Significant Increase In Odds Research Articles

Assessing the need for pioglitazone in the treatment of patients with type 2 diabetes: a meta-analysis of its risks and benefits from prospective trials

The safety and usefulness of pioglitazone (Pio) is repeatedly called into question due to the contradictory information available about it. A meta-analysis and risk benefit assessment was conducted to address the various points of debate regarding Pio. Electronic database search (Cochrane library, Embase & PubMed) resulted in 10 citations eligible for this meta-analysis (prospective, randomised studies), which was conducted using CMA software version 3 (Biostat Inc., Englewood, NJ, USA). The meta-analysis was registered with PROSPERO (ID: CRD42019122403) and compared pioglitazone with a control (anti-hyperglycemic agents without pioglitazone) in patients with either established cardiovascular disease or having high cardiovascular risk. Sensitivity and subgroup analysis were conducted to differentiate the effect of Pio against active controls and placebo. The use of Pio compared to the control group that did not use Pio resulted in a 14% and 23% significant reduction in odds of major adverse cardiac events (MACE: MH-OR, 0.86; 95% CI 0.75–0.98), and stroke (MH-OR, 0.77; 95% CI 0.60–0.99), respectively. This reduction in stroke was not significant in comparison to placebo on subgroup analysis. However, Pio significantly increased odds of heart failure (HF) (MH-OR, 1.47; 95% CI 1.26–1.71) as well as hospitalization for heart failure (hHF) (MH-OR, 1.48; 95% CI 1.21–1.81). In addition, the use of Pio was associated with a significant increase in odds of fractures in women (MH-OR, 2.05; 95% CI 1.28–3.27) and anaemia (MH-OR, 2.56; 95% CI 1.55–4.21). Pio has no significant effect on bladder cancer nor macular oedema. Pio has salutary effects on MACE. The positive effects are completely offset by the harm they seem to cause by way of heart failure, fractures, and anaemia. Pio should therefore be reserved for treatment of T2D with high CV risk or established cardiovascular (CV) disease only in selected patients where other antidiabetics are precluded and not routinely.

Exposure to family and domestic violence is associated with increased childhood hospitalisations.

BackgroundChildren’s exposure to family and domestic violence (FDV) is a global public health concern and is considered one of the most common and severe stressors children can experience. While it is acknowledged that children who are exposed to FDV have poorer general health, there is a lack of data on the outcomes of children exposed to FDV. The use of longitudinal data has been suggested as a way to gain an understanding of the impact on children’s long-term outcomes.MethodsOur cohort study used deidentified individual-level linked administrative data of children born 1987–2010, in Western Australia, who were exposed to FDV in the prenatal period (12 months prior to birth) to five years of age (early years).ResultsChildren exposed to FDV are more likely to be hospitalised than non-exposed children. Children exposed to FDV in both the prenatal and early childhood period had a threefold increased odds of mental health hospitalisation. We found a significant increase in odds of pregnancy-related hospitalisation in FDV exposed children. When stratified by Aboriginal status, Aboriginal children had a higher proportion of hospitalisations than non-Aboriginal children.ConclusionExposed children have an increased likelihood for hospitalisation than non-exposed children. Within the exposed cohort differences were apparent between Aboriginal and non-Aboriginal children. Aboriginal children had greater odds for hospitalisation in most of the diagnostic groups compared to their non-Aboriginal counterparts. Our findings represent an important advance in the literature with respect to the burden of disease of children exposed to FDV.

Role of FTO and MC4R Polymorphisms in Escalating Obesity and Their Indirect Association With Risk of T2D in Indian Population.

