Odds Ratio Research Articles

Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach

BackgroundAn estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa.MethodsThis study was based on secondary data sources from 33 Sub-Saharan countries’ recent Demography and Health surveys from 2010 to 2020. A weighted sample of 360,397 under-five children was included in the study. Bayesian multilevel binary logistic regression was fitted using the brms R package. Besides, leave one out information criteria was used for model comparison. The adjusted odds ratio (AOR) and its 95% credible interval (CrI) were reported for significant factors associated with under-five mortality. Clinical trial number: not applicable.ResultsThe prevalence of under-five mortality in sub Saharan Africa was 62 per 1000 live births (95%CI (56.29, 68.29). In sub region of SSA, it was 65 in central, 52 in eastern, 50 in southern and 73 in western region per 1000 live births. Multiple birth (AOR = 5.27; 95%CrI: 4.72, 5.87), number of under-five children 3 to 5 (AOR = 3.31; 95%CrI: 3.01, 3.60), caesarean section delivery (AOR = 1.64; 95%CrI: 1.47, 1.83), being unmarried (AOR = 1.16; 95%CrI 1.08, 1.26), using unimproved toilet (AOR = 1.08;95%CrI: 1.02, 1.16), birth order of 4th to 6th (AOR = 1.18; 95%CrI:1.1, 1.25),were risk factors of under-five mortality. Whereas, being female (AOR = 0.86; 95%CrI: 0.82, 0.91), preceding birth interval of 24–35 months (AOR = 0.61; 95%CrI: 0.57, 0.65) and above 36 months (AOR = 0.48; 95%CrI: 0.43, 0.49), ANC visit (AOR = 0.80; 95%CrI: 0.74 0.86), contraceptive use (AOR = 0.57; 95%CrI: 0.53, 0.61), were preventive factors of under-five mortality.ConclusionUnder-five mortality remains the highest in sub-Saharan Africa. Most of the risk factors of under-five mortality were found to be preventable. Policymakers and other stakeholders should enhance maternal education, lengthen birth interval, ANC visit, improved toilet facilities and, giving special attention to small size child and cesarean section delivery to reduce under-five mortality.

Correlation between hemoglobin, albumin, lymphocyte, and platelet score and short-term mortality in critically ill patients

BackgroundHemoglobin, albumin, lymphocyte and platelet (HALP) score is derived from the counts of hemoglobin, albumin, lymphocytes, and platelets. It serves as a valuable tool for assessing both inflammation and nutritional status in critically ill patients. However, there hasn’t been a specific study exploring the role of the HALP score in critically ill patients. Additionally, whether the HALP score exhibits an incremental effect on the Sequential Organ Failure Assessment (SOFA) score remains unknown.MethodsIn this study, we used the Medical Information Mart for Intensive Care (MIMIC-IV) version 2.2 database to evaluate the predictive value of HALP score for critically ill patients. The primary outcome investigated was intensive care unit (ICU) death, and the secondary outcomes included in-hospital mortality, ICU length of stay (LOS), hospital LOS, and 28-day mortality.ResultsWe analyzed 20,083 critically ill patients. In logistic regression, a low HALP score (HALP score < 3.56) showed higher risk of ICU death (adjusted odds ratio: 1.41, 95% confidence interval [CI]: 1.25 to 1.59). Additionally, the HALP score improved the predictive ability of the SOFA score (∆Area under curve: 0.009, p < 0.001). In Cox proportional hazards models, a low HALP score (HALP score < 3.2) was also associated with a higher risk of 28-day mortality (adjusted hazard ratio: 1.52, 95% CI: 1.33 to 1.74).ConclusionHALP score is associated with short-term mortality. Additionally, HALP score showed an incremental effect on SOFA score in predicting short-term mortality.

