Reduction In Odds Research Articles

Treatment of Spontaneous Subarachnoid Hemorrhage: A 20‐Year National Inpatient Sample Review

BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a major source of morbidity and mortality, and its management has undergone foundational changes over thepast 2 decades. We reviewed the National Inpatient Sample to outline the changes in severity of illness, surgical management, and patient outcomes over time. METHODS A retrospective cohort of admissions for spontaneous SAH in the National Inpatient Sample from 2001 to 2020 was reviewed, including those who underwent microsurgical or endovascular surgery to secure a ruptured aneurysm. National incidence was calculated, and multivariable regression was used to identify changes in incidence and outcome through time, segmented by epoch. RESULTS Review of the National Inpatient Sample identified 448 655 patients with SAH, of whom 181 590 underwent surgical aneurysm treatment. The incidence of spontaneous SAH fell −0.097 per 100 000 person‐years each year (95%CI, −0.144 to −0.049). Among patients surgically treated for aneurysmal SAH, the proportion of patients <50 years old fell from 40% to 30% between first and final epochs, and the proportion of those in the lowest stroke scale category, roughly equivalent to Hunt and Hess grade 1 or 2, fell from 66% to 45%. The proportion treated by microsurgery fell from 70% to 23% in favor of endovascular surgery. Hospital mortality among these treated cases was stable at 13% throughout the study period despite increasing illness severity indices. After adjustment, there was a 42% reduction of odds of hospital mortality in the final epoch compared with the first. CONCLUSION The incidence of hospitalization for spontaneous SAH fell between 2001 and 2020. Patients undergoing surgery to secure an aneurysm were more severely ill through time yet experienced a stable hospital mortality rate.

Race/Ethnic Differences in In-Hospital Mortality after Acute Ischemic Stroke.

Stroke mortality has declined, with differential changes by race; stroke is now the 5th leading cause of death overall, but 2nd leading cause of death in Black individuals. Little is known about recent race/ethnic and sex trends in in-hospital mortality after acute ischemic stroke (AIS) and whether system-level factors contribute to possible differences. Using the National Inpatient Sample, adults (≥18 years) with a primary diagnosis of AIS from 2006 to 2017 (n=643,912) were identified. We assessed in-hospital mortality by race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander [API], other), sex, and age. Hospitals were categorized by proportion of White patients served: "75% White hospitals", "50-75% White hospitals", and "<50% White hospitals". Using survey adjusted logistic regression, the association between race/ethnicity and odds of mortality was assessed, adjusting for key sociodemographic, clinical, and hospital characteristics (e.g., age, comorbidities, stroke severity, do not resuscitate orders, and palliative care). Overall, mortality decreased from 5.0% in 2006 to 2.9% in 2017 (p<0.001). Comparing 2012-2017 to 2006-2011, there was a 68% reduction in mortality odds overall after adjusting for covariates, most prominent in White individuals (69%) and smallest in Black individuals (57%). Compared to White patients, Black and Hispanic patients had lower odds of mortality (adjusted odds ratio (aOR) 0.82, 95% CI 0.78-0.87 and aOR 0.93, 95% CI 0.87-1.00), primarily driven by those >65 years (age x ethnicity interaction p < 0.0001). Compared to White men, Black, Hispanic, and API men, and Black women had lower aOR of mortality. The differences in mortality between White and all the other race/ethnic groups combined were most pronounced in 75% White hospitals (aOR 0.80, 0.74-0.87) compared to 50-75% White hospitals (aOR 0.85, 0.79-0.91) and <50% White hospitals (aOR 0.88, 0.81-0.95; interaction effect: p=0.005). AIS mortality decreased dramatically in recent years in all race/ethnic subgroups. Overall, while individuals of other race/ethnic subgroups had lower mortality odds compared to White individuals, this effect was significantly lower in hospitals serving predominantly White patients compared to those serving minority populations. White patients had higher , mortality than the other race/ethnic groups, a difference that was most striking in hospitals predominantly serving White patients. Further study is needed to understand these differences and to what extent sociocultural, biological, and system-level factors play a role.