IntroductionObesity plays a pivotal role in the development of metabolic syndrome—excessive body fat, spikes in blood glucose levels and hypertension—and ultimately leads to cardiovascular diseases and type 2 diabetes (T2D), if left unattended. The present study aimed to investigate the associated risk of T2D with obesity risk alleles of fat mass and obesity-associated (FTO) and melanocortin 4 receptor (MC4R) genes.MethodsThe study includes 400 subjects (300 T2D diabetic cases and 100 healthy controls). Genetic analysis was done by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods.ResultsThe findings of the study show no significant increase in odds of diabetes associated with the prevalence of FTO and MC4R minor alleles. Rare allele frequencies for “A” of FTO rs9939609 were 0.34 and 0.30 in cases and controls, respectively. Rare allele frequencies for A of MC4R rs12970134 were found to be more common in controls (0.45) than cases (0.41), but the difference was insignificant (p 0.246); however, an increase in body weight with the presence of allele “A” of the FTO gene (p value < 0.001) was found, indicating indirect involvement in the development of T2D. In addition, these were also correlated with the demographic/lifestyle and clinico-pathological parameters between T2D cases and controls. We found that T2D patients with a history of smoking and high consumption of alcohol, fast foods and sweetened beverages are at high risk of T2D compared to healthy controls (p < 0.01*).ConclusionThe present study concludes that there is no direct association of rs9939609 of the FTO gene with the occurrence of diabetes in the Indian population, but its role in T2D development cannot be overlooked altogether. Furthermore, we conclude that the rs9939609 of FTO carries a potential risk of obesity and because of this FTO rs9939609 T > A is widely considered an obesity-associated allele/single-nucleotide polymorphism (SNP).

Vocational Rehabilitation with or without Work Module for Patients with Chronic Musculoskeletal Pain and Sick Leave from Work: Longitudinal Impact on Work Participation

Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.

The Impact of Maternal BMI on Adverse Perinatal Outcomes in Shoulder Dystocia [36D

INTRODUCTION: Increasing BMI is associated with higher risk of shoulder dystocia (SD), but is it associated with other adverse perinatal outcomes (APOs) in the setting of SD? We sought to investigate this association. METHODS: This is a retrospective cohort study of singleton, non-anomalous, term vaginal deliveries complicated by SD between 2007–2011 using linked vital statistics and ICD-9 data. Neonatal outcomes included brachial plexus injury (BPI), clavicular fracture (CVF), 5-min-APGAR &lt;7, neonatal intensive care unit admission (NICUa), and composite of severe neonatal outcomes (neonatal seizure, APGAR score ≤3, neonatal death). Maternal outcomes included postpartum hemorrhage (PPH), 3rd/4th-degree perineal lacerations (PLs), and maternal blood transfusion (MBT). Chi-square tests were used to compare rates of APOs among BMI categories. Multivariable logistic regression was used to control for diabetes status, race/ethnicity, age, education, insurance status, parity, and prenatal care. RESULTS: In a cohort of 21,489 births complicated by SD, we found statistically significant increasing rates of BPIs, CVFs, 5-min-APGAR &lt;7, NICUa, and composite severe neonatal outcomes with rising maternal BMI. Incidence of PLs decreased significantly with increasing maternal BMI. Rates of PPH and MBT were not significantly different between groups. After controlling for confounders, there remained a statistically significant increase in odds of BPI, CVF, and NICUa (aOR 2.35, 1.59, and 1.26 respectively) and decreased odds of PLs (aOR 0.69, 95% CI 0.56–0.84) in obese women. CONCLUSION: Higher maternal BMI increases risk of complications in the setting of SD. Providers should exercise heightened awareness of the effect maternal BMI has on these potential outcomes when managing pregnancies complicated by SD.

Urban-rural disparity of preventive healthcare utilisation among children under the universal health insurance coverage in Taiwan: a national birth cohort analysis