Phenotypes of headache in patients with obstructive sleep apnea

Obstructive sleep apnea (OSA), characterized by repeatedly collapse of upper airway while sleeping, is a common disease; estimated to have a prevalence of 57% in adults. Headache is a common neurological symptom and can be bothersome. A meta-analysis found that 33% of patients with OSA may have headaches. There is limited data on risk factors for having headache in patients with OSA. This study aimed to find risk factors or phenotypes of headache in patients with OSA. This was a retrospective analytical study. The inclusion criteria were adult patients with age of 18 years or over and diagnosed as OSA by polysomnography. The primary outcome of this study was a symptom of headache. Predictors for headache in patients with OSA were executed by stepwise method of multivariable logistic regression analysis. There were 213 patients with OSA met the study criteria. Of those, 52 patients (24.41%) had headache. The most common type of headache was tension type (27 patients; 51.92%), followed by non-specific type (22 patients; 42.31%), and migraine type (3 patients; 5.77%). There were four significant factors including dyspnea, fatigue, dizziness, and macroglossia. Dyspnea had the highest adjusted odds ratio at 3.29 (95% confidence interval of 1.25, 8.54), while macroglossia had the lowest adjusted odds ratio at 2.10 (95% confidence interval of 1.01, 4.43). Patients with OSA who had the following phenotypes of dyspnea, fatigue, dizziness, and macroglossia may have a higher chance of having headache.

Assessment of Knowledge and Utilization of Computers Among Healthcare Workers in Benue South, Nigeria

Literature confirms that the low success rate of eHealth systems is closely linked to inadequate computer knowledge. Therefore, this study aimed to assess knowledge and utilization of computers among healthcare workers in Benue South. An institution-based quantitative cross-sectional study design was conducted in 120 health facilities, including primary healthcare centres, and private clinics. This study involved 430 healthcare workers. Using Python programming, descriptive and multivariable logistic regression analyses were conducted to assess the level of computer knowledge and utilization among participants, as well as to identify factors influencing their computer knowledge and utilization. Of the 430 participants, 233 (54.19%) of healthcare workers passed the computer knowledge test, 216 (50.23%) of health workers have access to computers, and 221 (51.40%) of them had undergone formal computer training. The findings revealed that 263 (61.16%) of healthcare workers exhibit good computer utilization, while 167 (38.84%) demonstrated poor utilization. Access to a computer (adjusted odds ratio [AOR]=2.83, 95% CI 0.48-1.60), and prior computer training (AOR=3.34, 95% CI 0.65-1.76) were found to be significantly associated with computer knowledge, while Access to a computer (AOR=2.98, 95% CI 0.48-1.70), Sex (AOR=2.23, 95% CI 0.28-1.32), Department (AOR=1.06, 95% CI 0.00-0.11), and prior computer training (AOR=5.53, 95% CI 1.10-2.32) were found to be significantly associated with computer utilization. These findings imply that improved access to computers and comprehensive computer training for healthcare professionals is vital for improved service delivery.

The association between polypharmacy and disease control in rheumatoid arthritis and systemic lupus erythematosus: a cohort study.

Polypharmacy can be associated with poor outcomes in chronic diseases. Our objective is to determine the prevalence of polypharmacy and its association with disease control in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). An observational study was conducted using the SARD database of the CHU de Québec. Participants newly diagnosed with RA or SLE enrolled in the database after 24 months were included. Collected data included number and type of medications, Charlson Comorbidity Index, and medication adherence (proportion of days covered during the first 180 days). Polypharmacy was defined as the simultaneous use ≥5 medications. Multivariable logistic and linear regressions were used to determine the association between polypharmacy and disease control (DAS28CRP, SLEDAI-2K). The study included 111 participants (RA = 81; SLE = 30). Medication count increased at two years in RA (mean ± SD): 4.6 ± 3.3 to 6.9 ± 3.6; and SLE: 6.5 ± 4.6 to 7.80 ± 4.82. Polypharmacy prevalence increased at two years: RA: from 43 to 74%; SLE: from 47 to 73%. Mean medication adherence exceeded 85%. For RA participants, polypharmacy was associated with a better DAS28CRP score at one year [adjusted odds ratio of achieving a poor outcome: 0.17 (95%CI 0.04-0.71)], but this association was lost at two years [2.88 (0.45-18.29)]. For SLE, polypharmacy was not associated with disease activity based on the SLEDAI-2K at one year [7.36 (0.26-211.16)] or two years [0.32 (0.05-1.99)]. Overall, polypharmacy is very prevalent in RA and SLE and could be positively associated with the level of disease control in the year after a diagnosis of RA.