Immune cells mediate the causal relationship between uveitis and colorectal cancer via Mendelian randomization analysis

Colorectal cancer (CRC) is one of the most common and deadly malignancies worldwide, and immune regulation plays a critical role in its development. This study investigates the causal relationships between uveitis, specific immune cell traits, and CRC using Mendelian Randomization (MR) analyses. A total of 21 single nucleotide polymorphisms (SNPs) associated with uveitis were identified, and the analysis revealed that a 1 log-odds increase in uveitis was linked to a statistically significant 3.0% reduction in CRC odds (IVW OR = 0.970, 95% CI: 0.946–0.995, P = 0.021). This protective effect was also observed using the weighted median approach (OR = 0.963, 95% CI: 0.931–0.997, P = 0.034), reinforcing the robustness of the findings. Furthermore, both univariable and multivariable MR analyses highlighted the significant causal influence of specific immune cell traits on CRC odds. Notably, the levels of extracellular monocyte HLA-DR expression emerged as a critical factor, with an associated increase in CRC odds (IVW OR = 1.084, 95% CI: 1.008–1.165, P = 0.030). The proportion of CRC odds mediated by the levels of extracellular monocyte HLA-DR expression, calculated as the ratio of the indirect effect to the total effect using estimates from multivariable MR analyses, was approximately 34.1%(95% CI: 10.23−58.04%). These findings underscore the complex interplay between immune regulation and carcinogenesis, offering insights into potential mechanisms underlying CRC development and suggesting avenues for targeted prevention and therapeutic strategies.

Participation, barriers, facilitators and bullying experiences of trans people in sport and fitness: findings from a national community survey of trans people in Australia.

This study aimed to assess participation rates of transgender and gender diverse (trans) people in sport/fitness activities, compare mental health outcomes for trans people participating in sport/fitness with those who do not and explore internal/external barriers and bullying experiences faced by trans people in sport/fitness contexts. A cross-sectional online survey open to trans people aged ≥16 years living in Australia was conducted between February and April 2023 and it assessed rates of sport/fitness participation, barriers to participation and bullying experiences through multiple-choice questions. Mental health measures comprised the Kessler Psychological Distress Scale (K10) and self-reported history of self-harm and suicidality. Covariate-adjusted binary logistic regression models tested associations between interpersonal factors, sport/fitness variables and mental health outcomes. Of 664 respondents (median age 32 years), around one-third (32.8%) regularly participated in sport/fitness. Common internal barriers to participation included anxiety about others' reactions (63.9%), body dissatisfaction/dysphoria (56.5%) and fears about feeling accepted/affirmed by others (54.7%). Respondents commonly reported experiencing inadequate bathroom/changing facilities (44.4%), exclusionary rules and regulations surrounding gender (36.7%), and invasive or uncomfortable policies or procedures (23.3%). Over one-third (34.4%) of trans people had experienced gender-based bullying or exclusion. Regular sport/fitness participation was associated with significantly lower K10 scores (mean difference=-4.4, 95% CI-5.8, -2.9, p<0.001) and a 40% reduction in odds of recent thoughts of self-harm and suicide (aOR 0.6, 95% CI 0.5, 0.9, p=0.01; aOR 0.6, 95%CI 0.4, 0.9, p=0.02). Trans people face significant barriers to sport/fitness despite experiencing significant mental health and personal benefits from participation. Affirming and including trans people in sport and fitness should be a key priority for sport and fitness federations, organisations and policy-makers.

Radial versus femoral access for rotational atherectomy angioplasty

Abstract Introduction The transfemoral approach (TFA) is a potentially advantageous acess site for complicated and prolonged percutaneous coronary angioplasty like rotational atherectomy (RA). Despite this, there is mounting data that suggests the transradial approach (TRA), an alternative to the TFA acess, is linked to reduced rates of mortality and access site complications. Aim This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of TRA for patients undergoing RA procedure. Methods In this retrospective study, we analyzed all RA procedures performed from March 2013 to June 2019 at our single center institution. Primary endpoints were procedural success, in-hospital mortality, and major adverse cardiovascular events (MACE) during hospitalization. Results Of the 98 patients undergoing RA, the TRA approach was chosen for 79% patients, and the TFA approach for 21% patients. No significant difference in procedural success rates was observed (94% vs. 91%, p=0.19). The use of RA via TRA correlated with a lower contrast volume (p=0.027) and a decreased post-procedure hospital stay (p=0.005). After multivariate adjustment, TRA demonstrated a noteworthy reduction in in-hospital mortality odds (OR: 0.62; 95% CI: 0.44 to 0.87; p = 0.003), major bleeding (OR: 0.48; 95% CI: 0.33 to 0.70; p &amp;lt; 0.001), MACE (OR: 0.68; 95% CI: 0.51 to 0.89; p = 0.015), and 30-day mortality (OR: 0.68; 95% CI: 0.51 to 0.89; p = 0.015). Conclusions Even though RA is a complex procedure, employing radial access (TRA) might be associated with favorable outcomes. These include a lower contrast volume, shorter hospital stay, and reduced odds of in-hospital mortality, major bleeding, MACE, and 30-day mortality compared to femoral access (TFA).

