Times Greater Risk Research Articles

The economic and psychological impacts of covid-19: a exploratory study of the intersection of traditional and new vulnerable groups in South Korea

BackgroundThe global impact of the COVID-19 pandemic has been extensive, disproportionately affecting various vulnerable populations. In addition to traditional vulnerable groups (TVGs) such as the elderly, women, people with lower education, disabled individuals, and low-income groups, new vulnerable groups (NVGs) have emerged, including essential workers, face-to-face workers, temporary workers, and the self-employed. This study focuses on exploring the economic and psychological effects of the pandemic on both traditional and newly recognized vulnerable groups within Korea.MethodsThe study employed multiple logistic regression using micro-level social survey data from Statistics Korea to calculate the odds ratio relating to two categories of vulnerable groups and their economic and mental health impacts. Additionally, through interaction term analysis, we tried to uncover the complex interrelationship between these non-vulnerable groups and target vulnerable groups.ResultsBoth the newly identified and traditional vulnerable groups showed higher likelihood of facing economic and mental health challenges compared to non-vulnerable groups. The likelihood of encountering a decrease in income and work-related stress was 2.17 times higher (95% CI = 1.90–2.47) for NVGs, while those belonging to TVGs had a 1.75-fold increase (95% CI = 1.47–2.08). Moreover, female self-employed workers faced higher overall stress at 1.36 times greater risk (95% CI = 1.08–1.71), whereas elderly individuals who are self-employed exhibited lower odds of experiencing such stress at the intersection between TVGs and NVGs.ConclusionThis research offers in-depth understanding of the diverse impacts of COVID-19 on at-risk groups. Furthermore, examinations that take into account interactions between NVGs and TVGs uncovered subtle effects within subgroup dynamics, suggesting that intersecting factors play a role in different levels of vulnerability. This provides valuable evidence for informing policy decisions and allocating resources.

284 Relationship between sow caliper measurements with sow reproductive performance and longevity in the herd

Abstract Ideal conditioned sows are desired because they maximize herd performance, improve female well-being, and optimize financial outcomes. Sow productivity has increased, and body composition of females has changed, with sows being leaner and having less adipose tissue compared with their predecessors. Our objective was to determine the relationship between sow caliper measurements with sow reproductive performance and longevity in the herd. Data collected in four different production systems located in the US and Brazil were used, with 3,083, 356, 7,456, and 26,773 individual PIC Camborough observations represented within each of these databases. Caliper measurements were collected at due to farrow and weaned sows and were recorded in units, standardized to an ideal range of 12 to 15 units. Caliper change in lactation was determined as the caliper units at weaning minus the caliper units pre-farrowing. Response variables included proportion of born alive and stillborn piglets, lactation feed intake, as well as removal and mortality risk for all causes, or specifically for reproductive and pelvic organ prolapse (POP) causes. Data were analyzed using generalized linear mixed models, hazard ratio analysis, and survival models with the lmer, glmer, and surv functions of R. Sow served as the experimental unit. Caliper measurements at farrowing had curvilinear associations (P < 0.05) with percentage born alive piglets and percentage stillborn piglets. Increasing caliper units at farrowing resulted in linear reduction (P < 0.05) in lactation average daily feed intake and in linear increase (P < 0.05) in caliper losses during lactation. Sows losing 1 to 2, 3 to 4, or 5 and greater caliper units in lactation had 1.5, 1.8, and 2.4 times, respectively, greater risk (P < 0.05) of being removed from the herd in the next cycle compared with sows that gained 0 or more units. Reduced caliper units in due-to-farrow sows resulted in reduced probability (P < 0.05) of survival in the next cycle considering prolapse removal reasons. Sows with due to farrow caliper units of 12 to 15 had 1 to 1.6 times (95% Odd Ratio Confidence Interval), 9 to 11 had 1.2 to 2.1 times, and less than 9 caliper units 3.1 to 3.2 times greater risk of death or being removed from the herd due to POP compared with those with >15 units. Reduced caliper units in due-to-farrow sows resulted in reduced probability of survival in the next cycle considering all removal and mortality causes. Specifically, sows with less than 9 caliper units at farrowing had 2.0 times greater risk (P < 0.05) of removal and 4.4 times greater risk (P < 0.05) of mortality compared with sows with over 15 caliper units. In summary, both under and over-conditioned sows have reduced productivity. Underconditioned sows are at greater risk for mortality and for POP related removal.