Association between Loa loa microfilaremia and anatomical hyposplenia in a rural area of the Republic of Congo: a population-based cross-sectional study

BackgroundData suggest excess mortality is associated with loiasis, which is endemic to Central Africa, although the underlying mechanisms remain unknown. We hypothesized that there could be an association between Loa loa microfilarial densities (MFD) and lower spleen volume (SV) due to micro-obstruction linked to circulating microfilariae (mf). This could result in functional hyposplenia and a higher burden of infections. Our objective was to investigate the impact of L. loa MFD and malaria on spleen’s bi-dimensional dimensions, volume, and parenchymal lesions.MethodsWe included 981 participants aged 18–88 years in a cross-sectional study conducted in May–June 2022 in the Republic of the Congo. Centralized ultrasonographic examination was performed. The primary outcomes included SV, splenomegaly (cranio-caudal-distance ≥ 13 cm), and anatomical hyposplenia (AH) (SV ≤ 80, ≤ 110 or ≤ 150 cm3). Blood samples were analyzed for L. loa MFD, Plasmodium-PCR, Anti-Plasmodium falciparum-IgG, total IgM, sickle-cell disease status, and hematological abnormalities. Linear and logistic regressions were used to assess these associations.ResultsAmong 981 participants, 139 (14.1%) had splenomegaly, and 26 (2.7%) and 175 (17.8%) had SV ≤ 80 and ≤ 150 cm3, respectively. L. loa microfilariae were detected in 353 (35.6%) participants. A gradient effect was observed in each model, with the highest MFD (> 30,000 mf/ml) having the highest adjusted odds ratio of 17.94 (95% CI: 2.91–110.76, P = 0.002), 5.94 (95% CI: 1.40–25.17, P = 0.016), and 5.77 (95% CI: 1.95–17.12, P = 0.002) for SV ≤ 80, 110, and 150 cm3, respectively. Anti-P. falciparum-IgG levels were gradually associated with splenomegaly. Fourteen participants met the criterion for hyper-reactive malarial splenomegaly (HMS). Conversely, higher L. loa MFD was correlated with AH, with an attributable fraction of 25%, and the presence of splenic parenchymal lesions.ConclusionsThis study provides a detailed description of spleen morphology and the factors influencing its size in a rural central African population. It demonstrates a strong association between L. loa MFD and reduced SV, suggesting that loiasis may lead to AH, and potentially to functional hyposplenia, with consequences such as increased susceptibility to bacterial infections. Malaria was associated with splenomegaly, with a figure of HMS consistent with estimates from other African countries.Graphical

Associations between nonrestorative sleep and suicidal ideation: a Japanese general population survey

Insomnia symptoms and short sleep duration are known to be associated with suicidal ideation. The aim of this study was to investigate the association between nonrestorative sleep (NRS), a subjective experience of feeling unrefreshed after waking up, and suicidal ideation in the general population. We analyzed data from a cross-sectional survey of 2559 randomly sampled adults living in Japan. The participants were asked about insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening), NRS, sleep duration, and the presence of suicidal ideation. Logistic regression analysis was used to examine the associations among short sleep duration (< 6 h), insomnia symptoms, NRS, and suicidal ideation. Possible confounding factors were adjusted using propensity scores. In the multivariate analysis adjusting for the confounding effects of other sleep-related factors, in addition to psychiatric, sociodemographic, and lifestyle factors, only NRS showed a positive association with suicidal ideation (adjusted odds ratio [aOR] = 2.266). These findings suggest the importance of focusing on NRS for suicide prevention in the general population.

Efficacy and Safety of intravenous alteplase for unknown onset stroke on prior antiplatelet therapy: post-hoc analysis of the EOS Individual Participant Data.