Inequalities in quality metrics for colorectal cancer surgery in older adults: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program registry

BackgroundWith a growing proportion of patients undergoing surgery for colorectal cancer being older adults, it is unknown whether traditional quality metrics are achieved as often compared with younger adults. This work was done with a view to understand tailoring needs of quality metrics for older adults with colorectal cancer. MethodsThis retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program registry to identify adults (≥18 years) between 2016 and 2021 who underwent elective colorectal cancer surgery for nonmetastatic cancer. older adults was defined as adults ≥65 years. The association between older adults and attainment of consensus quality metrics were evaluated using multivariable logistic regression adjusting for patient, cancer, and treatment factors. ResultsOf 46,159 patients undergoing elective colon cancer resection, 18,592 (40.3%) were older adults. Being an older adult was independently associated with a 14% reduction in odds of harvest of ≥12 nodes and 4.3 times increase in odds of 30-day mortality. Of 9,106 patients undergoing elective rectal cancer resection 5,143 (56.5%) were older adults. Being an older adult was independently associated with a 19% reduction in odds of harvest of ≥12 nodes, 2.3 times increase in odds of 30-day mortality and a 44% reduction in odds of receiving neoadjuvant radiation. Findings were robust to sensitivity analyses of alternate methods of handling missing data and alternate analytic approaches. ConclusionGiven unique needs of the older adult population, interpretation of disparities in quality metrics is challenging because of an inability to differentiate between patient factors, tailored care, or bias. Monitoring and reporting of quality metrics for older adults need to be re-evaluated with consideration to stratification, unique benchmarks, and older adult–specific quality metrics.

Changes in out-of-hospital cardiac arrest resuscitation quality during and after the COVID-19 pandemic

AimThe impact of personal protective equipment (PPE) on resuscitation quality is largely unknown. We sought to examine the effect of PPE requirements on CPR quality and resuscitation interventions during the COVID-19 pandemic in Victoria, Australia. MethodsWe performed a retrospective cohort study of adult OHCA patients of medical aetiology who received attempted resuscitation. The study consisted of three periods; a pre-COVID-19 period (1st March 2019 to 15th March 2020), the COVID-19 period (16th March 2020 to 12th October 2022) and a post-COVID-19 period (13th October 2022 to 30th June 2023). Multivariable quantile and logistic regression were used to examine changes in CPR metrics and time to resuscitation interventions across the three periods ResultsWe included 8,956 patients (2,389 pre-COVID-19, 4,935 during COVID-19 and 1,632 post-COVID-19). A number of CPR quality metrics deteriorated during the COVID-19 period compared to the pre-COVID-19 period, including: chest compression fraction (median difference [MD] −0.81 percentage points; 95% CI −1.07,-0.56), release velocity (MD −5.26 mm per second; 95% CI −9.79, −0.72) and resuscitation duration (MD −2.2 min; 95% CI −3.39, −1.05). The COVID-19 period was also associated with longer post-shock pauses (MD 0.22 s; 95% CI 0.05, 0.38), and a reduction in the risk-adjusted odds of receiving adrenaline administration within 5 mins (AOR 0.72, 95% CI 0.63 – 0.82) and laryngeal mask insertion within 10 mins of arrival (AOR 0.83, 95% CI 0.74 – 0.94). These factors, with the exception of resuscitation duration and time to larygeal mask insertion, remained significantly different from baseline for the post-COVID-19 period. ConclusionSeveral CPR quality metrics declined during the COVID-19 period and some remain below pre-pandemic levels. Further research is needed to understand these impacts on OHCA outcomes.

