Risk factors for highly pathogenic avian influenza in commercial layer chicken farms in bangladesh during 2011.

PubMed

Osmani, M G; Thornton, R N; Dhand, N K; Hoque, M A; Milon, Sk M A; Kalam, M A; Hossain, M; Yamage, M

2014-12-01

A case-control study conducted during 2011 involved 90 randomly selected commercial layer farms infected with highly pathogenic avian influenza type A subtype H5N1 (HPAI) and 175 control farms randomly selected from within 5 km of infected farms. A questionnaire was designed to obtain information about potential risk factors for contracting HPAI and was administered to farm owners or managers. Logistic regression analyses were conducted to identify significant risk factors. A total of 20 of 43 risk factors for contracting HPAI were identified after univariable logistic regression analysis. A multivariable logistic regression model was derived by forward stepwise selection. Both unmatched and matched analyses were performed. The key risk factors identified were numbers of staff, frequency of veterinary visits, presence of village chickens roaming on the farm and staff trading birds. Aggregating these findings with those from other studies resulted in a list of 16 key risk factors identified in Bangladesh. Most of these related to biosecurity. It is considered feasible for Bangladesh to achieve a very low incidence of HPAI. Using the cumulative list of risk factors to enhance biosecurity pertaining to commercial farms would facilitate this objective. © 2013 Blackwell Verlag GmbH.

Neuropsychological tests for predicting cognitive decline in older adults

PubMed Central

Baerresen, Kimberly M; Miller, Karen J; Hanson, Eric R; Miller, Justin S; Dye, Richelin V; Hartman, Richard E; Vermeersch, David; Small, Gary W

2015-01-01

Summary Aim To determine neuropsychological tests likely to predict cognitive decline. Methods A sample of nonconverters (n = 106) was compared with those who declined in cognitive status (n = 24). Significant univariate logistic regression prediction models were used to create multivariate logistic regression models to predict decline based on initial neuropsychological testing. Results Rey–Osterrieth Complex Figure Test (RCFT) Retention predicted conversion to mild cognitive impairment (MCI) while baseline Buschke Delay predicted conversion to Alzheimer’s disease (AD). Due to group sample size differences, additional analyses were conducted using a subsample of demographically matched nonconverters. Analyses indicated RCFT Retention predicted conversion to MCI and AD, and Buschke Delay predicted conversion to AD. Conclusion Results suggest RCFT Retention and Buschke Delay may be useful in predicting cognitive decline. PMID:26107318

Awareness and attitude of the public toward personalized medicine in Korea

PubMed Central

Lee, Iyn-Hyang; Kang, Hye-Young; Suh, Hae Sun; Lee, Sukhyang; Oh, Eun Sil

2018-01-01

Objectives As personalized medicine (PM) is expected to greatly improve health outcomes, efforts have recently been made for its clinical implementation in Korea. We aimed to evaluate public awareness and attitude regarding PM. Methods We performed a self-administered questionnaire survey to 703 adults, who participated in the survey on a voluntary basis. The primary outcome measures included public knowledge, attitude, and acceptance of PM. We conducted multinomial multivariate logistic analysis for outcome variables with three response categories and performed multivariate logistic regression analyses for dichotomous outcome variables. Results Only 28% of participants had knowledge that genetic factors can contribute to inter-individual variations in drug response and the definition of PM (199 out of 702). Higher family income was correlated with greater knowledge concerning PM (OR = 3.76, p = 0.034). A majority of respondents preferred integrated pharmacogenomic testing over drug-specific testing and agreed to inclusion of pharmacogenomic testing in the national health examination (64% and 77%, respectively), but only 51% were willing to pay for it. Discussion Our results identify the urgent need for public education as well as the potential health disparities in access to PM. This study helps to frame policies for implementing PM in clinical practice. PMID:29451916

Psychological distress among re-education through labour camp detainees in Guangxi Autonomous Region, China.

PubMed

Yap, Lorraine; Shu, Su; Zhang, Lei; Liu, Wei; Chen, Yi; Wu, Zunyou; Li, Jianghong; Wand, Handan; Donovan, Basil; Butler, Tony

2017-02-01

There is currently no information about the prevalence of, and factors contributing to psychological distress experienced by re-education through labour camp detainees in China. A cross-sectional face-to-face survey was conducted in three labour camps in Guangxi, China. The questionnaire covered socio-demographic characteristics; sexually transmissible infections (STIs); drug use; psychological distress (K-10); and health service usage and access inside the labour camps. K-10 scores were categorised as ≤30 (low to moderate distress) and  >30 or more (highly distressed). Univariate and multivariate logistic regression models identified factors independently associated with high K-10 scores for men and women separately. In total, 755 detainees, 576 (76%) men and 179 (24%) women, participated in the health survey. The study found 11.6% men versus 11.2% women detainees experienced high psychological distress, but no significant gender differences were observed (p> 0.05). Multivariate logistic regression showed that multiple physical health problems were significantly associated with high psychological distress among men. Drug treatment and forensic mental health services need to be established in detention centres in China to treat more than 10% of detainees with drug use and mental health disorders.

The High Prevalence of Incarceration History Among Black Men Who Have Sex With Men in the United States: Associations and Implications

PubMed Central

Magnus, Manya; Kuo, Irene; Wang, Lei; Liu, Ting-Yuan; Mayer, Kenneth H.

2014-01-01

Objectives. We examined lifetime incarceration history and its association with key characteristics among 1553 Black men who have sex with men (BMSM) recruited in 6 US cities. Methods. We conducted bivariate analyses of data collected from the HIV Prevention Trials Network 061 study from July 2009 through December 2011 to examine the relationship between incarceration history and demographic and psychosocial variables predating incarceration and multivariate logistic regression analyses to explore the associations between incarceration history and demographic and psychosocial variables found to be significant. We then used multivariate logistic regression models to explore the independent association between incarceration history and 6 outcome variables. Results. After adjusting for confounders, we found that increasing age, transgender identity, heterosexual or straight identity, history of childhood violence, and childhood sexual experience were significantly associated with incarceration history. A history of incarceration was also independently associated with any alcohol and drug use in the past 6 months. Conclusions. The findings highlight an elevated lifetime incarceration history among a geographically diverse sample of BMSM and the need to adequately assess the impact of incarceration among BMSM in the United States. PMID:24432948

Prevalence and predictors of suicidal ideations and attempts among homeless children and adolescents in Ghana.

PubMed

Oppong Asante, Kwaku; Meyer-Weitz, Anna

2017-05-01

This study aimed to determine the prevalence and risk factors associated with suicidal ideations and attempts among a sample of homeless street children and adolescents found in Accra, Ghana. A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana. An interviewer-administered questionnaire was used to collect data due to a low level of literacy among the study population. Bivariate and multivariate logistic regressions were fitted to analyse the data. The results indicated that 26.4% and 26.0% of the participants had attempted suicide and reported suicidal ideations respectively. The multivariate logistic regression showed that smoking, past and present use of alcohol, use of marijuana, and engagement in prostitution, were associated with suicidal ideations and suicide attempts. Suicidal ideations were associated with having been physically beaten, robbed, and assaulted with a weapon; while a suicide attempt was predicted by having been robbed and physically beaten. This study increased our understanding of the determinants of suicidal ideations and attempts among homeless youth. These findings suggest urgency to up-skill mental health workers to assess for risk factors and offer pathways to care for this vulnerable group.

Intracerebral hemorrhage after external ventricular drain placement: an evaluation of risk factors for post-procedural hemorrhagic complications.

PubMed

Rowe, A Shaun; Rinehart, Derrick R; Lezatte, Stephanie; Langdon, J Russell

2018-03-07

The objective of this study was to evaluate and identify the risk factors for developing a new or enlarged intracranial hemorrhage (ICH) after the placement of an external ventricular drain. A single center, nested case-control study of individuals who received an external ventricular drain from June 1, 2011 to June 30, 2014 was conducted at a large academic medical center. A bivariate analysis was conducted to compare those individuals who experienced a post-procedural intracranial hemorrhage to those who did not experience a new bleed. The variables identified as having a p-value less than 0.15 in the bivariate analysis were then evaluated using a multivariate logistic regression model. Twenty-seven of the eighty-one study participants experienced a new or enlarged intracranial hemorrhage after the placement of an external ventricular drain. Of these twenty-seven patients, 6 individuals received an antiplatelet within ninety-six hours of external ventricular drain placement (p = 0.024). The multivariate logistic regression model identified antiplatelet use within 96 h of external ventricular drain insertion as an independent risk factor for post-EVD ICH (OR 13.1; 95% CI 1.95-88.6; p = 0.008). Compared to those study participants who did not receive an antiplatelet within 96 h of external ventricular drain placement, those participants who did receive an antiplatelet were 13.1 times more likely to exhibit a new or enlarged intracranial hemorrhage.

Television Viewing and Its Association with Sedentary Behaviors, Self-Rated Heath and Academic Performance among Secondary School Students in Peru.

PubMed

Sharma, Bimala; Cosme Chavez, Rosemary; Jeong, Ae Suk; Nam, Eun Woo

2017-04-05

The study assessed television viewing >2 h a day and its association with sedentary behaviors, self-rated health, and academic performance among secondary school adolescents. A cross-sectional survey was conducted among randomly selected students in Lima in 2015. We measured self-reported responses of students using a standard questionnaire, and conducted in-depth interviews with 10 parents and 10 teachers. Chi-square test, correlation and multivariate logistic regression analysis were performed among 1234 students, and thematic analysis technique was used for qualitative information. A total of 23.1% adolescents reported watching television >2 h a day. Qualitative findings also show that adolescents spend most of their leisure time watching television, playing video games or using the Internet. Television viewing had a significant positive correlation with video game use in males and older adolescents, with Internet use in both sexes, and a negative correlation with self-rated health and academic performance in females. Multivariate logistic regression analysis shows that television viewing >2 h a day, independent of physical activity was associated with video games use >2 h a day, Internet use >2 h a day, poor/fair self-rated health and poor self-reported academic performance. Television viewing time and sex had a significant interaction effect on both video game use >2 h a day and Internet use >2 h a day. Reducing television viewing time may be an effective strategy for improving health and academic performance in adolescents.

Television Viewing and Its Association with Sedentary Behaviors, Self-Rated Health and Academic Performance among Secondary School Students in Peru

PubMed Central

Sharma, Bimala; Cosme Chavez, Rosemary; Jeong, Ae Suk; Nam, Eun Woo

2017-01-01

The study assessed television viewing >2 h a day and its association with sedentary behaviors, self-rated health, and academic performance among secondary school adolescents. A cross-sectional survey was conducted among randomly selected students in Lima in 2015. We measured self-reported responses of students using a standard questionnaire, and conducted in-depth interviews with 10 parents and 10 teachers. Chi-square test, correlation and multivariate logistic regression analysis were performed among 1234 students, and thematic analysis technique was used for qualitative information. A total of 23.1% adolescents reported watching television >2 h a day. Qualitative findings also show that adolescents spend most of their leisure time watching television, playing video games or using the Internet. Television viewing had a significant positive correlation with video game use in males and older adolescents, with Internet use in both sexes, and a negative correlation with self-rated health and academic performance in females. Multivariate logistic regression analysis shows that television viewing >2 h a day, independent of physical activity was associated with video games use >2 h a day, Internet use >2 h a day, poor/fair self-rated health and poor self-reported academic performance. Television viewing time and sex had a significant interaction effect on both video game use >2 h a day and Internet use >2 h a day. Reducing television viewing time may be an effective strategy for improving health and academic performance in adolescents. PMID:28379202

Physical function in older men with hyperkyphosis.

PubMed

Katzman, Wendy B; Harrison, Stephanie L; Fink, Howard A; Marshall, Lynn M; Orwoll, Eric; Barrett-Connor, Elizabeth; Cawthon, Peggy M; Kado, Deborah M

2015-05-01

Age-related hyperkyphosis has been associated with poor physical function and is a well-established predictor of adverse health outcomes in older women, but its impact on health in older men is less well understood. We conducted a cross-sectional study to evaluate the association of hyperkyphosis and physical function in 2,363 men, aged 71-98 (M = 79) from the Osteoporotic Fractures in Men Study. Kyphosis was measured using the Rancho Bernardo Study block method. Measurements of grip strength and lower extremity function, including gait speed over 6 m, narrow walk (measure of dynamic balance), repeated chair stands ability and time, and lower extremity power (Nottingham Power Rig) were included separately as primary outcomes. We investigated associations of kyphosis and each outcome in age-adjusted and multivariable linear or logistic regression models, controlling for age, clinic, education, race, bone mineral density, height, weight, diabetes, and physical activity. In multivariate linear regression, we observed a dose-related response of worse scores on each lower extremity physical function test as number of blocks increased, p for trend ≤.001. Using a cutoff of ≥4 blocks, 20% (N = 469) of men were characterized with hyperkyphosis. In multivariate logistic regression, men with hyperkyphosis had increased odds (range 1.5-1.8) of being in the worst quartile of performing lower extremity physical function tasks (p < .001 for each outcome). Kyphosis was not associated with grip strength in any multivariate analysis. Hyperkyphosis is associated with impaired lower extremity physical function in older men. Further studies are needed to determine the direction of causality. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Impact of Colic Pain as a Significant Factor for Predicting the Stone Free Rate of One-Session Shock Wave Lithotripsy for Treating Ureter Stones: A Bayesian Logistic Regression Model Analysis

PubMed Central

Chung, Doo Yong; Cho, Kang Su; Lee, Dae Hun; Han, Jang Hee; Kang, Dong Hyuk; Jung, Hae Do; Kown, Jong Kyou; Ham, Won Sik; Choi, Young Deuk; Lee, Joo Yong

2015-01-01

Purpose This study was conducted to evaluate colic pain as a prognostic pretreatment factor that can influence ureter stone clearance and to estimate the probability of stone-free status in shock wave lithotripsy (SWL) patients with a ureter stone. Materials and Methods We retrospectively reviewed the medical records of 1,418 patients who underwent their first SWL between 2005 and 2013. Among these patients, 551 had a ureter stone measuring 4–20 mm and were thus eligible for our analyses. The colic pain as the chief complaint was defined as either subjective flank pain during history taking and physical examination. Propensity-scores for established for colic pain was calculated for each patient using multivariate logistic regression based upon the following covariates: age, maximal stone length (MSL), and mean stone density (MSD). Each factor was evaluated as predictor for stone-free status by Bayesian and non-Bayesian logistic regression model. Results After propensity-score matching, 217 patients were extracted in each group from the total patient cohort. There were no statistical differences in variables used in propensity- score matching. One-session success and stone-free rate were also higher in the painful group (73.7% and 71.0%, respectively) than in the painless group (63.6% and 60.4%, respectively). In multivariate non-Bayesian and Bayesian logistic regression models, a painful stone, shorter MSL, and lower MSD were significant factors for one-session stone-free status in patients who underwent SWL. Conclusions Colic pain in patients with ureter calculi was one of the significant predicting factors including MSL and MSD for one-session stone-free status of SWL. PMID:25902059

The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents.

PubMed

Mameli, Chiara; Krakauer, Nir Y; Krakauer, Jesse C; Bosetti, Alessandra; Ferrari, Chiara Matilde; Moiana, Norma; Schneider, Laura; Borsani, Barbara; Genoni, Teresa; Zuccotti, Gianvincenzo

2018-01-01

A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2-18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis) and obesity-related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.

Association between serum CA 19-9 and metabolic syndrome: A cross-sectional study.

PubMed

Du, Rui; Cheng, Di; Lin, Lin; Sun, Jichao; Peng, Kui; Xu, Yu; Xu, Min; Chen, Yuhong; Bi, Yufang; Wang, Weiqing; Lu, Jieli; Ning, Guang

2017-11-01

Increasing evidence suggests that serum CA 19-9 is associated with abnormal glucose metabolism. However, data on the association between CA 19-9 and metabolic syndrome is limited. The aim of the present study was to investigate the association between serum CA 19-9 and metabolic syndrome. A cross-sectional study was conducted on 3641 participants aged ≥40 years from the Songnan Community, Baoshan District in Shanghai, China. Logistic regression analysis was used to evaluate the association between serum CA 19-9 and metabolic syndrome. Multivariate logistic regression analysis showed that compared with participants in the first tertile of serum CA 19-9, those in the second and third tertiles had increased odds ratios (OR) for prevalent metabolic syndrome (multivariate adjusted OR 1.46 [95% confidence interval {CI} 1.11-1.92] and 1.51 [95% CI 1.14-1.98]; P trend  = 0.005). In addition, participants with elevated serum CA 19-9 (≥37 U/mL) had an increased risk of prevalent metabolic syndrome compared with those with serum CA 19-9 < 37 U/mL (multivariate adjusted OR 2.10; 95% CI 1.21-3.65). Serum CA 19-9 is associated with an increased risk of prevalent metabolic syndrome. In order to confirm this association and identify potential mechanisms, prospective cohort and mechanic studies should be performed. © 2017 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Predictors of condom use and refusal among the population of Free State province in South Africa

PubMed Central

2012-01-01

Background This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa. Methods Through a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT) were used for analysing two response variables ‘ever used condom’ and ‘ever refused condom’. Results Eighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by ‘knowledge of correct use of condom’, condom availability, young age, being single and higher education. ‘Perceived need’ for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one’s HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms). In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables. Conclusions The use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms. PMID:22639964

Remote sensing and GIS-based landslide hazard analysis and cross-validation using multivariate logistic regression model on three test areas in Malaysia

NASA Astrophysics Data System (ADS)

Pradhan, Biswajeet

2010-05-01

This paper presents the results of the cross-validation of a multivariate logistic regression model using remote sensing data and GIS for landslide hazard analysis on the Penang, Cameron, and Selangor areas in Malaysia. Landslide locations in the study areas were identified by interpreting aerial photographs and satellite images, supported by field surveys. SPOT 5 and Landsat TM satellite imagery were used to map landcover and vegetation index, respectively. Maps of topography, soil type, lineaments and land cover were constructed from the spatial datasets. Ten factors which influence landslide occurrence, i.e., slope, aspect, curvature, distance from drainage, lithology, distance from lineaments, soil type, landcover, rainfall precipitation, and normalized difference vegetation index (ndvi), were extracted from the spatial database and the logistic regression coefficient of each factor was computed. Then the landslide hazard was analysed using the multivariate logistic regression coefficients derived not only from the data for the respective area but also using the logistic regression coefficients calculated from each of the other two areas (nine hazard maps in all) as a cross-validation of the model. For verification of the model, the results of the analyses were then compared with the field-verified landslide locations. Among the three cases of the application of logistic regression coefficient in the same study area, the case of Selangor based on the Selangor logistic regression coefficients showed the highest accuracy (94%), where as Penang based on the Penang coefficients showed the lowest accuracy (86%). Similarly, among the six cases from the cross application of logistic regression coefficient in other two areas, the case of Selangor based on logistic coefficient of Cameron showed highest (90%) prediction accuracy where as the case of Penang based on the Selangor logistic regression coefficients showed the lowest accuracy (79%). Qualitatively, the cross application model yields reasonable results which can be used for preliminary landslide hazard mapping.

Comparison of Multidimensional Item Response Models: Multivariate Normal Ability Distributions versus Multivariate Polytomous Ability Distributions. Research Report. ETS RR-08-45

ERIC Educational Resources Information Center

Haberman, Shelby J.; von Davier, Matthias; Lee, Yi-Hsuan

2008-01-01

Multidimensional item response models can be based on multivariate normal ability distributions or on multivariate polytomous ability distributions. For the case of simple structure in which each item corresponds to a unique dimension of the ability vector, some applications of the two-parameter logistic model to empirical data are employed to…

Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing.

PubMed

Stamate, Mirela Cristina; Todor, Nicolae; Cosgarea, Marcel

2015-01-01

The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but to what extent they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The aim of the study was to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches. The study included 105 adult subjects with normal hearing and hearing loss who underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developed to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves and to estimate the areas under the curves in order to compare different multivariate analyses. We compared the performance of each otoacoustic emission (transient, distorsion product) using three different multivariate analyses for each ear, when multi-frequency gold standards were used. We demonstrated that all multivariate analyses provided high values of the area under the curve proving the performance of the otoacoustic emissions. Each otoacoustic emission test presented high values of area under the curve, suggesting that implementing a multivariate approach to evaluate the performances of each otoacoustic emission test would serve to increase the accuracy in identifying the normal and impaired ears. We encountered the highest area under the curve value for the combined multivariate analysis suggesting that both otoacoustic emission tests should be used in assessing hearing status. Our multivariate analyses revealed that age is a constant predictor factor of the auditory status for both ears, but the presence of tinnitus was the most important predictor for the hearing level, only for the left ear. Age presented similar coefficients, but tinnitus coefficients, by their high value, produced the highest variations of the logistic scores, only for the left ear group, thus increasing the risk of hearing loss. We did not find gender differences between ears for any otoacoustic emission tests, but studies still debate this question as the results are contradictory. Neither gender, nor environment origin had any predictive value for the hearing status, according to the results of our study. Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies.

Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing

PubMed Central

STAMATE, MIRELA CRISTINA; TODOR, NICOLAE; COSGAREA, MARCEL

2015-01-01

Background and aim The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but to what extent they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The aim of the study was to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches. Methods The study included 105 adult subjects with normal hearing and hearing loss who underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developed to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves and to estimate the areas under the curves in order to compare different multivariate analyses. Results We compared the performance of each otoacoustic emission (transient, distorsion product) using three different multivariate analyses for each ear, when multi-frequency gold standards were used. We demonstrated that all multivariate analyses provided high values of the area under the curve proving the performance of the otoacoustic emissions. Each otoacoustic emission test presented high values of area under the curve, suggesting that implementing a multivariate approach to evaluate the performances of each otoacoustic emission test would serve to increase the accuracy in identifying the normal and impaired ears. We encountered the highest area under the curve value for the combined multivariate analysis suggesting that both otoacoustic emission tests should be used in assessing hearing status. Our multivariate analyses revealed that age is a constant predictor factor of the auditory status for both ears, but the presence of tinnitus was the most important predictor for the hearing level, only for the left ear. Age presented similar coefficients, but tinnitus coefficients, by their high value, produced the highest variations of the logistic scores, only for the left ear group, thus increasing the risk of hearing loss. We did not find gender differences between ears for any otoacoustic emission tests, but studies still debate this question as the results are contradictory. Neither gender, nor environment origin had any predictive value for the hearing status, according to the results of our study. Conclusion Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies. PMID:26733749

Kenyan female sex workers' use of female-controlled nonbarrier modern contraception: do they use condoms less consistently?

PubMed

Yam, Eileen A; Okal, Jerry; Musyoki, Helgar; Muraguri, Nicholas; Tun, Waimar; Sheehy, Meredith; Geibel, Scott

2016-03-01

To examine whether nonbarrier modern contraceptive use is associated with less consistent condom use among Kenyan female sex workers (FSWs). Researchers recruited 579 FSWs using respondent-driven sampling. We conducted multivariate logistic regression to examine the association between consistent condom use and female-controlled nonbarrier modern contraceptive use. A total of 98.8% reported using male condoms in the past month, and 64.6% reported using female-controlled nonbarrier modern contraception. In multivariate analysis, female-controlled nonbarrier modern contraceptive use was not associated with decreased condom use with clients or nonpaying partners. Consistency of condom use is not compromised when FSWs use available female-controlled nonbarrier modern contraception. FSWs should be encouraged to use condoms consistently, whether or not other methods are used simultaneously. Copyright © 2016 Elsevier Inc. All rights reserved.

Logistic models--an odd(s) kind of regression.

PubMed

Jupiter, Daniel C

2013-01-01

The logistic regression model bears some similarity to the multivariable linear regression with which we are familiar. However, the differences are great enough to warrant a discussion of the need for and interpretation of logistic regression. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Multivariate logistic regression analysis of postoperative complications and risk model establishment of gastrectomy for gastric cancer: A single-center cohort report.

PubMed

Zhou, Jinzhe; Zhou, Yanbing; Cao, Shougen; Li, Shikuan; Wang, Hao; Niu, Zhaojian; Chen, Dong; Wang, Dongsheng; Lv, Liang; Zhang, Jian; Li, Yu; Jiao, Xuelong; Tan, Xiaojie; Zhang, Jianli; Wang, Haibo; Zhang, Bingyuan; Lu, Yun; Sun, Zhenqing

2016-01-01

Reporting of surgical complications is common, but few provide information about the severity and estimate risk factors of complications. If have, but lack of specificity. We retrospectively analyzed data on 2795 gastric cancer patients underwent surgical procedure at the Affiliated Hospital of Qingdao University between June 2007 and June 2012, established multivariate logistic regression model to predictive risk factors related to the postoperative complications according to the Clavien-Dindo classification system. Twenty-four out of 86 variables were identified statistically significant in univariate logistic regression analysis, 11 significant variables entered multivariate analysis were employed to produce the risk model. Liver cirrhosis, diabetes mellitus, Child classification, invasion of neighboring organs, combined resection, introperative transfusion, Billroth II anastomosis of reconstruction, malnutrition, surgical volume of surgeons, operating time and age were independent risk factors for postoperative complications after gastrectomy. Based on logistic regression equation, p=Exp∑BiXi / (1+Exp∑BiXi), multivariate logistic regression predictive model that calculated the risk of postoperative morbidity was developed, p = 1/(1 + e((4.810-1.287X1-0.504X2-0.500X3-0.474X4-0.405X5-0.318X6-0.316X7-0.305X8-0.278X9-0.255X10-0.138X11))). The accuracy, sensitivity and specificity of the model to predict the postoperative complications were 86.7%, 76.2% and 88.6%, respectively. This risk model based on Clavien-Dindo grading severity of complications system and logistic regression analysis can predict severe morbidity specific to an individual patient's risk factors, estimate patients' risks and benefits of gastric surgery as an accurate decision-making tool and may serve as a template for the development of risk models for other surgical groups.

Recent Findings on the Prevalence of E-Cigarette Use Among Adults in the U.S.

PubMed

Wilson, Fernando A; Wang, Yang

2017-03-01

This study uses a recent source of nationally representative data from in-person surveys to examine national estimates of e-cigarette use among adults and their relationship with demographic, socioeconomic, and health behavior measures. Data were provided by the National Health Interview Survey, conducted by the Centers for Disease Control and Prevention. A total of 34,356 respondents aged ≥18 years were examined for 2014, the most recent and only year in which the National Health Interview Survey included questions on e-cigarette use. E-cigarette information included ever and current use. Univariate and multivariable logistic regression analyses were performed, adjusting for age, sex, race/ethnicity, education level, marital status, poverty, and smoking status. Analyses were conducted in 2016. Compared with those who had never tried e-cigarettes, e-cigarette users were more likely to be younger, male, non-Hispanic white, non-married, poorer, and current smokers. Multivariable logistic regression suggested that respondents with high school or some college education had significantly higher adjusted odds of ever using e-cigarettes relative to those with less than high school education. However, the adjusted odds were not significantly different for college or graduate school education. The results suggest that, unlike tobacco use, ever using e-cigarettes is positively related to income. Interestingly, e-cigarette use exhibits a non-linear relationship with education. Reasons for the relationship of e-cigarettes with education are unclear and warrant further research. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru.

PubMed

Lamm, Ryan; Alves, Clark; Perrotta, Grace; Murphy, Meagan; Messina, Catherine; Sanchez, Juan F; Perez, Erika; Rosales, Luis Angel; Lescano, Andres G; Smith, Edward; Valdivia, Hugo; Fuhrer, Jack; Ballard, Sarah-Blythe

2018-06-04

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ 2 test, t -test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted OR = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.

The relationship between hunger and mental health outcomes among school-going Ecuadorian adolescents.

PubMed

Romo, Matthew L; Abril-Ulloa, Victoria; Kelvin, Elizabeth A

2016-06-01

Mental health and food insecurity are major public health issues among adolescents in Ecuador. Our objective was to determine the relationship between hunger, symptoms of depression, and suicidal ideation among school-going Ecuadorian adolescents. We conducted crude and multivariable logistic regression models using data from the 2007 Global School-based Student Health Survey from Quito, Guayaquil, and Zamora, Ecuador (N = 5524). Hunger was defined as having gone hungry in the past 30 days due to lack of food in the home. Outcomes of interest were symptoms of depression and suicidal ideation with or without planning in the past year. Overall, 41.2 % (2200/5467) of students reported experiencing hunger. In multivariable logistic regression models, hunger had an increasing exposure-response relationship with symptoms of depression [sometimes hungry odds ratio (OR) 1.80, P = 0.0001; most of the time or always hungry OR 2.01, P < 0.0001] and suicidal ideation with planning (sometimes hungry OR 1.55, P = 0.04; most of the time or always hungry OR 2.63, P = 0.001). Hunger was associated with increased odds of symptoms of depression and suicidal ideation with planning. Strategies to improve mental health among adolescents in Ecuador should consider the potential contribution of hunger and food insecurity.

National reimbursement listing determinants of new cancer drugs: a retrospective analysis of 58 cancer treatment appraisals in 2007-2016 in South Korea.

PubMed

Kim, Eun-Sook; Kim, Jung-Ae; Lee, Eui-Kyung

2017-08-01

Since the positive-list system was introduced, concerns have been raised over restricting access to new cancer drugs in Korea. Policy changes in the decision-making process, such as risk-sharing agreement and the waiver of pharmacoeconomic data submission, were implemented to improve access to oncology medicines, and other factors are also involved in the reimbursement for cancer drugs. The aim of this study is to investigate the reimbursement listing determinants of new cancer drugs in Korea. All cancer treatment appraisals of Health Insurance Review and Assessment during 2007-2016 were analyzed based on 13 independent variables (comparative effectiveness, cost-effectiveness, drug-price comparison, oncology-specific policy, and innovation such as new mode of action). Univariate and multivariate logistic analyses were conducted. Of 58 analyzed submissions, 40% were listed in the national reimbursement formulary. In univariate analysis, four variables were related to listing: comparative effectiveness, drug-price comparison, new mode of action, and risk-sharing agreement. In multivariate logistic analysis, three variables significantly increased the likelihood of listing: clinical improvement, below alternative's price, and risk-sharing arrangement. Cancer drug's listing increased from 17% to 47% after risk-sharing agreement implementation. Clinical improvement, cost-effectiveness, and RSA application are critical to successful national reimbursement listing.

Hepatotoxicity during Treatment for Tuberculosis in People Living with HIV/AIDS.

PubMed

Araújo-Mariz, Carolline; Lopes, Edmundo Pessoa; Acioli-Santos, Bartolomeu; Maruza, Magda; Montarroyos, Ulisses Ramos; Ximenes, Ricardo Arraes de Alencar; Lacerda, Heloísa Ramos; Miranda-Filho, Demócrito de Barros; Albuquerque, Maria de Fátima P Militão de

2016-01-01

Hepatotoxicity is frequently reported as an adverse reaction during the treatment of tuberculosis. The aim of this study was to determine the incidence of hepatotoxicity and to identify predictive factors for developing hepatotoxicity after people living with HIV/AIDS (PLWHA) start treatment for tuberculosis. This was a prospective cohort study with PLWHA who were monitored during the first 60 days of tuberculosis treatment in Pernambuco, Brazil. Hepatotoxicity was considered increased levels of aminotransferase, namely those that rose to three times higher than the level before initiating tuberculosis treatment, these levels being associated with symptoms of hepatitis. We conducted a multivariate logistic regression analysis and the magnitude of the associations was expressed by the odds ratio with a confidence interval of 95%. Hepatotoxicity was observed in 53 (30.6%) of the 173 patients who started tuberculosis treatment. The final multivariate logistic regression model demonstrated that the use of fluconazole, malnutrition and the subject being classified as a phenotypically slow acetylator increased the risk of hepatotoxicity significantly. The incidence of hepatotoxicity during treatment for tuberculosis in PLWHA was high. Those classified as phenotypically slow acetylators and as malnourished should be targeted for specific care to reduce the risk of hepatotoxicity during treatment for tuberculosis. The use of fluconazole should be avoided during tuberculosis treatment in PLWHA.

Influences on call outcomes among Veteran callers to the National Veterans Crisis Line

PubMed Central

Britton, Peter C.; Bossarte, Robert M.; Thompson, Caitlin; Kemp, Janet; Conner, Kenneth R.

2016-01-01

This evaluation examined the association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls. From October 1-7, 2010, 665 Veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line, 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome, either a resolution or a referral, when compared to an unfavorable outcome, no resolution or referral. A multivariable logistic regression was used to identify correlates of responder-rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution and 59% with a referral to a local health care provider. Calls from high-risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high-risk Veteran callers. Responders appeared to use known risk and protective factors to determine caller risk. PMID:23611446

Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children.

PubMed

Wigen, Tove I; Skaret, Erik; Wang, Nina J

2009-11-01

The aim of this study was to explore associations between avoidance behaviour and dental anxiety in both parents and children and caries experience in 5-year-old children. It was hypothesised that parents' dental avoidance behaviour and dental anxiety were related to dental caries in 5-year-old children. Data were collected from dental records and by clinical and radiographic examination of 523 children. The parents completed a questionnaire regarding education, national background, dental anxiety, dental attendance, and behaviour management problems. Bivariate and multivariate logistic regression was conducted. Children having one or more missed dental appointments (OR = 4.7), child behaviour management problems (OR = 3.3), child dental anxiety (OR = 3.1), and parents avoiding dental care (OR = 2.1) were bivariately associated with caries experience at the age of 5 years. In multivariate logistic regression, having one or more missed dental appointments (OR = 4.0) and child behaviour management problems (OR = 2.4) were indicators for dental caries in 5-year-old children, when controlling for parents education and national origin. Parents that avoid bringing their child to scheduled dental appointments and previous experiences of behaviour management problems for the child indicated risk for dental caries in 5-year-old children.

The role of traumatic event history in non-medical use of prescription drugs among a nationally representative sample of US adolescents.

PubMed

McCauley, Jenna L; Danielson, Carla Kmett; Amstadter, Ananda B; Ruggiero, Kenneth J; Resnick, Heidi S; Hanson, Rochelle F; Smith, Daniel W; Saunders, Benjamin E; Kilpatrick, Dean G

2010-01-01

Building on previous research with adolescents that examined demographic variables and other forms of substance abuse in relation to non-medical use of prescription drugs (NMUPD), the current study examined potentially traumatic events, depression, posttraumatic stress disorder (PTSD), other substance use, and delinquent behavior as potential correlates of past-year non-medical use of prescription drugs. A nationally representative sample of 3,614 non-institutionalized, civilian, English-speaking adolescents (aged 12-17 years) residing in households with a telephone was selected. Demographic characteristics, traumatic event history, mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had used a prescription drug in a non-medical manner. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set were then entered into a final multivariable logistic regression to determine significant predictors of past-year NMUPD. NMUPD was endorsed by 6.7% of the sample (n = 242). The final multivariable model showed that lifetime history of delinquent behavior, other forms of substance use/abuse, history of witnessed violence, and lifetime history of PTSD were significantly associated with increased likelihood of NMUPD. Risk reduction efforts targeting NMUPD among adolescents who have witnessed significant violence, endorsed abuse of other substances and delinquent behavior, and/or endorsed PTSD are warranted. Interventions for adolescents with history of violence exposure or PTSD, or those adjudicated for delinquent behavior, should include treatment or prevention modules that specifically address NMUPD.

Factors related to treatment refusal in Taiwanese cancer patients.

PubMed

Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang

2015-01-01

Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (≥10times) (p=0.016). Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

MODELING SNAKE MICROHABITAT FROM RADIOTELEMETRY STUDIES USING POLYTOMOUS LOGISTIC REGRESSION

EPA Science Inventory

Multivariate analysis of snake microhabitat has historically used techniques that were derived under assumptions of normality and common covariance structure (e.g., discriminant function analysis, MANOVA). In this study, polytomous logistic regression (PLR which does not require ...

Body mass index, waist circumference, and arterial hypertension in students.

PubMed

Guilherme, Flávio Ricardo; Molena-Fernandes, Carlos Alexandre; Guilherme, Vânia Renata; Fávero, Maria Teresa Martins; dos Reis, Eliane Josefa Barbosa; Rinaldi, Wilson

2015-01-01

to investigate what is the best anthropometric predictor of arterial hypertension among private school students. this was a cross-sectional study with 286 students between the ages of 10 and 14 from two private schools in the city of Paranavaí, Paraná, Brazil. The following variables were analyzed: body mass index, waist circumference and blood pressure. Statistical analysis was conducted with Pearson's partial correlation test and multivariate logistic regression, with p<0.05. both anthropometric indicators displayed weak correlation with systolic and diastolic levels, with coefficients (r) ranging from 0.27 to 0.36 (p < 0.001). Multivariate analysis showed that the only anthropometric indicator associated with arterial hypertension was waist circumference (OR= 2.3; 95% CI: 1.1-4.5), regardless of age or gender. this age group, waist circumference appeared to be a better predictor for arterial hypertension than body mass index.

Factors associated with obstructive sleep apnea among commercial motor vehicle drivers.

PubMed

Xie, Wen; Chakrabarty, Sangita; Levine, Robert; Johnson, Roy; Talmage, James B

2011-02-01

Identify factors associated with obstructive sleep apnea (OSA) risk during commercial driver medical examinations. A case-control study was conducted at an occupational health clinic by reviewing the commercial driver medical examinations medical records performed from January 2007 to December 2008. The magnitude of association with OSA was estimated with logistic regression. Among 1890 commercial motor vehicle drivers, 51 were confirmed positive for OSA by polysomnography after initial screening by Joint Task Force guidelines, yielding estimated positive predictive values of 78.5% for the screening criteria. Multivariable logistic regression showed that body mass index ≥ 30 (odds ratio: 26.86), hypertension (odds ratio: 2.57), and diabetes (odds ratio: 2.03) were independently associated with OSA. Medical examiners' use of objectively measurable risk factors, such as obesity, history of hypertension, and/or diabetes, rather than symptoms, may be more effective in identifying undiagnosed OSA in commercial drivers during the commercial driver medical examinations.

Husband/Partner Intoxication and Intimate Partner Violence Against Women in the Philippines.

PubMed

Kerridge, Bradley T; Tran, Phu

2016-09-01

This study examined husband/partner intoxication and experience with physical, sexual, and emotional intimate partner violence against women (IPVAW) using data derived from a nationally representative survey conducted in the Philippines in 2013. Multivariate logistic regression analyses were used to examine the association between intoxication and 3 different types of intimate partner violence against women. Multinomial logistic regression was used to examine intoxication and severity of violence. In this sample, 28.8% of women reported experiencing any form of intimate partner violence and 92.9% of women reported their partner being intoxicated at least sometimes. Intoxication was significantly associated with all 3 types of intimate partner violence, while the odds of experiencing one form of IPVAW versus no form of IPVAW and 2 forms of IPVAW versus 1 form of IPVAW was greater among women reporting frequency of husband/partner intoxication as often. © 2016 APJPH.

PARAMETRIC AND NON PARAMETRIC (MARS: MULTIVARIATE ADDITIVE REGRESSION SPLINES) LOGISTIC REGRESSIONS FOR PREDICTION OF A DICHOTOMOUS RESPONSE VARIABLE WITH AN EXAMPLE FOR PRESENCE/ABSENCE OF AMPHIBIANS

EPA Science Inventory

The purpose of this report is to provide a reference manual that could be used by investigators for making informed use of logistic regression using two methods (standard logistic regression and MARS). The details for analyses of relationships between a dependent binary response ...

Access disparities to Magnet hospitals for patients undergoing neurosurgical operations

PubMed Central

Missios, Symeon; Bekelis, Kimon

2017-01-01

Background Centers of excellence focusing on quality improvement have demonstrated superior outcomes for a variety of surgical interventions. We investigated the presence of access disparities to hospitals recognized by the Magnet Recognition Program of the American Nurses Credentialing Center (ANCC) for patients undergoing neurosurgical operations. Methods We performed a cohort study of all neurosurgery patients who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009–2013. We examined the association of African-American race and lack of insurance with Magnet status hospitalization for neurosurgical procedures. A mixed effects propensity adjusted multivariable regression analysis was used to control for confounding. Results During the study period, 190,535 neurosurgical patients met the inclusion criteria. Using a multivariable logistic regression, we demonstrate that African-Americans had lower admission rates to Magnet institutions (OR 0.62; 95% CI, 0.58–0.67). This persisted in a mixed effects logistic regression model (OR 0.77; 95% CI, 0.70–0.83) to adjust for clustering at the patient county level, and a propensity score adjusted logistic regression model (OR 0.75; 95% CI, 0.69–0.82). Additionally, lack of insurance was associated with lower admission rates to Magnet institutions (OR 0.71; 95% CI, 0.68–0.73), in a multivariable logistic regression model. This persisted in a mixed effects logistic regression model (OR 0.72; 95% CI, 0.69–0.74), and a propensity score adjusted logistic regression model (OR 0.72; 95% CI, 0.69–0.75). Conclusions Using a comprehensive all-payer cohort of neurosurgery patients in New York State we identified an association of African-American race and lack of insurance with lower rates of admission to Magnet hospitals. PMID:28684152

Knowledge, Attitude, and Practices Regarding Vector-borne Diseases in Western Jamaica.

PubMed

Alobuia, Wilson M; Missikpode, Celestin; Aung, Maung; Jolly, Pauline E

2015-01-01

Outbreaks of vector-borne diseases (VBDs) such as dengue and malaria can overwhelm health systems in resource-poor countries. Environmental management strategies that reduce or eliminate vector breeding sites combined with improved personal prevention strategies can help to significantly reduce transmission of these infections. The aim of this study was to assess the knowledge, attitudes, and practices (KAPs) of residents in western Jamaica regarding control of mosquito vectors and protection from mosquito bites. A cross-sectional study was conducted between May and August 2010 among patients or family members of patients waiting to be seen at hospitals in western Jamaica. Participants completed an interviewer-administered questionnaire on sociodemographic factors and KAPs regarding VBDs. KAP scores were calculated and categorized as high or low based on the number of correct or positive responses. Logistic regression analyses were conducted to identify predictors of KAP and linear regression analysis conducted to determine if knowledge and attitude scores predicted practice scores. In all, 361 (85 men and 276 women) people participated in the study. Most participants (87%) scored low on knowledge and practice items (78%). Conversely, 78% scored high on attitude items. By multivariate logistic regression, housewives were 82% less likely than laborers to have high attitude scores; homeowners were 65% less likely than renters to have high attitude scores. Participants from households with 1 to 2 children were 3.4 times more likely to have high attitude scores compared with those from households with no children. Participants from households with at least 5 people were 65% less likely than those from households with fewer than 5 people to have high practice scores. By multivariable linear regression knowledge and attitude scores were significant predictors of practice score. The study revealed poor knowledge of VBDs and poor prevention practices among participants. It identified specific groups that can be targeted with vector control and personal protection interventions to decrease transmission of the infections. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Neighborhood socioeconomic status is associated with violent reinjury.

PubMed

Chong, Vincent E; Lee, Wayne S; Victorino, Gregory P

2015-11-01

Measures of individual socioeconomic status correlate with recurrent violent injury; however, neighborhood socioeconomic status may also matter. We conducted a review of victims of interpersonal violence treated at our trauma center, hypothesizing that the percent of the population living under the poverty level in their neighborhood is associated with recurrent violent victimization. We identified victims of interpersonal violence, ages 12-24, in our trauma registry from 2005-2010. Recurrent episodes of violent injury were identified through 2012. The percentage of the population living under the poverty level for the patient's zip code of residence was derived from United States census estimates and divided into quartiles. Multivariable logistic regression was conducted to evaluate predictors of violent injury recidivism. Our cohort consisted of 1890 patients. Multivariable logistic regression confirmed the following factors as independent predictors of violent injury recidivism: male sex (odds ratio [OR] = 2 [1.06-3.80]; P = 0.03), black race (OR = 2.1 [1.44-3.06]; P < 0.001), injury due to firearms (OR = 1.67 [1.12-2.50]; P = 0.01), and living in the lowest zip code socioeconomic quartile (OR = 1.59 [1.12-2.25]; P = 0.01). For young patients injured by violence, the socioeconomic position of their neighborhood of residence is independently correlated with their risk of violent reinjury. Low neighborhood socioeconomic status may be associated with a disrupted sense of safety after injury and also may alter a person's likelihood of engaging in behaviors correlated with recurrent violent injury. Programs aimed at reducing violent injury recidivism should address needs at the individual and neighborhood level. Copyright © 2015 Elsevier Inc. All rights reserved.

The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort

PubMed Central

Gaines, Alexis R.; Turner, Elizabeth L.; Moorman, Patricia G.; Freedland, Stephen J.; Keto, Christopher J.; McPhail, Megan E.; Grant, Delores J.; Vidal, Adriana C.

2014-01-01

Purpose Population-based studies have established a link between race and prostate cancer (PC) risk, but whether race predicts PC after adjusting for clinical characteristics is unclear. We investigated the association between race and risk of low- and high-grade PC in men undergoing initial prostate biopsy in an equal access medical center. Methods We conducted a retrospective record review of 887 men (48.6 % black, 51.4 % white) from the Durham Veterans Affairs Medical Center who underwent initial prostate biopsy between 2001 and 2009. Multivariable logistic regression analysis of race and biopsy outcome was conducted adjusting for age, body mass index, number of cores taken, prostate-specific antigen (PSA), and digital rectal examination findings. Multinomial logistic regression was used to test the association between black race and PC grade (Gleason <7 vs. ≥7). Results Black men were younger at biopsy (61 vs. 65 years, p <0.001) and had a higher pre-biopsy PSA (6.6 vs. 5.8 ng/ml, p = 0.001). A total of 499 men had PC on biopsy (245 low grade; 254 high grade). In multivariable analyses, black race was significantly predictive of PC overall [odds ratio 1.50, p = 0.006] and high-grade PC [relative risk ratio (RRR) 1.84, p = 0.001], but was not significantly associated with low-grade PC (RRR 1.29, p = 0.139). Conclusion In an equal access healthcare facility, black race was associated with greater risk of PC detection on initial biopsy and of high-grade PC after adjusting for clinical characteristics. Additional investigation of mechanisms linking black race and PC risk and PC aggressiveness is needed. PMID:24879044

The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort.

PubMed

Gaines, Alexis R; Turner, Elizabeth L; Moorman, Patricia G; Freedland, Stephen J; Keto, Christopher J; McPhail, Megan E; Grant, Delores J; Vidal, Adriana C; Hoyo, Cathrine

2014-08-01

Population-based studies have established a link between race and prostate cancer (PC) risk, but whether race predicts PC after adjusting for clinical characteristics is unclear. We investigated the association between race and risk of low- and high-grade PC in men undergoing initial prostate biopsy in an equal access medical center. We conducted a retrospective record review of 887 men (48.6 % black, 51.4 % white) from the Durham Veterans Affairs Medical Center who underwent initial prostate biopsy between 2001 and 2009. Multivariable logistic regression analysis of race and biopsy outcome was conducted adjusting for age, body mass index, number of cores taken, prostate-specific antigen (PSA), and digital rectal examination findings. Multinomial logistic regression was used to test the association between black race and PC grade (Gleason <7 vs. ≥7). Black men were younger at biopsy (61 vs. 65 years, p < 0.001) and had a higher pre-biopsy PSA (6.6 vs. 5.8 ng/ml, p = 0.001). A total of 499 men had PC on biopsy (245 low grade; 254 high grade). In multivariable analyses, black race was significantly predictive of PC overall [odds ratio 1.50, p = 0.006] and high-grade PC [relative risk ratio (RRR) 1.84, p = 0.001], but was not significantly associated with low-grade PC (RRR 1.29, p = 0.139). In an equal access healthcare facility, black race was associated with greater risk of PC detection on initial biopsy and of high-grade PC after adjusting for clinical characteristics. Additional investigation of mechanisms linking black race and PC risk and PC aggressiveness is needed.

Risk Factors of Catheter-Related Thrombosis (CRT) in Cancer Patients: A Patient-Level Data (IPD) Meta-Analysis of Clinical Trials and Prospective Studies

PubMed Central

Saber, W.; Moua, T.; Williams, E. C.; Verso, M.; Agnelli, G.; Couban, S.; Young, A.; De Cicco, M.; Biffi, R.; van Rooden, C. J.; Huisman, M. V.; Fagnani, D.; Cimminiello, C.; Moia, M.; Magagnoli, M.; Povoski, S. P.; Malak, S. F.; Lee, A. Y.

2010-01-01

Background Knowledge of independent, baseline risk factors of catheter-related thrombosis (CRT) may help select adult cancer patients at high risk to receive thromboprophylaxis. Objectives We conducted a meta-analysis of individual patient-level data to identify these baseline risk factors. Patients/Methods MEDLINE, EMBASE, CINAHL, CENTRAL, DARE, Grey literature databases were searched in all languages from 1995-2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient-level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. Results A total sample of 5636 subjects from 5 RCTs and 7 prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICC), decreased CRT risk (OR = 0.43; 95% CI, 0.23-0.80), whereas past history of deep vein thrombosis (DVT) (OR = 2.03; 95% CI, 1.05-3.92), subclavian venipuncture insertion technique (OR = 2.16; 95% CI, 1.07-4.34), and improper catheter tip location (OR = 1.92; 95% CI, 1.22-3.02), increased CRT risk. Conclusions CRT risk is increased with using PICC catheters, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings. PMID:21040443

Pregnancy outcome of patients following bariatric surgery as compared with obese women: a population-based study.

PubMed

Shai, Daniel; Shoham-Vardi, Ilana; Amsalem, Doron; Silverberg, Daniel; Levi, Isaac; Sheiner, Eyal

2014-02-01

To evaluate pregnancy outcome and rates of anemia in patients following bariatric operation in comparison with obese pregnant women. A retrospective population-based study comparing pregnancy outcome of patients following bariatric with the obese population was conducted. Multivariate logistic regression models were constructed to control for confounders. To evaluate the change in hemoglobin levels, we included women who had one pregnancy before the bariatric surgery and one following the surgery or two pregnancies for women with obesity. This study included 326 women who had one pregnancy before and after a bariatric surgery and 1612 obese women who had at least two consecutive deliveries. Using a multivariable logistic regression model, controlling for confounders such as maternal age, patients following bariatric surgery had lower rates of gestational diabetes mellitus (OR 0.7; 95% CI 0.5-0.9; p = 0.49) and macrosomia (OR 0.3; 95% CI 0.2-0.5; p < 0.001) as compared with obese parturients. Women post bariatric surgery were more likely to be anemic (hemoglobin <10 g/dL) as compared to obese parturients (48% versus 37%; OR, 1.5; 95% CI, 1.2-1.9; p < 0.001). A significant decline in hemoglobin level was noted in patients following bariatric surgery (a decline of 0.33 g/dL versus 0.18 g/dL between two consecutive pregnancies of obese women). Using another multivariable model with anemia as the outcome variable, bariatric was noted as a risk factor for anemia (adjusted OR = 1.45, 95%CI 1.13-1.86, p = 0.004). Women following bariatric surgery have lower risk for gestational diabetes mellitus and fetal macrosomia as compared with obese parturients. Nevertheless, bariatric surgery is a risk factor for anemia.

[Multivariate analysis of the association between consumption of fried food and gastric cancer and precancerous lesions].

PubMed

Guo, L W; Liu, S Z; Zhang, M; Chen, Q; Zhang, S K; Sun, X B

2018-02-06

Objective: To investigate the effect of fried food intake on the pathogenesis of gastric cancer and precancerous lesions. Methods: From 2005 to 2013, the residents aged 40-69 years from 11 counties/cities where cancer screening of upper gastrointestinal cancer were conducted in rural areas of Henan province as the subjects (82 367 cases). The information such as demography and lifestyle was collected. The residents were screened with endoscopic examination. The biopsy sampleswere diagnosed pathologically, according to pathological diagnosis criteria, the subjects with high risk were divided into the groups with different pathological degrees. The multivariate ordinal logistic regression analysis was used to analyze the relationship between the frequency of fried food intake and gastric cancer and precancerous lesions. Results: The study coverd 46 425 males and 35 942 females, with a age of (53.46±8.07)years. The study collected 6 707 cases of normal stomach, 2 325 cases of low grade intraepithelial neoplasia, 226 cases of high grade intraepithelial neoplasia and 331 cases of gastric cancer. Multivariate logistic regression analysis showed that, compared with those whoeat fried food less than one time per week, fried foods intake (<2 times/week: OR= 1.89, 95 %CI: 1.57-2.28; ≥ 2 times/week: OR= 1.91, 95 %CI: 1.66-2.20) were a risk factor for gastric cancer and precancerous lesions after adjustment for age, sex, marital status, educational level, body mass index (BMI), smoking and drinking status. Conclusion: The intake of fried food is a risk factor for gastric cancer and precancerous lesions. Therefore, reducing the intake of fried food can prevent the occurrence of gastric carcinoma and precancerous lesions.

Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture.

PubMed

Nuotio, M; Tuominen, P; Luukkaala, T

2016-03-01

We examined the association of nutritional status as measured by the Mini-Nutritional Assessment Short Form (MNA-SF) with changes in mobility, institutionalization and death after hip fracture. Population-based prospective data were collected on 472 out of 693 consecutive hip fracture patients aged 65 years and over between January 2010 and December 2012. Declined vs same or improved mobility level, institutionalization and death during the 4-month follow-up were the outcomes. Age, gender, American Society of Anesthesiologists scores, pre-fracture diagnosis of a memory disorder, mobility level, living arrangements and MNA-SF scores at baseline were the independent variables. Age-adjusted and multivariate logistic regression and Cox proportional hazards models were conducted. At baseline, 41 (9%) patients were malnourished and 200 (42%) patients at risk of malnutrition according to the MNA-SF. During the follow-up, 90 (19%) had died. In the multivariate Cox proportional hazards model, malnutrition (hazard ratio 2.16; 95% confidence interval (CI) 1.07-4.34) was associated with mortality. In the multivariate binary logistic regression analyses, risk of malnutrition (odds ratios (OR) 2.42; 95% CI 1.25-4.66) and malnutrition (OR 6.10;95% CI 2.01-18.5) predicted institutionalization. Risk of malnutrition (OR 2.03; 95% CI 1.24-3.31) was associated with decline in the mobility level. Malnutrition or risk of malnutrition as measured by the MNA-SF were independent predictors of negative outcomes after hip fracture. Patients classified as being at risk of malnutrition by the MNA-SF may constitute a patient population with mild-to-moderate malnutrition and may require specific attention when nutritional interventions are designed after hip fracture.

Multivariate logistic regression for predicting total culturable virus presence at the intake of a potable-water treatment plant: novel application of the atypical coliform/total coliform ratio.

PubMed

Black, L E; Brion, G M; Freitas, S J

2007-06-01

Predicting the presence of enteric viruses in surface waters is a complex modeling problem. Multiple water quality parameters that indicate the presence of human fecal material, the load of fecal material, and the amount of time fecal material has been in the environment are needed. This paper presents the results of a multiyear study of raw-water quality at the inlet of a potable-water plant that related 17 physical, chemical, and biological indices to the presence of enteric viruses as indicated by cytopathic changes in cell cultures. It was found that several simple, multivariate logistic regression models that could reliably identify observations of the presence or absence of total culturable virus could be fitted. The best models developed combined a fecal age indicator (the atypical coliform [AC]/total coliform [TC] ratio), the detectable presence of a human-associated sterol (epicoprostanol) to indicate the fecal source, and one of several fecal load indicators (the levels of Giardia species cysts, coliform bacteria, and coprostanol). The best fit to the data was found when the AC/TC ratio, the presence of epicoprostanol, and the density of fecal coliform bacteria were input into a simple, multivariate logistic regression equation, resulting in 84.5% and 78.6% accuracies for the identification of the presence and absence of total culturable virus, respectively. The AC/TC ratio was the most influential input variable in all of the models generated, but producing the best prediction required additional input related to the fecal source and the fecal load. The potential for replacing microbial indicators of fecal load with levels of coprostanol was proposed and evaluated by multivariate logistic regression modeling for the presence and absence of virus.

Preoperative predictive model of recovery of urinary continence after radical prostatectomy.

PubMed

Matsushita, Kazuhito; Kent, Matthew T; Vickers, Andrew J; von Bodman, Christian; Bernstein, Melanie; Touijer, Karim A; Coleman, Jonathan A; Laudone, Vincent T; Scardino, Peter T; Eastham, James A; Akin, Oguz; Sandhu, Jaspreet S

2015-10-01

To build a predictive model of urinary continence recovery after radical prostatectomy (RP) that incorporates magnetic resonance imaging (MRI) parameters and clinical data. We conducted a retrospective review of data from 2,849 patients who underwent pelvic staging MRI before RP from November 2001 to June 2010. We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI) and American Society of Anesthesiologists (ASA) score, and then used multivariable logistic regression to create our model. A nomogram was constructed using the multivariable logistic regression models. In all, 68% (1,742/2,559) and 82% (2,205/2,689) regained function at 6 and 12 months, respectively. In the base model, age, BMI and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (P < 0.005). Among the preoperative MRI measurements, membranous urethral length, which showed great significance, was incorporated into the base model to create the full model. For continence recovery at 6 months, the addition of membranous urethral length increased the area under the curve (AUC) to 0.664 for the validation set, an increase of 0.064 over the base model. For continence recovery at 12 months, the AUC was 0.674, an increase of 0.085 over the base model. Using our model, the likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI and ASA score. This model could be used for patient counselling and for the identification of patients at high risk for urinary incontinence in whom to study changes in operative technique that improve urinary function after RP. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Correlates of consistent condom use among men who have sex with men recruited through the Internet in Huzhou city: a cross-sectional survey.

PubMed

Jin, Meihua; Yang, Zhongrong; Dong, Zhengquan; Han, Jiankang

2013-12-01

There is growing evidence that men who have sex with men (MSM) are currently a group at high risk of HIV infection in China. Our study aims to know the factors affecting consistent condom use among MSM recruited through the internet in Huzhou city. An anonymous cross-sectional study was conducted by recruiting 410 MSM living in Huzhou city via the Internet. The socio-demographic profiles (age, education level, employment status, etc.) and sexual risk behaviors of the respondents were investigated. Bivariate logistic regression analyses were performed to compare the differences between consistent condom users and inconsistent condom users. Variables with significant bivariate between groups' differences were used as candidate variables in a stepwise multivariate logistic regression model. All statistical analyses were performed using SPSS for Windows 17.0, and a p value < 0.05 was considered to be statistically significant. According to their condom use, sixty-eight respondents were classified into two groups. One is consistent condom users, and the other is inconsistent condom users. Multivariate logistic regression showed that respondents who had a comprehensive knowledge of HIV (OR = 4.08, 95% CI: 1.85-8.99), who had sex with male sex workers (OR = 15.30, 95% CI: 5.89-39.75) and who had not drunk alcohol before sex (OR = 3.10, 95% CI: 1.38-6.95) were more likely to be consistent condom users. Consistent condom use among MSM was associated with comprehensive knowledge of HIV and a lack of alcohol use before sexual contact. As a result, reducing alcohol consumption and enhancing education regarding the risks of HIV among sexually active MSM would be effective in preventing of HIV transmission.

Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients.

PubMed

Armenteros-Yeguas, Victoria; Gárate-Echenique, Lucía; Tomás-López, Maria Aranzazu; Cristóbal-Domínguez, Estíbaliz; Moreno-de Gusmão, Breno; Miranda-Serrano, Erika; Moraza-Dulanto, Maria Inmaculada

2017-12-01

To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. A cross-sectional study was conducted. 'Highly complex' patients (n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access. © 2017 John Wiley & Sons Ltd.

Evaluating Cancer Patients' Expectations and Barriers Toward Traditional Chinese Medicine Utilization in China: A Patient-Support Group-Based Cross-Sectional Survey.

PubMed

Sun, Lingyun; Mao, Jun J; Vertosick, Emily; Seluzicki, Christina; Yang, Yufei

2018-06-01

Traditional Chinese medicine (TCM) is widely used among Chinese cancer patients. However, little is known about Chinese patients' expectations and barriers toward using TCM for cancer. We conducted a cross-sectional survey within a patient-support group, the Beijing Anti-Cancer Association. We measured the outcome, Chinese cancer survivors' expectations and barriers toward TCM utilization, using a modified version of ABCAM (Attitudes and Beliefs towards Complementary and Alternative Medicine), the ABTCM (Attitudes and Beliefs towards Traditional Chinese Medicine). We used multivariate models to evaluate the impact of socioeconomic status and clinical factors on their expectations and barriers (including treatment concerns and logistical challenges domain) toward TCM. Among 590 participants, most patients expected TCM to boost their immune system (96%), improve their physical health (96%), and reduce symptoms (94%). Many had logistical challenges (difficulty decocting herbs (58%) and finding a good TCM physician (55%)). A few were concerned that TCM might interfere with conventional treatments (7.6%), and that many TCM treatments are not based on scientific research (9.1%). In the multivariable regression model, age ≤60 years was independently associated with higher expectation score ( P = .031). Age ≤60 years (coefficient 5.0, P = .003) and localized disease (coefficient 9.5, P = .001) were both associated with higher treatment concerns. Active employment status (coefficient 9.0, P = .008) and localized disease (coefficient 7.5, P = .030) were related to more logistical challenges. Age and cancer stage were related to Chinese cancer patients' perceived expectations and barriers toward TCM use. Understanding these attitudes is important for reshaping the role that TCM plays in China's patient-centered comprehensive cancer care model.

Diabetes may affect intracranial aneurysm stabilization in older patients: Analysis based on intraoperative findings

PubMed Central

Song, Jihye; Shin, Yong Sam

2016-01-01

Background: Only a small proportion of aneurysms progress to rupture. Previous studies have focused on predicting the rupture risk of intracranial aneurysms. Atherosclerotic aneurysm wall appears resistant to rupture. The purpose of this study was to evaluate clinical and morphological factors affecting atherosclerosis of an aneurysm and identify the parameters that predict aneurysm stabilization. Methods: We conducted a retrospective analysis of 253 consecutive patients with 291 unruptured aneurysms who underwent clipping surgery in a single institution between January 2012 and October 2013. Aneurysms were categorized based on intraoperative video findings and assessed morphologic and demographic data. Aneurysms which had the atherosclerotic wall without any super thin and transparent portion were defined as stabilized group and the others as a not-stabilized group. Results: Of the 207 aneurysms, 176 (85.0%) were assigned to the not-stabilized group and 31 (15.0%) to the stabilized group. The relative proportion of stabilized aneurysms increased significantly as the age increased (P < 0.001). Univariate logistic analysis showed that age ≥65 years (P < 0.001), hypertension (P = 0.012), diabetes (P = 0.007), and height ≥3 mm (P = 0.007) were correlated with stabilized aneurysms. Multivariate logistic analysis showed that age ≥65 years (P = 0.009) and hypertension (P = 0.041) were strongly correlated with stable aneurysms. In older patients (≥65 years of age), multivariate logistic regression revealed that only diabetes was associated with stabilized aneurysms (P = 0.027). Conclusions: In patients ≥65 years of age, diabetes mellitus may highly predict the stabilized aneurysms. These results provide useful information in determining treatment and follow-up strategies, especially in older patients. PMID:27313965

Perinatal Depression and Associated Factors among Mothers in Southern Ethiopia: Evidence from Arba Minch Zuria Health and Demographic Surveillance Site.

PubMed

Gebremichael, Gebrekiros; Yihune, Manaye; Ajema, Dessalegn; Haftu, Desta; Gedamu, Genet

2018-01-01

Background. Perinatal depression is a serious mental health problem that can negatively affect the lives of women and children. The adverse consequences of perinatal depression in high-income countries also occur in low-income countries. Objective. To assess the perinatal depression and associated factors among mothers in Southern Ethiopia. Methods. A community based cross-sectional study was conducted among selected 728 study participants in Arba Minch Zuria HDSS. A pretested questionnaire was used to collect the data. Data were analyzed using STATA version 12 software. Descriptive statistical methods were used to summarize the characteristics of the mothers. Bivariate and multivariable logistic regression was used for analysis. Results. The prevalence of perinatal depression among the study period was 26.7%. In the final multivariable logistic regression, monthly income AOR (95% C.I): 4.2 (1.9, 9.3), parity [AOR (95% C.I): 0.14 (0.03, 0.65)], pregnancy complications AOR (95% C.I): 5 (2.5, 10.4), husband smoking status [AOR (95% C.I): 4.12 (1.6, 10.6)], history of previous depression AOR (95% C.I): 2.7 (1.54, 4.8), and family history of psychiatric disorders were the independent factors associated with perinatal depression. Conclusion. The study showed a high prevalence of perinatal depression among pregnant mothers and mothers who have less than a one-year-old child.

PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients.

