Significant Higher Odds Research Articles

Predictors of successful vaginal birth after one caesarean section at selected hospitals in Lusaka, Zambia

Background. Repeat caesarean section (CS) carries an increased risk of both maternal and neonatal morbidity and mortality. Planned vaginal birth after CS (VBAC), with an estimated success rate of 60 - 80%, is clinically safer than elective repeat CS, and also limits the rise in CSs. There is no single generalised validated tool to predict success of VBAC. Objectives. To determine predictors of successful VBAC among mothers with one previous CS at selected hospitals in Lusaka, Zambia. Method. Determination of independent predictors with significant high odds of a successful VBAC among mothers offered a trial of labour (TOL) was conducted in a cross-sectional study. Women with a history of one previous lower-segment CS, who were carrying a singleton fetus and were in established labour or draining amniotic fluid and scheduled for TOL after CS, were included in the study. Convenience sampling was used to enrol 290 participants. Using SPSS version 22, bivariate analysis and logistic regression analysis were used to analyse data. An independent factor associated with successful VBAC and with a p-value <0.05 was considered significant. Results. Of the participants, 236 (81.4%) had a successful vaginal delivery and 54 (18.6%) failed to deliver vaginally and required emergency CS. Key independent predictors of success of VBAC were primary education level (adjusted odds ratio (AOR) 2.21; 95% confidence interval (CI) 1.01 - 4.84), multiparity (AOR 4.81; 95% CI 1.16 - 19.93), previous successful VBAC (AOR 9.94; 95% CI 1.29 - 76.70), inter-delivery interval after the primary CS (AOR 18.54; 95% CI 5.98 - 57.48), a history of fetal distress (AOR 9.33; 95% CI 2.48 - 35.08), malpresentation (AOR 6.13; 95% CI 1.65 - 22.70) or failed induction of labour (AOR 20.52; 95% CI 3.32 - 127.03) as indications for the primary CS, Bishop score (AOR 7.06; 95% CI 1.92 - 25.97), cervical dilation (AOR 11.62; 95% CI 3.86 - 35.03), duration of labour (AOR 20.78; 95% CI 5.62 - 76.80), birthweight (AOR 6.80; 95% CI 3.33 - 13.91) and Apgar score (AOR 28.42; 95% CI 5.67 - 142.38). Conclusion. A combination of independent sociodemographic and obstetric factors that have significant high odds for a good outcome of VBAC could help predict success of delivery in a given population. This information could also aid in counselling mothers on mode of delivery.

Factors associated with severe or fatal clinical manifestations of SARS-CoV-2 infection after receiving the third dose of vaccine.

BackgroundLittle is known about vulnerability to severe COVID‐19 illness after vaccination completion with three doses of vaccine against COVID‐19.ObjectivesTo identify individual features associated with increased risk of severe clinical manifestation of SARS‐CoV‐2 infections after receiving the third dose of vaccine against COVID‐19.MethodsWe performed a nested case‐control study based on 3,360,116 citizens from Lombardy, Italy, aged 12 years or older who received the third dose of vaccine against COVID‐19 from 20 September through 31 December 2021. Individuals were followed from 14 days after vaccination completion until the occurrence of severe COVID‐19 illness, death unrelated to COVID‐19, emigration or 15 March 2022. For each case, controls were randomly selected to be 1:10 matched for the date of vaccination completion and municipality of residence. The association between candidate predictors and outcome was assessed through multivariable conditional logistic regression models.ResultsDuring 12,538,330 person‐months of follow‐up, 5171 cases of severe illness occurred. As age increased, a trend towards increasing odds of severe illness was observed. Male gender was a significant risk factor. As the number of contacts with the Regional Health Service increased, a trend towards increasing odds of severe illness was observed. Having had a previous SARS‐CoV‐2 infection was a significant protective factor. Having received the Moderna vaccine significantly decreased the odds of severe illness. Significant higher odds were associated with 42 diseases/conditions. Odds ratios ranged from 1.23 (diseases of the musculoskeletal system) to 5.00 (autoimmune disease).ConclusionsThis study provides useful insights for establishing priority in fourth‐dose vaccination programs.