Central Venous Access Device–Associated Skin Complications in Adults with Cancer: A Prospective Observational Study

To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications. A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.

A Study on Impact of Smoking on Semen Parameters

Introduction: Infertility approximately affects 15% of couple in India, among which male factor infertility isassociated as contributing factor causing infertility in 40- 50% of cases and sole cause in 15 -20% of cases. Semen analysis is a standard investigating tool in evaluating male infertility. Lifestyle factors namely diet, obesity, smoking, alcohol, stress, play a major role in health. Among these factors smoking is inevitable, causing detrimental effects on semen parameters and associated with lower fertility rates.Methodology: A cross sectional study was conducted among 295 male partners of women with infertility,attending the fertility Clinic, in reproductive medicine department over 10 months. Two hundred andninety five men satisfying the inclusion and exclusion criteria were selected by simple random sampling technique. The semen parameters of the participants were analysed, entire socio-demographic profile and detailed history was obtained using structured questionnaire and confidentiality was maintained. The results were ascertained using SPSS.Results: Among 295 participants, total 99 (33.55%) men had abnormal semen parameters. Nearly half of thestudy subjects (i.e.) 148 (50%) among 295 subjects were found to be smokers. Among 99 male with abnormalsemen parameters, 60 (61%) men who had abnormal semen parameters were smokers. This study proves a strong association between smoking on male fertility (1.9 times greater risk among smokers). Significant association (x 2 = 6.492, p = 0.0108) was found between smoking, reduced semen parameters and quality.Conclusion: Lifestyle modifications such as cessation of smoking, premarital and pre-conception health checkups, counselling, voluntary fertility testing by male partners, early detection and appropriate intervention the saves the reproductive potential. Men must be health educated for developing knowledge on ill effects of smoking, positive attitude, behavioural change and accept his responsibility for strengthening and caring his female partner amidst the societal pressures. Thus the present study substantiates more evidence to the existing literature.

The Relationship Between Shift Work Patterns and Cognitive Function Disorders in Health Workers at Hospital X, West Java, Indonesia

Introduction: Jobs with shift work patterns, especially irregular ones, can disrupt circadian rhythms and sleep quality, which then impacts cognitive function. Despite its importance, research on cognitive domain vulnerabilities related to shift work patterns is still limited. Sleep quality and cognitive function are critical in the context of hospital health services, where decisions and actions must be taken quickly and precisely to support patient safety.&#x0D; Methods: This research is a cross-sectional observational analytical study to determine the relationship between shift work patterns and impaired cognitive function. To measure sleep quality, the Pittsburgh Sleep Quality Index Indonesian (PSQI-Ina) is used, while cognitive function and cognitive domains were measured using Oxford Cognitive Screen (OCS) Indonesian (OCS-Ina), a cognitive instrument for stroke patients, which has been validated. The minimum sample size in this study was 72 samples. Correlation, principal component analysis, demographic analysis, and regression were used to characterize the relationship between PSQI-Ina, OCS-Ina, and other research variables.&#x0D; Results: A total of 83 health workers met the inclusion criteria and were included in the research. The results showed that 16 respondents (19.3%) experienced impaired cognitive function in the Attention domain and 2 respondents (2.4%) experienced impairment in 2 cognitive domains (Attention and Number Management). The results of statistical analysis showed a significant relationship with health workers who had part-time jobs having a 12.8-fold risk (OR 12.8; 95% CI 1.7-91; p = 0.011) of experiencing cognitive impairment. Then health workers who experience poor sleep quality (with a PSQI value &gt;5) have a 40.3 times greater risk (OR 40.3; 95% CI 2.2-708.1; p = 0.011) of experiencing cognitive impairment. Likewise, health workers with irregular shift work patterns have a 5.4 times risk of experiencing cognitive impairment (OR 5.4; 95% CI 0.1-26.6; p = 0.036).&#x0D; Conclusion: There is a relationship between shift work patterns and impaired cognitive function in the workplace. Hospitals should prioritize ergonomic shift work schedules, emphasizing speed and clockwise rotation, to support the well-being of their healthcare workers.