Predictors of Pre-Hypertension and Hypertension in Rural Adults: Insights Into the Impact of Yoga, Lifestyle, and Demographic Factors

Background: Hypertension is a leading risk factor for cardiovascular diseases, particularly in rural areas where healthcare access is limited. This study investigates predictors of pre-hypertension and hypertension, with a focus on yoga and lifestyle factors such as physical activity, smoking, and alcohol consumption. Methods: A cross-sectional study was conducted among rural adults to collect data on demographic factors (age, gender, education level), lifestyle habits (smoking, alcohol, physical activity), and yoga participation. Blood pressure was measured and classified into normal, pre-hypertension, and hypertension categories. Logistic regression was used to identify significant predictors of hypertension and pre-hypertension. Results: Key predictors of hypertension include age (OR = 0.998), gender (OR = 0.648 for males), and BMI (OR = 1.012). Alcohol consumption was significantly associated with higher hypertension risk (OR = 1.293). Yoga participation, particularly improvements in flexibility, showed a modest reduction in hypertension odds (OR = 0.945). Non-yoga physical activity also demonstrated a protective effect (OR = 0.958). Conclusion: Lifestyle factors such as alcohol consumption and physical activity play important roles in hypertension risk. While yoga showed some benefits, particularly in flexibility improvements, further research is needed to explore its longterm effects. Public health interventions targeting modifiable risk factors, including yoga, may help reduce the prevalence of hypertension in rural communities.

Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial

BackgroundSchool-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance.MethodsThe WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an ‘open cohort’. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat.ResultsOf 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes.ConclusionsThis large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes.Trial registrationClinicalTrials.gov, number NCT05024890.

Risk and protective factors associated with substance use among Puerto Rican youths after Hurricane María: a cross-sectional study

BackgroundIdentifying factors associated with post-disaster youth substance use is a crucial element of developing evidence-based prevention and intervention efforts. Hurricane María struck Puerto Rico in September of 2017 and the wide-spread impact from this disaster, including exposure to trauma, displacement, and disrupted social supports had the potential to negatively impact levels of substance use among youth across the archipelago. However, post-disaster substance use remains under-investigated in this context. The current study sought to identify risk and protective factors associated with substance use among Puerto Rican youth in the aftermath of Hurricane Maria.MethodsCross-sectional, secondary data analyses were conducted using school-based survey data collected at all schools in Puerto Rico between February 1 and June 29, 2018 (5–9 months after Hurricane María). Social supports, substance use, and trauma symptoms were assessed. An ordinal regression analysis was conducted to identify student factors associated with greater likelihood of post-disaster substance use.ResultsA total of 36,485 participants (50.7% female, grades 7–12), were included in an ordinal regression analysis that compared the likelihood of respondents endorsing high, low, or no substance use after Hurricane María based on reported adult social support, counselor/teacher social support, peer social support, ptsd symptomatology, and gender. Findings showed that, when compared to students that endorsed low or no substance use, those who reported having adult social support demonstrated a 58% reduction in odds (OR = 0.42, 95% CI: 0.34-0.53) of reporting high substance use after Hurricane María, while students who reported having teacher/counselor social support demonstrated a 21% reduction in odds (OR = 0.79, 95% CI: 0.69-0.89) of reporting high substance use. Additionally, those that reported having peer social support demonstrated a 31% increase in odds (OR = 1.31, 95% CI: 1.10 to 1.58) of reporting higher substance use, compared to those that reported low or no substance use.ConclusionsWhile social support was generally protective, prevention efforts to build positive family and community connections may be indicated. Evidence-based school screenings of substance use and trauma may help direct intervention to those most at risk for co-occurring issues.

Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage

BackgroundMinimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI...

Sleep duration, sleep problems and developmental trajectories of urinary incontinence: a prospective cohort study.

