Stepwise Binary Logistic Regression Research Articles

Pattern of Facial Fractures and Its Association with a Cervical Spine Injury in a Tertiary Hospital in Jordan.

Background Facial fractures can be accompanied by serious and life-threatening injuries such as cervical spine injury (CSI), which can lead to serious consequences if misdiagnosed. Objective To assess the patterns of maxillofacial fractures and to explore the association between these fractures and cervical spine injuries (CSIs) in patients with a traumatic facial injury. Methods A retrospective analysis was conducted on the data of the subjects who were admitted to the King Abdullah University Hospital (KAUH) and had a maxillofacial fracture in the period from January 2017 through December 2020. Stepwise binary logistic regression analysis was conducted to find the variables which are significantly and independently associated with CSIs. Results A total of 394 maxillofacial fractures were reported for a total of 221 subjects. The mandible was the most common site of the reported fractures (41.88%). The majority of the subjects had associated injuries (70.6%), of which 82.7% were CSIs. The most common type of the CSIs was the vertebral fracture (52%). Increased age (OR = 1.543, P < 0.05), having a mandibular fracture (OR = 4.382, P < 0.01), and having a maxillary fracture (OR = 3.269, P < 0.05) were significantly associated with the presence of CSI. Conclusion The current study revealed that the most common type of facial fracture occurred in the mandible area, and CSI was the most common fracture-associated injury (82.7%). Increased age and having mandibular or maxillary fracture were associated with an increased risk of developing CSI. Therefore, it is necessary to rule out the presence of concomitant CSI during the emergency management of maxillofacial fractures, particularly for elderly patients and those with mandibular or maxillary fractures.

A Survey on Depressive Symptoms and Its Correlates Amongst Physicians in Bangladesh During the COVID-19 Pandemic.

AimThe aim of this study was to determine the presence of depressive symptoms and understand the potential factors associated with these symptoms among physicians in Bangladesh during the COVID-19 pandemic.MethodsA cross-sectional study using an online survey was conducted in between April 21 and May 10, 2020, among physicians living in Bangladesh. Participants completed a series of demographic questions, COVID-19-related questions, and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics (frequency, percentage, mean and standard deviation), test statistics (chi-squared test and logistic regression) were performed to explore the association between physicians’ experience of depression symptoms and other study variables. Stepwise binary logistic regression was followed while conducting the multivariable analysis.ResultA total of 390 physicians completed the survey. Of them, 283 (72.6%) were found to be experiencing depressive symptoms. Predictors which were significantly associated with depressive symptoms were gender (with females more likely to experience depression than males), the presence of sleep disturbance, being highly exposed to media coverage about the pandemic, and fear around (a) COVID-19 infection, (b) being assaulted/humiliated by regulatory forces and (c) by the general public, while traveling to and from the hospital and treating patients during the countrywide lockdown.ConclusionThe findings of this study demonstrate that there is a high prevalence of depressive symptom among physicians especially among female physicians in Bangladesh during the COVID-19 pandemic. Immediate, adequate and effective interventions addressing gender specific needs are required amid this ongoing crisis and beyond.

Prevalence and Factors Associated with Overweight/Obesity in Adolescent School Girls: A Cross-Sectional Study in Kolkata, India

Overweight and obesity in adolescent girls are considered a leading global public health issues in recent times. There is a need to evaluate the potential socioeconomic and behavioural factors behind adolescents’ overweight and obesity in different environmental settings. The present study aims to understand the prevalence of overweight and obesity among urban adolescent school girls and to determine the association between selected socioeconomic and behavioural factors and overweight/obesity. This is a cross-sectional study using a multistage stratified cluster sampling with a sample size of 1041 adolescent girls aged 10 to 18 years from schools of Kolkata, India. Overall prevalence of overweight and obesity were 18.9% and 23.7%, respectively. The prevalence of overweight and obesity was higher among those adolescent girls whose parents had completed higher education (49.5%) and had higher monthly per capita household expenditure (48.4%). Stepwise binary logistic regression analysis confirmed that the probability of being overweight/ obese tended to be in adolescents who slept less than 7 hours per day (p&lt;0.001). Overweight /obesity was also higher among those children whose fathers were fatty (p=0.002), taken medicines three months before the survey (p=0.008), and watched television and mobile phones for more than 1 hour a day (p=0.039). Rapid change in modern lifestyles is seemingly decreasing sleep duration in adolescents with subsequent negative impact on their health.