ObjectiveIn the context of universal health insurance coverage, this study aimed to determine whether urban–rural inequality still exists in preventive health care (PHC) amongst children in Taiwan. Study designProspective cohort study. MethodsA total of 184,117 mothers and their children born in 2009 were identified as the study cohort. The number of children born in urban, satellite and rural areas was 40,176, 57,565 and 86,805, respectively. All children were followed for 7 years, before which a total of seven times PHC were provided by Taiwan's National Health Insurance (NHI) programme. Ordinal logistic regression models were used to associate urbanisation level with the frequency of PHC utilisation. Stratified analyses were further performed in accordance with the children's birth weight and the mothers' birthplace. ResultsChildren from satellite areas had higher utilisation for the first four scheduled PHC visits. Children living in urban areas received more PHC for the fifth and sixth scheduled visits. Compared with those from rural areas, children in satellite areas exhibited a small but significant increase in odds in PHC utilisation, with a covariate-adjusted odds ratio (aOR) of 1.04 and 95% confidence interval (CI) of 1.02–1.06. By contrast, no significant difference was observed between rural and urban areas (aOR = 1.01). Further stratified analyses suggest more evident urban–rural difference in PHC utilisation amongst children with low birth weight and foreign-born mothers. ConclusionsGiven a universal health insurance coverage and embedded mechanisms in increasing the availability of healthcare resources in Taiwan, a slight urban–rural difference is observed in PHC utilisation amongst children. Hence, sociodemographic inequality in utilisation of PHC still exists. This issue should be addressed through policy intervention.

Secondhand Smoking and Obesity Among Nonsmoking Adolescents Aged 12-15 Years From 38 Low- and Middle-Income Countries.

IntroductionSecondhand smoking (SHS) may be a risk factor for obesity in adolescence, but data on the association between SHS and obesity are scarce, especially from low- and middle-income countries (LMICs). Therefore, the aim of this study was to assess the association between SHS and obesity among adolescents aged 12–15 years from 38 LMICs.MethodsCross-sectional data from 38 LMICs that participated in the Global School-based Student Health Survey (GSHS) were analyzed. Body mass index was calculated based on measured weight and height. The 2007 WHO Child Growth reference was used to define obesity. SHS was categorized as no exposure, non-daily exposure (ie, 1–6 days), and daily exposure (ie, 7 days) based on the number of days exposed to secondhand smoke in the past 7 days. Multivariable logistic regression and meta-analyses were conducted to assess the associations.ResultsThe analyzed sample consisted of 88 209 adolescents aged 12–15 years who never smoked. The overall prevalence of non-daily and daily SHS was 34.2% and 15.7%, respectively. After adjustment for potential confounders, compared with no SHS, there was no significant association between non-daily SHS and obesity (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.86–1.02), but adolescents who reported daily SHS were significantly more likely to have obesity (OR = 1.19; 95% CI = 1.06–1.34).ConclusionsThe prevalence of SHS was high among adolescents in LMICs, and daily SHS was associated with a significant increase in odds of obesity. Future studies with longitudinal designs are warranted to assess causality and whether prevention of SHS can reduce the risk of obesity in adolescence.ImplicationsIn the present large multi-country study on adolescents aged 12–15 years from LMICs, nearly half of the students were exposed to non-daily or daily secondhand smoke. Overall, while non-daily SHS was not significantly associated with obesity, adolescents who reported daily SHS had a significant 1.19 (95% CI = 1.06–1.34) times higher odds of obesity than those who reported no exposure to secondhand smoke. To the best of our knowledge, this is the first multi-country study on SHS and obesity from LMICs, and also the largest study on this topic to date.

The Impact of Heavy Load Carrying on Musculoskeletal Pain and Disability Among Women in Shinyanga Region, Tanzania.

Background:Heavy load carrying has been associated with musculoskeletal discomfort (MSD) and disability. However, there is a lack of research investigating this association in resource-constrained settings where heavy load carrying by women is common.Objective(s):We assessed the impact of heavy load carrying on musculoskeletal pain and disability among women in Shinyanga Region, Tanzania, in an exploratory cross-sectional study.Methods:Eligible participants were a convenience sample of women, at least 18 years of age, who passed a study recruitment site carrying a load. We collected information on load-carrying practices, including frequency and time spent carrying water, wood, agricultural products, coal, sand, or rocks, and measured the weight of the load carried at the time. Outcomes included self-reported MSDs, defined as experiencing pain lasting >3 days in the neck, head, back, knees, feet and/or ankles within the last 1 year, and related disability. Using multivariable logistic regression we assessed for associations between load carrying exposures and MSDs and disability.Findings:Results showed a high prevalence of MSDs across the body regions assessed and evidence to suggest a relationship of back pain and related disability with several measures of load-carrying, including duration, frequency, and weight. Multivariable analyses revealed associations of increased load carrying exposures with low back pain (LBP) and related disability, including statistically significant increases in odds of LBP with increasing weight, total duration of load carrying/week and cumulative loads/week.Conclusions:Findings indicate a substantial burden of MSDs and disability in this population of women who carry heavy loads daily. The extent of discomfort and disability increased with increasing exposure to various load-carrying measures, especially for LBP. Larger epidemiologic studies that definitively assess relationships of load carrying with MSDs and disability are warranted.

