Simple Logistic Regression Analysis Research Articles

11.B. Workshop: COPERS - an international longitudinal study on coping and resilience during the COVID-19 pandemic

Abstract Background Mental health and resilience during the COVID-19 pandemic is a challenge for all indivduals. While evidence is emerging that the COVID pandemic has affected mental health of everybody, at this point, no comparable data about the extent of the COVID-19 pandemic impact on mental health and resilience on citizens in Europe are available. We aim to fill this gap in knowledge. Methods We conducted a longitudinal study in eight European countries including 18+ year old individuals using mixed methods sampling (e.g. convenience sampling, panel data sampling). Main outcomes were depression, anxiety, post-traumatic symptoms and resilience. Depression was assessed with the PHQ-9, anxiety with the GAD-7, substance use with the Audit, resilience with the BRS and the CD-RISK, stress symptoms with the Impact of Event Scale (IES-R). We assessed as potentially influencing factors socio-demographic factors (location, age, gender, education, profession, living situation), and COVID-19 specific factors, furthermore we investigated social support, social capital, loneliness, and domestic violence and alcohol consumption (AUDIT). We analyze every measurement point, starting from the baseline data, cross-sectional and longitudinally. For the longitudinal analyses, multiple linear regression analyses, simple logistic regression analyses, and multinomial logistic regression analyses are conducted to examine resilience trajectories. Furthermore, to simultaneously control for many variables that potentially confound the relationship between a mental health and resilience, propensity score matching is applied. Results In total as of 30. April. 2,442 individuals participated (female: n = 1,582 (64.8%), male: n = 672 (27.5%), diverse: n = 5 (0.2%), missing: n = 183 (7.5%) as well as an age bias (Median=33, Mean=36.30, SD = 14,46, age range=18years-80 years. Mental health outcomes varied widely within and between countries. In this panel European and country specific data will be presented and discussed. We present the data on behalf of the COPERS consortium, other members of the consortium will be present at the discussion. Speakers/Panelists Jutta Lindert Hochschule Emden-Leer, Emden, Germany Marija Jakubauskiene Vilnius University, Vilnius, Lithuania Marija Jevtic Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Edvaldo Begotaraj Department of Social and Developmental Psychology, Sapienza University, Rome, Italy Alessandro Morganti Politecnico di Milano, Milano, Italy Key messages To the best of our knowledge, no comparable multinational data about the impact of the COVID-19 pandemic impact on mental conditions and resilience on citizens in Europe are available. Scope and extent of mental conditions during the COVID pandemic vary; country specific most vulnerbale groups are identified.

Risk Factors and Complications Associated with Early Oral Intake in Patients Undergoing Microvascular Free Flap Reconstruction of the Oral Cavity: A Single-institution, Retrospective Study