Analysis of demographic and staging characteristics in patients with colorectal cancer using the SEER registry.

e15589 Background: Screening for colorectal cancer (CRC) has traditionally begun at age 50, with more recent guidelines suggesting beginning at age 45 to enhance earlier detection. Methods: Incidence data of CRC from the NCI’s Surveillance, Epidemiology, and End Results (SEER) Program 21 registry was utilized for this study. This study analyzed data from 2014-2018 with 95% confidence intervals for ages 50-64, 64-74, and 75+. Localized, regional and distant metastasis were coded according to the SEER database. Results: The incidence of CRC increased with age as individuals ages 75+ had the highest incidence at 211.8 per 100,000, compared to 70.7 for ages 50-64. In the age group of 75+, the incidence of localized CRC was 70.1 (95% CI: 69.2-71.0) and regional CRC was 69.2 (68.4-70.1) which was not statistically significant. Upon analyzing sex in CRC, female patients have a statistically lower chance of presenting with CRC at 59.5, 107.6, 192.1 for the age groups 50-64, 65-74, and 75+ respectively, whereas male counterparts have rates of 82.7, 152.9, and 240.2. Analysis of Asian females showed no difference in incidence of local and regional disease for ages 50-74. For ages 75+, the incidence of regional disease at 54.6 (51.3-58.1) was much higher than local disease at 45.3 (42.3- 48.5). Of note, Asian females aged 50-64, Hispanic females ages 65 and older, and Black and White females ages 75+ were equally likely to present with local or regional disease. White males had statistically significant higher odds of localized compared to regional cancer in all age groups. Further analysis shows that Asian males have an equal incidence of local and regional disease for ages 65 and above. Black males ages 75+ and Hispanic males ages 50+ had a similar incidence of local and regional CRC. Conclusions: Ensuring equitable access to screening and earlier screening may be beneficial and improve cancer-related mortality in certain demographics. A more modern data set should be analyzed to support these findings. This analysis was limited to incidence of CRC, and future studies assessing presentation at diagnosis could be insightful.[Table: see text]

0589 REM Sleep Behavior Disorder is Associated with Poor Outcomes in Pulmonary Embolism Hospitlizations

Abstract Introduction REM Sleep Behavior Disorder (RBD), is a rare sleep behavior disorder, characterized by loss of skeletal muscle atonia during REM sleep, resulting in prominent motor activity with exhibited behavior mirroring the image of the dreams during sleep. Other sleep disorders were studied before in patients with Pulmonary Embolism (PE). Although, REM sleep behavior disorder association with pulmonary embolism has never been described. In this study we aim to study the prevalence of RBD in patients admitted with PE, and to assess the association between RBD and PE. Methods Adults with principal diagnosis of Pulmonary Embolism (PE) on discharge were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis. We queried the 2019 National Inpatient Sample for secondary diagnosis of RBD, Obstructive Sleep Apnea (OSA) and other secondary diagnoses (hyperlipidemia,history of old myocardial infarction, atrial fibrillation, Chronic obstructive pulmonary disease, hypertension, heart failure, smoking, chronic kidney disease , electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses. Results In a total of 188,355 hospitalizations with PE primary diagnosis on discharge were included from the 2019 national inpatient sample, 25 hospitalizations had concomitant secondary diagnosis with RBD. The overall in-hospital mortality for PE was 3.2%. On weighted analysis, Patients with RBD had statistically significant higher odds for mortality compared to patients without [adjusted odds ratio (OR): 17.15; 95% confidence interval (CI): 2.75-106.8, p= 0.002], 20% mortality rate in patients with RBD compared to 0.03% in patients without RBD (p= 0.03). OSA did not show significant result for mortality when compared to without OSA [adjusted odds ratio (OR): 0.83; 95% confidence interval (CI): 0.67-1.04, p= 0.114]. Conclusion Our analysis showed a low number of patients with secondary diagnosis of RBD in hospitalizations with primary diagnosis of PE on discharge. However significant association between RBD and mortality in patients with PE primary diagnosis on discharge. The identification of patients with RBD in patients admitted with PE may help decrease mortality rate. Furthermore, our analysis showed that OSA is an independant variable for mortality in PE hospitalization. Support (If Any)

