Simple Logistic Regression Analysis Research Articles

Evaluation of Adverse Outcome Predictors in Neonatal Seizure: A Longitudinal Study from a Tertiary Centre of Eastern India

Introduction: Neonatal seizures are common but can be manifestations of serious underlying disorders and sometimes have a grave prognosis. Predictors for adverse outcomes are important for early referral and advanced interventions. Aim: To study the incidence and factors associated with neonatal seizure and to determine the predictors of adverse outcomes. Materials and Methods: This was a longitudinal study, conducted from April 2020 to March 2021 at a Rural Medical College (Midnapore Medical College and Hospital, West Bengal) in Eastern India. All the admitted newborns (N=143) in the Special Newborn Care Unit (SNCU), who had clinically evident seizures, were included in the study. Data were collected regarding the perinatal history, gestational age, type of delivery, birth weight, APGAR score at 1 and 5 minutes, and need for resuscitation at birth. The onset of the seizure, seizure type, investigation findings, possible aetiological diagnosis, and final outcome was noted. The management of neonatal seizures was as per the institutional protocol. Babies were followed up for a minimum of 28 days or throughout their hospital stay till discharge/death. The outcome was categorised into two categories: ‘favourable’ when there was a normal neurological examination and ‘unfavourable’ when there was any neurological impairment or death. Statistical analyses were performed using the Statistical Package for Social Sciences software version 25 (SPSS Inc., Chicago, IL, USA). Risk factors were determined by analysing outcomes using simple and multivariate logistic regression analysis. The p-values less than 0.05 were considered as statistically significant. Results: A total of 143 newborns had seizures out of 3126, making the incidence of neonatal seizures 4.57%. Males outnumbered females. Total 64.33% were preterm. Five minutes APGAR score <7 was noticed in 44.75%. The most common type was subtle seizure. Advanced resuscitation manoeuvre was required for 46.8% cases whereas mechanical ventilation was required in 11.88%. The most common aetiology was birth asphyxia (46.15%), and the cranial ultrasound showed Hypoxic Ishchaemic Encephalopathy (HIE) changes in 30.77% of cases. Multiple logistic regressions revealed only four factors, namely, preterm delivery (OR 5.82), need for extensive resuscitation manoeuvre (OR 6.21), presence of status epilepticus (OR 3.49) and abnormal cranial ultrasound (OR 1.02) to be the independent risk factors for unfavourable outcome. Conclusion: Clinical diagnosis of neonatal seizure could be useful in resource poor centers, where video-Electroencephalogram (EEG) is not available. Premature delivery, need for extensive resuscitation, presence of status epilepticus and abnormal cranial ultrasound were associated with poor short-term outcome.

Influence of Organizational Structure on the Performance of Financial Services Associations in Makueni and Kitui Counties of Kenya.

On the surface, the concept of strategy implementation may sound relatively simple, whereby a strategy is developed and put into practice. However, putting strategies into practice is far more challenging and complicated. The present study sought to determine the influence of organizational structure on the performance of FSA in Kitui and Makueni counties. The study adopted a cross-sectional survey research design, the sample for the study was 280 obtained through a stratified random sampling technique from a population of 938 possible participants. The study applied a questionnaire to gather data for the study using both physical and electronic procedures. Data was analyzed through descriptive and inferential analysis, where a simple binary logistic regression analysis was applied to test a null hypothesis. The study revealed a β of 0.973, a Wald statistic of 21.285, df= 1, and an Exp(B) = 4.812 which was associated with a p-value of 0.001. Firms that adopted flat structures instead of tall structures increased the odds of high performance by a factor of 4.812. The study concluded that organizational structure had a positive and significant influence on the performance of the FSA in Kitui and Makueni counties. The study also recommends for adoption of a flat organizational structure to promote a structure that is a flexible and responsive organizational structure to enhance performance.