Financial stress experienced by informal carers of adults with a chronic disease: Results from an Australian population-based cross-sectional survey.

To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease. Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics. Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20hours of care per week (AOR=2.39, 95% CI=1.48-3.86), transport assistance (AOR=1.89, 95% CI=1.15-3.09) and assistance with household tasks (AOR=1.92, 95% CI=1.14-3.26) and caring for a person with a mental illness (AOR=2.01, 95% CI=1.24-3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR=0.49, 95% CI=0.30-0.81) or dementia (AOR=0.40, 95% CI=0.21-0.76) was associated with decrease in odds. Financial stress was reported by more than 13% of carers, and factors other than household income were implicated.

409 Risk Factors of Readmission to Hospital for Eosinophilic Esophagitis in United States: A National Readmission Database Analysis

INTRODUCTION: Eosinophilic esophagitis (EoE), once considered a rare entity, is becoming a commonly encountered gastroenterological condition. In addition to increased clinical recognition of EoE, rising EoE related hospitalization in the United States have been reported. Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database, we aimed to identify factors associated with readmissions in population with EoE. METHODS: We performed a retrospective cohort study using 2012-2014 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes, we identified patients with discharge diagnoses of EoE (530.13) and ascertained other related comorbidities (asthma (493.XX) and esophageal reflux (530.81)) during index admission. We evaluated patients with EoE related hospitalization, from January 2012 to November 2014, and analyzed readmissions over 90 days after discharge. Logistic regression analyses were used to examine the factors associated with risk of 90-day readmission. RESULTS: Among 6,877 hospitalizations of EoE patients, 407 (3%) were readmitted within 90 days of the index hospitalization resulting in average annual excess charge of roughly $4 million. The common reasons for readmission were foreign body in the esophagus (6%) and dysphagia (7%). Ninety-eight of readmitted EoE cases were ages 19 years or above, and common comorbidities associated with readmissions were GERD (25%) and asthma (26%). In multivariable analysis of patients with EoE, female compared to males (OR 1.94, 95%CI: 1.16–3.24) and having co-morbid asthma compared to no-asthma comorbidity (OR 1.39, 95%CI: 1.25–3.14) were associated with a significant increase in odds of readmission. There was no significant difference in risk of readmission by the type of insurance. CONCLUSION: In a national sample of inpatients with EoE, the risk of 90-day readmission was significantly associated with female and having asthma co-morbidity. These factors may represent targets for interventions to prevent frequent hospital readmission in this population.

Familial and non-familial risk factors associated with incidence of colorectal cancer in young and middle-aged persons in Western Australia

AimsThe aim of this study was to examine factors including family history, medical history and comorbidities associated with the risk of colorectal cancer (CRC) in young (18–49 years) and middle-age (50–69 years) individuals. MethodsState records were used to identify individuals born in Western Australia between 1945 and 1996, and their first-degree relatives. Individuals in the cohort and their relatives were linked to State cancer registry, hospital and mortality data to identify diagnoses of CRC and other risk factors. The associations between CRC and identified risk factors were examined using multivariable logistic regression. ResultsFor both young and middle-aged patients, family history of CRC, and a history of smoking, inflammatory bowel disease, liver disease and non-CRC cancer were associated with a significant increase in odds of CRC. In middle-aged patients, having a colonoscopy in the previous 10 years was associated with a reduced odds of CRC regardless of the detection of polyps. However, in young patients only the absence of polyps as confirmed by colonoscopy was associated with a decreased risk of CRC (OR: 0.38, 95%CI: 0.26 – 0.54, p < 0.001). ConclusionsMany of the risk factors associated with CRC were similar in young and middle-aged persons, and should be used to identify high risk young patients for screening. The association between colonoscopy and polyps with CRC was modified by age, likely as the result of routine screening in middle-aged patients.