The effects of intravenous alteplase in patients with prior antiplatelet therapy (APT) remain controversial. We aimed to assess the efficacy and safety of imaging-based intravenous alteplase in patients with unknown-onset stroke with prior APT. Data from randomized controlled trials comparing alteplase with placebo/standard care in patients with unknown-onset acute ischemic stroke from the Evaluation of Unknown Onset Stroke Thrombolysis (EOS) individual patient data meta-analysis collaboration were analyzed. Favorable outcome was defined as a modified Rankin Scale score 0-1 at 90 d poststroke. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22-36 h and 90-d mortality. Overall, 780 patients had available baseline data on prior APT. Compared with the no prior APT group (n=523), the prior APT group (n=257) was older (72 years vs. 66 years) and had a higher prevalence of vascular risk factors. There was no interaction between prior APT and treatment effects of alteplase (p for interaction=0.23). In the prior APT patients, 55/125 (45%) patients in the alteplase group and 39/132 (30%) patients in the control group had a favorable outcome (adjusted odds ratio [aOR], 2.07 [95% CI, 1.18-3.64]). The rates of sICH and mortality in the alteplase and control groups were 5.6% and 0.8%, respectively (aOR, 7.78 [0.94-63.37]) and 6.5% and 6.1%, respectively (aOR, 1.12 [0.38-3.36]). In the no prior APT patients, 136 patients (50%) in the alteplase group and 112 patients (45%) in the control group had a favorable outcome (aOR, 1.39 [0.94-2.05]). Safety outcomes were not significantly different between the groups (sICH: 3 [1.1%] vs. 1 [0.4%]; mortality: 13 [4.9%] vs. 3 [1.2%]). Alteplase has consistent efficacy regardless of prior APT in patients with unknown-onset stroke. Additionally, prior APT does not significantly increase the risk of sICH or mortality.

Undernutrition and associated factors among incarcerated people in Bahir Dar and Finote Selam prison sites, Northwest Ethiopia: a cross-sectional study

BackgroundPrison is designed with punishment, correction and rehabilitation to the community in mind and these goals may conflict with the aims of healthcare. Incarcerated peoples’ dependency on the prison-limited food...

Pre- and postinjury financial hardship among trauma survivors: A national survey study.

National estimates of financial hardship because of injury are lacking, which limits our ability to both define and mitigate the impacts of financial outcomes of trauma care. Furthermore, the absence of preinjury data limits our understanding of the association between injury and financial hardship. We analyzed data from the 2014-2021 Medical Expenditure Panel Survey. We compared injured adults (18-64 years old) to uninjured controls using coarsened-exact matching on age, sex, race/ethnicity, income, payer, survey panel, and comorbidities. Our main outcome of interest was financial hardship, a composite of difficulty paying medical bills, paying medical bills off over time, and delaying medical care because of cost. As a secondary analysis, we evaluated the link between difficulty paying medical bills, delaying care, and poor health. We included a weighted sample of more than 79 million injured patients over the 8-year study period. Difference-in-differences analysis using uninjured, matched controls showed that injured patients experienced an 8.2 percentage point increase in financial hardship (23% relative increase, with 40.6% reporting financial hardship postinjury, p < 0.001) and 4.5 percentage point increase in poor health (20% relative increase, p < 0.001). Injured patients who reported difficulty with medical bills were more likely to report delaying care because of costs (adjusted odds ratio, 3.3; 95% confidence interval, 2.5-4.4), and those who delayed care were more likely to report poor health (adjusted odds ratio, 1.5; 95% confidence interval, 1.2-2.0). In this national analysis of financial hardship before and after injury, 40% of injured patients reported difficulty with medical bills and delayed medical care because of cost. Programs aimed at disrupting the path from injury to financial hardship to poor long-term health have the potential to benefit millions of injury survivors. Retrospective Cohort Study; Level III.

Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial.

Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures. A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H, Mann-Whitney U, Pearson's χ2, Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications. Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications (p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; >24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668). Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures. Therapeutic/Care Management; Level II.

Seizure after flumazenil reversal for total intravenous anaesthesia with remimazolam versus propofol: a matched retrospective cohort analysis of a large Japanese nationwide inpatient database.