Patient´s oral health literacy and associations with sociodemographic, source of information, and oral health variables

The objective of this study was to evaluate the levels of Oral ealth Literacy (OHL) among adult patients attending in a university dental clinic (UDC) and associations with diverse variables. A crosssectional study was conducted with a sample of 312 adult users of a UDC, from February to July 2018. Data collection was done by using a self-administered questionnaire including demographics, HeLD-14 for evaluating OHL, sources for accessing information about oral health, self-rated oral health (SROH), and reasons to look for the dentist. Simple and multiple logistic regression analyses were performed to assess the level of association between independent and dependent variables (OHL). The median value for HeLD-14 was 44.2 (sd=7.8). In the final model, the following users had a significantly higher likelihood of presenting lower OHL levels compared to their counterparts: those with up to elementary school (OR: 3.82, 95%CI: 1.85-7.88), those whose income was less than or equal to 2 Brazilian Minimum Wages (OR: 3.65, 95%CI: 1.37-9.76), those who use television/radio/newspaper/magazines/others as theirmain source of oral health information (OR: 1.97, 95%CI:1.17-3.30), those who classified their SROH as fair/poor (OR: 1.88, 95%CI: 1.08-3.26), and those who had gone to the dentist the last time due to pain/extraction (OR: 2.28, 95%CI: 1.35-3.85). The users' OHL levels were associated with sociodemographic variables, sources of information, and oral health, a fact that must be considered by dental students and their professors, in the processes of communication and health education with UDC users, to provide better oral health care for them.

Developing erythromycin resistance gene by heavy metals, Pb, Zn, and Co, in aquatic ecosystems

Industrial development is the main cause of environmental pollution with various substances such as antibiotics and heavy metals. Many heavy metals with antimicrobial properties could contribute to antibiotic resistance and the emergence of antibiotic resistance genes due to the co-selection phenomenon. The aim of this study was to investigate the concurrent presence and correlation between several heavy metals and the erythromycin resistance genes in six aquatic ecosystems of Iran. Distribution and assessment of 11 erythromycin resistance genes were investigated using specific primers and online enrichment and triple-quadrupole LC–MS/MS. The concentration of heavy metals was measured using inductively coupled plasma atomic emission spectroscopy by Thermo electron corporation. Principal component analysis was performed to globally compare and to determine the similarities and differences among different aquatic ecosystems in different parts of the world in terms of the concentration of zinc and lead in their water. The results of the simple logistic regression analysis for the correlation between erythromycin resistance genes and heavy metals concentrations revealed the most significant correlation between erythromycin resistance genes and Pb concentration, followed by Co and Zn concentrations.

Prediction of recurrent course of respiratory infections in premature infants

The problem of prevention of frequent respiratory diseases for children remains relevant. Among premature infants, the most vulnerable group are children with very low and extremely low birth weight. Therefore, the development of a clinical prognostic model for the development of respiratory recurrent infections in premature infants may be the basis for creating a preventive program of early intervention. Purpose - to determine the clinical and genetic determinants of the development of recurrent respiratory infections for children born with a body weight less than 1500 g and to develop an algorithm for early prediction of adverse effects. Materials and methods. A cohort prospective study was conducted, which involved 155 children with very low and extremely low body weight. Prediction of the development of recurrent respiratory diseases was performed using simple and step-by-step multiple logistic regression analysis. Genetic methods included polymorphism studies of the GSTP1, GSTT1, GSTM1, ACE, AGT2R1 and eNOS genes. Results. Important predictors of increased morbidity of the examined children in a simple logistic regression analysis were: body weight at 12 months <10 percentile, rickets in the first year of life and artificial feeding at discharge from the neonatal hospital. The study showed no effect of genes polymorphism of the glutathione-S-transferase family and genes of the renin-angiotensin system on the development of recurrent respiratory infections in children with born weight less than 1500 g. Conclusions. The developed model for predicting the recurrent course of respiratory infections for children born with a body weight less than 1500 g has a high specificity (95.35%) and moderate sensitivity (76.90%), which indicates the possibility of its use for a personalized approach to prevention adverse effects. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Effect of Sexually Transmitted Disease Services in Type B Hospitals on Patient Self-Treatment