PubMed

Ranney, Megan L; Patena, John V; Nugent, Nicole; Spirito, Anthony; Boyer, Edward; Zatzick, Douglas; Cunningham, Rebecca

2016-01-01

Posttraumatic stress disorder (PTSD) is often underdiagnosed and undertreated among adolescents. The objective of this analysis was to describe the prevalence and correlates of symptoms consistent with PTSD among adolescents presenting to an urban emergency department (ED). A cross-sectional survey of adolescents aged 13-17 years presenting to the ED for any reason was conducted between August 2013 and March 2014. Validated self-report measures were used to measure mental health symptoms, violence exposure and risky behaviors. Multivariate logistic regression analysis was performed to determine adjusted differences in associations between symptoms consistent with PTSD and predicted correlates. Of 353 adolescents, 23.2% reported current symptoms consistent with PTSD, 13.9% had moderate or higher depressive symptoms and 11.3% reported past-year suicidal ideation. Adolescents commonly reported physical peer violence (46.5%), cyberbullying (46.7%) and exposure to community violence (58.9%). On multivariate logistic regression, physical peer violence, cyberbullying victimization, exposure to community violence, female gender and alcohol or other drug use positively correlated with symptoms consistent with PTSD. Among adolescents presenting to the ED for any reason, symptoms consistent with PTSD, depressive symptoms, physical peer violence, cyberbullying and community violence exposure are common and interrelated. Greater attention to PTSD, both disorder and symptom levels, and its cooccurring risk factors is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of association of clinical aspects and IL1B tagSNPs with severe preeclampsia.

PubMed

Leme Galvão, Larissa Paes; Menezes, Filipe Emanuel; Mendonca, Caio; Barreto, Ikaro; Alvim-Pereira, Claudia; Alvim-Pereira, Fabiano; Gurgel, Ricardo

2016-01-01

This study investigates the association between IL1B genotypes using a tag SNP (single polymorphism) approach, maternal and environmental factors in Brazilian women with severe preeclampsia. A case-control study with a total of 456 patients (169 preeclamptic women and 287 controls) was conducted in the two reference maternity hospitals of Sergipe state, Northeast Brazil. A questionnaire was administered and DNA was extracted to genotype the population for four tag SNPs of the IL1Beta: rs 1143643, rs 1143633, rs 1143634 and rs 1143630. Haplotype association analysis and p-values were calculated using the THESIAS test. Odds ratio (OR) estimation, confidence interval (CI) and multivariate logistic regression were performed. High pregestational body mass index (pre-BMI), first gestation, cesarean section, more than six medical visits, low level of consciousness on admission and TC and TT genotype in rs1143630 of IL1Beta showed association with the preeclamptic group in univariate analysis. After multivariate logistic regression pre-BMI, first gestation and low level of consciousness on admission remained associated. We identified an association between clinical variables and preeclampsia. Univariate analysis suggested that inflammatory process-related genes, such as IL1B, may be involved and should be targeted in further studies. The identification of the genetic background involved in preeclampsia host response modulation is mandatory in order to understand the preeclampsia process.

Influence of education on HIV infection among pregnant women attending their antenatal care in Sekondi-Takoradi metropolis, Ghana.

PubMed

Orish, Verner N; Onyeabor, Onyekachi S; Boampong, Johnson N; Afoakwah, Richmond; Nwaefuna, Ekene; Acquah, Samuel; Orish, Esther O; Sanyaolu, Adekunle O; Iriemenam, Nnaemeka C

2014-08-01

This study investigated the influence of the level of education on HIV infection among pregnant women attending antenatal care in Sekondi-Takoradi, Ghana. A cross-sectional study was conducted at four hospitals in the Sekondi-Takoradi metropolis. The study group comprised 885 consenting pregnant women attending antenatal care clinics. Questionnaires were administered and venous blood samples were screened for HIV and other parameters. Multivariable logistic regression analyses were performed to determine the association between the level of education attained by the pregnant women and their HIV statuses. The data showed that 9.83% (87/885) of the pregnant women were HIV seropositive while 90.17% (798/885) were HIV seronegative. There were significant differences in mean age (years) between the HIV seropositive women (27.45 ± 5.5) and their HIV seronegative (26.02 ± 5.6) counterparts (p = .026) but the inference disappeared after adjustment (p = .22). Multivariable logistic regression analysis revealed that pregnant women with secondary/tertiary education were less likely to have HIV infection compared with those with none/primary education (adjusted OR, 0.53; 95% CI, 0.30-0.91; p = .022). Our data showed an association with higher level of education and HIV statuses of the pregnant women. It is imperative to encourage formal education among pregnant women in this region.

Risk factors for refractive errors in primary school children (6-12 years old) in Nakhon Pathom Province.

PubMed

Yingyong, Penpimol

2010-11-01

Refractive error is one of the leading causes of visual impairment in children. An analysis of risk factors for refractive error is required to reduce and prevent this common eye disease. To identify the risk factors associated with refractive errors in primary school children (6-12 year old) in Nakhon Pathom province. A population-based cross-sectional analytic study was conducted between October 2008 and September 2009 in Nakhon Pathom. Refractive error, parental refractive status, and hours per week of near activities (studying, reading books, watching television, playing with video games, or working on the computer) were assessed in 377 children who participated in this study. The most common type of refractive error in primary school children was myopia. Myopic children were more likely to have parents with myopia. Children with myopia spend more time at near activities. The multivariate odds ratio (95% confidence interval)for two myopic parents was 6.37 (2.26-17.78) and for each diopter-hour per week of near work was 1.019 (1.005-1.033). Multivariate logistic regression models show no confounding effects between parental myopia and near work suggesting that each factor has an independent association with myopia. Statistical analysis by logistic regression revealed that family history of refractive error and hours of near-work were significantly associated with refractive error in primary school children.

Incidence and risk factors of axial symptoms after cervical disc arthroplasty: a minimum 5-year follow-up study.

PubMed

Chen, Jing; Li, Jia; Qiu, Gang; Wei, Jingchao; Qiu, Yanfen; An, Yonghui; Shen, Yong

2016-09-20

The purpose of this study was to investigate whether uncovertebral joint ossification was a risk factor for axial symptoms (AS) after cervical disc arthroplasty (CDA). This retrospective study included 52 consecutive patients who underwent CDA for single-level cervical disc disease. To examine possible risk factors for AS after CDA, univariate and multivariate logistic regression analyses were conducted to compare data from the patients with and without AS (the AS and no-AS groups, respectively). Among the 52 patients examined, AS were observed in 24 patients (46.2 %), including a stiff neck (n = 11), neck pain and dullness (n = 10), and shoulder pain (n = 3). Uncovertebral joint ossification was detected in 22 (42.3 %) patients, including 17 patients in the AS group and 5 patients in the no-AS group. Clinical outcome improved during the follow-up period for the AS group. According to multivariate logistic regression analysis, uncovertebral joint ossification, cervical kyphosis, and range of motion (ROM) at the index level were identified as significant risk factors for AS after CDA. Satisfactory clinical outcomes were observed following CDA for the treatment of single-level cervical disc disease in the present cohort. In addition, uncovertebral joint ossification, cervical kyphosis, and ROM at the index level were found to affect the incidence of AS after CDA.

Phobic Anxiety and Plasma Levels of Global Oxidative Stress in Women.

PubMed

Hagan, Kaitlin A; Wu, Tianying; Rimm, Eric B; Eliassen, A Heather; Okereke, Olivia I

2015-01-01

Psychological distress has been hypothesized to be associated with adverse biologic states such as higher oxidative stress and inflammation. Yet, little is known about associations between a common form of distress - phobic anxiety - and global oxidative stress. Thus, we related phobic anxiety to plasma fluorescent oxidation products (FlOPs), a global oxidative stress marker. We conducted a cross-sectional analysis among 1,325 women (aged 43-70 years) from the Nurses' Health Study. Phobic anxiety was measured using the Crown-Crisp Index (CCI). Adjusted least-squares mean log-transformed FlOPs were calculated across phobic categories. Logistic regression models were used to calculate odds ratios (OR) comparing the highest CCI category (≥6 points) vs. lower scores, across FlOPs quartiles. No association was found between phobic anxiety categories and mean FlOP levels in multivariable adjusted linear models. Similarly, in multivariable logistic regression models there were no associations between FlOPs quartiles and likelihood of being in the highest phobic category. Comparing women in the highest vs. lowest FlOPs quartiles: FlOP_360: OR=0.68 (95% CI: 0.40-1.15); FlOP_320: OR=0.99 (95% CI: 0.61-1.61); FlOP_400: OR=0.92 (95% CI: 0.52, 1.63). No cross-sectional association was found between phobic anxiety and a plasma measure of global oxidative stress in this sample of middle-aged and older women.

Unhealthy lifestyle factors and depressive symptoms: A Japanese general adult population survey.

PubMed

Furihata, Ryuji; Konno, Chisato; Suzuki, Masahiro; Takahashi, Sakae; Kaneita, Yoshitaka; Ohida, Takashi; Uchiyama, Makoto

2018-07-01

To investigate the relationship between unhealthy lifestyles factors and depressive symptoms among the general adult population in Japan. Participants were randomly selected from the Japanese general adult population. Data from 2334 people aged 20 years or older were analyzed. This cross-sectional survey was conducted in August and September 2009. Participants completed a face-to-face interview about unhealthy lifestyle factors, including lack of exercise, skipping breakfast, a poorly balanced diet, snacking between meals, insufficient sleep, current smoking, alcohol drinking, and obesity. Presence of depressive symptoms was defined as a score of ≥ 16 on the Japanese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Relationships between unhealthy lifestyle factors and depressive symptoms were evaluated by multivariate logistic regression analysis adjusting for sociodemographic variables and other unhealthy lifestyle factors. Multivariate logistic regression analysis revealed that insufficient sleep, a poorly balanced diet, snacking between meals and lack of exercise were significantly associated with the prevalence of depressive symptoms, with odds ratios ranging from 1.56 for lack of exercise to 3.98 for insufficient sleep. Since this study was a cross-sectional study, causal relationships could not be determined. These results suggest that promoting a healthy lifestyle focused on sleep, food intake and exercise may be important for individuals with depressive symptoms. Copyright © 2018 Elsevier B.V. All rights reserved.

[Impact of heat waves on non-accidental deaths in Jinan, China].

PubMed

Zhang, J; Liu, S Q; Zhou, L; Gong, S P; Liu, Y L; Zhang, Y; Zhang, J

2016-02-20

To assess the impact of heat waves on non-accidental deaths, and to investigate the influencing factors for deaths caused by heat waves in Jinan, China. Daily death data and meteorological data for summer days with or without heat waves in Jinan from 2012 to 2014 were collected, and a cross-over analysis was conducted to evaluate the influence of heat waves on non-accidental deaths and deaths caused by other reasons. The univariate and multivariate logistic regression models were used to investigate the influencing factors for deaths caused by heat waves. The risks of non-accidental deaths and deaths caused by circulation system diseases during the days with heat waves were 1.82 times(95% CI: 1.47~2.36) and 1.53 times(95% CI: 1.14~2.07) those during the days without heat waves. The multivariate logistic regression analysis showed that old age(≥75 years)(OR=1.184, 95% CI: 1.068~1.313), low educational level(OR=1.187, 95% CI: 1.064~1.324), and deaths outside hospital(OR=1.105, 95% CI: 1.009~1.210) were associated with the high risk of deaths during the days with heat waves. Heat waves significantly increase the risk of non-accidental deaths and deaths caused by circulation system diseases in Jinan, and the deaths during the days with heat waves are related to age, educational level, and place of death.

Applied Statistics: From Bivariate through Multivariate Techniques [with CD-ROM

ERIC Educational Resources Information Center

Warner, Rebecca M.

2007-01-01

This book provides a clear introduction to widely used topics in bivariate and multivariate statistics, including multiple regression, discriminant analysis, MANOVA, factor analysis, and binary logistic regression. The approach is applied and does not require formal mathematics; equations are accompanied by verbal explanations. Students are asked…

Probability and predictors of cannabis use disorders relapse: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

PubMed

Flórez-Salamanca, Ludwing; Secades-Villa, Roberto; Budney, Alan J; García-Rodríguez, Olaya; Wang, Shuai; Blanco, Carlos

2013-09-01

This study aims to estimate the odds and predictors of Cannabis Use Disorders (CUD) relapse among individuals in remission. Analyses were done on the subsample of individuals with lifetime history of a CUD (abuse or dependence) who were in full remission at baseline (Wave 1) of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=2350). Univariate logistic regression models and hierarchical logistic regression model were implemented to estimate odds of relapse and identify predictors of relapse at 3 years follow up (Wave 2). The relapse rate of CUD was 6.63% over an average of 3.6 year follow-up period. In the multivariable model, the odds of relapse were inversely related to time in remission, whereas having a history of conduct disorder or a major depressive disorder after Wave 1 increased the risk of relapse. Our findings suggest that maintenance of remission is the most common outcome for individuals in remission from a CUD. Treatment approaches may improve rates of sustained remission of individuals with CUD and conduct disorder or major depressive disorder. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Family planning utilization and factors associated among women receiving abortion services in health facilities of central zone towns of Tigray, Northern Ethiopia: a cross sectional Study.

PubMed

Hagos, Goshu; Tura, Gurmesa; Kahsay, Gizienesh; Haile, Kebede; Grum, Teklit; Araya, Tsige

2018-06-05

Abortion remains among the leading causes of maternal death worldwide. Post-abortion contraception is significantly effective in preventing unintended pregnancy and abortion if provided before women leave the health facilty. However, the status of post-abortion family planning (PAFP) utilization and the contributing factors are not well studied in Tigray region. So, we conduct study aimed on family planning utilization and factors associated with it among women receiving abortion services. A facility based cross-sectional study design was conducted among women receiving abortion services in central zone of Tigray from December 2015to February 2016 using a total of 416 sample size. Women who came for abortion services were selected using systematic random sampling technique.. The data were collected using a pre-tested interviewer administered questionnair. Data were coded and entered in to Epi info 7 and then exported to SPSS for analysis. Descriptive statisticslike frequencies and mean were computed to display the results. Both Bivariable and multivariable logistic regression was used in the analysis. Variables statistically significant at p < 0.05 in the bivariable analysis were checked in multivariable logistic regration to identify independently associated factors. Then variables which were significantly associated with post abortion family planning utilization at p-value < 0.05 in the multivariable analysis were declared as significantly associated factors. A total of 409 abortion clients were interviewed in this study with 98.3% of response rate. Majority 290 (70.9%) of study participants utilized contracepives after abortion. Type of health facility, the decision maker on timing of having child, knowledge that pregnancy can happen soon after abortion and husband's opposition towards contraceptives were significantly associated with Post-abortion family planning ustilization. About one-third of abortion women failed to receive contraceptive before leaving the facility. Private facilities should strengthen utilization of contraceptives on post abortion care service. Health providers should provide counseling on timing of fertility-return following abortion before women left the facility once they receive abortion care. Women empowerment through enhancing community's awareness focusing on own decision making in the family planning utilization including the partner should be strengthened.

[Influences of environmental factors and interaction of several chemokines gene-environmental on systemic lupus erythematosus].

PubMed

Ye, Dong-qing; Hu, Yi-song; Li, Xiang-pei; Huang, Fen; Yang, Shi-gui; Hao, Jia-hu; Yin, Jing; Zhang, Guo-qing; Liu, Hui-hui

2004-11-01

To explore the impact of environmental factors, daily lifestyle, psycho-social factors and the interactions between environmental factors and chemokines genes on systemic lupus erythematosus (SLE). Case-control study was carried out and environmental factors for SLE were analyzed by univariate and multivariate unconditional logistic regression. Interactions between environmental factors and chemokines polymorphism contributing to systemic lupus erythematosus were also analyzed by logistic regression model. There were nineteen factors associated with SLE when univariate unconditional logistic regression was used. However, when multivariate unconditional logistic regression was used, only five factors showed having impacts on the disease, in which drinking well water (OR=0.099) was protective factor for SLE, and multiple drug allergy (OR=8.174), over-exposure to sunshine (OR=18.339), taking antibiotics (OR=9.630) and oral contraceptives were risk factors for SLE. When unconditional logistic regression model was used, results showed that there was interaction between eating irritable food and -2518MCP-1G/G genotype (OR=4.387). No interaction between environmental factors was found that contributing to SLE in this study. Many environmental factors were related to SLE, and there was an interaction between -2518MCP-1G/G genotype and eating irritable food.

Using Logistic Regression To Predict the Probability of Debris Flows Occurring in Areas Recently Burned By Wildland Fires

USGS Publications Warehouse

Rupert, Michael G.; Cannon, Susan H.; Gartner, Joseph E.

2003-01-01

Logistic regression was used to predict the probability of debris flows occurring in areas recently burned by wildland fires. Multiple logistic regression is conceptually similar to multiple linear regression because statistical relations between one dependent variable and several independent variables are evaluated. In logistic regression, however, the dependent variable is transformed to a binary variable (debris flow did or did not occur), and the actual probability of the debris flow occurring is statistically modeled. Data from 399 basins located within 15 wildland fires that burned during 2000-2002 in Colorado, Idaho, Montana, and New Mexico were evaluated. More than 35 independent variables describing the burn severity, geology, land surface gradient, rainfall, and soil properties were evaluated. The models were developed as follows: (1) Basins that did and did not produce debris flows were delineated from National Elevation Data using a Geographic Information System (GIS). (2) Data describing the burn severity, geology, land surface gradient, rainfall, and soil properties were determined for each basin. These data were then downloaded to a statistics software package for analysis using logistic regression. (3) Relations between the occurrence/non-occurrence of debris flows and burn severity, geology, land surface gradient, rainfall, and soil properties were evaluated and several preliminary multivariate logistic regression models were constructed. All possible combinations of independent variables were evaluated to determine which combination produced the most effective model. The multivariate model that best predicted the occurrence of debris flows was selected. (4) The multivariate logistic regression model was entered into a GIS, and a map showing the probability of debris flows was constructed. The most effective model incorporates the percentage of each basin with slope greater than 30 percent, percentage of land burned at medium and high burn severity in each basin, particle size sorting, average storm intensity (millimeters per hour), soil organic matter content, soil permeability, and soil drainage. The results of this study demonstrate that logistic regression is a valuable tool for predicting the probability of debris flows occurring in recently-burned landscapes.

Examining the Link Between Public Transit Use and Active Commuting

PubMed Central

Bopp, Melissa; Gayah, Vikash V.; Campbell, Matthew E.

2015-01-01

Background: An established relationship exists between public transportation (PT) use and physical activity. However, there is limited literature that examines the link between PT use and active commuting (AC) behavior. This study examines this link to determine if PT users commute more by active modes. Methods: A volunteer, convenience sample of adults (n = 748) completed an online survey about AC/PT patterns, demographic, psychosocial, community and environmental factors. t-test compared differences between PT riders and non-PT riders. Binary logistic regression analyses examined the effect of multiple factors on AC and a full logistic regression model was conducted to examine AC. Results: Non-PT riders (n = 596) reported less AC than PT riders. There were several significant relationships with AC for demographic, interpersonal, worksite, community and environmental factors when considering PT use. The logistic multivariate analysis for included age, number of children and perceived distance to work as negative predictors and PT use, feelings of bad weather and lack of on-street bike lanes as a barrier to AC, perceived behavioral control and spouse AC were positive predictors. Conclusions: This study revealed the complex relationship between AC and PT use. Further research should investigate how AC and public transit use are related. PMID:25898405

Examining the link between public transit use and active commuting.

PubMed

Bopp, Melissa; Gayah, Vikash V; Campbell, Matthew E

2015-04-17

An established relationship exists between public transportation (PT) use and physical activity. However, there is limited literature that examines the link between PT use and active commuting (AC) behavior. This study examines this link to determine if PT users commute more by active modes. A volunteer, convenience sample of adults (n = 748) completed an online survey about AC/PT patterns, demographic, psychosocial, community and environmental factors. t-test compared differences between PT riders and non-PT riders. Binary logistic regression analyses examined the effect of multiple factors on AC and a full logistic regression model was conducted to examine AC. Non-PT riders (n = 596) reported less AC than PT riders. There were several significant relationships with AC for demographic, interpersonal, worksite, community and environmental factors when considering PT use. The logistic multivariate analysis for included age, number of children and perceived distance to work as negative predictors and PT use, feelings of bad weather and lack of on-street bike lanes as a barrier to AC, perceived behavioral control and spouse AC were positive predictors. This study revealed the complex relationship between AC and PT use. Further research should investigate how AC and public transit use are related.

Patient satisfaction with intravenous acetaminophen: a pooled analysis of five randomized, placebo-controlled studies in the acute postoperative setting.

PubMed

Apfel, Christian C; Souza, Kimberly; Portillo, Juan; Dalal, Poorvi; Bergese, Sergio D

2015-01-01

Intravenous (IV) acetaminophen has been shown to reduce postoperative pain and opioid consumption, which may lead to increased patient satisfaction. To determine the effect IV acetaminophen has on patient satisfaction, a pooled analysis from methodologically homogenous studies was conducted. We obtained patient-level data from five randomized, placebo-controlled studies in adults undergoing elective surgery in which patient satisfaction was measured using a 4-point categorical rating scale. The primary endpoint was "excellent" satisfaction and the secondary endpoint was "good" or "excellent" satisfaction at 24 hr after first study drug administration. Bivariate analyses were conducted using the chi-square test and Student's t-test and multivariable analyses were conducted using logistic regression analysis. Patients receiving IV acetaminophen were more than twice as likely as those who received placebo to report "excellent" patient satisfaction ratings (32.3% vs. 15.9%, respectively). Of all variables that remained statistically significant in the multivariable analysis (i.e., type of surgery, duration of anesthesia, last pain rating, and opioid consumption), IV acetaminophen had the strongest positive effect on "excellent" patient satisfaction with an odds ratio of 2.76 (95% CI 1.81-4.23). Results for "excellent" or "good" satisfaction were similar. When given as part of a perioperative analgesic regimen, IV acetaminophen was associated with significantly improved patient satisfaction.

"Let Me Count the Ways:" Fostering Reasons for Living among Low-Income, Suicidal, African American Women

ERIC Educational Resources Information Center

West, Lindsey M.; Davis, Telsie A.; Thompson, Martie P.; Kaslow, Nadine J.

2011-01-01

Protective factors for fostering reasons for living were examined among low-income, suicidal, African American women. Bivariate logistic regressions revealed that higher levels of optimism, spiritual well-being, and family social support predicted reasons for living. Multivariate logistic regressions indicated that spiritual well-being showed…

ASCAL: A Microcomputer Program for Estimating Logistic IRT Item Parameters.

ERIC Educational Resources Information Center

Vale, C. David; Gialluca, Kathleen A.

ASCAL is a microcomputer-based program for calibrating items according to the three-parameter logistic model of item response theory. It uses a modified multivariate Newton-Raphson procedure for estimating item parameters. This study evaluated this procedure using Monte Carlo Simulation Techniques. The current version of ASCAL was then compared to…

Influences on parental acceptance of HPV vaccination in demonstration projects in Uganda and Vietnam.

PubMed

Galagan, Sean R; Paul, Proma; Menezes, Lysander; LaMontagne, D Scott

2013-06-26

This study investigates the effect of communication strategies on human papillomavirus (HPV) vaccine uptake in HPV vaccine demonstration projects in Uganda and Vietnam. Secondary analysis was conducted on data from surveys of a representative sample of parents and guardians of girls eligible for HPV vaccine, measuring three-dose coverage achieved in demonstration projects in 2008-2010. Univariate and multivariate logistic regression analysis calculated the unadjusted and adjusted odds of receiving at least one dose of HPV vaccine depending on exposure to community influencers; information, education, and communication (IEC) channels; and demographic factors. This study found that exposure to community influencers was associated with HPV vaccine uptake in a multivariate model controlling for other factors. Exposure to non-interactive IEC channels was only marginally associated with HPV vaccine uptake. These results underscore the need of HPV vaccine programs in low- and middle-income countries to involve and utilize key community influencers and stakeholders to maximize HPV vaccine uptake. Copyright © 2013 Elsevier Ltd. All rights reserved.

Insurance Coverage for Rehabilitation Therapies and Association with Social Participation Outcomes among Low-Income Children.

PubMed

Mirza, Mansha; Kim, Yoonsang

2016-01-01

(1) To profile children's health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3-17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Findings support the need for comprehensive coverage of all essential services under children's health insurance programs.

Risk Factors for Brachial Plexus Birth Injury

PubMed Central

Louden, Emily; Marcotte, Michael; Mehlman, Charles; Lippert, William; Huang, Bin; Paulson, Andrea

2018-01-01

Over the course of decades, the incidence of brachial plexus birth injury (BPBI) has increased despite advances in healthcare which would seem to assist in decreasing the rate. The aim of this study is to identify previously unknown risk factors for BPBI and the risk factors with potential to guide preventative measures. A case control study of 52 mothers who had delivered a child with a BPBI injury and 132 mothers who had delivered without BPBI injury was conducted. Univariate, multivariable and logistic regressions identified risk factors and their combinations. The odds of BPBI were 2.5 times higher when oxytocin was used and 3.7 times higher when tachysystole occurred. The odds of BPBI injury are increased when tachysystole and oxytocin occur during the mother’s labor. Logistic regression identified a higher risk for BPBI when more than three of the following variables (>30 lbs gained during the pregnancy, stage 2 labor >61.5 min, mother’s age >26.4 years, tachysystole, or fetal malpresentation) were present in any combination. PMID:29596309

Problematic Use of Video Games and Substance Abuse in Early Adolescence: A Cross-sectional Study.

PubMed

Gallimberti, Luigi; Buja, Alessandra; Chindamo, Sonia; Rabensteiner, Andrea; Terraneo, Alberto; Marini, Elena; Pérez, Luis Javier Gómez; Baldo, Vincenzo

2016-09-01

Problematic use of video games (PUVG) is associated with substance use in middle school students. The aim of our study was to examine the association between PUVG and substance abuse in children and young adolescents. A survey was conducted during the 2014-2015 school year in Padua (northeastern Italy). The sample consisted of 1156 students in grades 6 to 8. A multivariate logistic regression model was applied to seek associations between PUVG (dependent variable) and independent variables. Logistic regression showed that lifetime drunkenness, combined energy drink and alcohol consumption (lifetime), reading comics, and disrespect for rules increased the odds of PUVG, whereas playing competitive sport, eating fruit and/or vegetables daily, finding it easy to talk with fathers and being female lowered the odds of PUVG in early adolescence. Our findings show that PUVG is more likely in young adolescents at risk of substance abuse. Prevention schemes focusing on early adolescence should be based on a multicomponent intervention strategy that takes PUVG into account.

A Pilot Study of Reasons and Risk Factors for "No-Shows" in a Pediatric Neurology Clinic.

PubMed

Guzek, Lindsay M; Fadel, William F; Golomb, Meredith R

2015-09-01

Missed clinic appointments lead to decreased patient access, worse patient outcomes, and increased healthcare costs. The goal of this pilot study was to identify reasons for and risk factors associated with missed pediatric neurology outpatient appointments ("no-shows"). This was a prospective cohort study of patients scheduled for 1 week of clinic. Data on patient clinical and demographic information were collected by record review; data on reasons for missed appointments were collected by phone interviews. Univariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression to assess risk factors for missed appointments. Fifty-nine (25%) of 236 scheduled patients were no-shows. Scheduling conflicts (25.9%) and forgetting (20.4%) were the most common reasons for missed appointments. When controlling for confounding factors in the logistic regression, Medicaid (odds ratio 2.36), distance from clinic, and time since appointment was scheduled were associated with missed appointments. Further work in this area is needed. © The Author(s) 2014.

Association of comorbid mental health symptoms and physical health conditions with employee productivity.

PubMed

Parker, Kristin M; Wilson, Mark G; Vandenberg, Robert J; DeJoy, David M; Orpinas, Pamela

2009-10-01

This study tests the hypothesis that employees with comorbid physical health conditions and mental health symptoms are less productive than other employees. Self-reported health status and productivity measures were collected from 1723 employees of a national retail organization. chi2, analysis of variance, and linear contrast analyses were conducted to evaluate whether health status groups differed on productivity measures. Multivariate linear regression and multinomial logistic regression analyses were conducted to analyze how predictive health status was of productivity. Those with comorbidities were significantly less productive on all productivity measures compared with all other health status groups and those with only physical health conditions or mental health symptoms. Health status also significantly predicted levels of employee productivity. These findings provide evidence for the relationship between health statuses and productivity, which has potential programmatic implications.

Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

PubMed

Ai, Zi-Sheng; Gao, You-Shui; Sun, Yuan; Liu, Yue; Zhang, Chang-Qing; Jiang, Cheng-Hua

2013-03-01

Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults.

PubMed

Nielsen, Samara Joy; Trak-Fellermeier, Maria Angelica; Joshipura, Kaumudi; Dye, Bruce A

2016-12-01

Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention. Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age). Data from 6052 adults participating in NHANES 2009-2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status. In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis. We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake. © 2016 American Society for Nutrition.

Effects of Social Class and School Conditions on Educational Enrollment and Achievement of Boys and Girls in Rural Viet Nam

ERIC Educational Resources Information Center

Nguyen, Phuong L.

2006-01-01

This study examines the effects of parental SES, school quality, and community factors on children's enrollment and achievement in rural areas in Viet Nam, using logistic regression and ordered logistic regression. Multivariate analysis reveals significant differences in educational enrollment and outcomes by level of household expenditures and…

[Related factors in the elderly's use of municipal institutions: basic study for promoting participation in a care prevention program].

PubMed

Hirai, Hiroshi; Kondo, Katsunori

2008-01-01

This study was performed to examine factors related to the use of municipal institutions with the focus on 'Accessibility'. The data used in this analysis were from the AGES (Aichi Gerontological Evaluation Study) Project, conducted by Nihon Fukushi University located in Aichi Prefecture, Japan. A self-administrated questionnaires was mailed to 5,759 persons aged 65 years and older who were not disabled in 2006, and 2,795 persons responded. A dependent variable in the analysis was the use of municipal institutions (a Public Health Center, Welfare Center for the elderly and City Hall). Independent variables were age, disease, employment status, IADL (instrumental activities of daily living), depression (GDS: geriatric depression scale), self-rated feeling of health and 'Accessibility' (transportation mode and distance from municipal institutions). Multivariate logistic analysis was used to provide adjusted relative risk estimates for the associations between use of municipal institutions and related factors. In multivariate logistic analysis, 'Accessibility' showed a significant relative risk for the use of municipal institutions after controlling for other related factors. Compared with the elderly whose places of residence was located less than 250 meters from the municipal institutions, the relative risk for the elderly who resided more than 1,500 meters from the municipal institutions was around 0.4 (male: RR = 0.358; female: RR = 0.378). 'Accessibility' is significantly related to the use of municipal institutions. To promote use of the municipal institutions, improving elderly access may well be effective.

Social support, volunteering and health around the world: cross-national evidence from 139 countries.

PubMed

Kumar, Santosh; Calvo, Rocio; Avendano, Mauricio; Sivaramakrishnan, Kavita; Berkman, Lisa F

2012-03-01

High levels of social capital and social integration are associated with self-rated health in many developed countries. However, it is not known whether this association extends to non-western and less economically advanced countries. We examine associations between social support, volunteering, and self-rated health in 139 low-, middle- and high-income countries. Data come from the Gallup World Poll, an internationally comparable survey conducted yearly from 2005 to 2009 for those 15 and over. Volunteering was measured by self-reports of volunteering to an organization in the past month. Social support was based on self-reports of access to support from relatives and friends. We started by estimating random coefficient (multi-level) models and then used multivariate logistic regression to model health as a function of social support and volunteering, controlling for age, gender, education, marital status, and religiosity. We found statistically significant evidence of cross-national variation in the association between social capital variables and self-rated health. In the multivariate logistic model, self-rated health were significantly associated with having social support from friends and relatives and volunteering. Results from stratified analyses indicate that these associations are strikingly consistent across countries. Our results indicate that the link between social capital and health is not restricted to high-income countries but extends across many geographical regions regardless of their national-income level. Copyright © 2012 Elsevier Ltd. All rights reserved.

Phobic Anxiety and Plasma Levels of Global Oxidative Stress in Women

PubMed Central

Hagan, Kaitlin A.; Wu, Tianying; Rimm, Eric B.; Eliassen, A. Heather; Okereke, Olivia I.

2015-01-01

Background and Objectives Psychological distress has been hypothesized to be associated with adverse biologic states such as higher oxidative stress and inflammation. Yet, little is known about associations between a common form of distress – phobic anxiety – and global oxidative stress. Thus, we related phobic anxiety to plasma fluorescent oxidation products (FlOPs), a global oxidative stress marker. Methods We conducted a cross-sectional analysis among 1,325 women (aged 43-70 years) from the Nurses’ Health Study. Phobic anxiety was measured using the Crown-Crisp Index (CCI). Adjusted least-squares mean log-transformed FlOPs were calculated across phobic categories. Logistic regression models were used to calculate odds ratios (OR) comparing the highest CCI category (≥6 points) vs. lower scores, across FlOPs quartiles. Results No association was found between phobic anxiety categories and mean FlOP levels in multivariable adjusted linear models. Similarly, in multivariable logistic regression models there were no associations between FlOPs quartiles and likelihood of being in the highest phobic category. Comparing women in the highest vs. lowest FlOPs quartiles: FlOP_360: OR=0.68 (95% CI: 0.40-1.15); FlOP_320: OR=0.99 (95% CI: 0.61-1.61); FlOP_400: OR=0.92 (95% CI: 0.52, 1.63). Conclusions No cross-sectional association was found between phobic anxiety and a plasma measure of global oxidative stress in this sample of middle-aged and older women. PMID:26635425

Predictors of thirty-day readmission among hospitalized family medicine patients.

PubMed

Garrison, Gregory M; Mansukhani, Meghna P; Bohn, Bradley

2013-01-01

Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days. A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor. Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect. This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission.

The effects of malaria and HIV co-infection on hemoglobin levels among pregnant women in Sekondi-Takoradi, Ghana.

PubMed

Orish, Verner N; Onyeabor, Onyekachi S; Boampong, Johnson N; Acquah, Samuel; Sanyaolu, Adekunle O; Iriemenam, Nnaemeka C

2013-03-01

To assess the burden of maternal malaria and HIV among pregnant women in Ghana and to determine the risk of anemia among women with dual infection. A cross-sectional study was conducted at 4 hospitals in the Sekondi-Takoradi metropolis, Ghana. The study group comprised 872 consenting pregnant women attending prenatal care clinics. Venous blood samples were screened for malaria, HIV, and hemoglobin level. Multivariate logistic regression analysis was performed to determine the association between malaria, HIV, and risk of anemia. In all, 34.4% of the study cohort had anemia. Multivariate logistic regression analysis indicated that pregnant women with either malaria (odds ratio 1.99; 95% confidence interval, 1.43-2.77; P=<0.001) or HIV (odds ratio 1.78; 95% confidence interval, 1.13-2.80; P=0.014) had an increased risk of anemia. In adjusted models, pregnant women co-infected with both malaria and HIV displayed twice the risk of anemia. The adjusted odds ratio was 2.67 (95% confidence interval, 1.44-4.97; P=0.002). Pregnant women infected with both malaria and HIV are twice as likely to be anemic than women with a single infection or no infection. Measures to control malaria, HIV, and anemia during pregnancy are imperative to improve birth outcomes in this region of Ghana. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Peripherally inserted central catheter thrombosis incidence and risk factors in cancer patients: a double-center prospective investigation

PubMed Central

Liu, Yuxiu; Gao, Yufang; Wei, Lili; Chen, Weifen; Ma, Xiaoyan; Song, Lei

2015-01-01

Background Peripherally inserted central catheters (PICCs) are widely used in chemotherapy, but the reported PICC thrombosis incidence varies greatly, and risks of PICC thrombosis are not well defined. This study was to investigate the incidence and risk factors of PICC-related upper extremity vein thrombosis in cancer patients. Methods This was a prospective study conducted in two tertiary referral hospitals from May 2010 to February 2013. Cancer patients who were subject to PICC placement were enrolled and checked by Doppler ultrasound weekly for at least 1 month. Univariable and multivariable logistic regression analyses were applied for identification of risk factors. Results Three hundred and eleven cancer patients were enrolled in the study. One hundred and sixty (51.4%) developed PICC thrombosis, of which 87 (54.4%) cases were symptomatic. The mean time interval from PICC insertion to thrombosis onset was 11.04±5.538 days. The univariable logistic regression analysis showed that complications (odds ratio [OR] 1.686, P=0.032), less activity (OR 1.476, P=0.006), obesity (OR 3.148, P=0.000), and chemotherapy history (OR 3.405, P=0.030) were associated with PICC thrombosis. Multivariate analysis showed that less activity (OR 9.583, P=0.000) and obesity (OR 3.466, P=0.014) were significantly associated with PICC thrombosis. Conclusions The incidence of PICC thrombosis is relatively high, and nearly half are asymptomatic. Less activity and obesity are risk factors of PICC-related thrombosis. PMID:25673995

The association between physical activity and social isolation in community-dwelling older adults.

PubMed

Robins, Lauren M; Hill, Keith D; Finch, Caroline F; Clemson, Lindy; Haines, Terry

2018-02-01

Social isolation is an increasing concern in older community-dwelling adults. There is growing need to determine effective interventions addressing social isolation. This study aimed to determine whether a relationship exists between physical activity (recreational and/or household-based) and social isolation. An examination was conducted for whether group- or home-based falls prevention exercise was associated with social isolation. Cross-sectional analysis of telephone survey data was used to investigate relationships between physical activity, health, age, gender, living arrangements, ethnicity and participation in group- or home-based falls prevention exercise on social isolation. Univariable and multivariable ordered logistic regression analyses were conducted. Factors found to be significantly associated with reduced social isolation in multivariable analysis included living with a partner/spouse, reporting better general health, higher levels of household-based physical activity (OR = 1.03, CI = 1.01-1.05) and feeling less downhearted/depressed. Being more socially isolated was associated with symptoms of depression and a diagnosis of congestive heart failure (pseudo R 2 = 0.104). Findings suggest that household-based physical activity is related to social isolation in community-dwelling older adults. Further research is required to determine the nature of this relationship and to investigate the impact of group physical activity interventions on social isolation.

Racial/ethnic variation in health care satisfaction: The role of acculturation.

PubMed

Han, Woojae; Lee, Sungkyu

2016-10-01

This study examined the role of acculturation and racial/ethnic variation in health care satisfaction among four different racial/ethnic groups. The study sample consisted of 41,560 adults from the 2011 California Health Interview Survey. Health care satisfaction was measured via two questions regarding doctors' listening and explanations. Guided by Andersen's behavioral model of health care use, multivariate logistic regressions were conducted. Hispanic and Asian respondents showed the lowest levels of satisfaction with their doctors' listening and explanations, respectively. Acculturation was found to be a significant predictor of health care satisfaction. Health care professionals should develop ways of expanding culturally competent health care professionals, who are aware of racial/ethnic variation in health care satisfaction.

Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation

PubMed Central

MacLeod, Kara E.; Ragland, David R.; Prohaska, Thomas R.; Smith, Matthew Lee; Irmiter, Cheryl; Satariano, William A.

2015-01-01

Purpose of the Study: This study identified factors associated with canceling nonemergency medical transportation appointments among older adult Medicaid patients. Design and Methods: Data from 125,913 trips for 2,913 Delaware clients were examined. Mediation analyses, as well as, multivariate logistic regressions were conducted. Results: Over half of canceled trips were attributed to client reasons (e.g., no show, refusal). Client characteristics (e.g., race, sex, functional status) were associated with cancelations; however, these differed based on the cancelation reason. Regularly scheduled trips were less likely to be canceled. Implications: The evolving American health care system may increase service availability. Additional policies can improve service accessibility and overcome utilization barriers. PMID:24558264

The sociocultural context of family size preference, ideal sex composition, and induced abortion in India: findings from India's National Family Health surveys.

PubMed

Agrawal, Sutapa

2012-01-01

In this study, the author examined the effect of family size preference and sex composition of living children as determinants of induced abortion among women in India by analyzing 90,303 ever-married women aged 15-49, included in India's second National Family Health Survey, conducted in 1998-99. Multivariate logistic regression methods were used to examine the association between induced abortion and possible determinants. The results indicated that a woman's desire to limit family size with preferred sex composition of children, coupled with her autonomy and the sociocultural context, largely determines her experience of induced abortion in India.

[Use of multiple regression models in observational studies (1970-2013) and requirements of the STROBE guidelines in Spanish scientific journals].

PubMed

Real, J; Cleries, R; Forné, C; Roso-Llorach, A; Martínez-Sánchez, J M

In medicine and biomedical research, statistical techniques like logistic, linear, Cox and Poisson regression are widely known. The main objective is to describe the evolution of multivariate techniques used in observational studies indexed in PubMed (1970-2013), and to check the requirements of the STROBE guidelines in the author guidelines in Spanish journals indexed in PubMed. A targeted PubMed search was performed to identify papers that used logistic linear Cox and Poisson models. Furthermore, a review was also made of the author guidelines of journals published in Spain and indexed in PubMed and Web of Science. Only 6.1% of the indexed manuscripts included a term related to multivariate analysis, increasing from 0.14% in 1980 to 12.3% in 2013. In 2013, 6.7, 2.5, 3.5, and 0.31% of the manuscripts contained terms related to logistic, linear, Cox and Poisson regression, respectively. On the other hand, 12.8% of journals author guidelines explicitly recommend to follow the STROBE guidelines, and 35.9% recommend the CONSORT guideline. A low percentage of Spanish scientific journals indexed in PubMed include the STROBE statement requirement in the author guidelines. Multivariate regression models in published observational studies such as logistic regression, linear, Cox and Poisson are increasingly used both at international level, as well as in journals published in Spanish. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis

PubMed Central

2011-01-01

Introduction Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities. Methods In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality. Results Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival. Conclusions Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures. PMID:21693053

Individual, Psychosocial, and Social Correlates of Unprotected Anal Intercourse in a New Generation of Young Men Who Have Sex With Men in New York City

PubMed Central

Kapadia, Farzana; Siconolfi, Daniel E.; Moeller, Robert W.; Figueroa, Rafael Perez; Barton, Staci C.; Blachman-Forshay, Jaclyn

2013-01-01

Objectives. We examined associations of individual, psychosocial, and social factors with unprotected anal intercourse (UAI) among young men who have sex with men in New York City. Methods. Using baseline assessment data from 592 young men who have sex with men participating in an ongoing prospective cohort study, we conducted multivariable logistic regression analyses to examine the associations between covariates and likelihood of recently engaging in UAI with same-sex partners. Results. Nineteen percent reported recent UAI with a same-sex partner. In multivariable models, being in a current relationship with another man (adjusted odds ratio [AOR] = 4.87), an arrest history (AOR = 2.01), greater residential instability (AOR = 1.75), and unstable housing or homelessness (AOR = 3.10) was associated with recent UAI. Although high levels of gay community affinity and low internalized homophobia were associated with engaging in UAI in bivariate analyses, these associations did not persist in multivariable analyses. Conclusions. Associations of psychosocial and socially produced conditions with UAI among a new generation of young men who have sex with men warrant that HIV prevention programs and policies address structural factors that predispose sexual risk behaviors. PMID:23488487

Non-proportional odds multivariate logistic regression of ordinal family data.

PubMed

Zaloumis, Sophie G; Scurrah, Katrina J; Harrap, Stephen B; Ellis, Justine A; Gurrin, Lyle C

2015-03-01

Methods to examine whether genetic and/or environmental sources can account for the residual variation in ordinal family data usually assume proportional odds. However, standard software to fit the non-proportional odds model to ordinal family data is limited because the correlation structure of family data is more complex than for other types of clustered data. To perform these analyses we propose the non-proportional odds multivariate logistic regression model and take a simulation-based approach to model fitting using Markov chain Monte Carlo methods, such as partially collapsed Gibbs sampling and the Metropolis algorithm. We applied the proposed methodology to male pattern baldness data from the Victorian Family Heart Study. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Serum magnesium but not calcium was associated with hemorrhagic transformation in stroke overall and stroke subtypes: a case-control study in China.

PubMed

Tan, Ge; Yuan, Ruozhen; Wei, ChenChen; Xu, Mangmang; Liu, Ming

2018-05-26

Association between serum calcium and magnesium versus hemorrhagic transformation (HT) remains to be identified. A total of 1212 non-thrombolysis patients with serum calcium and magnesium collected within 24 h from stroke onset were enrolled. Backward stepwise multivariate logistic regression analysis was conducted to investigate association between calcium and magnesium versus HT. Calcium and magnesium were entered into logistic regression analysis in two models, separately: model 1, as continuous variable (per 1-mmol/L increase), and model 2, as four-categorized variable (being collapsed into quartiles). HT occurred in 140 patients (11.6%). Serum calcium was slightly lower in patients with HT than in patient without HT (P = 0.273). But serum magnesium was significantly lower in patients with HT than in patients without HT (P = 0.007). In logistic regression analysis, calcium displayed no association with HT. Magnesium, as either continuous or four-categorized variable, was independently and inversely associated with HT in stroke overall and stroke of large-artery atherosclerosis (LAA). The results demonstrated that serum calcium had no association with HT in patients without thrombolysis after acute ischemic stroke. Serum magnesium in low level was independently associated with increasing HT in stroke overall and particularly in stroke of LAA.

Development and validation of a mortality risk model for pediatric sepsis.

PubMed

Chen, Mengshi; Lu, Xiulan; Hu, Li; Liu, Pingping; Zhao, Wenjiao; Yan, Haipeng; Tang, Liang; Zhu, Yimin; Xiao, Zhenghui; Chen, Lizhang; Tan, Hongzhuan

2017-05-01

Pediatric sepsis is a burdensome public health problem. Assessing the mortality risk of pediatric sepsis patients, offering effective treatment guidance, and improving prognosis to reduce mortality rates, are crucial.We extracted data derived from electronic medical records of pediatric sepsis patients that were collected during the first 24 hours after admission to the pediatric intensive care unit (PICU) of the Hunan Children's hospital from January 2012 to June 2014. A total of 788 children were randomly divided into a training (592, 75%) and validation group (196, 25%). The risk factors for mortality among these patients were identified by conducting multivariate logistic regression in the training group. Based on the established logistic regression equation, the logit probabilities for all patients (in both groups) were calculated to verify the model's internal and external validities.According to the training group, 6 variables (brain natriuretic peptide, albumin, total bilirubin, D-dimer, lactate levels, and mechanical ventilation in 24 hours) were included in the final logistic regression model. The areas under the curves of the model were 0.854 (0.826, 0.881) and 0.844 (0.816, 0.873) in the training and validation groups, respectively.The Mortality Risk Model for Pediatric Sepsis we established in this study showed acceptable accuracy to predict the mortality risk in pediatric sepsis patients.

Development and validation of a mortality risk model for pediatric sepsis

PubMed Central

Chen, Mengshi; Lu, Xiulan; Hu, Li; Liu, Pingping; Zhao, Wenjiao; Yan, Haipeng; Tang, Liang; Zhu, Yimin; Xiao, Zhenghui; Chen, Lizhang; Tan, Hongzhuan

2017-01-01

Abstract Pediatric sepsis is a burdensome public health problem. Assessing the mortality risk of pediatric sepsis patients, offering effective treatment guidance, and improving prognosis to reduce mortality rates, are crucial. We extracted data derived from electronic medical records of pediatric sepsis patients that were collected during the first 24 hours after admission to the pediatric intensive care unit (PICU) of the Hunan Children's hospital from January 2012 to June 2014. A total of 788 children were randomly divided into a training (592, 75%) and validation group (196, 25%). The risk factors for mortality among these patients were identified by conducting multivariate logistic regression in the training group. Based on the established logistic regression equation, the logit probabilities for all patients (in both groups) were calculated to verify the model's internal and external validities. According to the training group, 6 variables (brain natriuretic peptide, albumin, total bilirubin, D-dimer, lactate levels, and mechanical ventilation in 24 hours) were included in the final logistic regression model. The areas under the curves of the model were 0.854 (0.826, 0.881) and 0.844 (0.816, 0.873) in the training and validation groups, respectively. The Mortality Risk Model for Pediatric Sepsis we established in this study showed acceptable accuracy to predict the mortality risk in pediatric sepsis patients. PMID:28514310

Socioeconomic inequality and obesity prevalence trends in Luxembourg, 1995-2007.

PubMed

Tchicaya, Anastase; Lorentz, Nathalie

2012-08-29

Overweight and obesity are becoming increasingly critical problems in most developed countries. Approximately 20% of adults in most European countries are obese. This study examines the prevalence of overweight and obesity in Luxembourg and their association with different demographic, socioeconomic (SES), and behavioural factors. The data used in this study were taken from 2 surveys on household income and living conditions conducted in 1995 and 2007. The target population was household residents aged 16 years and older, and body mass index (BMI) data were self-reported. Average BMI, overweight, and obesity prevalence rates were calculated according to each demographic (gender, nationality, marital status), SES (educational level, profession, and place of residence), and behavioural (physical activity and diet) factors. A multivariate logistic regression analysis was conducted to measure the relationship between obesity and demographic, SES, and behavioural factors. All analyses were conducted according to gender, and data used were weighted. Between 1995 and 2007, the average BMI remained nearly constant among men and women in the entire study population. Obesity prevalence increased by 24.5% through the study period (14.3% in 1995 to 17.8% in 2007). Obesity prevalence increased by 18.5% for men (15.1% in 1995 to 17.9% in 2007) and by 30% for women (13.6% in 1995 to 17.7% in 2007). Between 1995 and 2007, obesity increased sharply by 48.2% (from 11% to 16.3%) in Portuguese men, 76.7% (from 13.3% to 23.5%) in Portuguese women, 79.7% (from 17.2% to 30.9%) in widowed men, and 84.3% (from 12.1% to 22.3%) in divorced women. Multivariate logistic regression analysis showed that the relationship between the educational level and obesity was not statistically significant for men, but was significant for women. The prevalence of overweight and obesity is high in Luxembourg and has changed slightly in recent years. SES inequalities in obesity exist and are most compelling among women. The fight against obesity should focus on education, with emphasis on the socially disadvantaged segment of the population.

A Persistent Disparity: Smoking in Rural Sexual and Gender Minorities.

PubMed

Bennett, Keisa; McElroy, Jane A; Johnson, Andrew O; Munk, Niki; Everett, Kevin D

2015-03-01

Sexual and gender minorities (SGM) smoke cigarettes at higher rates than the general population. Historically, research in SGM health issues was conducted in urban populations and recent population-based studies seldom have sufficient SGM participants to distinguish urban from rural. Given that rural populations also tend to have a smoking disparity, and that many SGM live in rural areas, it is vitally important to understand the intersection of rural residence, SGM identity, and smoking. This study analyzes the patterns of smoking in urban and rural SGM in a large sample. We conducted an analysis of 4280 adult participants in the Out, Proud, and Healthy project with complete data on SGM status, smoking status, and zip code. Surveys were conducted at 6 Missouri Pride Festivals and online in 2012. Analysis involved descriptive and bivariate methods, and multivariable logistic regression. We used GIS mapping to demonstrate the dispersion of rural SGM participants. SGM had higher smoking proportion than the non-SGM recruited from these settings. In the multivariable model, SGM identity conferred 1.35 times the odds of being a current smoker when controlled for covariates. Rural residence was not independently significant, demonstrating the persistence of the smoking disparity in rural SGM. Mapping revealed widespread distribution of SGM in rural areas. The SGM smoking disparity persists among rural SGM. These communities would benefit from continued research into interventions targeting both SGM and rural tobacco control measures. Recruitment at Pride Festivals may provide a venue for reaching rural SGM for intervention.

TIMP1 and MMP9 are predictors of mortality in septic patients in the emergency department and intensive care unit unlike MMP9/TIMP1 ratio: Multivariate model.

PubMed

Niño, Maria Eugenia; Serrano, Sergio Eduardo; Niño, Daniela Camila; McCosham, Diana Margarita; Cardenas, Maria Eugenia; Villareal, Vivian Poleth; Lopez, Marcos; Pazin-Filho, Antonio; Jaimes, Fabian Alberto; Cunha, Fernando; Schulz, Richard; Torres-Dueñas, Diego

2017-01-01

Matrix metalloproteinases and tissue inhibitors of metalloproteinases could be promising biomarkers for establishing prognosis during the development of sepsis. It is necessary to clarify the relationship between matrix metalloproteinases and their tissue inhibitors. We conducted a cohort study with 563 septic patients, in order to elucidate the biological role and significance of these inflammatory biomarkers and their relationship to the severity and mortality of patients with sepsis. A multicentric prospective cohort was performed. The sample was composed of patients who had sepsis as defined by the International Conference 2001. Serum procalcitonin, creatinine, urea nitrogen, C-Reactive protein, TIMP1, TIMP2, MMP2 and MMP9 were quantified; each patient was followed until death or up to 30 days. A descriptive analysis was performed by calculating the mean and the 95% confidence interval for continuous variables and proportions for categorical variables. A multivariate logistic regression model was constructed by the method of intentional selection of covariates with mortality at 30 days as dependent variable and all the other variables as predictors. Of the 563 patients, 68 patients (12.1%) died within the first 30 days of hospitalization in the ICU. The mean values for TIMP1, TIMP2 and MMP2 were lower in survivors, MMP9 was higher in survivors. Multivariate logistic regression showed that age, SOFA and Charlson scores, along with TIMP1 concentration, were statistically associated with mortality at 30 days of septic patients; serum MMP9 was not statistically associated with mortality of patients, but was a confounder of the TIMP1 variable. It could be argued that plasma levels of TIMP1 should be considered as a promising prognostic biomarker in the setting of sepsis. Additionally, this study, like other studies with large numbers of septic patients does not support the predictive value of TIMP1 / MMP9.

Prevalence and Associated Risk Factors of Dyslexic Children in a Middle-Sized City of China: A Cross-Sectional Study

PubMed Central

Zhang, Jiajia; Mo, Shengnan; Shao, Shanshan; Zhong, Rong; Ke, Juntao; Lu, Xuzai; Miao, Xiaoping; Song, Ranran

2013-01-01

Background There are many discussions about dyslexia based on studies conducted in western countries, and some risk factors to dyslexia, such as gender and home literacy environment, have been widely accepted based on these studies. However, to our knowledge, there are few studies focusing on the risk factors of dyslexia in China. Therefore, the aim of our study was to investigate the prevalence of dyslexia and its potential risk factors. Methods A cross-sectional study was conducted in Qianjiang, a city in Hubei province, China. Two stages sampling strategy was applied to randomly selected 5 districts and 9 primary schools in Qianjiang. In total, 6,350 students participated in this study and there were 5,063 valid student questionnaires obtained for the final analyses. Additional questionnaires (such as Dyslexia Checklist for Chinese Children and Pupil Rating Scale) were used to identify dyslexic children. The chi-square test and multivariate logistic regression were employed to reveal the potential risk factors to dyslexia. Results Our study revealed that the prevalence of dyslexia was 3.9% in Qianjiang city, which is a middle-sized city in China. Among dyslexic children, the gender ratio (boys to girls) was nearly 3∶1. According to the P-value in the multivariate logistic regression, the gender (P<0.01), mother's education level (P<0.01), and learning habits (P<0.01) (active learning, scheduled reading time) were associated with dyslexia. Conclusion The prevalence rate of dyslexic children in middle-sized cities is 3.9%. The potential risk factors of dyslexic children revealed in this study will have a great impact on detecting and treating dyslexic children in China as early as possible, although more studies are still needed to further investigate the risk factors of dyslexic children in China. PMID:23457604

Clinical value of preoperative serum CA 19-9 and CA 125 levels in predicting the resectability of hilar cholangiocarcinoma.

PubMed

Hu, Hai-Jie; Mao, Hui; Tan, Yong-Qiong; Shrestha, Anuj; Ma, Wen-Jie; Yang, Qin; Wang, Jun-Ke; Cheng, Nan-Sheng; Li, Fu-Yu

2016-01-01

To examine the predictive value of tumor markers for evaluating tumor resectability in patients with hilar cholangiocarcinoma and to explore the prognostic effect of various preoperative factors on resectability in patients with potentially resectable tumors. Patients with potentially resectable tumors judged by radiologic examination were included. The receiver operating characteristic (ROC) analysis was conducted to evaluate serum carbohydrate antigenic determinant 19-9 (CA 19-9), carbohydrate antigen 125 (CA 125) and carcino embryonie antigen levels on tumor resectability. Univariate and multivariate logistic regression models were also conducted to analysis the correlation of preoperative factors with resectability. In patients with normal bilirubin levels, ROC curve analysis calculated the ideal CA 19-9 cut-off value of 203.96 U/ml in prediction of resectability, with a sensitivity of 83.7 %, specificity of 80 %, positive predictive value of 91.1 % and negative predictive value of 66.7 %. Meanwhile, the optimal cut-off value for CA 125 to predict resectability was 25.905 U/ml (sensitivity, 78.6 %; specificity, 67.5 %). In a multivariate logistic regression model, tumor size ≤3 cm (OR 4.149, 95 % CI 1.326-12.981, P = 0.015), preoperative CA 19-9 level ≤200 U/ml (OR 20.324, 95 % CI 6.509-63.467, P < 0.001), preoperative CA 125 levels ≤26 U/ml (OR 8.209, 95 % CI 2.624-25.677, P < 0.001) were independent determinants of resectability in patients diagnosed as hilar cholangiocarcinoma. Preoperative CA 19-9 and CA 125 levels predict resectability in patients with radiological resectable hilar cholangiocarcinoma. Increased preoperative CA 19-9 levels and CA 125 levels are associated with poor resectability rate.

Risk Factors for Sporadic Domestically Acquired Campylobacter Infections in Norway 2010–2011: A National Prospective Case-Control Study

PubMed Central

Mexia, Ricardo; Bruun, Tone; Kapperud, Georg; Lange, Heidi; Nygård, Karin; Vold, Line

2015-01-01

Background Campylobacteriosis is the most frequently reported food- and waterborne infection in Norway. We investigated the risk factors for sporadic Campylobacter infections in Norway in order to identify areas where control and prevention measures could be improved. Methods A national prospective case-control study of factors associated with Campylobacter infection was conducted from July 2010 to September 2011. Cases were recruited from the Norwegian Surveillance System of Communicable Diseases (MSIS). Controls were randomly selected from the Norwegian Population Registry. Cases and controls were mailed a paper questionnaire with a prepaid return envelope. Univariable analyses using logistic regression were conducted for all exposures. A final parsimonious multivariable model was developed using regularized/penalized logistic regression, and adjusted odds ratios were calculated. Results A total of 995 cases and 1501 controls were included in the study (response proportion 55% and 30%, respectively). Exposures that had significant increases in odds of Campylobacter infection in multivariable analysis were drinking water directly from river, stream, or lake (OR: 2.96), drinking purchased bottled water (OR: 1.78), eating chicken (1.69), eating meat that was undercooked (OR: 1.77), eating food made on a barbecue (OR: 1.55), living on a farm with livestock (OR: 1.74), having a dog in the household (OR: 1.39), and having household water supply serving fewer than 20 houses (OR: 1.92). Conclusions Consumption of poultry and untreated water remain important sources of Campylobacter infection in Norway, despite ongoing control efforts. The results justify the need for strengthening education for consumers and food handlers about the risks of cross-contamination when preparing poultry and with consuming raw or undercooked chicken. The public should also be reminded to take precautions when drinking untreated water in nature and ensure continued vigilance in order to protect and maintain the quality of water from small-scale water supply systems. PMID:26431341

Risk Factors for Sporadic Domestically Acquired Campylobacter Infections in Norway 2010-2011: A National Prospective Case-Control Study.

PubMed

MacDonald, Emily; White, Richard; Mexia, Ricardo; Bruun, Tone; Kapperud, Georg; Lange, Heidi; Nygård, Karin; Vold, Line

2015-01-01

Campylobacteriosis is the most frequently reported food- and waterborne infection in Norway. We investigated the risk factors for sporadic Campylobacter infections in Norway in order to identify areas where control and prevention measures could be improved. A national prospective case-control study of factors associated with Campylobacter infection was conducted from July 2010 to September 2011. Cases were recruited from the Norwegian Surveillance System of Communicable Diseases (MSIS). Controls were randomly selected from the Norwegian Population Registry. Cases and controls were mailed a paper questionnaire with a prepaid return envelope. Univariable analyses using logistic regression were conducted for all exposures. A final parsimonious multivariable model was developed using regularized/penalized logistic regression, and adjusted odds ratios were calculated. A total of 995 cases and 1501 controls were included in the study (response proportion 55% and 30%, respectively). Exposures that had significant increases in odds of Campylobacter infection in multivariable analysis were drinking water directly from river, stream, or lake (OR: 2.96), drinking purchased bottled water (OR: 1.78), eating chicken (1.69), eating meat that was undercooked (OR: 1.77), eating food made on a barbecue (OR: 1.55), living on a farm with livestock (OR: 1.74), having a dog in the household (OR: 1.39), and having household water supply serving fewer than 20 houses (OR: 1.92). Consumption of poultry and untreated water remain important sources of Campylobacter infection in Norway, despite ongoing control efforts. The results justify the need for strengthening education for consumers and food handlers about the risks of cross-contamination when preparing poultry and with consuming raw or undercooked chicken. The public should also be reminded to take precautions when drinking untreated water in nature and ensure continued vigilance in order to protect and maintain the quality of water from small-scale water supply systems.

High HIV prevalence and associated risk factors among female sex workers in Rwanda.

PubMed

Mutagoma, Mwumvaneza; Samuel, Malamba S; Kayitesi, Catherine; Gasasira, Antoine R; Chitou, Bassirou; Boer, Kimberly; Hedt-Gauthier, Bethany; Gupta, Neil; Ntaganira, Joseph; Nsanzimana, Sabin

2017-10-01

Human immunodeficiency virus (HIV) prevalence is often high among female sex workers (FSWs) in sub-Saharan Africa. Understanding the dynamics of HIV infection in this key population is critical to developing appropriate prevention strategies. We aimed to describe the prevalence and associated risk factors among a sample of FSWs in Rwanda from a survey conducted in 2010. A cross-sectional biological and behavioral survey was conducted among FSWs in Rwanda. Time-location sampling was used for participant recruitment from 4 to 18 February 2010. HIV testing was done using HIV rapid diagnostic tests (RDT) as per Rwandan national guidelines at the time of the survey. Elisa tests were simultaneously done on all samples tested HIV-positive on RDT. Proportions were used for sample description; multivariable logistic regression model was performed to analyze factors associated with HIV infection. Of 1338 women included in the study, 1112 consented to HIV testing, and the overall HIV prevalence was 51.0%. Sixty percent had been engaged in sex work for less than five years and 80% were street based. In multivariable logistic regression, HIV prevalence was higher in FSWs 25 years or older (adjusted odds ratio [aOR] = 1.83, 95% [confidence interval (CI): 1.42-2.37]), FSWs with consistent condom use in the last 30 days (aOR = 1.39, [95% CI: 1.05-1.82]), and FSWs experiencing at least one STI symptom in the last 12 months (aOR = 1.74 [95% CI: 1.34-2.26]). There was an inverse relationship between HIV prevalence and comprehensive HIV knowledge (aOR = 0.65, [95% CI: 0.48-0.88]). HIV prevalence was high among a sample of FSWs in Rwanda, and successful prevention strategies should focus on HIV education, treatment of sexually transmitted infections, and proper and consistent condom use using an outreach approach.

Social Determinants of Domestic Violence Among Saudi Married Women in Riyadh, Kingdom of Saudi Arabia.

PubMed

Alquaiz, ALJohara M; Almuneef, Maha; Kazi, Ambreen; Almeneessier, Aljohara

2017-12-01

Intimate partner violence is a worldwide public health problem. The objectives of this study were to measure the prevalence and types of domestic violence, and to explore the association between social determinants (sociodemographic factors, husband-related factors, and social support) and violence against women by their intimate partner (husband). We conducted a cross-sectional survey in 18 randomly selected primary health care centers and 13 private institutions (teaching institutes, government offices, social welfare organizations) in Riyadh, Saudi Arabia. Female data collectors took interview from 1,883 married Saudi females aged 30 to 75 years. Interviews included sociodemographic information, reproductive health variables, and social support questionnaire. Violence was measured using modified Intimate Partner Violence Against Women questionnaire developed by the World Health Organization. Multivariate logistic regression analysis was conducted. The lifetime prevalence for any type of violence was 43.0% ( n = 810). The most frequent type was controlling behavior (36.8%), followed by emotional violence (22%), sexual violence (12.7%), and physical violence (9.0%). Multivariate logistic regression analysis revealed that the following were associated with greater odds of reporting domestic violence: younger age 30 to 40 years (adjusted odds ratio [aOR] = 1.9, 95% confidence interval [CI] = [1.3, 3.0]), 41 to 50 years (aOR = 1.6, 95% CI = [1.1, 2.5]); lack of emotional support (aOR = 1.7, 95% CI = [1.2, 2.5]); lack of tangible support (aOR = 1.4, 95% CI = [1.1, 1.9]); and perceived poor self-health (aOR = 1.7, 95% CI = [1.0, 3.0]), husbands' poor health (aOR = 1.9, 95% CI = [1.2, 2.0]), and polygamy (aOR = 1.6, 95% CI = [1.5, 2.6]). Domestic violence occurs frequently in Saudi Arabia. Both social conditions and social relations are significantly associated with domestic violence against Saudi women. Furthermore, improvement in implementation of the local policies and multisectoral protection services can prevent women from domestic violence.