Risk Factors for Cervical Spine Injury in an Obtunded Blunt Trauma Patient

Background: In Thailand, many hospitals cannot send every obtunded blunt trauma patient for cervical spine CT scan because of the socioeconomic status. Knowing about the risk factors for cervical spine injury in an obtunded blunt trauma patient would help the clinician monitor for cervical spine injury. Objective: To identify the risk factors of cervical spine injury in an obtunded blunt trauma patient. Materials and Methods: The present study evaluated 400 obtunded blunt trauma patients with a GCS of less than 15, in the trauma center of Srinagarind Hospital between January 2015 and December 2019. The patients were chosen from the patient’s registry for the present retrospective cross-sectional study. A univariate analysis was fulfilled with potential risk factors such as age, gender, mechanism of injury, GCS, associated injury, and intracranial lesion. Then, multivariate analysis was used to identify the risk factors of cervical spine injury in obtunded blunt trauma patients. Results: Four hundred patients were included in the present study. Eighty-eight (22%, 95% CI 18.04 to 26.38) had a cervical spine injury. The mean age was 40.04 years, 73% were males with a male to female ratio of 2.7 to 1. For the mechanisms of injury, 66% of injuries resulted from motorcycle accidents, 15% from car accidents, and 14% from falls. From univariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (OR 1.93, 95% CI 1.05 to 3.54). Thoracic spine fracture had significant higher odds of cervical spine injury than other associate injuries (OR 6.2, 95% CI 1.45 to 26.5). From multivariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (aOR 1.99, 95% CI 1.07 to 3.68). Thoracic spine fracture had a significantly higher odds of cervical spine injury than the other associated injuries (aOR 6.4, 95% CI 1.48 to 27.63). In patients age older than 60 years, 42% of cervical spine injuries occurred from fall. Conclusion: From the present study, age older than 60 years and thoracic spine fracture are the significant risk factors of cervical spine injury in obtunded blunt trauma patients. Keywords: Cervical spine injury; Risk factors; Obtunded blunt trauma patient

A survey of speech pathologist practice patterns for consulting registered dieticians when recommending diet alterations

ABSTRACT Introduction: Diet modification in dysphagia management can significantly impact patient nutrition and hydration status. Since speech-language pathologists (SLPs) do not receive formal training in nutrition, consulting Registered Dieticians (RDs) to assist in diet recommendations is important for patient wellness. The study aimed to better understand current SLP practice patterns for consulting RDs and investigate how work setting, years of experience, education, and patient diagnosis may influence decisions. Methods: A six-item survey was provided to practicing SLPs via a web-based format. Descriptive statistics were used to describe trends in the frequency of RD consultation. Logistic regression was used to identify demographics or educational factors that showed statistically significant higher odds for consulting an RD. Results: 359 SLPs completed the entire survey. Thirty-nine percent of all SLPs and 40% of acute care SLPs indicated they have never or rarely (< 10% of the time) consult an RD prior to making a diet recommendation. Work setting and years of experience did not significantly impact the frequency of RD consults. However, those who had previously taken a course on the impact of diet modifications were 2.4 times more likely to consult an RD (p < 0.001). Conclusion: Since the majority (82%) of participants reported working in an inpatient setting and regulations require, at a minimum, access to an RD in a consultative capacity, the low percentage of consultations indicates an underutilization of a valuable resource. Increased educational opportunities that emphasize the impact of modiying diets may increase RD consultations and team-based decision-making to positively impact overall patient health.

Abstract LB089: A national study of alcohol consumption patterns among population-based U.S. cancer survivors compared with cancer-free controls