Background: Self-treatment is still a problem in disease treatment (Rakhmawati and Anggraini, 2010). This is supported by the large availability of drugs that are sold over the counter (Hadi, et. Al., 2010). However, there is not much research data regarding self-treatment by patients with sexually transmitted diseases (STD) and its relationship to hospital services. This study aimed to examine the effect of sexually transmitted disease ambulatory units services at Type B Hospital on patients self-treatment. Methods : The study was an analytic cross-sectional study. A total of 60 patients had their disease checked at the Sexually Transmitted Infectious Diseases Unit at the Dermatology and Venereology Department of the Regional General Hospital Dr. Soetomo Surabaya were selected consecutively and were interviewed about their experience with STD ambulatory services at type B hospitals and self-treatment. Simple and multiple logistic regression analyses were performed to prove the effect of the services on self-treatment at a significance level of 0.05. Results : Self-treatment was performed by 71.7% of the respondents. The distance to STD services of type B hospital that more than 8 km increased self-treatment (p = 0.042 OR = 4.043 95% CI = 1.050 - 15.568), while age (p = 0.063), gender (p = 0.126), treatment staff (p = 0.197), satisfaction (p = 0.298), type of disease (p = 0.967), duration of illness (p = 0.201) had no effect on self-treatment. Conclusions : Sexually transmitted disease services in type B hospitals did not affect the patients self-treatment behavior, but the distance of more than 8 km to the service increased patients self-treatment. STD services need to be expanded in such a way that the distance to the service is less than 8 kilometers.

Which Performance Tests Best Define the Special Judo Fitness Test Classification in Elite Judo Athletes?

The normative values of the Special Judo Fitness Test (SJFT) are used to evaluate judo athletes, and the question arises of which performance tests from crucial motor abilities best define the SJFT classification in elite judo athletes. This study aimed to investigate the relationship between elite judo athletes' physical performance and the evaluation using SJFT index norms. Nineteen judo athletes (11 females) (22.8 ± 2.5 years old) from the senior judo national team voluntarily participated in this study. Body composition, reaction time, balance, flexibility, agility, hand grip strength, 20 m sprint, vertical jump, SJFT, and Wingate tests were performed by athletes on four separate days at one-day intervals. Athletes were classified as regular and above (≥regular) or poor and below (≤poor) according to their SJFT index scores. Simple logistic regression analysis was used to evaluate this classification's consistency with performance test results. Odds ratios (OR) and 95% confidence intervals related to each possible factor and Wald test statistics were calculated. The SJFT index classification was associated with Wingate peak and mean power, vertical jump, and sprint performance results (p < 0.05), whereas it was not associated with body fat percentage, agility, reaction time, hand grip strength, flexibility, and balance performances (p > 0.05). SJFT index classificatory norms are mainly related to athletes' anaerobic power. Higher anaerobic power increases athletes' possibility of being classified as ≥regular.

Risk stratification system and visualized dynamic nomogram constructed for predicting diagnosis and prognosis in rare male breast cancer patients with bone metastases.

Bone metastases (BM) from malignant tumors could disrupt the balance between osteoclasts and osteoblasts and affect bone homeostasis. Malignant breast cancer (BC) is rare in male patients, and co-occurrence of BM is even rarer. Given its low incidence, there is limited research evaluating risk and prognosis. Despite the widespread application of nomograms to predict uncommon malignancies, no studies have constructed predictive models focusing on the diagnosis and prognosis of male breast cancer with bone metastases (MBCBM). This study selected all male breast cancer patients (MBC) between 2010 and 2019 in the Surveillance, Epidemiology, and End Results (SEER) database. We used simple and multivariate Logistic regression analyses to identify independent risk factors for BM in MBC patients. Then simple and multivariate Cox regression analyses were employed to determine the independent prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in MBCBM patients. We established and validated three new nomograms based on these independent factors. A total of 4187 MBC patients were included, with 191 (4.56%) having bone metastases at the time of diagnosis. The independent risk factors of BM in MBC patients included age, tumor size, marital status, T stage, and N stage. In MBCBM patients, independent prognostic factors for OS and CSS were both age, T stage, ER status, PR status, and surgery. The concordance index (C-index), the area under the curve (AUC) of the receiver operating characteristic curve (ROC), the calibration curve, and the decision curve analysis (DCA) confirmed that these three nomograms could accurately predict the diagnosis and prognosis of MBCBM patients with excellent discrimination and clinical utility superior to the TNM staging system. We then established two prognostic-based risk stratification systems and three visualized dynamic nomograms that could be applied in clinical practice. In conclusion, this study aimed to establish and validate an accurate novel nomogram to objectively predict the diagnosis and prognosis of MBCBM patients. On this basis, prognostic-based risk stratification systems and visualized dynamic nomograms were constructed to facilitate doctors and patients to quantify individual BM risk probability and survival probability to assist in personalized risk assessment and clinical decision-making.