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin.

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8-29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.

Children’s rates of COVID-19 vaccination as reported by parents, vaccine hesitancy, and determinants of COVID-19 vaccine uptake among children: a multi-country study from the Eastern Mediterranean Region

BackgroundHuge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children’s rates of COVID-19 Vaccination as reported by parents, to explore parents’ attitudes towards children’s COVID-19 vaccination, and to examine the factors associated with parents’ hesitancy towards children’s vaccination in several countries in the Eastern Mediterranean Region (EMR).MethodsThis study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders.ResultsThe prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents’ attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children’s vaccination was significantly correlated with parents’ age, education, occupation, parents’ previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children’s vaccination in the participating Arab countries is still not promising.ConclusionTo encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels.

Montreal Cognitive Assessment (MoCA) and Digit Symbol Substitution Test (DSST) as a screening tool for evaluation of cognitive deficits in schizophrenia

Cognitive deficit is one of the core features of schizophrenia and is associated with poor functional outcomes. There is a lack of validated criteria to screen and monitor cognitive deficits in schizophrenia. This study aimed to evaluate the concurrent validity and sensitivity of MoCA (Montreal Cognitive Assessment) and DSST (Digit Symbol Substitution Test) in identifying cognitive deficits in Schizophrenia comparing with a comprehensive MCCB [MATRICS (Measurement And Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery] equivalent battery. We did clinical and cognitive assessments on 30 patients with schizophrenia and 30 age and gender-matched healthy controls. The Cronbach's Alpha of MoCA was 0.839, and on adding the DSST, it increased to 0.859. In stepwise binary logistic regression, adding DSST to MoCA improved the prediction of cognitive impairment as defined by a comprehensive battery with 86.7% classification accuracy. Receiver operating characteristic curve analysis suggested a score of 25 of MoCA and 59 of DSST as an optimal cut-off in identifying severe cognitive deficits with an additional MoCA cut-off of 27 for identifying mild cognitive deficits. Combined MoCA and DSST is a sensitive and quick method to screen for neurocognitive deficits in schizophrenia.

Towards identifying a method of screening for autism amongst women with restrictive eating disorders.

ObjectiveUp to 37% of patients with anorexia nervosa score above cut‐off on autism screening measures. These individuals typically have poorer outcomes from standard eating disorder interventions and could therefore benefit from adaptations. Accurately identifying these individuals is important for improving autism referral processes and clinical pathway decisions. This study's aim was to identify subscales of questionnaires measuring constructs associated with either autism or eating disorders that, when combined with traditional autism screening measures, would improve the ability to identify women with restrictive eating disorders who might benefit from a full autism assessment.MethodOne hundred and sixty women with restrictive eating disorders, with (n = 42) or without (n = 118) an autism diagnosis completed a battery of questionnaires. Using conditional stepwise binary logistic regression, we attempted to improve the autism spectrum quotient 10 item's (AQ‐10) ability to discriminate between autistic and non‐autistic women in a restrictive eating disorder sample.ResultsIn a binary logistic regression model, the AQ‐10 reliably discriminated between autistic and non‐autistic women with an accuracy rate of 85% but had relatively low (69%) sensitivity, reflecting a high rate of false negatives. Adding three subscales to the model (Glasgow Sensory Questionnaire Auditory, Camouflaging Autistic Traits Questionnaire Compensation and Toronto Alexithymia Scale Externally Orientated Thinking) significantly improved its differentiating ability (accuracy = 88%, sensitivity = 76%, specificity = 92%).ConclusionsWe have identified three subscales that, when used in combination with the AQ‐10, may help clinicians understand the pattern of autistic traits in their patients with a restrictive eating disorder. This can inform clinical decisions about whether to refer for a full autism assessment and whether to adapt standard eating disorder treatments to accommodate autistic traits. Future studies are needed to test the model in samples where participants have undergone a full autism assessment.

Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study.

BackgroundEarly diagnosis and timely treatment of tuberculosis are critical for disease control and management. However, diagnostic delay remains severe around the world. We aim to evaluate the duration and factors associated with diagnostic delay of tuberculosis in Shenzhen, China.MethodsWe conducted a face-to-face interview to collect the whole care-seeking process of patients diagnosed with active TB in Shenzhen, China, from April 1 to September 30, 2021. The duration from symptom onset to confirmed diagnosis was recorded. The risk factors of diagnostic delay were identified by binary stepwise logistic regression analysis.ResultsAmong 288 confirmed TB cases, 170 (59.0%) were delayed diagnosis. The median diagnostic delay was 39.5 days. Median patient delay was 23 days and health system delay was 7 days. Income ≤315USD/month (OR = 2.97 [95% CI: 1.15–7.69]), cough (OR = 3.00 [95% CI: 1.16–7.76]), weight loss (OR = 15.59 [95% CI: 1.85–131.56]), use of traditional Chinese Medicine (OR = 5.03 [95% CI: 1.04–24.31]) and over-the-counter cough syrup (OR = 2.73 [95% CI: 1.10–6.76]) were significant risk factors for patient delay. Fever (OR = 0.13[95% CI: 0.04–0.48]) and hemoptysis (OR = 0.06 [95% CI0.01–0.30]) were protective factors for patient delay. Cough (OR = 2.85 [95% CI: 1.49–5.49]) and availability of chest X-ray (OR = 0.21[CI: 0.11–0.39]) were factors associated with health system delay.ConclusionDelayed diagnosis of tuberculosis remains an unresolved problem. Patients with low income, self-treatment with over-the-counter medicine and accepting TCM suffered from a higher risk of patient delay. It is important to give more help to the vulnerable people and strengthen tuberculosis knowledge among primary health providers. Keeping all health providers alert to TB symptoms can facilitate earlier TB diagnosis and better disease control.

Impact of hydrocortisone replacement on bone mineral density and bone turnover markers in patients with primary adrenal insufficiency.

A cross-sectional study was conducted in 37 PAI patients treated with HC. BMD and selected bone turnover markers (β-crosslaps and osteocalcin) were measured. A stepwise binary logistic regression model was applied to determine the independent variables associated with low BMD. Osteoporosis was noted in 14.3% and osteopenia in 34.3% of cases. These patients were older (p=0.01) and received higher daily HC dose compared to patients with normal BMD (p=0.01). BMD values in the lumbar spine and the femoral neck were negatively correlated with daily HC dose (r=-0.36, p=0.03 and r=-0.34, p=0.05, respectively). Plasma osteocalcin was negatively correlated with disease duration (r=-0.38, p=0.02) and cumulative HC dose (r=-0.43, p<0.01). In multivariate analysis, a daily HC dose ≥12 mg/m2/day was independently associated with a higher risk of osteopenia/osteoporosis [OR (95% CI), 9.0 (1.1-74.6); p=0.04]. Impaired bone mineralization in patients with PAI is correlated with HC dose. A daily HC dose ≥12 mg/m2/day was associated with an increased risk of osteopenia and osteoporosis in these patients.