Stroke, HIV and the Immune Reconstitution Inflammatory Syndrome in the absence of opportunistic infections

IntroductionStroke in people living with HIV (PLWH) has been described to occur soon after the initiation of antiretroviral therapy (ART) possibly related to the Immune Reconstitution Inflammatory Syndrome (IRIS). We sought to investigate whether there was a temporal association between stroke and recent ART initiation in the absence of opportunistic infections (OIs), and to identify risk factors for this. MethodsThis cross-sectional study recruited PLWH with new-onset stroke at a hospital in Johannesburg, South Africa, from 2014 to 2017, excluding all patients with OIs. Patients were assessed for ART duration, CD4 count, HIV viral load, inflammatory markers and cardiovascular risk factors. Results77 PLWH were recruited, of which 35 were on ART at the time of stroke. Of the patients with confirmed ART duration (n = 28), 9 (32.1%) had a stroke within the first 6 months of starting ART (crude incidence rate of 0.73 cases per patient year). In the period beyond 6 months, 19 strokes occurred (crude incidence rate of 0.21 cases per patient year), translating to a 3.5 times greater risk in the first 6 months (p = 0.0002). There were no clearly identified risk factors when comparing those who had strokes in the first 6 months to those after 6 months and ART-naïve patients. ConclusionAlmost a third of strokes in PLWH may be related to IRIS, with a crude incidence rate 3.5 times higher in the first 6 months following ART-initiation compared to beyond 6 months. This appears to be independent of OIs. Risk factors are unclear.

THE RELATIONSHIP BETWEEN GADGET USE AND THE INCIDENCE OF MYOPIA AMONG HIGH SCHOOL STUDENTS DURING ONLINE LEARNING

Background. Online learning is a solution to inhibit the transmission of viruses during the COVID-19 pandemic. However, students can be exposed to prolonged use of gadgets which can cause myopia. This study aimed to determine the relationship between gadget use and the incidence of myopia in students at SMA Muhammadiyah 1 Pekajangan Pekalongan during online learning.&#x0D; Methods. This study was a correlational study with a cross-sectional approach. The sample was 121 students from grades XI and XII selected by convenience sampling technique. Data were obtained using an online questionnaire. Chi Square test was used in bivariate analysis. Binary logistic regression was used in multivariate analysis.&#x0D; Results. The incidence of myopia in SMA Muhammadiyah 1 Pekajangan Pekalongan was 43.8%. Students who used gadgets with a duration of &gt; 6 hours were at risk of myopia by 9.733 times compared to students who used gadgets &lt;= 6 hours (p-value 0.001). Compared to students who used gadgets with moderate light intensity, students who used gadgets with bright intensity had a 50.058 times greater risk (p-value 0.002), students who used gadgets with dim light intensity had a 6.861 times greater risk (p-value 0.015). Students who used gadgets with a distance &lt; 30 cm had a risk of myopia of 15.030 times compared to students who used gadgets with a distance &gt;= 30 cm (p-value 0.013).&#x0D; Conclusion. There is an association between gadget use (in terms of duration, light intensity, and distance) and the incidence of myopia, even after controlling for genetic factor.

Trend in seroprevalence of HTLV-1/2 in Taiwanese blood donors-A 10-year follow-up.

