areas should be precisely identified and described through further research.

18: EPIDEMIOLOGY OF NONINVASIVE AND INVASIVE MECHANICAL VENTILATION USE FOR CHILDREN AT THE END OF LIFE

Introduction: Invasive mechanical ventilation (IMV) is an intensive intervention commonly experienced by children at the end of life. Non-invasive mechanical ventilation (NIV) is a potential alternative to IMV, and studies have shown increasing use of NIV without decreasing IMV for adults. The objective was to describe the trends, predictors, and hospital variability in use of NIV and IMV for children at the end of life. Methods: Multi-center retrospective cohort study of children 0 to 21 years who died in 1 of 37 hospitals in Pediatrics Health Information Systems (PHIS) Database between 2010 and 2019. ICD-9, ICD-10, and CTC codes were used to identify mode of ventilation (IMV, NIV, both or none). Descriptive statistics summarized socio-demographic and clinical characteristics by mode of ventilation, and hospital NIV use quartiles were calculated. The Cochran-Armitage test assessed for trends over time and multivariable random-effect logistic regression assessed for independent predictors of ventilatory support. Results: 41,091 patients (median age 0.4, IQR [0,6.7] y, 45% female, 42% white) died in the hospital. Increasing age predicted lower odds of IMV (aOR .95 per year, 95% CI .95-.96, p<.001) or both (aOR .98 per year, 95% CI .97-.99, p=.005) compared to none. Number of complex chronic conditions (CCC) (median [IQR]) was 2 [1,3] overall and for IMV, 3 [2,3] for NIV, and 3 [2,4] for both. Self-pay patients were less likely than commercially or government insured to receive IMV (aOR .69, 95% CI .56-.84, p<.001) or both (aOR .37, 95% CI .27-.5, p<.001). From 2010 to 2019, exposure to NIV increased (771 [18.8%] vs. 1075 [25.9%], p<.001) with no change in IMV (3636 [88.6%] vs. 3669 [88.5%], p=.86); increase in NIV was more often experienced as both (688 [16.8%] vs. 944 [22.8%]) than NIV (83 [2%] vs. 131 [3.2%]). For hospitals in the highest NIV use quartile, the aOR for any NIV was 6.16 (95% CI 3.98-9.52, p<.001) and any IMV was .8 (95% CI .55-1.17, p=.249) compared to the lowest NIV use quartile. Conclusions: Use of NIV has increased over time for children nearing the end of life, without a reciprocal decrease in use of IMV. Differences exist based on age, insurance status, and chronic medical complexity. Significant interhospital variability in NIV use exists, which does not correlate with use of IMV.

Trends in Cases, Hospitalizations, and Mortality Related to the Omicron BA.4/BA.5 Subvariants in South Africa.

In this study, we compared admission incidence risk and the risk of mortality in the Omicron BA.4/BA.5 wave to previous waves. Data from South Africa's SARS-CoV-2 case linelist, national COVID-19 hospital surveillance system, and Electronic Vaccine Data System were linked and analyzed. Wave periods were defined when the country passed a weekly incidence of 30 cases/100 000 population. In-hospital case fatality ratios (CFRs) during the Delta, Omicron BA.1/BA.2, and Omicron BA.4/BA.5 waves were compared using post-imputation random effect multivariable logistic regression models. The CFR was 25.9% (N = 37 538 of 144 778), 10.9% (N = 6123 of 56 384), and 8.2% (N = 1212 of 14 879) in the Delta, Omicron BA.1/BA.2, and Omicron BA.4/BA.5 waves, respectively. After adjusting for age, sex, race, comorbidities, health sector, and province, compared with the Omicron BA.4/BA.5 wave, patients had higher risk of mortality in the Omicron BA.1/BA.2 wave (adjusted odds ratio [aOR], 1.3; 95% confidence interval [CI]: 1.2-1.4) and Delta wave (aOR, 3.0; 95% CI: 2.8-3.2). Being partially vaccinated (aOR, 0.9; 95% CI: .9-.9), fully vaccinated (aOR, 0.6; 95% CI: .6-.7), and boosted (aOR, 0.4; 95% CI: .4-.5) and having prior laboratory-confirmed infection (aOR, 0.4; 95% CI: .3-.4) were associated with reduced risks of mortality. Overall, admission incidence risk and in-hospital mortality, which had increased progressively in South Africa's first 3 waves, decreased in the fourth Omicron BA.1/BA.2 wave and declined even further in the fifth Omicron BA.4/BA.5 wave. Mortality risk was lower in those with natural infection and vaccination, declining further as the number of vaccine doses increased.