Quality of Life and Its Association with Effort-Reward Imbalance among Medical Officers Working in Government Hospitals in Kuching, Sarawak, Malaysia.

Medical officers (MOs) face multiple sources of work-related stress, including work system transition, job insecurity, dissatisfaction with income and intense working environments. This study aimed to examine the quality of life (QOL), effort-reward imbalance (ERI) and their association among MOs working in government hospitals in Kuching, Sarawak, Malaysia. This cross-sectional study was conducted among MOs from Sarawak General Hospital and Hospital Sentosa from May 2018 to March 2020. A total of 614 participants were selected through convenient sampling. An email with a link to three sets of questionnaires via Google forms including a questionnaire on sociodemographic data and job characteristics, the World Health Organization Quality of Life-Brief version (WHOQOL-BREF) (Malay version) and the effort-reward imbalance (ERI-Q) (long version) was sent to potential participants. A total of 276 MOs completed and returned the questionnaires. Data were analysed using descriptive, simple and multiple logistic regression analysis. A P-value of less than 0.05 was taken as a statistically significant result. Most MOs reported no adversity in the workplace (i.e. 29% low effort/high reward, 5.1% high effort/high reward, 6.2% low effort/low reward and 23.6% high effort/low reward). More than half of MOs (54%) reported poor general QOL and were associated with a combination of active and passive on-calls (adjusted odds ratio [AOR] = 5.36, 95% confidence interval [CI]: 1.21, 23.79). Poor QOL in the physical domain was associated with the presence of chronic illness (AOR = 23.35; 95% CI: 4.25, 128.45), active on-calls (AOR = 14.75; 95% CI: 1.16, 188.35) and a combination of active and passive on-calls (AOR = 18.25; 95% CI: 1.39, 238.98). Men had a higher risk of poor QOL in the environmental domain (AOR = 2.03; 95% CI: 1.04, 3.98). Only 23.6% of MOs reported psychosocial adversity at work (high effort/low reward). High effort/low reward was associated with poor QOL in general (AOR = 4.71; 95% CI: 1.71, 13.01), physical (AOR = 4.53; 95% CI: 2.02, 10.17), psychological (AOR = 5.95; 95% CI: 2.82, 12.58) and environmental domains (AOR = 4.21; 95% CI: 1.95, 9.08). Low effort/high reward was found to have a lower likelihood of poor QOL in the social domain (AOR = 0.13; 95% CI: 0.04, 0.44). Higher ERI was found to be associated with poor QOL among MOs in government hospitals. Future research should focus on interventions to improve working conditions.

Mistreatment of Women during Childbirth and Associated Factors in Northern West Bank, Palestine.

Mistreatment of women during childbirth is a clear breach of women’s rights during childbirth. This study aimed to determine the prevalence and associated factors of mistreatment of women during childbirth in the north of West Bank, Palestine. A cross-sectional study was conducted among 269 women within the first 16 weeks of their last vaginal childbirth to understand the childbirth events by using proportionate stratified random sampling. An Arabic valid questionnaire was used as a study instrument. Simple and multiple logistic regression analyses were conducted to determine the factors associated with each type of mistreatment. The mean age of the women was 26.5 (SD 4.77) years. The overall prevalence of mistreatment was 97.8%. There were six types of mistreatment. Nine factors were significantly associated with the occurrence of one or more types of mistreatment. Delivery at a public childbirth facility was associated with all of the six types (aAdjOR: 2.17–16.77; p-values < 0.001–0.013). Women who lived in villages (aAdjOR 2.33; p-value = 0.047), had low education (aAdjOR 5.09; p-value = 0.004), underwent induction of labour (aAdjOR 3.03; p-value = 0.001), had a long duration of labour (aAdjOR 1.10; p-value = 0.011), did not receive pain killers (aAdjOR: 2.18–3.63; p-values = 0.010–0.020), or had an episiotomy or tear (aAdjOR 5.98; p-value < 0.001) were more likely to experience one or more types of mistreatment. With every one-hour increase in the duration of labor, women were 1.099 times more likely to experience a failure to meet the professional standard of care. Women were less likely to experience mistreatment with increasing age. Women with increasing age (aAdjOR: 0.91–0.92; p-values = 0.003–0.014) and parity (aAdjOR 0.72; p-value = 0.010) were less likely to experience mistreatment. Awareness of women’s fundamental rights during childbirth, making the childbirth process as normal as possible, and improving the childbirth facilities’ conditions, policies, practices and working environment may decrease mistreatment occurrence.