Suvorexant is associated with a low incidence of delirium in critically ill patients: a retrospective cohort study.

PubMed

Masuyama, Tomoyuki; Sanui, Masamitsu; Yoshida, Naoto; Iizuka, Yusuke; Ogi, Kunio; Yagihashi, Satoko; Nagatomo, Kanae; Sasabuchi, Yusuke; Lefor, Alan K

2018-02-08

Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU. This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital. Patients admitted to the ICU for 72 h or longer between January and June 2015 were evaluated for delirium using the Confusion Assessment Method for the Intensive Care Unit tool. We evaluated the incidence of delirium in patients who received suvorexant and those who did not. To adjust for confounding factors, multivariable logistic regression analysis was conducted. Study subjects included 118 patients, with a median age of 72 years and a median Acute Physiology and Chronic Health Evaluation II score of 18 points. Eighty-two patients (69.5%) were admitted after cardiovascular surgery. In the suvorexant group, there were fewer post-cardiovascular surgical patients and more medical patients. The duration of mechanical ventilation during ICU stay was longer in the suvorexant group, and sedatives and sleep inducers other than suvorexant were used more frequently in the suvorexant group. The incidence of delirium was 43.8% in the suvorexant group and 58.8% in the non-suvorexant group (P = 0.149). After adjustment for risk factors using multivariable logistic regression analysis, suvorexant was associated with a lower incidence of delirium (odds ratio = 0.23, 95% confidence interval: 0.07-0.73; P = 0.012). Suvorexant was associated with decreased odds of transitioning to delirium in critically ill patients. The use of suvorexant may lower the incidence of delirium in ICU patients. Future prospective studies are warranted. © 2018 Japanese Psychogeriatric Society.

Sample size calculations for case-control studies

Cancer.gov

This R package can be used to calculate the required samples size for unconditional multivariate analyses of unmatched case-control studies. The sample sizes are for a scalar exposure effect, such as binary, ordinal or continuous exposures. The sample sizes can also be computed for scalar interaction effects. The analyses account for the effects of potential confounder variables that are also included in the multivariate logistic model.

The association between maternal serious psychological distress and child obesity at 3 years: a cross-sectional analysis of the UK Millennium Cohort Data.

PubMed

Ramasubramanian, L; Lane, S; Rahman, A

2013-01-01

  The prevalence of child obesity is increasing rapidly worldwide. Early childhood has been identified as a critical time period for the development of obesity. Maternal mental health and early life environment are crucial factors and have been linked to adverse child outcomes. The objective of the study was to examine the relationship between maternal serious psychological distress and obesity in early childhood.   A cross-sectional analysis of data from the Millennium Cohort Study was conducted. Subjects consisted of all natural mothers (n= 10 465) who had complete and plausible data for Kessler-6 scores, socio-demographic and anthropometric variables, and their children for whom anthropometric measurements were completed at age 3. Maternal serious psychological distress was defined as a score of 13 or more on the Kessler-6 scale. Obesity was defined as body mass index ≥95th centile of the 1990 reference chart for age and sex in children. The data were analysed using spss 16. Maternal socio-demographic factors that are known to influence maternal mental health and child obesity were identified and adjusted using multivariate logistic regression.   Of the 10 465 mother-child dyads, 3.5% of mothers had serious psychological distress and 5.5% of children were obese at 3 years of age. Logistic regression analysis showed that maternal serious psychological distress was associated with early childhood obesity (P= 0.01; OR 1.62, 95% CI 1.11, 2.37). After adjusting for potential confounding factors using multivariate logistic regression, maternal serious psychological distress remained significantly associated with early childhood obesity (P= 0.01; OR 1.59, 95% CI 1.08, 2.34).   The results show that maternal serious psychological distress is independently associated with early childhood obesity. © 2011 Blackwell Publishing Ltd.

Comparison of Different Risk Perception Measures in Predicting Seasonal Influenza Vaccination among Healthy Chinese Adults in Hong Kong: A Prospective Longitudinal Study

PubMed Central

Liao, Qiuyan; Wong, Wing Sze; Fielding, Richard

2013-01-01

Background Risk perception is a reported predictor of vaccination uptake, but which measures of risk perception best predict influenza vaccination uptake remain unclear. Methodology During the main influenza seasons (between January and March) of 2009 (Wave 1) and 2010 (Wave 2),505 Chinese students and employees from a Hong Kong university completed an online survey. Multivariate logistic regression models were conducted to assess how well different risk perceptions measures in Wave 1 predicted vaccination uptake against seasonal influenza in Wave 2. Principal Findings The results of the multivariate logistic regression models showed that feeling at risk (β = 0.25, p = 0.021) was the better predictor compared with probability judgment while probability judgment (β = 0.25, p = 0.029 ) was better than beliefs about risk in predicting subsequent influenza vaccination uptake. Beliefs about risk and feeling at risk seemed to predict the same aspect of subsequent vaccination uptake because their associations with vaccination uptake became insignificant when paired into the logistic regression model. Similarly, to compare the four scales for assessing probability judgment in predicting vaccination uptake, the 7-point verbal scale remained a significant and stronger predictor for vaccination uptake when paired with other three scales; the 6-point verbal scale was a significant and stronger predictor when paired with the percentage scale or the 2-point verbal scale; and the percentage scale was a significant and stronger predictor only when paired with the 2-point verbal scale. Conclusions/Significance Beliefs about risk and feeling at risk are not well differentiated by Hong Kong Chinese people. Feeling at risk, an affective-cognitive dimension of risk perception predicts subsequent vaccination uptake better than do probability judgments. Among the four scales for assessing risk probability judgment, the 7-point verbal scale offered the best predictive power for subsequent vaccination uptake. PMID:23894292

Comparison of different risk perception measures in predicting seasonal influenza vaccination among healthy Chinese adults in Hong Kong: a prospective longitudinal study.

PubMed

Liao, Qiuyan; Wong, Wing Sze; Fielding, Richard

2013-01-01

Risk perception is a reported predictor of vaccination uptake, but which measures of risk perception best predict influenza vaccination uptake remain unclear. During the main influenza seasons (between January and March) of 2009 (Wave 1) and 2010 (Wave 2),505 Chinese students and employees from a Hong Kong university completed an online survey. Multivariate logistic regression models were conducted to assess how well different risk perceptions measures in Wave 1 predicted vaccination uptake against seasonal influenza in Wave 2. The results of the multivariate logistic regression models showed that feeling at risk (β = 0.25, p = 0.021) was the better predictor compared with probability judgment while probability judgment (β = 0.25, p = 0.029 ) was better than beliefs about risk in predicting subsequent influenza vaccination uptake. Beliefs about risk and feeling at risk seemed to predict the same aspect of subsequent vaccination uptake because their associations with vaccination uptake became insignificant when paired into the logistic regression model. Similarly, to compare the four scales for assessing probability judgment in predicting vaccination uptake, the 7-point verbal scale remained a significant and stronger predictor for vaccination uptake when paired with other three scales; the 6-point verbal scale was a significant and stronger predictor when paired with the percentage scale or the 2-point verbal scale; and the percentage scale was a significant and stronger predictor only when paired with the 2-point verbal scale. Beliefs about risk and feeling at risk are not well differentiated by Hong Kong Chinese people. Feeling at risk, an affective-cognitive dimension of risk perception predicts subsequent vaccination uptake better than do probability judgments. Among the four scales for assessing risk probability judgment, the 7-point verbal scale offered the best predictive power for subsequent vaccination uptake.

A case-control study of determinants for high and low dental caries prevalence in Nevada youth

PubMed Central

2010-01-01

Background The main purpose of this study was to compare the 30% of Nevada Youth who presented with the highest Decayed Missing and Filled Teeth (DMFT) index to a cohort who were caries free and to national NHANES data. Secondly, to explore the factors associated with higher caries prevalence in those with the highest DMFT scores compared to the caries-free group. Methods Over 4000 adolescents between ages 12 and 19 (Case Group: N = 2124; Control Group: N = 2045) received oral health screenings conducted in public/private middle and high schools in Nevada in 2008/2009 academic year. Caries prevalence was computed (Untreated decay scores [D-Score] and DMFT scores) for the 30% of Nevada Youth who presented with the highest DMFT score (case group) and compared to the control group (caries-free) and to national averages. Bivariate and multivariate logistic regression was used to analyze the relationship between selected variables and caries prevalence. Results A majority of the sample was non-Hispanic (62%), non-smokers (80%), and had dental insurance (70%). With the exception of gender, significant differences in mean D-scores were found in seven of the eight variables. All variables produced significant differences between the case and control groups in mean DMFT Scores. With the exception of smoking status, there were significant differences in seven of the eight variables in the bivariate logistic regression. All of the independent variables remained in the multivariate logistic regression model contributing significantly to over 40% of the variation in the increased DMFT status. The strongest predictors for the high DMFT status were racial background, age, fluoridated community, and applied sealants respectively. Gender, second hand smoke, insurance status, and tobacco use were significant, but to a lesser extent. Conclusions Findings from this study will aid in creating educational programs and other primary and secondary interventions to help promote oral health for Nevada youth, especially focusing on the subgroup that presents with the highest mean DMFT scores. PMID:21067620

Multiple imputation for handling missing outcome data when estimating the relative risk.

PubMed

Sullivan, Thomas R; Lee, Katherine J; Ryan, Philip; Salter, Amy B

2017-09-06

Multiple imputation is a popular approach to handling missing data in medical research, yet little is known about its applicability for estimating the relative risk. Standard methods for imputing incomplete binary outcomes involve logistic regression or an assumption of multivariate normality, whereas relative risks are typically estimated using log binomial models. It is unclear whether misspecification of the imputation model in this setting could lead to biased parameter estimates. Using simulated data, we evaluated the performance of multiple imputation for handling missing data prior to estimating adjusted relative risks from a correctly specified multivariable log binomial model. We considered an arbitrary pattern of missing data in both outcome and exposure variables, with missing data induced under missing at random mechanisms. Focusing on standard model-based methods of multiple imputation, missing data were imputed using multivariate normal imputation or fully conditional specification with a logistic imputation model for the outcome. Multivariate normal imputation performed poorly in the simulation study, consistently producing estimates of the relative risk that were biased towards the null. Despite outperforming multivariate normal imputation, fully conditional specification also produced somewhat biased estimates, with greater bias observed for higher outcome prevalences and larger relative risks. Deleting imputed outcomes from analysis datasets did not improve the performance of fully conditional specification. Both multivariate normal imputation and fully conditional specification produced biased estimates of the relative risk, presumably since both use a misspecified imputation model. Based on simulation results, we recommend researchers use fully conditional specification rather than multivariate normal imputation and retain imputed outcomes in the analysis when estimating relative risks. However fully conditional specification is not without its shortcomings, and so further research is needed to identify optimal approaches for relative risk estimation within the multiple imputation framework.

Using Logistic Regression to Predict the Probability of Debris Flows in Areas Burned by Wildfires, Southern California, 2003-2006

USGS Publications Warehouse

Rupert, Michael G.; Cannon, Susan H.; Gartner, Joseph E.; Michael, John A.; Helsel, Dennis R.

2008-01-01

Logistic regression was used to develop statistical models that can be used to predict the probability of debris flows in areas recently burned by wildfires by using data from 14 wildfires that burned in southern California during 2003-2006. Twenty-eight independent variables describing the basin morphology, burn severity, rainfall, and soil properties of 306 drainage basins located within those burned areas were evaluated. The models were developed as follows: (1) Basins that did and did not produce debris flows soon after the 2003 to 2006 fires were delineated from data in the National Elevation Dataset using a geographic information system; (2) Data describing the basin morphology, burn severity, rainfall, and soil properties were compiled for each basin. These data were then input to a statistics software package for analysis using logistic regression; and (3) Relations between the occurrence or absence of debris flows and the basin morphology, burn severity, rainfall, and soil properties were evaluated, and five multivariate logistic regression models were constructed. All possible combinations of independent variables were evaluated to determine which combinations produced the most effective models, and the multivariate models that best predicted the occurrence of debris flows were identified. Percentage of high burn severity and 3-hour peak rainfall intensity were significant variables in all models. Soil organic matter content and soil clay content were significant variables in all models except Model 5. Soil slope was a significant variable in all models except Model 4. The most suitable model can be selected from these five models on the basis of the availability of independent variables in the particular area of interest and field checking of probability maps. The multivariate logistic regression models can be entered into a geographic information system, and maps showing the probability of debris flows can be constructed in recently burned areas of southern California. This study demonstrates that logistic regression is a valuable tool for developing models that predict the probability of debris flows occurring in recently burned landscapes.

[Logistic regression model of noninvasive prediction for portal hypertensive gastropathy in patients with hepatitis B associated cirrhosis].

PubMed

Wang, Qingliang; Li, Xiaojie; Hu, Kunpeng; Zhao, Kun; Yang, Peisheng; Liu, Bo

2015-05-12

To explore the risk factors of portal hypertensive gastropathy (PHG) in patients with hepatitis B associated cirrhosis and establish a Logistic regression model of noninvasive prediction. The clinical data of 234 hospitalized patients with hepatitis B associated cirrhosis from March 2012 to March 2014 were analyzed retrospectively. The dependent variable was the occurrence of PHG while the independent variables were screened by binary Logistic analysis. Multivariate Logistic regression was used for further analysis of significant noninvasive independent variables. Logistic regression model was established and odds ratio was calculated for each factor. The accuracy, sensitivity and specificity of model were evaluated by the curve of receiver operating characteristic (ROC). According to univariate Logistic regression, the risk factors included hepatic dysfunction, albumin (ALB), bilirubin (TB), prothrombin time (PT), platelet (PLT), white blood cell (WBC), portal vein diameter, spleen index, splenic vein diameter, diameter ratio, PLT to spleen volume ratio, esophageal varices (EV) and gastric varices (GV). Multivariate analysis showed that hepatic dysfunction (X1), TB (X2), PLT (X3) and splenic vein diameter (X4) were the major occurring factors for PHG. The established regression model was Logit P=-2.667+2.186X1-2.167X2+0.725X3+0.976X4. The accuracy of model for PHG was 79.1% with a sensitivity of 77.2% and a specificity of 80.8%. Hepatic dysfunction, TB, PLT and splenic vein diameter are risk factors for PHG and the noninvasive predicted Logistic regression model was Logit P=-2.667+2.186X1-2.167X2+0.725X3+0.976X4.

Utility of an Abbreviated Dizziness Questionnaire to Differentiate between Causes of Vertigo and Guide Appropriate Referral: A Multicenter Prospective Blinded Study

PubMed Central

Roland, Lauren T.; Kallogjeri, Dorina; Sinks, Belinda C.; Rauch, Steven D.; Shepard, Neil T.; White, Judith A.; Goebel, Joel A.

2015-01-01

Objective Test performance of a focused dizziness questionnaire’s ability to discriminate between peripheral and non-peripheral causes of vertigo. Study Design Prospective multi-center Setting Four academic centers with experienced balance specialists Patients New dizzy patients Interventions A 32-question survey was given to participants. Balance specialists were blinded and a diagnosis was established for all participating patients within 6 months. Main outcomes Multinomial logistic regression was used to evaluate questionnaire performance in predicting final diagnosis and differentiating between peripheral and non-peripheral vertigo. Univariate and multivariable stepwise logistic regression were used to identify questions as significant predictors of the ultimate diagnosis. C-index was used to evaluate performance and discriminative power of the multivariable models. Results 437 patients participated in the study. Eight participants without confirmed diagnoses were excluded and 429 were included in the analysis. Multinomial regression revealed that the model had good overall predictive accuracy of 78.5% for the final diagnosis and 75.5% for differentiating between peripheral and non-peripheral vertigo. Univariate logistic regression identified significant predictors of three main categories of vertigo: peripheral, central and other. Predictors were entered into forward stepwise multivariable logistic regression. The discriminative power of the final models for peripheral, central and other causes were considered good as measured by c-indices of 0.75, 0.7 and 0.78, respectively. Conclusions This multicenter study demonstrates a focused dizziness questionnaire can accurately predict diagnosis for patients with chronic/relapsing dizziness referred to outpatient clinics. Additionally, this survey has significant capability to differentiate peripheral from non-peripheral causes of vertigo and may, in the future, serve as a screening tool for specialty referral. Clinical utility of this questionnaire to guide specialty referral is discussed. PMID:26485598

Utility of an Abbreviated Dizziness Questionnaire to Differentiate Between Causes of Vertigo and Guide Appropriate Referral: A Multicenter Prospective Blinded Study.

PubMed

Roland, Lauren T; Kallogjeri, Dorina; Sinks, Belinda C; Rauch, Steven D; Shepard, Neil T; White, Judith A; Goebel, Joel A

2015-12-01

Test performance of a focused dizziness questionnaire's ability to discriminate between peripheral and nonperipheral causes of vertigo. Prospective multicenter. Four academic centers with experienced balance specialists. New dizzy patients. A 32-question survey was given to participants. Balance specialists were blinded and a diagnosis was established for all participating patients within 6 months. Multinomial logistic regression was used to evaluate questionnaire performance in predicting final diagnosis and differentiating between peripheral and nonperipheral vertigo. Univariate and multivariable stepwise logistic regression were used to identify questions as significant predictors of the ultimate diagnosis. C-index was used to evaluate performance and discriminative power of the multivariable models. In total, 437 patients participated in the study. Eight participants without confirmed diagnoses were excluded and 429 were included in the analysis. Multinomial regression revealed that the model had good overall predictive accuracy of 78.5% for the final diagnosis and 75.5% for differentiating between peripheral and nonperipheral vertigo. Univariate logistic regression identified significant predictors of three main categories of vertigo: peripheral, central, and other. Predictors were entered into forward stepwise multivariable logistic regression. The discriminative power of the final models for peripheral, central, and other causes was considered good as measured by c-indices of 0.75, 0.7, and 0.78, respectively. This multicenter study demonstrates a focused dizziness questionnaire can accurately predict diagnosis for patients with chronic/relapsing dizziness referred to outpatient clinics. Additionally, this survey has significant capability to differentiate peripheral from nonperipheral causes of vertigo and may, in the future, serve as a screening tool for specialty referral. Clinical utility of this questionnaire to guide specialty referral is discussed.

The association between second-hand smoke exposure and depressive symptoms among pregnant women.

PubMed

Huang, Jingya; Wen, Guoming; Yang, Weikang; Yao, Zhenjiang; Wu, Chuan'an; Ye, Xiaohua

2017-10-01

Tobacco smoking and depression are strongly associated, but the possible association between second-hand smoke (SHS) exposure and depression is unclear. This study aimed to examine the possible relation between SHS exposure and depressive symptoms among pregnant women. A cross-sectional survey was conducted in Shenzhen, China, using a multistage sampling method. The univariable and multivariable logistic regression models were used to explore the associations between SHS exposure and depressive symptoms. Among 2176 pregnant women, 10.5% and 2.0% were classified as having probable and severe depressive symptoms. Both binary and multinomial logistic regression revealed that there were significantly increased risks of severe depressive symptoms corresponding to SHS exposure in homes or regular SHS exposure in workplaces using no exposure as reference. In addition, greater frequency of SHS exposure was significantly associated with the increased risk of severe depressive symptoms. Our findings suggest that SHS exposure is positively associated with depressive symptoms in a dose-response manner among the pregnant women. Copyright © 2017 Elsevier B.V. All rights reserved.

Hyperhomocysteinemia is a risk factor for Alzheimer's disease in an Algerian population.

PubMed

Nazef, Khaled; Khelil, Malika; Chelouti, Hiba; Kacimi, Ghouti; Bendini, Mohamed; Tazir, Meriem; Belarbi, Soraya; El Hadi Cherifi, Mohamed; Djerdjouri, Bahia

2014-04-01

There is growing evidence that increased blood concentration of total homocysteine (tHcy) may be a risk factor for Alzheimer's disease (AD). The present study was conducted to evaluate the association of serum tHcy and other biochemical risk factors with AD. This is a case-control study including 41 individuals diagnosed with AD and 46 nondemented controls. Serum levels of all studied biochemical parameters were performed. Univariate logistic regression showed a significant increase of tHcy (p = 0.008), urea (p = 0.036) and a significant decrease of vitamin B12 (p = 0.012) in AD group vs. controls. Using multivariate logistic regression, tHcy (p = 0.007, OR = 1.376) appeared as an independent risk factor predictor of AD. There was a significant positive correlation between tHcy and creatinine (p <0.0001). A negative correlation was found between tHcy and vitamin B12 (p <0.0001). Our findings support that hyperhomocysteinemia is a risk factor for AD in an Algerian population and is also associated with vitamin B12 deficiency. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database.

PubMed

Asher, Anthony L; Devin, Clinton J; McCutcheon, Brandon; Chotai, Silky; Archer, Kristin R; Nian, Hui; Harrell, Frank E; McGirt, Matthew; Mummaneni, Praveen V; Shaffrey, Christopher I; Foley, Kevin; Glassman, Steven D; Bydon, Mohamad

2017-12-01

OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration. METHODS A total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present. RESULTS In total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients' smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients' propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers. CONCLUSIONS Using a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

Behavioral correlates of fruit and vegetable intake in Puerto Rico: results from the Health Information National Trends Survey.

PubMed

Colón-López, Vivian; Banerjee, Geetanjoli; Gertz, Alida María; Ortiz, Ana Patricia; Calo, William; Finney-Rutten, Lila J; Colón-Ramos, Uriyoán; Hesse, Bradford W; Tortolero, Guillermo

2013-12-01

A diet high in fruit and vegetables (FV) is associated with a decreased risk for chronic diseases, such as cancer. Limited information exists regarding the factors associated with FV intake in persons living in Puerto Rico. The objective of this study was to examine sociodemographic, behavioral, and health-belief factors associated with dietary habits in Puerto Rico. Secondary data analysis of adults aged 18 years and older from the Puerto Rico Health Information National Trends Survey (HINTS-PR) conducted in 2009. Multivariate logistic regression models were used to identify factors associated with meeting the established recommendations for FV consumption. Only 14.5% of the adults in Puerto Rico met the recommendations for daily FV intake, and the vast majority (90.9%) were unaware of current recommendations. Bivariate analyses demonstrated that being obese, having lower than a high school education, and not knowing the recommendations were significantly associated with not meeting these recommendations. In the multivariate logistic regression analysis, being obese (OR = 3.77; 95% CI = 1.41-10.08) and not being aware of the current dietary recommendations (OR = 9.26; 95% CI = 3.77-22.73) continued to be significantly associated with not meeting the FV intake recommendations. The Puerto Rican population is far from meeting FV consumption recommendations, with prevalence estimates of consumption that are below the US median. Low FV intake might put the population in Puerto Rico at increased risk of developing cancer as well as a number of other chronic diseases that are secondary both to improper nutrition and to obesity.

Preconceptional antithyroid peroxidase antibodies, but not thyroid-stimulating hormone, are associated with decreased live birth rates in infertile women.

PubMed

Seungdamrong, Aimee; Steiner, Anne Z; Gracia, Clarisa R; Legro, Richard S; Diamond, Michael P; Coutifaris, Christos; Schlaff, William D; Casson, Peter; Christman, Gregory M; Robinson, Randal D; Huang, Hao; Alvero, Ruben; Hansen, Karl R; Jin, Susan; Eisenberg, Esther; Zhang, Heping; Santoro, Nanette

2017-10-25

To study whether preconceptual thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) antibodies are associated with poor reproductive outcomes in infertile women. Secondary analysis of data from two multicenter, randomized, controlled trials conducted by the Reproductive Medicine Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Multivariable logistic regression analyses were performed to assess the association between preconceptual TSH levels and anti-TPO antibodies. Not applicable. Serum samples from 1,468 infertile women were utilized. None. Cumulative conception, clinical pregnancy, miscarriage, and live birth rates were calculated. Conception, clinical pregnancy, miscarriage, and live birth rates did not differ between patients with TSH ≥2.5 mIU/L vs. TSH < 2.5 mIU/L. Women with anti-TPO antibodies had similar conception rates (33.3% vs. 36.3%) but higher miscarriage rates (43.9% vs. 25.3%) and lower live birth rates (17.1% vs. 25.4%) than those without anti-TPO antibodies. Adjusted, multivariable logistic regression models confirmed elevated odds of miscarriage (odds ratio 2.17, 95% confidence interval 1.12-4.22) and lower odds of live birth (oddr ratio 0.58, 95% confidence interval 0.35-0.96) in patients with anti-TPO antibodies. In infertile women, preconceptional TSH ≥2.5 mIU/L is not associated with adverse reproductive outcomes; however, anti-TPO antibodies are associated with increased risk of miscarriage and decreased probability of live birth. PPCOS II NCT00719186; AMIGOS NCT01044862. Copyright © 2017. Published by Elsevier Inc.

Job stress models, depressive disorders and work performance of engineers in microelectronics industry.

PubMed

Chen, Sung-Wei; Wang, Po-Chuan; Hsin, Ping-Lung; Oates, Anthony; Sun, I-Wen; Liu, Shen-Ing

2011-01-01

Microelectronic engineers are considered valuable human capital contributing significantly toward economic development, but they may encounter stressful work conditions in the context of a globalized industry. The study aims at identifying risk factors of depressive disorders primarily based on job stress models, the Demand-Control-Support and Effort-Reward Imbalance models, and at evaluating whether depressive disorders impair work performance in microelectronics engineers in Taiwan. The case-control study was conducted among 678 microelectronics engineers, 452 controls and 226 cases with depressive disorders which were defined by a score 17 or more on the Beck Depression Inventory and a psychiatrist's diagnosis. The self-administered questionnaires included the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, demography, psychosocial factors, health behaviors and work performance. Hierarchical logistic regression was applied to identify risk factors of depressive disorders. Multivariate linear regressions were used to determine factors affecting work performance. By hierarchical logistic regression, risk factors of depressive disorders are high demands, low work social support, high effort/reward ratio and low frequency of physical exercise. Combining the two job stress models may have better predictive power for depressive disorders than adopting either model alone. Three multivariate linear regressions provide similar results indicating that depressive disorders are associated with impaired work performance in terms of absence, role limitation and social functioning limitation. The results may provide insight into the applicability of job stress models in a globalized high-tech industry considerably focused in non-Western countries, and the design of workplace preventive strategies for depressive disorders in Asian electronics engineering population.

[Study on the adherence and related determinants among HIV-positive clients under methadone maintenance treatment in Dali,Yunnan province from 2005 to 2013].

PubMed

Jiang, Haibo; Cao, Xiaobin; Wang, Changhe; Luo, Wei; Li, Jianhua; Rou, Keming; Zhang, Bo; Fang, Yuehua; Li, Cong; Wu, Zunyou

2014-03-01

To describe the adherence and related determinants among HIV-positive methadone maintenance treatment(MMT)clients in Dali,Yunnan province from 2005 to 2013. Cases were selected from the "National MMT Information Management System". The main information included demographic, drug abuse behaviors prior to enrollment, MMT treatment and highly active antiretroviral therapy (HAART). Detailed medication records were collected to calculate the adherence to MMT. Multivariate unconditional logistic regression was conducted to analyze the impact factors of adherence. The MMT adherence rate of 480 subjects is 58.11%. Data from the multivariate unconditional logistic regression indicated that among those HIV-positive MMT clients that on HAART program (OR = 1.52, 95% CI:1.03-2.24), related factors as:having stable job(OR = 1.69, 95% CI:1.11-2.56), having compulsory history prior to enrollment in MMT (OR = 1.78, 95% CI:1.04-3.04) were likely to have higher rate on MMT adherence, whereas clients who showed positive result in the last urine morphine test (OR = 0.38, 95% CI:0.24-0.59) were associated with lower rate on MMT adherence. In order to improve the rate of adherence to MMT among those HIV-positive MMT clients, the coverage of HAART needed to be expanded and new approaches in combining MMT and HAART developed. Education and intervention efforts should be focused on clients who currently were jobless, those with last urine morphine testing as positive or had never received compulsory treatment.

HPV Vaccination Coverage of Male Adolescents in the United States

PubMed Central

Lu, Peng-jun; Yankey, David; Jeyarajah, Jenny; O’Halloran, Alissa; Elam-Evans, Laurie D.; Smith, Philip J.; Stokley, Shannon; Singleton, James A.; Dunne, Eileen F.

2018-01-01

Background In 2011, the Advisory Committee for Immunization Practices (ACIP) recommended routine use HPV vaccine for male adolescents. Methods We used the 2013 National Immunization Survey-Teen (NIS-Teen) data to assess HPV vaccine uptake (≥1 dose) and series completion (≥3 doses). Multivariable logistic regression analysis and a predictive marginal model were conducted to identify independent predictors of vaccination among adolescent males aged 13–17 years. Results HPV vaccination coverage with ≥1 dose was 34.6% while series completion (≥3 doses) was 13.9%. Coverage was significantly higher among non-Hispanic blacks and Hispanics compared with non-Hispanic white males. Multivariable logistic regression showed that characteristics independently associated with a higher likelihood of HPV vaccination (≥1 dose) included: being non-Hispanic black race or Hispanic ethnicity, having mothers who were widowed, divorced, or separated, having 1–3 physician contacts in the past 12 months, a well-child visit at age 11–12 years, having one or two vaccination providers, living in urban or suburban areas, and receiving vaccinations from more than one type of facility (p<0.05). Having mothers with some college or college education, having a higher family income to poverty ratio, living in South or Midwest, and receiving vaccinations from all STD/school/teen clinics or other facilities were independently associated with a lower likelihood of HPV vaccination (p<0.05). Conclusions Following recommendations for routine HPV vaccination among male adolescents, uptake in 2013 was low in males. Increased efforts are needed to improve vaccination coverage, especially for those who are least likely to be vaccinated. PMID:26504124

Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients.

PubMed

Poppler, Louis H; Groves, Andrew P; Sacks, Gina; Bansal, Anchal; Davidge, Kristen M; Sledge, Jenifer A; Tymkew, Heidi; Yan, Yan; Hasak, Jessica M; Potter, Patricia; Mackinnon, Susan E

2016-11-01

Identification of modifiable risk factors for falling is paramount in reducing the incidence and morbidity of falling. Peroneal neuropathy with an overt foot drop is a known risk factor for falling, but research into subclinical peroneal neuropathy (SCPN) resulting from compression at the fibular head is lacking. The purpose of our study was to determine the prevalence of SCPN in hospitalized patients and establish whether it is associated with a recent history of falling. We conducted a cross-sectional study of 100 medical inpatients at a large academic tertiary care hospital in St Louis, Missouri. General medical inpatients deemed at moderate to high risk for falling were enrolled in the summer of 2013. Patients were examined for findings that suggest peroneal neuropathy, fall risk, and a history of falling. Multivariate logistic regression was used to correlate SCPN with fall risk and a history of falls in the past year. The mean patient age was 53 years (SD = 13 years), and 59 patients (59%) were female. Thirty-one patients had examination findings consistent with SCPN. After accounting for various confounding variables within a multivariate logistic regression model, patients with SCPN were 4.7 times (95% CI, 1.4-15.9) more likely to report having fallen 1 or more times in the past year. Subclinical peroneal neuropathy is common in medical inpatients and is associated with a recent history of falling. Preventing or identifying SCPN in hospitalized patients provides an opportunity to modify activity and therapy, potentially reducing risk. © 2016 Annals of Family Medicine, Inc.

Predictors of Post-Traumatic Stress Disorder among Victims of Serious Motor Vehicle Accidents.

PubMed

Khodadadi-Hassankiadeh, Naema; Dehghan Nayeri, Nahid; Shahsavari, Hooman; Yousefzadeh-Chabok, Shahrokh; Haghani, Hamid

2017-10-01

Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder (PTSD) is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident. This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report (PSS), Beck Depression Inventory (BDI-II), and the Numeric Rating Scale (NRS) for pain. The data were analyzed in SPSS (Version 19) using Chi-square, Fischer's exact test and multivariate logistic regression. Significance level was considered P≤0.05. The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age (P=0.02), sex (P<0.001), education level (P<0.001), work status (P<0.001) and PTSD. Participants who reported pain (P<0.001) and depression (P<0.001) were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident. This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community.

Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status.

PubMed

Low, Lian Leng; Tay, Wei Yi; Ng, Matthew Joo Ming; Tan, Shu Yun; Liu, Nan; Lee, Kheng Hock

2018-01-01

Frequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore. An observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions. A total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions. Our study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk. Copyright: © Singapore Medical Association

Prevalence and Associated Factors of Sleep Quality among Adults in Jimma Town, Southwest Ethiopia: A Community-Based Cross-Sectional Study

PubMed Central

Geleta, Daniel

2018-01-01

Background An estimated 150 million people worldwide and nearly 17% of the populations in the developing nations are currently suffering from sleep problems. The aim of the present study was to determine the prevalence and associated factors of sleep quality among adults in Ethiopia. Method A cross-sectional study was conducted on 422 randomly selected adults using validated and pretested Pittsburgh Sleep Quality Index. Data were entered into EpiData and analyzed using SPSS version 20 considering bivariable (P value < 0.25) and multivariable (P < 0.05) logistic regression procedures at 95% confidence interval. Result The overall prevalence of poor sleep quality (PSQI score > 5) was 65.4% with higher proportion among males (79 (63.0%)) and age group of 40–49 years (174 (28.6%)). A multivariable logistic regression analysis indicated that age category of 40–49 years (AOR = 2 [95% CI (1.1, 3.6)]) (P = 0.03), monthly income ≤ 1000 ETB (AOR = 2.2 [95% CI (14, 3.5)]) (P = 0.01), current khat chewing (AOR = 1.8 [95% CI (1.1, 3.1)]) (P = 0.03), daily khat chewing (AOR = 3.4 [95% CI (1.2, 11.1)]) (P = 0.04), and obesity (AOR = 1.2 [95% CI (1.3, 2.5)]) (P = 0.03) were identified as risk factors of poor sleep quality. Conclusion The current study is informative for government to work on poverty reduction, create awareness for weight reduction, and develop legislation for khat control to prevent poor sleep quality. PMID:29850261

Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

PubMed

Zhao, Yu-Yang; Xu, Dong-Liang; Zhao, Fu-Jun; Han, Bang-Min; Shao, Yi; Zhao, Wei; Xia, Shu-Jie

2014-01-01

Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients (case group) and 341 nonCP/CPPS patients (control group). Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin (odds ratio (OR): 1.66, 95% confidence interval (CI): 1.04-2.66). In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 (95% CI, 1.2-2.88). The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS.

Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

PubMed

Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

2017-07-19

Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p < 0.05). Additionally, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, preoperative antibiotics, type of disease, and operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p < 0.05). Using binary logistic regression analyses, body mass index, smoking, diabetes mellitus, osteoporosis, preoperative antibiotics, fracture, operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

Associations of Social Support, Friends Only Known Through the Internet, and Health-Related Quality of Life with Internet Gaming Disorder in Adolescence.

PubMed

Wartberg, Lutz; Kriston, Levente; Kammerl, Rudolf

2017-07-01

Internet Gaming Disorder (IGD) has been included in the current edition of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5). In the present study, the relationship among social support, friends only known through the Internet, health-related quality of life, and IGD in adolescence was explored for the first time. For this purpose, 1,095 adolescents aged from 12 to 14 years were surveyed with a standardized questionnaire concerning IGD, self-perceived social support, proportion of friends only known through the Internet, and health-related quality of life. The authors conducted unpaired t-tests, a chi-square test, as well as correlation and logistic regression analyses. According to the statistical analyses, adolescents with IGD reported lower self-perceived social support, more friends only known through the Internet, and a lower health-related quality of life compared with the group without IGD. Both in bivariate and multivariate logistic regression models, statistically significant associations between IGD and male gender, a higher proportion of friends only known through the Internet, and a lower health-related quality of life (multivariate model: Nagelkerke's R 2  = 0.37) were revealed. Lower self-perceived social support was related to IGD in the bivariate model only. In summary, quality of life and social aspects seem to be important factors for IGD in adolescence and therefore should be incorporated in further (longitudinal) studies. The findings of the present survey may provide starting points for the development of prevention and intervention programs for adolescents affected by IGD.

The characteristics of non-respondents and respondents of a mental health survey among evacuees in a disaster: The Fukushima Health Management Survey

PubMed Central

Horikoshi, Naoko; Iwasa, Hajime; Yasumura, Seiji; Maeda, Masaharu

2017-01-01

Abstract The Fukushima Medical University conducted a mental health care program for evacuees after the Fukushima Daiichi nuclear power plant accident. However, the mental health status of non-respondents has not been considered for surveys using questionnaires. Therefore, the aim of this study was to clarify the characteristics of non-respondents and respondents. The target population of the survey (FY2011-2013) is people living in the nationally designated evacuation zone of Fukushima prefecture. Among these, the participants were 967 people (20 years or older). We examined factors that affected the difference between the groups of participants (i.e., non-respondents and respondents) using multivariate logistic regression analysis. Employment was higher in non-respondents (p=0.022) and they were also more socially isolated (p=0.047) when compared to respondents; non-respondents had a higher proportional risk of psychological distress compared to respondents (p<0.033). The results of the multivariate logistic regression analysis showed that, within the participants there was a significant association between employment status (OR=1.99, 95% confidence interval [CI]:1.12-3.51) and psychological distress (OR=2.17, 95% CI: 1.01-4.66). We found that non-respondents had a significantly higher proportion of psychological distress compared to the respondents. Although the non-respondents were the high-risk group, it is not possible to grasp the complexity of the situation by simply using questionnaire surveys. Therefore, in the future it is necessary to direct our efforts towards the mental health of non-respondents and respondents alike. PMID:29237989

The characteristics of non-respondents and respondents of a mental health survey among evacuees in a disaster: The Fukushima Health Management Survey.

PubMed

Horikoshi, Naoko; Iwasa, Hajime; Yasumura, Seiji; Maeda, Masaharu

2017-12-19

The Fukushima Medical University conducted a mental health care program for evacuees after the Fukushima Daiichi nuclear power plant accident. However, the mental health status of non-respondents has not been considered for surveys using questionnaires. Therefore, the aim of this study was to clarify the characteristics of non-respondents and respondents. The target population of the survey (FY2011-2013) is people living in the nationally designated evacuation zone of Fukushima prefecture. Among these, the participants were 967 people (20 years or older). We examined factors that affected the difference between the groups of participants (i.e., non-respondents and respondents) using multivariate logistic regression analysis. Employment was higher in non-respondents (p=0.022) and they were also more socially isolated (p=0.047) when compared to respondents; non-respondents had a higher proportional risk of psychological distress compared to respondents (p<0.033). The results of the multivariate logistic regression analysis showed that, within the participants there was a significant association between employment status (OR=1.99, 95% confidence interval [CI]:1.12-3.51) and psychological distress (OR=2.17, 95% CI:1.01-4.66). We found that non-respondents had a significantly higher proportion of psychological distress compared to the respondents. Although the non-respondents were the high-risk group, it is not possible to grasp the complexity of the situation by simply using questionnaire surveys. Therefore, in the future it is necessary to direct our efforts towards the mental health of non-respondents and respondents alike.

The Sociocultural Context of Family Size Preference, Ideal Sex Composition, and Induced Abortion in India: Findings From India’s National Family Health Surveys

PubMed Central

Agrawal, Sutapa

2017-01-01

In this study, the author examined the effect of family size preference and sex composition of living children as determinants of induced abortion among women in India by analyzing 90,303 ever-married women aged 15–49, included in India’s second National Family Health Survey, conducted in 1998–99. Multivariate logistic regression methods were used to examine the association between induced abortion and possible determinants. The results indicated that a woman’s desire to limit family size with preferred sex composition of children, coupled with her autonomy and the sociocultural context, largely determines her experience of induced abortion in India. PMID:23066963

Blastocoele expansion degree predicts live birth after single blastocyst transfer for fresh and vitrified/warmed single blastocyst transfer cycles.

PubMed

Du, Qing-Yun; Wang, En-Yin; Huang, Yan; Guo, Xiao-Yi; Xiong, Yu-Jing; Yu, Yi-Ping; Yao, Gui-Dong; Shi, Sen-Lin; Sun, Ying-Pu

2016-04-01

To evaluate the independent effects of the degree of blastocoele expansion and re-expansion and the inner cell mass (ICM) and trophectoderm (TE) grades on predicting live birth after fresh and vitrified/warmed single blastocyst transfer. Retrospective study. Reproductive medical center. Women undergoing 844 fresh and 370 vitrified/warmed single blastocyst transfer cycles. None. Live-birth rate correlated with blastocyst morphology parameters by logistic regression analysis and Spearman correlations analysis. The degree of blastocoele expansion and re-expansion was the only blastocyst morphology parameter that exhibited a significant ability to predict live birth in both fresh and vitrified/warmed single blastocyst transfer cycles respectively by multivariate logistic regression and Spearman correlations analysis. Although the ICM grade was significantly related to live birth in fresh cycles according to the univariate model, its effect was not maintained in the multivariate logistic analysis. In vitrified/warmed cycles, neither ICM nor TE grade was correlated with live birth by logistic regression analysis. This study is the first to confirm that the degree of blastocoele expansion and re-expansion is a better predictor of live birth after both fresh and vitrified/warmed single blastocyst transfer cycles than ICM or TE grade. Copyright © 2016. Published by Elsevier Inc.

Anger expression, violent behavior, and symptoms of depression among male college students in Ethiopia.

PubMed

Terasaki, Dale J; Gelaye, Bizu; Berhane, Yemane; Williams, Michelle A

2009-01-12

Depression is an important global public health problem. Given the scarcity of studies involving African youths, this study was conducted to evaluate the associations of anger expression and violent behavior with symptoms of depression among male college students. A self-administered questionnaire was used to collect information on socio-demographic and lifestyle characteristics and violent behavior among 1,176 college students in Awassa, Ethiopia in June, 2006. The questionnaire incorporated the Spielberger Anger-Out Expression (SAOE) scale and symptoms of depression were evaluated using the Patient Health Questionnaire (PHQ-9). Multivariable logistic regression procedures were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (95%CI). Symptoms of depression were evident in 23.6% of participants. Some 54.3% of students reported committing at least one act of violence in the current academic year; and 29.3% of students reported high (SAOE score > or = 15) levels of anger-expression. In multivariate analysis, moderate (OR = 1.97; 95%CI 1.33-2.93) and high (OR = 3.23; 95%CI 2.14-4.88) outward anger were statistically significantly associated with increased risks of depressive symptoms. Violent behavior was noted to be associated with depressive symptoms (OR = 1.82; 95%CI 1.37-2.40). Further research should be conducted to better characterize community and individual level determinants of anger-expression, violent behavior and depression among youths.

Pregnancy Intention and Post-partum Depressive Affect in Louisiana Pregnancy Risk Assessment Monitoring System.

PubMed

Suh, Elizabeth Y; Ma, Ping; Dunaway, Lauren Futrell; Theall, Katherine P

2016-05-01

Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner's pregnancy intentions and reported post-partum depressive symptoms (PPDs). Using Louisiana pregnancy risk assessment monitoring system, 2000-2003, a secondary cross-sectional analysis was conducted on 5549 mothers, stratified by race, who delivered a singleton, live birth and whose infant was still alive at the time of the survey. Bivariate and multivariable logistic regressions were conducted, taking into account the complex survey design. In multivariable models, unwanted pregnancies were associated with severe PPDs (aOR 1.76, 95 % CI 1.23-2.53). Furthermore, the association between husbands/partners' who did not want or care about the pregnancy and mild PPDs remained for White women (aOR 1.32, 95 % CI 1.02-1.69); while among Black women, neither parent's pregnancy intention were associated with mild or severe PPDs. This study supports existing research demonstrating the association between pregnancy intention and PPDs. This study contributes to the limited information on the role that partner pregnancy intention plays on maternal mental health outcomes, however further discussion is needed on the impact of this role across races. Findings can be used in programs aiming to reduce adverse mental health outcomes among high-risk mothers.

Association between cardiovascular risk factors and carotid intima-media thickness in prepubertal Brazilian children.

PubMed

Gazolla, Fernanda Mussi; Neves Bordallo, Maria Alice; Madeira, Isabel Rey; de Miranda Carvalho, Cecilia Noronha; Vieira Monteiro, Alexandra Maria; Pinheiro Rodrigues, Nádia Cristina; Borges, Marcos Antonio; Collett-Solberg, Paulo Ferrez; Muniz, Bruna Moreira; de Oliveira, Cecilia Lacroix; Pinheiro, Suellen Martins; de Queiroz Ribeiro, Rebeca Mathias

2015-05-01

Early exposure to cardiovascular risk factors creates a chronic inflammatory state that could damage the endothelium followed by thickening of the carotid intima-media. To investigate the association of cardiovascular risk factors and thickening of the carotid intima. Media in prepubertal children. In this cross-sectional study, carotid intima-media thickness (cIMT) and cardiovascular risk factors were assessed in 129 prepubertal children aged from 5 to 10 year. Association was assessed by simple and multivariate logistic regression analyses. In simple logistic regression analyses, body mass index (BMI) z-score, waist circumference, and systolic blood pressure (SBP) were positively associated with increased left, right, and average cIMT, whereas diastolic blood pressure was positively associated only with increased left and average cIMT (p<0.05). In multivariate logistic regression analyses increased left cIMT was positively associated to BMI z-score and SBP, and increased average cIMT was only positively associated to SBP (p<0.05). BMI z-score and SBP were the strongest risk factors for increased cIMT.

Incidence and risk factors of acute kidney injury after esophageal cancer surgery: A nested case-control study.

PubMed

Wang, Wen; Wang, Tong; Feng, Xiaoshuang; Sun, Li

2017-03-01

Acute kidney injury (AKI) has been increasingly recognized as a common and serious postoperative complication. Although many studies have been conducted to investigate postoperative AKI after thoracic surgery, little is known about AKI after esophageal surgery. Thus, we conducted this study to determine the incidence and identify risk factors of postoperative AKI after esophageal cancer surgery. A retrospective nested case-control study of patients undergoing elective esophageal cancer surgery between July 2013 and July 2016 in a single tertiary specialized cancer hospital was performed. The primary outcome was development of AKI. Conditional logistic regression analysis was performed to identify independent risk factors for AKI. Of 2094 patients, 51 (2.4%) developed postoperative AKI after esophageal cancer surgery. In multivariate conditional logistic regression analysis, four risk factors for AKI after esophageal surgery for cancer were identified: preoperative serum creatinine level (OR 1.040; 95% CI 1.012-1.069), duration of surgery (OR 1.009; 95% CI 1.005-1.014), smoking history (OR 3.029; 95% CI 1.092-8.399) and hypertension (OR 6.422; 95% CI 2.736-15.070). Postoperative AKI occurred in 2.4% of patients after esophageal surgery for cancer. Preoperative serum creatinine level, duration of surgery, smoking history and hypertension were independent risk factors for postoperative AKI. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Two models for evaluating landslide hazards

USGS Publications Warehouse

Davis, J.C.; Chung, C.-J.; Ohlmacher, G.C.

2006-01-01

Two alternative procedures for estimating landslide hazards were evaluated using data on topographic digital elevation models (DEMs) and bedrock lithologies in an area adjacent to the Missouri River in Atchison County, Kansas, USA. The two procedures are based on the likelihood ratio model but utilize different assumptions. The empirical likelihood ratio model is based on non-parametric empirical univariate frequency distribution functions under an assumption of conditional independence while the multivariate logistic discriminant model assumes that likelihood ratios can be expressed in terms of logistic functions. The relative hazards of occurrence of landslides were estimated by an empirical likelihood ratio model and by multivariate logistic discriminant analysis. Predictor variables consisted of grids containing topographic elevations, slope angles, and slope aspects calculated from a 30-m DEM. An integer grid of coded bedrock lithologies taken from digitized geologic maps was also used as a predictor variable. Both statistical models yield relative estimates in the form of the proportion of total map area predicted to already contain or to be the site of future landslides. The stabilities of estimates were checked by cross-validation of results from random subsamples, using each of the two procedures. Cell-by-cell comparisons of hazard maps made by the two models show that the two sets of estimates are virtually identical. This suggests that the empirical likelihood ratio and the logistic discriminant analysis models are robust with respect to the conditional independent assumption and the logistic function assumption, respectively, and that either model can be used successfully to evaluate landslide hazards. ?? 2006.

Predictors of unsafe sexual behavior among people living with human immunodeficiency virus/AIDS attending antiretroviral therapy center in Western India.

PubMed

Mehta, Kedar G; Baxi, Rajendra; Chavda, Parag; Patel, Sangita; Mazumdar, Vihang

2016-01-01

As more and more people with human immunodeficiency virus (HIV) live longer and healthier lives because of antiretroviral therapy (ART), an increasing number of sexual transmissions of HIV may arise from these people living with HIV/AIDS (PLWHA). Hence, this study is conducted to assess the predictors of unsafe sexual behavior among PLWHA on ART in Western India. The current cross-sectional study was carried out among 175 PLWHAs attending ART center of a Tertiary Care Hospital in Western India. Unsafe sex was defined as inconsistent and/or incorrect condom use. A total of 39 variables from four domains viz., sociodemographic, relationship-related, medical and psycho-social factors were studied for their relationship to unsafe sexual behavior. The variables found to be significantly associated with unsafe sex practices in bivariate analysis were explored by multivariate analysis using multiple logistic regression in SPSS 17.0 version. Fifty-eight percentage of PLWHAs were practicing unsafe sex. 15 out of total 39 variables showed significant association in bivariate analysis. Finally, 11 of them showed significant association in multivariate analysis. Young age group, illiteracy, lack of counseling, misbeliefs about condom use, nondisclosure to spouse and lack of partner communication were the major factors found to be independently associated with unsafe sex in multivariate analysis. Appropriate interventions like need-based counseling are required to address risk factors associated with unsafe sex.

Multivariate statistical analysis: Principles and applications to coorbital streams of meteorite falls

NASA Technical Reports Server (NTRS)

Wolf, S. F.; Lipschutz, M. E.

1993-01-01

Multivariate statistical analysis techniques (linear discriminant analysis and logistic regression) can provide powerful discrimination tools which are generally unfamiliar to the planetary science community. Fall parameters were used to identify a group of 17 H chondrites (Cluster 1) that were part of a coorbital stream which intersected Earth's orbit in May, from 1855 - 1895, and can be distinguished from all other H chondrite falls. Using multivariate statistical techniques, it was demonstrated that a totally different criterion, labile trace element contents - hence thermal histories - or 13 Cluster 1 meteorites are distinguishable from those of 45 non-Cluster 1 H chondrites. Here, we focus upon the principles of multivariate statistical techniques and illustrate their application using non-meteoritic and meteoritic examples.

Influence of professional preparation and class structure on sexuality topics taught in middle and high schools.

PubMed

Rhodes, Darson L; Kirchofer, Gregg; Hammig, Bart J; Ogletree, Roberta J

2013-05-01

This study examined the impact of professional preparation and class structure on sexuality topics taught and use of practice-based instructional strategies in US middle and high school health classes. Data from the classroom-level file of the 2006 School Health Policies and Programs were used. A series of multivariable logistic regression models were employed to determine if sexuality content taught was dependent on professional preparation and /or class structure (HE only versus HE/another subject combined). Additional multivariable logistic regression models were employed to determine if use of practice-based instructional strategies was dependent upon professional preparation and/or class structure. Years of teaching health topics and size of the school district were included as covariates in the multivariable logistic regression models. Findings indicated professionally prepared health educators were significantly more likely to teach 7 of the 13 sexuality topics as compared to nonprofessionally prepared health educators. There was no statistically significant difference in the instructional strategies used by professionally prepared and nonprofessionally prepared health educators. Exclusively health education classes versus combined classes were significantly more likely to have included 6 of the 13 topics and to have incorporated practice-based instructional strategies in the curricula. This study indicated professional preparation and class structure impacted sexuality content taught. Class structure also impacted whether opportunities for students to practice skills were made available. Results support the need for continued advocacy for professionally prepared health educators and health only courses. © 2013, American School Health Association.

Esophageal wall dose-surface maps do not improve the predictive performance of a multivariable NTCP model for acute esophageal toxicity in advanced stage NSCLC patients treated with intensity-modulated (chemo-)radiotherapy.

PubMed

Dankers, Frank; Wijsman, Robin; Troost, Esther G C; Monshouwer, René; Bussink, Johan; Hoffmann, Aswin L

2017-05-07

In our previous work, a multivariable normal-tissue complication probability (NTCP) model for acute esophageal toxicity (AET) Grade  ⩾2 after highly conformal (chemo-)radiotherapy for non-small cell lung cancer (NSCLC) was developed using multivariable logistic regression analysis incorporating clinical parameters and mean esophageal dose (MED). Since the esophagus is a tubular organ, spatial information of the esophageal wall dose distribution may be important in predicting AET. We investigated whether the incorporation of esophageal wall dose-surface data with spatial information improves the predictive power of our established NTCP model. For 149 NSCLC patients treated with highly conformal radiation therapy esophageal wall dose-surface histograms (DSHs) and polar dose-surface maps (DSMs) were generated. DSMs were used to generate new DSHs and dose-length-histograms that incorporate spatial information of the dose-surface distribution. From these histograms dose parameters were derived and univariate logistic regression analysis showed that they correlated significantly with AET. Following our previous work, new multivariable NTCP models were developed using the most significant dose histogram parameters based on univariate analysis (19 in total). However, the 19 new models incorporating esophageal wall dose-surface data with spatial information did not show improved predictive performance (area under the curve, AUC range 0.79-0.84) over the established multivariable NTCP model based on conventional dose-volume data (AUC  =  0.84). For prediction of AET, based on the proposed multivariable statistical approach, spatial information of the esophageal wall dose distribution is of no added value and it is sufficient to only consider MED as a predictive dosimetric parameter.

Esophageal wall dose-surface maps do not improve the predictive performance of a multivariable NTCP model for acute esophageal toxicity in advanced stage NSCLC patients treated with intensity-modulated (chemo-)radiotherapy

NASA Astrophysics Data System (ADS)

Dankers, Frank; Wijsman, Robin; Troost, Esther G. C.; Monshouwer, René; Bussink, Johan; Hoffmann, Aswin L.

2017-05-01

In our previous work, a multivariable normal-tissue complication probability (NTCP) model for acute esophageal toxicity (AET) Grade  ⩾2 after highly conformal (chemo-)radiotherapy for non-small cell lung cancer (NSCLC) was developed using multivariable logistic regression analysis incorporating clinical parameters and mean esophageal dose (MED). Since the esophagus is a tubular organ, spatial information of the esophageal wall dose distribution may be important in predicting AET. We investigated whether the incorporation of esophageal wall dose-surface data with spatial information improves the predictive power of our established NTCP model. For 149 NSCLC patients treated with highly conformal radiation therapy esophageal wall dose-surface histograms (DSHs) and polar dose-surface maps (DSMs) were generated. DSMs were used to generate new DSHs and dose-length-histograms that incorporate spatial information of the dose-surface distribution. From these histograms dose parameters were derived and univariate logistic regression analysis showed that they correlated significantly with AET. Following our previous work, new multivariable NTCP models were developed using the most significant dose histogram parameters based on univariate analysis (19 in total). However, the 19 new models incorporating esophageal wall dose-surface data with spatial information did not show improved predictive performance (area under the curve, AUC range 0.79-0.84) over the established multivariable NTCP model based on conventional dose-volume data (AUC  =  0.84). For prediction of AET, based on the proposed multivariable statistical approach, spatial information of the esophageal wall dose distribution is of no added value and it is sufficient to only consider MED as a predictive dosimetric parameter.

Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors.

PubMed

Fraser, Sarah L; Geoffroy, Dominique; Chachamovich, Eduardo; Kirmayer, Laurence J

2015-04-01

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities. © 2014 The American Association of Suicidology.

Maternal Complications Associated with Stillbirth Delivery: a Cross-Sectional Analysis

PubMed Central

Gold, Katherine J.; Mozurkewich, Ellen L.; Puder, Karoline S.; Treadwell, Marjorie C.

2016-01-01

This study sought to identify delivery complications associated with stillbirth labor and delivery. We conducted a retrospective chart review evaluating stillbirth demographics, pregnancy and maternal risk factors, and complications of labor and delivery. We performed bivariable analysis and multivariable logistic regression to evaluate factors associated with medical complications and variations by race. Our cohort included 543 mothers with stillbirth, of which two-thirds were African-American. We noted high rates of shoulder dystocia, clinical chorioamnionitis, postpartum hemorrhage, and retained placenta in women with stillbirths. 33 women (6%) experienced at least one serious maternal complication. Complication rates did not vary by maternal race. Providers who perform obstetrical care should be alert to the high rate of maternal medical complications associated with labor and delivery of a stillbirth fetus. PMID:26479679

Maternal complications associated with stillbirth delivery: A cross-sectional analysis.

PubMed

Gold, K J; Mozurkewich, E L; Puder, K S; Treadwell, M C

2016-01-01

This study sought to identify delivery complications associated with stillbirth labour and delivery. We conducted a retrospective chart review evaluating stillbirth demographics, pregnancy and maternal risk factors, and complications of labour and delivery. We performed bivariable analysis and multivariable logistic regression to evaluate factors associated with medical complications and variations by race. Our cohort included 543 mothers with stillbirth, of which two-thirds were African-American. We noted high rates of shoulder dystocia, clinical chorioamnionitis, postpartum haemorrhage and retained placenta in women with stillbirths. Thirty-three women (6%) experienced at least one serious maternal complication. Complication rates did not vary by maternal race. Providers who perform obstetrical care should be alert to the high rate of maternal medical complications associated with labour and delivery of a stillbirth foetus.

Perceived discrimination, psychological distress, and current smoking status: results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004-2008.

PubMed

Purnell, Jason Q; Peppone, Luke J; Alcaraz, Kassandra; McQueen, Amy; Guido, Joseph J; Carroll, Jennifer K; Shacham, Enbal; Morrow, Gary R

2012-05-01

We examined the association between perceived discrimination and smoking status and whether psychological distress mediated this relationship in a large, multiethnic sample. We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System Reactions to Race module to conduct multivariate logistic regression analyses and tests of mediation examining associations between perceived discrimination in health care and workplace settings, psychological distress, and current smoking status. Regardless of race/ethnicity, perceived discrimination was associated with increased odds of current smoking. Psychological distress was also a significant mediator of the discrimination-smoking association. Our results indicate that individuals who report discriminatory treatment in multiple domains may be more likely to smoke, in part, because of the psychological distress associated with such treatment.

Outcomes of the 5-4-3-2-1 Go! Childhood obesity community trial.

PubMed

Evans, W Douglas; Christoffel, Katherine K; Necheles, Jonathan; Becker, Adam B; Snider, Jeremy

2011-01-01

To determine effects of the 5-4-3-2-1 Go! community social marketing campaign on obesity risk factors. We randomly assigned 524 parents of 3- to 7-year-old children to receive 5-4-3-2-1 Go! counseling or not. We surveyed parents about 5-4-3-2-1 Go! behaviors and perceptions of children's behaviors at baseline and one year later. We conducted multivariable logistic regression for each outcome. Parents who received counseling consumed more fruits and vegetables at follow-up (OR 1.749, [95% CI: 1.01-3.059]). Parental exposure to messaging at children's school events was associated with higher water consumption (6.879, [1.954-24.212]). 5-4-3-2-1 Go! is a promising intervention.

Behavioral Correlates of Fruit and Vegetable Intake in Puerto Rico: Results from the Health Information National Trends Survey

PubMed Central

Colón-López, Vivian; Banerjee, Geetanjoli; Gertz, Alida María; Ortiz, Ana Patricia; Calo, William; Finney-Rutten, Lila J.; Colón-Ramos, Uriyoán; Hesse, Bradford W.; Tortolero, Guillermo

2016-01-01

Objective A diet high in fruit and vegetables (FV) is associated with a decreased risk for chronic diseases, such as cancer. Limited information exists regarding the factors associated with FV intake in persons living in Puerto Rico. The objective of this study was to examine sociodemographic, behavioral, and health-belief factors associated with dietary habits in Puerto Rico. Methods Secondary data analysis of adults aged 18 years and older from the Puerto Rico Health Information National Trends Survey (HINTS-PR) conducted in 2009. Multivariate logistic regression models were used to identify factors associated with meeting the established recommendations for FV consumption. Results Only 14.5% of the adults in Puerto Rico met the recommendations for daily FV intake, and the vast majority (90.9%) were unaware of current recommendations. Bivariate analyses demonstrated that being obese, having lower than a high school education, and not knowing the recommendations were significantly associated with not meeting these recommendations. In the multivariate logistic regression analysis, being obese (OR = 3.77; 95% CI = 1.41-10.08) and not being aware of the current dietary recommendations (OR = 9.26; 95% CI = 3.77-22.73) continued to be significantly associated with not meeting the FV intake recommendations. Conclusion The Puerto Rican population is far from meeting FV consumption recommendations, with prevalence estimates of consumption that are below the US median. Low FV intake might put the population in Puerto Rico at increased risk of developing cancer as well as a number of other chronic diseases that are secondary both to improper nutrition and to obesity. PMID:24397217

Variation in intensive care unit utilization and mortality after blunt splenic injury.

PubMed

Kaufman, Elinore J; Wiebe, Douglas J; Martin, Niels D; Pascual, Jose L; Reilly, Patrick M; Holena, Daniel N

2016-06-15

Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma centers. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman's rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement between high and low-ICU-utilization centers. Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers than at low-utilization centers. Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Affordable Care Act Qualified Health Plan Coverage: Association With Improved HIV Viral Suppression for AIDS Drug Assistance Program Clients in a Medicaid Nonexpansion State

PubMed Central

McManus, Kathleen A.; Rhodes, Anne; Bailey, Steven; Yerkes, Lauren; Engelhard, Carolyn L.; Ingersoll, Karen S.; Stukenborg, George J.; Dillingham, Rebecca

2016-01-01

Background. With the Patient Protection and Affordable Care Act, many state AIDS Drug Assistance Programs (ADAPs) shifted their healthcare delivery model from direct medication provision to purchasing qualified health plans (QHPs). The objective of this study was to characterize the demographic and healthcare delivery factors associated with Virginia ADAP clients' QHP enrollment and to assess the relationship between QHP coverage and human immunodeficiency virus (HIV) viral suppression. Methods. The cohort included persons living with HIV who were enrolled in the Virginia ADAP (n = 3933). Data were collected from 1 January 2013 through 31 December 2014. Multivariable binary logistic regression was conducted to assess for associations with QHP enrollment and between QHP coverage and viral load (VL) suppression. Results. In the cohort, 47.1% enrolled in QHPs, and enrollment varied significantly based on demographic and healthcare delivery factors. In multivariable binary logistic regression, controlling for time, age, sex, race/ethnicity, and region, factors significantly associated with achieving HIV viral suppression included QHP coverage (adjusted odds ratio, 1.346; 95% confidence interval, 1.041–1.740; P = .02), an initially undetectable VL (2.809; 2.174–3.636; P < .001), HIV rather than AIDS disease status (1.377; 1.049–1.808; P = .02), and HIV clinic (P < .001). Conclusions. QHP coverage was associated with viral suppression, an essential outcome for individuals and for public health. Promoting QHP coverage in clinics that provide care to persons living with HIV may offer a new opportunity to increase rates of viral suppression. PMID:27143661

Factors contributing to attrition behavior in diabetes self-management programs: A mixed method approach

PubMed Central

Gucciardi, Enza; DeMelo, Margaret; Offenheim, Ana; Stewart, Donna E

2008-01-01

Background Diabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs. Methods We conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization. Results Working full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results. Conclusion Reducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians. PMID:18248673

Risk factors for reinsertion of urinary catheter after early removal in thoracic surgical patients.

PubMed

Young, John; Geraci, Travis; Milman, Steven; Maslow, Andrew; Jones, Richard N; Ng, Thomas

2018-03-08

To reduce the incidence of urinary tract infection, Surgical Care Improvement Project 9 mandates the removal of urinary catheters within 48 hours postoperatively. In patients with thoracic epidural anesthesia, we sought to determine the rate of catheter reinsertion, the complications of reinsertion, and the factors associated with reinsertion. We conducted a prospective observational study of consecutive patients undergoing major pulmonary or esophageal resection with thoracic epidural analgesia over a 2-year period. As per Surgical Care Improvement Project 9, all urinary catheters were removed within 48 hours postoperatively. Excluded were patients with chronic indwelling catheter, patients with urostomy, and patients requiring continued strict urine output monitoring. Multivariable logistic regression analysis was used to identify independent risk factors for urinary catheter reinsertion. Thirteen patients met exclusion criteria. Of the 275 patients evaluated, 60 (21.8%) required reinsertion of urinary catheter. There was no difference in the urinary tract infection rate between patients requiring reinsertion (1/60 [1.7%]) versus patients not requiring reinsertion (1/215 [0.5%], P = .389). Urethral trauma during reinsertion was seen in 1 of 60 patients (1.7%). After reinsertion, discharge with urinary catheter was required in 4 of 60 patients (6.7%). Multivariable logistic regression analysis found esophagectomy, lower body mass index, and benign prostatic hypertrophy to be independent risk factors associated with catheter reinsertion after early removal in the presence of thoracic epidural analgesia. When applying Surgical Care Improvement Project 9 to patients undergoing thoracic procedures with thoracic epidural analgesia, consideration to delayed removal of urinary catheter may be warranted in patients with multiple risk factors for reinsertion. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Factors associated with syphilis treatment failure and reinfection: a longitudinal cohort study in Shenzhen, China.