The epidemiologic characteristics and outcomes following intentional burn injury at a regional burn center

IntroductionIntentional burn injury outcomes are usually more severe, have a high mortality and are seen more often in low and middle-income countries. This study will examine the epidemiological characteristics of intentional burn injury patients and mortality outcomes at a regional Burn Center. MethodsThis is a retrospective study of 11,977 patients admitted to a regional Burn center from 2002 to 2015.Variables analyzed were basic demographics (sex, age, and race), total body surface area of burn (%TBSA), presence of inhalation injury, Charlson comorbidity index, intent of injury, mortality, and hospital and ICU length of stay (LOS). Chi-square tests, bivariate analysis and logistic regression models were utilized to determine the effect of burn intent on outcomes. ResultsEleven thousand eight hundred and twenty-three (n = 11,823) adult and pediatric patients from 2002 to 2015 were included in the study. Three hundred and forty-eight (n = 348, 2.9%) patients had intentional burn injuries (IBI). Patients with IBI were younger, 26.5 ± 20 years compared to the non-intentional burn injury (NIBI) group (32 ± 22 years, p < 0.001). Mean %TBSA was significantly higher in the IBI vs. NIBI group at 14.6 ± 20 vs. 6.4 ± 10%, p < 0.001, respectively. Overall, Non-whites (n = 230, 66%) were more likely to have IBI, p < 0.001. Inhalation injury and mortality were statistically significant in the IBI group compared to the NIBI group, (n = 54,16%) vs. (n = 30, 9%) and (n = 649,6%) vs. (n = 329,2.9%), p < 0.001, respectively. Multivariate logistic regression did not show any significant increase in odds of mortality based on burn intent. In subgroup analysis of self-inflicted (SIB) vs. assault burns, SIB patients were significantly older, 38 years (±14.7) vs. 22.4 years (±20.5), p < 0.001 and had a higher %TBSA, 26.5 (±29.6) vs. 10.3 (±13.6), p < 0.001. Seventy three percent (n = 187, 73%) of assault burn patients were Nonwhite and Whites were more likely to incur self-inflicted burns, (n = 53% p < 0.001). ConclusionWe show that patients with intentional burn injuries have an associated increased %TBSA and inhalation injury without increased adjusted odds for mortality. Intentional burns increase health care expenditures. Violence prevention initiatives and access to mental health providers may be beneficial in reducing intentional burn injury burden.

Smoked Tobacco, Air Pollution, and Tuberculosis in Lao PDR: Findings from a National Sample.

In 2017, more than half of the global burden of incident tuberculosis (TB) came from the Western Pacific region. In Lao People’s Democratic Republic (PDR), the high rates of tobacco use and use of polluting biomass fuels for cooking (e.g., wood, charcoal, crop waste, dung) represent significant risk factors for TB. The purpose of this study was to determine the association between self-reported (1) smoking and TB; and (2) exposure to air pollution (from both cooking fires and environmental tobacco smoke) and TB among adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR—a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Utilizing a nationally representative sample and inferential, multivariable methods, we observed a significant increase in odds of self-reported TB among those who smoked tobacco (OR = 1.73, 95% CI = (1.00 to 2.98)). Larger multivariable models identified independent contributions from exposure to tobacco pipes (OR = 21.51, 95% CI = (6.34 to 72.89)) and communal outdoor fires (OR = 2.27, 95% CI = (1.15 to 4.49)). An index measuring combined exposure to smoked tobacco, environmental tobacco smoke in enclosed workspace, indoor cooking fire, trash fires, and other outdoor communal fires also showed a positive association (OR per added exposure = 1.47, 95% CI = (1.14 to 1.89)). The findings of this study underscore the need for multi-sectoral collaboration between tobacco control, environmental health, TB prevention and treatment programs, national authorities, policy makers, civil groups, and the private sector to address the convergence of potential risk factors impacting respiratory health in Lao PDR.