Plasma miR-451a predicts atrial fibrillation recurrence after pulmonary vein ablation

Abstract Background/Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia diagnosed in European countries. Several studies have shown that catheter ablation is a more effective treatment than antiarrhythmic drugs and should be prioritised in symptomatic patients. However, AF recurrence after catheter ablation remains a challenge. MiRNAs have been identified, in recent years, as epigenetic modulators in numerous biological processes, including cardiac electric conduction. MiRNAs can be easily detected in the circulation, making them attractive as potential biomarkers for risk stratification in AF patients. Purpose Our purpose is to find a miRNA able to predict the AF recurrence after catheter ablation. Methods 44 patients submitted to catheter ablation were consecutively recruited and classified based on recurrence after a follow up of 12 to 48 months. Peripheral and left atrium blood samples were collected before catheter ablation. Human Cardiovascular Disease miScript miRNA PCR Arrays were performed to analyse 84 miRNAs altered in cardiovascular disease. Significant miRNAs changes in ΔCt levels were assessed using Two-way ANOVA and post hoc Tukey tests. Simple logistic regression analysis was performed to analyse association to AF recurrence. KEGG pathway enrichment analysis was performed to identify the most enriched targets and pathways involved in AF recurrence. Results In our cohort, overall recurrence rate was 47.7%. qPCR expression analysis showed increased levels of miR-328-3p and decreased levels of miR-486-5p in recurrent patients, both in peripheral as well as left atrial blood. Our results also showed decreased levels of miR-let-7b-5p and miR-451a in recurrent patients, but selectively regulated in peripheral and atrial blood, respectively (Figure 1). Simple logistic regression analysis showed a significant association between blood atrial levels of miR-451a and AF recurrence (Figure 2A). KEGG pathway enrichment analysis showed that miR-451a could be involved in epigenetic regulation of myocardial electromechanic integrity (Figure 2B). Conclusion Expression analysis of atrial blood miR-451a levels, prior to catheter ablation, could be a good a risk stratifier of recurrence. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IN607A2019/02. Xunta of Galicia. Grants for the consolidation and structuring of competitive research units in the universities of the Galician University System, in the public research organizations of Galicia and in other entities of the Galician R&amp;D System 2019

Factors associated withspontaneous nystagmus changes in acute Ménière's disease.

Neuro-otological factors that influence changes in spontaneous nystagmus (SN) during vertigo attacks in Ménière's disease (MD) remain unclear. To identify neuro-otological factors that might influence the initial direction of SN and the directional change of SN. A prospective, observational study of 22 patients with definite MD to evaluate the initial direction and directional change of SN during vertigo attacks, endolymphatic hydrops (EH) volume, and the function of horizontal semicircular canal and hearing levels. SN consistently began as irritative in 17 of 22 cases, and 9 of 17 cases showed a definite change in direction after onset. SN consistently began as paralytic in 5 of 22 cases, and 3 of 5 cases showed a definite change in direction after onset. Subjects in the irritative initial SN group had less severe degrees of hearing loss, smaller cochlear and vestibular EH volume than the paralytic initial SN group (P = 0.017, < 0.001, and 0.009, respectively). Subjects in the SN direction change group had significantly smaller maximum slow phase velocity, percentage of caloric weakness and canal paresis than the no SN direction change group (P = 0.001, 0.006, and 0.001, respectively). Simple logistic regression analysis showed that smaller EH volume was significantly associated with initial irritative SN (OR = 0.867, 95% CI 0.762-0.988, P = 0.032) and that the degree of canal paresis was negatively associated with the presence of directional change of SN (OR = 0.022, 95% CI 0.002-0.289, P = 0.004). The morphology of EH and canal paresis may independently affect the characteristics of SN in patients with MD.

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study.

Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients’ life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan–Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients’ disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50–69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan–Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, “Gender” (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56–7.81, p-value = 0.040), “Presence of metastases” (HR: 3.76; 95% CI: 1.89–7.32, p-value = 0.010), “Metastasis site: Liver” (HR: 5.04; 95% CI: 1.71–19.05, p-value = 0.039), “Lymphovascular permeation” (HR: 2.94; 95% CI: 1.99–5.92, p-value = 0.021), and “CEA-level” (HR: 2.43; 95% CI: 1.49–5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient’s comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.