PubMed

Luo, Zhenzhou; Zhu, Lin; Ding, Yi; Yuan, Jun; Li, Wu; Wu, Qiuhong; Tian, Lishan; Zhang, Li; Zhou, Guomao; Zhang, Tao; Ma, Jianping; Chen, Zhongwei; Yang, Tubao; Feng, Tiejian; Zhang, Min

2017-09-13

The treatment failure and reinfection rates among syphilis patients are high, and relevant studies in China are limited. The aim of this study was to detect the rates of treatment failure and reinfection after syphilis treatment and to explore the potential associated factors. We conducted a longitudinal cohort study in a sexually transmitted disease clinic, the Department of Dermatology and Venereology in Nanshan Center for Chronic Disease Control. Serological testing was performed at baseline and throughout the 2-year follow-up for syphilis patients. To identify potential predictors of treatment outcomes, multivariate logistics analyses were utilized to compare the demographic and clinical characteristics of patients with serological failure/reinfection to those with serological cure/serofast. From June 2011 to June 2016, a total of 1133 patients were screened for syphilis. Among the 770 patients who completed the 2-year follow-up, 510 first-diagnosed patients were included in the final analysis. Multivariate logistics analysis revealed the stage of syphilis (secondary syphilis VS. primary syphilis: adjusted odds ratio, 3.50; 95% confidence interval, 1.11-15.47; p = 0.04), HIV status (positive VS. negative: adjusted odds ratio, 3.06; 95% confidence interval, 1.15-8.04; p = 0.02) and frequency of condom use (always use VS. never use: adjusted odds ratio, 0.28; 95% confidence interval 0.08-0.75; p = 0.02) were significantly associated with the serological outcome. The clinical implications of our findings suggest that it is very important to perform regular clinical and serologic evaluations after treatment. Health counseling and safety education on sex activity should be intensified among HIV-infected patients and secondary syphilis patients after treatment.

Impact of hospital market competition on endovascular aneurysm repair adoption and outcomes.

PubMed

Sethi, Rosh K V; Henry, Antonia J; Hevelone, Nathanael D; Lipsitz, Stuart R; Belkin, Michael; Nguyen, Louis L

2013-09-01

The share of total abdominal aortic aneurysm (AAA) repairs performed by endovascular aneurysm repair (EVAR) increased rapidly from 32% in 2001 to 65% in 2006 with considerable variation between states. We hypothesized that hospitals in competitive markets were early EVAR adopters and had improved AAA repair outcomes. Nationwide Inpatient Sample and linked Hospital Market Structure (HMS) data was queried for patients who underwent repair for nonruptured AAA in 2003. In HMS, the Herfindahl Hirschman Index (HHI, range 0-1) is a validated and widely accepted economic measure of competition. Hospital markets were defined using a variable geographic radius that encompassed 90% of discharged patients. We conducted bivariate and multivariable linear and logistic regression analyses for the dependent variable of EVAR use. A propensity score-adjusted multivariable logistic regression model was used to control for treatment bias in the assessment of competition on AAA repair outcomes. A weighted total of 21,600 patients was included in our analyses. Patients at more competitive hospitals (lower HHI) were at increased odds of undergoing EVAR vs open repair (odds ratio, 1.127 per 0.1 decrease in HHI; P < .0127) after adjusting for patient demographics, comorbidities, and hospital level factors (bed size, teaching status, AAA repair volume, and ownership). Competition was not associated with differences in in-hospital mortality or vascular, neurologic, or other minor postoperative complications. Greater hospital competition is significantly associated with increased EVAR adoption at a time when diffusion of this technology passed its tipping point. Hospital competition does not influence post-AAA repair outcomes. These results suggest that adoption of novel vascular technology is not solely driven by clinical indications but may also be influenced by market forces. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Traditional herbal medicine use among people living with HIV/AIDS in Gondar, Ethiopia: Do their health care providers know?

PubMed

Haile, Kaleab Taye; Ayele, Asnakew Achaw; Mekuria, Abebe Basazn; Demeke, Chilot Abiyu; Gebresillassie, Begashaw Melaku; Erku, Daniel Asfaw

2017-12-01

People living with HIV/AIDS (PLWHA) are increasingly using herbal remedies due to the chronic nature of the disease, the complexities of treatment modalities and the difficulty in adhering to the therapeutic regimens. Yet, research on herbal medicine use in this patient population is scarce in Ethiopia. The present study aimed at investigating the prevalence and factors associated with the use of traditional herbal medicine among PLWHA in Gondar, Ethiopia. A cross sectional survey was conducted on 360 PLWHA attending the outpatient clinic of University of Gondar referral and teaching hospital from September 1 to 30, 2016. A questionnaire about the socio-demographic, disease characteristics as well as traditional herbal medicine use was filled by the respondents. Descriptive statistics, univariate and multivariate logistic regression analyses were performed to determine prevalence and correlates of herbal medicine use. Out of 360 respondents, 255 (70.8%) used traditional herbal medicine. The most common herbal preparations used by PLWHA were Ginger (Zingiber officinale) (47%), Garlic (Allium sativum L.) (40.8%) and Moringa (Moringa stenopetala) (31.4%). Majority of herbal medicine users rarely disclose their use of herbal medicines to their health care providers (61.2%). Only lower educational status was found to be strong predictors of herbal medicine use in the multivariate logistic regression. The use of herbal medicine among PLWHA is a routine practice and associated with a lower educational status. Patients also rarely disclose their use of herbal medicines to their health care providers. From the stand point of high prevalence and low disclosure rate, health care providers should often consult patients regarding herbal medicine use. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors affecting patients' adherence to orthodontic appointments.

PubMed

Bukhari, Omair M; Sohrabi, Keyvan; Tavares, Mary

2016-03-01

Studies show that attendance at orthodontic appointments affects treatment outcomes, treatment duration, and the probability of side effects. The aim of this study was to predict factors that influence patients' attendance at orthodontic appointments. We conducted a face-to-face guided interview survey of 153 participants from orthodontic clinics in the Greater Boston area. Attendance at scheduled orthodontic appointments was self-reported as always, sometimes, or rarely. Participants' characteristics, including demographics, dental insurance, and oral hygiene practices, were self-reported. Moreover, from dental records, we collected the time that the participants spent undergoing active orthodontic treatment. Multivariable ordered logistic regression was used to report proportional odds ratios and attendance probabilities. A likelihood ratio test was performed to ensure that the proportional odds assumption held. For overall appointment attendance, 76% of the participants reported always attending, 16% reported sometimes attending, and 8% reported rarely attending. Based on multivariable logistic regression (adjusted for age, race, and sex), the participants with optimal oral hygiene practices were almost 6 times (5.9) more likely to attend appointments than those who did not (P = 0.002). The odds of attending appointments decreased significantly (by 23%) for every 6-month increase in treatment duration (P = 0.008). Participants covered by non-Medicaid insurance were 4 times (P = 0.018) more likely to attend appointments than were those with Medicaid insurance. Our findings indicate that adherence to orthodontic treatment follow-up visits was strongly correlated to insurance type, treatment duration, and oral hygiene practices. Unlike previous studies, sex was not a significant predictor of adherence. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Client-Related Factors Associated with a "Less than Good" Experience of Midwifery Care during Childbirth in the Netherlands.

PubMed

Baas, Carien I; Wiegers, Therese A; de Cock, T Paul; Erwich, Jan Jaap H M; Spelten, Evelien R; de Boer, Michiel R; Hutton, Eileen K

2017-03-01

A "less than good" experience during childbirth can affect a mother's early interaction with her child and may significantly influence a woman's emotional well-being. In this study, we focus on clients who experienced midwifery care provided during childbirth as "less than good" care. The aim of this study was to understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve this care. This study was part of the "DELIVER study" where mothers report on the care they received. We used generalized estimation equations to control for correlations within midwife practices. Forward multivariate logistic regression analyses were conducted to model the client-related factors associated with the experienced midwifery care during childbirth. We included the responses of 2,377 women. In the multivariable logistic regression model, odds of reporting "less than good care" were significantly higher for women who experienced an unplanned cesarean birth (OR 2.21 [CI 1.19-4.09]), an instrumental birth (OR 1.55 [CI 1.08-2.23]), and less control during the dilation phase (OR 0.98 [CI 0.97-0.99]) and pushing phase (OR 0.98 [CI 0.97-0.99]). Birth-related factors were more likely than maternal characteristics to be associated with the experience of midwifery care during childbirth. We conclude that there is room for midwives to improve their care for women during childbirth particularly in improving the patient centeredness of the care provider, using strategies to enhance sense of control, and focusing on the particular needs of those who experience instrumental vaginal or unplanned cesarean births. © 2016 Wiley Periodicals, Inc.

Quality of radiotherapy reporting in randomized controlled trials of prostate cancer.

PubMed

Soon, Yu Yang; Chen, Desiree; Tan, Teng Hwee; Tey, Jeremy

2018-06-07

Good radiotherapy reporting in clinical trials of prostate radiotherapy is important because it will allow accurate reproducibility of radiotherapy treatment and minimize treatment variations that can affect patient outcomes. The aim of our study is to assess the quality of prostate radiotherapy (RT) treatment reporting in randomized controlled trials in prostate cancer. We searched MEDLINE for randomized trials of prostate cancer, published from 1996 to 2016 and included prostate RT as one of the intervention arms. We assessed if the investigators reported the ten criteria adequately in the trial reports: RT dose prescription method; RT dose-planning procedures; organs at risk (OAR) dose constraints; target volume definition, simulation procedures; treatment verification procedures; total RT dose; fractionation schedule; conduct of quality assurance (QA) as well as presence or absence of deviations in RT treatment planning and delivery. We performed multivariate logistic regression to determine the factors that may influence the quality of reporting. We found 59 eligible trials. There was significant variability in the quality of reporting. Target volume definition, total RT dose and fractionation schedule were reported adequately in 97% of included trials. OAR constraints, simulation procedures and presence or absence of deviations in RT treatment planning and delivery were reported adequately in 30% of included trials. Twenty-four trials (40%) reported seven criteria or more adequately. Multivariable logistic analysis showed that trials that published their quality assurance results and cooperative group trials were more likely to have adequate quality in reporting in at least seven criteria. There is significant variability in the quality of reporting on prostate radiotherapy treatment in randomized trials of prostate cancer. We need to have consensus guidelines to standardize the reporting of radiotherapy treatment in randomized trials.

Prevalence of kidney stones and associated risk factors in the Shunyi District of Beijing, China.

PubMed

Jiang, Y G; He, L H; Luo, G T; Zhang, X D

2017-10-01

Kidney stone formation is a multifactorial condition that involves interaction of environmental and genetic factors. Presence of kidney stones is strongly related to other diseases, which may result in a heavy economic and social burden. Clinical data on the prevalence and influencing factors in kidney stone disease in the north of China are scarce. In this study, we explored the prevalence of kidney stone and potentially associated risk factors in the Shunyi District of Beijing, China. A population-based cross-sectional study was conducted from December 2011 to November 2012 in a northern area of China. Participants were interviewed in randomly selected towns. Univariate analysis of continuous and categorical variables was first performed by calculation of Spearman's correlation coefficient and Pearson Chi squared value, respectively. Variables with statistical significance were further analysed by multivariate logistic regression to explore the potential influencing factors. A total of 3350 participants (1091 males and 2259 females) completed the survey and the response rate was 99.67%. Among the participants, 3.61% were diagnosed with kidney stone. Univariate analysis showed that significant differences were evident in 31 variables. Blood and urine tests were performed in 100 randomly selected patients with kidney stone and 100 healthy controls. Serum creatinine, calcium, and uric acid were significantly different between the patients with kidney stone and healthy controls. Multivariate logistic regression revealed that being male (odds ratio=102.681; 95% confidence interval, 1.062-9925.797), daily intake of white spirits (6.331; 1.204-33.282), and a history of urolithiasis (1797.775; 24.228-133 396.982) were factors potentially associated with kidney stone prevalence. Male gender, drinking white spirits, and a history of urolithiasis are potentially associated with kidney stone formation.

Use of Simvastatin and Risk of Acute Pancreatitis: A Nationwide Case-Control Study in Taiwan.

PubMed

Lin, Chih-Ming; Liao, Kuan-Fu; Lin, Cheng-Li; Lai, Shih-Wei

2017-07-01

The correlation between simvastatin use and acute pancreatitis is explored. A case-control study was conducted to analyze claim data from the Taiwan National Health Insurance Program. The case group comprising a total of 3882 subjects aged 20 to 84 years with their first acute pancreatitis episode occurring between 1998 and 2011 formed the case group, against 3790 randomly selected controls matched for sex, age, comorbidities, and index year of acute pancreatitis diagnosis. Recent use of simvastatin was defined as subjects whose last remaining simvastatin tablet was noted ≤7 days before the date of acute pancreatitis diagnosis. Remote use of simvastatin was defined as subjects whose last remaining 1 tablet for simvastatin was noted >7 days before the date of acute pancreatitis diagnosis. Never use of simvastatin was defined as subjects who had never been prescribed simvastatin. A multivariable unconditional logistic regression model was used to estimate the odds ratio and 95%CI to explore the correlation between simvastatin use and acute pancreatitis. After adjustment for confounders, multivariable logistic regression analysis revealed that the adjusted odds ratio of acute pancreatitis was 1.3 for subjects with recent use of simvastatin (95%CI 1.02, 1.73), when compared with those with never use of simvastatin. The crude odds ratio decreased to 1.1 for those with remote use of simvastatin (95%CI 0.93, 1.34) but without statistical significance. Recent use of simvastatin is associated with acute pancreatitis. Clinicians should consider the possibility of simvastatin-associated acute pancreatitis for patients presenting for acute pancreatitis without known cause. © 2017, The American College of Clinical Pharmacology.

Characteristics of Adults Who Switched From Cigarette Smoking to E-cigarettes.

PubMed

Park, Su Hyun; Duncan, Dustin T; Shahawy, Omar El; Lee, Lily; Shearston, Jenni A; Tamura, Kosuke; Sherman, Scott E; Weitzman, Michael

2017-11-01

Because of the rapidly increasing use of electronic cigarettes (e-cigarettes), this study aimed to investigate the individual characteristics and state-level prevalence of U.S. adults who have switched to e-cigarettes from traditional cigarettes. Data from the 2012-2013 and 2013-2014 National Adult Tobacco Surveys were analyzed in 2016. Relative percent change in switching was estimated, and the state-specific prevalence of adults who switched to e-cigarettes from traditional cigarettes was calculated and mapped. Multivariate logistic regression was conducted to examine how switching varied by sociodemographic subgroups and region. Overall, the number of individuals who switched from traditional cigarettes to e-cigarettes increased by approximately 100% over the 1-year interval. Significant increases were found among a number of sociodemographics and regions. Multivariate logistic regression analyses showed that young adults and those living in the South and West were more likely to switch to e-cigarettes, compared to former smokers who did not switch. Compared with current dual users, those with higher education and those who were not single were more likely to switch to e-cigarettes. The state with the highest prevalence of switching was New Mexico (7.3%), whereas Connecticut had the lowest prevalence (0.8 %) among former smokers. There is an increase in the progression from traditional cigarette use to e-cigarette use. Further research is warranted to determine whether this change continues and facilitates cigarette smoking cessation as a possible public health benefit and opportunity to save lives rather than constitutes a potential threat to public health. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Socio-demographic correlates of participation in mammography: a survey among women aged between 35- 69 in Tehran, Iran.

PubMed

Samah, Asnarulkhadi Abu; Ahmadian, Maryam

2012-01-01

The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio- demographic predictors of mammography utilization among participants. The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (P <0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P <0.05)with mammography participation. The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women after adjusting for all other demographic variables in the model.

Is maternal education a social vaccine for childhood malaria infection? A cross-sectional study from war-torn Democratic Republic of Congo.

PubMed

Ma, Cary; Claude, Kasereka Masumbuko; Kibendelwa, Zacharie Tsongo; Brooks, Hannah; Zheng, Xiaonan; Hawkes, Michael

2017-03-01

In zones of violent conflict in the tropics, social disruption leads to elevated child mortality, of which malaria is the leading cause. Understanding the social determinants of malaria transmission may be helpful to optimize malaria control efforts. We conducted a cross-sectional study of healthy children aged 2 months to 5 years attending well-child and/or immunization visits in the Democratic Republic of Congo (DRC). Six hundred and forty-seven children were tested for malaria antigenemia by rapid diagnostic test and the accompanying parent or legal guardian simultaneously completed a survey questionnaire related to demographics, socioeconomic status, maternal education, as well as bednet use and recent febrile illness. We examined the associations between variables using multivariable logistic regression analysis, chi-squared statistic, Fisher's exact test, and Spearman's rank correlation, as appropriate. One hundred and twenty-three out of the 647 (19%) children in the study tested positive for malaria. Higher levels of maternal education were associated with a lower risk of malaria in their children. The prevalence of malaria in children of mothers with no education, primary school, and beyond primary was 41/138 (30%), 41/241 (17%), and 39/262 (15%), respectively (p = 0.001). In a multivariable logistic regression model adjusting for the effect of a child's age and study site, the following remained significant predictors of malaria antigenemia: maternal education, number of children under five per household, and HIV serostatus. Higher maternal education, through several putative causal pathways, was associated with lower malaria prevalence among children in the DRC. Our findings suggest that maternal education might be an effective 'social vaccine' against malaria in the DRC and globally.

Prevalence of Substance Use among Lesbian, Gay, Bisexual, and Transgender Youth in Military Families: Findings from the California Healthy Kids Survey.

PubMed

De Pedro, Kris Tunac; Shim-Pelayo, Holly

2018-01-05

In addition to the challenges associated with military life, lesbian, gay, bisexual, and transgender (LGBT) youth in military families may face stressors associated with having a stigmatized sexual orientation and/or gender identity or expression, placing them at risk of substance use. To the authors' knowledge, this is the first study exploring substance use outcomes among LGBT youth in military families. This study assessed the role of military connection, LGB identity, and transgender identity on lifetime and past 30-day substance use. This study is a secondary data analysis of the 2013-2015 California Healthy Kids Survey (CHKS). The study's participants (n = 634,978) were students attending middle and high schools in nearly all school districts in California. The study outcomes were lifetime and past 30-day cigarette, alcohol, tobacco, and marijuana use. Chi-square tests of associations (including cross-tabulations) and multivariate logistic regressions were conducted to address the study aims. Multivariate logistic regression results indicated that military connection, LGB identity, and transgender identity were significantly associated with an increased odd of lifetime and past 30-day substance use. Compared to military non-transgender youth, military transgender youth had an increased likelihood of past 30-day cigarette use and past 30-day alcohol use. In addition, military LGB youth were 3.62 times as likely as military non-LGB youth to report past 30-day cigarette use. Conclusions/Importance: This study provides researchers with knowledge about the behavioral health of LGBT youth in military families, a vulnerable subgroup within the military-connected youth population, thus informing substance use prevention programs.

Increased risk of SSEs in bone-only metastatic breast cancer patients treated with zoledronic acid.

PubMed

Yanae, Masashi; Fujimoto, Shinichiro; Tane, Kaori; Tanioka, Maki; Fujiwara, Kimiko; Tsubaki, Masanobu; Yamazoe, Yuzuru; Morishima, Yoshiyuki; Chiba, Yasutaka; Takao, Shintaro; Komoike, Yoshifumi; Tsurutani, Junji; Nakagawa, Kazuhiko; Nishida, Shozo

2017-09-01

Bone represents one of the most common sites to which breast cancer cells metastasize. Patients experience skeletal related adverse events (pathological fractures, spinal cord compressions, and irradiation for deteriorated pain on bone) even during treatment with zoledronic acid (ZA). Therefore, we conducted a retrospective cohort study to investigate the predictive factors for symptomatic skeletal events (SSEs) in bone-metastasized breast cancer (b-MBC) patients. We retrospectively collected data on b-MBC patients treated with ZA. Patient characteristics, including age, subtype, the presence of non-bone lesions, the presence of multiple bone metastases at the commencement of ZA therapy, duration of ZA therapy, the time interval between breast cancer diagnosis and the initiation of ZA therapy, and type of systemic therapy, presence of previous SSE were analyzed using multivariable logistic regression analysis. The medical records of 183 patients were reviewed and 176 eligible patients were analyzed. The median age was 59 (range, 30-87) years. Eighty-seven patients were aged ≥60 years and 89 patients were aged < 60 years. The proportions of patients with estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2-positive disease were 81.8%, 63.1%, and 17.6%, respectively. Fifty-three patients had bone-only MBC at the commencement of ZA therapy. SSEs were observed in 42 patients. In the multivariable logistic regression analysis, bone-only MBC but not a breast cancer subtype was an independent risk factor for an SSE during ZA therapy (odds ratio: 3.878, 95% confidence interval: 1.647-9.481; p = 0.002). Bone-only MBC patients are more likely to experience an SSE even after treatment with ZA.

Implementation of Evidence-Based Practice in Relation to a Clinical Nursing Ladder System: A National Survey in Taiwan

PubMed Central

Weng, Yi-Hao; Chen, Chiehfeng; Kuo, Ken N; Yang, Chun-Yuh; Lo, Heng-Lien; Chen, Kee-Hsin; Chiu, Ya-Wen

2015-01-01

Background Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. Methods A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. Results Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. Linking Evidence to Action The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation. PMID:25588625

Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design.

PubMed

Jebena, Mulusew G; Taha, Mohammed; Nakajima, Motohiro; Lemieux, Andrine; Lemessa, Fikre; Hoffman, Richard; Tesfaye, Markos; Belachew, Tefera; Workineh, Netsanet; Kebede, Esayas; Gemechu, Teklu; Tariku, Yinebeb; Segni, Hailemariam; Kolsteren, Patrick; al'Absi, Mustafa

2015-10-08

There are compelling theoretical and empirical reasons that link household food insecurity to mental distress in the setting where both problems are common. However, little is known about their association during pregnancy in Ethiopia. A cross-sectional study was conducted to examine the association of household food insecurity with mental distress during pregnancy. Six hundred and forty-two pregnant women were recruited from 11 health centers and one hospital. Probability proportional to size (PPS) and consecutive sampling techniques were employed to recruit study subjects until the desired sample size was obtained. The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress and a 9-item Household Food Insecurity Access Scale was used to measure food security status. Descriptive and inferential statistics were computed accordingly. Multivariate logistic regression was used to estimate the effect of food insecurity on mental distress. Fifty eight of the respondents (9%) were moderately food insecure and 144 of the respondents (22.4%) had mental distress. Food insecurity was also associated with mental distress. Pregnant women living in food insecure households were 4 times more likely to have mental distress than their counterparts (COR = 3.77, 95% CI: 2.17, 6.55). After controlling for confounders, a multivariate logistic regression model supported a link between food insecurity and mental distress (AOR = 4.15, 95% CI: 1.67, 10.32). The study found a significant association between food insecurity and mental distress. However, the mechanism by which food insecurity is associated with mental distress is not clear. Further investigation is therefore needed to understand either how food insecurity during pregnancy leads to mental distress or weather mental distress is a contributing factor in the development of food insecurity.

Predictors of Post-Traumatic Stress Disorder among Victims of Serious Motor Vehicle Accidents

PubMed Central

Khodadadi-Hassankiadeh, Naema; Dehghan Nayeri, Nahid; Shahsavari, Hooman; Yousefzadeh-Chabok, Shahrokh; Haghani, Hamid

2017-01-01

ABSTRACT Background: Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder (PTSD) is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident. Methods: This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report (PSS), Beck Depression Inventory (BDI-II), and the Numeric Rating Scale (NRS) for pain. The data were analyzed in SPSS (Version 19) using Chi-square, Fischer’s exact test and multivariate logistic regression. Significance level was considered P≤0.05. Results: The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age (P=0.02), sex (P<0.001), education level (P<0.001), work status (P<0.001) and PTSD. Participants who reported pain (P<0.001) and depression (P<0.001) were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident. Conclusion: This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community. PMID:29043281

Prevalence of Diabetes and Associated Factors in the Uyghur and Han Population in Xinjiang, China.

PubMed

Gong, Haiying; Pa, Lize; Wang, Ke; Mu, Hebuli; Dong, Fen; Ya, Shengjiang; Xu, Guodong; Tao, Ning; Pan, Li; Wang, Bin; Shan, Guangliang

2015-10-14

To estimate the prevalence of diabetes and identify risk factors in the Uyghur and Han population in Xinjiang, China. A cross-sectional study in urban and rural areas in Xinjiang, including 2863 members of the Uyghur population and 3060 of the Han population aged 20 to 80 years, was conducted from June 2013 to August 2013. Data on fasting plasma glucose (FPG) and personal history of diabetes were used to estimate the prevalence of diabetes. Data on demographic characteristics, lifestyle risk factors, and lipid profiles were collected to identify risks factors using the multivariate logistic regression model. In urban areas, the age- and gender-standardized prevalence of diabetes was 8.21%, and the age- and gender-standardized prevalence of diabetes was higher in the Uyghur population (10.47%) than in the Han population (7.36%). In rural areas, the age- and gender-standardized prevalence of diabetes was 6.08%, and it did not differ significantly between the Uyghur population (5.71%) and the Han population (6.59%). The results of the multivariate logistic regression analysis showed that older age, obesity, high triglycerides (TG), and hypertension were all associated with an increased risk of diabetes in the Uyghur and Han population. Urban residence and low high-density lipoprotein cholesterol (HDL-C) were associated with an increased risk of diabetes in the Uyghur population. Being an ex-drinker was associated with an increased risk of diabetes and heavy physical activity was associated with a decreased risk of diabetes in the Han population. Our study indicates that diabetes is more prevalent in the Uyghur population compared with the Han population in urban areas. Strategies aimed at the prevention of diabetes require ethnic targeting.

A retrospective study: Multivariate logistic regression analysis of the outcomes after pressure sores reconstruction with fasciocutaneous, myocutaneous, and perforator flaps.

PubMed

Chiu, Yu-Jen; Liao, Wen-Chieh; Wang, Tien-Hsiang; Shih, Yu-Chung; Ma, Hsu; Lin, Chih-Hsun; Wu, Szu-Hsien; Perng, Cherng-Kang

2017-08-01

Despite significant advances in medical care and surgical techniques, pressure sore reconstruction is still prone to elevated rates of complication and recurrence. We conducted a retrospective study to investigate not only complication and recurrence rates following pressure sore reconstruction but also preoperative risk stratification. This study included 181 ulcers underwent flap operations between January 2002 and December 2013 were included in the study. We performed a multivariable logistic regression model, which offers a regression-based method accounting for the within-patient correlation of the success or failure of each flap. The overall complication and recurrence rates for all flaps were 46.4% and 16.0%, respectively, with a mean follow-up period of 55.4 ± 38.0 months. No statistically significant differences of complication and recurrence rates were observed among three different reconstruction methods. In subsequent analysis, albumin ≤3.0 g/dl and paraplegia were significantly associated with higher postoperative complication. The anatomic factor, ischial wound location, significantly trended toward the development of ulcer recurrence. In the fasciocutaneous group, paraplegia had significant correlation to higher complication and recurrence rates. In the musculocutaneous flap group, variables had no significant correlation to complication and recurrence rates. In the free-style perforator group, ischial wound location and malnourished status correlated with significantly higher complication rates; ischial wound location also correlated with significantly higher recurrence rate. Ultimately, our review of a noteworthy cohort with lengthy follow-up helped identify and confirm certain risk factors that can facilitate a more informed and thoughtful pre- and postoperative decision-making process for patients with pressure ulcers. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Is maternal education a social vaccine for childhood malaria infection? A cross-sectional study from war-torn Democratic Republic of Congo

PubMed Central

Ma, Cary; Claude, Kasereka Masumbuko; Kibendelwa, Zacharie Tsongo; Brooks, Hannah; Zheng, Xiaonan; Hawkes, Michael

2017-01-01

In zones of violent conflict in the tropics, social disruption leads to elevated child mortality, of which malaria is the leading cause. Understanding the social determinants of malaria transmission may be helpful to optimize malaria control efforts. We conducted a cross-sectional study of healthy children aged 2 months to 5 years attending well-child and/or immunization visits in the Democratic Republic of Congo (DRC). Six hundred and forty-seven children were tested for malaria antigenemia by rapid diagnostic test and the accompanying parent or legal guardian simultaneously completed a survey questionnaire related to demographics, socioeconomic status, maternal education, as well as bednet use and recent febrile illness. We examined the associations between variables using multivariable logistic regression analysis, chi-squared statistic, Fisher’s exact test, and Spearman’s rank correlation, as appropriate. One hundred and twenty-three out of the 647 (19%) children in the study tested positive for malaria. Higher levels of maternal education were associated with a lower risk of malaria in their children. The prevalence of malaria in children of mothers with no education, primary school, and beyond primary was 41/138 (30%), 41/241 (17%), and 39/262 (15%), respectively (p = 0.001). In a multivariable logistic regression model adjusting for the effect of a child’s age and study site, the following remained significant predictors of malaria antigenemia: maternal education, number of children under five per household, and HIV serostatus. Higher maternal education, through several putative causal pathways, was associated with lower malaria prevalence among children in the DRC. Our findings suggest that maternal education might be an effective ‘social vaccine’ against malaria in the DRC and globally. PMID:28220714

High-risk sexual behavior among people living with HIV/AIDS attending tertiary care hospitals in district of Northern India

PubMed Central

Shukla, Mukesh; Agarwal, Monica; Singh, Jai Vir; Tripathi, Anil Kumar; Srivastava, Anand Kumar; Singh, Vijay Kumar

2016-01-01

Context: Prevention with a positive approach has been advocated as one of the main strategies to diminish the new instances of HIV and the target are those who are engaged in high-risk sexual behavior. Therefore, understanding the risky behaviors of the HIV-infected individual is important. Aims: This study aimed to assess the prevalence and the predictors of high-risk sexual behavior among people living with HIV/AIDS (PLHA). Settings and Design: A hospital-based cross-sectional study was conducted at antiretroviral therapy centers of two tertiary care hospitals in Lucknow. Materials and Methods: A total of 322 HIV-positive patients were interviewed about their sexual behaviors during last 3 months using a pretested questionnaire. Statistical Analysis Used: Probability (p) was calculated to test for statistical significance at 5% level of significance. Association between risk factors and high-risk sexual behavior was determined using bivariate analysis followed by multivariate logistic regression. Results: Prevalence of high-risk sexual behavior was 24.5%. Of these patients, multiple sexual partners were reported by 67.3% whereas about 46.9% were engaged in unprotected sex. Multivariate logistic regression analysis revealed that high-risk sexual behavior was significantly associated with nonsupporting attitude of spouse (odds ratio [OR]: 18; 95% confidence interval [CI]: 1.4–225.5; P = 0.02) and alcohol consumption (OR: 9.3; 95% CI: 2.4–35.4; P = 0.001). Conclusions: Specific intervention addressing alcohol consumption and encouragement of spouse and family support should be integrated in the routine HIV/AIDS care and treatment apart from HIV transmission and prevention knowledge. PMID:27190412

The impact of pediatric obesity on hospitalized children with lower respiratory tract infections in the United States.

PubMed

Okubo, Yusuke; Nochioka, Kotaro; Testa, Marcia A

2018-04-01

Obesity is the most common public health problem and is a clinically complicating risk factor among hospitalized children. The impact of pediatric obesity on the severity and morbidity of lower respiratory tract infections remains unclear. We conducted a retrospective cohort study of bronchitis and pneumonia among children aged 2-20 years using hospital discharge records. The data were obtained from the Kid's Inpatient Database in 2003, 2006, 2009, and 2012, and were weighted to estimate the number of hospitalizations in the United States. We used the International Classification of Diseases, Ninth Revision, Clinical Modification code (278.0×) to classify whether the patient was obese or not. We investigated the associations between pediatric obesity and use of mechanical ventilation using multivariable logistic regression model. In addition, we ascertained the relationships between pediatric obesity, comorbid blood stream infections, mean healthcare cost, and length of hospital stay. We estimated a total of 133 602 hospitalizations with pneumonia and bronchitis among children aged between 2 and 20 years. Obesity was significantly associated with use of mechanical ventilation (adjusted OR 2.90, 95% CI 2.15-3.90), comorbid bacteremia or septicemia (adjusted OR 1.58, 95% CI 1.03-2.44), elevated healthcare costs (adjusted difference $383, 95%CI $276-$476), and prolonged length of hospital stay (difference 0.32 days, 95%CI 0.23-0.40 days), after adjusting for patient and hospital characteristics using multivariable logistic regression models. Pediatric obesity is an independent risk factor for severity and morbidity among pediatric patients with lower respiratory tract infections. These findings suggest the importance of obesity prevention for pediatric populations. © 2017 John Wiley & Sons Ltd.

Use of dental services by immigration status in the United States.

PubMed

Wilson, Fernando A; Wang, Yang; Stimpson, Jim P; McFarland, Kimberly K; Singh, Karan P

2016-03-01

There is limited research with mixed findings comparing differences in oral health outcomes and the use of dental services by immigration status. The authors conducted a study by reviewing nationally representative data to describe differences in dental care among noncitizens, naturalized citizens, and US-born citizens in the United States. The authors used nationally representative data from the 2008-2012 Medical Expenditure Panel Survey to examine dental care for US-born citizens, naturalized citizens, and noncitizens 18 years and older. Total analytical sample size was 98,107 adults. They used multivariate logistic regression to model dental service use adjusting for confounding factors. Naturalized citizens and noncitizens were significantly less likely to have at least 1 dental visit within 12 months (39.5% and 23.1%, respectively) compared with US-born citizens (43.6%; P < .001). Among users, a smaller proportion of comprehensive examination visits were for naturalized citizens and noncitizens (75.9% and 71.4%, respectively) compared with US-born citizens (82.8%; P < .01). Noncitizen visits to dentists were also more likely to involve tooth extraction compared with those of US-born citizens (11.3% versus 8.8%; P < .01). Multivariate logistic regression suggests both non- and naturalized citizens had lower adjusted odds of having a comprehensive examination compared with US-born citizens during a visit (P < .01). Noncitizens and naturalized citizens had a lower rate of dental service use, and noncitizens were more likely to have had tooth extraction compared with US-born citizens. Increased outreach efforts tailored to noncitizens and naturalized citizens who are at high risk of experiencing dental problems are needed, particularly to address misperceptions on the necessity of preventive dental visits. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

Blended learning in situated contexts: 3-year evaluation of an online peer review project.

PubMed

Bridges, S; Chang, J W W; Chu, C H; Gardner, K

2014-08-01

Situated and sociocultural perspectives on learning indicate that the design of complex tasks supported by educational technologies holds potential for dental education in moving novices towards closer approximation of the clinical outcomes of their expert mentors. A cross-faculty-, student-centred, web-based project in operative dentistry was established within the Universitas 21 (U21) network of higher education institutions to support university goals for internationalisation in clinical learning by enabling distributed interactions across sites and institutions. This paper aims to present evaluation of one dental faculty's project experience of curriculum redesign for deeper student learning. A mixed-method case study approach was utilised. Three cohorts of second-year students from a 5-year bachelor of dental surgery (BDS) programme were invited to participate in annual surveys and focus group interviews on project completion. Survey data were analysed for differences between years using multivariate logistical regression analysis. Thematic analysis of questionnaire open responses and interview transcripts was conducted. Multivariate logistic regression analysis noted significant differences across items over time indicating learning improvements, attainment of university aims and the positive influence of redesign. Students perceived the enquiry-based project as stimulating and motivating, and building confidence in operative techniques. Institutional goals for greater understanding of others and lifelong learning showed improvement over time. Despite positive scores, students indicated global citizenship and intercultural understanding were conceptually challenging. Establishment of online student learning communities through a blended approach to learning stimulated motivation and intellectual engagement, thereby supporting a situated approach to cognition. Sociocultural perspectives indicate that novice-expert interactions supported student development of professional identities. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Variation in ICU Utilization and Mortality After Blunt Splenic Injury

PubMed Central

Kaufman, Elinore J.; Wiebe, Douglas J.; Martin, Niels D.; Pascual, Jose L.; Reilly, Patrick M.; Holena, Daniel N.

2016-01-01

Background While trauma patients are frequently cared for in the ICU, admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. Materials and Methods We conducted a retrospective cohort study of patients treated for blunt splenic injuries at 30 level I and II Pennsylvania trauma centers, 2011–2014. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman’s rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement, between high- and low-ICU-utilization centers. Results Of 2,587 patients with blunt splenic injuries, 63.9% (1,654) were admitted to the ICU. Median injury severity score (ISS) was 17 overall, 13 for non-ICU patients and 17 for ICU patients (p < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9% to 87.3%. Risk-adjusted mortality rates ranged from 1.2% to 9.6%. There was no correlation between O:E ratios for ICU utilization and mortality (rs = −0.2595, p=0.2103). Proportionately fewer ICU patients at high-utilization centers received critical care procedures than at low-utilization centers. Conclusions Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. PMID:27363642

Assessing the Role of Environmental Conditions on Efficacy Rates of Heterorhabditis indica (Nematoda: Heterorhabditidae) for Controlling Aethina tumida (Coleoptera: Nitidulidae) in Honey Bee (Hymenoptera: Apidae) Colonies: a Citizen Science Approach.

PubMed

Hill, Elizabeth S; Smythe, Ashleigh B; Delaney, Deborah A

2016-02-01

Certain species of entomopathogenic nematodes, such as Heterorhabditis indica Poinar, Karunakar & David, have the potential to be effective controls for Aethina tumida (Murray), or small hive beetles, when applied to the soil surrounding honey bee (Apis mellifera L.) hives. Despite the efficacy of H. indica, beekeepers have struggled to use them successfully as a biocontrol. It is believed that the sensitivity of H. indica to certain environmental conditions is the primary reason for this lack of success. Although research has been conducted to explore the impact of specific environmental conditions--such as soil moisture or soil temperature-on entomopathogenic nematode infectivity, no study to date has taken a comprehensive approach that considers the impact of multiple environmental conditions simultaneously. In exploring this, a multivariate logistic regression model was used to determine what environmental conditions resulted in reductions of A. tumida populations in honey bee colonies. To obtain the sample sizes necessary to run a multivariate logistic regression, this study utilized citizen scientist beekeepers and their hives from across the mid-Atlantic region of the United States. Results suggest that soil moisture, soil temperatures, sunlight exposure, and groundcover contribute to the efficacy of H. indica in reducing A. tumida populations in A. mellifera colonies. The results of this study offer direction for future research on the environmental preferences of H. indica and can be used to educate beekeepers about methods for better utilizing H. indica as a biological control. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

PubMed

Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

2017-07-01

Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

High prevalence of anemia in 10-month-old Japanese infants with breastfeeding.

PubMed

Kimura, Masahiko; Kurozawa, Youichi; Saito, Yumi; Watanabe, Hiroshi; Kobayashi, Ayame; Taketani, Takeshi

2018-05-05

Anemia in infancy is still prevalent in developing countries. Commercial iron-fortified complementary foods or iron drops are not available in Japan and breastfed infants have a higher risk of anemia. We studied anemia screening in infants in 10-month old infants and evaluated whether breastfeeding is a risk factor for anemia. Anemia screening was performed during a regular health check of 10-month children at four local pediatric clinics in Shimane prefecture, Japan. Venous blood was obtained for complete blood count. The clinical characteristics of each child were obtained through a questionnaire. Anemia was defined as a hemoglobin level < 11.0 g/dL. Children were categorized into anemia and no-anemia and univariate analyses were conducted to compare with clinical variables. Multivariate logistic regression analyses for anemia were performed to adjust for several clinical variables. We analyzed data in 325 children. In the univariate analyses, anemia was associated with breastfeeding, monthly body weight gain and gestational week. Multivariate logistic regression analyses revealed that anemia was associated with feeding type and gestational week, where the odds ratio (OR) of partial breastfeeding and formula feeding was 0.446 (95% confidential interval [CI], 0.208-0.957) and 0.223 ([CI], 0.075-0.660) respectively, compared to exclusive breastfeeding, in which the OR was taken as 1.0 and the OR of gestational week was 0.753 ([CI], 0583-0.972). Breastfeeding was an important factor for anemia in 10-month-old Japanese infants. Breastfed infants after 6 months of age may need sufficient iron sources such as iron supplements or iron fortified complimentary foods. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Self-reported mental health among US military personnel prior and subsequent to the terrorist attacks of September 11, 2001.

PubMed

Smith, Tyler C; Smith, Besa; Corbeil, Thomas E; Riddle, James R; Ryan, Margaret A K

2004-08-01

There is much concern over the potential for short- and long-term adverse mental health effects caused by the terrorist attacks on September 11, 2001. This analysis used data from the Millennium Cohort Study to identify subgroups of US military members who enrolled in the cohort and reported their mental health status before the traumatic events of September 11 and soon after September 11. While adjusting for confounding, multivariable logistic regression, analysis of variance, and multivariate ordinal, or polychotomous logistic regression were used to compare 18 self-reported mental health measures in US military members who enrolled in the cohort before September 11, 2001 with those military personnel who enrolled after September 11, 2001. In contrast to studies of other populations, military respondents reported fewer mental health problems in the months immediately after September 11, 2001.

Associations among Obesity, Eating Speed, and Oral Health

PubMed Central

Sonoda, Chikanobu; Fukuda, Hideki; Kitamura, Masayasu; Hayashida, Hideaki; Kawashita, Yumiko; Furugen, Reiko; Koyama, Zenya; Saito, Toshiyuki

2018-01-01

Objective This study was conducted to understand how eating speed and oral health condition are associated with obesity in Japanese working men. Methods We studied a total of 863 men attending an annual medical checkup of the Japanese Maritime Self Defense Force in Sasebo City, Japan. Participants answered a questionnaire about their eating speed, and we examined their anthropometric status in terms of BMI, waist circumference, and oral health condition, especially periodontal disease and number of functional teeth. Multivariate logistic regression analyses adjusting for potential confounding variables were performed. Results The multivariate-adjusted odds ratio for waist circumference greater than 90 cm of the ‘very fast’ group compared to the ‘slow, very slow’ group was 5.22 (95% confidence interval 1.81–15.06) after adjusting for potential confounding factors. Individuals were more likely to have waist circumference greater than 90 cm if they had a larger ‘number of missing functional teeth’ (odds ratio 1.14; 95% confidence interval 1.01–1.28) and severe periodontal disease (odds ratio 2.74; 95% confidence interval, 1.46–5.13). Conclusion Eating speed, the number of missing functional teeth, and severe periodontal disease are associated independently with larger waist circumference. PMID:29669358

Insight and suicidality in psychosis: A cross-sectional study.

PubMed

Massons, Carmen; Lopez-Morinigo, Javier-David; Pousa, Esther; Ruiz, Ada; Ochoa, Susana; Usall, Judith; Nieto, Lourdes; Cobo, Jesus; David, Anthony S; Dutta, Rina

2017-06-01

We aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders. 143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted. Those subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of "disturbed thinking and loss of control over the situation" and "having a vague feeling that something is wrong") were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality. Suicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality. Copyright © 2017. Published by Elsevier B.V.

Predictors of readmission after successful electroconvulsive therapy for depression: a chart review study.

PubMed

Uchida, Takahito; Kishimoto, Taishiro; Koreki, Akihiro; Nakao, Shigetsugu; Owada, Ai; Koizumi, Teruki; Saito, Atsuyuki; Sato, Minako; Sawada, Shinya; Matsuzaki, Ryuta; Petrides, Georgios; Mimura, Masaru

2016-11-01

The study aimed to identify the predictors for readmission after a successful electroconvulsive therapy (ECT) course. Medical charts of patients who received ECT for major depressive episodes were reviewed. Patients' demographic characteristics and treatment parameters, such as ECT charge, seizure duration, the number of ECT sessions and pharmacotherapy, were extracted. We compared differences between those who were readmitted after successful ECT within 6 and 12 months, versus those not readmitted. We also conducted a multivariate logistic regression analysis to identify the predictors for readmission. Out of 51 patients who were discharged after ECT, 27 patients met the inclusion criteria and were included in the analysis. Eight patients were readmitted within 6 months after discharge, and four more patients were readmitted during the next 6-month follow up. Comparing patients who were and were not readmitted, we found no significant differences between groups, including ECT parameters such as the number of ECT sessions, average charge and final charge. No predictors for readmission were found through multivariate analysis. Although patients who require higher ECT charge and more sessions seem to be prone to readmission, our dataset suggested that none of these types of ECT parameters were risk factors for readmission.

Associations of Adolescent Hopelessness and Self-Worth With Pregnancy Attempts and Pregnancy Desire

PubMed Central

Fedorowicz, Anna R.; Schreiner, Pamela J.; Bolland, John M.

2014-01-01

Objectives. We examined the associations of pregnancy desire (ambivalence or happiness about a pregnancy in the next year) and recent pregnancy attempts with hopelessness and self-worth among low-income adolescents. Methods. To evaluate independent associations among the study variables, we conducted gender-stratified multivariable logistic regression analyses with data derived from 2285 sexually experienced 9- to 18-year-old participants in the Mobile Youth Survey between 2006 and 2009. Results. Fifty-seven percent of youths reported a desire for pregnancy and 9% reported pregnancy attempts. In multivariable analyses, hopelessness was positively associated and self-worth was negatively associated with pregnancy attempts among both female and male youths. Hopelessness was weakly associated (P = .05) with pregnancy desire among female youths. Conclusions. The negative association of self-worth and the positive association of hopelessness with pregnancy attempts among young men as well as young women and the association of hopelessness with pregnancy desire among young women raise questions about why pregnancy is apparently valued by youths who rate their social and cognitive competence as low and who live in an environment with few options for material success. PMID:24922147

Eye donation - awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia.

PubMed

Bhandary, Sulatha; Khanna, Rajesh; Rao, Krishna A; Rao, Lavanya G; Lingam, Kamala D; Binu, V

2011-01-01

Corneal blindness accounts for 3.42% of blindness in Malaysia; the rate of eye donation is low. The aim of the study was to assess the awareness about eye donation and willingness to donate eyes among attendants of patients at various clinics in Melaka, Malaysia. This observational study was conducted on attendants who accompanied patients (n = 400) visiting various outpatient departments of the General Hospital and two peripheral clinics in Melaka between August and October 2007. The participants answered a questionnaire (Malay and English versions) which included demographic profile, awareness of eye donation, knowledge regarding facts of eye donation, and willingness to donate eyes. Univariate and multivariate logistic regression was performed at 5% level of significance. Awareness of eye donation was observed in 276 (69%) participants. Multivariate analysis showed that awareness was more among females when compared to males (P = 0.009). Of the 276 participants who were aware of eye donation, only 34.42% were willing to donate eyes. Willingness was more among the Indian race (P = 0.02) and males (P = 0.02). Educational status did not influence the willingness to donate eyes. Although majority of participants were aware of eye donation, willingness to donate eyes was poor.

Comparison of Xenon-Enhanced Area-Detector CT and Krypton Ventilation SPECT/CT for Assessment of Pulmonary Functional Loss and Disease Severity in Smokers.

PubMed

Ohno, Yoshiharu; Fujisawa, Yasuko; Takenaka, Daisuke; Kaminaga, Shigeo; Seki, Shinichiro; Sugihara, Naoki; Yoshikawa, Takeshi

2018-02-01

The objective of this study was to compare the capability of xenon-enhanced area-detector CT (ADCT) performed with a subtraction technique and coregistered 81m Kr-ventilation SPECT/CT for the assessment of pulmonary functional loss and disease severity in smokers. Forty-six consecutive smokers (32 men and 14 women; mean age, 67.0 years) underwent prospective unenhanced and xenon-enhanced ADCT, 81m Kr-ventilation SPECT/CT, and pulmonary function tests. Disease severity was evaluated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. CT-based functional lung volume (FLV), the percentage of wall area to total airway area (WA%), and ventilated FLV on xenon-enhanced ADCT and SPECT/CT were calculated for each smoker. All indexes were correlated with percentage of forced expiratory volume in 1 second (%FEV 1 ) using step-wise regression analyses, and univariate and multivariate logistic regression analyses were performed. In addition, the diagnostic accuracy of the proposed model was compared with that of each radiologic index by means of McNemar analysis. Multivariate logistic regression showed that %FEV 1 was significantly affected (r = 0.77, r 2 = 0.59) by two factors: the first factor, ventilated FLV on xenon-enhanced ADCT (p < 0.0001); and the second factor, WA% (p = 0.004). Univariate logistic regression analyses indicated that all indexes significantly affected GOLD classification (p < 0.05). Multivariate logistic regression analyses revealed that ventilated FLV on xenon-enhanced ADCT and CT-based FLV significantly influenced GOLD classification (p < 0.0001). The diagnostic accuracy of the proposed model was significantly higher than that of ventilated FLV on SPECT/CT (p = 0.03) and WA% (p = 0.008). Xenon-enhanced ADCT is more effective than 81m Kr-ventilation SPECT/CT for the assessment of pulmonary functional loss and disease severity.

The combination of ovarian volume and outline has better diagnostic accuracy than prostate-specific antigen (PSA) concentrations in women with polycystic ovarian syndrome (PCOs).

PubMed

Bili, Eleni; Bili, Authors Eleni; Dampala, Kaliopi; Iakovou, Ioannis; Tsolakidis, Dimitrios; Giannakou, Anastasia; Tarlatzis, Basil C

2014-08-01

The aim of this study was to determine the performance of prostate specific antigen (PSA) and ultrasound parameters, such as ovarian volume and outline, in the diagnosis of polycystic ovary syndrome (PCOS). This prospective, observational, case-controlled study included 43 women with PCOS, and 40 controls. Between day 3 and 5 of the menstrual cycle, fasting serum samples were collected and transvaginal ultrasound was performed. The diagnostic performance of each parameter [total PSA (tPSA), total-to-free PSA ratio (tPSA:fPSA), ovarian volume, ovarian outline] was estimated by means of receiver operating characteristic (ROC) analysis, along with area under the curve (AUC), threshold, sensitivity, specificity as well as positive (+) and negative (-) likelihood ratios (LRs). Multivariate logistical regression models, using ovarian volume and ovarian outline, were constructed. The tPSA and tPSA:fPSA ratio resulted in AUC of 0.74 and 0.70, respectively, with moderate specificity/sensitivity and insufficient LR+/- values. In the multivariate logistic regression model, the combination of ovarian volume and outline had a sensitivity of 97.7% and a specificity of 97.5% in the diagnosis of PCOS, with +LR and -LR values of 39.1 and 0.02, respectively. In women with PCOS, tPSA and tPSA:fPSA ratio have similar diagnostic performance. The use of a multivariate logistic regression model, incorporating ovarian volume and outline, offers very good diagnostic accuracy in distinguishing women with PCOS patients from controls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Association among stress, personality traits, and sleep bruxism in children.

PubMed

Serra-Negra, Junia M; Paiva, Saul M; Flores-Mendoza, Carmen E; Ramos-Jorge, Maria L; Pordeus, Isabela A

2012-01-01

The purpose of this study was to determine the association among stress levels, personality traits, and sleep bruxism in children. A population-based case control study (proportion=1:2) was conducted involving 120 7- to 11-year-olds with sleep bruxism and 240 children without sleep bruxism. The sample was randomly selected from schools in Belo Horizonte, Minas Gerais, Brazil. The following instruments were used for data collection: questionnaire administered to parents; child stress scale; and neuroticism and responsibility scales of the big five questionnaire for children. Psychological tests were administered and evaluated by psychologists. Sleep bruxism was diagnosed from parents' reports. The chi-square test, as well as binary and multivariate logistic regression, was applied for statistical analysis. In the adjusted logistic model, children with a high level of stress, due to psychological reactions (odds ratio=1.8; confidence interval=1.1-2.9) and a high sense of responsibility (OR=1.6; CI=1.0-2.5) vs those with low levels of these psychological traits, presented a nearly 2-fold greater chance of exhibiting the habit of sleep bruxism. High levels of stress and responsibility are key factors in the development of sleep bruxism among children.

Exploring Audiologists' Language and Hearing Aid Uptake in Initial Rehabilitation Appointments.

PubMed

Sciacca, Anna; Meyer, Carly; Ekberg, Katie; Barr, Caitlin; Hickson, Louise

2017-06-13

The study aimed (a) to profile audiologists' language during the diagnosis and management planning phase of hearing assessment appointments and (b) to explore associations between audiologists' language and patients' decisions to obtain hearing aids. Sixty-two audiologist-patient dyads participated. Patient participants were aged 55 years or older. Hearing assessment appointments were audiovisually recorded and transcribed for analysis. Audiologists' language was profiled using two measures: general language complexity and use of jargon. A binomial, multivariate logistic regression analysis was conducted to investigate the associations between these language measures and hearing aid uptake. The logistic regression model revealed that the Flesch-Kincaid reading grade level of audiologists' language was significantly associated with hearing aid uptake. Patients were less likely to obtain hearing aids when audiologists' language was at a higher reading grade level. No associations were found between audiologists' use of jargon and hearing aid uptake. Audiologists' use of complex language may present a barrier for patients to understand hearing rehabilitation recommendations. Reduced understanding may limit patient participation in the decision-making process and result in patients being less willing to trial hearing aids. Clear, concise language is recommended to facilitate shared decision making.

Factors associated with adult poisoning in northern Malaysia: a case-control study.

PubMed

Fathelrahman, A I; Ab Rahman, A F; Zain, Z Mohd; Tengku, M A

2006-04-01

Data on adult risk factors associated with drug or chemical poisonings in Malaysia are scarce. The objective of the study was to identify possible risk factors associated with adult admissions to the Penang General Hospital (PGH) due to chemical poisoning and/or drug overdose. The present study was a case-control study, conducted over 18 weeks. One hundred acutely poisoned adult patients admitted to PGH during the period from September 2003 to February 2004 were considered as cases. Two hundred patients admitted to the same medical wards for other illnesses, during the same period, were matched for age and gender with the poisoned cases and thus selected as controls. McNemar test and binary logistic were used for univariate analysis and logistic regression analysis for multivariate analyses. The odds ratio (OR) and its 95% confidence interval (95% CI) were calculated for each predictor variable. Positive histories of psychiatric illness and previous poisoning, problems in boy/girl friend relationships, family problems, marital problems, Indian ethnicity, Chinese ethnicity, living in rented houses and living in a household with less than five people were significant risk factors associated with adult admissions due to poisoning.

Evaluating associations between sources of information, knowledge of the human papillomavirus, and human papillomavirus vaccine uptake for adult women in California.

PubMed

Almeida, Cristina M; Tiro, Jasmin A; Rodriguez, Michael A; Diamant, Allison L

2012-04-19

Vaccines have the potential to reduce morbidity from HPV infections if age-eligible patients receive and parents know about them. Content analyses have demonstrated significant range in the quality of HPV information obtained from different sources. The purpose of this study was to determine the pattern of associations between information source and level of knowledge about HPV and vaccine receipt/intention. We analyzed the 2007 California Health Interview Survey, a population-based, statewide random digit dial survey, using data on adult females ages 18-65 who had heard about HPV (n=16,806). One-way ANOVA and multivariate logistic regression assessed the associations between source of information (advertisement only, advertisement plus other sources, and non-advertisement sources) and knowledge of HPV (3 or greater correct on a 4-point scale). Multivariate logistic regressions were conducted on a subsample of vaccine-eligible women and parents to assess vaccine uptake or intention. Less than half of respondents (43%) correctly answered 3 or more of the HPV knowledge questions. Mean knowledge scores were significantly different when comparing women who reported advertisement only, non-advertisement, and advertisement plus other sources of information (p<0.001). In multivariate analysis, women who reported non-advertisement sources (OR 2.44, 95% CI 2.07-2.87) and advertisements plus other sources (OR 3.03, 95% CI 2.57-3.58) were more likely to have knowledge scores above the 75% level than women who relied on advertisements alone. In the subsample of vaccine-eligible women and parents, those who reported advertisements plus other sources (OR 1.85, 95% CI 1.30-2.62) were more likely to have received or intend to receive the vaccine than those who reported advertisements as their sole information source. Advertisements are the most commonly reported source of information about HPV, and while they inform women of the existence of the vaccine, they do not contribute to accurate knowledge about the virus, nor do they appear to influence vaccine uptake. Other sources may play a larger role in refining knowledge and/or improving uptake. Copyright © 2012 Elsevier Ltd. All rights reserved.

Association between breastfeeding duration, non-nutritive sucking habits and dental arch dimensions in deciduous dentition: a cross-sectional study.

PubMed

Agarwal, Shiv Shankar; Nehra, Karan; Sharma, Mohit; Jayan, Balakrishna; Poonia, Anish; Bhattal, Hiteshwar

2014-10-31

This cross-sectional retrospective study was conducted to determine association between breastfeeding duration, non-nutritive sucking habits, dental arch transverse diameters, posterior crossbite and anterior open bite in deciduous dentition. 415 children (228 males and 187 females), 4 to 6 years old, from a mixed Indian population were clinically examined. Based on written questionnaire answered by parents, children were divided into two groups: group 1 (breastfed for <6 months (n = 158)) and group 2 (breastfed for ≥6 months (n = 257)). The associations were analysed using chi-square test (P < 0.05 taken as statistically significant). Odds ratio (OR) was calculated to determine the strength of associations tested. Multivariate logistic regression analysis was done for obtaining independent predictors of posterior crossbite and maxillary and mandibular IMD (Inter-molar distance) and ICD (Inter-canine distance). Non-nutritive sucking (NNS) was present in 15.18% children (20.3% in group 1 as compared to 12.1% in group 2 (P = 0.024)). The average ICD and IMD in maxilla and average IMD in mandible were significantly higher among group 2 as compared to group 1 (P < 0.01). In mandible, average ICD did not differ significantly between the two groups (P = 0.342). The distribution of anterior open bite did not differ significantly between the two groups (P = 0.865). The distribution of posterior crossbite was significantly different between the two groups (P = 0.001). OR assessment (OR = 1.852) revealed that group 1 had almost twofold higher prevalence of NNS habits than group 2. Multivariate logistic regression analysis revealed that the first group had independently fourfold increased risk of developing crossbite compared to the second group (OR = 4.3). Multivariate linear regression analysis also revealed that age and breastfeeding duration were the most significant determinants of ICD and IMD. An increased prevalence of NNS in the first group suggests that NNS is a dominant variable in the association between breastfeeding duration and reduced intra-arch transverse diameters which leads to increased prevalence of posterior crossbites as seen in our study. Mandibular inter-canine width is however unaffected due to a lowered tongue posture seen in these children.

Impacts of rising health care costs on families with employment-based private insurance: a national analysis with state fixed effects.

PubMed

Yu, Hao; Dick, Andrew W

2012-10-01

Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern. Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996-2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses. The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution. Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families. © Health Research and Educational Trust.

Impacts of Rising Health Care Costs on Families with Employment-Based Private Insurance: A National Analysis with State Fixed Effects

PubMed Central

Yu, Hao; Dick, Andrew W

2012-01-01

Background Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern. Methods Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996–2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses. Results The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution. Conclusions Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families. PMID:22417314

Low Serum Levels of Uric Acid are Associated With Development of Poststroke Depression.

PubMed

Gu, Yingying; Han, Bin; Wang, Liping; Chang, Yaling; Zhu, Lin; Ren, Wenwei; Yan, Mengjiao; Zhang, Xiangyang; He, Jincai

2015-11-01

Poststroke depression (PSD) is a frequent complication of stroke that has been associated with poorer outcome of stroke patients. This study sought to examine the possible association between serum uric acid levels and the development of PSD.We recruited 196 patients with acute ischemic stroke and 100 healthy volunteers. Serum uric acid levels were tested by uricase-PAP method within 24 hr after admission. Neuropsychological evaluations were conducted at 3-month poststroke. The 17-item Hamilton Depression Scale was used to assess depressive symptoms. Diagnosis of PSD was made in accordance with DSM-IV criteria for depression. Multivariate analyses were conducted using logistic regression models.Fifty-six patients (28.6%) were diagnosed as having PSD at 3 months. PSD patients showed significantly lower levels of uric acid at baseline as compared to non-PSD patients (237.02 ± 43.43 vs 309.10 ± 67.44 μmol/L, t = -8.86, P < 0.001). In multivariate analyses, uric acid levels (≤239.0 and ≥328.1 μmol/L) were independently associated with the development of PSD (OR, 7.76; 95% confidence interval [CI], 2.56-23.47, P < 0.001 and OR, 0.05; 95% CI, 0.01-0.43, P = 0.01, respectively) after adjustment for possible variables.Serum uric acid levels at admission are found to be correlated with PSD and may predict its development at 3 months after stroke.

Anger expression, violent behavior, and symptoms of depression among male college students in Ethiopia

PubMed Central

Terasaki, Dale J; Gelaye, Bizu; Berhane, Yemane; Williams, Michelle A

2009-01-01

Background Depression is an important global public health problem. Given the scarcity of studies involving African youths, this study was conducted to evaluate the associations of anger expression and violent behavior with symptoms of depression among male college students. Methods A self-administered questionnaire was used to collect information on socio-demographic and lifestyle characteristics and violent behavior among 1,176 college students in Awassa, Ethiopia in June, 2006. The questionnaire incorporated the Spielberger Anger-Out Expression (SAOE) scale and symptoms of depression were evaluated using the Patient Health Questionnaire (PHQ-9). Multivariable logistic regression procedures were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (95%CI). Results Symptoms of depression were evident in 23.6% of participants. Some 54.3% of students reported committing at least one act of violence in the current academic year; and 29.3% of students reported high (SAOE score ≥ 15) levels of anger-expression. In multivariate analysis, moderate (OR = 1.97; 95%CI 1.33–2.93) and high (OR = 3.23; 95%CI 2.14–4.88) outward anger were statistically significantly associated with increased risks of depressive symptoms. Violent behavior was noted to be associated with depressive symptoms (OR = 1.82; 95%CI 1.37–2.40). Conclusion Further research should be conducted to better characterize community and individual level determinants of anger-expression, violent behavior and depression among youths. PMID:19138431

Factors Predicting Ethiopian Anesthetists' Intention to Leave Their Job.

PubMed

Kols, Adrienne; Kibwana, Sharon; Molla, Yohannes; Ayalew, Firew; Teshome, Mihereteab; van Roosmalen, Jos; Stekelenburg, Jelle

2018-05-01

Ethiopia has rapidly expanded training programs for associate clinician anesthetists in order to address shortages of anesthesia providers. However, retaining them in the public health sector has proven challenging. This study aimed to determine anesthetists' intentions to leave their jobs and identify factors that predict turnover intentions. A nationally representative, cross-sectional survey of 251 anesthetists working in public-sector hospitals in Ethiopia was conducted in 2014. Respondents were asked whether they planned to leave the job in the next year and what factors they considered important when making decisions to quit. Bivariate and multivariable logistic regressions were conducted to investigate 16 potential predictors of turnover intentions, including personal and facility characteristics as well as decision-making factors. Almost half (n = 120; 47.8%) of anesthetists planned to leave their jobs in the next year, and turnover intentions peaked among those with 2-5 years of experience. Turnover intentions were not associated with the compulsory service obligation. Anesthetists rated salary and opportunities for professional development as the most important factors in decisions to quit. Five predictors of turnover intentions were significant in the multivariable model: younger age, working at a district rather than regional or referral hospital, the perceived importance of living conditions, opportunities for professional development, and conditions at the workplace. Human resources strategies focused on improving living conditions for anesthetists and expanding professional development opportunities may increase retention. Special attention should be focused on younger anesthetists and those posted at district hospitals.

LANDSCAPE METRICS THAT ARE USEFUL FOR EXPLAINING ESTUARINE ECOLOGICAL RESPONSES

EPA Science Inventory

We investigated whether land use/cover characteristics of watersheds associated with estuaries exhibit a strong enough signal to make landscape metrics useful for predicting estuarine ecological condition. We used multivariate logistic regression models to discriminate between su...

Predictors of early breastfeeding initiation among mothers of children under 24 months of age in rural part of West Ethiopia.