PurposeData on early oral intake (PO) after free flap reconstruction of the oral cavity have been limited. Recent studies have shown that resumption of PO after free flap reconstruction does not lead to increased morbidity and has resulted in decreased hospital stay.1,2 The objective of the study is to assess postoperative complications associated with early PO after free flap reconstruction of the oral cavity and to define clinical predictors for early PO. Materials and methodsA retrospective study was designed and implemented to capture all patients who were treated from 2014 to 2019 at a tertiary hospital and academic medical center. Inclusion criteria included oral cavity defects as a result of malignant or benign disease, trauma, osteoradionecrosis, and medication-related osteonecrosis that required a vascularized free flap reconstruction. Exclusion criteria included unresectable tumors, pharyngeal or laryngeal defects, and facial defects with minimal intraoral involvement (i.e., skin cancer). Clinical and surgical variables were collected and analyzed. The treatment group received PO within 4 days postoperatively. The control group had PO after 4 days postoperatively. The primary outcome was an early complication during the primary hospitalization. Secondary outcomes included late complications and length of stay (LOS). Student's T-test and Chi-square test were used to compare continuous and categorical variables, respectively. In cases where an unequal distribution or a small sample size is present, Mann-Whitney U or Fisher's Exact test was performed. Study variables that were statistically associated with the primary outcome in the bivariate analysis were selected as independent variables for logistic regression analysis. Multivariable logistic regression analysis was used to control for demographic and clinical variables that were statistically significant in the simple logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were recorded and interpreted for the regression analysis. For all tests, P values of < .05 were statistically significant. ResultsA total of 457 free flap reconstructions were screened for eligibility. The study sample composed of 423 reconstructions in 164 females and 259 males with the mean age of 59 (range 14-88 years) and mean follow-up duration of 25 months. Sixteen percent of the sample had prior radiotherapy or chemoradiotherapy, and 70% were treated for malignant disease. The majority underwent a tracheostomy (81.6%) and unilateral neck dissection (75.4%). Half had a gastrostomy tube (G-tube) during their hospitalization. The flap success rate was 98%. Patients in the treatment group were less likely to have a tracheostomy, bilateral neck dissection, and g-tube compared to the control group (P < .01) (Table 1). Defect volumes were significantly smaller in the treatment group compared to the control group (P < .01) with buccal and maxillary defects being more common in the treatment group (P < .01). Early PO was associated with decreased LOS (P < .01) and comparable complications (P > .10) in the treatment group compared to the control group (Table 2). Patients in the control group had a higher incidence of neck infection and salivary leak during the primary hospitalization compared to the treatment group. Late complications such as exposed hardware or bone, neck infection, and orocutaneous fistula were more frequent in the control group compared to the treatment group (Table 3). Multivariable regression analysis showed that tracheostomy and defect volume were significant predictors for early PO (P < .01). ConclusionEarly PO after free flap reconstruction of the oral cavity decreases LOS and does not lead to worse outcomes with regards to early and late complications. However, factors such as defect location, defect volume, and tracheostomy may increase the risk for complications and can help guide surgeons in deciding the optimal timing for postoperative PO.

Patient gender does not influence referral to an orthopaedic surgeon by advanced practice orthopaedic providers: a prospective observational study in Canada

BackgroundThe role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients’ decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients’ reasons for not accepting a consultation with a surgeon.MethodsThis was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire.ResultsEight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = − 0.02, 95% CI: − 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = − 0.05, 95% CI: − 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery.ConclusionsThere is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic.

Survival and prognostic indicators in downer dairy cows presented to a referring hospital: A retrospective study (1318 cases).

BackgroundDowner cow syndrome, a common problem in dairy cattle, represents a diagnostic and therapeutic challenge for the attending veterinarian. Identifying prognostic indicators and assessing the odds of survival may improve the accuracy of the clinician's prognosis at the time of diagnosis.ObjectiveTo describe a population of downer dairy cows referred to a hospital and investigate predictors of outcome.AnimalsRecumbent adult dairy cows (cows unable or unwilling to stand without help) treated at a referral hospital.MethodsData at the time of admission were collected from medical records of downer dairy cows treated at the Centre Hospitalier Universitaire Vétérinaire between 1994 and 2016. Simple and multivariable logistic regression analyses were performed to assess the association of predictors with the outcome.ResultsAmong 1318 cows included, 727 (55%) cows were discharged, and 591 (45%) cows died or were euthanized. Cows with longer time of recumbency before referral (odds ratio [OR] = 3.6), tachycardia (100‐120 beats per minute [bpm], OR = 1.93; >120 bpm, OR = 2.92), tachypnea (OR = 1.76), hypothermia (OR = 2.08), anemia (OR = 3.30), neutropenia (OR = 1.7), high aspartate aminotransferase activity (500‐1000 U/L, OR = 2.16; >1000 U/L, OR = 6.69), and increased serum creatinine concentration (OR = 1.75) had higher odds of nonsurvival.Conclusions and Clinical ImportanceThese findings may help the practitioner to consider treatment options and decide if referral is likely beneficial based on the odds of success. Early recognition of low chance of survival may facilitate an early decision for euthanasia.