A Retrospective Cross-Sectional Study on the Association Between Newborn’s Head Circumference at Birth and Obstetric Anal Sphincter Injuries among Primigravidae

Introduction: Obstetric anal sphincter injuries (OASIS) is a term used to describe third- and fourth- degree perineal trauma during childbirth. There are a lot of risk factors associated with OASIS, however newborn’s head circumference (HC) at birth as a risk factor is understudied. The aim of this study was to determine the incidence of OASIS and establish the association between newborn’s HC at birth and OASIS among primigravidae who delivered in Hospital Raja Permaisuri Bainun (HRPB) from 2016 to 2018. Other OASIS risk factors were also analysed. Methods: This was a retrospective cross-sectional study among primigravidae who delivered in HRPB from 2016 till 2018. Systematic sampling method was used, and the total sample recruited was 538. Women who sustained OASIS were compared to women without OASIS. Simple and multiple logistic regression analysis were used to look for the association between associated risk factors and OASIS. Results: The incidence of OASIS in HRPB during the study period was 2.0%. Newborn’s HC at birth (p=0.588) was not significantly associated with OASIS, whereas birth weight (OR 1.002 95%CI 1.001-1.004 p=0.06) and instrumental delivery (OR 8.13 95%CI 1.91-34.59 p=0.05) were significant risk factors for OASIS. Conclusion: Overall incidence of OASIS in HRPB was 2.0%, which is within the normal range. Newborn’s HC was not significantly associated with the occurrence of OASIS. Birth weight and instrumental delivery were significant risk factor for OASIS. This information can be used for patient counselling and shared decision making.

Maternal overweight and obesity and its associated factors and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected black South African pregnant women.

This study aimed to investigate various variables between maternal overweight and/or obesity versus normal-weight pregnant black South African women living with and without human immunodeficiency virus (HIV). A cross-sectional study design was employed. A total of 200 pregnant women were enrolled in the study, categorized according to body mass index (BMI) (kg/m2 ) into two groups: (1) overweight/obese (≥25 kg/m2 ) (n=97); and (2) nonoverweight/nonobese (<25 kg/m2 ) (n=103), where 90 were HIV-infected and 110 were HIV-uninfected. The differences between the maternal BMI categories were assessed using Fisher's exact t-test and the χ2 test. Simple and multiple logistic regression analyses were used to determine factors associated with maternal overweight and obesity. Multiple logistic regression analysis showed that maternal age (odds ratio [OR]: 1.061; 95% confidence interval [CI] 1.008-1.117; p=0.023) and gestational age (OR: 1.121; 95% CI 1.005-1.251; p=0.041) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. For maternal health outcomes, multiple logistic regression analysis showed that hypertensive disorders (OR: 0.273; 95% CI 0.124-0.601; p=0.001) and anemia (OR: 2.420; 95% CI 1.283-4.563; p=0.006) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. The overweight/obese HIV-infected participants (OR: 0.233; 95% CI 0.075-0.717; p=0.011) had increased odds for developing hypertensive disorders compared to HIV-uninfected overweight/obese participants (OR: 0.471; 95% CI 0.172-1.291; p=0.143). Maternal overweight/obesity in both HIV-infected and HIV-uninfected pregnant black South African women was significantly associated with maternal age, gestational age, HPT disorders, and anemia. Maternal overweight/obesity decreased the odds for anemia, but increased the odds for the development of HPT disorders, especially in the HIV-infected pregnant women.