Fatigue have impact on the sexual problems in Chinese females with systemic lupus erythematosus

BackgroundSystemic lupus erythematosus (SLE) might affect all aspects of life including sexual function; previous study indicated that fatigue was the risk factor of sexual dysfunction. The current study aims to investigate the effects of SLE on Chinese mainland female patients’ sexual problems compared with healthy subjects and to investigate the relationship among fatigue, disease parameters, depression, quality of life and sexual problems in Chinese female patients with SLE.MethodsA total of 128 female SLE patients (mean age: 43.65 ± 7.13 years) and 121 healthy female controls (mean age 43.59 ± 6.57 years) were included in this cross-sectional study. All data were collected consecutively by face-to-face questionnaires from January 2021 to December 2021. SLE patients completed questionnaires for demographic or clinical variables, the 10-cm Visual Analog Scale for pain, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for disease activity, the multidimensional fatigue inventory (MFI) for fatigue, the patient health questionnaire-9 (PHQ-9) for depression, the Female Sexual Function Index (FSFI) for problems, and the Short Form 12 health survey for quality of life. Independent sample t-test, Mann–Whitney U-test, Chi-square test, and forward stepwise binary logistic regression model were used to analyze these data.ResultsOur results showed that the prevalence of female sexual problems was 78.9% in SLE patients, which was significantly higher than the controls (56.7%; p < 0.05). The results found that having child (OR 23.04; p < 0.000), age (OR 1.11; p = 0.002), DMARDs usage (OR 0.04; p = 0.004), MFI total score (OR 1.06; p = 0.006), and disease duration (OR 1.16; p = 0.043) were the potential risk factors of female sexual problems by forward stepwise binary logistic regression.ConclusionThe present study reported that female sexual problems was more common in Chinese SLE female patients compared to controls. Having child, age, DMARDs usage, fatigue, and disease duration had great impacts on female sexual problems in Chinese SLE patients. Rheumatologists and nurses should pay close attention to SLE female patients’ sexual problems, especially those having no child, older age, not using DMARDs, fatigue, or long disease duration by health education or other methods to improve their sexual problems, and ultimately improve SLE patients’ quality of life.

Clinical variables, including novel joint index, associated with future patient-physician discordance in global assessment of rheumatoid arthritis (RA) disease activity based on a large RA database in Japan.

Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA-PhGA discordance and the variables associated with future positive discordance (PGA > PhGA) based on the NinJa database in Japan. We examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10-cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis. Due to the small number of patients with RA categorized as having negative discordance (PGA < PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C-reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP. Positive discordance may persist. Circumventing this requires adequate management of pain and functional impairment.

P1458: PATTERNS OF LONG-TERM HEMATOPOIETIC RECOVERY IMPACT SURVIVAL OUTCOMES AFTER CD19-DIRECTED CAR T-CELL THERAPY FOR R/R LBCL