PubMed

Hailemariam, Tsedeke Wolde; Adeba, Emiru; Sufa, Alem

2015-10-21

The World Health Organization recommends initiation of breastfeeding within the first hour after childbirth. In developing countries alone, early initiation of breastfeeding could save as many as 1.45 million lives each year by reducing deaths mainly due to diarrheal disorders and lower respiratory tract infections in children. The current study aimed to determine the rate and the predictors of breastfeeding initiation in East Wollega Zones of West Ethiopia. A community-based, cross-sectional study was conducted from April to May 2014 among 594 mothers who had children less than 24 months. Multi stage cluster sampling method was used to select the study population. Eligible mothers were invited to interview using pretested questionnaires to gather data regarding sociodemographics, health-related variables, breastfeeding initiation, and current breastfeeding practices. A multivariable logistic regression analysis was used to identify independent predictors of early initiation of breastfeeding after controlling for confounding variables. A sample of 593 mothers was included in the study. Breastfeeding was initiated by 83.1 % of mothers within the first hour of childbirth. Being a housewife (AOR (95 % CI) = 2.48 (1.54- 3.99)) and infant received colostrum (AOR (95 % CI) =2.22 (1.08-4.55)) were significant positive predictors for early breastfeeding initiation as revealed by logistic regression. The multivariable logistic regression analysis showed that the mothers who had no radio and/or TV in the household (AOR (95 % CI = 0.55 (0.35-0.88)), were not exposure to health information (AOR (95 % CI) = 0.44 (0.25-0.75)), and infants were provided with prelacteal feeds (AOR (95 % CI)=0.30 (0.14-0.65)) were less likely to initiate breastfeeding. The rate of timely initiation of breastfeeding was high. Breastfeeding promotion program is essential to encourage the practice of timely initiation of breastfeeding, and reduce the practice of providing prelacteal feeds within three days of life. Thus appropriate health information is vital to boost early initiation of breastfeeding.

Contribution of spoken language and socio-economic background to adolescents' educational achievement at age 16 years.

PubMed

Spencer, Sarah; Clegg, Judy; Stackhouse, Joy; Rush, Robert

2017-03-01

Well-documented associations exist between socio-economic background and language ability in early childhood, and between educational attainment and language ability in children with clinically referred language impairment. However, very little research has looked at the associations between language ability, educational attainment and socio-economic background during adolescence, particularly in populations without language impairment. To investigate: (1) whether adolescents with higher educational outcomes overall had higher language abilities; and (2) associations between adolescent language ability, socio-economic background and educational outcomes, specifically in relation to Mathematics, English Language and English Literature GCSE grade. A total of 151 participants completed five standardized language assessments measuring vocabulary, comprehension of sentences and spoken paragraphs, and narrative skills and one nonverbal assessment when between 13 and 14 years old. These data were compared with the participants' educational achievement obtained upon leaving secondary education (16 years old). Univariate logistic regressions were employed to identify those language assessments and demographic factors that were associated with achieving a targeted A * -C grade in English Language, English Literature and Mathematics General Certificate of Secondary Education (GCSE) at 16 years. Further logistic regressions were then conducted to examine further the contribution of socio-economic background and spoken language skills in the multivariate models. Vocabulary, comprehension of sentences and spoken paragraphs, and mean length utterance in a narrative task along with socio-economic background contributed to whether participants achieved an A * -C grade in GCSE Mathematics and English Language and English Literature. Nonverbal ability contributed to English Language and Mathematics. The results of multivariate logistic regressions then found that vocabulary skills were particularly relevant to all three GCSE outcomes. Socio-economic background only remained important for English Language, once language assessment scores and demographic information were considered. Language ability, and in particular vocabulary, plays an important role for educational achievement. Results confirm a need for ongoing support for spoken language ability throughout secondary education and a potential role for speech and language therapy provision in the continuing drive to reduce the gap in educational attainment between groups from differing socio-economic backgrounds. © 2016 Royal College of Speech and Language Therapists.

Who continues to stock oral artemisinin monotherapy? Results of a provider survey in Myanmar.

PubMed

Thein, Si Thu; Sudhinaraset, May; Khin, Hnin Su Su; McFarland, Willi; Aung, Tin

2016-06-22

Artemisinin-based combination therapy (ACT) is a key strategy for global malaria elimination efforts. However, the development of artemisinin-resistant malaria parasites threatens progress and continued usage of oral artemisinin monotherapies (AMT) predisposes the selection of drug resistant strains. This is particularly a problem along the Myanmar/Thailand border. The artemisinin monotherapy replacement programme (AMTR) was established in 2012 to remove oral AMT from stocks in Myanmar, specifically by replacing oral AMT with quality-assured ACT and conducting behavioural change communication activities to the outlets dispensing anti-malarial medications. This study attempts to quantify the characteristics of outlet providers who continue to stock oral AMT despite these concerted efforts. A cross-sectional survey of all types of private sector outlets that were stocking anti-malarial drugs in 13 townships of Eastern Myanmar was implemented from July to August 2014. A total of 573 outlets were included. Bivariate and multivariable logistic regressions were conducted to assess outlet and provider-level characteristics associated with stocking oral AMT. In total, 2939 outlets in Eastern Myanmar were screened for presence of any anti-malarial drugs in August 2014. The study found that 573 (19.5 %) had some kind of oral anti-malarial drug in stock at the time of survey and among them, 96 (16.8 %) stocked oral AMT. In bivariate analyses, compared to health care facilities, itinerant drug vendors, retailers and health workers were less likely to stock oral AMT (33.3 vs 12.9, 10.0, 8.1 %, OR = 0.30, 0.22, 0.18, respectively). Providers who cut blister pack or sell partial courses (40.6 vs 11.7 %, OR 5.18, CI 3.18-8.44) and those who based their stock decision on consumer demand (32.8 vs 12.1 %, OR 3.54, CI 2.21-5.63) were more likely to stock oAMT. Multivariate logistic regressions produced similar significant associations. Private healthcare facilities and drug shops and providers who prioritize consumers' demand instead of recommended practices were more likely to stock oral AMT. Malaria elimination strategies should include targeted interventions to effectively reach those outlets.

The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study

PubMed Central

Maignien, Chloé; Gayet, Vanessa; Pocate-Cheriet, Khaled; Marcellin, Louis; Chapron, Charles

2018-01-01

Background Controlled ovarian stimulation in assisted reproduction technology (ART) may alters endometrial receptivity by an advancement of endometrial development. Recently, technical improvements in vitrification make deferred frozen-thawed embryo transfer (Def-ET) a feasible alternative to fresh embryo transfer (ET). In endometriosis-related infertility the eutopic endometrium is abnormal and its functional alterations are seen as likely to alter the quality of endometrial receptivity. One question in the endometriosis ART-management is to know whether Def-ET could restore optimal receptivity in endometriosis-affected women leading to increase in pregnancy rates. Objective To compare cumulative ART-outcomes between fresh versus Def-ET in endometriosis-infertile women. Materials and methods This matched cohort study compared def-ET strategy to fresh ET strategy between 01/10/2012 and 31/12/2014. One hundred and thirty-five endometriosis-affected women with a scheduled def-ET cycle and 424 endometriosis-affected women with a scheduled fresh ET cycle were eligible for matching. Matching criteria were: age, number of prior ART cycles, and endometriosis phenotype. Statistical analyses were conducted using univariable and multivariable logistic regression models. Results 135 in the fresh ET group and 135 in the def-ET group were included in the analysis. The cumulative clinical pregnancy rate was significantly increased in the def-ET group compared to the fresh ET group [58 (43%) vs. 40 (29.6%), p = 0.047]. The cumulative ongoing pregnancy rate was 34.8% (n = 47) and 17.8% (n = 24) respectively in the Def-ET and the fresh-ET groups (p = 0.005). After multivariable conditional logistic regression analysis, Def-ET was associated with a significant increase in the cumulative ongoing pregnancy rate as compared to fresh ET (OR = 1.76, CI95% 1.06–2.92, p = 0.028). Conclusion Def-ET in endometriosis-affected women was associated with significantly higher cumulative ongoing pregnancy rates. Our preliminary results suggest that Def-ET for endometriosis-affected women is an attractive option that could increase their ART success rates. Future studies, with a randomized design, should be conducted to further confirm those results. PMID:29630610

Evaluation of risk factors for perforated peptic ulcer.

PubMed

Yamamoto, Kazuki; Takahashi, Osamu; Arioka, Hiroko; Kobayashi, Daiki

2018-02-15

The aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU). At St. Luke's International Hospital in Tokyo, Japan, a case control study was performed between August 2004 and March 2016. All patients diagnosed with PPU were included. As control subjects, patients with age, sex and date of CT scan corresponding to those of the PPU subjects were included in the study at a proportion of 2 controls for every PPU subject. All data such as past medical histories, physical findings, and laboratory data were collected through chart reviews. Univariate analyses and multivariate analyses with logistic regression were conducted, and receiver operating characteristic curves (ROCs) were calculated to show validity. Sensitivity analyses were performed to confirm results using a stepwise method and conditional logistic regression. A total of 408 patients were included in this study; 136 were a group of patients with PPU, and 272 were a control group. Univariate analysis showed statistical significance in many categories. Four different models of multivariate analyses were conducted, and significant differences were found for muscular defense and a history of peptic ulcer disease (PUD) in all models. The conditional forced-entry analysis of muscular defense showed an odds ratio (OR) of 23.8 (95% confidence interval [CI]: 5.70-100.0), and the analysis of PUD history showed an OR of 6.40 (95% CI: 1.13-36.2). The sensitivity analysis showed consistent results, with an OR of 23.8-366.2 for muscular defense and an OR of 3.67-7.81 for PUD history. The area under the curve (AUC) of all models was high enough to confirm the results. However, anticoagulants, known risk factors for PUD, did not increase the risk for PPU in our study. The conditional forced-entry analysis of anticoagulant use showed an OR of 0.85 (95% CI: 0.03-22.3). The evaluation of prediction factors and development of a prediction rule for PPU may help our decision making in performing a CT scan for patients with acute abdominal pain.

An exploration of the relationship between youth assets and engagement in risky sexual behaviors.

PubMed

Evans, Alexandra E; Sanderson, Maureen; Griffin, Sarah F; Reininger, Belinda; Vincent, Murray L; Parra-Medina, Debra; Valois, Robert F; Taylor, Doug

2004-11-01

To examine the relationship between specific youth assets and adolescents' engagement in risky sexual behaviors, as measured by an Aggregate Sexual Risk score, and to specifically explore which youth assets and demographic variables were predictive of youth engagement in risky sexual intercourse. A total of 2108 sexually active high school students attending public high schools in a southern state completed a self-report questionnaire that measured youth assets. Based upon responses to items measuring risk behaviors, an Aggregate Sexual Risk score was calculated for each student. Unconditional logistic regression and multivariate logistic regression analyses were conducted to examine the relationships between the assets and the Aggregate Risk Score. Four separate analyses (white females, white males, black females, and black males) were conducted. In general, the patterns in all four groups indicated that students who had an Aggregate Risk Score of > or = 3 (high risk) possessed less of the measured youth assets. The assets that were most significantly associated with engagement in risky sexual behaviors included self peer values regarding risky behaviors, quantity of other adult support, and youths' empathetic relationships. Thus, students who reported not having these assets were significantly more likely to engage in the risky sexual behaviors. Results underscore the relationship of specific youth assets to sexual risk behaviors. Health researcher and practitioners who work to prevent teen pregnancy and sexually transmitted infections among teenagers need to understand and acknowledge these factors within this population so that the assets can be built or strengthened.

Age-Specific Prevalence of and Risk Factors for Anal Human Papillomavirus (HPV) among Men Who Have Sex with Women and Men Who Have Sex with Men: The HPV in Men (HIM) Study

PubMed Central

Carvalho da Silva, Roberto J.; Baggio, Maria Luiza; Lu, Beibei; Smith, Danélle; Abrahamsen, Martha; Papenfuss, Mary; Villa, Luisa L.; Lazcano-Ponce, Eduardo; Giuliano, Anna R.

2011-01-01

Background. An increasing incidence of anal cancer among men suggests a need to better understand anal canal human papillomavirus (HPV) infection among human immunodeficiency virus–negative men. Methods. Genotyping for HPV was conducted on cells from the anal canal among men who have sex with women (MSW) and men who have sex with men (MSM), aged 18–70 years, from Brazil, Mexico, and the United States. Factors associated with anal HPV infection were assessed using multivariable logistic regression. Results. The prevalence of any HPV type and oncogenic HPV types did not differ by city. Anal canal HPV prevalence was 12.2% among 1305 MSW and 47.2% among 176 MSM. Among MSW, reporting a lifetime number of ≥10 female sex partners, a primary sexual relationship <1 year in duration, and a prior hepatitis B diagnosis were independently associated with detection of any anal HPV in multivariable analysis. Among MSM, a younger age, reporting ≥2 male anal sex partners in the past 3 months, and never using a condom for anal sex in the past 6 months were independently associated with detection of any anal HPV in multivariable analysis. Conclusions. Number of sex partners was associated with anal HPV infection in both MSW and MSM. Anal HPV infection in men may be mediated by age, duration of sexual relationship, and condom use. PMID:21148496

Anxiety, worry and cognitive risk estimate in relation to protective behaviors during the 2009 influenza A/H1N1 pandemic in Hong Kong: ten cross-sectional surveys

PubMed Central

2014-01-01

Background Few studies have investigated associations between psychological and behavioral indices throughout a major epidemic. This study was aimed to compare the strength of associations between different cognitive and affective measures of risk and self-reported protective behaviors in a series of ten cross-sectional surveys conducted throughout the first wave of influenza A/H1N1 pandemic. Methods All surveys were conducted using questionnaire-based telephone interviews, with random digit dialing to recruit adults from the general population. Measures of anxiety and worry (affective) and perceived risk (cognitive) regarding A/H1N1 were made in 10 serial surveys. Multivariate logistic regression models were used to estimate the cognitive/affective-behavioral associations in each survey while multilevel logistic models were conducted to estimate the average effects of each cognitive/affective measure on adoption of protective behaviors throughout the ten surveys. Results Excepting state anxiety, other affective measures including “anticipated worry”, “experienced worry” and “current worry” specific to A/H1N1 risk were consistently and strongly associated with adoption of protective behaviors across different survey periods. However, the cognitive-behavioral associations were weaker and inconsistent across the ten surveys. Perceived A/H1N1 severity relative to SARS had stronger associations with adoption of protective behaviors in the late epidemic periods than in the early epidemic periods. Conclusion Risk-specific worries appear to be significantly associated with the adoption of protective behaviors at different epidemic stages, whereas cognitive measures may become more important in understanding people’s behavioral responses later in epidemics. Future epidemic-related psycho-behavioral research should include more affective-loaded measures of risk. PMID:24674239

Lameness detection in dairy cattle: single predictor v. multivariate analysis of image-based posture processing and behaviour and performance sensing.

PubMed

Van Hertem, T; Bahr, C; Schlageter Tello, A; Viazzi, S; Steensels, M; Romanini, C E B; Lokhorst, C; Maltz, E; Halachmi, I; Berckmans, D

2016-09-01

The objective of this study was to evaluate if a multi-sensor system (milk, activity, body posture) was a better classifier for lameness than the single-sensor-based detection models. Between September 2013 and August 2014, 3629 cow observations were collected on a commercial dairy farm in Belgium. Human locomotion scoring was used as reference for the model development and evaluation. Cow behaviour and performance was measured with existing sensors that were already present at the farm. A prototype of three-dimensional-based video recording system was used to quantify automatically the back posture of a cow. For the single predictor comparisons, a receiver operating characteristics curve was made. For the multivariate detection models, logistic regression and generalized linear mixed models (GLMM) were developed. The best lameness classification model was obtained by the multi-sensor analysis (area under the receiver operating characteristics curve (AUC)=0.757±0.029), containing a combination of milk and milking variables, activity and gait and posture variables from videos. Second, the multivariate video-based system (AUC=0.732±0.011) performed better than the multivariate milk sensors (AUC=0.604±0.026) and the multivariate behaviour sensors (AUC=0.633±0.018). The video-based system performed better than the combined behaviour and performance-based detection model (AUC=0.669±0.028), indicating that it is worthwhile to consider a video-based lameness detection system, regardless the presence of other existing sensors in the farm. The results suggest that Θ2, the feature variable for the back curvature around the hip joints, with an AUC of 0.719 is the best single predictor variable for lameness detection based on locomotion scoring. In general, this study showed that the video-based back posture monitoring system is outperforming the behaviour and performance sensing techniques for locomotion scoring-based lameness detection. A GLMM with seven specific variables (walking speed, back posture measurement, daytime activity, milk yield, lactation stage, milk peak flow rate and milk peak conductivity) is the best combination of variables for lameness classification. The accuracy on four-level lameness classification was 60.3%. The accuracy improved to 79.8% for binary lameness classification. The binary GLMM obtained a sensitivity of 68.5% and a specificity of 87.6%, which both exceed the sensitivity (52.1%±4.7%) and specificity (83.2%±2.3%) of the multi-sensor logistic regression model. This shows that the repeated measures analysis in the GLMM, taking into account the individual history of the animal, outperforms the classification when thresholds based on herd level (a statistical population) are used.

The Joint Effects of Lifestyle Factors and Comorbidities on the Risk of Colorectal Cancer: A Large Chinese Retrospective Case-Control Study

PubMed Central

Hu, Hai; Zhou, Yangyang; Ren, Shujuan; Wu, Jiajin; Zhu, Meiying; Chen, Donghui; Yang, Haiyan; Wang, Liwei

2015-01-01

Background Colorectal cancer (CRC) is a major cause of cancer morbidity and mortality. In previous epidemiologic studies, the respective correlation between lifestyle factors and comorbidity and CRC has been extensively studied. However, little is known about their joint effects on CRC. Methods We conducted a retrospective case-control study of 1,144 diagnosed CRC patients and 60,549 community controls. A structured questionnaire was administered to the participants about their socio-demographic factors, anthropometric measures, comorbidity history and lifestyle factors. Logistic regression model was used to calculate the odds ratio (ORs) and 95% confidence intervals (95%CIs) for each factor. According to the results from logistic regression model, we further developed healthy lifestyle index (HLI) and comorbidity history index (CHI) to investigate their independent and joint effects on CRC risk. Results Four lifestyle factors (including physical activities, sleep, red meat and vegetable consumption) and four types of comorbidity (including diabetes, hyperlipidemia, history of inflammatory bowel disease and polyps) were found to be independently associated with the risk of CRC in multivariant logistic regression model. Intriguingly, their combined pattern- HLI and CHI demonstrated significant correlation with CRC risk independently (ORHLI: 3.91, 95%CI: 3.13–4.88; ORCHI: 2.49, 95%CI: 2.11–2.93) and jointly (OR: 10.33, 95%CI: 6.59–16.18). Conclusions There are synergistic effects of lifestyle factors and comorbidity on the risk of colorectal cancer in the Chinese population. PMID:26710070

Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention.

PubMed

Agha, Sohail

2011-11-30

Demand-side financing projects are now being implemented in many developing countries, yet evidence showing that they reach the poor is scanty. A maternal health voucher scheme provided voucher-paid services in Jhang, a predominantly rural district of Pakistan, during 2010. A pre-test/post-test quasi-experimental design was used to assess the changes in the proportion of facility-based deliveries and related maternal health services among the poor. Household interviews were conducted with randomly selected women in the intervention and control union councils, before and after the intervention.A strong outreach model was used. Voucher promoters were given basic training in identification of poor women using the Poverty Scorecard for Pakistan, in the types of problems women could face during delivery, and in the promotion of antenatal care (ANC), institutional delivery and postnatal care (PNC). Voucher booklets valued at Rs. 4,000 ($48), including three ANC visits, a PNC visit, an institutional delivery, and a postnatal family planning visit, were sold for Rs. 100 ($1.2) to low-income women targeted by project outreach workers. Women suffering from complications were referred to emergency obstetric care services.Analysis was conducted at the bivariate and the multivariate levels. At the multivariate level, logistic regression analysis was conducted to determine whether the increase in institutional delivery was greater among poor women (defined for this study as women in the fourth or fifth quintiles) relative to non-poor women (defined for this study as women in the first quintile) in the intervention union councils compared to the control union councils. Bivariate analysis showed significant increases in the institutional delivery rate among women in the fourth or fifth wealth quintiles in the intervention union councils but no significant changes in this indicator among women in the same wealth quintiles in the control union councils. Multivariate analysis showed that the increase in institutional delivery among poor women relative to non-poor women was significantly greater in the intervention compared to the control union councils. Demand-side financing projects using vouchers can be an effective way of reducing inequities in institutional delivery.

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

PubMed

Gong, Xu; Cui, Jianli; Jiang, Ziping; Lu, Laijin; Li, Xiucun

2018-03-01

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction. © 2017 Royal Australasian College of Surgeons.

Artificial neural network, genetic algorithm, and logistic regression applications for predicting renal colic in emergency settings.

PubMed

Eken, Cenker; Bilge, Ugur; Kartal, Mutlu; Eray, Oktay

2009-06-03

Logistic regression is the most common statistical model for processing multivariate data in the medical literature. Artificial intelligence models like an artificial neural network (ANN) and genetic algorithm (GA) may also be useful to interpret medical data. The purpose of this study was to perform artificial intelligence models on a medical data sheet and compare to logistic regression. ANN, GA, and logistic regression analysis were carried out on a data sheet of a previously published article regarding patients presenting to an emergency department with flank pain suspicious for renal colic. The study population was composed of 227 patients: 176 patients had a diagnosis of urinary stone, while 51 ultimately had no calculus. The GA found two decision rules in predicting urinary stones. Rule 1 consisted of being male, pain not spreading to back, and no fever. In rule 2, pelvicaliceal dilatation on bedside ultrasonography replaced no fever. ANN, GA rule 1, GA rule 2, and logistic regression had a sensitivity of 94.9, 67.6, 56.8, and 95.5%, a specificity of 78.4, 76.47, 86.3, and 47.1%, a positive likelihood ratio of 4.4, 2.9, 4.1, and 1.8, and a negative likelihood ratio of 0.06, 0.42, 0.5, and 0.09, respectively. The area under the curve was found to be 0.867, 0.720, 0.715, and 0.713 for all applications, respectively. Data mining techniques such as ANN and GA can be used for predicting renal colic in emergency settings and to constitute clinical decision rules. They may be an alternative to conventional multivariate analysis applications used in biostatistics.

Measures of work-family conflict predict sickness absence from work.

PubMed

Clays, Els; Kittel, France; Godin, Isabelle; Bacquer, Dirk De; Backer, Guy De

2009-08-01

To examine the relation between work-family conflict and sickness absence. The BELSTRESS III study comprised 2983 middle-aged workers. Strain-based work-home interference (WHI) and home-work interference (HWI) were assessed by means of self-administered questionnaires. Prospective data of registered sickness absence during 12-months follow-up were collected. Multiple logistic regression analysis was conducted. HWI was positively and significantly related to high sickness absence duration (at least 10 sick leave days) and high sickness absence frequency (at least 3 sick leave episodes) in men and women, also after adjustments were made for sociodemographic variables, health indicators, and environmental psychosocial factors. In multivariate analysis, no association between WHI and sickness absence was found. HWI was positively and significantly related to high sickness absence duration and frequency during 12-months follow-up in male and female workers.

Perceived Discrimination, Psychological Distress, and Current Smoking Status: Results From the Behavioral Risk Factor Surveillance System Reactions to Race Module, 2004–2008

PubMed Central

Peppone, Luke J.; Alcaraz, Kassandra; McQueen, Amy; Guido, Joseph J.; Carroll, Jennifer K.; Shacham, Enbal; Morrow, Gary R.

2012-01-01

Objectives. We examined the association between perceived discrimination and smoking status and whether psychological distress mediated this relationship in a large, multiethnic sample. Methods. We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System Reactions to Race module to conduct multivariate logistic regression analyses and tests of mediation examining associations between perceived discrimination in health care and workplace settings, psychological distress, and current smoking status. Results. Regardless of race/ethnicity, perceived discrimination was associated with increased odds of current smoking. Psychological distress was also a significant mediator of the discrimination–smoking association. Conclusions. Our results indicate that individuals who report discriminatory treatment in multiple domains may be more likely to smoke, in part, because of the psychological distress associated with such treatment. PMID:22420821

Determinants of utilization of sufficient tetanus toxoid immunization during pregnancy: evidence from the Kenya Demographic and Health Survey, 2008-2009.

PubMed

Haile, Zelalem T; Chertok, Ilana R Azulay; Teweldeberhan, Asli K

2013-06-01

Although the effectiveness of tetanus toxoid (TT) immunization during pregnancy in preventing maternal and neonatal tetanus is well established, in many developing countries, TT immunization programs are underutilized. The objective of this study was to examine factors associated with sufficient TT immunization among postpartum women in Kenya. Population based secondary data analysis was conducted using de-identified data from the 2008-2009 Kenyan Demographic and Health Survey (KDHS) for 1,370 female participants who had a live birth during or within 12 months of the cross-sectional survey. Chi-square test and independent sample t test were conducted to assess bivariate associations and a multivariable logistic regression analysis was conducted to examine associations before and after adjustment for demographic, socioeconomic, cultural, and access to care factors. The main factors contributing to having been sufficiently immunized against tetanus were lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Implications for health care providers and other professionals involved in development of strategies and interventions aimed at improving immunization rates are discussed.

Victimization and Suicidality among Female College Students

ERIC Educational Resources Information Center

Leone, Janel M.; Carroll, James M.

2016-01-01

Objective: To investigate the predictive role of victimization in suicidality among college women. Participants: Female respondents to the American College Health Association National College Health Assessment II (N = 258). Methods: Multivariate logistic regression analyses examined the relationship between victimization and suicidality. Results:…

Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation.

PubMed

Li, Meng; Chen, Shicai; Wang, Wei; Chen, Donghui; Zhu, Minhui; Liu, Fei; Zhang, Caiyun; Li, Yan; Zheng, Hongliang

2014-08-01

To investigate the efficacy of laryngeal reinnervation with ansa cervicalis among unilateral vocal fold paralysis (UVFP) patients with different denervation durations. We retrospectively reviewed 349 consecutive UVFP cases of delayed ansa cervicalis to the recurrent laryngeal nerve (RLN) anastomosis. Potential influencing factors were analyzed in multivariable logistic regression analysis. Stratification analysis performed was aimed at one of the identified significant variables: denervation duration. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT), and laryngeal electromyography (EMG) were performed preoperatively and postoperatively. Gender, age, preoperative EMG status and denervation duration were analyzed in multivariable logistic regression analysis. Stratification analysis was performed on denervation duration, which was divided into three groups according to the interval between RLN injury and reinnervation: group A, 6 to 12 months; group B, 12 to 24 months; and group C, > 24 months. Age, preoperative EMG, and denervation duration were identified as significant variables in multivariable logistic regression analysis. Stratification analysis on denervation duration showed significant differences between group A and C and between group B and C (P < 0.05)-but showed no significant difference between group A and B (P > 0.05) with regard to parameters overall grade, jitter, shimmer, noise-to-harmonics ratio, MPT, and postoperative EMG. In addition, videostroboscopic and laryngeal EMG data, perceptual and acoustic parameters, and MPT values were significantly improved postoperatively in each denervation duration group (P < 0.01). Although delayed laryngeal reinnervation is proved valid for UVFP, surgical outcome is better if the procedure is performed within 2 years after nerve injury than that over 2 years. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Nomogram for prediction of level 2 axillary lymph node metastasis in proven level 1 node-positive breast cancer patients.

PubMed

Jiang, Yanlin; Xu, Hong; Zhang, Hao; Ou, Xunyan; Xu, Zhen; Ai, Liping; Sun, Lisha; Liu, Caigang

2017-09-22

The current management of the axilla in level 1 node-positive breast cancer patients is axillary lymph node dissection regardless of the status of the level 2 axillary lymph nodes. The goal of this study was to develop a nomogram predicting the probability of level 2 axillary lymph node metastasis (L-2-ALNM) in patients with level 1 axillary node-positive breast cancer. We reviewed the records of 974 patients with pathology-confirmed level 1 node-positive breast cancer between 2010 and 2014 at the Liaoning Cancer Hospital and Institute. The patients were randomized 1:1 and divided into a modeling group and a validation group. Clinical and pathological features of the patients were assessed with uni- and multivariate logistic regression. A nomogram based on independent predictors for the L-2-ALNM identified by multivariate logistic regression was constructed. Independent predictors of L-2-ALNM by the multivariate logistic regression analysis included tumor size, Ki-67 status, histological grade, and number of positive level 1 axillary lymph nodes. The areas under the receiver operating characteristic curve of the modeling set and the validation set were 0.828 and 0.816, respectively. The false-negative rates of the L-2-ALNM nomogram were 1.82% and 7.41% for the predicted probability cut-off points of < 6% and < 10%, respectively, when applied to the validation group. Our nomogram could help predict L-2-ALNM in patients with level 1 axillary lymph node metastasis. Patients with a low probability of L-2-ALNM could be spared level 2 axillary lymph node dissection, thereby reducing postoperative morbidity.

Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke in US hospitals.

PubMed

Brinjikji, W; Rabinstein, A A; McDonald, J S; Cloft, H J

2014-03-01

Previous studies have demonstrated that socioeconomic disparities in the treatment of cerebrovascular diseases exist. We studied a large administrative data base to study disparities in the utilization of mechanical thrombectomy for acute ischemic stroke. With the utilization of the Perspective data base, we studied disparities in mechanical thrombectomy utilization between patient race and insurance status in 1) all patients presenting with acute ischemic stroke and 2) patients presenting with acute ischemic stroke at centers that performed mechanical thrombectomy. We examined utilization rates of mechanical thrombectomy by race/ethnicity (white, black, and Hispanic) and insurance status (Medicare, Medicaid, self-pay, and private). Multivariate logistic regression analysis adjusting for potential confounding variables was performed to study the association between race/insurance status and mechanical thrombectomy utilization. The overall mechanical thrombectomy utilization rate was 0.15% (371/249,336); utilization rate at centers that performed mechanical thrombectomy was 1.0% (371/35,376). In the sample of all patients with acute ischemic stroke, multivariate logistic regression analysis demonstrated that uninsured patients had significantly lower odds of mechanical thrombectomy utilization compared with privately insured patients (OR = 0.52, 95% CI = 0.25-0.95, P = .03), as did Medicare patients (OR = 0.53, 95% CI = 0.41-0.70, P < .0001). Blacks had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.35, 95% CI = 0.23-0.51, P < .0001). When considering only patients treated at centers performing mechanical thrombectomy, multivariate logistic regression analysis demonstrated that insurance was not associated with significant disparities in mechanical thrombectomy utilization; however, black patients had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.41, 95% CI = 0.27-0.60, P < .0001). Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.

Association Between Duration of Breast Feeding and Metabolic Syndrome: The Korean National Health and Nutrition Examination Surveys.

PubMed

Choi, Se Rin; Kim, Yong Min; Cho, Min Su; Kim, So Hyun; Shim, Young Suk

2017-04-01

This study aimed to evaluate the association of the lifelong duration of breast feeding with metabolic syndrome (MetS) and its components in Korean parous women aged 19-50 years. A total of 4724 participants from the Korean National Health and Nutritional Survey were included. Subjects were divided into four groups according to the duration of breast feeding: ≤5, 6-11, 12-23, or ≥24 months groups. The adjusted odds ratios (ORs) of MetS and its components were assessed according to the duration of breast feeding. Women who breastfed for 6-11 months had an OR of 0.67 (95% confidence interval [CI], 0.54-0.86) for elevated blood pressure (BP) compared with those who breastfed for ≤5 months after adjustment for possible confounders in a multivariable logistic regression analyses. Women who breastfed for 12-23 months were associated with an OR of 0.68 (95% CI, 0.54-0.86) for elevated BP, an OR of 0.78 (95% CI, 0.62-0.97) for elevated glucose, and an OR of 0.73 (95% CI, 0.56-0.95) for MetS compared with those who breastfed for ≤5 months in a multivariable logistic regression analyses. Women who breastfed for ≥24 months had an OR of 0.62 (95% CI, 0.52-0.84) for elevated glucose, an OR of 0.76 (95% CI, 0.60-0.96) for elevated triglycerides, and an OR of 0.70 (95% CI, 0.53-0.92) for MetS compared with those who breastfed for ≤5 months in a multivariable logistic regression analyses. Our results suggest that lifelong breast feeding for ≥12 months may be associated with lower risk for MetS.

Quantitative fibrosis parameters highly predict esophageal-gastro varices in primary biliary cirrhosis.

PubMed

Wu, Q-M; Zhao, X-Y; You, H

2016-01-01

Esophageal-gastro Varices (EGV) may develop in any histological stages of primary biliary cirrhosis (PBC). We aim to establish and validate quantitative fibrosis (qFibrosis) parameters in portal, septal and fibrillar areas as ideal predictors of EGV in PBC patients. PBC patients with liver biopsy, esophagogastroscopy and Second Harmonic Generation (SHG)/Two-photon Excited Fluorescence (TPEF) microscopy images were retrospectively enrolled in this study. qFibrosis parameters in portal, septal and fibrillar areas were acquired by computer-assisted SHG/TPEF imaging system. Independent predictor was identified using multivariate logistic regression analysis. PBC patients with liver biopsy, esophagogastroscopy and Second Harmonic Generation (SHG)/Two-photon Excited Fluorescence (TPEF) microscopy images were retrospectively enrolled in this study. qFibrosis parameters in portal, septal and fibrillar areas were acquired by computer-assisted SHG/TPEF imaging system. Independent predictor was identified using multivariate logistic regression analysis. Among the forty-nine PBC patients with qFibrosis images, twenty-nine PBC patients with both esophagogastroscopy data and qFibrosis data were selected out for EGV prognosis analysis and 44.8% (13/29) of them had EGV. The qFibrosis parameters of collagen percentage and number of crosslink in fibrillar area, short/long/thin strings number and length/width of the strings in septa area were associated with EGV (p < 0.05). Multivariate logistic analysis showed that the collagen percentage in fibrillar area ≥ 3.6% was an independent factor to predict EGV (odds ratio 6.9; 95% confidence interval 1.6-27.4). The area under receiver operating characteristic (ROC), diagnostic sensitivity and specificity was 0.9, 100% and 75% respectively. Collagen percentage in Collagen percentage in the fibrillar area as an independent predictor can highly predict EGV in PBC patients.

Controlled pattern imputation for sensitivity analysis of longitudinal binary and ordinal outcomes with nonignorable dropout.

PubMed

Tang, Yongqiang

2018-04-30

The controlled imputation method refers to a class of pattern mixture models that have been commonly used as sensitivity analyses of longitudinal clinical trials with nonignorable dropout in recent years. These pattern mixture models assume that participants in the experimental arm after dropout have similar response profiles to the control participants or have worse outcomes than otherwise similar participants who remain on the experimental treatment. In spite of its popularity, the controlled imputation has not been formally developed for longitudinal binary and ordinal outcomes partially due to the lack of a natural multivariate distribution for such endpoints. In this paper, we propose 2 approaches for implementing the controlled imputation for binary and ordinal data based respectively on the sequential logistic regression and the multivariate probit model. Efficient Markov chain Monte Carlo algorithms are developed for missing data imputation by using the monotone data augmentation technique for the sequential logistic regression and a parameter-expanded monotone data augmentation scheme for the multivariate probit model. We assess the performance of the proposed procedures by simulation and the analysis of a schizophrenia clinical trial and compare them with the fully conditional specification, last observation carried forward, and baseline observation carried forward imputation methods. Copyright © 2018 John Wiley & Sons, Ltd.

LASSO NTCP predictors for the incidence of xerostomia in patients with head and neck squamous cell carcinoma and nasopharyngeal carcinoma

PubMed Central

Lee, Tsair-Fwu; Liou, Ming-Hsiang; Huang, Yu-Jie; Chao, Pei-Ju; Ting, Hui-Min; Lee, Hsiao-Yi

2014-01-01

To predict the incidence of moderate-to-severe patient-reported xerostomia among head and neck squamous cell carcinoma (HNSCC) and nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT). Multivariable normal tissue complication probability (NTCP) models were developed by using quality of life questionnaire datasets from 152 patients with HNSCC and 84 patients with NPC. The primary endpoint was defined as moderate-to-severe xerostomia after IMRT. The numbers of predictive factors for a multivariable logistic regression model were determined using the least absolute shrinkage and selection operator (LASSO) with bootstrapping technique. Four predictive models were achieved by LASSO with the smallest number of factors while preserving predictive value with higher AUC performance. For all models, the dosimetric factors for the mean dose given to the contralateral and ipsilateral parotid gland were selected as the most significant predictors. Followed by the different clinical and socio-economic factors being selected, namely age, financial status, T stage, and education for different models were chosen. The predicted incidence of xerostomia for HNSCC and NPC patients can be improved by using multivariable logistic regression models with LASSO technique. The predictive model developed in HNSCC cannot be generalized to NPC cohort treated with IMRT without validation and vice versa. PMID:25163814

Associations between physical activity parenting practices and adolescent girls' self-perceptions and physical activity intentions.

PubMed

Sebire, Simon J; Haase, Anne M; Montgomery, Alan A; McNeill, Jade; Jago, Russ

2014-05-01

The current study investigated cross-sectional associations between maternal and paternal logistic and modeling physical activity support and the self-efficacy, self-esteem, and physical activity intentions of 11- to 12-year-old girls. 210 girls reported perceptions of maternal and paternal logistic and modeling support and their self-efficacy, self-esteem and intention to be physically active. Data were analyzed using multivariable regression models. Maternal logistic support was positively associated with participants' self-esteem, physical activity self-efficacy, and intention to be active. Maternal modeling was positively associated with self-efficacy. Paternal modeling was positively associated with self-esteem and self-efficacy but there was no evidence that paternal logistic support was associated with the psychosocial variables. Activity-related parenting practices were associated with psychosocial correlates of physical activity among adolescent girls. Logistic support from mothers, rather than modeling support or paternal support may be a particularly important target when designing interventions aimed at preventing the age-related decline in physical activity among girls.

Alternative High School Students: Prevalence and Correlates of Overweight

ERIC Educational Resources Information Center

Kubik, Martha Y.; Davey, Cynthia; Fulkerson, Jayne A.; Sirard, John; Story, Mary; Arcan, Chrisa

2009-01-01

Objective: To determine prevalence and correlates of overweight among adolescents attending alternative high schools (AHS). Methods: AHS students (n=145) from 6 schools completed surveys and anthropometric measures. Cross-sectional associations were assessed using mixed model multivariate logistic regression. Results: Among students, 42% were…

Presenteeism Attitudes and Behavior Among Missouri Kindergarten to Twelfth Grade (K-12) School Nurses.

PubMed

Rebmann, Terri; Turner, James Austin; Kunerth, Allison K

2016-12-01

Working while ill (presenteeism) with symptoms of influenza-like illness can contribute to outbreaks, but little is known about school nurse presenteeism. Missouri Association of School Nurses members (N = 396) were sent a survey in 2013/2014. A chi square test was conducted to compare having a school culture that encourages presenteeism versus actual sick leave policies. Multivariate logistic regression was conducted to delineate factors associated with presenteeism. In total, 133 school nurses participated (33.6% response rate). Almost half (42.1%, n = 56) reported presenteeism. Nurses were more likely to feel pressure to engage in presenteeism than reported punitive sick leave policies (14.3% vs. 3.8%, χ 2 = 18.3, p < .001). Presenteeism was associated with perceived pressure, odds ratio (OR) = 4.8, confidence interval (CI) = [1.5, 15.8], p < .01, and having a mild illness, OR = 3.6, CI = [1.4, 9.7], p = .01. Many school nurses engage in presenteeism, and this appears to be associated with organizational cultural norms rather than established sick leave policies. © The Author(s) 2016.

Quality Reporting of Multivariable Regression Models in Observational Studies: Review of a Representative Sample of Articles Published in Biomedical Journals.

PubMed

Real, Jordi; Forné, Carles; Roso-Llorach, Albert; Martínez-Sánchez, Jose M

2016-05-01

Controlling for confounders is a crucial step in analytical observational studies, and multivariable models are widely used as statistical adjustment techniques. However, the validation of the assumptions of the multivariable regression models (MRMs) should be made clear in scientific reporting. The objective of this study is to review the quality of statistical reporting of the most commonly used MRMs (logistic, linear, and Cox regression) that were applied in analytical observational studies published between 2003 and 2014 by journals indexed in MEDLINE.Review of a representative sample of articles indexed in MEDLINE (n = 428) with observational design and use of MRMs (logistic, linear, and Cox regression). We assessed the quality of reporting about: model assumptions and goodness-of-fit, interactions, sensitivity analysis, crude and adjusted effect estimate, and specification of more than 1 adjusted model.The tests of underlying assumptions or goodness-of-fit of the MRMs used were described in 26.2% (95% CI: 22.0-30.3) of the articles and 18.5% (95% CI: 14.8-22.1) reported the interaction analysis. Reporting of all items assessed was higher in articles published in journals with a higher impact factor.A low percentage of articles indexed in MEDLINE that used multivariable techniques provided information demonstrating rigorous application of the model selected as an adjustment method. Given the importance of these methods to the final results and conclusions of observational studies, greater rigor is required in reporting the use of MRMs in the scientific literature.

Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey.

PubMed

Jones, G Morgan; Roe, Neil A; Louden, Les; Tubbs, Crystal R

2017-12-01

Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes.

Community-based tobacco cessation program among women in Mumbai, India.

PubMed

Mishra, G A; Kulkarni, S V; Majmudar, P V; Gupta, S D; Shastri, S S

2014-12-01

Globally tobacco epidemic kills nearly six million people annually. Consumption of tobacco products is on the rise in low- and middle-income countries. Tobacco is addictive; hence, tobacco users need support in quitting. Providing tobacco cessation services to women in community enabling them to quit tobacco, identifying factors associated with quitting and documenting the processes involved to establish a replicable "model tobacco cessation program." This is a community based tobacco cessation program of one year duration conducted among women in a low socioeconomic area of Mumbai, India. It involved three interventions conducted at three months interval, comprised of health education, games and counseling sessions and a post intervention follow-up. Uni and multivariate analysis was performed to find out association of various factors with quitting tobacco. The average compliance in three intervention rounds was 95.2%. The mean age at initiation of tobacco was 17.3 years. Tobacco use among family members and in the community was primary reasons for initiation and addiction to tobacco was an important factor for continuation, whereas health education and counseling seemed to be largely responsible for quitting. The quit rate at the end of the programme was 33.5%. Multivariate logistic regression analysis found that women in higher age groups and women consuming tobacco at multiple locations are less likely to quit tobacco. Changing cultural norms associated with smokeless tobacco, strict implementation of antitobacco laws in the community and work places and providing cessation support are important measures in preventing initiation and continuation of tobacco use among women in India.

Comparing Anxiety and Depression in Patients With Takotsubo Stress Cardiomyopathy to Those With Acute Coronary Syndrome.

PubMed

Goh, Anne C H; Wong, Stephanie; Zaroff, Jonathan G; Shafaee, Navid; Lundstrom, Robert J

2016-01-01

To determine whether anxiety or depression is associated with takotsubo stress cardiomyopathy (TSCM). A retrospective case-control study was conducted among 73 TSCM cases and 111 acute coronary syndrome (ACS) controls matched for age, sex, and cardiac catheterization date. The study was conducted between May 1, 2009, and February 28, 2010. The Hospital Anxiety and Depression Scale was completed by all participants after hospital discharge. The Hospital Anxiety and Depression Scale was used to assess psychological distress with measurement of anxiety and depression scores. The presence of a stressful emotional or physical trigger before the TSCM presentation was determined. Univariate testing was performed to quantify the associations between anxiety and depression and TSCM trigger status. Multivariable logistic regression was used to quantify the independent associations between anxiety and depression and TSCM status after controlling for relevant covariates. The mean anxiety score was 6.7 ± 4.7 for TSCM cases versus 5.4 ± 3.4 for ACS controls (P = .06). The mean depression score was 4.3 ± 3.7 for TSCM cases versus 4.0 ± 3.1 for controls (P = .61). Anxiety was particularly associated with TSCM status with an emotional trigger (P = .05). After multivariable adjustment, anxiety (OR = 1.13; 95% CI, 1.01-1.26; P = .03) was associated with TSCM status but depression was not (OR = 0.94; 95% CI, 0.83-1.05; P = .29). In comparison with a control group with ACS, patients who presented with TSCM have higher levels of anxiety but not depression.

Anti-Müllerian hormone and risk of ovarian cancer in nine cohorts.

PubMed

Jung, Seungyoun; Allen, Naomi; Arslan, Alan A; Baglietto, Laura; Barricarte, Aurelio; Brinton, Louise A; Egleston, Brian L; Falk, Roni T; Fortner, Renée T; Helzlsouer, Kathy J; Gao, Yutang; Idahl, Annika; Kaaks, Rudolph; Krogh, Vittorio; Merritt, Melissa A; Lundin, Eva; Onland-Moret, N Charlotte; Rinaldi, Sabina; Schock, Helena; Shu, Xiao-Ou; Sluss, Patrick M; Staats, Paul N; Sacerdote, Carlotta; Travis, Ruth C; Tjønneland, Anne; Trichopoulou, Antonia; Tworoger, Shelley S; Visvanathan, Kala; Weiderpass, Elisabete; Zeleniuch-Jacquotte, Anne; Dorgan, Joanne F

2018-01-15

Animal and experimental data suggest that anti-Müllerian hormone (AMH) serves as a marker of ovarian reserve and inhibits the growth of ovarian tumors. However, few epidemiologic studies have examined the association between AMH and ovarian cancer risk. We conducted a nested case-control study of 302 ovarian cancer cases and 336 matched controls from nine cohorts. Prediagnostic blood samples of premenopausal women were assayed for AMH using a picoAMH enzyme-linked immunosorbent assay. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable-adjusted conditional logistic regression. AMH concentration was not associated with overall ovarian cancer risk. The multivariable-adjusted OR (95% CI), comparing the highest to the lowest quartile of AMH, was 0.99 (0.59-1.67) (P trend : 0.91). The association did not differ by age at blood draw or oral contraceptive use (all P heterogeneity : ≥0.26). There also was no evidence for heterogeneity of risk for tumors defined by histologic developmental pathway, stage, and grade, and by age at diagnosis and time between blood draw and diagnosis (all P heterogeneity : ≥0.39). In conclusion, this analysis of mostly late premenopausal women from nine cohorts does not support the hypothesized inverse association between prediagnostic circulating levels of AMH and risk of ovarian cancer. © 2017 UICC.

Ties that bind: community attachment and the experience of discrimination among Black men who have sex with men

PubMed Central

Van Sluytman, Laurens; Spikes, Pilgrim; Nandi, Vijay; Van Tieu, Hong; Frye, Victoria; Patterson, Jocelyn; Koblin, Beryl

2015-01-01

In the USA, the impact of psychological distress may be greater for Black men who have sex with men given that they may experience both racial discrimination in society at large and discrimination due to sexual orientation within Black communities. Attachments to community members may play a role in addressing psychological distress for members of this vulnerable population. This analysis is based on 312 Black men who have sex with men recruited for a behavioural intervention trial in New York City. Analyses were conducted using bivariate and multivariable logistic regression to examine the relationship of discrimination and community attachment to psychological distress. Most participants (63%) reported exposure to both discrimination due to race and sexual orientation. However, a majority of participants (89%) also reported racial and/or sexual orientation community attachment. Psychological distress was significant and negatively associated with older age (40 years and above), being a high school graduate and having racial and/or sexual orientation community attachments. Psychological distress was significantly and positively associated with being HIV-positive and experiencing both racial and sexual orientation discrimination. Similar results were found in the multivariable model. Susceptibility to disparate psychological distress outcomes must be understood in relation to social membership, including its particular norms, structures and ecological milieu. PMID:25647586

Ties that bind: community attachment and the experience of discrimination among Black men who have sex with men.

PubMed

Van Sluytman, Laurens; Spikes, Pilgrim; Nandi, Vijay; Van Tieu, Hong; Frye, Victoria; Patterson, Jocelyn; Koblin, Beryl

2015-01-01

In the USA, the impact of psychological distress may be greater for Black men who have sex with men given that they may experience both racial discrimination in society at large and discrimination due to sexual orientation within Black communities. Attachments to community members may play a role in addressing psychological distress for members of this vulnerable population. This analysis is based on 312 Black men who have sex with men recruited for a behavioural intervention trial in New York City. Analyses were conducted using bivariate and multivariable logistic regression to examine the relationship of discrimination and community attachment to psychological distress. Most participants (63%) reported exposure to both discrimination due to race and sexual orientation. However, a majority of participants (89%) also reported racial and/or sexual orientation community attachment. Psychological distress was significant and negatively associated with older age (40 years and above), being a high school graduate and having racial and/or sexual orientation community attachments. Psychological distress was significantly and positively associated with being HIV-positive and experiencing both racial and sexual orientation discrimination. Similar results were found in the multivariable model. Susceptibility to disparate psychological distress outcomes must be understood in relation to social membership, including its particular norms, structures and ecological milieu.

Abandonment of antiretroviral therapy among HIV-positive patients attended at the reference center for HIV/AIDS in Vitória, Brazil.

PubMed

Zago, Adriana Marchon; Morelato, Paola; Endringer, Emmanuele de Angeli; Dan, Germano de Freitas; Ribeiro, Evanira Mendes; Miranda, Angelica Espinosa

2012-01-01

This study evaluates the risk factors for the abandonment of antiretroviral therapy (ART) among patients receiving care in an AIDS clinic in Vitória, Brazil. We conducted a case-control study of patients with AIDS attending a reference center for sexually transmitted disease (STD)/AIDS. A total of 62 patients, who abandoned therapy in 2008, and 188 HIV-infected patients answered an interview including demographic, social, and clinical characteristics. Risk factors associated with abandon in univariate analysis were entered into logistic regression models. A total of 250 patients were included in the study. Groups were similar regarding age, gender, and monthly income. In the final multivariate model, illicit drug use (adjusted odds ratio [AOR], 2.3; 95% confidence interval [CI], 1.03-5.07), previous abandon of medication (AOR 38.6; 95% CI 10.49-142.25), last CD4 count <200 cells/mm(3) (AOR 1.5; 95% CI 1.03-2.10), and viral load higher than 1000 copies/mL (AOR 2.0 (95% CI 1.34-3.09) were independent predictors of abandonment of ART. In addition to the clinical indicators, behavioral factors remained important throughout the multivariate analysis in our study.

The role of a lack of social integration in never having undergone breast cancer screening: results from a population-based, representative survey in the Paris metropolitan area in 2010.

PubMed

Rondet, Claire; Soler, Marion; Ringa, Virginie; Parizot, Isabelle; Chauvin, Pierre

2013-10-01

This study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account. The SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS. 6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day period were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age. This study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives. © 2013.

Low creatinine clearance is a risk factor for D2 gastrectomy after neoadjuvant chemotherapy.

PubMed

Hayashi, Tsutomu; Aoyama, Toru; Tanabe, Kazuaki; Nishikawa, Kazuhiro; Ito, Yuichi; Ogata, Takashi; Cho, Haruhiko; Morita, Satoshi; Miyashita, Yumi; Tsuburaya, Akira; Sakamoto, Junichi; Yoshikawa, Takaki

2014-09-01

The feasibility and safety of D2 surgery following neoadjuvant chemotherapy (NAC) has not been fully evaluated in patients with gastric cancer. Moreover, risk factor for surgical complications after D2 gastrectomy following NAC is also unknown. The purpose of the present study was to identify risk factors of postoperative complications after D2 surgery following NAC. This study was conducted as an exploratory analysis of a prospective, randomized Phase II trial of NAC. The surgical complications were assessed and classified according to the Clavien-Dindo classification. A uni- and multivariate logistic regression analyses were performed to identify risk factors for morbidity. Among 83 patients who were registered to the Phase II trial, 69 patients received the NAC and D2 gastrectomy. Postoperative complications were identified in 18 patients and the overall morbidity rate was 26.1 %. The results of univariate and multivariate analyses of various factors for overall operative morbidity, creatinine clearance (CCr) ≤ 60 ml/min (P = 0.016) was identified as sole significant independent risk factor for overall morbidity. Occurrence of pancreatic fistula was significantly higher in the patients with a low CCr than in those with a high CCr. Low CCr was a significant risk factor for surgical complications in D2 gastrectomy after NAC. Careful attention is required for these patients.

Soy consumption reduces the risk of non-small-cell lung cancers with epidermal growth factor receptor mutations among Japanese.

PubMed

Matsuo, Keitaro; Hiraki, Akio; Ito, Hidemi; Kosaka, Takayuki; Suzuki, Takeshi; Hirose, Kaoru; Wakai, Kenji; Yatabe, Yasushi; Mitsudomi, Tetsuya; Tajima, Kazuo

2008-06-01

Epidermal growth factor receptor (EGFR) mutations play substantial roles in genesis and proliferation of non-small-cell lung cancers (NSCLCs). We recently found that reproductive factors have a substantial impact on risk of development of NSCLCs featuring such EGFR mutations. Therefore, we explored the influence of dietary habits on NSCLC risk with reference to the EGFR mutational status. We conducted a case-control study using 353 patients with NSCLCs (122 EGFR mutated and 231 EGFR wild-type) and 1765 age-sex matched non-cancer control subjects. Dietary exposure was based on a semiquantitative food frequency questionnaire and impact of major food items, like meats, seafoods, vegetables and soybean products was assessed by multivariate logistic regression. Soybean products demonstrated a protective association with EGFR mutated, but not EGFR wild-type NSCLCs, with multivariate-adjusted odds ratios and 95% confidence intervals for the 2nd and 3rd tertile of soybean product consumption of 0.79 (0.50-1.27) and 0.56 (0.34-0.93) relative to those in the lowest tertile (trend P = 0.023). In conclusion, soy consumption may exert a protective association against the development of NSCLCs with EGFR mutations, providing possible insights into mechanisms of their genesis.

Predictors of the Perception of Smoking Health Risks in Smokers With or Without Schizophrenia.

PubMed

Kowalczyk, William J; Wehring, Heidi J; Burton, George; Raley, Heather; Feldman, Stephanie; Heishman, Stephen J; Kelly, Deanna L

2017-01-01

This study sought to examine the predictors of health risk perception in smokers with or without schizophrenia. The health risk subscale from the Smoking Consequences Questionnaire was dichotomized and used to measure health risk perception in smokers with (n = 67) and without schizophrenia (n = 100). A backward stepwise logistic regression was conducted using variables associated at the bivariate level to determine multivariate predictors. Overall, 62.5% of smokers without schizophrenia and 40.3% of smokers with schizophrenia completely recognize the health risks of smoking (p ≤ .01). Multivariate predictors for smokers without schizophrenia included: sex (Exp (B) = .3; p < .05), Smoking Consequences Questionnaire state enhancement (Exp (B) = .69; p < .01), and craving relief (Exp (B) = 1.8; p < .01). Among smokers with schizophrenia, predictors were education (Exp (B) = .7; p < .05), nicotine dependence (Exp (B) = .5; p < .01), motivation to quit (Exp (B) = 1.8; p < .01), and Smoking Consequences Questionnaire craving relief (Exp (B) = 1.8; p < .01). There was overlap and differences between predictors in smokers with and without schizophrenia. Commonly used techniques for education on the health consequences of cigarettes may work in smokers with schizophrenia, but intervention efforts specifically tailored to smokers with schizophrenia might be more efficacious.

Predictors of the Perception of Smoking Health Risks in Smokers With or Without Schizophrenia

PubMed Central

Kowalczyk, William J.; Wehring, Heidi J.; Burton, George; Raley, Heather; Feldman, Stephanie; Heishman, Stephen J.; Kelly, Deanna L.

2017-01-01

Objective This study sought to examine the predictors of health risk perception in smokers with or without schizophrenia. Methods The health risk subscale from the Smoking Consequences Questionnaire was dichotomized and used to measure health risk perception in smokers with (n = 67) and without schizophrenia (n = 100). A backward stepwise logistic regression was conducted using variables associated at the bivariate level to determine multivariate predictors. Results Overall, 62.5% of smokers without schizophrenia and 40.3% of smokers with schizophrenia completely recognize the health risks of smoking (p ≤ .01). Multivariate predictors for smokers without schizophrenia included: sex (Exp (B) = .3; p < .05), Smoking Consequences Questionnaire state enhancement (Exp (B) = .69; p < .01), and craving relief (Exp (B) = 1.8; p < .01). Among smokers with schizophrenia, predictors were education (Exp (B) = .7; p < .05), nicotine dependence (Exp (B) = .5; p < .01), motivation to quit (Exp (B) = 1.8; p < .01), and Smoking Consequences Questionnaire craving relief (Exp (B) = 1.8; p < .01). Conclusions There was overlap and differences between predictors in smokers with and without schizophrenia. Commonly used techniques for education on the health consequences of cigarettes may work in smokers with schizophrenia, but intervention efforts specifically tailored to smokers with schizophrenia might be more efficacious. PMID:27858591

Reporting of research quality characteristics of studies published in 6 major clinical dental specialty journals.

PubMed

Pandis, Nikolaos; Polychronopoulou, Argy; Madianos, Phoebus; Makou, Margarita; Eliades, Theodore

2011-06-01

The objective of this article was to record reporting characteristics related to study quality of research published in major specialty dental journals with the highest impact factor (Journal of Endodontics, Journal of Oral and Maxillofacial Surgery, American Journal of Orthodontics and Dentofacial Orthopedics; Pediatric Dentistry, Journal of Clinical Periodontology, and International Journal of Prosthetic Dentistry). The included articles were classified into the following 3 broad subject categories: (1) cross-sectional (snap-shot), (2) observational, and (3) interventional. Multinomial logistic regression was conducted for effect estimation using the journal as the response and randomization, sample calculation, confounding discussed, multivariate analysis, effect measurement, and confidence intervals as the explanatory variables. The results showed that cross-sectional studies were the dominant design (55%), whereas observational investigations accounted for 13%, and interventions/clinical trials for 32%. Reporting on quality characteristics was low for all variables: random allocation (15%), sample size calculation (7%), confounding issues/possible confounders (38%), effect measurements (16%), and multivariate analysis (21%). Eighty-four percent of the published articles reported a statistically significant main finding and only 13% presented confidence intervals. The Journal of Clinical Periodontology showed the highest probability of including quality characteristics in reporting results among all dental journals. Copyright © 2011 Elsevier Inc. All rights reserved.

The lexical development of children with hearing impairment and associated factors.

PubMed

Penna, Leticia Macedo; Lemos, Stela Maris Aguiar; Alves, Cláudia Regina Lindgren

2014-01-01

This study aimed at analyzing the association between the lexical development of children with hearing impairment and their psychosocial and socioeconomic characteristics and medical history. An analytic transversal study was conducted in an Auditive Health Attention Service. One hundred and ten children from 6 to 10 years old using hearing aids and presenting hearing loss that ranged from light to deep levels were evaluated. All children were subjected to oral, written language and auditory perception tests. Parents answered a structured questionnaire to collect data from their medical history and socioeconomic status, and questionnaires about the features of the family environment and psychosocial characteristics. Multivariate analysis was performed by logistic regression, being the initial model composed by variables with p<0,20 in the univariate analysis. In the final model, we adopted a significance level of 5%. The final model of the multivariate analysis showed an association between the performance on the vocabulary test and the results of phonemic discrimination test (OR=0.81; 95%CI 0.73-0.89). The results show the importance of stimulating the auditory processing, particularly the phonemic discrimination skill, throughout the rehabilitation process of children with hearing impairment. This stimulation can enhance lexical development and minimize the metalanguage and learning difficulties often observed in these children.

Eye donation – Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia

PubMed Central

Bhandary, Sulatha; Khanna, Rajesh; Rao, Krishna A; Rao, Lavanya G; Lingam, Kamala D; Binu, V

2011-01-01

Aim: Corneal blindness accounts for 3.42% of blindness in Malaysia; the rate of eye donation is low. The aim of the study was to assess the awareness about eye donation and willingness to donate eyes among attendants of patients at various clinics in Melaka, Malaysia. Materials and Methods: This observational study was conducted on attendants who accompanied patients (n = 400) visiting various outpatient departments of the General Hospital and two peripheral clinics in Melaka between August and October 2007. The participants answered a questionnaire (Malay and English versions) which included demographic profile, awareness of eye donation, knowledge regarding facts of eye donation, and willingness to donate eyes. Univariate and multivariate logistic regression was performed at 5% level of significance. Results: Awareness of eye donation was observed in 276 (69%) participants. Multivariate analysis showed that awareness was more among females when compared to males (P = 0.009). Of the 276 participants who were aware of eye donation, only 34.42% were willing to donate eyes. Willingness was more among the Indian race (P = 0.02) and males (P = 0.02). Educational status did not influence the willingness to donate eyes. Conclusions: Although majority of participants were aware of eye donation, willingness to donate eyes was poor. PMID:21157071

Sex trade in a male-to-female transgender population: psychosocial correlates of inconsistent condom use.

PubMed

Clements-Nolle, Kristen; Guzman, Robert; Harris, Susan G

2008-03-01

Research suggests that because of economic necessity, many male-to-female (MTF) transgender individuals trade sex for money, drugs, housing, and other things they may need. To date, no studies have quantitatively assessed psychosocial correlates of condom use with this population. We conducted a cross sectional study with 190 MTF transgender individuals involved in sex trade in San Francisco, California. Multivariate logistic regression was used to determine factors independently associated with inconsistent condom use during receptive anal sex with exchange partners. About one fifth of our participants reported inconsistent condom use during receptive anal sex in the past 6 months. In the multivariate model, low self-esteem [adjusted odds ratio (AOR)=3.09; 95% confidence interval (CI) (1.28, 7.47)], a history of forced sex or rape [AOR=2.91; 95% CI (1.06, 8.01)], and use of crack-cocaine [AOR=2.59; 95% CI (1.09, 6.13)] were independently associated with inconsistent condom use. Our findings highlight an urgent need for multilevel risk reduction interventions for MTF transgender individuals involved in sex trade. Such interventions will be most effective if they address the psychosocial context of sexual risk taking by focusing on issues such as low self-esteem, sexual violence, and illicit drug use.

Independent Correlates of Reported Gambling Problems amongst Indigenous Australians

ERIC Educational Resources Information Center

Stevens, Matthew; Young, Martin

2010-01-01

To identify independent correlates of reported gambling problems amongst the Indigenous population of Australia. A cross-sectional design was applied to a nationally representative sample of the Indigenous population. Estimates of reported gambling problems are presented by remoteness and jurisdiction. Multivariable logistic regression was used to…

Correlates of Gambling among Eighth-Grade Boys and Girls

ERIC Educational Resources Information Center

Chaumeton, Nigel R.; Ramowski, Sarah K.; Nystrom, Robert J.

2011-01-01

Background: This study examined the correlates of gambling behavior among eighth-grade students. Methods: Children (n = 15,865) enrolled in publicly funded schools in Oregon completed the 2008 Oregon Healthy Teens survey. Multivariate logistic regression analyses assessed the combined and independent associations between risk and protective…

Life Satisfaction and Violent Behaviors among Middle School Students

ERIC Educational Resources Information Center

Valois, Robert F.; Paxton, Raheem J.; Zullig, Keith J.; Huebner, E. Scott

2006-01-01

We explored relationships between violent behaviors and perceived life satisfaction among 2,138 middle school students in a southern state using the CDC Middle School Youth Risk Behavior Survey (MSYRBS) and the Brief Multidimensional Student Life Satisfaction Scale (BMSLSS). Logistic regression analyses and multivariate models constructed…

The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study

PubMed Central

Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Tsai, Chin-Chung

2016-01-01

Background Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. Objective The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. Methods We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. Results We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). Conclusions The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. PMID:27927606

Factors associated with seasonal influenza vaccination in pregnant women.

PubMed

Henninger, Michelle L; Irving, Stephanie A; Thompson, Mark; Avalos, Lyndsay Ammon; Ball, Sarah W; Shifflett, Pat; Naleway, Allison L

2015-05-01

This observational study followed a cohort of pregnant women during the 2010-2011 influenza season to determine factors associated with vaccination. Participants were 1105 pregnant women who completed a survey assessing health beliefs related to vaccination upon enrollment and were then followed to determine vaccination status by the end of the 2010-2011 influenza season. We conducted univariate and multivariate analyses to explore factors associated with vaccination status and a factor analysis of survey items to identify health beliefs associated with vaccination. Sixty-three percent (n=701) of the participants were vaccinated. In the univariate analyses, multiple factors were associated with vaccination status, including maternal age, race, marital status, educational level, and gravidity. Factor analysis identified two health belief factors associated with vaccination: participant's positive views (factor 1) and negative views (factor 2) of influenza vaccination. In a multivariate logistic regression model, factor 1 was associated with increased likelihood of vaccination (adjusted odds ratio [aOR]=2.18; 95% confidence interval [CI]=1.72-2.78), whereas factor 2 was associated with decreased likelihood of vaccination (aOR=0.36; 95% CI=0.28-0.46). After controlling for the two health belief factors in multivariate analyses, demographic factors significant in univariate analyses were no longer significant. Women who received a provider recommendation were about three times more likely to be vaccinated (aOR=3.14; 95% CI=1.99-4.96). Pregnant women's health beliefs about vaccination appear to be more important than demographic and maternal factors previously associated with vaccination status. Provider recommendation remains one of the most critical factors influencing vaccination during pregnancy.