Abstract Alcohol consumption is a modifiable risk factor for several cancers. Previous studies have also shown a positive association between alcohol and cancer progression, recurrence and cancer-related death. Few studies have been conducted to characterize alcohol consumption patterns among cancer survivors compared to cancer-free individuals. This cross-sectional study combined data from NHANES between 1999-2016 to compare alcohol consumption behaviors among adults with a history of cancer to cancer-free population controls. Multinomial logistic regression was used to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of drinking status among survivors (former drinkers; current drinkers; never drinkers) compared to controls. Multivariable logistic regression models were also used within current drinkers to calculate the adjusted odds of binge drinking and exceeding moderate drinking. Models were adjusted for demographic and socioeconomic factors. A total of 3,113 survivors and 39,527 controls were included. Compared with controls, survivors were less likely to be current drinkers (63.4% vs. 72.6% in controls) and were more likely to be former drinkers (24.4% vs. 15.5% in controls). The odds of being current drinkers vs. never drinkers was significantly lower among survivors compared with controls (aOR: 0.84, 95% CI: 0.71-0.99, p-value: 0.04), while no significant odds of being former drinkers vs. never drinkers was observed. When comparing survivors to controls by cancer type, breast cancer survivors had lower odds of being current drinkers vs. never drinkers (aOR: 0.67, 95% CI: 0.51-0.88, p-value&amp;lt;0.01), and they also had significant lower odds of binge drinking when compared with controls (aOR: 0.43, 95% CI: 0.20-0.95, p-value: 0.04). Prostate cancer survivors had higher odds of being current drinker vs. never drinker compared with controls; however, the result was not significant (aOR: 1.33, 95% CI: 0.92-2.11, p-value: 0.18) and the multivariable logistic regression models showed that current drinkers had lower odds of being exceeding moderate drinkers (aOR:0.71, 95% CI: 0.50-1.00, p-value: 0.05) and being binge drinkers (aOR: 0.35, 95% CI: 0.16-0.74, p-value&amp;lt;0.01) compared with controls. We also observed significant higher odds of being binge drinkers among cervical cancer survivors (aOR:2.51, 95% CI: 1.27-4.92, p-value&amp;lt;0.01). No significant association between cancer status and drinking behaviors were observed by the number of cancers diagnosed and the years since diagnosis. Our findings suggest that cancer survivors are at lower odds of being current drinkers when compared with cancer-free population controls. Given the high odds of binge drinking among cervical cancer survivors, public health strategies are needed to reduce alcohol consumption in this group. Citation Format: Junrui Lyu, Maneet Kaur, Avonne E. Connor. A national study of alcohol consumption patterns among population-based U.S. cancer survivors compared with cancer-free controls [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB089.

Rising strong: a housing-based intervention to prevent childhood out-of-home placements from families impacted by housing instability, opioid use, and other substance use disorders

ABSTRACT Rising Strong is a housing-based intervention created to reunify families involved in the child welfare system by providing housing, opioid and other substance use disorder treatment, and other supports. There were 45 families in the program; 37 of those families consented to an 18-month program evaluation. Preliminary data indicates 56% of parents used opioids in the past year with statistically significant higher odds of experiencing symptoms of depression and trauma-related stress than those who did not report opioid use. Other results describe how the program overcame challenges and offers recommendations for developing a unique co-occurring treatment program.

Association between mental health, caries experience and gingival health of adolescents in sub-urban Nigeria

BackgroundThis study assessed the association of mental health problems and risk indicators of mental health problems with caries experience and moderate/severe gingivitis in adolescents.MethodsA cross-sectional household survey was conducted in Osun State, Nigeria. Data collected from 10 to 19-years-old adolescents between December 2018 and January 2019 were sociodemographic variables (age, sex, socioeconomic status); oral health indicators (tooth brushing, use of fluoridated toothpaste, consumption of refined carbohydrates in-between-meals, dental services utilization, dental anxiety and plaque); mental health indicators (smoking habits, intake of alcohol and use of psychoactive drugs) and mental health problems (low and high). Gingival health (healthy gingiva/mild gingivitis versus moderate/severe gingivitis) and caries experience (present or absent) were also assessed. A series of five logistic regression models were constructed to determine the association between presence of caries experience and presence of moderate/severe gingivitis) with blocks of independent variables. The blocks were: model 1—sociodemographic factors; model 2—oral health indicators; model 3—mental health indicators and model 4—mental health problems. Model 5 included all factors from models 1 to 4.ResultsThere were 1234 adolescents with a mean (SD) age of 14.6 (2.7) years. Also, 21.1% of participants had high risk of mental health problems, 3.7% had caries experience, and 8.1% had moderate/severe gingivitis. Model 5 had the best fit for the two dependent variables. The use of psychoactive substances (AOR 2.67; 95% CI 1.14, 6.26) was associated with significantly higher odds of caries experience. The frequent consumption of refined carbohydrates in-between-meals (AOR: 0.41; 95% CI 0.25, 0.66) and severe dental anxiety (AOR0.48; 95% CI 0.23, 0.99) were associated with significantly lower odds of moderate/severe gingivitis. Plaque was associated with significant higher odds of moderate/severe gingivitis (AOR 13.50; 95% CI 8.66, 21.04). High risk of mental health problems was not significantly associated with caries experience (AOR 1.84; 95% CI 0.97, 3.49) or moderate/severe gingivitis (AOR 0.80; 95% CI 0.45, 1.44).ConclusionThe association between mental problems and risk indicators with oral diseases in Nigerian adolescents indicates a need for integrated mental and oral health care to improve the wellbeing of adolescents.