Background: Real-world evidence has underlined the role of hematological toxicity and infections in driving the toxicity burden of CD19 CAR-T. We have recently developed a classification system for post-CAR-T hematotoxicity, identifying three unique phenotypes of neutrophil recovery (Rejeski et al Blood 2021). However, their prognostic impact remains poorly understood. Aims: We sought to understand potential pathomechanisms underlying hematopoietic recovery patterns, and characterize their influence on toxicity and clinical outcomes. Methods: In this multicenter retrospective observational study, we analyzed 316 pts. receiving Axicabtagene ciloleucel (n=194) or Tisagenlecleucel (n=122) for R/R LBCL in a real-world setting. The phenotypes of neutrophil recovery were defined as follows: 1) Quick Recovery: sustained neutrophil recovery without a second dip below an ANC<1000/µl. 2) Intermittent Recovery: neutrophil recovery (ANC>1500/µl) followed by a second dip with an ANC<1000/µl after day 21. 3) Aplastic: continuous severe neutropenia (ANC<500/µl) ≥14 days. Multivariate analysis was performed as stepwise binary logistic regression for the aplastic vs. non-aplastic phenotypes. Variables with a p<0.2 on univariate analysis were included. Clinical outcomes were studied via Kaplan-Meier estimates. Serum cytokines were analyzed using the Ella automated immunoassay system (ProteinSimple) in 70 pt. from Moffitt Cancer Center. The plasma proteome was characterized in a further 38 pts. from the LMU Munich across four time points (day 0, 4, 14, 28) using a 92-protein multiplex proximity extension assay (Olink Bioscience). Results: The overall distribution of the ‘quick’ (Q), ‘intermittent’ (I) and ‘aplastic’ (A) phenotypes was 40%, 41%, and 19%, respectively. Prior to lymphodepletion, ‘aplastic’ patients displayed increased systemic inflammation (median ferritin 1168 ng/ml), impaired hematopoietic function (median platelet count 101 G/l) and high tumor burden (median LDH 344 U/l). ‘Aplastic’ patients displayed a longer median duration of severe neutropenia, (A vs. I vs. Q: 28 vs. 10 vs. 5 days, p<0.001), higher rate of severe infections (A vs. I vs. Q: 40% vs. 22% vs. 18%), and a trend towards higher 1-year non-relapse mortality (A vs. I: 10% vs. 4%, p=0.09). Progression-free (PFS) and overall survival (OS) was poor in the ‘aplastic’ patients (Fig. 1, 1-yr PFS 24%, 1-yr OS 48%). On the other hand, ‘intermittent’ patients exhibited the best survival outcomes (HR for PFS, I vs. A: 0.46, 95% CI 0.32-0.69). Median PFS was 3 vs. 4 vs. 20 months (A vs. Q v. I, p<0.001); median OS was 8 vs. 23 months vs. not reached (A vs. Q v. I, p=0.0025). On multivariate regression (n=316), the aplastic phenotype was primarily driven by baseline ECOG (OR=1.6, p=0.05), ferritin (OR=2.5, p=0.01), ANC (OR=0.3, p=0.01), and hemoglobin (OR=0.8, p=0.04). Of note, high-grade CRS/ICANS and CAR product were not associated with the aplastic phenotype. Initial analyses of inflammatory patterns revealed higher peak IL-15 levels and an increased ratio of ANG2 to ANG1 in ‘aplastic’ patients in both cohorts, with ANG-1 levels decreasing over time. Image:Summary/Conclusion: Hematopoietic recovery patterns impact disease outcomes after CD19 CAR-T. Surprisingly, a phenotype associated with recurrent neutrophil dips (i.e. prolonged cytopenia) was associated with improved survival outcomes. The poor-risk ‘aplastic’ phenotype was driven by baseline inflammation and hematopoietic function, and characterized by progressive endothelial dysfunction. Further mechanistic exploration is warranted and ongoing.

Misconceptions Related to COVID 19 Vaccines Among the Jordanian Population: Myth and Public Health.

This study assesses misconceptions about coronavirus disease 2019 (COVID-19) vaccine and the factors associated with misconception among Jordanians. A cross-sectional online survey was conducted. The survey was formulated on Google Forms, and was hosted on an online platform. These questions were created based on extensive review of online information about the vaccines. Frequencies and percentages (%) were used for categorical variables, while means and standard deviations (SDs) were used for continuous variables. Stepwise binary logistic regression was conducted to evaluate variables associated with participant's misconception questions. Of 1195 survey respondents who participated in the study, 41.3% had received the COVID-19 vaccine. The mean misconception score was (60.0 ± 19.1). The statement with the highest mean was "The vaccine hasn't been tested on enough people" (3.6 ± 1.0). The statement with the lowest mean was "The COVID-19 vaccine includes a microchip to control us" (2.2 ± 1.1) in the conspiracy theory portion. Females, 18- to 29-age group, higher educational level, living in a city, the participants who took lectures about the COVID-19 vaccine and vaccinated participants had higher odds of being in the low misconception level group. Targeted campaigns and vaccine safety information should be part of a broader health education campaign to alleviate vaccination safety concerns.

A simple predictive model with internal validation for assessment of stone-left after ureteroscopic lithotripsy in upper ureteral stones.