Factors associated with condom breakage among female sex workers in the Western Region of Ghana.

Condoms have been extensively demonstrated as being effective in reducing Human Immunodeficiency Virus (HIV) infection rates among both men and women. With proper use and production, condom breakage is ideally minimal. However, breakage is reportedly a widespread problem among Female Sex Workers (FSWs), who are classified as a Key Population and warrant special transmission prevention efforts. Nationally, Ghana records an average rate of 5% of condom breakage. This study sought to identify the factors associated with condom breakage among FSWs in the western region of Ghana, a region with an extensive sex worker population and HIV incidence rate of 2.5%, higher than the national average. This study employed a cross-sectional survey among FSW populations in the Western region, Ghana. A sample of 416 participants were proportionately invited between brothel based and roamer communities to participate in the surveys. A total of 403 consented to participate indicating a response rate of 96.9%. Data were analysed for frequencies and prevalence of variables including condom breakage. At the bivariate level, associations with breakage were examined and statistically significant variables were analysed with simple and multiple logistic regression analysis. Of the 403 research participants who consented to participate, 17.4% had experienced breakage over the past week. Brothel-based FSWs were only half as likely to report condom breakage as non-brothel based FSWs (aOR = 0.526; 95% CI, 0.296 - 0.936). Notably, FSWs who consumed alcohol-containing drinks every day were only 65.2% as likely as those who consumed alcohol at least once a week or less than once a week or never to experience condom breakage (aOR = 0.348; 95% CI, 0.164 - 0.740). The study determined that the occurrence of condom breakage among FSWs in the western region was 17.4%. Factors significantly associated with condom breakage were being non-brothel based, frequency of alcohol consumption and parity. Condom use education programmes targeted at non-brothel based FSWs are necessary to reduce breakage and lower the risk of HIV transmission.

The prediction of morbidity related to vaginal delivery in nulliparous women – A secondary analysis from the genesis multicenter trial

ObjectiveIn the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery. Study designThe national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39 + 0- and 40 + 6-weeks’ gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤ 7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated. ResultsA total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p < 0.001), PPH (p < 0.008), NICU admission (p < 0.001), low Apgar score at one-minute (p < 0.001) and OASI (p = 0.009). The morbidity associated with OVD was significantly higher compared to spontaneous vaginal delivery, including NICU admission (p < 0.001), PPH (p = 0.022), birth injury (p < 0.001), shoulder dystocia (p = 0.002) and Apgar score of<7 at one-minute (p < 0.001). The positive likelihood ratios for composite outcomes (where the OVD was excluded) increases with increasing risk score from 1.005 at risk score of 5% to 2.507 for risk score of>50%. ConclusionIn women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery.

Ectopic pancreatic fat as a risk factor for hypertension in children and adolescents with nonalcoholic fatty liver disease.

Although nonalcoholic fatty liver disease (NAFLD) is known to be a risk factor for cardiovascular diseases, few studies have reported an association between ectopic fat deposition and metabolic complications, including hypertension, in children with NAFLD. The present study evaluated the risk factors for hypertension in children with NAFLD from the aspect of ectopic fat. This cross‐sectional retrospective study investigated 65 children with NAFLD (49 boys, mean age 13.0 ± 3.2 years, mean body mass index z‐score [BMI‐z] 2.5 ± 1.2), who underwent liver biopsy and magnetic resonance imaging‐based fat fraction measurement for ectopic hepatic and pancreatic fats, as well as anthropometry, blood pressure, laboratory tests, and body composition analysis. A logistic regression model was used to identify the risk factors for hypertension. Through a simple logistic regression analysis, age (OR 1.392), BMI‐z (OR 3.971), waist circumference‐to‐height ratio (OR 1.136), fat‐free mass index (OR 1.444), γ‐glutamyl transferase (OR 1.021), quantitative insulin sensitivity check index (OR 0.743), dyslipidemia (OR 5.357), and pancreatic fat fraction (PFF) (OR 1.205) were associated with hypertension. The optimal cut‐off of PFF to divide children with NAFLD into two groups with and without hypertension was 4.39% (area under the curve 0.754, p = .001, sensitivity 82.4%, specificity 73.9%). Multiple logistic regression analysis in the fully adjusted model revealed both BMI‐z (OR 4.912, 95% CI, 1.463–16.497) and PFF (OR 1.279, 95% CI, 1.007–1.624) were independent risk factors for hypertension. In conclusions, in addition to BMI‐z, ectopic pancreatic fat is an important risk factor for hypertension in children with NAFLD.