Timing of opioid administration as a quality indicator for pain crises in sickle cell disease.

PubMed

Mathias, Melissa D; McCavit, Timothy L

2015-03-01

Time to opioid administration (TTO) has been suggested as a quality of care measure for sickle cell disease patients with vaso-occlusive crisis (VOC). We sought to determine whether TTO was associated with outcomes of emergency department (ED) visits for VOC. We conducted a single-center retrospective cohort study of ED visits for VOC. The primary outcome was hospital admission, with secondary outcomes of change between the first 2 pain scores, area under the curve (AUC) for pain scores at 4 hours (pain score AUC), total ED length of stay, and total intravenous opioids. In both univariate and multivariate analyses, mixed regression (logistic for admission, linear for secondary outcome variables) was used to evaluate association of TTO with outcome. In 177 subjects, 414 ED visits for VOC were identified. Inpatient admission occurred in 53% of visits. The median TTO for admitted patients was 86 minutes vs 87 minutes for those not admitted. TTO was not associated with inpatient admission in either univariate or multivariate analyses. In multivariate analyses with secondary outcomes, decreased TTO was associated with greater improvement between the first 2 pain scores, decreased pain score AUC, decreased total ED length of stay, and increased total opioids. Although TTO was not associated with admission, it was independently associated with 4 important secondary outcomes: change in initial pain scores, pain score AUC, total ED length of stay, and total intravenous opioids. The association of a process measure, TTO, with these outcomes encourages the institution of TTO reduction efforts in the ED. Copyright © 2015 by the American Academy of Pediatrics.

Factors Associated with the Emergence of Highly Pathogenic Avian Influenza A (H5N1) Poultry Outbreaks in China: Evidence from an Epidemiological Investigation in Ningxia, 2012.

PubMed

Liu, H; Zhou, X; Zhao, Y; Zheng, D; Wang, J; Wang, X; Castellan, D; Huang, B; Wang, Z; Soares Magalhães, R J

2017-06-01

In April 2012, highly pathogenic avian influenza virus of the H5N1 subtype (HPAIV H5N1) emerged in poultry layers in Ningxia. A retrospective case-control study was conducted to identify possible risk factors associated with the emergence of H5N1 infection and describe and quantify the spatial variation in H5N1 infection. A multivariable logistic regression model was used to identify risk factors significantly associated with the presence of infection; residual spatial variation in H5N1 risk unaccounted by the factors included in the multivariable model was investigated using a semivariogram. Our results indicate that HPAIV H5N1-infected farms were three times more likely to improperly dispose farm waste [adjusted OR = 0.37; 95% CI: 0.12-0.82] and five times more likely to have had visitors in their farm within the past month [adjusted OR = 5.47; 95% CI: 1.97-15.64] compared to H5N1-non-infected farms. The variables included in the final multivariable model accounted only 20% for the spatial clustering of H5N1 infection. The average size of a H5N1 cluster was 660 m. Bio-exclusion practices should be strengthened on poultry farms to prevent further emergence of H5N1 infection. For future poultry depopulation, operations should consider H5N1 disease clusters to be as large as 700 m. © 2015 Blackwell Verlag GmbH.

The Influence of Witnessing Inter-parental Violence and Bullying Victimization in Involvement in Fighting among Adolescents: Evidence from a School-based Cross-sectional Survey in Peru

PubMed Central

Sharma, Bimala; Nam, Eun Woo; Kim, Ha Yun; Kim, Jong Koo

2016-01-01

Background Witnessing inter-parental violence and bullying victimization is common for many children and adolescents. This study examines the role of witnessing inter-parental violence and bullying victimization in involvement in physical fighting among Peruvian adolescents. Methods A cross-sectional study was conducted among 1,368 randomly selected adolescents in 2015. We conducted logistic regression analyses to obtain crude and adjusted odds ratios with 95% confidence intervals for involvement in fighting among male and female adolescents. Results Among all adolescents, 35.8% had been involved in fighting in the last 12 months, 32.9% had been victim of verbal bullying and 37.9% had been the victim of physical bullying. Additionally, 39.2% and 27.8% of adolescents witnessed violence against their mother and father, respectively, at least once in their lives. Multivariate logistic regression analyses found that late adolescence, participation in economic activities, being the victim of verbal bullying, stress, and witnessing violence against the father among male adolescents, and self-rated academic performance and being the victim of physical or verbal bullying among female adolescents were associated with higher odds of being involved in fighting. Conclusion Verbal bullying victimization and witnessing violence against the father in males and bullying victimization in females were associated with greater odds of adolescents being involved in fighting. Creating a non-violent environment at both home and school would be an effective strategy for reducing fighting among the adolescent population. PMID:27358837

The impact of truant and alcohol-related behavior on educational aspirations: a study of US high school seniors.

PubMed

Barry, Adam E; Chaney, Beth; Chaney, J Don

2011-08-01

Truancy and alcohol use are quality indicators of academic achievement and success. However, there remains a paucity of substantive research articulating the impact these deviant behaviors have on an adolescent's educational aspirations. The purpose of this study is to assess whether recent alcohol use and truancy impact students' educational aspirations among a nationally representative sample of US high school seniors. This study conducted a secondary data analysis of the Monitoring the Future project data, 2006. Logistic regression was conducted to assess how alcohol use and truancy affected educational aspirations. Subsequent interaction effects were assessed in the final multivariable model. Demographic variables such as age, sex, race, and father and mother's educational level were included as covariates in the regression model. Results indicate that as students engage in increased alcohol use and/or truancy, educational aspirations decrease. Thus, students who indicated a desire to attend a 4-year college/university were less likely to engage in high-risk drinking behavior and/or truancy. Moreover, in testing the interaction between truancy and alcohol use, as it relates to educational aspirations, the logistic regression model found both of these independent variables to be statistically significant predictors of the likelihood students would attend a 4-year college/university. To ensure that adolescents further their education and maximize their potential life opportunities, school and public health officials should initiate efforts to reduce alcohol consumption and truancy among students. Furthermore, future research should examine the risk and protective factors that may influence one's educational aspirations. © 2011, American School Health Association.

Uncontrolled diabetes mellitus: prevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan.

PubMed

Siddiqui, Fahad Javaid; Avan, Bilal Iqbal; Mahmud, Sadia; Nanan, Debra J; Jabbar, Abdul; Assam, Pryseley Nkouibert

2015-01-01

This study aimed to explore the prevalence of, and factors associated with, uncontrolled diabetes mellitus (UDM) in a community setting in Pakistan. A single-center, cross-sectional study, conducted in a community-based specialized care center (SCC) for diabetes in District Central Karachi, in 2003, registered 452 type 2 DM participants, tested for HbA1c and interviewed face-to-face for other information. Logistic regression analysis was conducted to identify factors associated with UDM. Prevalence of UDM among diabetes patients was found to be 38.9% (95% CI: 34.4-43.4%). Multivariable logistic regression model analysis indicated that age <50 years (OR: 1.9; 95% CI: 1.2-2.9), being diagnosed in a hospital (vs. a clinic) (OR: 1.8; 95% CI: 1.1-2.8), diabetes information from a doctor or nurse only (vs. multiple sources) (OR: 1.8; 95% CI: 1.2-2.9), higher monthly treatment cost (OR: 1.3; 95% CI: 1.1-1.6; for every extra 500 PKR), and higher consumption of tea (OR: 1.5; 95% CI: 1.0-2.2; for every 2 extra cups) were independently associated with UDM. The prevalence of UDM was approximately 39% among persons with type 2 diabetes visiting a community based SCC for diabetes. Modifiable risk factors such as sources of diabetes information and black tea consumption can be considered as potential targets of interventions in Karachi. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Youth tobacco sales in a metropolitan county: factors associated with compliance.

PubMed

Pearson, Dave C; Song, Lin; Valdez, Roger B; Angulo, Antoinette S

2007-08-01

To describe and identify factors associated with tobacco sales in a metropolitan county. King County, Washington is the largest county in Washington State with an estimated population of 1.8 million or about 30% of the state's population. The data analysis is based on compliance checks in King County between January 2001 and March 2005. The 8879 checks were conducted by 91 youth operatives aged 14-17. Analysis of data was completed in 2006. The outcome variable for this analysis was whether "a sale was made" to a youth operative during a compliance check. Associations between independent variables and the outcome variable were examined using 2 x 2 tables, univariate (unadjusted) logistic regression, and multivariate (adjusted) logistic regression analysis. Overall tobacco sales during the 4-year and 3-month period was 7.7%. Convenience stores selling gas were significantly more likely to sell tobacco products to minors, whereas restaurants, bars, and tobacco discount stores were less likely to sell to minors. Other factors that were significantly associated with sales are described. In a county that has adopted many of the required youth access laws, opportunities still exist to reduce sales of tobacco products to minors. Asking for age and photo identification still appears to be an effective strategy in reducing sales of tobacco products to minors.

Medication adherence among patients in a chronic disease clinic.

PubMed

Tourkmani, Ayla M; Al Khashan, Hisham I; Albabtain, Monirah A; Al Harbi, Turki J; Al Qahatani, Hala B; Bakhiet, Ahmed H

2012-12-01

To assess motivation and knowledge domains of medication adherence intention, and to determine their predictors in an ambulatory setting. We conducted a cross-sectional survey study among patients attending a chronic disease clinic at the Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia between June and September 2010. Adherence intention was assessed using Modified Morisky Scale. Predictors of low motivation and/or knowledge were determined using logistic regression models. A total of 347 patients were interviewed during the study duration. Most patients (75.5%) had 2 or more chronic diseases with an average of 6.3 +/- 2.3 medications, and 6.5 +/- 2.9 pills per prescription. The frequency of adherence intention was low (4.6%), variable (37.2%), and high (58.2%). In multivariate logistic regression analysis, younger age and having asthma were significantly associated with low motivation, while male gender, single status, and not having hypertension were significantly associated with low knowledge. Single status was the only independent predictor of low adherence intention. In a population with multiple chronic diseases and high illiteracy rate, more than 40% had low/variable intention to adhere to prescribed medications. Identifying predictors of this group may help in providing group-specific interventional programs.

Determinants of Prelacteal Feeding in Rural Northern India

PubMed Central

Roy, Manas Pratim; Mohan, Uday; Singh, Shivendra Kumar; Singh, Vijay Kumar; Srivastava, Anand Kumar

2014-01-01

Background: Prelacteal feeding is an underestimated problem in a developing country like India, where infant mortality rate is quite high. The present study tried to find out the factors determining prelacteal feeding in rural areas of north India. Methods: A crosssectional study was conducted among recently delivered women of rural Uttar Pradesh, India. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected as the subjects, following systematic random sampling. Chi-square test and logistic regression were used to find out the predictors for prelacteal feeding. Results: Overall, 40.1% of mothers gave prelacteal feeding to their newborn. Factors significantly associated with such practice, after simple logistic regression, were age, caste, socioeconomic status, and place of delivery. At multivariate level, age (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.13-2.74), caste and place of delivery (OR = 2.23, 95% CI = 1.21-4.10) were found to determine prelacteal feeding significantly, indicating that young age, high caste, and home deliveries could affect the practice positively. Conclusions: The problem of prelacteal feeding is still prevalent in rural India. Age, caste, and place of delivery were associated with the problem. For ensuring neonatal health, the problem should be addressed with due gravity, with emphasis on exclusive breast feeding. PMID:24932400

Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China.

PubMed

Xu, Wenjian; Zheng, Lijun; Xu, Yin; Zheng, Yong

2017-02-17

Social attitudes toward male homosexuality in China so far are still not optimistic. Sexual minorities in China have reported high levels of internalized homophobia. This Internet-based study examined the associations among internalized homophobia, mental health, sexual behaviors, and outness among 435 gay/bisexual men in Southwest China from 2014 to 2015. Latent profile analysis, confirmatory factor analysis, univariate logistic regression, and separate multivariate logistic regression analyses were conducted. This descriptive study found the Internalized Homophobia Scale to be suitable for use in China. The sample demonstrated a high prevalence of internalized homophobia. Latent profile analysis suggested a 2-class solution as optimal, and a high level of internalized homophobia was significantly associated with greater psychological distress (Wald = 6.49, AOR = 1.66), transactional sex during the previous 6 months (Wald = 5.23, AOR = 2.77), more sexual compulsions (Wald = 14.05, AOR = 2.12), and the concealment of sexual identity from others (Wald = 30.70, AOR = 0.30) and parents (Wald = 6.72, AOR = 0.49). These findings contribute to our understanding of internalized homophobia in China, and highlight the need to decrease gay-related psychological stress/distress and improve public health services.

Personalised electronic messages to improve sun protection in young adults.

PubMed

Mair, Sarah; Soyer, H Peter; Youl, Philippa; Hurst, Cameron; Marshall, Alison; Janda, Monika

2012-07-01

We studied the acceptability and feasibility of delivering sun protection messages via electronic media such as short message services (SMS) to people aged 18-40 years. An online survey was conducted using a pre-established panel of volunteers. We compared the characteristics of those who indicated that they would like to be alerted to the UV index, with those who would not, using bivariate logistic regression. Characteristics found to be associated with a desire to receive such advice were entered into a multivariate logistic regression analysis. The median age of the 141 participants was 34 years. Overall, 80% of participants agreed that they would like to receive some form of sun protection advice. Of these, 20% preferred to receive it via SMS and 42% via email. Willingness to receive electronic messages about the UV index was associated with being unsure about whether a suntanned person would look healthy and greater use of sun protection in the past. Careful attention to message framing and timing of message delivery, and focus on the short-term effects of sun exposure such as sunburn and skin ageing should increase the acceptability of such messages to young people. Sun protection messages delivered to young adults via electronic media appear to be feasible and acceptable.

Modeling the probability of giving birth at health institutions among pregnant women attending antenatal care in West Shewa Zone, Oromia, Ethiopia: a cross sectional study.

PubMed

Dida, Nagasa; Birhanu, Zewdie; Gerbaba, Mulusew; Tilahun, Dejen; Morankar, Sudhakar

2014-06-01

Although ante natal care and institutional delivery is effective means for reducing maternal morbidity and mortality, the probability of giving birth at health institutions among ante natal care attendants has not been modeled in Ethiopia. Therefore, the objective of this study was to model predictors of giving birth at health institutions among expectant mothers following antenatal care. Facility based cross sectional study design was conducted among 322 consecutively selected mothers who were following ante natal care in two districts of West Shewa Zone, Oromia Regional State, Ethiopia. Participants were proportionally recruited from six health institutions. The data were analyzed using SPSS version 17.0. Multivariable logistic regression was employed to develop the prediction model. The final regression model had good discrimination power (89.2%), optimum sensitivity (89.0%) and specificity (80.0%) to predict the probability of giving birth at health institutions. Accordingly, self efficacy (beta=0.41), perceived barrier (beta=-0.31) and perceived susceptibility (beta=0.29) were significantly predicted the probability of giving birth at health institutions. The present study showed that logistic regression model has predicted the probability of giving birth at health institutions and identified significant predictors which health care providers should take into account in promotion of institutional delivery.

Factors Associated with Suicidal Ideation and Suicide Attempt among School-Going Urban Adolescents in Peru

PubMed Central

Sharma, Bimala; Nam, Eun Woo; Kim, Ha Yun; Kim, Jong Koo

2015-01-01

The study examines the prevalence of suicidal ideation and suicide attempt, and associated factors among school-going urban adolescents in Peru. A cross-sectional survey was conducted in a sample of 916 secondary school adolescents in 2014. A structured questionnaire adapted from Global School-based Student Health Survey was used to obtain information. Data were analyzed using logistic regression models at 5% level of significance. Overall, 26.3% reported having suicidal ideation, and 17.5% reported having attempted suicide during the past 12 months. Multivariate logistic regression analysis showed that female sex, being in a fight, being insulted, being attacked, perceived unhappiness, smoking and sexual intercourse initiation were significantly associated with increased risk of suicidal ideation, while female sex, being in a fight, being insulted, being attacked, perceived unhappiness, alcohol and illicit drug use were related to suicide attempt. The prevalence of suicidal ideation and suicide attempts observed in the survey area is relatively high. Female adolescents are particularly vulnerable to report suicidal ideation and suicide attempt. Interventions that address the issue of violence against adolescents, fighting with peers, health risk behaviors particularly initiation of smoking, alcohol and illicit drug use and encourage supportive role of parents may reduce the risk of suicidal behaviors. PMID:26610536

Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

PubMed

Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

2017-06-01

To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals. © Health Research and Educational Trust.

Reasons for Cigarillo Initiation and Cigarillo Manipulation Methods among Adolescents.

PubMed

Kong, Grace; Bold, Krysten W; Simon, Patricia; Camenga, Deepa R; Cavallo, Dana A; Krishnan-Sarin, Suchitra

2017-04-01

To understand reasons for cigarillo initiation and cigarillo manipulation methods among adolescents. We conducted surveys in 8 Connecticut high schools to assess reasons for trying a cigarillo and cigarillo manipulation methods. We used multivariable logistic regressions to assess associations with demographics and tobacco use status. Among ever cigarillo users (N = 697, 33.6% girls, 16.7 years old [SD = 1.14], 62.1% White), top reasons for trying a cigarillo were curiosity (41.9%), appealing flavors (32.9%), because "friends use it" (25.3%), and low cost (22.4%). Overall, 40.3% of ever cigarillo users added marijuana (to create blunts) and 39.2% did not manipulate the product. Endorsement of these reasons for initiation and manipulation methods differed significantly across sex, age, SES and other tobacco use. Cigarillo regulations should include restricting all appealing flavors, increasing the cost, monitoring the restriction of sales of cigarillos to minors, and decreasing the appeal of cigarillo manipulation.

Predictors of Cervical Cancer Screening for Rarely or Never Screened Rural Appalachian Women

PubMed Central

Hatcher, Jennifer; Studts, Christina R.; Dignan, Mark; Turner, Lisa M.; Schoenberg, Nancy E.

2011-01-01

Background and Purpose Women who have not had a Papanicolaou test in five years or more have increased risk of developing invasive cervical cancer. This study compares Appalachian women whose last screening was more than one year ago but less than five years ago with those not screened for the previous five years or more. Methods Using PRECEDE/PROCEED as a guide, factors related to obtaining Pap tests were examined using cross-sectional data from 345 Appalachian Kentucky women. Bivariate and multivariate analyses were conducted to identify predictors of screening. Results Thirty-four percent of participants were rarely- or never-screened. In multiple logistic regression analyses, several factors increased those odds, including belief that cervical cancer has symptoms, and not having a regular source of medical care. Conclusion The findings from this study may lead to the development of effective intervention and policies that increase cervical cancer screening in this population. PMID:21317514

Perceived individual, social, and environmental factors for physical activity and walking.

PubMed

Granner, Michelle L; Sharpe, Patricia A; Hutto, Brent; Wilcox, Sara; Addy, Cheryl L

2007-07-01

Few studies have explored associations of individual, social, and environmental factors with physical activity and walking behavior. A random-digit-dial questionnaire, which included selected individual, social, and environmental variables, was administered to 2025 adults, age 18 y and older, in two adjacent counties in a southeastern state. Logistic regressions were conducted adjusting for age, race, sex, education, and employment. In multivariate models, somewhat different variables were associated with physical activity versus regular walking. Self-efficacy (OR = 19.19), having an exercise partner (OR = 1.47), recreation facilities (OR = 1.54), and safety of trails from crime (OR = 0.72) were associated with physical activity level; while self-efficacy (OR = 4.22), known walking routes (OR = 1.54), recreation facilities (OR = 1.57-1.59), and safety of trails from crime (OR = 0.69) were associated with regular walking behavior. Physical activity and walking behaviors were associated with similar variables in this study.

Getting to the Truth: Evaluating National Tobacco Countermarketing Campaigns

PubMed Central

Farrelly, Matthew C.; Healton, Cheryl G.; Davis, Kevin C.; Messeri, Peter; Hersey, James C.; Haviland, M. Lyndon

2002-01-01

Objectives. This study examines how the American Legacy Foundation's “truth” campaign and Philip Morris's “Think. Don't Smoke” campaign have influenced youths' attitudes, beliefs, and intentions toward tobacco. Methods. We analyzed 2 telephone surveys of 12- to 17-year-olds with multivariate logistic regressions: a baseline survey conducted before the launch of “truth” and a second survey 10 months into the “truth” campaign. Results. Exposure to “truth” countermarketing advertisements was consistently associated with an increase in anti-tobacco attitudes and beliefs, whereas exposure to Philip Morris advertisements generally was not. In addition, those exposed to Philip Morris advertisements were more likely to be open to the idea of smoking. Conclusions. Whereas exposure to the “truth” campaign positively changed youths' attitudes toward tobacco, the Philip Morris campaign had a counterproductive influence. (Am J Public Health. 2002;92:901–907) PMID:12036775

Oral health impact of periodontal diseases in adolescents.

PubMed

López, R; Baelum, V

2007-11-01

The need for treatment of destructive periodontal diseases is based on observations made by oral health professionals, who, prompted by clinical findings, recommend treatment. We hypothesized that clinical signs of periodontal destruction have an impact on the oral-health-related quality of life of adolescents. We conducted a cross-sectional study among 9203 Chilean high school students sampled by a multistage random cluster procedure. We recorded clinical attachment levels and the presence of necrotizing ulcerative gingivitis. The students answered the Spanish version of the Oral Health Impact Profile and provided information on several socio-economic indicators. The results of multivariable logistic regression analyses (adjusted for age, gender, and tooth loss) showed that both attachment loss [OR = 2.0] and necrotizing ulcerative gingivitis [OR = 1.6] were significantly associated with higher impact on the Oral Health Related Quality of Life of adolescents. Individuals in lower socioeconomic positions systematically reported a higher impact on their oral-health-related quality of life.

Mental Health and Related Factors of Hospital Nurses.

PubMed

Nukui, Hiroshi; Murakami, Michio; Midorikawa, Sanae; Suenaga, Minako; Rokkaku, Yuichi; Yabe, Hirooki; Ohtsuru, Akira

2017-03-01

The mental health of hospital nurses is a key health issue in public health promotion during the recovery phase following the Fukushima disaster. In this study, conducted 4 years after the disaster, we analyzed the overall mental health, knowledge, risk perception of radiation, and work and daily life burdens of nurses working at medical institutions in the Fukushima Prefecture (collection rate = 89.6%; response number = 730). Overall mental health status was estimated using the 12-item version of the General Health Questionnaire, and 333 respondents (45.6%) scored above the 12-item General Health Questionnaire threshold point (≥4), indicating probable emotional distress compared with the general population under normal circumstances. Multivariate logistic analysis suggested that the ability to cope with daily life and work-related stressors were more important than risk perception and acquisition of knowledge regarding radiation and its control methods for supporting the mental health of nurses following the Fukushima disaster.

Relationships Between Integration and Drug Use Among Deported Migrants in Tijuana, Mexico.

PubMed

Horyniak, Danielle; Pinedo, Miguel; Burgos, Jose Luis; Ojeda, Victoria D

2017-10-01

Deported migrants face numerous challenges which may elevate their risk for drug use. We examined relationships between integration and drug use among deported migrants in Tijuana, Mexico. A cross-sectional survey conducted at a free health clinic included 255 deported Mexican-born migrants residing in Tijuana ≥6 months. Multivariable logistic regression examined associations between variables across four integration domains (public participation, social connections, macro-level facilitators and foundations) and recent (past 6-month) drug use. The prevalence of recent drug use was 46 %. Having sought work in Tijuana in the past 6 months, greater household affluence, lifetime history of incarceration in both US and Mexico, and lacking health insurance were independently associated with recent drug use. Policies that support access to employment, adequate housing and healthcare in Mexico, particularly for justice-involved deportees, may facilitate successful integration and reduce potential stressors that may contribute to drug use.

Making Professional Decisions in Research: Measurement and Key Predictors

PubMed Central

Antes, Alison L.; Chibnall, John T.; Baldwin, Kari A.; Tait, Raymond C.; Vander Wal, Jillon S.; DuBois, James M.

2016-01-01

The professional decision-making in research (PDR) measure was administered to 400 NIH-funded and industry-funded investigators, along with measures of cynicism, moral disengagement, compliance disengagement, impulsivity, work stressors, knowledge of responsible conduct of research (RCR), and socially desirable response tendencies. Negative associations were found for the PDR and measures of cynicism, moral disengagement, and compliance disengagement, while positive associations were found for the PDR and RCR knowledge and positive urgency, an impulsivity subscale. PDR scores were not related to socially desirable responding, or to measures of work stressors and the remaining impulsivity subscales. In a multivariate logistic regression analysis, lower moral disengagement scores, higher RCR knowledge, and identifying the United States as one’s nation of origin emerged as key predictors of stronger performance on the PDR. The implications of these findings for understanding the measurement of decision-making in research and future directions for research and RCR education are discussed. PMID:27093003

Determinants of Breast and Cervical Cancer Screening Uptake Among Women in Turkey.

PubMed

Sözmen, Kaan; Unal, Belgin; Sakarya, Sibel; Dinc, Gonul; Yardim, Nazan; Keskinkilic, Bekir; Ergör, Gül

2016-09-01

The aim of the study was to assess the influence of sociodemographic characteristics on breast and cervical cancer screening among women 30 years and older in Turkey. We used data from the National Chronic Diseases and Risk Factors Survey conducted by the Ministry of Health in 2011. Multivariate logistic regression analysis was used to assess the association of sociodemographic factors, lifestyle variables, and cancer screening. Overall, 22.0% of women ever had a Pap smear test for cervical cancer screening and 19.0% ever had a mammography for breast cancer screening(n = 6846). Individuals with a university degree, social security, doing moderate physical activity, and consuming 5 portions of fruit or vegetable/day were more likely to receive Pap smear test and mammography. Residing in the eastern region and living in rural area was associated with lower likelihood of receiving both types of screening. © 2016 APJPH.

Motivations and Predictors of Cheating in Pharmacy School

PubMed Central

Nguyen, Kathy; Shah, Bijal M.; Doroudgar, Shadi; Bidwal, Monica K.

2016-01-01

Objective. To assess the prevalence, methods, and motivations for didactic cheating among pharmacy students and to determine predictive factors for cheating in pharmacy colleges and schools. Methods. A 45-item cross-sectional survey was conducted at all four doctor of pharmacy programs in Northern California. For data analysis, t test, Fisher exact test, and logistic regression were used. Results. Overall, 11.8% of students admitted to cheating in pharmacy school. Primary motivations for cheating included fear of failure, procrastination, and stress. In multivariate analysis, the only predictor for cheating in pharmacy school was a history of cheating in undergraduate studies. Conclusion. Cheating occurs in pharmacy schools and is motivated by fear of failure, procrastination, and stress. A history of past cheating predicts pharmacy school cheating. The information presented may help programs better understand their student population and lead to a reassessment of ethical culture, testing procedures, and prevention programs. PMID:27899829

Shift Work Is Associated with Metabolic Syndrome in Young Female Korean Workers.

PubMed

Yu, Kyoung Hwa; Yi, Yu Hyeon; Kim, Yun Jin; Cho, Byung Mann; Lee, Sang Yeoup; Lee, Jeong Gyu; Jeong, Dong Wook; Ji, So Yeon

2017-03-01

Shift work is associated with health problems, including metabolic syndrome. This study investigated the association between shift work and metabolic syndrome in young workers. A total of 3,317 subjects aged 20-40 years enrolled in the 2011-2012 Korean National Health and Nutrition Examination Survey were divided into shift and day workers. We conducted a cross-sectional study and calculated odds ratios using multivariate logistic regression analysis in order to examine the association between shift work and metabolic syndrome. The prevalence of metabolic syndrome was 14.3% and 7.1% among male and female shift workers, respectively. After adjusting for confounding factors, shift work was associated with metabolic syndrome in female workers (odds ratio, 2.53; 95% confidence interval, 1.12 to 5.70). Shift work was associated with metabolic syndrome in young women. Timely efforts are necessary to manage metabolic syndrome in the workplace.

Turnover and Associated Factors in Asian Foreign-Educated Nurses.

PubMed

Geun, Hyo Geun; Redman, Richard W; McCullagh, Marjorie C

2016-05-01

The purposes of this study are to (1) describe the gap between expected and perceived organizational experiences among Asian foreign-educated nurses (FENs) in the United States and (2) to examine factors associated with turnover in their 1st year of employment. Little is known about factors associated with turnover among Asian FENs. A cross-sectional design with a convenience sampling was conducted. Subjects (n = 201) responded either via Web-based or mail survey. A series of simple and multivariable logistic regressions were used. Expectations of FENs before organizational entry were significantly higher than their experiences. The FENs who reported less organizational responsibility than expected were more likely to leave their 1st employment to move to another organization or unit. This study may contribute to our understanding of the potential factors that assist or interfere with the organization's administrative retention plan for Asian FENs.

Nationwide firefighter survey: the prevalence of lower back pain and its related psychological factors among Korean firefighters.

PubMed

Kim, Min Gi; Seo, Ju-Il; Kim, KyooSang; Ahn, Yeon-Soon

2017-12-01

The main objective of this study was to assess the prevalence of lower back pain (LBP) and clarify the effect of work-related psychological factors on LBP. Nationwide survey data collected from male Korean firefighters (FIFS) were used. To identify the risk factors (work-related psychological factors such as job stress and depression) affecting LBP, the χ 2 test and multivariate logistic regression analyses were conducted. The prevalence of LBP was 19.3% and was highest in the emergency medical service (31.8%) part of FF job types. Within job stress, an uncomfortable physical environment, high mental job demand and organizational injustice were associated with LBP. However, inadequate social support inversely associated with LBP. Depression and high-risk alcohol drinking were related to LBP. LBP was closely related to job stress, depression and alcohol intake. Proper interventions of psychological factors should therefore be addressed to control LBP in FIFS.

Physical activity, psychosocial and perceived environmental factors in adolescents from Northeast Brazil.

PubMed

Farias Júnior, José Cazuza de; Reis, Rodrigo Siqueira; Hallal, Pedro Curi

2014-05-01

The aim of this study was to evaluate the association between levels of physical activity, psychosocial and perceived environmental factors in adolescents from Northeastern Brazil. A cross-sectional epidemiologic study was conducted with 2,859 adolescents enrolled in secondary schools (57.8% females; mean = 16.5 years; SD = 1.2) in the city of João Pessoa, Paraíba State, Brazil. The following physical activity correlates were measured: attitude, self-efficacy, social support from friends and parents, and perceived environmental characteristics. Physical activity was measured using a questionnaire. Multivariable ordinal logistic regression with proportional odds model analysis showed that the following factors are positively related to physical activity levels in adolescents: attitude, self-efficacy, as well as social support from parents and friends. Physical activity intervention programs should increase self-efficacy and social support from parents and friends, as well as a positive attitude toward physical activity.

Determinants of Sunburn and Sun Protection of Agricultural Workers During Occupational and Recreational Activities.

PubMed

Backes, Claudine; Milon, Antoine; Koechlin, Alice; Vernez, David; Bulliard, Jean-Luc

2017-11-01

The aim of this study was to identify determinants of occupational sunburn in agricultural workers and assess their occupational and recreational sun protection habits. Specific surveys of agricultural workers in Switzerland and France were conducted (N = 1538). Multivariate logistic regressions identified occupational sunburn determinants. Occupational and recreational sun protection habits were estimated and correlated. One-year occupational and recreational sunburn prevalences were 19.8% and 11.5%, respectively. Occupational sunburn increased with having a recent recreational sunburn, highly sensitive skin, young age, high perceived skin cancer risk, using sunscreen, and not wearing a hat. Correlation between protection habits during work and leisure was substantial (rs 0.5 to 0.7). Skin health knowledge was high and pro-tanning attitude moderate. Potentially modifiable sunburn determinants and suboptimal recreational and occupational sun protection practices were identified in agricultural workers. Refining and tailoring sun protection messages targeting the agricultural sector are needed.

The base rates and factors associated with reported access to firearms in psychiatric inpatients.

PubMed

Kolla, Bhanu Prakash; O'Connor, Stephen S; Lineberry, Timothy W

2011-01-01

The aim of this study was to define whether specific patient demographic groups, diagnoses or other factors are associated with psychiatric inpatients reporting firearms access. A retrospective medical records review study was conducted using information on access to firearms from electronic medical records for all patients 16 years and older admitted between July 2007 and May 2008 at the Mayo Clinic Psychiatric Hospital in Rochester, MN. Data were obtained only on patients providing authorization for record review. Data were analyzed using univariate and multivariate logistic regression analyses accounting for gender, diagnostic groups, comorbid substance use, history of suicide attempts and family history of suicide/suicide attempts. Seventy-four percent (1169/1580) of patients provided research authorization. The ratio of men to women was identical in both research and nonresearch authorization groups. There were 14.6% of inpatients who reported firearms access. In univariate analysis, men were more likely (P<.0001) to report access than women, and a history of previous suicide attempt(s) was associated with decreased access (P=.02). Multiple logistic regression analyses controlling for other factors found females and patients with history of previous suicide attempt(s) less likely to report access, while patients with a family history of suicide or suicide attempts reported increased firearms access. Diagnostic groups were not associated with access on univariate or multiple logistic regression analyses. Men and inpatients with a family history of suicide/suicide attempts were more likely to report firearms access. Clinicians should develop standardized systems of identification of firearms access and provide guidance on removal. Copyright © 2011 Elsevier Inc. All rights reserved.

Comparative Research of Navy Voluntary Education at Operational Commands

DTIC Science & Technology

2017-03-01

return on investment, ROI, logistic regression, multivariate analysis, descriptive statistics, Markov, time-series, linear programming 15. NUMBER...21  B.  DESCRIPTIVE STATISTICS TABLES ...............................................25  C.  PRIVACY CONSIDERATIONS...THIS PAGE INTENTIONALLY LEFT BLANK xi LIST OF TABLES Table 1.  Variables and Descriptions . Adapted from NETC (2016). .......................21

Perceived Neighborhood Social Disorder and Attitudes toward Reporting Domestic Violence against Women

ERIC Educational Resources Information Center

Gracia, Enrique; Herrero, Juan

2007-01-01

This study aims to explore the relationship between perceived neighborhood social disorder and attitudes toward reporting domestic violence against women. Data from a national representative sample (N = 14,994) of Spaniards 18 years old and older were used. Multivariate logistic regression analysis showed that perceived neighborhood social…

Psychosocial Correlates of Dating Violence Victimization among Latino Youth

ERIC Educational Resources Information Center

Howard, Donna E.; Beck, Kenneth; Kerr, Melissa Hallmark; Shattuck, Teresa

2005-01-01

To examine the association between physical dating violence victimization and risk and protective factors, an anonymous, cross-sectional, self-reported survey was administered to Latino youth (n = 446) residing in suburban Washington, DC. Multivariate logistic regression models were constructed, and adjusted OR and 95% CI were examined.…

Challenging Conventional Wisdom for Multivariate Statistical Models with Small Samples

ERIC Educational Resources Information Center

McNeish, Daniel

2017-01-01

In education research, small samples are common because of financial limitations, logistical challenges, or exploratory studies. With small samples, statistical principles on which researchers rely do not hold, leading to trust issues with model estimates and possible replication issues when scaling up. Researchers are generally aware of such…

Association of sleep disturbances with cognitive impairment and depression in maintenance memodialysis patients

USDA-ARS?s Scientific Manuscript database

There are few data on the relationship of sleep with measures of cognitive function and symptoms of depression in dialysis patients. We evaluated the relationship of sleep with cognitive function and symptoms of depression in 168 hemodialysis patients, using multivariable linear and logistic regress...

Multi-variant study of obesity risk genes in African Americans: The Jackson Heart Study.

PubMed

Liu, Shijian; Wilson, James G; Jiang, Fan; Griswold, Michael; Correa, Adolfo; Mei, Hao

2016-11-30

Genome-wide association study (GWAS) has been successful in identifying obesity risk genes by single-variant association analysis. For this study, we designed steps of analysis strategy and aimed to identify multi-variant effects on obesity risk among candidate genes. Our analyses were focused on 2137 African American participants with body mass index measured in the Jackson Heart Study and 657 common single nucleotide polymorphisms (SNPs) genotyped at 8 GWAS-identified obesity risk genes. Single-variant association test showed that no SNPs reached significance after multiple testing adjustment. The following gene-gene interaction analysis, which was focused on SNPs with unadjusted p-value<0.10, identified 6 significant multi-variant associations. Logistic regression showed that SNPs in these associations did not have significant linear interactions; examination of genetic risk score evidenced that 4 multi-variant associations had significant additive effects of risk SNPs; and haplotype association test presented that all multi-variant associations contained one or several combinations of particular alleles or haplotypes, associated with increased obesity risk. Our study evidenced that obesity risk genes generated multi-variant effects, which can be additive or non-linear interactions, and multi-variant study is an important supplement to existing GWAS for understanding genetic effects of obesity risk genes. Copyright © 2016 Elsevier B.V. All rights reserved.

Socio-economic Correlates of Malnutrition among Married Women in Bangladesh.

PubMed

Mostafa Kamal, S M; Md Aynul, Islam

2010-12-01

This paper examines the prevalence and socio-economic correlates of malnutrition among ever married non-pregnant women of reproductive age of Bangladesh using a nationally representative weighted sample of 10,145. Body mass index was used to measure nutritional status. Both bivariate and multivariate statistical analyses were employed to assess the relationship between socio-economic characteristics and women's nutritional status. Overall, 28.5% of the women were found to be underweight. The fixed effect multivariate binary logistic regression analysis yielded significantly increased risk of underweight for the young, currently working, non-Muslim, rural residents, widowed, divorced or separated women. Significant wide variations of malnourishment prevailed in the administrative regions of the country. Wealth index and women's education were the most important determinants of underweight. The multivariate logistic regression analysis revealed that the risk of being underweight was almost seven times higher (OR=6.76, 95% CI=5.20-8.80) among women with no formal education as compared to those with higher education and the likelihood of underweight was significantly (p<0.001) 5.2 times (OR=5.23, 95% CI=4.51-6.07) in the poorest as compared to their richest counterparts. Poverty alleviation programmes should be strengthened targeting the poor. Effective policies, information and health education programmes for women are required to ensure adequate access to health services and for them to understand the components of a healthy diet.

Identification of Users for a Smoking Cessation Mobile App: Quantitative Study

PubMed Central

Postel, Marloes G; Pieterse, Marcel E

2018-01-01

Background The number of mobile apps that support smoking cessation is growing, indicating the potential of the mobile phone as a means to support cessation. Knowledge about the potential end users for cessation apps results in suggestions to target potential user groups in a dissemination strategy, leading to a possible increase in the satisfaction and adherence of cessation apps. Objective This study aimed to characterize potential end users for a specific mobile health (mHealth) smoking cessation app. Methods A quantitative study was conducted among 955 Dutch smokers and ex-smokers. The respondents were primarily recruited from addiction care facilities and hospitals through Web-based media via websites and forums. The respondents were surveyed on their demographics, smoking behavior, and personal innovativeness. The intention to use and the attitude toward a cessation app were determined on a 5-point Likert scale. To study the association between the characteristics and intention to use and attitude, univariate and multivariate ordinal logistic regression analyses were performed. Results The multivariate ordinal logistic regression showed that the number of previous quit attempts (odds ratio [OR] 4.1, 95% CI 2.4-7.0, and OR 3.5, 95% CI 2.0-5.9) and the score on the Fagerstrom Test of Nicotine Dependence (OR 0.8, 95% CI 0.8-0.9, and OR 0.8, 95% CI 0.8-0.9) positively correlates with the intention to use a cessation app and the attitude toward cessation apps, respectively. Personal innovativeness also positively correlates with the intention to use (OR 0.3, 95% CI 0.2-0.4) and the attitude towards (OR 0.2, 95% CI 0.1-0.4) a cessation app. No associations between demographics and the intention to use or the attitude toward using a cessation app were observed. Conclusions This study is among the first to show that demographic characteristics such as age and level of education are not associated with the intention to use and the attitude toward using a cessation app when characteristics related specifically to the app, such as nicotine dependency and the number of quit attempts, are present in a multivariate regression model. This study shows that the use of mHealth apps depends on characteristics related to the content of the app rather than general user characteristics. PMID:29631988

Estimating Contraceptive Prevalence Using Logistics Data for Short-Acting Methods: Analysis Across 30 Countries.

PubMed

Cunningham, Marc; Bock, Ariella; Brown, Niquelle; Sacher, Suzy; Hatch, Benjamin; Inglis, Andrew; Aronovich, Dana

2015-09-01

Contraceptive prevalence rate (CPR) is a vital indicator used by country governments, international donors, and other stakeholders for measuring progress in family planning programs against country targets and global initiatives as well as for estimating health outcomes. Because of the need for more frequent CPR estimates than population-based surveys currently provide, alternative approaches for estimating CPRs are being explored, including using contraceptive logistics data. Using data from the Demographic and Health Surveys (DHS) in 30 countries, population data from the United States Census Bureau International Database, and logistics data from the Procurement Planning and Monitoring Report (PPMR) and the Pipeline Monitoring and Procurement Planning System (PipeLine), we developed and evaluated 3 models to generate country-level, public-sector contraceptive prevalence estimates for injectable contraceptives, oral contraceptives, and male condoms. Models included: direct estimation through existing couple-years of protection (CYP) conversion factors, bivariate linear regression, and multivariate linear regression. Model evaluation consisted of comparing the referent DHS prevalence rates for each short-acting method with the model-generated prevalence rate using multiple metrics, including mean absolute error and proportion of countries where the modeled prevalence rate for each method was within 1, 2, or 5 percentage points of the DHS referent value. For the methods studied, family planning use estimates from public-sector logistics data were correlated with those from the DHS, validating the quality and accuracy of current public-sector logistics data. Logistics data for oral and injectable contraceptives were significantly associated (P<.05) with the referent DHS values for both bivariate and multivariate models. For condoms, however, that association was only significant for the bivariate model. With the exception of the CYP-based model for condoms, models were able to estimate public-sector prevalence rates for each short-acting method to within 2 percentage points in at least 85% of countries. Public-sector contraceptive logistics data are strongly correlated with public-sector prevalence rates for short-acting methods, demonstrating the quality of current logistics data and their ability to provide relatively accurate prevalence estimates. The models provide a starting point for generating interim estimates of contraceptive use when timely survey data are unavailable. All models except the condoms CYP model performed well; the regression models were most accurate but the CYP model offers the simplest calculation method. Future work extending the research to other modern methods, relating subnational logistics data with prevalence rates, and tracking that relationship over time is needed. © Cunningham et al.

Estimating Contraceptive Prevalence Using Logistics Data for Short-Acting Methods: Analysis Across 30 Countries

PubMed Central

Cunningham, Marc; Brown, Niquelle; Sacher, Suzy; Hatch, Benjamin; Inglis, Andrew; Aronovich, Dana

2015-01-01

Background: Contraceptive prevalence rate (CPR) is a vital indicator used by country governments, international donors, and other stakeholders for measuring progress in family planning programs against country targets and global initiatives as well as for estimating health outcomes. Because of the need for more frequent CPR estimates than population-based surveys currently provide, alternative approaches for estimating CPRs are being explored, including using contraceptive logistics data. Methods: Using data from the Demographic and Health Surveys (DHS) in 30 countries, population data from the United States Census Bureau International Database, and logistics data from the Procurement Planning and Monitoring Report (PPMR) and the Pipeline Monitoring and Procurement Planning System (PipeLine), we developed and evaluated 3 models to generate country-level, public-sector contraceptive prevalence estimates for injectable contraceptives, oral contraceptives, and male condoms. Models included: direct estimation through existing couple-years of protection (CYP) conversion factors, bivariate linear regression, and multivariate linear regression. Model evaluation consisted of comparing the referent DHS prevalence rates for each short-acting method with the model-generated prevalence rate using multiple metrics, including mean absolute error and proportion of countries where the modeled prevalence rate for each method was within 1, 2, or 5 percentage points of the DHS referent value. Results: For the methods studied, family planning use estimates from public-sector logistics data were correlated with those from the DHS, validating the quality and accuracy of current public-sector logistics data. Logistics data for oral and injectable contraceptives were significantly associated (P<.05) with the referent DHS values for both bivariate and multivariate models. For condoms, however, that association was only significant for the bivariate model. With the exception of the CYP-based model for condoms, models were able to estimate public-sector prevalence rates for each short-acting method to within 2 percentage points in at least 85% of countries. Conclusions: Public-sector contraceptive logistics data are strongly correlated with public-sector prevalence rates for short-acting methods, demonstrating the quality of current logistics data and their ability to provide relatively accurate prevalence estimates. The models provide a starting point for generating interim estimates of contraceptive use when timely survey data are unavailable. All models except the condoms CYP model performed well; the regression models were most accurate but the CYP model offers the simplest calculation method. Future work extending the research to other modern methods, relating subnational logistics data with prevalence rates, and tracking that relationship over time is needed. PMID:26374805

Neurophysiological correlates of depressive symptoms in young adults: A quantitative EEG study.

PubMed

Lee, Poh Foong; Kan, Donica Pei Xin; Croarkin, Paul; Phang, Cheng Kar; Doruk, Deniz

2018-01-01

There is an unmet need for practical and reliable biomarkers for mood disorders in young adults. Identifying the brain activity associated with the early signs of depressive disorders could have important diagnostic and therapeutic implications. In this study we sought to investigate the EEG characteristics in young adults with newly identified depressive symptoms. Based on the initial screening, a total of 100 participants (n = 50 euthymic, n = 50 depressive) underwent 32-channel EEG acquisition. Simple logistic regression and C-statistic were used to explore if EEG power could be used to discriminate between the groups. The strongest EEG predictors of mood using multivariate logistic regression models. Simple logistic regression analysis with subsequent C-statistics revealed that only high-alpha and beta power originating from the left central cortex (C3) have a reliable discriminative value (ROC curve >0.7 (70%)) for differentiating the depressive group from the euthymic group. Multivariate regression analysis showed that the single most significant predictor of group (depressive vs. euthymic) is the high-alpha power over C3 (p = 0.03). The present findings suggest that EEG is a useful tool in the identification of neurophysiological correlates of depressive symptoms in young adults with no previous psychiatric history. Our results could guide future studies investigating the early neurophysiological changes and surrogate outcomes in depression. Copyright © 2017 Elsevier Ltd. All rights reserved.

Reproductive factors, nutritional status and serum 25(OH)D levels in women with breast cancer: A case control study.

PubMed

Sofi, Nighat Y; Jain, Monika; Kapil, Umesh; Seenu, Vuthaluru; R, Lakshmy; Yadav, Chander P; Pandey, Ravindra M; Sareen, Neha

2018-01-01

The study was conducted with an objective to investigate the association between reproductive factors, nutritional status and serum 25(OH)D levels among women diagnosed with breast cancer (BC). A total of 200 women with BC attending a tertiary healthcare institute of Delhi, India matched with 200 healthy women for age (±2years) and socio economic status were included in the study. Data was collected on socio-demographic profile, reproductive factors, physical activity and dietary intake (24h dietary recall and food frequency questionnaire) using interviewer administered structured questionnaires and standard tools. Non fasting blood samples (5ml) were collected for the biochemical estimation of serum 25(OH)D and calcium levels by chemiluminescent immunoassay and colorimetric assay technique. Data was analyzed by univariable conditional logistic regression and significant variables with (p<0.05), were analyzed in final model by conditional multivariable logistic regression analysis. The mean age of patients at diagnosis of BC was 45±10years. Results of multivariable conditional logistic regression analysis revealed significantly higher odds of BC for reproductive factors like age at marriage (more than 23 years), number of abortions, history or current use of oral contraceptive pills (OCP), with [OR (95% CI)] of [2.4 (1.2-4.9)], [4.0 (1.6-12.6)], [2.4 (1.2-5.0)]. Women with physically light activities and occasional consumption of eggs were found to have higher odds of BC [4.6 (1.6-13.0)] and [3.2 (1.6-6.3)]. Women with serum 25(OH)D levels less than 20ng/ml and calcium levels less than 10.5mg/dl had higher odds of having BC [2.4 (1.2-5.1)] and [3.7 (1.5-8.8)]. A protective effect of urban areas as place of residence and energy intake greater than 50% of Recommended Dietary Allowance (RDA) per day against BC was observed (p<0.05). The findings of the present study revealed a significant association of reproductive and dietary factors in addition to sedentary physical activity and low serum 25(OH)D levels in women diagnosed with BC. Copyright © 2017 Elsevier Ltd. All rights reserved.

Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation.

PubMed

Ross, Ian; Mejia, Carlos; Melendez, Johanna; Chan, Philip A; Nunn, Amy C; Powderly, William; Goodenberger, Katherine; Liu, Jingxia; Mayer, Kenneth H; Patel, Rupa R

2017-01-01

HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala.

Vitamin D status modifies the association between statin use and musculoskeletal pain: a population based study.

PubMed

Morioka, Travis Y; Lee, Alice J; Bertisch, Suzanne; Buettner, Catherine

2015-01-01

Past studies examining the effect of vitamin D on statin myalgia have been variable; however, these studies were done in limited samples not representative of the general population. We aimed to evaluate whether vitamin D status modifies the association between statin use and musculoskeletal pain in a sample representative of the general population. We conducted a cross-sectional study using the National Health and Nutrition Examination Survey 2001-2004. Musculoskeletal symptoms and statin use were self-reported. Vitamin D status was assessed using serum 25 hydroxyvitamin D (25[OH]D), categorized as <15 ng/mL or ≥15 ng/mL. To evaluate if vitamin D status modifies the association between statin use and prevalent musculoskeletal pain, we performed multivariable-adjusted logistic regression models stratified by 25(OH)D status. Among 5907 participants ≥40 years old, mean serum 25(OH)D was 23.6 ng/mL (95% CI, 22.9-24.3). In stratified multivariable-adjusted logistic regression models, individuals with 25(OH)D <15 ng/mL, using a statin had a significantly higher odds of musculoskeletal pain compared to those not using a statin (adjusted odds ratio [aOR], 1.90; 95% CI, 1.18-3.05). Among those with 25(OH)D ≥15 ng/mL, we found no significant association between statin use and musculoskeletal pain (aOR, 0.91; 95% CI, 0.71-1.16). Among adults ≥ 40 years old with 25(OH)D <15 ng/mL, statin users had nearly 2 times greater odds of reporting musculoskeletal pain compared to non-statin users. Our findings support the hypothesis that vitamin D deficiency modifies the risk of musculoskeletal symptoms experienced with statin use. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Awareness, treatment, control of diabetes mellitus and the risk factors: survey results from northeast China.

PubMed

Wang, Chang; Yu, Yaqin; Zhang, Xiangyang; Li, Yong; Kou, Changgui; Li, Bo; Tao, Yuchun; Zhen, Qing; He, Huan; Kanu, Joseph Sam; Huang, Xufeng; Han, Mei; Liu, Yawen

2014-01-01

The awareness, treatment and control of diabetes mellitus (DM) can effectively reflect on the social status of diabetes conditions. Although several researchers have investigated the awareness, treatment and control rates of diabetes mellitus in China, little is known about their association with risk factors. This study aims to examine the relationship between risk factors and awareness, treatment and control of diabetes mellitus in northeast China. A cross-sectional survey was conducted in 2012. Multistage stratified random cluster sampling design was used to select participants aged 18 to 79 years old. The analysis was based on a representative sample of 1,854 adult subjects. Multivariable logistic regression analysis was used to examine socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus. The awareness, treatment, and control rates of diabetes mellitus were 64.1%, 52.9% and 44.2%, respectively. In the multivariable logistic regression analysis, family history of diabetes was significantly positively associated with awareness (OR, 2.145; 95% CI, 1.600-2.875) and treatment (OR, 2.021; 95% CI, 1.559-2.619) of diabetes mellitus, while negatively associated with control (OR, 0.671; 95% CI, 0.529-0.951). Cigarette smokers and alcohol drinkers were less likely than non-smokers and non-drinkers to be aware of their blood glucose levels (OR, 0.895, 0.614; 95% CI, 0.659-1.216, 0.446-0.844, respectively). Participants who frequently exercise were more likely to be aware of their diabetic conditions than people who never or rarely exercise (OR, 2.003; 95% CI, 1.513-2.651). We found that the awareness and treatment of diabetes mellitus were positively associated with age and were high in participants with a family history of diabetes and those who exercise frequently, but low for cigarette smokers and alcohol drinkers. Participants with a family history of diabetes had their diabetic condition poorly controlled.

A survey of community members' perceptions of medical errors in Oman

PubMed Central

Al-Mandhari, Ahmed S; Al-Shafaee, Mohammed A; Al-Azri, Mohammed H; Al-Zakwani, Ibrahim S; Khan, Mushtaq; Al-Waily, Ahmed M; Rizvi, Syed

2008-01-01

Background Errors have been the concern of providers and consumers of health care services. However, consumers' perception of medical errors in developing countries is rarely explored. The aim of this study is to assess community members' perceptions about medical errors and to analyse the factors affecting this perception in one Middle East country, Oman. Methods Face to face interviews were conducted with heads of 212 households in two villages in North Al-Batinah region of Oman selected because of close proximity to the Sultan Qaboos University (SQU), Muscat, Oman. Participants' perceived knowledge about medical errors was assessed. Responses were coded and categorised. Analyses were performed using Pearson's χ2, Fisher's exact tests, and multivariate logistic regression model wherever appropriate. Results Seventy-eight percent (n = 165) of participants believed they knew what was meant by medical errors. Of these, 34% and 26.5% related medical errors to wrong medications or diagnoses, respectively. Understanding of medical errors was correlated inversely with age and positively with family income. Multivariate logistic regression revealed that a one-year increase in age was associated with a 4% reduction in perceived knowledge of medical errors (CI: 1% to 7%; p = 0.045). The study found that 49% of those who believed they knew the meaning of medical errors had experienced such errors. The most common consequence of the errors was severe pain (45%). Of the 165 informed participants, 49% felt that an uncaring health care professional was the main cause of medical errors. Younger participants were able to list more possible causes of medical errors than were older subjects (Incident Rate Ratio of 0.98; p < 0.001). Conclusion The majority of participants believed they knew the meaning of medical errors. Younger participants were more likely to be aware of such errors and could list one or more causes. PMID:18664245

Sociodemographic Characteristics of Pregnant Women Exposed to Domestic Violence During Pregnancy in an Iranian Setting

PubMed Central

Hajikhani Golchin, Nayereh Azam; Hamzehgardeshi, Zeinab; Hamzehgardeshi, Leila; Shirzad Ahoodashti, Mahboobeh

2014-01-01

Background: Domestic violence refers to any type of physical, sexual, and psychological abuse enforced in the setting of familial relationships. Domestic violence has a significant relationship with poor outcome among pregnant women. Success in resolving this social phenomenon rests on accurate assessment of the society and the factors associated with violence in that specific community. Objectives: The present study was conducted to assess the demographic characteristics of pregnant women exposed to different types of domestic violence during pregnancy in Iranian setting. Patients and Methods: This is a descriptive-analytic, cross-sectional study. Sampling was done with convenience sampling method. in the current study, 301 pregnant women aged 15-45 years of Iranian nationality who were referred to the hospital for delivery or abortion, regardless of the gestational age, were selected as the subjects. Data collection tools consisted of a sociodemographic questionnaire and a violence checklist. Violence was assessed using Revised Conflict Tactics Scale (CTS2). Data were analyzed using descriptive and analytic statistics on SPSS version 16 (SPSS, Chicago, IL, USA) and STATA version 10. The characteristics of the participants were presented as mean ± SD or number and percentage. Differences between variables were determined by the χ2 test, and multivariate logistic regression. P < 0.05 was considered significant. Results: According to the findings, 34.56% of participants had experienced psychological violence, 28.24% physical violence, and 3.65% sexual violence. Multivariate logistic regression revealed a statistically significant relationship only in the case of physical violence and history of penal conviction for partner (Adjusted Odds Ratio (AOR) = 12.60) and a patriarchal household (AOR = 16.75). Conclusions: As domestic violence is greatly influenced by the customs and cultures of each community, no single strategy can be adopted to resolve it universally. Simultaneously, it is necessary to adopt comprehensive measures to control factors associated with domestic violence in the healthcare, judiciary, and the educational systems in order to prevent and curb this social challenge. PMID:24910784

Differential diagnosis between tuberculous spondylodiscitis and pyogenic spontaneous spondylodiscitis: a multicenter descriptive and comparative study.

PubMed

Yoon, Young K; Jo, Yu M; Kwon, Hyun H; Yoon, Hee J; Lee, Eun J; Park, So Y; Park, Seong Y; Choo, Eun J; Ryu, Seong Y; Lee, Mi S; Yang, Kyung S; Kim, Shin W

2015-08-01

Although tuberculous and pyogenic spondylodiscitis are common causes of spinal infections, their protean manifestation complicates differential diagnosis. The clinical, laboratory, and radiologic characteristics of tuberculous and pyogenic spontaneous spondylodiscitis were compared in this study. This multicenter retrospective study was conducted in 11 teaching hospitals in the Republic of Korea from January 2011 to December 2013. Study subjects included adult patients (≥18 years) diagnosed with tuberculous (n=60) or pyogenic (n=117) spontaneous spondylodiscitis. Risk factors for tuberculous spondylodiscitis were determined, and their predictive performance was evaluated. Multivariate logistic regression analysis was performed to determine predictors independently associated with tuberculous spondylodiscitis. Receiver-operating characteristic curve analysis using the presence or absence of risk factors was used to generate a risk index to identify patients with increased probability of tuberculous spondylodiscitis. Of 177 patients, multivariate logistic regression analysis showed that patients with tuberculous spondylodiscitis (n=60) were more frequently women, with increased nonlumbar spinal involvement and associated non-spinal lesions, delayed diagnosis, higher serum albumin levels, reduced white blood cell counts, and lower C-reactive protein and procalcitonin levels. Among 117 patients with pyogenic spondylodiscitis, the most frequent causative microorganism was Staphylococcus aureus (64.1%). The mean diagnostic delay was significantly shorter, which may reflect higher clinical expression leading to earlier diagnosis. A combination of clinical data and biomarkers had better predictive value for differential diagnosis compared with biomarkers alone, with an area under the curve of 0.93, and sensitivity, specificity, and positive and negative predictive values of 95.0%, 79.5%, 70.4%, and 96.9%, respectively. This study provides guidance for clinicians to predict the causative organisms of spondylodiscitis in uncertain situations and before culture or pathologic examinations. Clinical data and single biomarkers combined can be useful for differential diagnoses between tuberculous and pyogenic spondylodiscitis. Copyright © 2015. Published by Elsevier Inc.

Urologists in cyberspace: A review of the quality of health information from American urologists' websites using three validated tools.

PubMed

Wong, Lih-Ming; Yan, Hanmu; Margel, David; Fleshner, Neil E

2013-01-01

In this paper, we evaluate a sample of urologists' web-sites, based in the United States, using three validated instruments: the Health on the Net Foundation code of conduct (HONcode), DISCERN and LIDA tools. We also discuss how medical websites can be improved. We used the 10 most populous cities in America, identified from the US Census Bureau, and searched using www.google. com to find the first 10 websites using the terms "urologist + city." Each website was scored using the HONcode, DISCERN and LIDA instruments. The median score for each tool was used to dichotomize the cohort and multivariable logistic regression was used to identify independent predictors of higher scores. Of the 100 websites found, 78 were analyzed. There were 18 academic institutions, 43 group and 17 solo practices. A medical website design service had been used by 18 websites. The HONcode badge was seen on 3 websites (4%). Social media was used by 16 websites. Multivariable logistic regression showed predictors of higher scores for each tool. For HONcode, academic centres (OR 6.8, CI 1.2-37.3, p = 0.028) and the use of a medical website design service (OR 17.2, CI 3.8-78.1, p = 0.001) predicted a higher score. With DISCERN, academic centres (OR 23.13, p = 0.002, CI 3.15-169.9 and group practices (OR 7.19, p = 0.022, CI 1.33-38.93) were predictors of higher scores. Finally, with the LIDA tool, there were no predictors of higher scores. Pearson correlation did not show any correlation between the three scores. Using 3 validated tools for appraising online health information, we found a wide variation in the quality of urologists' websites in the United States. Increased awareness of standards and available resources, coupled with guidance from health professional regulatory bodies, would improve the quality urological health information on medical websites.

Surgery for Infective Endocarditis: Outcomes and Predictors of Mortality in 360 Consecutive Patients

PubMed Central

Farag, Mina; Borst, Tobias; Sabashnikov, Anton; Zeriouh, Mohamed; Schmack, Bastian; Arif, Rawa; Beller, Carsten J.; Popov, Aron-Frederik; Kallenbach, Klaus; Ruhparwar, Arjang; Dohmen, Pascal M.; Szabó, Gábor; Karck, Matthias; Weymann, Alexander

2017-01-01

Background A retrospective analysis was conducted of the early and long-term outcomes after surgery for infective endocarditis (IE). Material/Methods We included 360 patients with IE operated upon between 1993 and 2012. The primary endpoint was overall cumulative postoperative survival at 30 days. Secondary endpoints were early postoperative outcomes and complication rates. Factors associated with 30-day mortality were analyzed. Results Mean age was 58.7±14.7 years and 26.9% (n=97) were female. The mean follow-up was 4.41±4.53 years. Postoperative survival was 81.7% at 30 days, 69.4% at 1 year, 63.3% at 5 years, and 63.3% at 10 years. Non-survivors were significantly older (p=0.014), with higher NYHA Class (p=0.002), had higher rates of preoperative diabetes mellitus (p=0.005), renal failure (p=0.001), and hepatic disease (p=0.002). Furthermore, non-survivors had higher baseline alanine aminotransferase (ALT, p=0.048), aspartate transaminase (AST, p=0.027), bilirubin (p=0.013), white cell count (WCC, p=0.034), and CRP (p=0.049). Factors associated with 30-day mortality were longer duration of surgery, CPB, and aortic cross-clamping times (p<0.001, p<0.001, and p=0.003, respectively), as well as higher RBC, FFP, and platelet transfusion requirements (p<0.001, p=0.005, and p<0.001, respectively). Multivariate logistic regression analysis revealed liver cirrhosis (OR 4.583, 95-CI: 1.096–19.170, p=0.037) and longer CPB time (OR 1.025, 95-CI 1.008–1.042, p=0.004) as independent predictors of 30-day mortality. Conclusions Surgical treatment of IE shows satisfactory early, midterm, and long-term results. Multivariate logistic regression analysis revealed cirrhosis and longer CPB time as independent predictors of 30-day mortality. PMID:28740070

Seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women from Bobo Dioulasso, Burkina Faso.

PubMed

Bamba, Sanata; Cissé, Mamoudou; Sangaré, Ibrahim; Zida, Adama; Ouattara, Souleymane; Guiguemdé, Robert T

2017-07-11

Toxoplasmosis is one of the common worldwide parasitic zoonosis due to Toxoplasma gondii (T. gondii). Toxoplasmosis during pregnancy can result in fetal and neonatal death or various congenital defects. The aim of this study was to assess the seroprevalence and risk factors of T. gondii infection in pregnant women following antenatal care (ANC) services at Bobo Dioulasso. A cross-sectional study was conducted enrolling a sample of 316 pregnant women attending ANC at centers for maternal and child health of Bobo-Dioulasso town from March 2013 to February 2014. Data on socio-demographic and potential risk factors were collected from each study participant using structured questionnaire through face-to-face interview. Moreover, venous blood specimens were collected and tested for IgM and IgG anti-T. gondii antibodies by enzyme-linked immunosorbent assay and enzyme linked fluorescent assay, respectively. Multivariable logistic regression modeling was used to identify the potential predictor variables for T. gondii infection. The overall seroprevalence for T. gondii infection was 31.1% (98/316). All the pregnant women were positive for IgG anti-bodies exclusively. Multivariable logistic regression analysis showed that having at least a secondary education level (AOR = 2.23; 95% CI: [1.04-4.63]); being urban resident (AOR = 2.81; 95% CI: [1.24-6.86]) and the consumption of meat combination (pork + beef + mutton + wild meat + poultry) (AOR = 4.00; 95% CI: [1.06-15.24]) were potential risk factors of T. gondii infection. Toxoplasmosis is frequent in pregnant women and studies that show incidence of T. gondii among the neonates have to be done to introduce routine antenatal screening program to control congenital toxoplasmosis. There is the need for preventive measures such as education of pregnant women about the transmission routes and prevention methods of toxoplasmosis at ANC clinics.