This study evaluated the Human T-lymphotropic virus (HTLV) screening policy impact on the HTLV seroprevalence from 2009 to 2018 as well as the differences between administrative districts in terms of prevalence distribution in Taiwan. Since February 1996, the Taiwan Blood Services Foundation (TBSF) had conducted HTLV screening of blood donors. The HTLV seroprevalence was 0.032% in 1999. This cross-sectional study included donors' data collected from blood donation centres across Taiwan from 2009 to 2018. Enzyme immunoassay and Western blot assay were used for screening and confirmation of HTLV infections. In this study, the researchers calculated the trends in the HTLV rates of first-time and repeat donors across time as well as the HTLV prevalence distribution across the 22 administrative districts of Taiwan. Amongst 17 977 429 employed blood donations, 739 HTLV-seropositive donations (4.11 per 100 000 donations) were identified. The HTLV-positive donors were aged between 17 and 64 years, with a median age of 49 years. The overall seropositivity rates of first-time and repeat donors were 34.36/100 000 and 1.27/100 000. HTLV seroprevalence in first-time blood donors significantly decreased by 57% (crude odds ratio [95% confidence interval] (crude OR [95% CI]) = 0.43 [0.28-0.64]) within 10 years. A slight decline was also identified in repeat donors (crude OR [95% CI] = 0.73 [0.4-1.32]). Donors from different districts showed significantly varied prevalence. Most districts with high prevalence are situated in eastern Taiwan, for both donation types. Older blood donors were more likely to be infected with HTLV than younger ones in first time and repeat donors. Middle age donors (50-65 years) had an 18.47-39.65 greater risk than those aged <20 years. Significant higher risk of female was observed in both donation types. Amongst different age groups, first-time female donors increase 1.31-1.88 times infection risk and female in repeat donor group had 1.55-3.43 times greater risk. Over years of implementation of the HTLV blood donor screening policy by the TBSF, the HTLV seroprevalence of first-time donors has decreased consistently. Moreover, the HTLV seroprevalence of repeat donors has dropped considerably. This implies that the screening policy provides continued benefit. Females and older blood donors were more likely infected with HTLV than males and younger blood donors. The influence of age on infection was greater amongst first-time donors than amongst repeat donors. Therefore, appropriate measures should be taken to ensure public safety.

Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion.

To examine the frequency and association of neck pain symptoms in patients with a concussion. Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.

Lipoprotein(a) in Youth and Prediction of Major Cardiovascular Outcomes in Adulthood.

Elevated lipoprotein(a) [Lp(a)] is a common risk factor for cardiovascular disease outcomes with unknown mechanisms. We examined its potential role in identifying youths who are at increased risk of developing adult atherosclerotic cardiovascular disease (ASCVD). Lp(a) levels measured in youth 9 to 24 years of age were linked to adult ASCVD and carotid intima-media thickness in the YFS (Cardiovascular Risk in Young Finns Study), in which 95 of the original 3596 participants (2.7%) recruited as children have been diagnosed with ASCVD at a median of 47 years of age. Results observed in YFS were replicated with the use of data for White participants from the BHS (Bogalusa Heart Study). In BHS, 587 White individuals had data on youth Lp(a) (measured at 8-17 years of age) and information on adult events, including 15 cases and 572 noncases. Analyses were performed with the use of Cox proportional hazard regression. In YFS, those who had been exposed to high Lp(a) level in youth [defined as Lp(a) ≥30 mg/dL] had ≈2 times greater risk of developing adult ASCVD compared with nonexposed individuals (hazard ratio, 2.0 [95% CI, 1.4-2.6]). Youth risk factors, including Lp(a), low-density lipoprotein cholesterol, body mass index, and smoking, were all independently associated with higher risk. In BHS, in an age- and sex-adjusted model, White individuals who had been exposed to high Lp(a) had 2.5 times greater risk (95% CI, 0.9-6.8) of developing adult ASCVD compared with nonexposed individuals. When also adjusted for low-density lipoprotein cholesterol and body mass index, the risk associated with high Lp(a) remained unchanged (hazard ratio, 2.4 [95% CI, 0.8-7.3]). In a multivariable model for pooled data, individuals exposed to high Lp(a) had 2.0 times greater risk (95% CI, 1.0-3.7) of developing adult ASCVD compared with nonexposed individuals. No association was detected between youth Lp(a) and adult carotid artery thickness in either cohort or pooled data. Elevated Lp(a) level identified in youth is a risk factor for adult atherosclerotic cardiovascular outcomes but not for increased carotid intima-media thickness.

Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury

Firearm injuries are a leading cause of morbidity and mortality among US children and adolescents. Despite evidence demonstrating mental health sequelae for children and adolescents who have experienced a firearm injury, little is known about mental health care utilization after a firearm injury. To evaluate mental health care utilization in the 12 months after a firearm injury among Medicaid-insured and commercially insured children and adolescents compared with propensity score-matched controls. This propensity score-matched retrospective cohort analysis assessed 2127 children and adolescents, aged 0 to 17 years, with a firearm injury that occurred between January 1, 2016, and December 31, 2017, compared with 2127 matched controls using MarketScan Medicaid and commercial claims data. Claims data were analyzed 12 months before and after injury, with the total study period spanning from January 1, 2015, to December 31, 2018. Nonfatal firearm injury. The primary outcome of interest was a dichotomous variable representing any mental health care utilization in the 12 months after injury. Secondary outcomes included psychotherapy utilization, substance use-related utilization, and a psychotropic medication prescription. Logistic regression modeling was used to estimate relative risks with adjusted analyses of dichotomous outcomes. The overall cohort consisted of 4254 children and adolescents, of whom 2127 (mean [SD] age, 13.5 [4.1] years; 1722 [81.0%] male) had an initial encounter for a firearm injury and an equal number of matched controls (mean [SD] age, 13.5 [4.1] years; 1720 [80.9%] male). Children and adolescents with a firearm injury had a 1.40 times greater risk (95% CI, 1.25-1.56; P < .001) of utilizing mental health services in the 12 months after their injury compared with children and adolescents without a firearm injury, after controlling for potential confounders. Children and adolescents with a firearm injury had a 1.23 times greater risk (95% CI, 1.06-1.43; P = .007) of utilizing psychotherapy and a 1.40 times greater risk (95% CI, 1.19-1.64; P < .001) of substance use-related utilization. Among those who experienced a firearm injury, Black children and adolescents were 1.64 times more likely (95% CI, 1.23-2.19; P < .001) to utilize mental health care compared with White children and adolescents. This propensity score-matched cohort study found that children and adolescents with a firearm injury had a greater risk of utilizing mental health services in the 12 months after their injury compared with those without an injury, and significant racial disparities were associated with use of mental health services. The findings suggest that health care practitioners should be aware of this increased risk and ensure adequate mental health follow-up for these patients.

Positive or U-Shaped Association of Elevated Hemoglobin Concentration Levels with Metabolic Syndrome and Metabolic Components: Findings from Taiwan Biobank and UK Biobank.

Iron overnutrition has been implicated with a higher risk of developing metabolic and cardiovascular diseases, including metabolic syndrome (MetS), whereas iron deficiency anemia exacerbates many underlying chronic conditions. Hemoglobin (Hb) concentration in the blood, which reflects a major functional iron (i.e., heme iron) in the body, may serve as a surrogate of the nutritional status of iron. We conducted sex-specific observational association studies in which we carefully titrated the association between Hb deciles and MetS and its components among the Taiwanese Han Chinese (HC) from the Taiwan Biobank and Europeans of White ancestry from the UK Biobank, representing two large ethnicities. Our data show that at higher-than-normal levels of Hb, increasing deciles of Hb concentration were significantly associated with MetS across all sex subgroups in both ethnicities, with the highest deciles resulting in up to three times greater risk than the reference group [Taiwanese HC: OR = 3.17 (95% CI, 2.75–3.67) for Hb ≥ 16.5 g/dL in men, OR = 3.11 (2.78–3.47) for Hb ≥ 14.5 g/dL in women; European Whites: OR = 1.89 (1.80–1.98) for Hb ≥ 16.24 g/dL in men, OR = 2.35 (2.24–2.47) for Hb ≥ 14.68 g/dL in women]. The association between stronger risks and increasing Hb deciles was similarly observed with all metabolic components except diabetes. Here we found that both the highest Hb decile groups and contrarily the lowest ones, with respect to the reference, were associated with higher odds of diabetes in both ethnic groups [e.g., Taiwanese HC men: OR = 1.64 (1.33–2.02) for Hb ≥ 16.5 g/dL, OR = 1.71 (1.39–2.10) for Hb ≤ 13.5 g/dL; European Whites women: OR = 1.39 (1.26–1.45) for Hb ≥ 14.68 g/dL, OR = 1.81 (1.63–2.01) for Hb ≤ 12.39 g/dL]. These findings confirm that elevated Hb concentrations, a potential indicator of iron overnutrition, may play a role in the pathophysiology of MetS and metabolic components.