Are Dropped Bone Grafts Safe to be Re-used? - An Experimental Study Comparing Efficacy of Chlorhexidine, Povidone-Iodine and Alcohol.

Introduction:A dilemma arises when a bone graft or fracture fragment is accidentally dropped on the operation theatre floor and becomes contaminated. This study aimed to determine the efficacy of simple and readily available antiseptic solutions in disinfecting contaminated bones.Material and Methods:This experimental study involved 225 bone specimens prepared from discarded bone fragments during a series of 45 knee and hip arthroplasty surgeries. The bone fragments were cut into five identical cubes and were randomly assigned to either control (positive or negative), or experimental groups (0.5% chlorhexidine, 10% povidone-iodine or 70% alcohol). The control negative was to determine pre-contamination culture. All bone specimens, except the control negative group were uniformly contaminated by dropping on the operation theatre floor. Subsequently, the dropped bone specimens except for the control positive group, were disinfected by immersing in a respective antiseptic solution for 10 minutes, before transported to the microbiology laboratory for incubation.Results:The incidence of a positive culture from a dropped bone fragment was 86.5%. From the 37 specimens sent for each group, the incidence of positive culture was 5.4% (2 specimens) after being disinfected using chlorhexidine, 67.6% (25 specimens) using povidone-iodine and 81.1% (30 specimens) using alcohol. Simple logistic regression analysis demonstrated that chlorhexidine was significantly effective in disinfecting contaminated bones (p-value <0.001, odd ratio 0.009). Povidone-iodine and alcohol were not statistically significant (p-value 0.059 and 0.53, respectively). Organisms identified were Bacillus species and coagulase negative Staphylococcus. No gram-negative bacteria were isolated.Conclusion:A total of 0.5% chlorhexidine is effective and superior in disinfecting contaminated bones.

Association between internet addiction and suicidal ideation in university students

Objective: to investigate the evidence in the literature on the association between internet addiction and suicidal ideation in university students. Method: an integrative review of publications on the CINAHL, EMBASE, LILACS, MEDLINE, PubMed, PsycInfo, SciELO, SCOPUS, Web of Science and Biblioteca Virtual em Saúde databases was carried out, without restrictions regarding language or publication date. The final sample comprised 5 articles, which were organized and characterized according to author, year, method, sample, country, instruments and results. Results: the prevalence of internet addiction among university students ranged from 7.7% to 27.3%, and suicidal ideation from 7.4% to 36.1%. The results of simple logistic regression analyses showed a significant association between internet addiction and suicidal ideation, although on multiple logistic regression this association was not statistically significant for 2 out of the 5 studies reviewed. Subjects at risk of or with addiction to the internet had a significantly higher rate of suicidal ideation compared with controls. Conclusion: although the presence of association does not indicate causality, these findings serve as an early warning sign to parents, educators and health professionals, indicating the need for longitudinal studies to further elucidate this relationship.

Different GLIM criteria combinations change prevalence of malnutrition in patients with intestinal insufficiency or intestinal failure.