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95% CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95% CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95% CI, 1.01-1.31; P = .03). This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients.

Variation in Clinical Treatment and Outcomes by Race Among US Veterans Hospitalized With COVID-19

Patients from racially and ethnically minoritized populations, such as Black and Hispanic patients, may be less likely to receive evidence-based COVID-19 treatments than White patients, contributing to adverse clinical outcomes. To determine whether clinical treatments and outcomes among patients hospitalized with COVID-19 were associated with race. This retrospective cohort study was conducted in 130 Department of Veterans Affairs Medical Centers (VAMCs) between March 1, 2020, and February 28, 2022, with a 60-day follow-up period until May 1, 2022. Participants included veterans hospitalized with COVID-19. Data were analyzed from May 6 to June 2, 2022. Self-reported race. Clinical care processes (eg, intensive care unit [ICU] admission; organ support measures, including invasive and noninvasive mechanical ventilation; prone position therapy, and COVID-19-specific medical treatments) were quantified. Clinical outcomes of interest included in-hospital mortality, 60-day mortality, and 30-day readmissions. Outcomes were assessed with multivariable random effects logistic regression models to estimate the association of race with outcomes not attributable to known mediators, such as socioeconomic status and age, while adjusting for potential confounding between outcomes and mediators. A total of 43 222 veterans (12 135 Black veterans [28.1%]; 31 087 White veterans [71.9%]; 40 717 [94.2%] men) with a median (IQR) age of 71 (62-77) years who were hospitalized with SARS-CoV-2 infection were included. Controlling for site of treatment, Black patients were equally likely to be admitted to the ICU (4806 Black patients [39.6%] vs 13 427 White patients [43.2%]; within-center adjusted odds ratio [aOR], 0.95; 95% CI, 0.88-1.02; P = .17). Two-thirds of patients treated with supplemental oxygen or noninvasive or invasive mechanical ventilation also received systemic steroids, but Black veterans were less likely to receive steroids (within-center aOR, 0.88; 95% CI, 0.80-0.96; P = .004; between-center aOR, 0.67; 95% CI, 0.48-0.96; P = .03). Similarly, Black patients were less likely to receive remdesivir (within-center aOR, 0.89; 95% CI, 0.83-0.95; P < .001; between-center aOR, 0.68; 95% CI, 0.47-0.99; P = .02) or treatment with immunomodulatory drugs (within-center aOR, 0.77; 95% CI, 0.67-0.87; P < .001). After adjusting for patient demographic characteristics, chronic health conditions, severity of acute illness, and receipt of COVID-19-specific treatments, there was no association of Black race with hospital mortality (within-center aOR, 0.98; 95% CI, 0.86-1.10; P = .71) or 30-day readmission (within-center aOR, 0.95; 95% CI, 0.88-1.04; P = .28). These findings suggest that Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based COVID-19 treatments, including systemic steroids, remdesivir, and immunomodulatory drugs.

Can more information be extracted from bovine TB skin test outcomes to inform animal risk management? A retrospective observational animal-level study