To examine if preschool sleep duration and sleep problems are associated with urinary incontinence (UI) at primary school-age. We used multinomial logistic regression to examine the association of child sleep duration/problems (3½ years) with UI trajectories (4-9years) in 8751 (4507 boys, 4244 girls) from the Avon Longitudinal Study of Parents and Children. We adjusted for sex, socioeconomic indicators, mothers' emotional/practical/financial support, developmental delay, stressful life events, temperament, and emotional/behaviour problems. Preschool children who slept more than 8½ hours per night had a decreased probability of UI at school-age. There was a 33% reduction in odds of daytime wetting per additional hour of sleep (odds ratio [OR] = 0.67, 95% confidence interval [CI]0.52-0.86). Sleep problems were associated with increased odds of UI e.g., getting up after being put to bed was associated with daytime wetting (OR = 2.20, 95% CI 1.43-3.39); breathing problems whilst sleeping were associated with delayed bladder control (OR = 1.68, 95% CI 1.12-2.52), and night-time waking was associated with persistent (day and night) wetting (OR = 1.53, 95% CI 1.16-2.00). Waking during the night and waking up early in the morning were associated with reduced odds of bedwetting at school-age (OR = 0.76, 95% CI 0.61-0.96 and OR = 0.80, 95% CI 0.64-0.99 respectively). Preschool children who sleep for longer have a lower likelihood of UI at school-age, whilst those with sleep problems are more likely to experience daytime wetting and combined (day and night) wetting, but not bedwetting alone. Short sleep duration and sleep problems in early childhood could be indicators of future problems attaining and maintaining bladder control.

Optimising postoperative care: Same-day discharge after transurethral resection of the prostate.

This study aims to assess the feasibility and safety of same-day discharge after transurethral resection of the prostate. Five years of records were retrospectively analysed. Length of stay categorised patients into Groups 1 (same-day discharge) and 2 (standard-length discharge). Logistic regression analysis was performed, controlling for clinicodemographic factors. Student's t-test compared continuous bladder irrigation and catheter dwell times. A total of 459 patients were identified between 2016 and 2021, 280 in Group 1 and 179 in Group 2, with median ages of 71.0 (interquartile range 36-92) and 72.0 (interquartile range 47-101) years (p = 0.067), respectively. Same-day discharge rates notably increased post-2018 (p = 0.025). Median prostate tissue resected in Group 2 was 7.1g (3.4-12.4g) and in Group 1 was 4.9g (2.4-10.2g; p = 0.034). While continuous bladder irrigation >1 hour was significantly lower in Group 1 than Group 2 (96.8% versus 27.4%; p = 0.0001), catheter dwell times were comparable (70.1 and 70.8 hours, respectively). Control-adjusted results showed a 40% reduction in emergency department representation odds for Group 1 compared with Group 2 (odds ratio = 0.60; 95% confidence interval = 0.37-0.99; p = 0.04). Length of stay was not significantly associated with hospital readmissions (p = 0.11). Continuous bladder irrigation for <1 hour in Group 1 was associated with a reduced emergency department representation (odds ratio = 0.43; 95% confidence interval = 0.197-0.980) but not readmission (odds ratio = 0.413; 95% confidence interval = 0.166-1.104). Same-day discharge post-transurethral resection of the prostate may be a viable and safe option for carefully selected patients.

#3043 Epidemiology of infective endocarditis in long term hemodialysis patients in France, from 2014 to 2019

Abstract Background and Aims Infective endocarditis (IE) is a frequent pathology among patients treated with long-term hemodialysis (HD). Its epidemiology and risk factors are scarcely reported in this specific population in France. This study aims to describe the frequency and characteristics of IE in long-term hemodialysis patients in mainland France. Method From the national Programme de médicalisation des systèmes d'information (PMSI) data, we selected patients initiating a renal replacement therapy by long-term hemodialysis from 2014 to 2017, with a follow up from 2017 to 2019. Within this population, we defined hospitalizations due to IE by using the CIM-10 coding system. We analyzed various comorbidities such as sociodemographic factors, cardiovascular diseases, cancer, diabetes and vascular access, identified within the PMSI during a minimum duration of 4 years, looking for IE risk factors. As the IE incidence has a low frequency for this follow up length, it was analyzed with a Poisson distribution model. Results We studied 38 569 patients, with a 36 month follow up. Fig. 1 shows IE incidence during the follow up, in which we identified 2492 cases of EI. The incidence rate was 6.69, or 7 out of 100 000 at first month and 1.97 out of 100 000 at twelve months. In multivariate analysis we found the following risk factors associated with EI: having a central vascular catheter (CVC) as initial vascular access while starting renal replacement therapy, compared to an arteriovenous fistula, OR 2.49 [2.29-2.71], diabetes OR 1.25 [1.14-1.35], cardiovascular conditions OR 1.35 [1.23-1.48] and increasing age was associated with a reduction of an IE diagnosis odds. Conclusion Our study highlights a high IE frequency among long-term hemodialysis patients. Its incidence is particularly high during the first year and decreases afterwards. The main risk factors were: CVC, preexisting cardiovascular conditions and diabetes.