Rapid Assessment of Visual Impairment in Urban Population of Delhi, India

PubMed Central

Gupta, Noopur; Vashist, Praveen; Malhotra, Sumit; Senjam, Suraj Singh; Misra, Vasundhara; Bhardwaj, Amit

2015-01-01

Purpose To determine the prevalence, causes and associated demographic factors related to visual impairment amongst the urban population of New Delhi, India. Methods A population-based, cross-sectional study was conducted in East Delhi district using cluster random sampling methodology. This Rapid Assessment of Visual Impairment (RAVI) survey involved examination of all individuals aged 40 years and above in 24 randomly selected clusters of the district. Visual acuity (VA) assessment and comprehensive ocular examination were done during the door-to-door survey. A questionnaire was used to collect personal and demographic information of the study population. Blindness and Visual Impairment was defined as presenting VA <3/60and <6/18 in the better eye, respectively. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for visual impairment. Results Of 2421 subjects enumerated, 2331 (96.3%) were available for ophthalmic examination. Among those examined, 49.3% were males. The prevalence of visual impairment (VI) in the study population, was 11.4% (95% C.I. 10.1, 12.7) and that of blindness was 1.2% (95% C.I. 0.8, 1.6). Uncorrected refractive error was the leading cause of VI accounting for 53.4% of all VI followed by cataract (33.8%). With multivariable logistic regression, the odds of having VI increased with age (OR= 24.6[95% C.I.: 14.9, 40.7]; p<0.001). Illiterate participants were more likely to have VI [OR= 1.5 (95% C.I.: 1.1,2.1)] when compared to educated participants. Conclusions The first implementation of the RAVI methodology in a North Indian population revealed that the burden of visual impairment is considerable in this region despite availability of adequate eye care facilities. Awareness generation and simple interventions like cataract surgery and provision of spectacles will help to eliminate the major causes of blindness and visual impairment in this region. PMID:25915659

Rapid assessment of visual impairment in urban population of Delhi, India.

PubMed

Gupta, Noopur; Vashist, Praveen; Malhotra, Sumit; Senjam, Suraj Singh; Misra, Vasundhara; Bhardwaj, Amit

2015-01-01

To determine the prevalence, causes and associated demographic factors related to visual impairment amongst the urban population of New Delhi, India. A population-based, cross-sectional study was conducted in East Delhi district using cluster random sampling methodology. This Rapid Assessment of Visual Impairment (RAVI) survey involved examination of all individuals aged 40 years and above in 24 randomly selected clusters of the district. Visual acuity (VA) assessment and comprehensive ocular examination were done during the door-to-door survey. A questionnaire was used to collect personal and demographic information of the study population. Blindness and Visual Impairment was defined as presenting VA < 3/60 and < 6/18 in the better eye, respectively. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for visual impairment. Of 2421 subjects enumerated, 2331 (96.3%) were available for ophthalmic examination. Among those examined, 49.3% were males. The prevalence of visual impairment (VI) in the study population, was 11.4% (95% C.I. 10.1, 12.7) and that of blindness was 1.2% (95% C.I. 0.8, 1.6). Uncorrected refractive error was the leading cause of VI accounting for 53.4% of all VI followed by cataract (33.8%). With multivariable logistic regression, the odds of having VI increased with age (OR = 24.6[95% C.I.: 14.9, 40.7]; p < 0.001). Illiterate participants were more likely to have VI [OR = 1.5 (95% C.I.: 1.1,2.1)] when compared to educated participants. The first implementation of the RAVI methodology in a North Indian population revealed that the burden of visual impairment is considerable in this region despite availability of adequate eye care facilities. Awareness generation and simple interventions like cataract surgery and provision of spectacles will help to eliminate the major causes of blindness and visual impairment in this region.

Prenatal diagnosis of prevalence of the right heart: associated anomalies and outcome predictors.

PubMed

Peng, Ruan; Xie, Hong-Ning; Zhu, Yun-Xiao; Li, Li-Juan; Du, Liu; Zheng, Ju

2014-07-01

To analyze the characteristics, associations, and outcomes of prevalence of the right heart and to evaluate the use of sonography to predict the risk of a poor prognosis in fetuses with this condition. We conducted a retrospective cohort study of 182 fetuses with prevalence of the right heart. At the initial evaluation, the left ventricle (LV) and right ventricle (RV) sizes, left atrium and right atrium sizes, great artery diameters, appearance of the aortic arch and ductus arteriosus arch, and flow direction across the foramen ovale and aortic arch were documented. Malformations were documented in fetuses with intracardiac anomalies, who were divided into groups with and without coexisting extracardiac defects. The RV-LV diameter ratio and main pulmonary artery-to-aortic root diameter ratio were calculated and compared. The following variables were analyzed: coexisting intracardiac anomalies, associated extracardiac anomalies, diagnosis before 24 gestational weeks, fetal growth restriction, reversed flow across the foramen ovale, reversed flow in the aortic arch, and RV-LV ratio greater than 2.0. Relationships between these sonographic findings and the prognosis were evaluated by multivariable logistic regression. Of the 182 fetuses, 1 (0.5%) had intrauterine death, and 25 (13.7%) had neonatal death; 1 (0.5%) had selective reduction, and 106 (58.2%) underwent termination of pregnancy; 49 (26.9%) survived at this writing. The mean RV-LV ratio was 1.67. Multivariable logistic regression revealed that only 2 sonographic parameters, coexisting intracardiac anomalies (odds ratio, 17.75; 95% confidence interval, 4.18-75.26) and diagnosis before 24 weeks (odds ratio, 17.26; 95% confidence interval, 1.80-165.39) were significantly associated with a poor prognosis. The sonographic parameters of coexisting intracardiac anomalies and diagnosis before 24 gestational weeks are significant independent predictors of a poor prognosis in fetuses with prevalence of the right heart. Combinations of these risk factors may be useful in prenatal consultation. © 2014 by the American Institute of Ultrasound in Medicine.

Culture-bound syndromes in Hispanic primary care patients.

PubMed

Bayles, Bryan P; Katerndahl, David A

2009-01-01

We sought to document Hispanic primary care patients' knowledge and experience of five culture-bound syndromes (CBS), as well as the basic socio-cultural correlates of these disorders. A convenience sample of 100 adult Hispanic patients presenting in an urban South Texas primary care clinic was recruited to complete a brief cross-sectional survey, presented in an oral format. Interviews sought information concerning five culture-bound syndromes--susto, empacho, nervios, mal de ojo, and ataques de nervios. Additional demographic, socio-economic, and acculturation data was collected. Descriptive and bivariate statistics (chi square, Fisher's) were used to assess relationships among variables and experience with each CBS. A multivariate logistic analysis was conducted to determine the possible contributions of age, gender, acculturation, and education to the personal experience of a culture-bound syndrome. Results indicate that 77% of respondents had knowledge of all five syndromes, with 42% reporting having personally experienced at least one CBS. Nervios was the most commonly suffered disorder, being reported by 30 respondents. This was followed, in declining order ofprevalence, by susto, mal de ojo, empacho, and ataques de nervios. Multivariate logistic regression analysis found that higher education beyond high school was associated with a slightly decreased likelihood of reporting having suffered from any culture-bound syndrome. While co-occurrence among these disorders occurred, the patterns of predictors suggest that the co-occurrence is not a reflection of mislabeling of one common syndrome. Knowledge of and experience with culture-bound syndromes is common among Hispanic primary care patients in South Texas. Healthcare providers ought to consider discussing these illnesses in a non-judgmental manner with patients who present with symptoms that are consistent with these syndromes. Future studies, with larger sample sizes, are warranted to elucidate the nature of culture-bound disorders and their relationships with conventional diagnostic entities and treatment-seeking behaviors.

Association between obesity and chronic periodontitis: a cross-sectional study.

PubMed

Palle, Ajay Reddy; Reddy, C M Sanjeeva Kumar; Shankar, B Shiva; Gelli, Vemsi; Sudhakar, Jaradoddi; Reddy, K Krishna Mohana

2013-03-01

Chronic periodontitis is multifactorial and numerous risk factors have been identified to contribute in the disease progression. Current study aimed to conduct a cross-sectional study in a population of patients with cardiovascular diseases in order to correlate the association between obesity [body mass index (BMI) and waist circumference (WC)] and periodontal disease parameters. The study was of a cross-sectional design and a total of 201 patients were examined after obtaining their informed consent. Subjects who had a history of cardiovascular diseases and under treatment were included in the study. Two indicators of obesity were used: BMI and WC. The following periodontal parameters were assessed: Probing depth, clinical attachment level. The oral hygiene status of the subjects was assessed by the oral hygiene index (OHI, simplified) given by John C Greene and Jack R Vermillion. The influence of the BMI and other confounding variables on periodontitis severity was assessed by multivariate logistic regression analysis. Data were analyzed using SPSS. Significant association was seen with low density lipoproteins (LDL) and severity of periodontitis (p < 0.005), triglyceride levels (TGL) and severity of periodontitis (p < 0.005), cholesterol and severity of periodontitis (p < 0.005), BMI and severity of periodontitis (p < 0.001), OHI and severity of periodontitis (p < 0.001). Significant association was seen with smoking and severity of periodontitis (p < 0.005), BMI and severity of periodontitis (p < 0.001), WC and severity of periodontitis (p < 0.001), cholesterol and severity of periodontitis (p < 0.001), OHI and severity of periodontitis (p < 0.001). Obesity has been implicated as a risk factor for several conditions including cardiovascular disease, diabetes, etc. In our study the relation between measures of overall and abdominal obesity (BMI and WC) and periodontal disease showed significant association in the multivariate logistic regression analysis independent of other confounding factors. Obesity can act as a significant risk factor in progression of periodontitis.

[Related factors for severe liver fibrosis in chronic hepatitis C patients with remunerated blood donation history in Jurong of Jiangsu province].

PubMed

Yao, Y N; Huang, P; Chen, H B; Zhang, L; Chen, M Z; Yu, R B

2017-01-10

Objective: The incidence of liver fibrosis in patients with chronic hepatitis C is high. Without effective treatment, it would lead to liver cirrhosis. This study is to identify the related factors for the incidence of liver fibrosis in patients with chronic hepatitis C in order to make early intervention treatment and reduce the case fatality rate. Methods: This cross-sectional survey was conducted in adults aged ≥50 years with local residence for more than 5 years in Jurong of Jiangsu province from March to May in 2015, the patients infected with hepatitis C virus through remunerated blood donation were screened and included in the analysis. Descriptive statistical analysis was done to compare the differences in the incidence of liver fibrosis among the patients with different age, sex and education level or co-infected with hepatitis B virus or not. The risk factors for severe liver fibrosis were identified with univariate and multivariate logistic regression analysis. Liver fibrosis was diagnosed by using FIB-4 index method. Results: A total of 719 patients with chronic hepatitis C were surveyed. Severe liver fibrosis developed in 285 of the 719 patients, in whom 21.84 % was males. Multivariate logistic regression analysis showed that the patients with higher education level ( OR =0.65, 95 %CI : 0.47-0.90) and with access of antiviral therapy ( OR =0.33, 95 %CI : 0.22-0.49) had lower risk for severe liver fibrosis, the patients with high fasting blood glucose level ( OR =1.80, 95 % CI : 1.19-2.77) and abnormal white blood cell count ( OR =2.77, 95 % CI : 1.95-3.90) had higher risk for severe liver fibrosis. Conclusions: The incidence of severe liver fibrosis in patients with hepatitis C was affected by many factors. Higher education level and antiviral therapy were the protective factors, but high fasting blood glucose level and abnormal white blood cell count were the risk factors.

Analysis of Blood Glucose Distribution Characteristics and Its Risk Factors among a Health Examination Population in Wuhu (China)

PubMed Central

Song, Jiangen; Zha, Xiaojuan; Li, Haibo; Guo, Rui; Zhu, Yu; Wen, Yufeng

2016-01-01

Background: Diabetes mellitus (DM) and Impaired Fasting Glucose (IFG) represent serious threats to human health, and as a result, this study was aimed at understanding the blood glucose distribution characteristics and the risk factors among a large health examination population in China. Methods: An investigation with physical and biochemical examinations and questionnaires was conducted in the physical examination center from 2011 to 2014 and as a result 175,122 physical examination attendees were enrolled in this study. Multivariate logistic regression was used to explore the factors influencing blood sugar levels. Results: The rates of IFG and DM were 6.0% and 3.8%. Prevalence were 7.6%/5.1% in males and 5.1%/2.8% in females for IFG and DM, respectively. The prevalence of IFG and DM were thus higher in males than in females. In the normal group, except high density lipoprotein (HDL) that was significantly higher than in the IFG and DM group, the other indexes (age, body mass index (BMI), glucose (Glu), total cholesterol (TC) and total glycerides (TG) were lower than those in the IFG and DM group. The proportion of IFG and DM also increased with the increases in proportion of abnormal blood pressure, smoking and alcohol consumption. Multivariate logistic regression analysis showed that increasing age, high BMI, high TC, high TG and low HDL increased the risk of diabetes, while in males, in addition to the above factors, the smoking and drinking factors also increased the risk of diabetes. After the age of 65, the blood glucose level reached a peak in males, while in females, the increasing trends was on the rise. The inflexion age of the fast rise was younger in males than in females. Conclusion: The study population showed a high prevalence of DM and IFG among the adults. Regular physical examination for the early detection of diabetes is recommended in the high-risk population. PMID:27043603

Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study.

PubMed

Nishi, Taiki; Kamikura, Takahisa; Funada, Akira; Myojo, Yasuhiro; Ishida, Tetsuya; Inaba, Hideo

2016-01-01

Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival after out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival, and regional classifications based on BCPR- and EMS-related indexes. Logit analysis including all regional classifications revealed that the number of BLS training course participants per population or bystander's own performance of BCPR without DA-CPR was not associated with the survival. Multivariable logistic regression including the OHCA backgrounds known to be associated with survival (BCPR provision, arrest aetiology, initial rhythm, patient age, time intervals of witness-to-call and call-to-arrival at patient), the following regional classifications based on DA-CPR but not on EMS were associated with survival: sensitivity of DA-CPR [adjusted odds ratio (95% confidence intervals) for advanced region; those for intermediate region, with developing region as reference, 1.277 (1.131-1.441); 1.162 (1.058-1.277)]; the proportion of bystanders to follow DA-CPR [1.749 (1.554-1.967); 1.280 (1.188-1.380)]. Good outcomes of bystander-witnessed OHCAs correlate with regions having higher sensitivity of DA-CPR and larger proportion of bystanders to follow DA-CPR. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Chest cage angle difference and rotation of main thoracic curve are independent risk factors of postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis.

PubMed

Yagi, Mitsuru; Takemitsu, Masakazu; Machida, Masafumi

2013-09-01

Retrospective case series of surgically treated adolescent patients with scoliosis. To assess the prevalence and independent risk factors for postoperative shoulder imbalance in surgically treated adolescent patients with idiopathic scoliosis. Despite recent reports that have identified risk factors for postoperative shoulder imbalance, the relative risks remain unclear. A retrospective review of 85 consecutive patients treated with thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the patient radiographical measurements and demographics. Shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. A SHD more than 2 cm indicated an unbalanced shoulder. Patient demographics and radiographical data were studied to determine risk factors for postoperative SHD. The potential risk factors included age, sex, Risser sign, Cobb angle, flexibility, and apical vertebral rotation (AVR) of the main curve, upper-instrumented vertebra level, SHD, and clavicle chest cage angle difference (CCAD). Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for postoperative shoulder imbalance. Of the 85 patients, 21 patients presented postoperative shoulder imbalance. The univariate analysis indicated age, Risser sign, Cobb angle of the main curve, AVR of the main curve, and CCAD as risk factors, but the multivariate logistic regression analysis showed that only AVR of the main curve and CCAD were independent risk factors for postoperative shoulder imbalance (AVR, P = 0.04, odds ratio (OR): 3.54; CCAD, P = 0.01, OR: 5.10). Postoperative shoulder imbalance was observed in 25% of the surgically treated adolescent patients. The CCAD and AVR of the main thoracic curve were independent risk factors for postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis. The significant correlation between CCAD and postoperative shoulder imbalance seen in this study strongly suggests that the relationship of the shoulder girdle and chest cage has a role in maintaining shoulder balance.

Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention.

PubMed

Walters, Suzan M; Reilly, Kathleen H; Neaigus, Alan; Braunstein, Sarah

2017-06-29

Women who inject drugs (WWID) are at heightened risk for HIV due to biological, behavioral, and structural factors. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for WWID. However, little is known about WWID awareness of PrEP, which is a necessary step that must occur before PrEP uptake. We report factors associated with greater awareness among WWID to identify efficient means of awareness dissemination. Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Multivariable logistic regression was used to estimate adjusted associations and determine differences in awareness of PrEP. The analysis consisted of 118 WWID. Awareness of PrEP was relatively low (31%), and risk factors were high. In the last 12 months, almost two thirds (65%) reported condomless sex, approximately one third (31%) reported transactional sex, and one third (32%) reported sharing injection equipment. In multivariable logistic regression, increased PrEP awareness was associated with reported transactional sex (AOR 3.32, 95% CI 1.22-9.00) and having a conversation about HIV prevention at a syringe exchange program (SEP) (AOR 7.61, 95% CI 2.65-21.84). We did not find race, education, household income, age, binge drinking, or sexual identity to be significantly associated with PrEP awareness. Large proportions of WWID were unaware of PrEP. These findings suggest that social networks (specifically sex work and SEP networks) are an efficient means for disseminating messaging about prevention materials such as PrEP. We recommend that SEP access increase, SEP processes be adopted in other health care settings, and WWID networks be utilized to increase PrEP awareness.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey.

PubMed

Zarrouq, B; Bendaou, B; El Asri, A; Achour, S; Rammouz, I; Aalouane, R; Lyoussi, B; Khelafa, S; Bout, A; Berhili, N; Hlal, H; Najdi, A; Nejjari, C; El Rhazi, K

2016-06-04

Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study.

PubMed

Zhou, Qing; Yu, Ting; Liu, Yuan; Shi, Ruifen; Tian, Suping; Yang, Chaoxia; Gan, Huaxiu; Zhu, Yanying; Liang, Xia; Wang, Ling; Wu, Zhenhua; Huang, Jinping; Hu, Ailing

2018-02-01

To ascertain the pressure ulcer prevalence in secondary and tertiary general hospitals in different areas of Guangdong Province in China and explore the possible risk factors that are related to pressure ulcers. Few multicentre studies have been conducted on pressure ulcer prevalence in Chinese hospitals. A cross-sectional study design was used. Data from a total of 25,264 patients were included in the analysis at 25 hospitals in China. The investigators were divided into two groups. The investigators in group 1 examined the patients' skin. When a pressure ulcer was found, a pressure ulcer assessment form was completed. The investigators in group 2 provided guidance to the nurses, who assessed all patients and completed another questionnaire. A multivariate logistic regression analysis was used to analyse the relationship between the possible risk factors and pressure ulcer. The overall prevalence rate of pressure ulcers in the 25 hospitals ranged from 0%-3.49%, with a mean of 1.26%. The most common stage of the pressure ulcers was stage II (41.4%); most common anatomical locations were sacrum (39.5%) and the feet (16.4%). Braden score (p < .001), expected length of stay (p < .001), incontinence (p < .001), care group (p = .011), hospital location (p < .001), type of hospitals (p = .004), ages of patients (p < .001) were associations of pressure ulcers from the multivariate logistic regression analysis. The overall prevalence rate of pressure ulcers in Chinese hospitals was lower than that reported in previous investigations. Specific characteristics of pressure ulcer patients were as follows: low Braden score, longer expected length of stay, double incontinence, an ICU and a medical ward, hospital location in the Pearl River Delta, a university hospital and an older patient. The survey could make managers know their prevalence level of pressure ulcers and provide priorities for clinical nurses. © 2017 John Wiley & Sons Ltd.

Factors associated with study attrition in a pilot randomised controlled trial to explore the role of exercise-assisted reduction to stop (EARS) smoking in disadvantaged groups.

PubMed

Thompson, T P; Greaves, C J; Ayres, R; Aveyard, P; Warren, F C; Byng, R; Taylor, R S; Campbell, J L; Ussher, M; Michie, S; West, R; Taylor, A H

2016-10-27

Study attrition has the potential to compromise a trial's internal and external validity. The aim of the present study was to identify factors associated with participant attrition in a pilot trial of the effectiveness of a novel behavioural support intervention focused on increasing physical activity to reduce smoking, to inform the methods to reduce attrition in a definitive trial. Disadvantaged smokers who wanted to reduce but not quit were randomised (N = 99), of whom 61 (62 %) completed follow-up assessments at 16 weeks. Univariable logistic regression was conducted to determine the effects of intervention arm, method of recruitment, and participant characteristics (sociodemographic factors, and lifestyle, behavioural and attitudinal characteristics) on attrition, followed by multivariable logistic regression on those factors found to be related to attrition. Participants with low confidence to quit, and who were undertaking less than 150 mins of moderate and vigorous physical activity per week at baseline were less likely to complete the 16-week follow-up assessment. Exploratory analysis revealed that those who were lost to follow-up early in the trial (i.e., by 4 weeks), compared with those completing the study, were younger, had smoked for fewer years and had lower confidence to quit in the next 6 months. Participants who recorded a higher expired air carbon monoxide reading at baseline were more likely to drop out late in the study, as were those recruited via follow-up telephone calls. Multivariable analyses showed that only completing less than 150 mins of physical activity retained any confidence in predicting attrition in the presence of other variables. The findings indicate that those who take more effort to be recruited, are younger, are heavier smokers, have less confidence to quit, and are less physically active are more likely to withdraw or be lost to follow-up.

Analysis of Blood Glucose Distribution Characteristics and Its Risk Factors among a Health Examination Population in Wuhu (China).

PubMed

Song, Jiangen; Zha, Xiaojuan; Li, Haibo; Guo, Rui; Zhu, Yu; Wen, Yufeng

2016-03-31

Diabetes mellitus (DM) and Impaired Fasting Glucose (IFG) represent serious threats to human health, and as a result, this study was aimed at understanding the blood glucose distribution characteristics and the risk factors among a large health examination population in China. An investigation with physical and biochemical examinations and questionnaires was conducted in the physical examination center from 2011 to 2014 and as a result 175,122 physical examination attendees were enrolled in this study. Multivariate logistic regression was used to explore the factors influencing blood sugar levels. The rates of IFG and DM were 6.0% and 3.8%. Prevalence were 7.6%/5.1% in males and 5.1%/2.8% in females for IFG and DM, respectively. The prevalence of IFG and DM were thus higher in males than in females. In the normal group, except high density lipoprotein (HDL) that was significantly higher than in the IFG and DM group, the other indexes (age, body mass index (BMI), glucose (Glu), total cholesterol (TC) and total glycerides (TG) were lower than those in the IFG and DM group. The proportion of IFG and DM also increased with the increases in proportion of abnormal blood pressure, smoking and alcohol consumption. Multivariate logistic regression analysis showed that increasing age, high BMI, high TC, high TG and low HDL increased the risk of diabetes, while in males, in addition to the above factors, the smoking and drinking factors also increased the risk of diabetes. After the age of 65, the blood glucose level reached a peak in males, while in females, the increasing trends was on the rise. The inflexion age of the fast rise was younger in males than in females. The study population showed a high prevalence of DM and IFG among the adults. Regular physical examination for the early detection of diabetes is recommended in the high-risk population.

The factors associated with negative colonoscopy in screening subjects with positive immunochemical stool occult blood test outcomes.

PubMed

Ting, Po-Hsiang; Lin, Xi-Hsuan; Jiang, Jeng-Kai; Luo, Jiing-Chyuan; Chen, Ping-Hsien; Wang, Yen-Po; Hsin, I-Fang; Perng, Chin Lin; Hou, Ming-Chih; Lee, Fa-Yauh

2018-05-16

The immunochemical fecal occult blood test (iFOBT) is an alternative method to colonoscopy that can be used for colorectal cancer (CRC) screening. If the iFOBT result is positive, a colonoscopy is recommended. In this retrospective study, we identify factors associated with negative colonoscopy and positive iFOBT results obtained during CRC screening. We collected data for subjects who received a colonoscopy at Taipei Veterans General Hospital after receiving a positive iFOBT result during CRC screening from January 2015 to December 2015. Subjects' baseline data, medications, and co-morbidities as well as colonoscopy and histological findings were recorded. A negative colonoscopy result was defined as no detection of any colorectal neoplasia including non-advanced adenoma, advanced adenoma, and adenocarciona. Multivariate logistic regression analysis was conducted to identify the associated factors in screening subjects with positive iFOBT but negative colonoscopy results. 559 (46.3%) out of 1207 eligible study subjects received a colonoscopy with a negative result. Multivariate logistic regression analysis revealed that the use of antiplatelets [odds ratio (OR) = 0.654; 95% confidence interval (CI), 0.434-0.986], occurrence of hemorrhoid (OR = 0.595; 95% CI, 0.460-0.768), and the existence of colitis/ulcer (OR = 0.358; 95% CI, 0.162-0.789) were independent factors associated with negative colonoscopy but positive iFOBT results during CRC screening. The colon clean level, underlying diseases of gastrointestinal bleeding tendency (e.g., chronic kidney disease, cirrhosis), and the use of anticoagulant or nonsteroidal anti-inflammatory agents were not associated with negative colonoscopy and positive iFOBT results. The use of antiplatelet agents and the presence of hemorrhoids and colitis/ulcers were factors associated with negative colonoscopy and positive iFOBT results. Copyright © 2018. Published by Elsevier Taiwan LLC.

Characteristics and treatment outcomes of patients with multi-drug resistant tuberculosis at a tertiary care hospital in Peshawar, Pakistan

PubMed Central

Khan, Mazhar A.; Mehreen, Sumaira; Basit, Anila; Khan, Raza A.; Jan, Faheem; Ullah, Irfan; Ihtesham, Muhammad; Khan, Afsar; Ullah, Ubaid; Javaid, Arshad

2015-01-01

Objectives: To determine characteristics and treatment outcomes of multidrugs resistant tuberculosis (MDR-TB) patients and risk factors for poor outcomes in MDR-TB patients in a tertiary care hospital in Peshawar, Pakistan. Methods: This retrospective study was conducted at the Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital Peshawar, Pakistan and included all MDR-TB patients registered between January 2012 and December 2012. A special proforma was used for data collection. Analysis was performed using SPSS version 16, after exporting data from the proforma. Differences in proportions were assessed using Pearson’s Chi square test whereas for predictors of poor outcomes, multivariate logistic regression analysis with Wald Statistical criteria using backward elimination method was performed. Results: The treatment success rate was 74.3%. In univariate analysis, poor outcomes were associated in patients with age ≥44 years (odds ratio [OR]=0.250; 95% confidence interval [CI]: 0.114-0.519, p=0.001), rural residence (OR=0.417; 95% CI: 0.18-0.937, p=0.03), lung cavitation (OR=0.22; 95% CI, 0.007-0.067, p=0.001), resistance to second line drugs (SLD) (OR=3.441; 95% CI: 1.579-7.497, p=0.001), and resistance to ofloxacin (OR=2.944; 95% CI: 1.361-6.365, p=0.005); whereas multivariate logistic regression analysis, poor outcomes were associated in patients with age ≥44 years (OR=0.249, 95% CI: 0.075-0.828, p=0.023), rural residence (OR=0.143, 95% CI: 0.052-0.774, p=0.032), and cavitatory lungs (OR=0.022, 95% CI: 0.007-0.072, p=0.000). Conclusion: The MDR-TB patient needs special attention for better treatment outcomes. The presence of older age, rural area residence, resistance to ofloxacin, SLD resistance, and cavitary disease are independent prognostic factors for poor outcome in patients with MDR-TB. PMID:26620989

Over- and undersupply in home care: a representative multicenter correlational study.

PubMed

Lahmann, Nils A; Suhr, Ralf; Kuntz, Simone; Kottner, Jan

2015-04-01

Quality assurance and funding of care become a major challenge against the background of demographic changes in western societies. The primary aim of the study was to identify possible misclassification, respectively over and undersupply of care by comparing the Barthel Index of clients of home care service with the level of care (Stage 0, I, II, III) according to the statutory German long-term care insurance. In 2012, a multi-center point prevalence study of 878 randomly selected clients of 100 randomly selected home care services across Germany was conducted. According to a standardized study protocol, demographics, the Barthel Index and the nurses' professional judgment-whether a client requires more nursing care-were assessed. Associations of the Barthel items and professional judgment were analyzed using univariate (Chi-square) and multivariate (logistic regression and classification-regression-tree-models) statistics. In each level of care, the Barthel Index showed large variability e.g. in level II ranging from 0 to 100 points. Multivariate logistic regression regarding possible under- and oversupply revealed occasionally fecal incontinence (2.1; 95 % CI 1.2-3.7), urinary incontinence (2.0; 95 % CI 1.1-3.6), feeding (1.7; 95 % CI 1.0-2.9), immobility (0.2; 95 % CI 0.1-0.6) and to be female (1.8; 95 % CI 1.2-2.6) to be statistically significantly associated. The variability in Barthel Index in each level of care found in this study indicated a large general misclassification of home care clients according to their actual need of care. Professional caregivers identified occasional incontinence, help with eating and drinking and mobility (especially in female clients) as areas of possible under- and oversupply of care. The statutory German long-term care insurance classification should be modified according to the above finding to increase the quality of care in home care clients.

The use of inferior vena cava filters in spine trauma: A nationwide study using the National Trauma Data Bank.

PubMed

Sabharwal, Samir; Fox, Adam D; Vives, Michael J

2018-05-07

Objective To determine the prevalence and variation of inferior vena cava filter (IVCF) use in the spine trauma population and evaluate patient and facility level factors associated with their use. Study Design Retrospective cohort. Participants/Outcome Measures Patients with spinal injuries were identified by ICD-9 codes from the National Trauma Data Bank (NTDB), the best validated national trauma database. Patients whose spine injuries were operatively treated and those who received IVCF were identified from procedure description fields. Additional information compiled included patient demographics, injury severity score (ISS), time until surgery, concomitant fractures, and facility level information. Multivariate logistic regression analyses were conducted to examine the relationship of associated factors for IVCF use. Results Of the 120,920 patients identified with spinal injuries, 2.4% received prophylactic IVCF. Of the 13,273 patients with operatively treated spinal injuries, 8.2% received prophylactic IVCF. Of the 7,770 patients with spinal cord injury (SCI), 10.8% received prophylactic IVCF. The interquartile ranges of placement rates among centers demonstrated greater than 10 fold variation. Based on multivariate logistic regression, ISS score >12 demonstrated the strongest association with prophylactic IVCF (adjusted OR = 4.908). Concomitant pelvic and lower extremity fractures (adj OR 2.573 and 2.522) were also associated with their use. Conclusions Currently the only data regarding existing IVCF use in the spine trauma population amounts to surveys. The present study provides the most detailed and objective information regarding their use in this setting. Even in the operatively treated and SCI subgroups, prophylactic filters were used in only a small percentage of cases but placement rates varied widely among centers. More severely injured patients (ISS >12) had highest odds of receiving prophylactic IVCF. Further study is needed to clarify their role in this vulnerable population.

Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women

PubMed Central

2013-01-01

Background The proven benefit of integrating cervical cancer screening programme into HIV care has led to its adoption as a standard of care. However this is not operational in most HIV clinics in Nigeria. Of the various reasons given for non-implementation, none is backed by scientific evidence. This study was conducted to assess the willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. Methods A cross sectional study of HIV positive women attending a large HIV treatment centre in Lagos, Nigeria. Respondents were identified using stratified sampling method. A pretested questionnaire was used to obtain information by trained research assistants. Obtained information were coded and managed using SPSS for windows version 19. Multivariate logistic regression model was used to determine independent predictor for acceptance of cervical cancer screening. Results Of the 1517 respondents that returned completed questionnaires, 853 (56.2%) were aware of cervical cancer. Though previous cervical cancer screening was low at 9.4%, 79.8% (1210) accepted to take the test. Cost of the test (35.2%) and religious denial (14.0%) were the most common reasons given for refusal to take the test. After controlling for confounding variables in a multivariate logistic regression model, having a tertiary education (OR = 1.4; 95% CI: 1.03-1.84), no living child (OR: 1.5; 95% CI: 1.1-2.0), recent HIV diagnosis (OR: 1.5; 95% CI: 1.1-2.0) and being aware of cervical cancer (OR: 1.5; 95% CI: 1.2-2.0) retained independent association with acceptance to screen for cervical cancer. Conclusions The study shows that HIV positive women in our environment are willing to screen for cervical cancer and that the integration of reproductive health service into existing HIV programmes will strengthen rather than disrupt the services. PMID:23327453

Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population–based FIN-D2D survey

PubMed Central

2012-01-01

Background There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population–based FIN-D2D survey conducted in 2007. Methods Out of 4500, 2682 participants (60%) aged 45–74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models. Results The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0–365) in participants with DS and 7 (0–120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries. Conclusions PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors. PMID:22781103

Association of perceived neighborhood characteristics, socioeconomic status and rural residency with health outcomes in Egyptian patients with systemic lupus erythematosus: one center study.

PubMed

Abdul-Sattar, Amal B; Abou El Magd, Sahar

2017-12-01

To investigate the role of perceived neighborhood characteristics, socioeconomic status (SES) and rural residency in influencing the health status outcome of Egyptian patients with systemic lupus erythematosus (SLE). Eighty patients affected with SLE were consecutively included in this a single-center cross-sectional study from July, 2011 to July, 2013. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, the Medical Outcomes Study Short Form-36 Health Survey physical functioning score and Center for Epidemiologic Studies-Depression (CES-D score of ≥ 19 points). Multivariate logistic regression analyses were conducted. Results from multivariate logistic regression analyses, a separate adjusted model of each perceived neighborhood characteristic, indicate associations of worse perceived social cohesion with higher SLAQ scores (P < 0.01) and associations of worse perceived neighborhood aesthetics and safety with lower SF-36 physical functioning scores after adjusting for covariates (P < 0.01). Regarding the association of socioeconomic status and rural residency with health status outcomes, the results found association of poor socioeconomic status with the three health status outcome measures and association between rural residency and depression symptoms. Individuals had increased odds of depressive symptoms if they perceived worse neighborhood social cohesion (odds ratio [OR]: 2.14; CI: 1.42-2.80), if they perceived worse neighborhood safety (OR: 1.64; CI: 1.02-2.40) and if they perceived worse neighborhood aesthetic characteristics (OR: 2.79; CI: 1.84-3.38). Study findings indicate that poor socioeconomic status, rural residency and perceived neighborhood characteristics are associated with depression; worse perceived neighborhood aesthetics and safety are associated with lower SF-36 physical functioning, and worse neighborhood social cohesion is associated with higher disease activity among patients with SLE. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Associations of Individual-Related and Job-Related Risk Factors with Nonfatal Occupational Injury in the Coal Workers of Shanxi Province: A Cross-Sectional Study

PubMed Central

Qiao, Nan; Wang, Cong; Wang, Tong; Huang, Jian-Jun; Sun, Chen-Ming; Liang, Jie; Liu, Xiao-Meng

2015-01-01

Objectives To assess the relationships between the risk factors and the incidence of nonfatal occupational injury of coal mine workers of Shanxi Province. Methods A cross-sectional study was conducted from July 2013 to December 2013, and 4319 workers were recruited from more than 200,000 coal mine employees who are exposed to continuous potential risk of occupational injuries by using a two-stage stratified cluster sampling method. Trained interviewers having necessary medical knowledge conducted face-to-face interviews with the participants. Univariate and multivariable logistic regression models were used to estimate the odds ratio (OR) and the 95% confidence interval (CI). Results A total number of 3618 effective respondents were got from 4319 participants (83.77%) and the mean age of the participants was 41.5 years with the standard deviation of 8.65. Significant crude odds ratios were observed for all factors considered except for marital status, education, work duration, BMI, EPQ-RSC(P) scale and EPQ-RSC(L) scale. Results from multivariable logistic regression model showed significant adjusted odds ratios for risk factors including gender (female vs male 0.275, 0.094–0.800), age (≥55 vs ≤25yr 0.169, 0.032–0.900), work type (light physical labor vs heavy physical labor 0.504, 0.328–0.774), workplace (underground auxiliary vs underground front-line 0.595, 0.385–0.919), length of shiftwork experience (0~5yr vs no shift 2.075, 1.287–3.344 and ≥15yr vs no shift 2.076, 1.230–3.504) and EPQ-RSC(E) score (extraversion vs introversion 0.538, 0.334–0.867). Conclusions Several risk factors of nonfatal occupational injury were identified including male, age, heavy physical labor, underground front-line, length of shiftwork experience and introversion. The coal mining enterprises should pay attention to controlling the hazards associated with frontline physical work. Workers’ behaviors, life styles and personality traits should also be considered, so that the enterprises could set achievable targets for workers and lessen the exposed period to the risky underground workstation. PMID:26230266

[Analysis on sleep duration of 6-12 years old school children in school-day in 8 provinces, China].

PubMed

Shi, Wenhui; Zhai, Yi; Li, Weirong; Shen, Chong; Shi, Xiaoming

2015-05-01

To analyze the influencing factors for sleep duration of school children aged 6-12 years in school-day in 8 provinces in China. The cross sectional study was conducted among 20,603 children aged 6-12 years and selected through stratified random cluster sampling in 8 provinces (municipality and autonomous region) with different geographic characteristics and economic development level in China from September to November, 2010 to understand their sleep duration in school-day and related habits. t test and χ2 test were used to compare the sleep duration of the children. Multivariate stepwise logistic regression analysis was conducted to identify the influencing factors. The survey indicated that the daily average sleep duration of the children in school days was 9.11 hours. The proportions of the children with serious insufficient sleep, insufficient sleep and sufficient sleep were 32.82% (7,672/20,603), 39.70% (8,179/20,603) and 27.48% (5,662/20,603), the children's sleep duration declined with age, so did proportion of children with serious insufficient sleep. There were no sex, urban or rural area and household income level specific significant differences in sleep duration among the children surveyed, and there were no sex specific differences in the proportion of children with serious insufficient sleep, insufficient sleep and sufficient sleep, however, these proportions were statistically different between urban area and rural area and among the regions with different economic level. The proportions of children with serious insufficient sleep and sufficient sleep was higher in rural area than in urban area (χ2=59.96, χ2=45.47, P<0.05), while the proportion of children with insufficient sleep was lower in rural area than in urban area. In the economy developed region, the proportion of children with insufficient sleep was lowest, the difference was statistical significant. After adjusting for sex, weight, diet and exercise time, multivariate logistic regression analysis showed that the factors benefiting children to have 10 hours sleep every day included having high protein diet, exercise, high household economic status and living in urban area. The problem of school children having insufficient sleep was serious in China, especially in the rural area.

The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health.

PubMed

Cheung, Kei Long; Ten Klooster, Peter M; Smit, Cees; de Vries, Hein; Pieterse, Marcel E

2017-03-23

In public health monitoring of young people it is critical to understand the effects of selective non-response, in particular when a controversial topic is involved like substance abuse or sexual behaviour. Research that is dependent upon voluntary subject participation is particularly vulnerable to sampling bias. As respondents whose participation is hardest to elicit on a voluntary basis are also more likely to report risk behaviour, this potentially leads to underestimation of risk factor prevalence. Inviting adolescents to participate in a home-sent postal survey is a typical voluntary recruitment strategy with high non-response, as opposed to mandatory participation during school time. This study examines the extent to which prevalence estimates of adolescent health-related characteristics are biased due to different sampling methods, and whether this also biases within-subject analyses. Cross-sectional datasets collected in 2011 in Twente and IJsselland, two similar and adjacent regions in the Netherlands, were used. In total, 9360 youngsters in a mandatory sample (Twente) and 1952 youngsters in a voluntary sample (IJsselland) participated in the study. To test whether the samples differed on health-related variables, we conducted both univariate and multivariable logistic regression analyses controlling for any demographic difference between the samples. Additional multivariable logistic regressions were conducted to examine moderating effects of sampling method on associations between health-related variables. As expected, females, older individuals, as well as individuals with higher education levels, were over-represented in the voluntary sample, compared to the mandatory sample. Respondents in the voluntary sample tended to smoke less, consume less alcohol (ever, lifetime, and past four weeks), have better mental health, have better subjective health status, have more positive school experiences and have less sexual intercourse than respondents in the mandatory sample. No moderating effects were found for sampling method on associations between variables. This is one of first studies to provide strong evidence that voluntary recruitment may lead to a strong non-response bias in health-related prevalence estimates in adolescents, as compared to mandatory recruitment. The resulting underestimation in prevalence of health behaviours and well-being measures appeared large, up to a four-fold lower proportion for self-reported alcohol consumption. Correlations between variables, though, appeared to be insensitive to sampling bias.

Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture.

PubMed

Bouma, Wobbe; Wijdh-den Hamer, Inez J; Koene, Bart M; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E; van der Horst, Iwan C C; Gorman, Joseph H; Gorman, Robert C; Mariani, Massimo A

2014-10-18

Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear which patients are at highest risk. In this study we sought to determine in-hospital mortality and its predictors for patients who underwent mitral valve surgery for post-MI PMR. Between January 1990 and December 2012, 48 consecutive patients (mean age 64.9 ± 10.8 years) underwent mitral valve repair (n = 10) or replacement (n = 38) for post-MI PMR. Clinical data, echocardiographic data, catheterization data, and surgical reports were reviewed. Univariate and multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality. Intraoperative mortality was 4.2% and in-hospital mortality was 25.0%. Univariate and multivariate logistic regression analyses revealed the logistic EuroSCORE and EuroSCORE II as independent predictors of in-hospital mortality. Receiver operating characteristics curves showed an optimal cutoff value of 40% for the logistic EuroSCORE (area under the curve 0.85, 95% CI 0.71-1.00, P < 0.001) and of 25% for the EuroSCORE II (area under the curve 0.83, 95% CI 0.68-0.99, P = 0.001). After removal of the EuroSCOREs from the model, complete PMR and intraoperative intra-aortic balloon pump (IABP) requirement were independent predictors of in-hospital mortality. The logistic EuroSCORE (optimal cutoff ≥ 40%), EuroSCORE II (optimal cutoff ≥ 25%), complete PMR, and intraoperative IABP requirement are strong independent predictors of in-hospital mortality in patients undergoing mitral valve surgery for post-MI PMR. These predictors may aid in surgical decision making and they may help improve the quality of informed consent.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.

PubMed

Basques, Bryce A; Golinvaux, Nicholas S; Bohl, Daniel D; Yacob, Alem; Toy, Jason O; Varthi, Arya G; Grauer, Jonathan N

2014-10-15

Retrospective database review. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. 3.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection

PubMed Central

Basques, Bryce A.; Golinvaux, Nicholas S.; Bohl, Daniel D.; Yacob, Alem; Toy, Jason O.; Varthi, Arya G.; Grauer, Jonathan N.

2014-01-01

Study Design Retrospective database review. Objective To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Summary of Background Data Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which includes data from over 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. Results A total of 23,670 elective spine procedures were identified, of which 2,226 (9.4%) used an operating microscope. The average patient age was 55.1 ± 14.4 years. The average operative time (incision to closure) was 125.7 ± 82.0 minutes. Microscope use was associated with minor increases in preoperative room time (+2.9 minutes, p=0.013), operative time (+13.2 minutes, p<0.001), and total room time (+18.6 minutes, p<0.001) on multivariate analysis. A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and non-microscope groups for occurrence of any infection, superficial surgical site infection (SSI), deep SSI, organ space infection, or sepsis/septic shock, regardless of surgery type. Conclusions We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. PMID:25188600

A national mass media smoking cessation campaign: effects by race/ethnicity and education.

PubMed

Vallone, Donna M; Niederdeppe, Jeff; Richardson, Amanda Kalaydjian; Patwardhan, Pallavi; Niaura, Raymond; Cullen, Jennifer

2011-01-01

To assess the effectiveness of a large-scale, national smoking cessation media campaign, the EX campaign, across racial/ethnic and educational subgroups. A longitudinal random-digit-dial panel study conducted prior to and 6 months following the national launch of the campaign. The sample was drawn from eight designated media markets in the United States. The baseline survey was conducted on 5616 current smokers, aged 18 to 49 years, and 4067 (73% follow-up response rate) were resurveyed at the 6-month follow-up. The primary independent variable is confirmed awareness of the campaign advertising, and the outcome variables are follow-up cessation-related cognitions index score and quit attempts. Multivariable logistic and linear regression analyses were conducted within racial/ethnic and educational strata to assess the strength of association between confirmed awareness of campaign advertising and cessation-related outcomes. Confirmed awareness of campaign advertising increased favorable cessation-related cognitions among Hispanics and quit attempts among non-Hispanic blacks, and increased favorable cessation-related cognitions and quit attempts among smokers with less than a high school education. These results suggest that the EX campaign may be effective in promoting cessation-related cognitions and behaviors among minority and disadvantaged smokers who experience a disproportionate burden of tobacco-related illness and mortality.

Clinical management provided by board-certificated physiatrists in early rehabilitation is a significant determinant of functional improvement in acute stroke patients: a retrospective analysis of Japan rehabilitation database.

PubMed

Kinoshita, Shoji; Kakuda, Wataru; Momosaki, Ryo; Yamada, Naoki; Sugawara, Hidekazu; Watanabe, Shu; Abo, Masahiro

2015-05-01

Early rehabilitation for acute stroke patients is widely recommended. We tested the hypothesis that clinical outcome of stroke patients who receive early rehabilitation managed by board-certificated physiatrists (BCP) is generally better than that provided by other medical specialties. Data of stroke patients who underwent early rehabilitation in 19 acute hospitals between January 2005 and December 2013 were collected from the Japan Rehabilitation Database and analyzed retrospectively. Multivariate linear regression analysis using generalized estimating equations method was performed to assess the association between Functional Independence Measure (FIM) effectiveness and management provided by BCP in early rehabilitation. In addition, multivariate logistic regression analysis was also performed to assess the impact of management provided by BCP in acute phase on discharge destination. After setting the inclusion criteria, data of 3838 stroke patients were eligible for analysis. BCP provided early rehabilitation in 814 patients (21.2%). Both the duration of daily exercise time and the frequency of regular conferencing were significantly higher for patients managed by BCP than by other specialties. Although the mortality rate was not different, multivariate regression analysis showed that FIM effectiveness correlated significantly and positively with the management provided by BCP (coefficient, .35; 95% confidence interval [CI], .012-.059; P < .005). In addition, multivariate logistic analysis identified clinical management by BCP as a significant determinant of home discharge (odds ratio, 1.24; 95% CI, 1.08-1.44; P < .005). Our retrospective cohort study demonstrated that clinical management provided by BCP in early rehabilitation can lead to functional recovery of acute stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Determinants of Anabolic-Androgenic Steroid Risk Perceptions in Youth Populations: A Multivariate Analysis

ERIC Educational Resources Information Center

Denham, Bryan E.

2009-01-01

Grounded conceptually in social cognitive theory, this research examines how personal, behavioral, and environmental factors are associated with risk perceptions of anabolic-androgenic steroids. Ordinal logistic regression and logit log-linear models applied to data gathered from high-school seniors (N = 2,160) in the 2005 Monitoring the Future…

Music and Suicidality: A Quantitative Review and Extension

ERIC Educational Resources Information Center

Stack, Steven; Lester, David; Rosenberg, Jonathan S.

2012-01-01

This article provides the first quantitative review of the literature on music and suicidality. Multivariate logistic regression techniques are applied to 90 findings from 21 studies. Investigations employing ecological data on suicide completions are 19.2 times more apt than other studies to report a link between music and suicide. More recent…

Factors Associated with Participation in Employment for High School Leavers with Autism

ERIC Educational Resources Information Center

Chiang, Hsu-Min; Cheung, Ying Kuen; Li, Huacheng; Tsai, Luke Y.

2013-01-01

This study aimed to identify the factors associated with participation in employment for high school leavers with autism. A secondary data analysis of the National Longitudinal Transition Study 2 (NLTS2) data was performed. Potential factors were assessed using a weighted multivariate logistic regression. This study found that annual household…

School-Related Predictors of Smoking, Drinking and Drug Use: Evidence from the Belfast Youth Development Study

ERIC Educational Resources Information Center

Perra, Oliver; Fletcher, Adam; Bonell, Chris; Higgins, Kathryn; McCrystal, Patrick

2012-01-01

Objective: To examine whether students' school engagement, relationships with teachers, educational aspirations and involvement in fights at school are associated with various measures of subsequent substance use. Methods: Data were drawn from the Belfast Youth Development Study (n = 2968). Multivariate logistic models examined associations…

Associations between Smoking and Extreme Dieting among Adolescents

ERIC Educational Resources Information Center

Seo, Dong-Chul; Jiang, Nan

2009-01-01

This study examined the association between cigarette smoking and dieting behaviors and trends in that association among US adolescents in grades 9-12 between 1999 and 2007. Youth Risk Behavior Survey datasets were analyzed using the multivariable logistic regression method. The sample size of each survey year ranged from 13,554 to 15,273 with…

Changes in Loneliness during Middle Childhood Predict Risk for Adolescent Suicidality Indirectly through Mental Health Problems

ERIC Educational Resources Information Center

Jones, Angela C.; Schinka, Katherine C.; van Dulmen, Manfred H. M.; Bossarte, Robert M.; Swahn, Monica H.

2011-01-01

We investigated whether changes in loneliness during middle childhood as well as from middle childhood into adolescence were associated with adolescent self-harm behaviors and suicidal thoughts using a community sample of 889 participants. Multivariate logistic regressions indicate that the relationship between changes in loneliness and…

Differences in Health Determinants between International and Domestic Students at a German.

ERIC Educational Resources Information Center

Kramer, Alexander; Prufer-Kramer, Luise; Stock, Christiane; Tshiananga, Jacques Tshiang

2004-01-01

The authors used a standardized questionnaire to survey 201 international and 193 German students at the University of Bielefeld, Germany, to determine differences in health practices between the 2 groups and to identify targets for health-promoting interventions. Multivariate logistic regression models revealed that long-term female international…

Correlates of HIV knowledge and Sexual risk behaviors among Female Military Personnel

PubMed Central

Essien, E. James; Monjok, Emmanuel; Chen, Hua; Abughosh, Susan; Ekong, Ernest; Peters, Ronald J.; Holmes, Laurens; Holstad, Marcia M.; Mgbere, Osaro

2010-01-01

Objective Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. Method The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Results Multivariate logistic regression analysis revealed that level of education and knowing someone with HIV/AIDS were significant (p<0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P<0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P<0.05) associated with number of children, annual income, and number of sexual partners. Conclusion Data indicates the importance of incorporating these predictor variables into intervention designs. PMID:20387111

Nurses' decision making in heart failure management based on heart failure certification status.

PubMed

Albert, Nancy M; Bena, James F; Buxbaum, Denise; Martensen, Linda; Morrison, Shannon L; Prasun, Marilyn A; Stamp, Kelly D

Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown. Examine the value of certification based nurses' decision-making. Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models. Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62). Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. Copyright © 2018 Elsevier Inc. All rights reserved.

High Loading of Polygenic Risk for ADHD in Children With Comorbid Aggression

PubMed Central

Hamshere, Marian L.; Langley, Kate; Martin, Joanna; Agha, Sharifah Shameem; Stergiakouli, Evangelia; Anney, Richard J.L.; Buitelaar, Jan; Faraone, Stephen V.; Lesch, Klaus-Peter; Neale, Benjamin M.; Franke, Barbara; Sonuga-Barke, Edmund; Asherson, Philip; Merwood, Andrew; Kuntsi, Jonna; Medland, Sarah E.; Ripke, Stephan; Steinhausen, Hans-Christoph; Freitag, Christine; Reif, Andreas; Renner, Tobias J.; Romanos, Marcel; Romanos, Jasmin; Warnke, Andreas; Meyer, Jobst; Palmason, Haukur; Vasquez, Alejandro Arias; Lambregts-Rommelse, Nanda; Roeyers, Herbert; Biederman, Joseph; Doyle, Alysa E.; Hakonarson, Hakon; Rothenberger, Aribert; Banaschewski, Tobias; Oades, Robert D.; McGough, James J.; Kent, Lindsey; Williams, Nigel; Owen, Michael J.; Holmans, Peter

2013-01-01

Objective Although attention deficit hyperactivity disorder (ADHD) is highly heritable, genome-wide association studies (GWAS) have not yet identified any common genetic variants that contribute to risk. There is evidence that aggression or conduct disorder in children with ADHD indexes higher genetic loading and clinical severity. The authors examine whether common genetic variants considered en masse as polygenic scores for ADHD are especially enriched in children with comorbid conduct disorder. Method Polygenic scores derived from an ADHD GWAS meta-analysis were calculated in an independent ADHD sample (452 case subjects, 5,081 comparison subjects). Multivariate logistic regression analyses were employed to compare polygenic scores in the ADHD and comparison groups and test for higher scores in ADHD case subjects with comorbid conduct disorder relative to comparison subjects and relative to those without comorbid conduct disorder. Association with symptom scores was tested using linear regression. Results Polygenic risk for ADHD, derived from the meta-analysis, was higher in the independent ADHD group than in the comparison group. Polygenic score was significantly higher in ADHD case subjects with conduct disorder relative to ADHD case subjects without conduct disorder. ADHD polygenic score showed significant association with comorbid conduct disorder symptoms. This relationship was explained by the aggression items. Conclusions Common genetic variation is relevant to ADHD, especially in individuals with comorbid aggression. The findings suggest that the previously published ADHD GWAS meta-analysis contains weak but true associations with common variants, support for which falls below genome-wide significance levels. The findings also highlight the fact that aggression in ADHD indexes genetic as well as clinical severity. PMID:23599091

Epidemiologic programs for computers and calculators. A microcomputer program for multiple logistic regression by unconditional and conditional maximum likelihood methods.

PubMed

Campos-Filho, N; Franco, E L

1989-02-01

A frequent procedure in matched case-control studies is to report results from the multivariate unmatched analyses if they do not differ substantially from the ones obtained after conditioning on the matching variables. Although conceptually simple, this rule requires that an extensive series of logistic regression models be evaluated by both the conditional and unconditional maximum likelihood methods. Most computer programs for logistic regression employ only one maximum likelihood method, which requires that the analyses be performed in separate steps. This paper describes a Pascal microcomputer (IBM PC) program that performs multiple logistic regression by both maximum likelihood estimation methods, which obviates the need for switching between programs to obtain relative risk estimates from both matched and unmatched analyses. The program calculates most standard statistics and allows factoring of categorical or continuous variables by two distinct methods of contrast. A built-in, descriptive statistics option allows the user to inspect the distribution of cases and controls across categories of any given variable.

Association of Discharge Home with Home Health Care and 30-day Readmission after Pancreatectomy

PubMed Central

Sanford, Dominic E; Olsen, Margaret A; Bommarito, Kerry M; Shah, Manish; Fields, Ryan C; Hawkins, William G; Jaques, David P; Linehan, David C

2014-01-01

Background We sought to determine if discharge home with home health care (HHC) is an independent predictor of increased readmission following pancreatectomy. Study Design We examined 30-day readmissions in patients undergoing pancreatectomy using the Healthcare Cost and Utilization Project State Inpatient Database for California from 2009 to 2011. Readmissions were categorized as severe or non-severe using the Modified Accordion Severity Grading System. Multivariable logistic regression models were used to examine the association of discharge home with HHC and 30-day readmission using discharge home without HHC as the reference group. Propensity score matching was used as an additional analysis to compare the rate of 30-day readmission between patients discharged home with HHC to patients discharged home without HHC. Results 3,573 patients underwent pancreatectomy and 752 (21.0%) were readmitted within 30 days of discharge. In a multivariable logistic regression model, discharge home with HHC was an independent predictor of increased 30-day readmission (OR=1.37; 95%CI=1.11-1.69, p=0.004). Using propensity score matching, patients who received HHC had a significantly increased rate of 30-day readmission compared to patients discharged home without HHC (24.3% vs 19.8%, p<0.001). Patients discharged home with HHC had a significantly increased rate of non-severe readmission compared to those discharged home without HHC by univariate comparison (19.2% vs 13.9%, p<0.001), but not severe readmission (6.4% vs 4.7%, p= 0.08). In multivariable logistic regression models, excluding patients discharged to facilities, discharge home with HHC was an independent predictor of increased non-severe readmissions (OR=1.41; 95%CI=1.11-1.79, p=0.005), but not severe readmissions (OR=1.31; 95%CI=0.88-1.93, p=0.18). Conclusions Discharge home with HHC following pancreatectomy is an independent predictor of increased 30-day readmission; specifically, these services are associated with increased non-severe readmissions, but not severe readmissions. PMID:25440026

Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer?

PubMed

Martinez, Kathryn A; Snyder, Claire F; Malin, Jennifer L; Dy, Sydney M

2014-12-01

Developing interventions to address racial/ethnic cancer pain disparities requires exploration of the role of socioeconomic status, health status, and pain severity from the time of diagnosis. To examine patterns of disparities in cancer pain by evaluating differences by race/ethnicity in the odds of reporting pain and in pain severity, controlling for key patient-level covariates. This study used data from a nationally representative cohort of colorectal and lung cancer patients. Multivariable logistic regression was conducted to examine the relationship between race/ethnicity and reporting pain. Multivariable linear regression was then conducted, among those who reported pain, to determine differences in pain severity by race/ethnicity. The cohort included 5761 individuals (14% black, 7% Hispanic/Latino, 6% Asian or Pacific Islander, and 3% multiracial), among whom 48% reported pain. The adjusted odds of reporting differed only for multiracial patients, who were more likely to report pain than whites (odds ratio: 1.54; P = 0.036). However, among those with pain, severity was higher for black patients (β = 6.6; P ≤ 0.001) and multiracial patients (β = 4.5; P = 0.036) relative to white patients. Lower educational attainment, depressed affect, and lower levels of wealth also were associated with higher pain severity. Although the odds of experiencing pain differed only for multiracial patients, among those reporting pain, both blacks and multiracial individuals reported higher pain severity than whites. Sociodemographic status, health status, and depression were associated with severity but did not explain the disparity. Interventions to address these disparities will need to focus on reported severity and patient-level factors. Published by Elsevier Inc.

Socioeconomic Inequalities in Oral Health Among Unmarried and Married Women: Evidence From a Population-Based Study in Japan.

PubMed

Murakami, Keiko; Ohkubo, Takayoshi; Hashimoto, Hideki

2018-03-24

Socioeconomic inequalities in oral health have been reported in developed countries, but the influence of marital status has rarely been considered. Our aim was to examine marital status differentials in the association between socioeconomic status (SES) and oral health among community-dwelling Japanese women. From 2010 to 2011, a questionnaire survey was conducted among residents aged 25-50 years in Japanese metropolitan areas. Valid responses were received from 626 unmarried women and 1,620 married women. Women's own and husbands' educational attainment and equivalent income were used to assess SES. Self-rated "fair" or "poor" oral health was defined as poor oral health. Multiple logistic regression analysis was conducted to examine which SES indicators were associated with oral health. The prevalence of poor oral health was 21.1% among unmarried women and 23.8% among married women. Among unmarried women, equivalent income was not associated with oral health, but women's own education was significantly associated with oral health; the multivariate-adjusted odds ratio of poor oral health among those with high school education or lower compared to those with university education or higher was 2.14 (95% confidence interval, 1.19-3.87). Among married women, neither women's own nor husbands' education was associated with oral health, but equivalent income was significantly associated with oral health, particularly among housewives; the multivariate-adjusted odds ratio of poor oral health among those in the lowest compared with highest income quartile was 1.57 (95% confidence interval, 1.08-2.27). These findings indicate that marital status should be considered when examining associations between SES and oral health among Japanese women.

Rural and urban disparities in health-seeking for fever in Myanmar: findings from a probability-based household survey.

PubMed

Aung, Tin; Lwin, Moh Moh; Sudhinaraset, May; Wei, Chongyi

2016-07-25

The World Health Organization (WHO) recognizes Myanmar as having the highest burden of malaria in the Greater Mekong Sub-region (GMS). Early diagnosis and proper treatment are critical in containing malaria. The objective of this study was to assess determinants of seeking treatment for fever from trained providers across rural and urban areas in Eastern Myanmar. A cross-sectional survey was conducted during the high malaria seasons in the eastern part Myanmar between August and September 2014. Multi-staged cluster sampling was used to sample households. A series of questions related to treatment-seeking for fever were asked. Bivariate and multivariate logistic regressions were conducted to identify independent correlates of seeking treatment for fever from trained providers. The analysis was restricted to 637 participants who reported either themselves or their family members having had fever 2 weeks prior to the interview. In the multivariate analysis, rural residents were less likely to have sought treatment from trained providers (AOR = 0.60, 95 % CI 0.42-0.88; p = 0.01) while residents who had fever patients between the ages of 5 and 14 years (AOR = 1.60, 95 % CI 0.90-2.53; p = 0.05); and those who knew that sleeping under bed nets can prevent malaria (AOR = 2.08, 95 % CI 1.00-4.30; p = 0.05); were borderline more likely to have sought treatment. This study suggests that rural populations need improved access to trained providers. Additionally, future programmes should focus on increasing knowledge around malaria prevention and treatment.

Stigma and Health-Related Quality of Life in Sexual Minorities.

PubMed

Austin, S Bryn; Gordon, Allegra R; Ziyadeh, Najat J; Charlton, Brittany M; Katz-Wise, Sabra L; Samnaliev, Mihail

2017-10-01

Stigma against sexual minorities is well documented, but its long-term consequences for health-related quality of life (HRQL) are unknown. This study examined stigma-related predictors of sexual orientation disparities in HRQL and their contribution to young adult HRQL disparities. In 2013, participants (N=7,304, aged 18-31 years) reported sexual orientation (completely heterosexual [CH], mostly heterosexual, bisexual, and lesbian/gay). The EQ5D-5L, preference weighted for the U.S. population, was used to assess HRQL (range, -0.109 [worse than dead] to 1 [full health]). In prior waves conducted during adolescence, participants reported past-year bullying victimization (range, 1 [never] to 5 [several times/week]) and subjective social status (SSS) in their school (range, 1 [top] to 10 [bottom]). Analyses conducted in 2016 used longitudinal, multivariable linear and logistic regression to assess the contribution of bullying victimization and SSS in adolescence to sexual orientation disparities in HRQL in young adulthood, controlling for confounders and stratified by gender. Compared with CHs, both female and male sexual minorities reported more bullying victimization and lower SSS in adolescence and lower HRQL in young adulthood (HRQL score among women: mostly heterosexual, 0.878; bisexual, 0.839; lesbian, 0.848; CH, 0.913; HRQL score among men: mostly heterosexual, 0.877; bisexual, 0.882; gay, 0.890; CH, 0.925; all p-values <0.05). When bullying and SSS were added into multivariable models, orientation group effect estimates were attenuated substantially, suggesting bullying and lower SSS in adolescence partly explained HRQL disparities in young adulthood. Stigma-related experiences in adolescence may have lasting adverse effects on sexual minority health in adulthood. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women.

PubMed

Lacombe-Duncan, Ashley; Logie, Carmen H

2016-12-27

Lesbian, gay, bisexual, and queer (LGBQ) women have increased risk of breast cancer yet lower use of early detection screening than heterosexual women. This lower use may be due in part to sexual stigma. The study purpose was to explore correlates of past two-year clinical breast examination (CBE) among LGBQ women to better understand screening disparities, particularly among gender non-conforming LGBQ women. A cross-sectional Internet-based survey was conducted with LGBQ women in 2011-2012. We conducted multivariate logistic regression to assess the associations between individual, social/structural and health care factors and past two-year CBE among LGBQ women (n = 414), including a subsample of gender non-conforming LGBQ women (n = 148). In multivariate analyses, significant correlates of past two-year CBE among the full sample included sexually transmitted infection knowledge (OR: 1.12, 95% CI: 1.05, 1.19), sexual risk practices (OR: 0.92, 95% CI: 0.87, 0.98), past two-year Papanicolaou test (OR: 8.36, 95% CI: 4.24, 16.45), having a regular source of health care (OR: 4.84, 95% CI: 2.60, 9.01), and health care provider knowing one's sexual orientation (OR: 3.60, 95% CI: 2.29, 5.81). Among gender non-conforming LGBQ women, perceived gender non-conformity stigma (OR: 0.85, 95% CI: 0.74, 0.99) and belief that one's health care provider is uncomfortable with one's sexual orientation (OR: 0.33, 95% CI: 0.11, 1.00) were also associated with lower screening. These findings enhance understanding of individual, social/structural, and health care factors correlated with CBE among LGBQ women. More research is needed to understand the complex interplay of these factors to inform multi-level interventions to address screening disparities for diverse LGBQ women.

HIV and other sexually transmitted infections among men, transgenders and women selling sex in two cities in Pakistan: a cross-sectional prevalence survey.