Due to lack of global consensus in diagnosing malnutrition, Global Leadership Initiative on Malnutrition (GLIM) has suggested the GLIM criteria based on etiological and phenotypical criteria. The aim of this study was to investigate the prevalence of malnutrition in patients with intestinal insufficiency (INS) or intestinal failure (IF) based on the different GLIM criteria combinations to diagnose malnutrition. Furthermore, the aim was to investigate the severity of malnutrition in the two patient groups. A cross-sectional study with INS patients on enteral nutrition and IF patients on home parenteral nutrition. We recorded age, gender, weight, height, fat free mass index (FFMI) by bioelectrical impedance analysis, handgrip strength (HGS), arm muscle circumference (AMC) and biochemical parameters: plasma albumin (p-alb) and plasma C-reactive protein (p-CRP). Further, we calculated Glasgow prognostic score (GPS) and body mass index (BMI). T-test, Chi-square test and simple logistic regression analysis. Significance level: p<0.05. In total 277 INS and IF patients were included (age 59.5±15.2 years, male 43,7%, BMI 22.1±4.3kg/m2). Groups were comparable according to number, age and gender but more IF patients had decreased BMI, p-alb, HGS and FFMI and increased CRP and GPS 1 or 2. Prevalence of malnutrition using GPS 1 or 2 combined with BMI, FFMI or HGS was 22.6%, 23.4%, 26.3% for INS, respectively (p=0.756) and 40.7%, 40.0%, 59.3% for IF, respectively (p=0.001). Agreement between the criteria combinations were: 8.0% for INS and 25.7% for IF. Significantly more with IF was diagnosed with severe malnutrition as compared to no malnutrition (43 vs. 26, p=0.012, OR 2.1 [CI95% 1.2-3.8]), but only a tendency in the group with moderate malnutrition as compared to no malnutrition (27 vs. 22, p=0.180, OR 1.6 [CI95% 0.8-3.0]) CONCLUSION: We found both prevalence and severity of malnutrition to be higher in IF than INS patients. GLIM-criteria were able to identify approximately same prevalence of malnutrition in INS but not in IF, when combining GPS 1 or 2 with BMI, FFMI and HGS. However, the agreement was poor in both groups. Consequently, further validation of GLIM is needed - including association to clinical outcome in lack of a gold standard.

The Differences of Population Birth Defects in Epidemiology Analysis between the Rural and Urban Areas of Hunan Province in China, 2014-2018.

Objectives To compare the differences of epidemiology analysis in population birth defects (BDs) between the rural and urban areas of Hunan Province in China. Methods The data of population-based BDs in Liuyang county (rural) and Shifeng district (urban) in Hunan Province for 2014–2018 were analyzed. BD prevalence rates, percentage change, and annual percentage change (APC) by sex and age were calculated to evaluate time trends. Risk factors associated with BDs were assessed using simple and multiple logistic regression analyses. Results The BD prevalence rate per 10,000 perinatal infants (PIs) was 220.54 (95% CI: 211.26-230.13) in Liuyang and 181.14 (95% CI: 161.18-202.87) in Shifeng. Significant decreasing trends in BD prevalence rates were noted in the female PIs (APC = −9.31, P = 0.044) and the total BD prevalence rate in Shifeng (APC = −14.14, P = 0.039). Risk factors for BDs were as follows: rural area, male PIs, PIs with gestational age < 37 weeks, PIs with birth weight < 2500 g, and migrant pregnancies. Conclusions We should focus on rural areas, reduce the prevalence of premature and low birth weight infants, and provide maternal healthcare services for migrant pregnancies for BD prevention from the perspective of population-based BD surveillance.

The influence of medical and social risk factors on the development of hypertension in the adult population at the regional level