The impact of comorbid spinal pain in depression on work participation and clinical remission following brief or short psychotherapy. Secondary analysis of a randomized controlled trial with two-year follow-up

This explorative study analyses the influence of baseline comorbid long-lasting spinal pain (CSP) on improvement of long term work participation and clinical remission of mental health illness following either brief coping-focussed or short-term psychotherapy for depression. Whether type of treatment modifies outcome with or without CSP is also analysed. A secondary post hoc subgroup analysis of a pragmatic randomised controlled trial. Brief or standard short psychotherapy. Based on baseline assessment, the sample was subdivided into a subgroup with and a subgroup without CSP. Work participation and clinical remission of depression and anxiety were assessed as treatment outcome at two-year follow-up. Simple and multivariate logistic regression analyses, across the intervention arms, were applied to evaluate the impact of CSP on treatment outcome. Selected baseline variables were considered as potential confounders and included as variates if relevant. The modifying effect of CSP on treatment outcome was evaluated by including intervention modality as an interaction term. Among the 236 participants with depressive symptoms, 83 participants (35%) were identified with CSP. In simple logistic regression analysis, CSP reduced improvements on both work participation and clinical remission rate. In the multivariate analysis however, the impact of CSP on work participation and on clinical remission were not significant after adjusting for confounding variables. Reduction of work participation was mainly explained by the higher age of the CSP participants and the reduced clinical remission by the additional co-occurrence of anxiety symptoms at baseline. The occurrence of CSP at baseline did not modify long term outcome of brief compared to short psychotherapy. CSP at baseline reduced work participation and worsened remission of mental health symptoms two-year following psychotherapy. Older age and more severe baseline anxiety are associated to reduced effectiveness. Type of psychotherapy received did not contribute to differences.

111. Risk factors for ambulatory surgery conversion to extended stay among patients undergoing one- or two-level posterior lumbar decompression

<h3>BACKGROUND CONTEXT</h3> Ambulatory surgery (AMS), or outpatient surgery, is increasingly common for patients with lumbar spine disease. Previous reports suggest AMS is associated with lower cost and similar quality of care compared to conventional inpatient spine surgery. Under the current Center for Medicare and Medicaid services (CMS) two-midnight rule, a prolonged stay beyond 48 hours is considered an inpatient admission. AMS patients may unintentionally be subjected to extended hospital stays, which can lead to higher medical costs. An unanticipated extension of hospitalization can be a great burden not only to patients, but to medical providers and insurance companies. However, little is known about the risk factors for AMS conversion to extended stay. <h3>PURPOSE</h3> To investigate the factors associated with the conversion of patient status from ambulatory surgery (outpatient) to observation stay (OS) (less than 48 hours) or inpatient (greater than 48 hours). <h3>STUDY DESIGN/SETTING</h3> Retrospective study. <h3>PATIENT SAMPLE</h3> This study included 1,096 adult patients undergoing one- or two-level lumbar decompression surgery at a single academic institution from January 1, 2019 to March 16, 2020. <h3>OUTCOME MEASURES</h3> Conversion rate and risk factors from AMS to OS or inpatient. <h3>METHODS</h3> Ethical board approval was obtained for this study. The records of patients who underwent one- or two-level lumbar decompression surgery planned for AMS were retropectively reviewed. Patients were categorized in three groups based on length of stay that consisted of AMS, OS (less than 48-hour stay), and inpatient (staying greater than 48 hours). Data on patient demographics, medical co-morbidities, surgical information including intraoperative complications and postsurgical pain scores, and administrative information such as operation start time were collected. Simple and multivariable logistic regression analyses were conducted comparing AMS patients and OS/inpatient. Statistical signicance was defined as p <0.05. <h3>RESULTS</h3> Of the 1,096 patients, 641 (58%) patients were converted to either OS (486, 44%) or inpatinet (155, 14%) status. The multivariable analysis demonstrated that age (>80 years old), high ASA grade, history of sleep apnea, drain use, high estimated blood loss, long operation, laminectomy for spinal stenosis, late operation start time, and a high pain score in the acute care unit were considered independent risk factors for AMS conversion to OS/inpatient status. <h3>CONCLUSIONS</h3> Our results indicated that several surgical factors along with patient factors are significantly associated with AMS conversion. Addressing modifiable surgical factors, such as blood loss and operation start time and postoperative pain management might reduce the AMS conversion rate and be beneficial to patients and facilities. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Inflammatory Indexes as Prognostic Factors of Survival in Geriatric Patients with Hepatocellular Carcinoma: A Case Control Study of Eight Slovak Centers.