BackgroundStone free rate in upper ureteral stones is not as high. We sought to identify easily accessible risk factors attributing to stones left in the ureteroscopy in the treatment of upper ureteral calculi, and to build a simple and reliable predictive model.MethodsPatients treating only for upper ureteral stones in 2018 were retrospectively analyzed. Correlations between factors and the stone free rate were analyzed using bidirectional stepwise regression, curve fitting and binary logistic regression. Stone shape was judged by the gap between length and width in the two-dimensional section. A predictive nomogram model was built based on those selected variables (P<0.05). The area under the receiver operator characteristic curve (AUC) and calibration curve were used to access its discrimination and calibration. Decision curve analysis (DCA) was conducted to test the clinical usefulness.ResultsTotally, 275 patients with 284 stones were enrolled in this research. Bidirectional stepwise regression showed that stone length had a significant effect on stone free, instead of width or burden. Stone shapes were also found playing a big role. Curve fitting showed that quasi-circular stones had a high risk of retropulsion, and eventually led to stone left. Finally, stone length, shape, modality, and the distance of stones to the ureteropelvic junction were enrolled in the model. Among them, the distance of the stone to the ureteropelvic junction showed a noticeable impact on stone left. AUC was 0.803 (95% CI: 0.730–0.876), and the calibration curve showed good calibration of the model (concordance index, 0.792). DCA indicated the model added net benefit to patients.ConclusionsThe present predictive model based on those factors, stones length, shape, modality, and distance of the stone to the ureteropelvic junction was easy, reliable and useful.

Screening influencing factors of blood stasis constitution in traditional Chinese medicine

ObjectiveTo study the influencing factors of blood stasis constitution and provide a basis for treating blood stasis-related diseases by traditional Chinese medicine (TCM) constitution identification. MethodsData were collected using the self-developed TCM constitution identification platform based on B/S model by the project team. The obtained data were divided into blood stasis constitution and normal constitution groups. The differences of the categorical type influencing factors (gender, birth mode, feeding mode within four months of birth, family history, marital status, eating habits, sleeping habits, exercise habits, emotional state, stress situation, and living environment) and the quantitative type influencing factors (sleep time, age, and mother's age at birth) on the constitution of the two groups were analyzed. In the single-factor analysis, the Pearson's chi-square test was selected for the categorical variable, and the independent sample t test and Mann-Whitney U nonparametric test were selected for the quantitative variables according to whether they conformed to the positive-terrestrial distribution; the binary logistic stepwise regression method was selected for the multi-factor analysis. ResultsThe data of 318 cases were collected from the TCM composition identification platform, and 159 cases of blood stasis constitution were used as the experimental group and 159 cases of normal constitution were used as the control group. The Pearson's chi-square test yielded significant differences (P < 0.05) in the effects of gender, pressure situation, family history, living environment, emotional state, exercise habits, and dietary habits on blood stasis constitution. The independent samples t test yielded differences in sleep duration between the blood stasis constitution and normal constitution populations (P < 0.05), which meant sleep duration of the blood stasis constitution population was less than that of the normal constitution population. The Mann-Whitney U nonparametric test results accepted the original hypothesis that there was no difference in the distribution of age and mother’s age at birth across constitution types (P > 0.05). Binary logistic regression analysis showed that gender, family history, marital status, living environment, exercise habits, and emotional state were risk factors for blood stasis constitution (P < 0.05). ConclusionGender, family history, living environment, emotional state, and exercise habits were significant influencing factors of blood stasis constitution. Blood stasis constitution populations can pay more attention to these influencing factors in their daily life for the prevention and reconciliation of blood stasis constitution.

C.3 Childhood Absence Epilepsy: Prevalence of neuropsychiatric comorbidities and predictors of treatment resistance