Remimazolam is a novel anaesthetic and sedative agent that offers several advantages, including minimal adverse haemodynamic effects and availability of a specific antidote, flumazenil. Flumazenil can induce seizures as an adverse effect; however, the incidence of seizures after flumazenil reversal after total intravenous anaesthesia with remimazolam (remimazolam-flumazenil) remains unknown. We compared the risk of seizures between total i.v. anaesthesia with remimazolam-flumazenil or propofol. We retrospectively identified patients who underwent elective surgery (excluding brain surgery) with total i.v. anaesthesia in Japan between April 2020 and March 2022 using the Japanese Diagnosis Procedure Combination database. Patients were divided into remimazolam-flumazenil and propofol groups. Patients in the remimazolam-flumazenil group were matched to those in the propofol group at a variable ratio of 1:3 (maximum) based on age, sex, hospital, and type of surgery. We conducted conditional logistic regression analyses to assess the association between total i.v. anaesthesia with remimazolam-flumazenil and the incidence of perioperative seizures. We identified 12 033 patients who underwent total i.v. anaesthesia with remimazolam-flumazenil and 432 275 patients with propofol, creating a matched cohort of 19 105. The crude incidence of seizures was 0.66% (95% confidence interval, 0.63-0.68%). There was no significant difference in seizures between the two groups (adjusted odds ratio, 1.08; 95% confidence interval, 0.49-2.37). We observed no significant differences in perioperative seizures between remimazolam-flumazenil and propofol in patients undergoing non-neurological surgery. This suggests that remimazolam-flumazenil is a possible alternative to total i.v. anaesthesia with propofol.

Unwinding of Continuous Medicaid Coverage Among Pediatric Community Health Center Patients

During the COVID-19 pandemic public health emergency, states provided continuous Medicaid coverage to enrollees. In April 2023, states began to unwind this continuous coverage, prompting concern about the impact of this on pediatric patients. To examine loss of coverage during the unwinding of continuous Medicaid coverage among pediatric patients seen at community-based health care organizations. This cohort study with statistical analysis in November 2024 included pediatric patients from a multistate network of community-based health care organizations. Participants were aged up to 17 years at both their last Medicaid-insured visit during the continuous coverage period and at their first visit during the unwinding period (April 1, 2023, to March 31, 2024). Age, sex, race and ethnicity, language, and medical complexity. The main outcome was Medicaid disenrollment to uninsured status during the unwinding period. Logistic regression was used to estimate the odds of ever being uninsured during unwinding, and Cox proportional hazards regression models were used to examine the time to uninsured status from the start of unwinding in each patient's state of residence through the end of March 2024. Associations between age, sex, race and ethnicity, language, and medical complexity and the outcome were assessed. Among 450 146 pediatric patients, mean (SD) patient age was 8.11 (5.07) years and 50.1% were male. Overall, 8.7% were disenrolled from Medicaid to uninsured status. Patients aged 12 to 17 years had the highest estimated disenrollment among age groups (10.5%), but after adjustment, all other age groups had lower odds of disenrollment compared with those younger than 1 year. Females had higher odds of disenrollment (adjusted odds ratio [AOR], 1.15 [95% CI, 1.13-1.18]; adjusted hazard ratio [AHR], 1.14 [95% CI, 1.12-1.17]) than males. American Indian or Alaska Native patients had higher odds of disenrollment (AOR, 1.95 [95% CI, 1.81-2.09]; AHR, 1.81 [95% CI, 1.05-3.13]) than White patients, with estimated disenrollment of 17.1% vs 9.4%. Compared with patients with low medical complexity, those with either chronic but noncomplex (AOR, 1.83 [95% CI, 1.79-1.88]; AHR, 1.80 [95% CI, 1.44-2.27]) or complex chronic (AOR, 1.95 95% CI, 1.89-2.00]; AHR, 1.92 [95% CI, 1.67-2.21]) medical complexity had higher odds of disenrollment. In this cohort study of previously Medicaid-insured pediatric patients seen at community-based health care organizations, a meaningful proportion of patients were disenrolled to uninsured status during the unwinding of continuous Medicaid coverage, with associated differences by demographic and clinical characteristics. This could impact access to care and health outcomes for the patients.