Migration Intentions and Alcohol Use Among Adolescents in West-Central Mexico.

This study explores the association between migration intentions and alcohol use among west-central Mexico adolescents living in high migration communities. This study used the baseline data from the Family Migration and Early Life Outcomes (FAMELO) project (N = 1286), collected in 2018. We used multiple imputations to address missingness and propensity score matching to reduce the selection bias. We also conducted subgroup analyses to compare gender difference (i.e., boys vs. girls) on the relationship between migration intention and alcohol use. The findings show that for the whole sample, youth with migration intentions had significant higher odds (OR = 1.78; p = .010) of having a lifetime drinking experience when compared to youth who reported no interest in living abroad, but this association remained significant only for boys (OR = 2.14; p = .010). This study makes an important contribution to our understanding of the etiology of migration intentions and alcohol use for adolescents living in sending migration communities. The findings have specific alcohol prevention, policy, and future research implications in Mexico and the U.S.

TO DETERMINE RELATION OF SYMPTOM DURATION IN OUTCOME OF CTS

Background &amp; Method: The study was conducted at the neurology Department of Amaltas Institute of Medical Sciences, Dewas, M.P. In our laboratory, the hands are evaluated for CTS using standard techniques with Nicolet Viking IV (ver12). The skin temperature of the body part, under evaluation, is measured using a probe connected to the machine and is maintained at 310c using a commercial hot air blower.&#x0D; Result: The number of symptomatic hands was more in females (73 vs. 27%) and persons with high BMI (61.5 vs. 38.5); 27.7% of the hands belonged to the persons having concomitant medical issues. Female gender showed slightly higher odds (OR 1.2, CI 0.5-2.6, two-tailed p= 0.5) for remission on medical therapy. The median duration of symptoms of our study population was12 months (mean 24.16 ± 28.93 months). We had 40 patients having CTS in bilateral hands (n= 80 hands), while 50 patients had unilateral hand symptoms (n= 50 hands). Forty-one (31.5%) hands were symptomatic for 10 months or less (median 6 months) while remaining 89 hands were symptomatic for longer than 10 months (median 24 months). Shorter duration of the symptoms, at presentation, had significant higher odds of spontaneous remission (OR 9.47 CI 3.8-23.1, two-tailed p= &lt;0.0001). &#x0D; Conclusion: In conclusion, it seems reasonable to treat subjects of CTS, conservatively for first ten months after symptom onset, more so when they have four or more out of the seven favorable factors.&#x0D; Keywords: Symptom, CTS, MMA &amp; SDL.