The aim of the study was to investigate the impact of medical and social risk factors (RF) on the development of arterial hypertension (AH) in the adult population at the regional level (Zaporizhzhia, Ukraine). Materials and methods. The study, after obtaining an informed consent, involved 2000 patients, residents of Zaporizhzhia region, including 1000 patients (522 men and 478 women, mean age 51.60 ± 0.85 years) with AH and 1000 patients (478 men and 522 women, mean age 49.80 ± 0.94 years) without AH. The relationship between hypertension and the action of already known RF, the reliable connection of which has been proven by many studies, including burdened heredity, overweight, excessive alcohol consumption, smoking, physical inactivity, and some social and economic RF. In order to achieve the goal of the study, we used a set of general scientific and special interrelated and consistently applied methods: system analysis, bibliosemantic, descriptive statistics, calculating the odds ratio (OR) of the event with a 95 % confidence interval (CI); values of P to define statistical significance. Results. According to our study, the simple logistic regression analysis of persons from the study cohort reveals a reliable relationship (P &lt; 0.05) between AH and family history of hypertension, overweight, physical inactivity, smoking. Along with the well-known RF, the residents of the Zaporizhzhia region are exposed to other social and economic RF, in particular, poor living standards (OR 2.45; 95 % CІ 2.04–2.94; P &lt; 0.0001), unemployment (OR 1.9; 95 % CІ 1.38–2.64; P &lt; 0.0001), lack of healthcare facilities at the place of residence (OR 0.29; 95 % CІ 0.22–0.35; P &lt; 0.0001), low level of education (OR 2.39; 95 % CІ 1.97–2.91; P &lt; 0.0001). Conclusions. It has been found that along with the traditional risk factors, the residents of the Zaporizhzhia region have other social and economic risk factors, including poor living standards, low average income, unemployment, lack of healthcare facilities at the place of residence, low level of education.

Prevalence and factors associated with behavioural problems in children with epilepsy attending Mulago hospital, Uganda: A cross-sectional study

Purpose: To determine the prevalence of behavioural problems and the associated factors in children with epilepsy (CWE). Methods: This was a cross-sectional study conducted at Mulago National Referral Hospital, Kampala, Uganda, from December 2019 to May 2020. A total of 300 CWE aged 6 to 17 years were consecutively enrolled and assessed for behavioural problems using the Strengths and Difficulties Questionnaire. We obtained data on the associated factors by using pretested structured questionnaires, the Rosenberg Self-Esteem Scale, the Kilifi Stigma Scale of Epilepsy, the Morisky medication adherence scale and the Tumaini Child Health Screener for childhood disabilities. Simple logistic regression and multivariate analysis was done to determine the associated factors while adjusting for the presence of neurodevelopmental disorders and childhood disabilities. Results: Behavioural problems were detected in 108/300 CWE (36%) with more internalizing (28%) than externalizing (21%) behaviour scores noted. The odds of behavioural problems increased with the presence of co-morbid neurodevelopmental disorders or childhood disabilities (cOR: 5.42, p-value < 0.001). Factors associated with occurrence of behavioural problems were high stigma perception (aOR: 4.06, p-value < 0.001) and being seizure-free in the last six months (aOR: 3.43, p-value =0.031) while being an adolescent (aOR: 0.33, p=0.001) lessened the risk. Conclusions: Behavioural problems occur in more than a third of CWE. They are more in the internalizing domain than in the externalizing domain. Their odds increase with high perceived stigma and in the first six months of seizure control.

Human papilloma virus screening: evaluation of testing and surveillance in rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus

Background and objectivesImmunosuppression is a known risk factor for cervical cancer. Women with rheumatic conditions are immunosuppressed due to the disease and the treatments. One of the main risk factors for this neoplasm is the lack of adherence to early detection programmes for human papillomavirus. The objectives of this study were to evaluate the adherence to the screening programme of patients in the Rheumatology Clinic, as well as to evaluate the prevalence of cervical lesions and their association with the different disease characteristics and the treatments received. MethodsA descriptive retrospective study. The electronic medical history of patients actively being followed up in a tertiary hospital with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and systemic lupus erythematosus (SLE) were reviewed. ResultsFinally, 307 patients were included. No data were found for screening programme attendance in up to 42.4% of the patients (39.6% in RA, 43.8% in PSA and 46% in SLE). Among the patients who attended the screening programme at least once (57.6%), the prevalence of cervical dysplasia was 5.1%. No cases of neoplasia were found. In the simple logistic regression analysis, there was no association between attending the screening programme and any variable. The study also showed no association between the variables collected and the presence of infection and dysplasia. ConclusionThese results are influenced by the absence of screening data in a significant percentage of patients and by the low prevalence of dysplasia found in this series of patients with rheumatic diseases.