#1097 Linking changes in individual performance scores to survival outcomes in chronic hemodialysis patients

Abstract Background and Aims Chronic kidney disease (CKD) management has advanced significantly over recent years, yet mortality rates among hemodialysis (HD) patients remain high. This study aims to assess the impact of changes in an individualized patient performance score (IPPS) on survival in a large cohort of HD patients. Method This multicentre, observational, prospective cohort study included HD patients across 19 countries, starting from January 1st, 2022. We followed these patients for one year, categorizing them based on their survival status at year's end. We calculated the mean IPPS monthly, from June to December 2021, and divided the patients into tertiles based on their December 2021 scores. Subsequently, we formed five groups based on their IPPS dynamics over six months. We used Kaplan-Meier and Cox regression analyses to evaluate survival, presenting the results as hazard ratios (HR) and 95% confidence intervals (95% CI). A p-value below 0.05 was considered statistically significant. The IPPS, ranging from 0 to 100, was calculated based on eight key performance areas, with higher scores indicating better medical performance: Vascular Access (20 points): type of vascular access, episodes of thrombosis and infection); HD adequacy (20 points): eKt/V, blood flow and treatment time; Anemia (20 points): hemoglobin concentration, transferrin saturation, ferritin; Arterial hypertension (10 points): mean arterial pressure; Mineral Bone disease (15 points): iPTH, plasmatic phosphorus and calcium; Fluid status (5 points): percentage of interdialytic fluid gain; Nutrition (5 points): plasmatic albumin and phosphorus and Others (5 points): influenzae vaccination, transplantation status and hospitalization events. The final score is obtained by the weighted sum of positive clinical factors, subtracted from the weighted sum of negative clinical factors and is reported as a number ranging from 0 to 100, with a higher score representing a better medical performance. Results The study included 10 458 HD patients. In the survival analysis, a significant reduction in mortality odds was observed in patients with a stable IPPS of 72 or lower, compared to those with a score consistently above 86. Patients transitioning from the lowest to the highest tertile in six months had a mortality HR similar to those consistently in the highest tertile. On the other hand, patients showing an improvement in IPPS score from the lowest to the highest tertile in the same period had a mortality HR similar to the intermediate group (Table 1). Conclusion A lower total IPPS score (&amp;lt;72) was associated with a threefold increase in mortality risk compared to scores above 86. An increase in IPPS from the lowest to the highest tertile correlated with a significant reduction in mortality, equating to the survival rates of patients consistently scoring high. These findings underscore the potential of IPPS as a valuable tool for guiding clinical interventions in the HD population to enhance patient survival.

Sepsis mortality among patients with haematological malignancy admitted to intensive care 2000–2022: a binational cohort study

BackgroundSepsis occurs in 12–27% of patients with haematological malignancy within a year of diagnosis. Sepsis mortality has improved in non-cancer patients in the last two decades, but longitudinal trends in patients with haematological malignancy are not well characterised. We aimed to compare outcomes, including temporal changes, in patients with and without a haematological malignancy admitted to ICU with a primary diagnosis of sepsis in Australia and New Zealand over the past two decades.MethodsWe performed a retrospective cohort study of 282,627 patients with a primary intensive care unit (ICU) admission diagnosis of sepsis including 17,313 patients with haematological malignancy, admitted to 216 intensive care units (ICUs) in Australia or New Zealand between January 2000 and December 2022. Annual crude and adjusted in-hospital mortality were reported. Risk factors for in-hospital mortality were determined using a mixed methods logistic regression model and were used to calculate annual changes in mortality.ResultsIn-hospital sepsis mortality decreased in patients with haematological malignancy, from 55.6% (95% CI 46.5–64.6%) in 2000 to 23.1% (95% CI 20.8–25.5%) in 2021. In patients without haematological malignancy mortality decreased from 33.1% (95% CI 31.3–35.1%) to 14.4% (95% CI 13.8–14.8%). This decrease remained significant after adjusting for mortality predictors including age, SOFA score and comorbidities, as estimated by adjusted annual odds of in-hospital death. The reduction in odds of death was of greater magnitude in patients with haematological malignancy than those without (OR 0.954, 95% CI 0.947–0.961 vs. OR 0.968, 95% CI 0.966–0.971, p < 0.001). However, absolute risk of in-hospital mortality remained higher in patients with haematological malignancy. Older age, higher SOFA score, presence of comorbidities, and mechanical ventilation were associated with increased mortality. Leukopenia (white cell count < 1.0 × 109 cells/L) was not associated with increased mortality in patients with haematological malignancy (p = 0.60).ConclusionsSepsis mortality has improved in patients with haematological malignancy admitted to ICU. However, mortality remains higher in patients with haematological malignancy than those without.Graphical abstract