S0327 Patient Perspectives and Experience With Colorectal Cancer Screening

INTRODUCTION: Compliance with colorectal cancer (CRC) screening is dependent on patient’s perceptions and care provider’s recommendations. Characterizing the patient’s decision-parameters regarding CRC screening and predictors of getting a colonoscopy has not been well studied. This study addressed both of these aspects of CRC screening from the patient perspective. METHODS: WebMD conducted a consumer survey from May 14 to May 26, 2020. Data were collected anonymously via pop-up from the WebMD page. The study was exempt from institutional review board approval. Respondents were from the United States and were 50 years of age or older. They must have had a CRC screening recommended to them previously. 238 consumers responded; data were used for 233 who had complete responses. Descriptive statistics were calculated, and logistic regression examined significant predictors of getting any CRC screening or a colonoscopy. RESULTS: 69% selected colonoscopy as their CRC screening (Table 1). 15% of participants reported that they discussed multiple options with providers, and only 36% of those got a colonoscopy (Table 2). Participants who discussed multiple tests with their providers had significantly lower odds of getting a colonoscopy (Table 3). Patients who did not discuss multiple options were over 7 times more likely to get a colonoscopy. Patients whose providers recommended a colonoscopy had significant higher odds (3 times as likely to get) of having a CRC screening performed. CONCLUSION: Patient perception of CRC screening is weighted towards detection of cancers and polyps, yet only 69% chose colonoscopy. Notably, patient expressed desire for polyp detection paradoxically was not associated with getting colonoscopy. Although 95% selected detection of precancerous polyps or detection of both cancer and polyps as an important feature of their screening, 30% ultimately didn’t get a colonoscopy. Presenting multiple options when discussing CRC screening may inhibit patient selection of colonoscopy screening. Better understanding of patient’s perspectives for CRC screening identifies areas for patient directed education as well as care providers to direct these conversations. Limitations include the use of a convenience sample, and thereby, data represent those who use the internet to find health information at WebMD.com and are not representative of all races and ethnicities or ages over 50.Table 1.: Descriptive Characteristics for Patient SampleTable 2.: CRC Screening Test Selection for Those Who Discussed Multiple OptionsTable 3.: Logistic Regression Results for Colonoscopy as Last CRC Screening Method

Long-term Survival Analysis of Total Ankle Arthroplasty and Patient Risk Factor for Failure

Category:Ankle; Ankle ArthritisIntroduction/Purpose:The aim of current study is to perform long-term survival analysis for TAA of 5619 cases, and identify patient risk for failure of TAA.Methods:Total of 7516 cases of TAA were identified from national insurance claim data of South Korea during 2007 to 2018. After exclusion of bilateral cases and cases performed on 2018, total 5619 cases of primary TAA cases were included. TAA failure was defined as case with revision arthroplasty or case with TAA implant removal and arthrodesis after primary TAA. Patient age, hospital size, comorbidities were included for survival analysis. Kaplan-Meier survival analysis was performed during study period, and Multivariable Cox regression analysis were performed.Results:During study period, five-year survival rate was 95.4%, and 10-year survival rate was 91.1%, and mean survival duration was 9.6 years. Regression analysis revealed that younger age (< 65, adjusted hazard ration (AHR), 1.812; p< 0.001), chronic pulmonary disease (AHR, 1.476; p= 0.013), diabetes (AHR, 1.443; p= 0.014), alcohol consumption (AHR, 1.524; p= 0.032) showed significant high odds ratio for TAA failure.Conclusion:Current study was performed with largest cohort with TAA procedures in literature. 10-year survival rate was 91.4%, young age and some comorbidities revealed as significant predictor for TAA failure.

Quantification of risk factors for bovine viral diarrhea virus in cattle herds: A systematic search and meta-analysis of observational studies

Bovine viral diarrhea virus (BVDV) is endemic in many parts of the world, and multiple countries have implemented surveillance activities for disease control or eradication. In such control programs, the disease-free status can be compromised by factors that pose risks for introduction or persistence of the virus. The aim of the present study was to gain a comprehensive overview of possible risk factors for BVDV infection in cattle herds in Europe and to assess their importance. Papers that considered risk factors for BVDV infection in cattle were identified through a systematic search. Further selection of papers eligible for quantitative analysis was performed using a predefined checklist, including (1) appropriate region (i.e., studies performed in Europe), (2) representativeness of the study population, (3) quality of statistical analysis, and (4) availability of sufficient quantitative data. In total, 18 observational studies were selected. Data were analyzed by a random-effects meta-analysis to obtain pooled estimates of the odds of BVDV infection. Meta-analyses were performed on 6 risk factors: herd type, herd size, participation in shows or markets, introduction of cattle, grazing, and contact with other cattle herds on pasture. Significant higher odds were found for dairy herds (odds ratio, OR = 1.63, 95% confidence interval, CI: 1.06-2.50) compared with beef herds, for larger herds (OR = 1.04 for every 10 extra animals in the herd, 95% CI: 1.02-1.06), for herds that participate in shows or markets (OR = 1.45, 95% CI: 1.10-1.91), for herds that introduced cattle into the herd (OR = 1.41, 95% CI: 1.18-1.69), and for herds that share pasture or have direct contact with cattle of other herds at pasture (OR = 1.32, 95% CI: 1.07-1.63). These pooled values must be interpreted with care, as there was a high level of heterogeneity between studies. However, they do give an indication of the importance of the most frequently studied risk factors and can therefore assist in the development, evaluation, and optimization of BVDV control programs.