Association Between Comorbidities and Inpatient Postpartum Permanent Contraception Completion.

To evaluate whether comorbidities (defined as both medical conditions and peripartum complications) are associated with inpatient postpartum permanent contraception by tubal surgery completion. This is a secondary analysis of a multisite retrospective cohort study of patients who had documented plans for permanent contraception. Our primary outcome was inpatient completion of postpartum permanent contraception by tubal surgery. We used univariable and multivariable logistic regression analyses to examine associations between aggregate and individual comorbidities and the attainment of inpatient postpartum permanent contraception. In this study of 2,226 pregnant people, 53.4% of patients received postpartum permanent contraception by the time of hospital discharge, and 70.8% of patients had documented comorbidities. Although patients with medical conditions initially had lower odds of permanent contraception completion compared with those without any comorbidities (adjusted odds ratio [aOR] 0.77, 95% CI, 0.64-0.93), this association was no longer significant after adjusting for multiple comparisons (adjusted P=.06). This association also was not significant for patients with peripartum complications (aOR 0.86, 95% CI, 0.64-1.16, adjusted P=.42). Similarly, when individual comorbidities were assessed, patients with hypertension (aOR 0.80, 95% CI, 0.65-0.97, adjusted P=.06), mental health diagnoses (aOR 0.80, 95% CI, 0.66-0.96, adjusted P=.06), and elevated body mass index (BMI, 40 or higher) (aOR 0.77, 95% CI, 0.63-0.95, adjusted P=.06) had no significant differences in odds of immediate permanent contraception attainment after adjusting for multiple comparisons. Though the balance of risks and benefits is imperative for surgical care, it is imperative that modifiable barriers to desired permanent contraception are mitigated. There were no statistically significant differences in inpatient postpartum permanent contraception attainment for patients with medical conditions in our study; however, further study is needed to better elucidate the complex relationships between medical comorbidities and contraception.

Predictors of moderate, severe, and critical COVID-19 infection in a largely vaccinated kidney transplant recipient cohort during the Omicron era: the importance of timely booster vaccinations and early presentation to care.

Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period. This single-center retrospective study included KTRs aged ≥18 years diagnosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI); moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness. Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006-1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155-1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212-0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956-0.986). KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.

Predictive Validity of Hospital-Associated Complications of Older People Identified Using Diagnosis Procedure Combination Data From an Acute Care Hospital in Japan: Observational Study.

A composite outcome of hospital-associated complications of older people (HAC-OP; comprising functional decline, delirium, incontinence, falls, and pressure injuries) has been proposed as an outcome measure reflecting quality of acute hospital care. Estimating HAC-OP from routinely collected administrative data could facilitate the rapid and standardized evaluation of interventions in the clinical setting, thereby supporting the development, improvement, and wider implementation of effective interventions. This study aimed to create a Diagnosis Procedure Combination (DPC) data version of the HAC-OP measure (HAC-OP-DPC) and demonstrate its predictive validity by assessing its associations with hospital length of stay (LOS) and discharge destination. This retrospective cohort study acquired DPC data (routinely collected administrative data) from a general acute care hospital in Tokyo, Japan. We included data from index hospitalizations for patients aged ≥65 years hospitalized for ≥3 days and discharged between July 2016 and March 2021. HAC-OP-DPC were identified using diagnostic codes for functional decline, incontinence, delirium, pressure injury, and falls occurring during the index hospitalization. Generalized linear regression models were used to examine the associations between HAC-OP-DPC and LOS, and logistic regression models were used to examine the associations between HAC-OP-DPC and discharge to other hospitals and long-term care facilities (LTCFs). Among 15,278 patients, 3610 (23.6%) patients had coding evidence of one or more HAC-OP-DPC (1: 18.8% and ≥2: 4.8%). Using "no HAC-OP-DPC" as the reference category, the analysis showed a significant and graded association with longer LOS (adjusted risk ratio for patients with one HAC-OP-DPC 1.29, 95% CI 1.25-1.33; adjusted risk ratio for ≥2 HAC-OP-DPC 1.97, 95% CI 1.87-2.08), discharge to another hospital (adjusted odds ratio [AOR] for one HAC-OP-DPC 2.36, 95% CI 2.10-2.65; AOR for ≥2 HAC-OP-DPC 6.96, 95% CI 5.81-8.35), and discharge to LTCFs (AOR for one HAC-OP-DPC 1.35, 95% CI 1.09-1.67; AOR for ≥2 HAC-OP-DPC 1.68, 95% CI 1.18-2.39). Each individual HAC-OP was also significantly associated with longer LOS and discharge to another hospital, but only delirium was associated with discharge to LTCF. This study demonstrated the predictive validity of the HAC-OP-DPC measure for longer LOS and discharge to other hospitals and LTCFs. To attain a more robust understanding of these relationships, additional studies are needed to verify our findings in other hospitals and regions. The clinical implementation of HAC-OP-DPC, which is identified using routinely collected administrative data, could support the evaluation of integrated interventions aimed at optimizing inpatient care for older adults.