Predictive value of the quantitative fetal fibronectin levels for the management of women presenting with threatened preterm labour - A revised cut off level: A retrospective cohort study.

ObjectiveTo evaluate a new a cut off level of fetal fibronectin as a predictor of birth in women with threatened preterm labour.DesignA retrospective cohort study performed at Ipswich hospital, Ipswich, Queensland, Australia, in women with threatened preterm labour with intact membranes between 23 weeks to 34 + 6 week gestation.Study designA quantitative fetal fibronectin (fFN) was performed. Maternal demographics and birth outcome data were extracted from the routinely collected perinatal data held by the hospital. The odds of preterm birth were estimated for each cut off value of fFN (10, 50 and 200 ng ml−1) using logistic regression and accounting for multiple presentations by the same woman.ResultsAmong the 447 presentations and 376 pregnancies, rates of preterm birth <34 weeks were 2.9%, 9.2%, 3.3%, 19.6%, 4.2% and 35.3% for each category of values respectively (fFN <10, ≥10, <50, ≥50, <200 and ≥200 ng ml−1). Birth rates within 7 d of testing were 1.1%, 7.5%, 1.8%, 16.1%, 2.1% and 41.2% respectively. Comparing fFN level of <10 to a level of 10-199 ng ml−1 there was no significant increase in odds of preterm birth < 34 weeks or birth within the next 7 d (OR 2.28, 95% CI 0.84-6.17 and OR 3.61, 95% CI 0.89-14.7 respectively.ConclusionIn women presenting with TPL, those with levels of <200 ng ml−1 have a low risk of birthing within 7 d or before 34 weeks gestation. This allows a personalised decision making and probable discharge home without need for steroid loading.

Minimally Effective Dose of Bone Morphogenetic Protein in Minimally Invasive Lumbar Interbody Fusions: Six Hundred Ninety Patients in a Dose-Finding Longitudinal Cohort Study.

Retrospective longitudinal cohort. We sought to demonstrate the minimally effective bone morphogenetic protein (BMP) dose to achieve fusion in minimally invasive transforaminal lumbar interbody fusions. Multiple studies have been conducted, which used a wide range of BMP doses for lumbar fusions highlighting associated risks and benefits. There is, however, a paucity in the literature in determining the minimally effective dose. Consecutive patients who underwent transforaminal lumbar interbody fusion from 2009 to 2014 were reviewed. Fusion was determined by a combination of computed tomography and dynamic x-ray by independent radiologists. We used backward stepwise multiple logistic regression with fusion as the dependent variable to determine whether BMP dose/level was a significant predictor for fusion. To determine the minimally effective dose of BMP/level, separate logistic regressions for different BMP dose ranges and sensitivity analyses were used. A P value ≤0.025 was considered significant. There were 1102 interspaces among 690 patients. Average BMP dose was 1.28 mg/level. Overall fusion was 95.2% with a mean follow-up of 19 months. BMP dose/level was a significant predictor for fusion. Odds of fusion increased by 2.02 when BMP dose range was increased from (0.16-1 mg/level) to (1.0-2 mg/level), but fusion odds did not increase when BMP dose increased to more than 2 mg/level. BMP dose/level was a significant predictor for fusion. There was a significant increase in odds of fusion when BMP dose increased from 0.16 to 1 mg/level to 1.0 to 2 mg/level. No benefit from increasing the dose more than 2 mg/level was found, suggesting 1.0 mg/level to be the minimally effective BMP dose. 3.

The impact of substance use on treatment as a compulsory patient.

This paper considers the impact of having a diagnosis of substance use disorder on the utilisation of compulsory orders under the Victorian Mental Health Act (2014). We analysed the subsequent treatment episodes over 2 years of people who had been on a community treatment order for at least 3 months and determined the odds of a further treatment order if there was a diagnosis of substance use at or about the time the index community treatment order ended. An additional diagnosis of a substance use disorder was coded in 47.7% and was associated with significantly increased odds of a subsequent treatment order in the following 2 years for those with a main diagnosis of schizophrenia (AOR = 3.03, p<0.001) and 'other' disorders (AOR = 11.60, p=0.002). Those with a main diagnosis of mood disorder had a significant increase in odds for an inpatient treatment order if there was an additional substance use disorder diagnosis (AOR = 3.81, p=0.006). Having an additional diagnosis of substance use disorder was associated with increased likelihood of being placed on an order. This study supports greater emphasis being given to treatment of substance use concurrently with that of mental illness.