Background: Seizures in childhood absence epilepsy (CAE) are typically easily controlled with anti-seizure medications (ASMs). Factors predictive of treatment resistance remain unclear. Our objectives were to assess prevalence of neuropsychiatric problems and factors influencing treatment resistance in a cohort of CAE at a single centre. Methods: We retrospectively reviewed patients with CAE diagnosed between January 1999 and December 2016 with at least 1-year follow-up. Treatment resistance was defined as failure to respond to two appropriate ASMs. Exclusion criteria included eyelid myoclonia with absence, myoclonic absence, and generalized tonic-clonic (GTC) seizures prior to absence seizures. Results: The study population comprised 164 patients (65 males) with mean age at seizures onset of 6.1years. 21% had treatment-resistant seizures. The first ASM was Ethosuximide (63.4%), Valproic acid (23.2%), and Lamotrigine (6.7%). 32.9% of children had learning disabilities, 28.7% ADHD, and 12.8 % anxiety.A stepwise binary logistic regression analysis identified GTC seizures, learning disability (LD) and ongoing general spike and wave on EEG as predictors of treatment resistance. At last follow-up (average of 5.4 years), 43.3% of children were seizure-free off ASMs. Conclusions: 21% of children with CAE had treatment-resistant seizures. LD, GTC and failure of normalization of the EEG were associated with treatment resistance.

Backwards Stepwise Binary Logistic Regression for Determination Population Growth Rate Factor in Java Island

The high population growth rate can impact various fields due to several factors. Some of the impacts of this high rate are high poverty rates, unemployment, consumption levels, inequality in education figures, gender empowerment index, and increasingly narrow land or area. Therefore, research on the rate of population growth using data on poverty, unemployment, consumption levels, education rates, gender empowerment index, and area makes sense. This data was taken from the official website of the Central Statistics Agency for six provinces on the island of Java, Indonesia. The data used contains missing data so that the missing data is presumed by using the k-nearest neighbour method. The estimated missing data values were modelled using binary logistic regression. Variables that significantly affect the rate of population growth, namely the level of consumption, gender empowerment index, and area, are obtained using the backward stepwise method and are selected based on the smallest Aikakes criterion information value or the one with the most excellent accuracy rate.

Longitudinal screening for depression and anxiety in prostate cancer (PC) and association with disease and treatment factors.

5023 Background: Untreated depression and anxiety are associated with worse outcomes in patients with cancer. Despite recommendations for longitudinal screening, many patients are only assessed at the start of care. Men with PC often experience many phases of disease or treatment over a span of years, and androgen deprivation therapy (ADT) is associated with mood changes and depression. How depressive or anxiety symptoms fluctuate in men with PC, influenced by disease and treatment factors, is not well-described. Methods: Men with ≥1 Urology or Medical Oncology clinic visit for PC in the prior 6 months were emailed the PHQ-9 and GAD-7 depression and anxiety screening tools every 60 days; a score of ≥10 (moderate to severe symptoms) on either was considered a positive screen. Baseline characteristics and disease/treatment changes (PSA, radiographic, or biopsy progression, treatment change or start, or discontinuation of treatment due to lack of efficacy or toxicity) were collected by survey and chart review. We report early findings of factors associated with a positive screen or change in screening status with χ2 and forward stepwise binary logistic regression (model inputs: receipt of ADT or disease/treatment change during study, and variables previously associated with depression or anxiety: age, race, marital status, education, income, history of psychiatric disorder, use of psychoactive medication, time since diagnosis, and localized, biochemically recurrent, or metastatic disease). Results: From 6/2021-12/2021, 201 men enrolled. At baseline, 50.7% had localized, 18.9% biochemically recurrent, and 30.3% metastatic disease; 40.8% were on ADT; 30.8% had a history of psychiatric disorder (22.9% depression, 19.9% anxiety, 9.0% other); and 24.9% were on psychoactive medication (19.9% antidepressant, 8.5% anxiolytic, 2.0% antipsychotic). 184 men completed at least 2 screens with mean follow-up 6.5 months (SD 1.3). 32 men (15.9%) screened positive at least once (15.4% PHQ-9, 4.5% GAD-7), of which half (N = 16) initially screened negative and later positive. Changing from a negative to positive screen was more likely when a disease/treatment change occurred during the study (18.3% vs 4.5%, p = 0.003). A higher proportion of men on ADT screened positive, especially if newly started during the study or in the 60 days preceding (35.7% new ADT vs 24.7% continuing ADT vs 8.0% no ADT, p = 0.002). In fully adjusted multivariable analyses, factors associated with a positive screen were history of psychiatric disorder (OR 6.3, 95% CI 2.6-15.4, p &lt; 0.001), receipt of ADT (OR 3.8, 95% CI 1.5-9.5, p = 0.005), and lower income bracket (OR 1.7, 95% CI 1.3-2.5, p = 0.002). Conclusions: Longitudinal screening for depression and anxiety in PC identifies men who initially screen negative. Symptoms are associated with ADT and disease or treatment changes, which may inform optimal screening practices.