Sjogren\u2019s syndrome is associated with higher rate of non-home discharge after primary hip arthroplasty and higher transfusion rates after primary hip or knee arthroplasty: a U.S. cohort study

BackgroundTo assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA).MethodsWe used the 1998–2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region.ResultsWe examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998 to 2014; 12,772 (0.2%) primary TKAs and 6222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates.ConclusionsPeople with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

Patterns and Prevalence of Germline BRCA1 and BRCA2 Mutations among High-Risk Breast Cancer Patients in Jordan: A Study of 500 Patients.

Purpose Knowledge of BRCA1 and BRCA2 mutations has a significant clinical impact on the management and prevention of breast cancer. In this study, we evaluate the pattern and prevalence of germline mutations in BRCA1 and BRCA2 among high-risk Jordanian breast cancer patients selected as per international guidelines. Methods BRCA1 and BRCA2 testing were performed at a reference genetic lab. Mutations were classified as pathogenic/likely pathogenic and variant of uncertain significance (VUS). Results A total of 517 patients, median age: 39 (range: 19–78) years, were enrolled. Among the whole group, 72 (13.9%) patients had pathogenic or likely pathogenic BRCA1 (n = 24, 4.6%) or BRCA2 (n = 48, 9.3%) mutations, while 53 (10.3%) others had VUS. Among 333 younger (≤40 years) patients, mutations were observed in 44 (13.2%). Positive mutations were found in 40 (16.5%) patients with one or more close relatives with breast cancer and in 20 (35.1%) of the 57 patients with triple-negative disease. Multivariate analysis showed that a triple-negative status, history of two or more close relatives with breast cancer, and history of one or more close relatives with invasive ovarian cancer were associated with significant high odds ratios (OR) of carrying a pathogenic variant, with an OR (95% CI) of 5.08 (2.66–9.67), 3.24 (1.78–5.89), and 2.97 (1.04–8.52), respectively. Conclusions BRCA1 and BRCA2 mutations are not uncommon among Jordanian patients. Young age has the weakest association with positive mutations, while patients with triple-negative disease, especially those with an additional positive family history, have the highest mutation rate.

Does Higher Percentages of Women With Higher Education Within District Impacts Individuals Use of Contraception in Uttar Pradesh?

Uttar Pradesh in India is high fertility state which contributes maximum to India&amp;rsquo;s population growth. The use of family planning method is amongst the lowest in the State and has witnessed a decline during the two consecutive National Family Health Survey (NFHS) period of round 3 &amp;amp; 4. The use of any methods of contraception declined from 56.3% in 2005-06 to 53.5 % in 2015-16. A decline of 2.8 percent points in-spite of all the programmatic push. Similarly, the use of any modern contraceptive methods declined from 48.5% to 47.8% during this period. This decline in the use of contraception necessitates revisiting determinants of contraceptive use at the district (group) level. The availability of district level data from NFHS-4 makes it possible to estimate between district variations in contraceptive use in UP. The Intra-class correlation coefficient of 0.1528 reveals that 15.28 percent of the variation in contraceptive use is due to between district differences in Uttar Pradesh while 84.72 percent variation is due to within district individual differences. At individual level younger age, higher parity, Hindu religion, educated secondary or higher school levels and those belonging to higher SES other than poor quintile have significant higher odds of contraceptive use. At district (group) level, the higher percentages of women educated higher school levels within district significantly determines the use of contraception in Uttar Pradesh.