Current US prevalence of myocardial injury patterns and clinical outcomes among hospitalised patients with familial hypercholesterolaemia: insight from the National Inpatient Sample—a retrospective cohort study

BackgroundFamilial hypercholesterolaemia (FH) increases propensity for premature atherosclerotic disease. Knowledge of inpatient outcomes among patients with FH admitted with acute myocardial injury (AMI) is limited.ObjectivesOur study aimed to identify myocardial...

Interest subvention for crop loans in India: Win-win or win-lose ?

Interest subsidies on crop loans are a common feature of rural credit markets in developing countries. The objective behind giving interest subsidies is two-fold – increasing access to credit and improving loan repayment rates, and is therefore regarded as a win-win for the borrower and the lender. This study focusses on a policy intervention that provides interest subsidy for crop loans availed under the Kisan Credit Card (KCC) scheme - India's flagship program to provide short-term agricultural credit for farmers. Using a unique dataset from a large public sector bank in India, we evaluate the causal impact of this intervention on both credit access and loan repayment behavior. We also capture the heterogeneous impact of the policy on new and existing borrowers. The results of econometric analysis - a combination of matching and difference-in-difference techniques - show a substantial increase (35%) in new loans, in addition to 20% decrease in the overall loan amount, indicating increased breadth and depth of access. However, contrary to standard economic theories, we observe a reduction in odds of repayment. Further, we find that the interest rate subsidy worsens the repayment rates of existing borrowers too. Our findings underscore the importance of various operational and behavioral aspects of the agricultural lending ecosystem to design win-win credit policies.

Association between serum P16ink4A concentration and CIN and cervical cancer among women attending a cervical cancer clinic in western Uganda: A case control study

IntroductionTissue expression of P16ink4A is correlated with cervical lesions. In this study we determined the association between serum P16ink4A concentrations and cervical lesions among women attending the cervical cancer clinic at Mbarara Regional Hospital (MRRH) South Western Uganda. Material and MethodsWe recruited 90 cervical intraepithelial neoplasia (CIN) cases, 90 cervical cancer (CC) cases before treatment and 90 controls. Clinical and demographic data were recorded. Serum P16ink4A concentrations were measured by quantitative Elisa. Cases were confirmed with cytology and/or histology. Descriptive statistics and logistic regression were done with STATA 17 and P-values of <0.05 were considered statistically significant. ResultsThe mean serum P16ink4A concentration among CIN cases, CC cases and controls was 1.11(+/−0.66) ng/ml, 1.45(+/−1.11) ng/ml and 1.13(+/−0.61) ng/ml respectively (p = 0.008). 50 % of CIN cases and controls as well as 60 % of CC cases had P16ink4A concentration above 0.946 ng/ml. There were increased odds of CIN for serum P16ink4A though statistically insignificant (AOR: 1.11, p-value: 0.70). There was also a statistically significant reduction in odds of CC for serum P16ink4A (AOR: 0.55, p-value: 0.01). ConclusionSerum P16ink4A may likely be associated with cervical lesions especially CC in our study population and this may aid detection of such lesions. Diagnostic utility studies for circulating P16ink4A in detection of cervical cancer are recommended.

Rural Vascular Trauma: Time to Care.

Previous rural vascular trauma research has focused on case series dating back two decades. The current research aims to measure clinical decline in comparison to time to care in rural vascular trauma. This single-center retrospective cohort study included adult trauma patients with vascular injury who were admitted to a level II trauma center. Multivariable logistic regression assessed the effect of clinical decline based on arrival within the golden hour. 149 patients were included. For every 1 unit increase in the shock index ratio, there was 99.9% reduction in odds that the patient would arrive to the trauma center within the golden hour. This study is the first of its kind within the last two decades to comprehensively review rural vascular trauma. Our research showed clinical decline in SIR associated with prolonged time to care and will allow us to optimize pre-hospital care and transport in regions with prolonged arrival times.