A Systematic Literature Review with Meta-analysis on Risk Factors for Hypertension

Introduction: Hypertension is a manifestation of hemodynamic imbalances resulting in various cardiovascular complications and others in the body systems. The prevalence of hypertension in Indonesian adults aged 18 years was 34.1%, and it increased by 8.3%. Globally, it accounts for about 60% of deaths. This study aimed to analyze risk factors for hypertension in industrial workers. Methods: This study used a meta-analysis, a statistical method that combines previous studies to find an effect size value or summary on JASP software. Data in this study came from database online and were sorted according to the inclusion-exclusion criteria following PRISMA. In the final step, 14 research articles were collected. Results and Discussion: Noise intensity had a 1.974 times greater risk on the prevalence of hypertension in industrial workers; work period had 2.316 times greater risk; duration of exposure gave a 1.716 times greater risk; and smoking had a 1.896 times greater risk. Conclusion: The highest risks for the incidence of hypertension in industrial workers come from period of work, noise intensity, and smoking habits; while, the lowest is in the length of exposure

Risk Factors of Postoperative Nausea and Vomiting on General Anesthesia in RSUD Abdul Wahab Sjahranie Samarinda

Postoperative Nausea and Vomiting (PONV) is the nauseous feeling within 24 hours after surgery. PONV increases the risk of fluid and electrolyte imbalance, re-opening of the surgical wound, and aspiration of gastric fluid. This study aimed to analyze the effect of postoperative opioid administration, duration of anesthesia, type of surgery, and BMI on the incidence of nausea and vomiting after surgery under general anesthesia, at Abdul Wahab Sjahranie Hospital, Samarinda. The research design employed in this research was a retrospective cohort study. The number of samples was 92 patients. The results of the analysis showed an increased risk of PONV in underweight – normal BMI patients (1.45 times higher risk; p=0.035), patients who received postoperative opioids (1.64 times higher risk; p=0.005), patients who underwent surgery that was potentially stimulating the vagus nerve (1.52 times riskier; p=0.02), and patients with anesthetic duration of more than 2 hours (1.93 times greater risk; p=0.007). Therefore, it could be concluded that BMI, postoperative opioid use, type of surgery, and duration of anesthesia influenced PONV incident on the use of general anesthesia at RSUD Abdul Wahab Sjahranie, Samarinda.&#x0D; Keywords: postoperative nausea and vomiting, BMI, opioid after surgery, type of surgery, anesthesia duration

Cardiovascular Morbidity and Mortality in COVID-19: A Multicenter Retrospective Analysis