STUDENTS’ KNOWLEDGE AND RISK OF COMMITTING MEDICATION ERRORS IN TWO SCHOOLS OF PHARMACY IN NIGERIA

Objective: The aim of this study was to determine the knowledge of prescription errors, the certainty of such knowledge, and the risk of committing medication errors among pharmacy students in two universities in Nigeria.&#x0D; Methods: This study was a cross-sectional comparative survey between pharmacy students of two universities in Nigeria: University of Nigeria, Nsukka (UNN) and Nnamdi Azikiwe University (NAU), Awka. Study variables were measured using four simulated prescriptions and questionnaires. Chi-square test, independent t-test, and ordinal regression analyses were used to assess study outcomes.&#x0D; Results: A total of 339 pharmacy students (239 in UNN and 100 in NAU), with a mean age of 24 (2.8) years and 57.2% (n=194) male students, participated in this study. Their accurate knowledge of each of the prescriptions were 294 (86.72%), 166 (48.97%), 199 (58.70%), and 248 (73.16%) for prescriptions with error of drug allergy, error of drug interaction, no error, and wrong dose of a drug, respectively. Students from UNN were more likely to commit a statistically significant high risk of error compared to NAU students in prescriptions with a drug allergy and wrong dose, while students in the 4th year class had a statistically significant higher odds of committing a drug interaction prescription error compared to final year students.&#x0D; Conclusion: Pharmacy students evaluated in this study had good knowledge of medication error detection. The risk of these pharmacy students committing a prescription error was evident in nearly all prescriptions tested and the students’ school was the major predictor of these risks.

Associations between degrees of task delegation and adherence to COPD guidelines on spirometry testing in general practice - a national cross-sectional study

BackgroundThe healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care.MethodsWe carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics.ResultsGPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively).ConclusionDelegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.

Abstract 1202: Spatial analysis of late-stage oropharyngeal cancer diagnosis in Florida: Hierarchical models and geographically-weighted regression

Abstract Literature on spatial variation of cancer outcomes in the US remains scarce. Studies have not assessed how late-stage OPC diagnosis varies across geography nor the effect of spatially different socioeconomic factors. Identifying risk factors that have higher impact on certain localities can help inform clinicians and policy-makers. Our study aimed to evaluate spatial differences in stage of diagnosis of oropharyngeal cancer (OPC) in Florida using hierarchical and geographically-weighted regression (GWR) models. We used the Florida Cancer Data System to derive a cohort of 57,082 patients diagnosed with OPC during 1990-2010. The individual-level covariates that informed our models consisted of age at diagnosis, gender, race, married status, health insurance payer, history of cigarette smoking, and year of diagnosis. Patients' addresses were geocoded to obtain a point feature used to map the spatial distribution of individuals using ArcGIS. A hot-spot analysis (Getis-or-Gi) revealed areas of high clustering of patients with late-stage diagnosis. To evaluate spatially-relevant factors for such variation, we fitted a mixed logistic regression model using PROC GLIMMIX in SAS with the individual-level variables in addition to county and census tract-level covariates. We used US Census data to extract records on the percent of residents unemployed, living in poverty, and foreign-born. Variables for the county level extracted from the Area Health Resource File and the Behavioral Risk Factor Data included the percent of residents engaging in heavy drinking, who couldn't visit a dentist due to cost, and who were smokers, a flag for Health Professional Shortage Areas for primary care doctors and dentists, presence of a hospital with oncology services, and a flag for rural designation. The model showed significant higher odds for late-stage OPC diagnosis for non-White patients (OR 1.63, 95%CI 1.48-1.79 for Black and 1.29, 95%CI 1.03-1.62 for other-race), current smoker status (OR 1.45, 95%CI 1.36-1.54), former smoker status (OR 1.36, 95%CI 1.27-1.45), patients without health insurance (OR 1.60, 95%CI 1.41-1.82), patients covered by Medicaid (OR 1.73, 95%CI 1.5-1.97), patients diagnosed with cancer in pharyngeal sites (OR 4.74, 95%CI 4.53-4.95), and higher percentage of residents in census tract living in poverty (OR 1.01, 95%CI 1.00-1.011). The GWR conducted at the county-level revealed areas where coefficients associated with various risk-factors contributed to a higher proportion of late-stage OPC diagnosis. For easier communication of findings, we created density maps that will be presented. Our study empirically showed variation of late-stage OPC diagnosis across Florida and differential effects of spatial socioeconomic factors. Future public health initiatives can use a targeted approach to focus resources in these specific areas more likely to be impacted. Citation Format: Juan M. Hincapie-Castillo, Yi Guo, Natalie L. Silver, Hong Xiao. Spatial analysis of late-stage oropharyngeal cancer diagnosis in Florida: Hierarchical models and geographically-weighted regression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1202.