Analysis of Early Post-Radiation Surgical Management of Metastatic Spinal Tumors

Background/Objectives: Radiotherapy is one of the various treatment options for patients with metastatic spinal tumors (MST). However, it is difficult to say that this is definitely an optimal treatment for MST, and there are several patients who need surgical treatment because pain or neurologic deficits occur even after radiotherapy. Therefore, this study aimed to analyze which patients received early operative treatment after radiotherapy. Methods: We included 81 patients who underwent decompression and fusion surgery after radiotherapy for MST. Patients who underwent surgery within 6 months after radiotherapy were classified as the early operation group (group E, n = 47), while surgery cases after 6 months after radiotherapy were assigned to the late operation group (group L, n = 34). Risk factor analysis using multivariate regression analysis for early operative treatment after radiotherapy was performed. Also, we analyzed the period from radiotherapy to surgery according to the Bilsky grade. Results: In multivariate analysis, pathologic fractures and semirigid (thoracic) lesions were more frequent in group E than group L (adjusted odds ratio, 4.282, 10.524; p = 0.001, 0.039). In subgroup analysis, there was a difference in the period from radiotherapy to surgery in Bilsky grades above 2 than Bilsky grade 1 (grade 1, 13.6 ± 11.4 months, grade 2, 6.9 ± 6.8 months, grade 3, 6.6 ± 7.5 months; grade 1 vs. 2, p = 0.049, grade 1 vs. 3, p = 0.047). Conclusions: Although the information in this study may only be limited to patients who underwent surgery, early operative treatment after radiotherapy is highly likely for patients with MST accompanied by a Bilsky grade above 2, pathologic fracture and thoracic lesion. In these patients, surgical treatment could be considered as the primary treatment.

The association between implicit culture beliefs and intercultural sensitivity: anticipated intergroup exclusion and stigma as underlying processes

South Asians and Chinese mainlanders are two distinct cultural minority groups in the Hong Kong context. Grounded in theories and findings on implicit beliefs, this study examined the mediating roles of anticipated intergroup exclusion and stigma toward these cultural minority groups in the link between implicit culture beliefs and intercultural sensitivity. A total of 192 university students aged between 18 and 26 years old (M = 21.18; SD = 1.82) residing in Hong Kong participated in this study. Participants completed self-report questionnaires that assessed fixed versus malleable beliefs about cultural attributes, anticipated intergroup exclusion towards South Asians and Chinese mainlanders, stigma towards South Asians and Chinese mainlanders, and intercultural sensitivity. Path analysis and bootstrapping were applied to test the mediation model. Results showed that fixed implicit beliefs about cultural attributes were related to anticipated intergroup exclusion, greater stigma towards cultural minority groups, and lower intercultural sensitivity. However, only greater stigma towards South Asians, but not towards Chinese mainlanders, was then significantly associated with lower intercultural sensitivity. Taken together, the present study revealed the partial mediating roles of anticipated intergroup exclusion and stigma towards cultural minorities (i.e., South Asians and Chinese mainlanders) between implicit culture beliefs and intercultural sensitivity in the context of Hong Kong. In addition, the strengths of associations among anticipated intergroup exclusion, stigma, and intercultural sensitivity differed as a function of cultural groups.