The Odds of Stage IV Melanoma Diagnoses Based on Socioeconomic Factors

When diagnosed at stage 0-I, melanoma has a 5-year survival rate of 92% to 100% in comparison with stage IV, which has a 5-year survival rate of 15% to 20%. The objective of this article is to identify what socioeconomic and demographic factors were associated with increased odds in receiving a delayed melanoma diagnosis. This study analyzed the odds of 108,628 patients from the National Cancer Database who were diagnosed between 2004 and 2012 with American Joint Committee on Cancer stage 0-I and stage IV based on race, sex, insurance type, income, facility type, and education. We identified significantly (P < .05) increased odds of stage IV primary melanoma diagnosis in those who had nonprivate insurance, including Medicare (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.19-1.45), other government insurance (OR = 2.19, 95% CI: 1.61-2.98), Medicaid (OR = 6.97, 95% CI: 5.98-8.13), or no insurance (OR = 5.10, 95% CI: 4.41-5.91). Increased odds of late-stage melanoma were also associated with male sex (OR = 1.46, 95% CI: 1.36-1.57), race and ethnicity other than non-Hispanic white such as Hispanic whites (OR = 1.49, 95% CI: 1.15-1.92) or African Americans (OR=4.81, 95% CI: 3.75-6.18), and who had decreased education (OR = 1.19, 95% CI: 1.09-1.30). There was not a significant increase in odds of late-stage melanoma in patients from areas with the lowest levels of income compared with areas of highest income. Certain socioeconomic and demographic factors are associated with odds of a later-stage melanoma diagnosis.

Impact of Early (

The impact of surgical timing in neurological recovery in thoracic and thoracolumbar traumatic spinal cord injury (tSCI) is still a subject of discussion. While in cervical tSCI one may expect a beneficial effect of early intervention within 24 h, especially in complete cases, this has not yet been demonstrated clearly for thoracic tSCI. This study addresses neurological improvement after early and late surgery for thoracic and thoracolumbar tSCI. A systematic search retrieved 14 publications of observational studies reporting outcome measurements after surgery in 1075 patients with thoracic and thoracolumbar tSCI from PubMed and Embase databases. Surgery was considered early within 24 h and late thereafter. An improvement of at least one and two grades on the American Spinal Injury Association Impairment Scale (ASIA) was evaluated. The Meta-Analyses and Systematic Reviews of Observational Studies guidelines were followed. Improvement rates were summarized using individual patient data in a Bayesian random effects model and compared for those with early and late surgery. In the qualitative analysis, six of seven studies, which investigated the effect of surgical timing, observed a significant effect of early surgery on at least one ASIA grade improvement. Quantitative analysis in 948 patients with thoracic and thoracolumbar tSCI data, however, did not reveal a significant increase in odds of ≥1 ASIA grade recovery in early surgery (66.8% [95% confidence interval (CI): 45.0-87.8%] compared with late surgery (48.9% [95% CI: 25.1-70.7%; odds ratio (OR) 2.2 (95% CI: 0.6-14.0]). This study did not observe a significant beneficial effect of surgical decompression within 24 h in patients with thoracic and thoracolumbar tSCI.

Proband and Familial Autoimmune Diseases Are Associated With Proband Diagnosis of Autism Spectrum Disorders.