Continual tailoring of control programmes of endemic pathogens during long-term eradication campaigns requires detailed analysis of surveillance data to inform evidence-based policy. Bovine tuberculosis is a disease where long-term control and eradication programs are in train in several countries. The primary diagnostic tool, the intradermal tuberculin test, used to identify infected animals can be interpreted using different criteria and cut-offs, facilitating flexibility in its use as a basis to inform interventions.We investigated the comparative risk of animals failing a single intradermal comparative tuberculin test (SICTT) based on their previous tuberculin test result following a higher risk test-type (reactor retest of an infected herd). The study was a retrospective cohort design, and the primary exposure was the test status following a reactor retest classified as mutually exclusive categories based on bovine and avian tuberculin reactions: standard interpretation inconclusive (Sdi), severe interpretation inconclusive (Svi), single intradermal test (SIT) reactors (SITr), SIT inconclusive (SITi), avian tuberculin reactors (Ar), and test negative animals. Random effects multivariable logistic regression was used to investigate future risk. Cross-validation and downscaling was used to explore model performance. Alternate models with differing outcome test types were also explored.The models were trained on 844,207 observations from June 2018 to June 2021. Sdi, Svi, SITr, SITi and Ar were associated with the following odds ratios 12.242 (95 %CIs: 5.236–28.625; p < 0.001), 4.101 (95 %CIs: 3.423–4.913; p < 0.001), 2.503 (95 %CIs: 1.878–3.338; p < 0.001), 1.741 (95 %CIs: 1.195–2.538; p = 0.004) and 1.065 (95 %CIs: 0.833–1.361; p = 0.616) for failing the next test, respectively. High model performance was achieved with inclusion of random effects for both training and test evaluation datasets (AUC: 0.94; Balanced accuracy: 0.84), but fixed-effects only predictions exhibited moderate performance (AUC: 0.70; Balanced accuracy: 0.69). This reflects that 55 % of the risk of test failure relates to between herd heterogeneity based on intra-class correlation, while controlling for fixed effects. Other factors that were associated with increasing risk included age (older cohorts were at greater risk than the youngest cohort), breakdown history of the herd (greater number of breakdowns prior to the study period), and the time between exposure test and outcome test.These results provide further evidence to inform risk-based management policies for TB, including the removal of Sdi animals in higher risk situations, supplementary testing of cattle based on tuberculin responses and the provision of risk management advice to herd owners. The results characterise the future animal-level risk posed by Svis and suggest this risk may require policy led interventions.

Factors Associated With Psychiatric Readmission of Youths in a Racially Diverse and Urban Hospital Setting.

This study examined predictors of readmission to a psychiatric inpatient unit of an urban children's hospital within 1 year of discharge among a racially diverse sample of youths. The authors retrospectively analyzed 2 years of electronic health record data of inpatient psychiatric unit admissions (N=1,604). Multivariate logistic regression and random-effects multinomial logistic regression were used for analyses. The estimated odds ratios for any readmission within 1 year of discharge were significantly higher for Black youths, youths insured by Medicaid, and youths with a length of stay longer than 7 days. Factors remained strongly predictive when examining multiple readmissions versus no readmissions. Black youths, youths insured by Medicaid, and youths with longer stays were more likely than other youths to be readmitted. Findings suggest the need for interventions such as care coordination to target predictors of readmission and the need to examine inequities in the health care system.

High prescribing of antibiotics is associated with high prescribing of opioids in medical and dental providers.

High prescribers of antibiotics and opioids are an important target for stewardship interventions. The goal of this study was to assess the association between high antibiotic and high opioid prescribing by provider type. A national cross-sectional study. 2015-2017 Department of Veterans Affairs (VA) electronic health record data. Prescribers were identified as dentists (2017: n=1346) and medical providers (physicians n=23,072; advanced practice providers [APP] n=7705; and other providers [pharmacists/chiropractors] n=3674) (2017: n=34,451). High prescribing was defined as being in the top 25% of visit-based rates of antibiotic or opioid prescribing (number of prescriptions/number of dental or medical visits). Multivariable random effects logistic regression with clustering by facility was used to assess the adjusted association between high antibiotic and opioid prescribing. Medical providers prescribed 4,348,670 antibiotic and 10,256,706 opioid prescriptions; dentists prescribed 277,170 antibiotic and 124,103 opioid prescriptions. Among all high prescribers of antibiotics, 40% were also high prescribers of opioids as compared to 18% of those who were not high antibiotic prescribers (p < 0.0001). High prescribing of antibiotics was associated with high prescribing of opioids in medical providers (adjusted odds ratio [aOR]=2.87, 95% confidence interval [CI]=2.72-3.04) and dentists (aOR=8.40, 95% CI 6.00-11.76). Older provider age, specific US geographic regions, and lower VA facility complexity and rurality were also associated with high opioid prescribing by medical providers. In dentists, younger provider age, male gender, specific regions of the United States, and lower number of dentists in a facility were associated with high opioid prescribing. At the facility level, high dental prescribers of antibiotics or opioids were not at the same facilities as high medical prescribers, respectively (p < 0.0001). High antibiotic prescribing was associated with high opioid prescribing. Thus, stewardship interventions targeting both medication classes may have higher impact to efficiently reduce prescribing of medications with high public health impact. Provider-targeted interventions are needed to improve antibiotic and opioid prescribing in both dentists and medical providers.