Early-stage randomised controlled trial of therapist-supported online cognitive therapy for post-traumatic stress disorder in young people.

Effective face-to-face treatments for Post-Traumatic Stress Disorder (PTSD) are available, but most young people with PTSD do not receive effective treatment. Therapist-supported online Cognitive Therapy has the potential to improve accessibility of effective treatment. This early-stage trial gathered data on the feasibility, acceptability, and initial signal of clinical efficacy of a novel online Cognitive Therapy program for young people with PTSD. A two-arm, parallel-groups, single-blind, early-stage feasibility RCT compared online Cognitive Therapy to a waitlList condition. Participants were N = 31 adolescents (12-17 years-old) with a diagnosis of PTSD, randomised in a 1:1 ratio using minimisation. Thresholds for progression to a larger trial were set a priori for recruitment rate, data completeness, and the initial signal of clinical efficacy. The primary clinical outcome was PTSD diagnosis at 16 weeks post-randomisation. Secondary clinical outcomes were continuous measures of PTSD, depression, and anxiety at 16 weeks; and at 38 weeks in the online Cognitive Therapy arm. All pre-determined feasibility thresholds for progression to a larger trial were met. We recruited to target at a rate of 1-2 participants/month. No patient dropped out of therapy; 94% of all participants were retained at 16 weeks. At 16-weeks, the intention-to-treat (ITT) effect adjusted odds ratio was 0.20 (95% CI, 0.02, 1.42), indicating that the odds of meeting PTSD caseness after online therapy were 80% lower than after the waitlist (10/16 participants met PTSD caseness after therapy compared to 11/13 after WL). Effect-size estimates for all secondary clinical outcomes were large-moderate; improvements were sustained 38 weeks after online Cognitive Therapy. Therapist-supported online Cognitive Therapy for PTSD is acceptable to young people and has potential for meaningful and sustained clinical effects. A larger trial appears feasible to deliver. Further work is needed to refine the intervention and its delivery and to evaluate it in a larger confirmatory trial.

Risk Factors for Venous Thromboembolism (VTE) Following Anterior Cruciate Ligament (ACL) Reconstruction: A Systematic Review and Meta-Analysis.

Thromboembolism (VTE) is an uncommon, but potentially serious complication in patients who undergo anterior cruciate ligament (ACL) reconstruction. PubMed, EMBASE, and Cochrane databases were searched for relevant studies published until July 16, 2023. Eligible studies were those investigating patients who were undergoing ACL reconstruction, with the primary focus on factors associated with VTE including age, sex, body mass index (BMI), hypertension, smoking, type of surgical setting (outpatient vs. inpatient), and tourniquet time. Six studies consisted of a total of 47,886 patients underwent ACL reconstruction were included. The VTE rate ranged between 0.4% and 11.0%, and the mean patient age ranged from 26.8 to 33.25 years. The meta-analysis revealed no significant association between VTE risk and sex (pooled adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI]: 0.88-1.85). Furthermore, the meta-analysis showed a significantly higher risk of VTE in smokers compared to non-smokers, favoring non-smokers (pooled aOR = 1.71, 95% CI: 1.16-2.54). The systematic review identified several other potential factors, including older age, BMI, hypertension, smoking, surgical setting, and tourniquet time, which were documented in at least 2 included studies. However, while some of these factors showed reported significance, the number of studies was insufficient to generate a pooled result. According to our meta-analysis, sex does not appear to be a significant risk factor for VTE in patients undergoing ACL reconstruction. However, more evidence is needed to determine whether factors such as older age, BMI, hypertension, outpatient vs. inpatient surgery, and tourniquet time are associated with increased VTE risk. Caution is still advised when managing patients with these risk factors in the context of ACL reconstruction. A future meta-analysis is warranted once a sufficient number of studies are available to draw more definitive conclusions. IV.