Is maternal autonomy associated with child nutritional status? Evidence from a cross-sectional study in India.

Despite India's steady economic growth over recent the period, the burden of childhood malnutrition persists, contributing to higher neonatal and infant mortality. There is limited evidence available to contextualise mothers' crucial role in childcare practices and health status in the Indian context. This study attempts to assess the association between maternal autonomy and the nutritional status of children under five. We used samples of 38,685 mother-child pairs from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015-16. We considered three widely used indicators of child nutrition as outcome variables: stunting, wasting, and underweight. Maternal autonomy (measured from three dimensions: household decision-making, freedom of physical movement, and access to economic resources/control over assets) was the key predictor variable, and various child demographics, maternal, and household characteristics were considered control variables. Stepwise binary logistic regression models were performed to examine the association. Of study participants, 38%, 21%, and 35% of children were stunted, wasted, and underweight, respectively. Our results (models 1 to 4) indicate that mothers with greater autonomy were significantly associated with lower odds of malnourished children. After controlling for all potential confounding variables (in model 5), maternal autonomy had a statistically insignificant association with children's stunting (Odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.87, 1.00) and wasting (OR: 0.92; 95% CI: 0.85, 1.00). However, a significant relationship (though marginally) was retained with underweight (OR: 0.94; 95% CI: 0.88, 0.99). In addition, socio-demographic characteristics such as child age, birth order, maternal education, maternal BMI, place of residence and household wealth quintile were found to be strong predictors of child nutritional status. Future policies should not only inform women's empowerment programmes but also emphasise effective interventions toward improving female educational attainment and nutritional status of women, as well as addressing socioeconomic inequalities in order to combat the persistent burden of childhood malnutrition in India.

Point-of-care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus.

ABSTRACTAimsAssessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time‐consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point‐of‐care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN.MethodsNerve amplitude (AMPPOCD) and conduction velocity (CVPOCD) were measured in a cross‐sectional study including 198 asymptomatic patients with type 1 diabetes. CAN was diagnosed by the Ewing score and power spectral heart rate [low‐frequency (LF) and high‐frequency (HF) activity]. Diagnostic accuracy was determined by ROC curves.ResultsCVPOCD and AMPPOCD showed positive correlations with LF and HF, and a negative correlation with age. Overall, AMPPOCD had an 81.7% accuracy in identifying CAN [AUC = 0.817 (95% CI 0.692–0.942)] with an AMPPOCD ≤6 μV showing 90% sensitivity and 73% specificity. In a stepwise binary logistic regression analysis, the model (R 2: 0.297; P < 0.001) retained the duration of type 1 diabetes [β: 1.131 (95% CI: 1.051–1.216); P = 0.001) and A1c [β: 2.131 (95% CI: 1.060–4.283); P = 0.034) as significant predictors of CAN. The combination of AMPPOCD ≤6 μV + a type 1 diabetes duration of ≥8 years maximized the sensitivity, showing a diagnostic performance of 87% [AUC = 0.867 (95% CI 0.769–0.965)] with 90%, 76%, and 99%, sensitivity, specificity, and NPV, respectively. Adding A1c ≥ 7% to this model maintained accuracy [AUC = 0.867 (95% CI: 0.788–0.963) and NPV (99%), while increasing specificity to 84%.ConclusionsThe combination of AMPPOCD with A1c and the duration of type 1 diabetes mellitus showed a good performance for the detection of asymptomatic CAN, making POCD an easy and rapid test for its routine screening in the clinical setting.