Background: Single-center data from COVID-19 studies suggest clinical risk factors for cardiovascular and prothrombotic complications. This study aims to identify clinical risk factors that increased the risk of pulmonary embolism (PE), myocardial infarction (MI), cerebrovascular accident (CVA), mortality, and a composite of major adverse cardiovascular events (MACE) in an urban and diverse multicenter setting. Methods: Between February and June, 2020, 4,547 patients were seen in the ER of 17 northeastern US hospitals and tested positive for COVID-19; of these, 1,171 patients were treated and released. We retrospectively analyzed the data on 3,376 patients who were admitted to these hospitals. A multivariable logistical regression analyzed patient characteristics and comorbidities in relation to said complications. Results: COVID-19 infected patients with a history of any cancer were at 2.64 times greater risk (1.519, 4.533; p=.0005) of developing PE; however, increasing age decreased the risk for PE. Patients with a history of heart failure with preserved or reduced ejection fraction (HFpEF, HFrEF) (OR=1.918; 95% CI: 1.230, 2.990; p=.0041 and OR=3.205; 95% CI: 2.272, 4.520; p&lt;.0001), ischemic heart disease (IHD) (OR=2.429; 95% CI: 1.836, 3.215; p&lt;.0001), end stage renal disease (ESRD) (OR=1.566 95% CI: 1.002, 2.446; p=.0489) were at higher risk for MI. Women had decreased odds of CVA compared to men (OR=0.716; 95% CI: 0.529, 0.970; p=.0308). ESRD had a positive association with CVA (OR=2.465; 95% CI: 1.545, 3.934; p=.0002). HFrEF was highly associated with MACE while women had decreased odds of MACE (OR=2.020; 95% CI: 1.453, 2.810; p&lt;.0001). Patients with HFrEF (OR=1.623; 95% CI: 1.191, 2.211; p=.0021), chronic kidney disease (OR=1.712; 95% CI: 1.227, 2.389; p=0.0016), and diabetes (OR=1.170; 95% CI: 0.973, 1.407; p=0.0960) had an increased risk of mortality from COVID-19. Conclusion: Our analysis identified comorbidities that were strongly associated with major COVID-19 complications. Utilizing these findings may help guide clinicians with risk stratification and earlier clinical interventions. Keywords: COVID-19; Mortality; Myocardial infarction; Pulmonary embolism; Cerebrovascular accident

MO423: Does Renal Dysfunction Improve the Predictive Value of Hatch Score for Postoperative Atrial Fibrillation?

Abstract BACKGROUND AND AIMS Postoperative atrial fibrillation (POAF) is a frequent arrhythmic complication in cardiac surgery. Studies of this potential complication have not been able to elucidate its aetiology nor to identify the predictors of its occurrence. The aim of this study was to evaluate the predictive role of a renal dysfunction for POAF in patients undergoing cardiac surgery interventions. We also aimed to determine the role of renal dysfunction in improving the diagnostic accuracy of hypertension, age, transitory attack/stroke, chronic obstructive pulmonary disease, heart failure (HATCH) score for POAF. METHOD This prospective monocentric observational study included 178 consecutive patients who underwent cardiac surgery interventions in the State University Clinic for Cardiac Surgery of Skopje, Republic of North Macedonia, between September 2017 and September 2018. Patients were divided into two groups, according to the absence or occurrence of POAF. HATCH score was calculated and recorded for each patient. A new R-HATCH score was derived by the addition of renal dysfunction to the existing HATCH score and its predictive value for POAF was tested and compared to HATCH. RESULTS POAF occurred in 90/178 patients (50.56%). The average estimated glomerular filtration rate (eGFR) in the group developing POAF was significantly lower, 78.4 ± 26.9 versus 93.0 ± 29.0 mL/min/1,73m2 (P = 0.0005). Patients with GFR &amp;lt; 60mL/min/1.73m2 had almost a 5 times greater risk of developing POAF. The addition of renal dysfunction to HATCH score improved its predictive accuracy in our study. The area under the receiver operating characteristic curve increased from 0.73 to 0.76 (P &amp;lt; 0.001). CONCLUSION The addition of preoperative renal dysfunction could improve the diagnostic accuracy of HATCH score for POAF.