Hubungan Pengetahuan, Sikap dan Peran Orangtua terhadap Praktik Kesehatan Reproduksi Remaja pada Pelajar SMP Negeri 16 Kupang

Adolescence is a period of transitional development between childhood and adulthood where adolescents are vulnerable to peer influence in terms of interests, attitudes, appearances, and behaviors. This vulnerability may lead to various issues including reproductive health problems. The incidence of adolescent reproductive health problems such as early pregnancy and childbirth, unsafe abortion, sexually transmitted infections including Human Immunodeficiency Virus, sexual harassment/rape is influenced by factors of knowledge, attitudes, and the role of parents. The purpose of this study was to analyze factors related to reproductive health practices at SMP Negeri 16 Kupang. This research was an analytic observational study with a cross-sectional approach. The sample consisted of 155 adolescents. The study was conducted in August 2020. Data analysis in this study used simple logistic regression analysis. The results found that 52.9% of adolescents had poor reproductive health practices. Reproductive health practice was associated with knowledge (p = 0.000), and the role of parents (p = 0.048) while attitudes (p = 0.948) was found unrelated to the practice. Increasing understanding of the importance of maintaining reproductive health is necessary to help adolescents anticipate the impact of reproductive health problems.

Risk of malnutrition in pulmonary fibrosis outpatients

Background: Literature is sparse regarding disease related malnutrition (DRM) among patients with pulmonary fibrosis. We aimed to investigate the prevalence of unintended weight loss (UWL) within three months, reduced food intake (RFI) within the past week, and associations to nutrition impact symptoms (NIS), in an outpatient population of patients with pulmonary fibrosis. Methods: The prevalence of UWL and NIS were sought in a cross-sectional questionnaire study, consecutively including a convenience sample of 100 patients, as they visited the outpatient clinic. Medical records were sought for time from diagnosis and comorbidities. Associations were examined through Chi square and simple logistic regression analysis. Results: Among the 100 included patients, 66% were male, mean age was 68.1(SD 12.9), and BMI was 27.9 (SD 5.9). UWL was found in 18 (18%) with a mean weight loss of 6.2 Kg (SD 3.9), 16% had RFI and 7% had both UWL and RFI. Patients with RFI and NIS had higher odds for UWL. Women, no education and living alone were the most associated risk factors for UWL. Conclusion: UWL was seen in almost one fifth of pulmonary fibrosis outpatients. Patients with NIS and RFI had higher odds for UWL. UWL seems feasible for initial nutritional risk screening in pulmonary fibrosis outpatient clinics, and may serve as an indication for the need for full screening and assessment.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal.

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors.Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables.Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28).Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08–1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31–3.47) and with scores 24–29 (OR 1.92; 95% CI 1.07–3.43) or 11–23 (OR 2.09; 95% CI 1.15–3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24–9 (OR 2.38; 95% CI 1.31–4.33) or low 11–23 (OR 5.31; 95% CI 2.69–10.45) scores in neuroticism were more likely to evaluate their health as very good/good.Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Predictors of Depression and Insomnia in Community-Dwelling Elderly People: A Cross-Sectional Evidence of Their Bidirectional Relationship.

ObjectiveThe aim of this study was to examine associated factors of depression and insomnia in community-dwelling elderly people in order to identify independent predictors.Materials and methodsA cross-sectional study was conducted among 250 older people aged 60 years and over living in an urban area. A stratified random sampling method was used for recruiting samples from five Open Care Centers for Elderly People of the Municipality of Larissa, Greece. Data were obtained through a questionnaire that included demographic, socioeconomic, and health-related characteristics, 15-item Geriatric Depression Scale (GDS-15), and Athens Insomnia Scale (AIS). Simple and multiple logistic regression analysis was performed.ResultsThe prevalence of depression and insomnia was 28.4% (95% CI: 22.9-33.9) and 39.2% (95% CI: 33.0-45.4), respectively. Our findings showed that the overall GDS-15 score was positively related to the overall AIS score (r = 0.405; p < 0.001). The best-fit regression analysis demonstrated four significant predictors (marital status, monthly income, body weight status, and insomnia) explaining 31.6% of the variance in depression risk. Moreover, community-dwelling elderly Greek people with insomnia symptoms were females, had a lower monthly income, and more likely to suffer from chronic diseases and depression.ConclusionThese findings point to the importance of recognizing risk factors for both depression and insomnia in attempting to apply preventive interventions in the elderly and optimize their quality of life.