Background and Aims: Hepatocellular cancer (HCC) often occurs in geriatric patients. The aim of our study was to compare overall survival and progression-free survival between geriatric patients (>75 years) and patients younger than 75 years and to identify predictive factors of survival in geriatric patients with HCC. Material and Methods: We performed a retrospective analysis of patients with HCC diagnosed in Slovakia between 2010–2016. Cases (HCC patients ≥75 years) were matched to controls (HCC patients <74 years) based on the propensity score (gender, BCLC stage and the first-line treatment). Results: We included 148 patients (84 men, 57%) with HCC. There were no differences between cases and controls in the baseline characteristics. The overall survival in geriatric patients with HCC was comparable to younger controls (p = 0.42). The one-, two-, and three-year overall survival was 42% and 31%, 19% and 12%, and 12% and 9% in geriatric patients and controls, respectively (p = 0.2, 0.4, 0.8). Similarly, there was no difference in the one- and two-year progression-free survival: 28% and 18% vs. 10% and 7% in geriatric HCC patients and controls, respectively (p = 0.2, 1, -). There was no case–control difference between geriatric HCC patients and younger HCC controls in the overall survival in the subpopulation of patients with no known comorbidities (p = 0.5), one and two comorbidities (p = 0.49), and three or more comorbidities (p = 0.39). Log (CRP), log (NLR), log (PLR), and log (SII) were all associated with the three-year survival in geriatric HCC patients in simple logistic regression analyses. However, this time, only log (NLR) remained associated even after controlling for the age and BCLC confounding (OR 5.32, 95% CI 1.43–28.85). Conclusions. We found no differences in overall survival and progression-free survival between older and younger HCC patients. Parameters of subclinical inflammation predict prognosis in geriatric patients with HCC. A limitation of the study is small number of the treated patients; therefore, further investigation is warranted.

A retrospective risk factor analysis of infection and wound dehiscence following guided bone regeneration in cystectomy defects of the jaws

This study's objective is to determine if the combined use of bone substitutes and collagen membranes is related to worse postoperative outcomes after intra-osseous oral cystectomies. Additional risk factors mentioned in the existing literature were retrospectively analysed by reviewing the medical records and imaging tests of adult patients. Age, gender, smoking habit, cyst location, size, shape, histopathology, perilesional osteosclerosis and associated intracystic third molars were registered. The type of biomaterials applied and the number of bony walls remaining after surgery were also identified. All factors were analysed in relation to wound dehiscence and postoperative infection. Simple and multiple logistic regression analyses were performed to exclude possible confounding effects between the risk factors identified. In a sample of 211 cystectomies, guided bone regeneration was not significantly associated with infection, only the presence of impacted third molars was (p = 0.0219). This finding remained true, even in cysts larger than 25 mm. However, the risk of wound dehiscence was 4.9 times higher when biomaterials were applied (CI 95%, 1.6818–12.8274, p = 0.0014). In accordance with recent studies, these findings suggest that whenever guided bone regeneration might prove useful after cyst enucleation, avoiding chemically cross-linked membranes should be considered.

Factors associated with uncontrolled blood pressure in hypertensive Brazilians

Uncontrolled hypertension has a high prevalence and is related to numerous negative health outcomes. This study aimed to investigate the factors associated with the lack of blood pressure control in hypertensive Brazilians treated in public and private services. This is an analytical, multicentric, and national cross‐sectional study, carried out with adult hypertensive patients, monitored in 45 outpatient clinics (September 2013 to October 2015) in a prospective record interview, clinical, and anthropometric assessment. Outcome variables included uncontrolled pressure (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg). Simple and multiple logistic regression analyses were performed. Two thousand six hundred forty‐three participants were assessed with a mean age of 61.6 ± 11.9 years, 55.7% of women, and 46.4% with uncontrolled blood pressure (BP). The following were associated with uncontrolled BP: age over 60 years (OR: 1.31 [1.11–1.55]); practice of irregular physical activity (OR: 1.28 [1.06–1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46–2.22]); increased body mass index (OR: 1.02 [1.01–1.04]); low adherence to drug treatment (OR: 1.22 [1.04–1.44]) and menopause (OR: 1.36 [1.07–1.72]). The following were negatively associated: fruit consumption (OR: 0.90 [0.85–0.94]); presence of dyslipidemia (OR: 0.75 [0.64–0.89]), acute myocardial infarction (OR: 0.59 [0.46–0.76]), and peripheral arterial disease (OR: 0.52 [0.34‐0.78]). Factors associated with difficult‐to‐control blood pressure are the same that increase the risk for hypertension, while the presence of atherosclerotic disease and its outcomes were associated with better control.