RELEVANSI KEPATUHAN PENGOBATAN DENGAN KEJADIAN TB MDR DI RUMAH SAKIT UMUM DAERAH EMBUNG FATIMAH KOTA BATAM TAHUN 2019

MDR TB (multidrug-resistant) is tuberculosis caused by Mycobacterium tuberculosis which has developed immunity to OAT (rifampin and isoniazid). The incidences of MDR TB are an artificial phenomenon (artificial phenomenon) due to inadequate TB treatment. Adherence to TB treatment is a factor that influences the incidence of MDR TB. This study aims to determine the relationship of adherence with the incidence of MDR TB in TB patients with a case-control design. The number of respondents in this study was 20 case respondents and 20 control respondents at Embung Fatimah Hospital, Batam City. The sampling technique used purposive sampling with a non-probability sampling technique. The results of the chi-square test obtained a p-value = 0.004 (&lt; 0.05), then H? is accepted, this indicates that there is a significant relationship between adherence and the incidence of MDR TB in Embung Fatimah Hospital, Batam City in 2019, with an OR value of 7,000 where medication adherence with no category has a seven times greater risk of developing MDR TB. This study concludes that there is a relationship between compliance with the incidence of MDR TB at Embung Fatimah Hospital, Batam City, in 2019. The implication of this study is to identify one of the factors that have a relationship with the incidence of MDR TB to reduce the increase in the incidence of MDR TB.&#x0D; Keywords: Relevance, Compliance, MDR TB, OAT, TB

Nature, Prevalence, and Impact of Undernutrition on Intelligence Among School Children: A Cross-Sectional Study from South India

Good nutrition is a basic criterion for optimum health, productivity, and overall functional efficiency. The children who had malnutrition in their early years secured poor cognitive test scores in school years compared to children with optimal nutrition. The present study aimed to associate the degrees of undernutrition and intelligence among school children. This is a cross-sectional study that included 600 children aged 6 and 12 years, and assessed the anthropometry and intelligence quotient levels through appropriate scales. The results revealed that the higher percentage of stunted, underweight, and thinness were highly associated with below-average intelligence, which was more than two times greater risk compared to the percentage with the degrees of undernutrition to the above-average intelligence. The children’s age, gender, birth weight, and socioeconomic status were also strongly associated with the intelligence quotient level. This study offers new insight for formulating the policies and intervention programs in the future.

GIVING ATHLETES A VOICE TO IMPROVE PRIMARY OA PREVENTION PRACTICE IN SPORT

Purpose: Previous knee joint injury, such as an anterior cruciate ligament (ACL) rupture, is one of the strongest risk factors for the onset of knee osteoarthritis (OA). One in two people who sustain an ACL injury will develop knee OA before the age of 40. ACL injuries are common in high-risk sports that require athletes to jump, land and pivot, with women at 2-8 times greater risk than men. Primary OA prevention strategies, such as exercise-based ACL injury prevention programs, can reduce ACL injury among women by 67%.

Determinants of multimorbidity of infectious diseases among under-five children in Bangladesh: role of community context

BackgroundThe presence of more than one morbid condition among children has become a global public health concern. Studies carried out in Bangladesh have primarily focused on diarrhoea and acute respiratory tract infections independently without considering their co-occurrence effect. The present study examines the multimorbid conditions of infectious diseases in under-five Bangladeshi children. It explores multimorbidity determinants and the role of community context, which are often overlooked in previous literature.MethodsUtilizing the most recent Demographic and Health Survey of Bangladesh (2017–18), we used mixed-effects random-intercept Poisson regression models to understand the determinants of multimorbidity of infectious diseases in under-five Bangladeshi children considering the community-level characteristics.Results The present study found that 28% of the children experienced multimorbidity two weeks prior to the survey. Community-level variability across all the statistical models was statistically significant at the 5% level. On average, the incidence rate of multimorbidity was 1.34 times higher among children from high-risk communities than children from low-risk communities. Moreover, children residing in rural areas and other urban areas involved 1.29 [CI: 1.11, 1.51] and 1.28 [CI: 1.11, 1.47] times greater risk of multimorbidity respectively compared to children from city corporations. Additionally, the multimorbidity incidence was 1.16 times [CI: 1.03, 1.30] higher among children from high-altitude communities than children living in low-altitude communities.ConclusionThe significant effect of public handwashing places suggests community-based interventions among individuals to learn hygiene habits among themselves, thus, the severity of coexistence nature of infectious diseases. A higher incidence of coexistence of such infectious diseases in the poor and semi-urban populace further recommends a targeted awareness of a clean environment and primary healthcare programmes.