United States ED Visits by Adult Women for Nonfatal Intimate Partner Strangulation, 2006 to 2014: Prevalence and Associated Characteristics

IntroductionNonfatal intimate partner strangulation poses significant acute and long-term morbidity risks and also heightens women’s risk for future femicide. The lifetime prevalence of nonfatal intimate partner strangulation has been estimated to be approximately 10%, or 11 million women, in the general United States population. Given the potential for significant health risks and serious consequences of strangulation, this study adds to the limited literature by estimating prevalence and describing the associated characteristics of strangulation-related visits among United States ED visits by adult women after intimate partner violence. MethodsPrevalence estimation as well as simple and multivariable logistic regression analyses were completed using data from the Nationwide Emergency Department Sample spanning the years 2006 to 2014. ResultsThe prevalence of strangulation codes was estimated at 1.2% of all intimate partner violence visits. Adjusting for visits, hospital characteristics, and visit year, higher odds of strangulation were noted in younger women, metropolitan hospitals, level I/II trauma centers, and non-Northeast regions. Increases in strangulation events among intimate partner violence–related visits in recent years were also observed. DiscussionA relatively low prevalence may reflect an underestimate of true nonfatal intimate partner strangulation visits owing to coding or a very low rate of ED visits for this issue. Higher odds of strangulation among intimate partner violence visits by women in more recent years may be due to increased recognition and documentation by frontline clinicians and coding teams. Continued research is needed to further inform clinical, postcare, and social policy efforts.

ADAMTS13 activity decreases in the early phase of trauma associated with coagulopathy and systemic inflammation: a prospective observational study

BackgroundWe conducted a prospective observational study for investigating the changes in the 13th member of a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) and its association with the coagulofibrinolytic response in adult trauma patients.MethodsIn 39 trauma patients hospitalized for longer than 7 days, time-course changes in biomarkers of coagulofibrinolysis and systemic inflammation along with ADAMTS13 activity were examined. The patients were stratified into three groups based on ADAMTS13 activities on admission (day 0): normal group (≥70%), mildly decreased group (≥50 and < 70%) and moderately decreased group (< 50%).ResultsAmong 39 patients with a median Injury Severity Score (ISS) of 20, 11 patients developed disseminated intravascular coagulation (DIC) and 16 patients required transfusion. Six of 39 patients (15.4%) showed moderate decreased ADAMTS13 activity to < 50%, and 20 patients (51.3%) showed mild drops (≥50 and < 70%). These changes in ADAMTS13 activity on day 0 were significantly correlated with changes in IL-6 and other coagulofibrinolytic markers such as platelet counts, prothrombin time and fibrin/fibrinogen degradation product (FDP). Antithrombin activity (AT) and serum albumin (Alb) level showed significantly positive linear correlations with ADAMTS13 activity (AT: r = 0.513, p < 0.001; Alb: r = 0.647, p < 0.001). Simple logistic regression analyses showed that ADAMTS13 activity, if less than 50%, was significantly correlated with the development of DIC (OR 7.499, 95%CI 1.121–49.242, p = 0.038) and the need for transfusion of fresh frozen plasma (OR 9.000, 95%CI 1.327–61.025, p = 0.028).ConclusionsADAMTS13 activity decreased even in the early phase of trauma, which was complicated by coagulopathy and systemic inflammation. Furthermore, the decrease in ADAMTS13 activity was correlated with DIC and plasma transfusion.