There is evidence that parental autoimmune diseases (ADs) are associated with autism spectrum disorders (ASD) in offspring. The association between offspring ASD and ADs diagnosed in siblings and probands remains less clear. We examined whether proband and familial diagnoses of ADs were associated with increased odds of ASD in probands. The study is based on a nested case-control design that used data from a large national birth cohort (N= 1.2 million) in Finland. There were 4,600 cases of ASD and controls matched 1:4 on date of birth, sex, and residence. Data were accessed from national medical, birth, and central registries. Probands had a statistically significant increase in odds of ASD when they (adjusted odds ratio [OR]= 1.2), their mother (adjusted OR= 1.1), or their sibling (adjusted OR= 1.2) were diagnosed with an AD. With regard to specific ADs, we found a statistically significant increase in odds of ASD in probands diagnosed with autoimmune thyroiditis (adjusted OR= 2.7). Further analyses considering ADs by body system yielded a statistically significant increase in odds of ASD in probands with ADs associated with the central/peripheral nervous (adjusted OR= 4.8) and skin/mucous membrane (adjusted OR= 1.3) systems. Probands of mothers diagnosed with ear/eye (adjusted OR= 1.6) or respiratory (adjusted OR= 1.4) ADs, or siblings diagnosed with skin/mucous membrane ADs (adjusted OR= 1.3) also had increased odds of ASD. The findings suggest that there may be common pathogenic, developmental mechanisms related to autoimmunity that are associated with the etiology of ASD.

Hospital admission on weekends for patients who have surgery and 30-day mortality in Ontario, Canada: A matched cohort study.

BackgroundHealthcare interventions on weekends have been associated with increased mortality and adverse clinical outcomes, but these findings are inconsistent. We hypothesized that patients admitted to hospital on weekends who have surgery have an increased risk of death compared with patients who are admitted and have surgery on weekdays.Methods and findingsThis matched cohort study included 318,202 adult patients from Ontario health administrative and demographic databases, admitted to acute care hospitals from 1 January 2005 to 31 December 2015. A total of 159,101 patients who were admitted on weekends and underwent noncardiac surgery were classified by day of surgery (weekend versus weekday) and matched 1:1 to patients who both were admitted and had surgery on a weekday (Tuesday to Thursday); matching was based on age (in years), anesthesia basic unit value for the surgical procedure, median neighborhood household income quintile, resource utilization band (a ranking system of overall morbidity), rurality of home location, year of admission, and urgency of admission. Of weekend admissions, 16.2% (25,872) were elective and 53.9% (85,744) had surgery on the weekend of admission. The primary outcome was all-cause mortality within 30 days of the date of hospital admission. The 30-day all-cause mortality for patients admitted on weekends who had noncardiac surgery was 2.6% (4,211/159,101) versus 2.5% (3,901/159,101) for those who were admitted and had surgery on weekdays (adjusted odds ratio [OR] 1.05; 95% CI 1.00 to 1.11; P = 0.03). However, there was significant heterogeneity in the increased odds of death according to the urgency of admission and when surgery was performed (weekend versus weekday). For urgent admissions on weekends (n = 133,229), there was no significant increase in odds of mortality when surgery was performed on the weekend (adjusted OR 1.02; 95% CI 0.95 to 1.09; P = 0.7) or on a subsequent weekday (adjusted OR 1.05; 95% CI 0.98 to 1.12; P = 0.2) compared to urgent admissions on weekdays. Elective admissions on weekends (n = 25,782) had increased risk of death both when surgery was performed on the weekend (adjusted OR 3.30; 95% CI 1.98 to 5.49; P < 0.001) and when surgery was performed on a subsequent weekday (adjusted OR 2.70; 95% CI 1.81 to 4.03; P < 0.001). The main limitations of this study were the lack of data regarding reason for admission and cause of increased time interval from admission to surgery for some cases, the small number of deaths in some subgroups (i.e., elective surgery), and the possibility of residual unmeasured confounding from increased illness severity for weekend admissions.ConclusionsWhen patients have surgery during their hospitalization, admission on weekends in Ontario, Canada, was associated with a small but significant proportional increase in 30-day all-cause mortality, but there was significant heterogeneity in outcomes depending on the urgency of admission and when surgery was performed. An increased risk of death was found only for elective admissions on weekends; whether this is a function of patient-level factors or represents a true weekend effect needs to be further elucidated. These findings have potential implications for resource allocation in hospitals and the redistribution of elective surgery to weekends.