PubMed

Hawkes, S; Collumbien, M; Platt, L; Lalji, N; Rizvi, N; Andreasen, A; Chow, J; Muzaffar, R; ur-Rehman, H; Siddiqui, N; Hasan, S; Bokhari, A

2009-04-01

The extent and possibilities of spread of the HIV epidemic are not fully understood in Pakistan. A survey was conducted among men, women and transgender populations selling sex in Rawalpindi (Punjab) and Abbottabad (North West Frontier Province) in order to inform evidence-based programme planning. A cross-sectional survey was performed with participants recruited through respondent-driven sampling. Male and transgender sex workers were analysed in three gender groups; women were analysed as one group. Behavioural surveys were conducted and clinical specimens collected. Laboratory tests looked for evidence of acute infection (gonorrhoea, Chlamydia, syphilis, Trichomonas) and infection over the lifetime (HIV, herpes simplex virus-2, syphilis). Predictors of infection were explored using univariable and multivariable logistic regression. The prevalence of HIV was low in 917 male and transgender sex workers and absent in 533 female sex workers in the study. High levels of current sexually transmitted infections were found, predominantly among transgender sex workers. Risk behaviours were common and knowledge of HIV was extremely low. Multivariable analysis found a large number of factors associated with higher levels of infection, including experience of forced first sex. Protection against risk was low, but those sex workers who reported using condoms at last sex had lower rates of infection. The HIV epidemic is currently in its early stages among people who sell sex, but there may be potential for a much greater spread given the levels of other sexually transmitted infections found and the concomitant low levels of both protective knowledge and risk-reducing behaviours. Action is needed now to avert an epidemic. Framing interventions by upholding the recognition and protection of human rights is vital.

Risk factors for fibromyalgia: the role of violence against women.

PubMed

Ruiz-Pérez, Isabel; Plazaola-Castaño, Juncal; Cáliz-Cáliz, Rafael; Rodríguez-Calvo, Isabel; García-Sánchez, Antonio; Ferrer-González, Miguel Angel; Guzmán-Ubeda, Manuel; del Río-Lozano, María; López-Chicheri García, Isabel

2009-07-01

The objectives of the study were to analyse the association between fibromyalgia (FM) and violence against women and to explore the association between FM and sociodemographic factors, social support and psychological distress. A case-control study was conducted in a Spanish hospital. Cases were women diagnosed with FM, with no signs of any other type of inflammatory rheumatic disorder, who were seen at the Rheumatology Department of the hospital. Controls were women not diagnosed with FM who were seen at the Ear, Nose and Throat Department of the same hospital. A self-administered anonymous questionnaire was used to gather data on sociodemographic characteristics, violence, social support and psychological distress. Uni-, bi- and multivariate logistic regression analyses were conducted; 287 cases and 287 controls were recruited. The multivariate analysis showed that the probability of presenting FM increased with age (odds ratios (OR) = 1.06; CI95% = 1.03-1.09); that employed women and housewives were more likely to have the syndrome than unemployed women or students (OR = 4.97; CI95% = 1.45-17.02, and OR = 3.47; CI95% = 0.98-12.22, respectively); that the lower the educational level, the higher the probability of having FM; and that psychological distress was positively associated with the syndrome (OR = 4.62; CI95% = 2.68-7.97). Although abuse was more prevalent in cases than in controls, the differences were not statistically significant. However, frequency of abuse was positively and significantly correlated with FM. Although the aetiology of FM is still uncertain, it seems that certain psychosocial factors may be associated with the syndrome. Therefore, an interdisciplinary approach to the treatment of patients affected with this syndrome should be considered.

Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China.

PubMed

Wang, Bo; Li, Xiaoming; Stanton, Bonita; Kamali, Vafa; Naar-King, Sylvie; Shah, Iqbal; Thomas, Ronald

2007-07-31

In recent years, more adolescents are engaging in premarital sex in China. However, only a limited number of studies have explored out-of-school youth's sexual attitudes and behaviors, critical for prevention intervention development. Using data from the baseline survey of a comprehensive sex education program that was conducted in a suburb of Shanghai in 2000-2002, this study describes sexual attitudes, patterns of communication on sexual matters, and premarital sexual behavior among 1,304 out-of-school youth. Multivariate logistic regression analysis was conducted to examine the factors associated with youth's premarital sexual intercourse. The majority (60%) of out-of-school youth held favorable attitudes towards premarital sex. Males were more likely to have favorable attitudes compared with females. Male youth generally did not communicate with either parent about sex, while one-third of female youth talked to their mothers about sexual matters. Both males and females chose their friends as the person with whom they were most likely to talk about sexual matters. About 18% of the youth reported having engaged in sexual intercourse. One-fifth of sexually active youth had always used a contraceptive method, and one-quarter had been pregnant (or had impregnated a partner). There were no gender differences in rate of premarital sex or frequency of contraceptive use. Multivariate analysis revealed that age, education, family structure, parent's discipline, attitudes towards premarital sex, pattern of communication and dating were significantly associated with youth premarital sex. A substantial proportion of out-of-school youth engage in risky sexual behaviors. Prevention programs that empower communication and sexual negotiation skills, and promote condom use should be implemented for this vulnerable group.

Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youth in China

PubMed Central

Wang, Bo; Li, Xiaoming; Stanton, Bonita; Kamali, Vafa; Naar-King, Sylvie; Shah, Iqbal; Thomas, Ronald

2007-01-01

Background In recent years, more adolescents are engaging in premarital sex in China. However, only a limited number of studies have explored out-of-school youth's sexual attitudes and behaviors, critical for prevention intervention development. Methods Using data from the baseline survey of a comprehensive sex education program that was conducted in a suburb of Shanghai in 2000–2002, this study describes sexual attitudes, patterns of communication on sexual matters, and premarital sexual behavior among 1,304 out-of-school youth. Multivariate logistic regression analysis was conducted to examine the factors associated with youth's premarital sexual intercourse. Results The majority (60%) of out-of-school youth held favorable attitudes towards premarital sex. Males were more likely to have favorable attitudes compared with females. Male youth generally did not communicate with either parent about sex, while one-third of female youth talked to their mothers about sexual matters. Both males and females chose their friends as the person with whom they were most likely to talk about sexual matters. About 18% of the youth reported having engaged in sexual intercourse. One-fifth of sexually active youth had always used a contraceptive method, and one-quarter had been pregnant (or had impregnated a partner). There were no gender differences in rate of premarital sex or frequency of contraceptive use. Multivariate analysis revealed that age, education, family structure, parent's discipline, attitudes towards premarital sex, pattern of communication and dating were significantly associated with youth premarital sex. Conclusion A substantial proportion of out-of-school youth engage in risky sexual behaviors. Prevention programs that empower communication and sexual negotiation skills, and promote condom use should be implemented for this vulnerable group. PMID:17672903

Partner's influences and other correlates of prenatal alcohol use.

PubMed

van der Wulp, Nickie Y; Hoving, Ciska; de Vries, Hein

2015-04-01

To investigate the influence of partners on alcohol consumption in pregnant women within the context of other factors. A Dutch nationwide online cross-sectional study among 158 pregnant women and their partners was conducted. To identify correlates of prenatal alcohol use, including perceived and reported partner norm (i.e. partner's belief regarding acceptability of prenatal alcohol use), partner modeling (i.e. partner's alcohol use during the woman's pregnancy) and partner support (i.e. partner's help in abstaining from alcohol during pregnancy), independent sample T-tests and Chi square tests were conducted. Correlation analyses tested the relationship between perceived and reported partner influence. Multivariate logistic hierarchical regression analyses tested the independent impact of partner's perceived and reported influence next to other correlates from the I-Change Model. Pregnant women who consumed alcohol perceived a weaker partner norm (p < 0.001) and less partner modeling (p < 0.05), with the partner reporting a weaker norm (p < 0.001), more drinking days per week (p < 0.05) and weaker support (p < 0.05). Perceived and reported partner norm, modeling and support were positively related (respectively p < 0.01, p < 0.01 and p < 0.05). The multivariate analyses demonstrated that pregnant women with a higher education who perceived lower severity of harm due to prenatal alcohol use and a weaker partner norm were more likely to use alcohol (R(2) = 0.42). This study demonstrated that perceived partner norm was the most critical of the constructs of perceived and reported partner influences in explaining prenatal alcohol use.

Quantifying Burnout among Emergency Medicine Professionals

PubMed Central

Wilson, William; Raj, Jeffrey Pradeep; Narayan, Girish; Ghiya, Murtuza; Murty, Shakuntala; Joseph, Bobby

2017-01-01

Background: Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE), depersonalization(DP) and diminished feelings of personal accomplishment(PA). Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD) of 4 select tertiary care teaching hospitals in South India. Methods: A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory. Univariate and Multivariate analyses were conducted using binary logistic regression models to identify predictors of burnout. Results: Total number of professionals interviewed were 105 of which 71.5% were women and 51.4% were doctors. Majority (78.1%) belonged to the age group 20-30 years. Prevalence of moderate to severe burnout in the 3 principal components EE, DP and PA were 64.8%, 71.4% and 73.3% respectively. After multivariate analysis, the risk factors [adjusted odds ratio (95% confidence intervals) for DP included facing more criticism [3.57(1.25,10.19)], disturbed sleep [6.44(1.45,28.49)] and being short tempered [3.14(1.09,9.09)]. While there were no statistically significant risk factors for EE, being affected by mortality [2.35(1.12,3.94)] and fear of medication errors [3.61(1.26, 10.37)] appeared to be significant predictors of PA. Conclusion: Degree of burn out among doctors and nurses is moderately high in all of the three principal components and some of the predictors identified were criticism, disturbed sleep, short tempered nature, fear of committing errors and witnessing death in EMD. PMID:29097859

Intraoperative Conversion From Partial to Radical Nephrectomy: Incidence, Predictive Factors, and Outcomes.

PubMed

Petros, Firas G; Keskin, Sarp K; Yu, Kai-Jie; Li, Roger; Metcalfe, Michael J; Fellman, Bryan M; Chang, Courtney M; Gu, Cindy; Tamboli, Pheroze; Matin, Surena F; Karam, Jose A; Wood, Christopher G

2018-06-01

To evaluate preoperative and intraoperative predictors of conversion to radical nephrectomy (RN) in a cohort of patients undergoing a planned partial nephrectomy (PN) for renal cell carcinoma (RCC). A single-center, retrospective review was conducted using our PN database that includes patients who were scheduled to undergo PN (regardless of the approach) but were converted to RN between August 1990 and December 2016. Reasons for conversion were collected from the operative report. Patient demographics and perioperative variables were compared with the successful PN group. Univariate and multivariate logistic regression analyses were conducted to assess predictors of conversion. A total of 1857 patients were scheduled to undergo PN. Of these patients, 90 (5%) were converted to RN. The multivariate model showed that larger tumor size (odds ratio [OR] = 1.20, P = .040), higher RENAL nephrometry score (OR = 1.41, P = .001), hilar tumor or renal sinus invasion (OR = 2.80, P = .004), laparoscopic PN (OR = 7.34, P <.001), intraoperative bleeding (OR = 19.62, P <.001), positive surgical margin (OR = 31.85, P <.001), and advanced pathologic tumor-stage (T3 or T4) (OR = 7.29, P <.001) were associated with increased odds of intraoperative conversion to RN. The rate of conversion to RN was low in patients who were scheduled to undergo PN in this series. Larger tumor size with increasing complexity, hilar tumor location or renal sinus invasion, locally advanced tumors, laparoscopic PN but not robotic PN, bleeding complication, and positive surgical margin were associated with intraoperative conversion from scheduled PN to RN. Copyright © 2018 Elsevier Inc. All rights reserved.

Quantifying Burnout among Emergency Medicine Professionals.

PubMed

Wilson, William; Raj, Jeffrey Pradeep; Narayan, Girish; Ghiya, Murtuza; Murty, Shakuntala; Joseph, Bobby

2017-01-01

Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE), depersonalization(DP) and diminished feelings of personal accomplishment(PA). Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD) of 4 select tertiary care teaching hospitals in South India. A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory. Univariate and Multivariate analyses were conducted using binary logistic regression models to identify predictors of burnout. Total number of professionals interviewed were 105 of which 71.5% were women and 51.4% were doctors. Majority (78.1%) belonged to the age group 20-30 years. Prevalence of moderate to severe burnout in the 3 principal components EE, DP and PA were 64.8%, 71.4% and 73.3% respectively. After multivariate analysis, the risk factors [adjusted odds ratio (95% confidence intervals) for DP included facing more criticism [3.57(1.25,10.19)], disturbed sleep [6.44(1.45,28.49)] and being short tempered [3.14(1.09,9.09)]. While there were no statistically significant risk factors for EE, being affected by mortality [2.35(1.12,3.94)] and fear of medication errors [3.61(1.26, 10.37)] appeared to be significant predictors of PA. Degree of burn out among doctors and nurses is moderately high in all of the three principal components and some of the predictors identified were criticism, disturbed sleep, short tempered nature, fear of committing errors and witnessing death in EMD.

Characteristics of Fibromyalgia Independently Predict Poorer Long‐Term Analgesic Outcomes Following Total Knee and Hip Arthroplasty

PubMed Central

Urquhart, Andrew G.; Hassett, Afton L.; Tsodikov, Alex; Hallstrom, Brian R.; Wood, Nathan I.; Williams, David A.; Clauw, Daniel J.

2015-01-01

Objective While psychosocial factors have been associated with poorer outcomes after knee and hip arthroplasty, we hypothesized that augmented pain perception, as occurs in conditions such as fibromyalgia, may account for decreased responsiveness to primary knee and hip arthroplasty. Methods A prospective, observational cohort study was conducted. Preoperative phenotyping was conducted using validated questionnaires to assess pain, function, depression, anxiety, and catastrophizing. Participants also completed the 2011 fibromyalgia survey questionnaire, which addresses the widespread body pain and comorbid symptoms associated with characteristics of fibromyalgia. Results Of the 665 participants, 464 were retained 6 months after surgery. Since individuals who met criteria for being classified as having fibromyalgia were expected to respond less favorably, all primary analyses excluded these individuals (6% of the cohort). In the multivariate linear regression model predicting change in knee/hip pain (primary outcome), a higher fibromyalgia survey score was independently predictive of less improvement in pain (estimate −0.25, SE 0.044; P < 0.00001). Lower baseline joint pain scores and knee (versus hip) arthroplasty were also predictive of less improvement (R2 = 0.58). The same covariates were predictive in the multivariate logistic regression model for change in knee/hip pain, with a 17.8% increase in the odds of failure to meet the threshold of 50% improvement for every 1‐point increase in fibromyalgia survey score (P = 0.00032). The fibromyalgia survey score was also independently predictive of change in overall pain and patient global impression of change. Conclusion Our findings indicate that the fibromyalgia survey score is a robust predictor of poorer arthroplasty outcomes, even among individuals whose score falls well below the threshold for the categorical diagnosis of fibromyalgia. PMID:25772388

Learning investment indicators through data extension

NASA Astrophysics Data System (ADS)

Dvořák, Marek

2017-07-01

Stock prices in the form of time series were analysed using single and multivariate statistical methods. After simple data preprocessing in the form of logarithmic differences, we augmented this single variate time series to a multivariate representation. This method makes use of sliding windows to calculate several dozen of new variables using simple statistic tools like first and second moments as well as more complicated statistic, like auto-regression coefficients and residual analysis, followed by an optional quadratic transformation that was further used for data extension. These were used as a explanatory variables in a regularized logistic LASSO regression which tried to estimate Buy-Sell Index (BSI) from real stock market data.

An assessment study of CVD related risk factors in a tribal population of India.

PubMed

Kandpal, Vani; Sachdeva, M P; Saraswathy, K N

2016-05-25

Non communicable diseases (NCDs) have become a major concern for global health. Cardiovascular diseases (CVDs) contribute 48 % towards the deaths due to NCDs in India. Though studies have been conducted in urban and rural areas, data related to tribal communities is limited. The present study aims to examine various CVD related risk factors including hypertension, elevated fasting blood glucose, obesity and metabolic syndrome among a tribal population. The present study was an observational, cross- sectional study conducted on Rang Bhotias, a tribal population of India. The participants were adults of age between 20 and 60 years. Prior to blood sample collection, interview schedule was administered which included relevant information like age, lifestyle, socio-economic status, education and occupation In addition to this, various anthropometric and physiological measurements were taken. Logistic regression was used to examine the association of the various health disorders related to CVDs with age, gender and behavioural factors (smoking, alcohol consumption and physical activity). A total of 288 participants were surveyed for the study including 104 males and 184 females. High BMI (56.6 %), hypertension (43.4 %), metabolic syndrome (39.2 %) and abdominal obesity (33.7 %) were the most prevalent CVD risk factors observed in the population. The multivariate logistic regression analysis, conducted to examine the contribution of risk factors including behavioural risk factors on the studied abnormalities, revealed age to be a significant risk factor for all the abnormalities except elevated fasting blood glucose. Gender and physical inactivity contributed significantly towards development of hypertension. Physical inactivity was also found to be associated with high BMI levels. In the present study, hypertension, high BMI levels, MS and abdominal obesity have been found to be high among the studied population. The status of the population with respect to these abnormalities implicates susceptibility of the community towards various common disorders. The prevention and treatment intervention programs should be implemented taking into consideration age and gender.

Risk factors for microbial bioburden during daily wear of silicone hydrogel contact lenses.

PubMed

Jiang, Ying; Jacobs, Michael; Bajaksouzian, Saralee; Foster, Altreisha N; Debanne, Sara M; Bielefeld, Roger; Garvey, Matt; Raghupathy, Sangeetha; Kern, Jami; Szczotka-Flynn, Loretta B

2014-05-01

To assess risk factors associated with substantial microbial bioburden of lids, conjunctivae, contact lenses, and storage cases during daily wear of silicone hydrogel contact lenses. Two hundred eighteen patients were fit to lotrafilcon A lenses, randomized to use either a multipurpose solution or a hydrogen peroxide care system, and followed up for 1 year. Lenses, lens transport saline, lids, conjunctivae, and storage cases were cultured and considered to have substantial microbial bioburden when they harbored high levels of commensal or pathogenic organisms. Univariate and multivariate logistic regression analyses were conducted to examine which demographic covariates were associated with significant bioburden at each location while controlling for solution use. In multivariate analyses, smoking trended toward an association with lens bioburden (odds ratio [OR]=2.15, 95% confidence interval [CI]: 0.95-4.88). Clerical occupations were found to be associated with more frequent overall storage case contamination (OR=3.51, 95% CI: 1.15-10.70) and, specifically, higher gram-positive storage case contamination (OR=5.57, 95% CI: 1.82-17.06). The peroxide system was associated with more frequent storage case contamination (OR=7.6, 95% CI: 3.79-15.19). Coagulase-negative staphylococci (CNS) were the most frequently cultured organisms within storage cases, and in multivariate analyses, CNS were more frequently found in storage cases of peroxide users (OR=6.12, 95% CI: 2.91-13.09). Clerical occupations were associated with increased microbial bioburden of storage cases during daily wear of silicone hydrogel lenses. Smoking may increase the risk of lens contamination. Storage cases are most frequently contaminated with normal skin flora, and peroxide cases were associated with more frequent contamination. However, the solution type was not associated with lid or lens contamination nor with corneal infiltrative events in this study.

A model and nomogram to predict tumor site origin for squamous cell cancer confined to cervical lymph nodes.

PubMed

Ali, Arif N; Switchenko, Jeffrey M; Kim, Sungjin; Kowalski, Jeanne; El-Deiry, Mark W; Beitler, Jonathan J

2014-11-15

The current study was conducted to develop a multifactorial statistical model to predict the specific head and neck (H&N) tumor site origin in cases of squamous cell carcinoma confined to the cervical lymph nodes ("unknown primaries"). The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for patients with an H&N tumor site who were diagnosed between 2004 and 2011. The SEER patients were identified according to their H&N primary tumor site and clinically positive cervical lymph node levels at the time of presentation. The SEER patient data set was randomly divided into 2 data sets for the purposes of internal split-sample validation. The effects of cervical lymph node levels, age, race, and sex on H&N primary tumor site were examined using univariate and multivariate analyses. Multivariate logistic regression models and an associated set of nomograms were developed based on relevant factors to provide probabilities of tumor site origin. Analysis of the SEER database identified 20,011 patients with H&N disease with both site-level and lymph node-level data. Sex, race, age, and lymph node levels were associated with primary H&N tumor site (nasopharynx, hypopharynx, oropharynx, and larynx) in the multivariate models. Internal validation techniques affirmed the accuracy of these models on separate data. The incorporation of epidemiologic and lymph node data into a predictive model has the potential to provide valuable guidance to clinicians in the treatment of patients with squamous cell carcinoma confined to the cervical lymph nodes. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases.

PubMed

Hardy, Krista L; Davis, Kathryn E; Constantine, Ryan S; Chen, Mo; Hein, Rachel; Jewell, James L; Dirisala, Karunakar; Lysikowski, Jerzy; Reed, Gary; Kenkel, Jeffrey M

2014-05-01

Little evidence within plastic surgery literature supports the precept that longer operative times lead to greater morbidity. The authors investigate surgery duration as a determinant of morbidity, with the goal of defining a clinically relevant time for increased risk. A retrospective chart review was conducted of patients who underwent a broad range of complex plastic surgical procedures (n = 1801 procedures) at UT Southwestern Medical Center in Dallas, Texas, from January 1, 2008 to January 31, 2012. Adjusting for possible confounders, multivariate logistic regression assessed surgery duration as an independent predictor of morbidity. To define a cutoff for increased risk, incidence of complications was compared among quintiles of surgery duration. Stratification by type of surgery controlled for procedural complexity. A total of 1753 cases were included in multivariate analyses with an overall complication rate of 27.8%. Most operations were combined (75.8%), averaging 4.9 concurrent procedures. Each hour increase in surgery duration was associated with a 21% rise in odds of morbidity (P < .0001). Compared with the first quintile of operative time (<2.0 hours), there was no change in complications until after 3.1 hours of surgery (odds ratio, 1.6; P = .017), with progressively greater odds increases of 3.1 times after 4.5 hours (P < .0001) and 4.7 times after 6.8 hours (P < .0001). When stratified by type of surgery, longer operations continued to be associated with greater morbidity. Surgery duration is an independent predictor of complications, with a significantly increased risk above 3 hours. Although procedural complexity undoubtedly affects morbidity, operative time should factor into surgical decision making.

Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children

PubMed Central

Coker, Tumaini R.; Elliott, Marc N.; Kataoka, Sheryl; Schwebel, David C.; Mrug, Sylvie; Grunbaum, Jo Anne; Cuccaro, Paula; Peskin, Melissa F.; Schuster, Mark A.

2015-01-01

Objective The aim of this study was to examine racial/ethnic differences in fifth grade children’s mental health care utilization. Methods We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization. Results Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P <.001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models. Conclusions Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children. PMID:19329099

The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study.

PubMed

Hsieh, Ronan Wenhan; Chen, Likwang; Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Chen, Yen-Yuan; Tsai, Chin-Chung

2016-12-07

Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). The inconsistent quality of health-related information obtained from the Internet may be associated with patients' increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. ©Ronan Wenhan Hsieh, Likwang Chen, Tsung-Fu Chen, Jyh-Chong Liang, Tzu-Bin Lin, Yen-Yuan Chen, Chin-Chung Tsai. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.12.2016.

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

PubMed Central

Dlouhy, Brian J.; Madhavan, Karthik; Clinger, John D.; Reddy, Ambur; Dawson, Jeffrey D.; O’Brien, Erin K.; Chang, Eugene; Graham, Scott M.; Greenlee, Jeremy D. W.

2012-01-01

Object Postoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery. Methods The authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage. Results In 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m2, p = 0.006). Multivariate analyses indicate that for every 5-kg/m2 increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10–2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak. Conclusions Elevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m2 have meticulous sellar reconstruction at surgery and close monitoring postoperatively. PMID:22443502

Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia.

PubMed

Matsuo, Koji; Ramzan, Amin A; Gualtieri, Marc R; Mhawech-Fauceglia, Paulette; Machida, Hiroko; Moeini, Aida; Dancz, Christina E; Ueda, Yutaka; Roman, Lynda D

2015-11-01

Although a fraction of endometrial hyperplasia cases have concurrent endometrial carcinoma, patient characteristics associated with concurrent malignancy are not well described. The aim of our study was to identify predictive clinico-pathologic factors for concurrent endometrial carcinoma among patients with endometrial hyperplasia. A case-control study was conducted to compare endometrial hyperplasia in both preoperative endometrial biopsy and hysterectomy specimens (n=168) and endometrial carcinoma in hysterectomy specimen but endometrial hyperplasia in preoperative endometrial biopsy (n=43). Clinico-pathologic factors were examined to identify independent risk factors of concurrent endometrial carcinoma in a multivariate logistic regression model. The most common histologic subtype in preoperative endometrial biopsy was complex hyperplasia with atypia [CAH] (n=129) followed by complex hyperplasia without atypia (n=58) and simple hyperplasia with or without atypia (n=24). The majority of endometrial carcinomas were grade 1 (86.0%) and stage I (83.7%). In multivariate analysis, age 40-59 (odds ratio [OR] 3.07, p=0.021), age≥60 (OR 6.65, p=0.005), BMI≥35kg/m(2) (OR 2.32, p=0.029), diabetes mellitus (OR 2.51, p=0.019), and CAH (OR 9.01, p=0.042) were independent predictors of concurrent endometrial carcinoma. The risk of concurrent endometrial carcinoma rose dramatically with increasing number of risk factors identified in multivariate model (none 0%, 1 risk factor 7.0%, 2 risk factors 17.6%, 3 risk factors 35.8%, and 4 risk factors 45.5%, p<0.001). Hormonal treatment was associated with decreased risk of concurrent endometrial cancer in those with ≥3 risk factors. Older age, obesity, diabetes mellitus, and CAH are predictive of concurrent endometrial carcinoma in endometrial hyperplasia patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Likelihood of illegal alcohol sales at professional sport stadiums.

PubMed

Toomey, Traci L; Erickson, Darin J; Lenk, Kathleen M; Kilian, Gunna R

2008-11-01

Several studies have assessed the propensity for illegal alcohol sales at licensed alcohol establishments and community festivals, but no previous studies examined the propensity for these sales at professional sport stadiums. In this study, we assessed the likelihood of alcohol sales to both underage youth and obviously intoxicated patrons at professional sports stadiums across the United States, and assessed the factors related to likelihood of both types of alcohol sales. We conducted pseudo-underage (i.e., persons age 21 or older who appear under 21) and pseudo-intoxicated (i.e., persons feigning intoxication) alcohol purchase attempts at stadiums that house professional hockey, basketball, baseball, and football teams. We conducted the purchase attempts at 16 sport stadiums located in 5 states. We measured 2 outcome variables: pseudo-underage sale (yes, no) and pseudo-intoxicated sale (yes, no), and 3 types of independent variables: (1) seller characteristics, (2) purchase attempt characteristics, and (3) event characteristics. Following univariate and bivariate analyses, we a separate series of logistic generalized mixed regression models for each outcome variable. The overall sales rates to the pseudo-underage and pseudo-intoxicated buyers were 18% and 74%, respectively. In the multivariate logistic analyses, we found that the odds of a sale to a pseudo-underage buyer in the stands was 2.9 as large as the odds of a sale at the concession booths (30% vs. 13%; p = 0.01). The odds of a sale to an obviously intoxicated buyer in the stands was 2.9 as large as the odds of a sale at the concession booths (89% vs. 73%; p = 0.02). Similar to studies assessing illegal alcohol sales at licensed alcohol establishments and community festivals, findings from this study shows the need for interventions specifically focused on illegal alcohol sales at professional sporting events.

Predictors of Health-Care Utilization Among Children 6–59 Months of Age in Zambézia Province, Mozambique

PubMed Central

Bayham, Mary; Blevins, Meridith; Lopez, Melanie; Olupona, Omo; González-Calvo, Lazaro; Ndatimana, Elisée; Green, Ann F.; Moon, Troy D.

2017-01-01

Globally, approximately 5.9 million children under 5 years of age died in 2015, a reduction of over 50% since 1990. Millennium Development Goal 4 established the goal of reducing child mortality by two-thirds by 2015. Multiple countries have surpassed this goal; however, regional and within-country inequities exist. We sought to study determinants of health-care utilization among children 6–59 months of age with fever, diarrhea, and respiratory symptoms in Zambézia Province, Mozambique. We conducted a population-based cross-sectional survey of female heads of household between April and May 2014. Mobile teams conducted interviews in 262 enumeration areas, with three distinct districts being oversampled for improved precision. Descriptive statistics and logistic regression using Stata 13.1 and R 3.2.2 were used to examine factors associated with health-care utilization. A total of 2,317 children were evaluated in this study. Mothers' median age was 26 years, whereas child median age was 24 months. The proportion of children reporting fever, diarrhea, or respiratory illness in the prior 30 days was 44%, 22%, and 22%, respectively. Health-care utilization varied with 65% seeking health care for fever, compared with 57% for diarrhea and 25% for respiratory illness. In multivariable logistic regression, the characteristics most associated with health-care utilization across illnesses were delivery of last child at a facility, higher maternal education, and household ownership of a radio. The decision or ability to use health care is a multifaceted behavior swayed by societal norms, values, socioeconomics, and perceived need. Recognizing the predictors of a particular population may offer useful information to increase uptake in health-care services. PMID:27821686

Environmental Risk Factors in Han and Uyghur Children with Dyslexia: A Comparative Study.

PubMed

Zhao, Hua; Zhang, Baoping; Chen, Yun; Zhou, Xiang; Zuo, Pengxiang

2016-01-01

Several studies have been conducted to explore risk factors for dyslexia. However, most studies examining dyslexia have been skewed toward Western countries, and few have considered two nationalities simultaneously. This study focused on differences in dyslexia prevalence and potential environmental risk factors between Han and Uyghur children. A cross-sectional study was conducted in Kashgar and Aksu, cities in Xinjiang province, China. A two-stage sampling strategy was used to recruit 2,854 students in grades 3-6 from 5 primary schools in 5 districts; 2,348 valid student questionnaires were included in the analysis. Dyslexia checklists for Chinese and Uyghur children and pupil rating scales were used to identify children with dyslexia. Questions related to the home literacy environment and reading ability were used to evaluate potential environmental risk factors. Single factor analysis and multivariate logistic regression were used to examine prevalence and risk factors for dyslexia. Dyslexia prevalence differed significantly between Han (3.9%) and Uyghur (7.0%) children (P < 0.05), and the boy-to-girl diagnosis ratio was almost 2:1. Multiple logistic regression analysis showed that ethnic differences in dyslexia prevalence between Han and Uyghur children could have occurred because of factors such as mother's occupation (P = 0.02, OR = 0.04, 95% CI = 0.01-0.68) and the frequency with which parents told stories (P = 0.00, OR = 4.50, 95% CI = 1.67-12.11). The prevalence of dyslexia was high in all children, particularly those in the Uyghur group. Environmental factors could have been responsible for some of the differences observed. The results contribute to the early identification and management of dyslexia in children from these two groups and research examining developmental dyslexia and differences in racial genetics.

Khat chewing habit among school students of Jazan region, Saudi Arabia.

PubMed

Alsanosy, Rashad Mohammed; Mahfouz, Mohamed Salih; Gaffar, Abdelrahim Mutwakel

2013-01-01

The use of Khat leaves (Catha edulis) in Jazan, southwest of KSA, is prevalent among all segments of the population. This study was conducted to assess the prevalence and predictors of Khat chewing among intermediate and secondary school students of Jazan region. A cross-sectional survey was conducted in late 2011 in Jazan region. A random sample of 3923 students was selected from 72 intermediate and upper secondary schools representing the different educational sectors of the region. A structured self-administered questionnaire was used for data collection. Descriptive statistics, a chi-squared test and logistic regression were performed to examine the prevalence, associations and predictors of Khat chewing. The overall Khat chewing prevalence among students was 20.5% (95% C.I.: 19.27-21.79). The prevalence was significantly higher among males, at 33.1% (95% CI: 31.16-35.08), than among females 4.3% (95% C.I.: 3.39-5.31) ( P <0.001). Univariate analysis revealed that gender, age, academic performance, friends' smoking and Khat chewing, and students' smoking status were associated with a significantly high risk of Khat chewing ( P <0.001 for all). The multivariate logistic regression analysis suggested that the most important independent predictors of Khat chewing among the students in our sample were students' smoking status (OR = 13.02, P <0.001), friends' use of Khat (OR = 5.65, P <0.001), gender (OR = 4.62, P <0.001), and friend's use of tobacco (OR = 1.43, P <0.001). A significant percentage of students chew Khat. The abuse of Khat is significantly associated with gender, peer influence, and cigarette smoking. Intervention programs are needed to create awareness among school students and to reduce the prevalence of the habit and its unfavorable consequences.

Experience with peritoneal thermal injury during subcutaneous endoscopically assisted ligation for pediatric inguinal hernia.

PubMed

St-Louis, Etienne; Chabot, Annie; Stagg, Hayden; Baird, Robert

2018-05-01

Subcutaneous endoscopically-assisted ligation (SEAL) for pediatric inguinal hernia repair has gained in popularity although variations in techniques exist. Peritoneal scarring by thermal injury has been described as an adjunct. We explored the hypothesized inverse-correlation between peritoneal scarring and recurrence after SEAL. We conducted a single-center retrospective review of all patients <18years old undergoing SEAL between 2010 and 2016 (REB-20172727). Demographics and outcomes were investigated. Univariate and multivariable logistic regressions were performed to evaluate the association between peritoneal scarring and recurrence. We identified 272 patients. Median age was 3years, 35% were female, and 19% were born premature. Median follow-up was 30months, ≥1 visit/patient. Bilaterality was noted in 35%. There were no reported cases of metachronous hernia, vas injury, testicular atrophy or chronic pain, and recurrence rate was 4.6%. Prematurity, unilateral repair, incarceration, and suture-type (Ti-Cron® vs. Ethibond®) had significant correlation with recurrence on univariate analysis (p<0.25). Surgeon experience did not. Peritoneal scarring, performed in 195 cases (72%), was not predictive of recurrence (adjusted OR=0.87, p=0.830) on multivariable analysis. The rate of complications with SEAL compares favorably to published data. Thermal injury was not associated with improved recurrence rates. The benefits of peritoneal scarring may not outweigh the risks. III - Retrospective Case-Control Study. Copyright © 2018. Published by Elsevier Inc.

The current use and attitudes towards tumor genome sequencing in breast cancer

PubMed Central

Gingras, I.; Sonnenblick, A.; de Azambuja, E.; Paesmans, M.; Delaloge, S.; Aftimos, Philippe; Piccart, M. J.; Sotiriou, C.; Ignatiadis, M.; Azim, H. A.

2016-01-01

There is increasing availability of technologies that can interrogate the genomic landscape of an individual tumor; however, their impact on daily practice remains uncertain. We conducted a 28-item survey to investigate the current attitudes towards the integration of tumor genome sequencing in breast cancer management. A link to the survey was communicated via newsletters of several oncological societies, and dedicated mailing by academic research groups. Multivariable logistic regression modeling was carried out to determine the relationship between predictors and outcomes. 215 physicians participated to the survey. The majority were medical oncologists (88%), practicing in Europe (70%) and working in academic institutions (66%). Tumor genome sequencing was requested by 82 participants (38%), of whom 21% reported low confidence in their genomic knowledge, and 56% considered tumor genome sequencing to be poorly accessible. In multivariable analysis, having time allocated to research (OR 3.37, 95% CI 1.84–6.15, p < 0.0001), working in Asia (OR 5.76, 95% CI 1.57 – 21.15, p = 0.01) and having institutional guidelines for molecular sequencing (OR 2.09, 95% 0.99–4.42, p = 0.05) were associated with a higher probability of use. In conclusion, our survey indicates that tumor genome sequencing is sometimes used, albeit not widely, in guiding management of breast cancer patients. PMID:26931736

Association of being bullied in school with suicide ideation and planning among rural middle school adolescents.

PubMed

Bhatta, Madhav P; Shakya, Sunita; Jefferis, Eric

2014-11-01

This study examined the association of ever being bullied in school with suicide ideation (ever thinking about killing oneself) and ever seriously making a plan to kill oneself (suicide planning) among rural middle school adolescents. Using the US Centers for Disease Control and Prevention's Middle School Youth Risk Behavior Survey instrument, 2 cross-sectional surveys were conducted among middle school adolescents (N = 1082) in a rural Appalachian county in Ohio in 2009 and 2012. Multivariable logistic regression models assessed the relationship of ever being bullied in school with suicide ideation and planning. Overall, a total of 468 participants (43.1%) reported ever being bullied in school, and 22.3% and 13.2% of the adolescents surveyed reported suicide ideation and planning, respectively. In the multivariable analyses, ever being bullied in school was significantly associated with both suicide ideation (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.7-3.5) and planning (OR = 2.5; 95% CI: 1.6-3.8). The results show a strong association between being bullied in school and suicide ideation and planning among rural middle school adolescents. Prevention of bullying in school as early as in middle school should be a strategy for reducing suicide ideation and planning among adolescents. © 2014, American School Health Association.

Association between diabetes mellitus and hearing impairment in American and Korean populations.

PubMed

Moon, Shinje; Park, Jung Hwan; Yu, Jae Myung; Choi, Moon-Ki; Yoo, Hyung Joon

2018-04-20

The aim of this study was to evaluate ethnic- and sex-specific associations between DM and hearing impairment. For this cross-sectional study using National Health and Nutrition Examination Survey in the U.S. and Korea, the total number of eligible participants included was 7081 in the U.S. and 15,704 in Korea. Hearing impairment was defined as a pure tone threshold level ≥ 25 dB. Multivariate logistic regression analysis was conducted, adjusting for age, sex, race/ethnicity, socioeconomic status, body mass index, noise exposure, smoking, hypertension, and dyslipidemia. The association between DM and hearing impairment was found to be sex-specific. The multivariate adjusted ORs of high-frequency impairment were 0.843 (95% CI, 0.524-1.356) in American men, and 1.073 (95% CI, 0.835-1.379) in Korean men, while the ORs in women from U.S. and Korea were 1.911 (95% CI, 1.244-2.935) and 1.421 (95% CI, 1.103-1.830), respectively. A subgroup analysis of each race/ethnicity among the U.S. adults showed similar results. In contrast to high-frequency impairment, there was no significant association between low-frequency impairment and DM in both men and women. Our results suggest that DM is associated with hearing impairment in only women, irrespective of race/ethnicity groups. Copyright © 2018. Published by Elsevier Inc.

A novel practical scoring for early diagnosis of traumatic bowel injury without obvious solid organ injury in hemodynamically stable patients.

PubMed

Zarour, Ahmad; El-Menyar, Ayman; Khattabi, Mazen; Tayyem, Raed; Hamed, Osama; Mahmood, Ismail; Abdelrahman, Husham; Chiu, William; Al-Thani, Hassan

2014-01-01

To develop a scoring tool based on clinical and radiological findings for early diagnosis and intervention in hemodynamically stable patients with traumatic bowel and mesenteric injury (TBMI) without obvious solid organ injury (SOI). A retrospective analysis was conducted for all traumatic abdominal injury patients in Qatar from 2008 to 2011. Data included demographics and clinical, radiological and operative findings. Multivariate logistic regression was performed to analyze the predictors for the need of therapeutic laparotomy. A total of 105 patients met the inclusion criteria with a mean age of 33 ± 15. Motor Vehicle Crashes (58%) and fall (21%) were the major MOI. Using Receiver operating characteristic curve, Z-score of >9 was the cutoff point (AUC = 0.98) for high probability of the presence of TBMI requiring surgical intervention. Z-Score >9 was found to have sensitivity (96.7%), specificity (97.4%), PPV (93.5%) and NPV (98.7%). Multivariate regression analysis found Z-score (>9) to be an independent predictor for the need of exploratory laparotomy (OR7.0; 95% CI: 2.46-19.78, p = 0.001). This novel tool for early diagnosis of TBMI is found to be simple and helpful in selecting stable patients with free intra-abdominal fluid without SOI for exploratory Laparotomy. However, further prospective studies are warranted. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Not just a woman's business! Understanding men and women's knowledge of HPV, the HPV vaccine, and HPV-associated cancers.

PubMed

Osazuwa-Peters, Nosayaba; Adjei Boakye, Eric; Mohammed, Kahee A; Tobo, Betelihem B; Geneus, Christian J; Schootman, Mario

2017-06-01

Few studies have included men when assessing differences in knowledge about HPV, and HPV-associated cancers. We examined gender differences in knowledge about HPV, HPV vaccine, and HPV-associated cancers. Multivariable logistic regression models were used to analyze data of 3,677 survey respondents aged 18 years and older from the 2014 Health Information National Trends Survey. Covariates included age, race/ethnicity, marital status, education, income level, regular provider, general health, internet use, and family structure aged 9 to 27 years. Analyses were conducted in 2015. Sixty-four percent of respondents had heard of HPV and the HPV vaccine. Seventy-eight percent of respondents knew HPV causes cervical cancer, but only 29% knew it causes penile cancer, 26% knew it causes anal cancer, and 30% knew it causes oral cancer. In multivariable analyses, males were less likely to have heard of HPV (aOR: 0.33; 95% CI: 0.25-0.45), and less likely to have heard of the HPV vaccine (aOR: 0.24; 95% CI: 0.18-0.32) compared to females. No differences existed between males and females regarding knowledge about HPV-associated cancers. In conclusion, knowledge of HPV, the vaccine, and HPV-associated cancers in both males and females in the United States remains very low, especially among men. Copyright © 2017 Elsevier Inc. All rights reserved.

Free Triiodothyronine Concentrations are Inversely Associated with Elevated Carotid Intima-Media Thickness in Middle-Aged and Elderly Chinese Population.

PubMed

Zhou, Yulin; Zhao, Liebin; Wang, Tiange; Hong, Jie; Zhang, Jie; Xu, Baihui; Huang, Xiaolin; Xu, Min; Bi, Yufang

2016-01-01

Increased carotid artery intima media thickness (C-IMT) is an early feature of atherosclerosis. It has been reported to be altered in patients with thyroid dysfunction, and the evidence is still controversial. The present study aimed to explore the relationship between C-IMT and possible variations in thyroid function in Chinese adults aged 40 years and above. A community-based cross-sectional study was conducted among 2276 non-diabetic participants. Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were determined by chemiluminescent microparticle immunoassay. The prevalence of elevated C-IMT decreased according to FT3 quartiles (29.8%, 24.3%, 24.2%, and 22.2%, P for trend=0.005). In both univariate and multivariate linear regression analyses, FT3 levels were inversely associated with C-IMT (both P values ≤ 0.002). Multivariate-adjusted logistic regression analysis showed that high FT3 levels were associated with low prevalent elevated C-IMT. The adjusted odds ratio for elevated C-IMT was 0.71 (95% confidence interval, 0.52-0.99, P=0.04) when comparing the highest with the lowest quartile of FT3. Serum FT3 levels were inversely associated with elevated C-IMT in middle-aged and elderly Chinese adults without diabetes, independent of traditional risk factors for atherosclerosis.

Risk factors for wound disruption following cesarean delivery.

PubMed

Subramaniam, Akila; Jauk, Victoria C; Figueroa, Dana; Biggio, Joseph R; Owen, John; Tita, Alan T N

2014-08-01

Risk factors for post-cesarean wound infection, but not disruption, are well-described in the literature. The primary objective of this study was to identify risk factors for non-infectious post-cesarean wound disruption. Secondary analysis was conducted using data from a single-center randomized controlled trial of staple versus suture skin closure in women ≥24 weeks' gestation undergoing cesarean delivery. Wound disruption was defined as subcutaneous skin or fascial dehiscence excluding primary wound infections. Composite wound morbidity (disruption or infection) was examined as a secondary outcome. Patient demographics, medical co-morbidities, and intrapartum characteristics were evaluated as potential risk factors using multivariable logistic regression. Of the 398 randomized patients, 340, including 26 with disruptions (7.6%) met inclusion criteria and were analyzed. After multivariable adjustments, African-American race (aOR 3.9, 95% CI 1.1-13.8) and staple - as opposed to suture - wound closure (aOR 5.4, 95% CI 1.8-16.1) remained significant risk factors for disruption; non-significant increases were observed for body mass index ≥30 (aOR 2.1, 95% CI 0.6-7.5), but not for diabetes mellitus (aOR 0.9, 95% CI 0.3-2.9). RESULTS for composite wound morbidity were similar. Skin closure with staples, African-American race, and considering the relatively small sample size, potentially obesity are associated with increased risk of non-infectious post-cesarean wound disruption.

Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic.

PubMed

Marconi, Vincent C; Wu, Baohua; Hampton, Jane; Ordóñez, Claudia E; Johnson, Brent A; Singh, Dinesh; John, Sally; Gordon, Michelle; Hare, Anna; Murphy, Richard; Nachega, Jean; Kuritzkes, Daniel R; del Rio, Carlos; Sunpath, Henry

2013-12-01

We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ≥ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL ≤ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.

Association between depression and diabetes amongst adults in Bangladesh: a hospital based case–control study

PubMed Central

Islam, Sheikh Mohammed Shariful; Ferrari, Uta; Seissler, Jochen; Niessen, Louis; Lechner, Andreas

2015-01-01

Methods A matched case–control study was conducted among 591 consecutive patients with diabetes attending a tertiary hospital in Dhaka and 591 controls matched for age, sex and area of residence without diabetes not related with the index–case. Depression was measured using the Patient Health Questionnaire–9. Multivariate logistic regression was performed to examine the association between depression and diabetes. Results The mean age (±standard deviation) of the participants was 50.4 ± 11.4 years, with a male to female ratio of 43:57. The prevalence of depression was 45.2% and 19.8% among cases and controls, respectively. In the multivariate analysis, mild as well as moderate to severe depression were significantly associated with diabetes and independent of sociodemographic factors and co–morbidity (adjusted odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1.4–2.9 and adjusted OR = 6.4, 95% CI = 3.4–12.3; P < 0.001 for both). Conclusion The high prevalence and strong association of depression in individuals with diabetes in Bangladesh suggests that depression should be routinely screened for patients with diabetes at the clinics and that management strategies adequate for resource–poor settings need to be developed. Further research to determine the pathophysiological role of depression in the development of diabetes is merited. PMID:26649173

Glycated hemoglobin as a predictor for metabolic syndrome in an Iranian population with normal glucose tolerance.

PubMed

Janghorbani, Mohsen; Amini, Masoud

2012-12-01

The aim of this study was to determine the ability of glycated hemoglobin (GHb) to predict metabolic syndrome in an Iranian population with normal glucose tolerance (NGT). A cross-sectional study of first-degree relatives (FDRs) of patients with type 2 diabetes was conducted from 2003 to 2005. A total of 1386 FDRs of consecutive patients with type 2 diabetes 30-60 years old (355 men and 1031 women) with NGT were examined. All subjects underwent a standard 75-gram 2-h oral glucose tolerance test and GHb measurement. Consensus criteria in 2009 were used to identify metabolic syndrome. Unadjusted and adjusted multivariate logistic regression analysis was performed to assess the risk of metabolic syndrome. The mean [standard deviation (SD)] age of participants was 42.4 (6.3) years. The prevalence of metabolic syndrome was 17.5% in men and 21.5% in women. The multivariate-adjusted odds ratio (95% CI) of metabolic syndrome was 2.01 (1.03, 3.93) for the highest quintile of GHb compared with lowest quintile. These data indicate that GHb was associated with metabolic syndrome, independently of gender among FDRs of patients with type 2 diabetes with NGT. These data indicate that GHb below the level for prediabetes might be a predictive measure of metabolic syndrome in FDRs of patients with type 2 diabetes with NGT.

Tuberculin reactivity and tuberculosis epidemiology in the Pakaanóva (Wari') Indians of Rondônia, south-western Brazilian Amazon.

PubMed

Escobar, A L; Coimbra, C E A; Camacho, L A B; Santos, R V

2004-01-01

To investigate the characteristics of tuberculin skin test reactivity in the Pakaanóva Indians, in Amazonia, Brazil, after revaccination of all study participants with bacille Calmette-Guerin (BCG). The investigation was designed as a post-BCG vaccination purified protein derivative (PPD) survey. Data included PPD readings, age, sex, nutritional status, place of residence, previous tuberculosis, physical examinations and BCG status. Bivariate and multivariate logistic regression analyses were conducted. About 90% (n = 505) of the total population participated. One third (32.1%) of the subjects presented induration > or = 10 mm at 72 h. Induration sizes showed weak linear correlation with age; differences between sexes were not observed. Skin reaction was not associated with nutritional status. Individuals with a history of tuberculosis were six times more likely to test positive. History of tuberculosis, age, and previous BCG vaccination were significantly associated with PPD reactivity in the multivariate analyses. The Pakaanóva showed a high proportion (58.4%) of non-reactors, even with a recent BCG booster. Sex differences in PPD reactivity were either not present or could not be demonstrated. The association between age and PPD reactivity resembles that observed in other Amazonian populations. The authors discuss the potential of PPD testing as a screening tool to enhance tuberculosis detection, especially in indigenous populations in Amazonia with limited access to health services.

Health care workplace discrimination and physician turnover.

PubMed

Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M; Bright, Cedric; Krumholz, Harlan M; Bradley, Elizabeth H

2009-12-01

To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value < .01), and 40% were contemplating a career change (vs 10% among those who had not experienced workplace discrimination, p value < .001). Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

Urbanisation and geographic variation of overweight and obesity in India: a cross-sectional analysis of the Indian Demographic Health Survey 2005-2006.

PubMed

Siddiqui, Saad T; Kandala, Ngianga-Bakwin; Stranges, Saverio

2015-09-01

We examined the nationwide geographic variation of overweight and obesity in India, as well as a range of potential correlates of excess body fat. We conducted cross-sectional analyses of the 2005-2006 Indian Demographic Health Survey (IDHS), based on 161,050 individuals (age range 18-54 years). Multivariate logistic regression models were used to determine odds ratios (OR) of overweight and obesity compared to normal weight with associated correlates. The overall prevalence was 12.4% for overweight, 3.2% for obesity, and 26.5% for underweight. After multivariate adjustment, obesity was nearly thrice more likely in urban areas than in rural (OR 2.73, 95% CI 2.53-2.94). Women were 2.71 times more likely to be obese than men (95% CI 2.50-2.95). Better socioeconomic status was significantly associated with overweight and obesity. Overweight (OR 1.38, 95% CI 1.31-1.47) and obesity (OR 1.46, 95% CI 1.32-1.61) were most likely to occur in India's Southern zone, when controlled for confounding factors. High-risk estimates for overweight/obesity in urban settings, along with socioeconomic prowess in India and the resulting nutritional transition make a compelling case for public health policy on healthy lifestyles to avert the growing burden of non-communicable diseases associated with overweight/obesity.

Impact of Managed Care Health Insurance System for Indigent Patients with Rheumatoid Arthritis in Puerto Rico

PubMed Central

Santiago-Casas, Yesenia; González-Rivera, Tania; Castro-Santana, Lesliane; Ríos, Grissel; Martínez, David; Rodríguez, Vanessa; González-Alcover, Rafael; Mayor, Ángel M.; Vilá, Luis M.

2013-01-01

The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared to non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per Disease Activity Score 28), comorbid conditions, functional status (per Health Assessment Questionnaire, HAQ), and pharmacologic profile were determined. Data were examined using univariable and multivariable (logistic regression) analyses. The mean (standard deviation [SD]) age of the study population was 56.6 (13.5) years; 180 (84.1%) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status, while having a lower exposure to biologic agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long term outcomes. PMID:23314687

Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico.

PubMed

Santiago-Casas, Yesenia; González-Rivera, Tania; Castro-Santana, Lesliane; Ríos, Grissel; Martínez, David; Rodríguez, Vanessa; González-Alcover, Rafael; Mayor, Angel M; Vilá, Luis M

2013-06-01

The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared with non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per disease activity score 28), comorbid conditions, functional status (per Health Assessment Questionnaire), and pharmacologic profile were determined. Data were examined using uni- and multivariable (logistic regression) analyses. The mean (standard deviation (SD)) age of the study population was 56.6 (13.5) years; 180 (84.1 %) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting, and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses, RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status while having a lower exposure to biological agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long-term outcomes.

ADCYAP1R1 and asthma in Puerto Rican children.

PubMed

Chen, Wei; Boutaoui, Nadia; Brehm, John M; Han, Yueh-Ying; Schmitz, Cassandra; Cressley, Alex; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Baccarelli, Andrea A; Weeks, Daniel E; Kolls, Jay K; Canino, Glorisa; Celedón, Juan C

2013-03-15

Epigenetic and/or genetic variation in the gene encoding the receptor for adenylate-cyclase activating polypeptide 1 (ADCYAP1R1) has been linked to post-traumatic stress disorder in adults and anxiety in children. Psychosocial stress has been linked to asthma morbidity in Puerto Rican children. To examine whether epigenetic or genetic variation in ADCYAP1R1 is associated with childhood asthma in Puerto Ricans. We conducted a case-control study of 516 children ages 6-14 years living in San Juan, Puerto Rico. We assessed methylation at a CpG site in the promoter of ADCYAP1R1 (cg11218385) using a pyrosequencing assay in DNA from white blood cells. We tested whether cg11218385 methylation (range, 0.4-6.1%) is associated with asthma using logistic regression. We also examined whether exposure to violence (assessed by the Exposure to Violence [ETV] Scale in children 9 yr and older) is associated with cg11218385 methylation (using linear regression) or asthma (using logistic regression). Logistic regression was used to test for association between a single nucleotide polymorphism in ADCYAP1R1 (rs2267735) and asthma under an additive model. All multivariate models were adjusted for age, sex, household income, and principal components. EACH 1% increment in cg11218385 methylation was associated with increased odds of asthma (adjusted odds ratio, 1.3; 95% confidence interval, 1.0-1.6; P = 0.03). Among children 9 years and older, exposure to violence was associated with cg11218385 methylation. The C allele of single nucleotide polymorphism rs2267735 was significantly associated with increased odds of asthma (adjusted odds ratio, 1.3; 95% confidence interval, 1.02-1.67; P = 0.03). Epigenetic and genetic variants in ADCYAP1R1 are associated with asthma in Puerto Rican children.

Determinants of unmet need for family planning in rural Burkina Faso: a multilevel logistic regression analysis.

PubMed

Wulifan, Joseph K; Jahn, Albrecht; Hien, Hervé; Ilboudo, Patrick Christian; Meda, Nicolas; Robyn, Paul Jacob; Saidou Hamadou, T; Haidara, Ousmane; De Allegri, Manuela

2017-12-19

Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11-2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04-2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03-2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361-2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24-0.73)] was associated with a lower probability of experiencing unmet need for family planning. Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning.

Willingness to Accept HIV Pre-Exposure Prophylaxis among Chinese Men Who Have Sex with Men

PubMed Central

Li, Shuming; Li, Dongliang; Zhang, Lifen; Fan, Wensheng; Yang, Xueying; Yu, Mingrun; Xiao, Dong; Yan, Li; Zhang, Zheng; Shi, Wei; Luo, Fengji; Ruan, Yuhua; Jin, Qi

2012-01-01

Objective We investigated the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and potential predicting factors. Methods This study was conducted among MSM in Beijing, China. Study participants, randomly selected from an MSM cohort, completed a structured questionnaire, and provided their blood samples to test for HIV infection and syphilis. Univariate logistic regression analyses were performed to evaluate the factors associated with willingness to accept (WTA) PrEP. Factors independently associated with willingness to accept were identified by entering variables into stepwise logistic regression analysis. Results A total of 152 MSM completed the survey; 11.2% had ever heard of PrEP and 67.8% were willing to accept it. Univariate analysis showed that age, years of education, consistent condom use in the past 6 months, heterosexual behavior in the past 6 months, having ever heard of PrEP and the side effects of antiretroviral drugs, and worry about antiretroviral drugs cost were significantly associated with willingness to accept PrEP. In the multivariate logistic regression model, only consistent condom use in the past 6 months (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.13–0.70) and having ever heard of the side effects of antiretroviral drugs (OR: 0.30; 95% CI: 0.14–0.67) were independently associated with willingness to accept PrEP. Conclusions The awareness of PrEP in the MSM population was low. Sexual behavioral characteristics and knowledge about ART drugs may have effects on willingness to accept PrEP. Comprehensive prevention strategies should be recommended in the MSM community. PMID:22479320

Development of clinical decision rules to predict recurrent shock in dengue

PubMed Central

2013-01-01

Introduction Mortality from dengue infection is mostly due to shock. Among dengue patients with shock, approximately 30% have recurrent shock that requires a treatment change. Here, we report development of a clinical rule for use during a patient’s first shock episode to predict a recurrent shock episode. Methods The study was conducted in Center for Preventive Medicine in Vinh Long province and the Children’s Hospital No. 2 in Ho Chi Minh City, Vietnam. We included 444 dengue patients with shock, 126 of whom had recurrent shock (28%). Univariate and multivariate analyses and a preprocessing method were used to evaluate and select 14 clinical and laboratory signs recorded at shock onset. Five variables (admission day, purpura/ecchymosis, ascites/pleural effusion, blood platelet count and pulse pressure) were finally trained and validated by a 10-fold validation strategy with 10 times of repetition, using a logistic regression model. Results The results showed that shorter admission day (fewer days prior to admission), purpura/ecchymosis, ascites/pleural effusion, low platelet count and narrow pulse pressure were independently associated with recurrent shock. Our logistic prediction model was capable of predicting recurrent shock when compared to the null method (P < 0.05) and was not outperformed by other prediction models. Our final scoring rule provided relatively good accuracy (AUC, 0.73; sensitivity and specificity, 68%). Score points derived from the logistic prediction model revealed identical accuracy with AUCs at 0.73. Using a cutoff value greater than −154.5, our simple scoring rule showed a sensitivity of 68.3% and a specificity of 68.2%. Conclusions Our simple clinical rule is not to replace clinical judgment, but to help clinicians predict recurrent shock during a patient’s first dengue shock episode. PMID:24295509

Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan.

PubMed

Fikree, F F; Gray, R H

1996-01-01

A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socio-economic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.

[Association between physical and psychosocial impacts of oral disorders and quality of life among the elderly].

PubMed

Martins, Andréa Maria Eleutério de Barros Lima; Jones, Kimberly Marie; Souza, João Gabriel Silva; Pordeus, Isabela Almeida

2014-08-01

This study sought to evaluate the association between the impact of oral disorders in terms of physical/psychosocial dimensions and quality of life among the elderly. It involved a cross-sectional study conducted among the elderly (65-74 years) in 2008/2009. The social impact was assessed using the Oral Health Impact Profile (OHIP 14) and the quality of life using the SF 12 Short-Form Health Survey. Descriptive, univariate and multivariate (logistic regression) analysis was conducted with correction for the design effect, using SPSS(r)18.0 software. Of the 800 individuals approached, 736 elderly individuals participated (TR = 92%), with a mean age of 67.77 years, the majority of whom showed no impact based on the measurement of the prevalence of OHIP. The functional limitation dimension of the OHIP was associated with the physical domain of the SF12, irrespective of the other variables investigated. However, the seriousness of OHIP and its psychological discomfort and disability dimensions was associated with the mental domain of the SF12. The conclusion reached is that some impacts of oral disorders were associated with unsatisfactory quality of life in the physical and mental domains.

Risk factors for hepatitis C virus infection in the Colombian Caribbean coast: A case-control study.

PubMed

Yepes, Ismael de Jesús; Lince, Beatriz; Caez, Clara; De Vuono, Giovanni

2016-12-01

An estimated 6.8-8.9 million people are infected with hepatitis C virus in Latin America, of which less than 1% receives antiviral treatment. Studies so far in Colombia have attempted to determine the prevalence of the disease in some risk groups, thus preventing the identification of other factors potentially involved in the spread of the infection. To identify traditional and non-traditional risk factors for chronic hepatitis C in the Colombian Caribbean coast. This was a case-control study (1:3) matched by health care provider and age (± 10 years) conducted at the primary care level of gastroenterology and hepatology outpatient services. All patients with a positive ELISA underwent a confirmatory viral load test. A multivariate logistic regression analysis identified the independent predictors of infection. Blood transfusion (OR=159.2; 95% CI: 35.4-715; p<0.001) and history of hospitalization before 1994 (OR=4.7; 95% CI: 1.3-17.1; p=0.018) were identified as the only two independent predictors of infection. It is necessary to check the reproducibility of these results and to conduct cost-effectiveness studies before recommending their use in the design of new screening strategies.

Medical students' knowledge and attitudes toward organ donation: results of a Dutch survey.

PubMed

Figueroa, C A; Mesfum, E T; Acton, N T; Kunst, A E

2013-01-01

In the Netherlands, as in many other countries, a paucity of research exists on the attitudes and intentions of medical students toward organ donation. These students are of interest for the effect that increasing medical knowledge might have on the willingness to register as a donor. To examine which factors determine medical students' willingness to register as donors. We conducted a cross-sectional survey among medical students at the University of Amsterdam. Our questionnaire included questions on actual donor registration, motives, knowledge, and attitudes toward donation. To assess which factors were related to self-reported donor registration status, we conducted multivariate logistic regression analyses. We received 506 questionnaires (response rate at least 84%). The majority of respondents (80%) intended to donate organs, while 59% were registered. Self-reported medical knowledge and positive attitudes on donation were independently associated with registering as a donor. A rising study year was associated with registering as a donor; this could be explained by increasing medical knowledge and changing attitudes. The results of our study suggest that willingness to register as a donor increases with a rising level of knowledge on organ donation up to some minimal level. Copyright © 2013. Published by Elsevier Inc.

Is there a relationship between periodontal conditions and number of medications among the elderly?

PubMed

Natto, Zuhair S; Aladmawy, Majdi; Alshaeri, Heba K; Alasqah, Mohammed; Papas, Athena

2016-03-01

To investigate possible correlations of clinical attachment level and pocket depth with number of medications in elderly individuals. Intra-oral examinations for 139 patients visiting Tufts dental clinic were done. Periodontal assessments were performed with a manual UNC-15 periodontal probe to measure probing depth (PD) and clinical attachment level (CAL) at 6 sites. Complete lists of patients' medications were obtained during the examinations. Statistical analysis involved Kruskal-Wallis, chi square and multivariate logistic regression analyses. Age and health status attained statistical significance (p< 0.05), in contingency table analysis with number of medications. Number of medications had an effect on CAL: increased attachment loss was observed when 4 or more medications were being taken by the patient. Number of medications did not have any effect on periodontal PD. In multivariate logistic regression analysis, 6 or more medications had a higher risk of attachment loss (>3mm) when compared to the no-medication group, in crude OR (1.20, 95% CI:0.22-6.64), and age adjusted (OR=1.16, 95% CI:0.21-6.45), but not with the multivariate model (OR=0.71, 95% CI:0.11-4.39). CAL seems to be more sensitive to the number of medications taken, when compared to PD. However, it is not possible to discriminate at exactly what number of drug combinations the breakdown in CAL will happen. We need to do further analysis, including more subjects, to understand the possible synergistic mechanisms for different drug and periodontal responses.

Self-declared stock ownership and association with positive trial outcome in randomized controlled trials with binary outcomes published in general medical journals: a cross-sectional study.

PubMed

Falk Delgado, Alberto; Falk Delgado, Anna

2017-07-26

Describe the prevalence and types of conflicts of interest (COI) in published randomized controlled trials (RCTs) in general medical journals with a binary primary outcome and assess the association between conflicts of interest and favorable outcome. Parallel-group RCTs with a binary primary outcome published in three general medical journals during 2013-2015 were identified. COI type, funding source, and outcome were extracted. Binomial logistic regression model was performed to assess association between COI and funding source with outcome. A total of 509 consecutive parallel-group RCTs were included in the study. COI was reported in 74% in mixed funded RCTs and in 99% in for-profit funded RCTs. Stock ownership was reported in none of the non-profit RCTs, in 7% of mixed funded RCTs, and in 50% of for-profit funded RCTs. Mixed-funded RCTs had employees from the funding company in 11% and for-profit RCTs in 76%. Multivariable logistic regression revealed that stock ownership in the funding company among any of the authors was associated with a favorable outcome (odds ratio = 3.53; 95% confidence interval = 1.59-7.86; p < 0.01). COI in for-profit funded RCTs is extensive, because the factors related to COI are not fully independent, a multivariable analysis should be cautiously interpreted. However, after multivariable adjustment only stock ownership from the funding company among authors is associated with a favorable outcome.

Confounder summary scores when comparing the effects of multiple drug exposures.

PubMed

Cadarette, Suzanne M; Gagne, Joshua J; Solomon, Daniel H; Katz, Jeffrey N; Stürmer, Til

2010-01-01

Little information is available comparing methods to adjust for confounding when considering multiple drug exposures. We compared three analytic strategies to control for confounding based on measured variables: conventional multivariable, exposure propensity score (EPS), and disease risk score (DRS). Each method was applied to a dataset (2000-2006) recently used to examine the comparative effectiveness of four drugs. The relative effectiveness of risedronate, nasal calcitonin, and raloxifene in preventing non-vertebral fracture, were each compared to alendronate. EPSs were derived both by using multinomial logistic regression (single model EPS) and by three separate logistic regression models (separate model EPS). DRSs were derived and event rates compared using Cox proportional hazard models. DRSs derived among the entire cohort (full cohort DRS) was compared to DRSs derived only among the referent alendronate (unexposed cohort DRS). Less than 8% deviation from the base estimate (conventional multivariable) was observed applying single model EPS, separate model EPS or full cohort DRS. Applying the unexposed cohort DRS when background risk for fracture differed between comparison drug exposure cohorts resulted in -7 to + 13% deviation from our base estimate. With sufficient numbers of exposed and outcomes, either conventional multivariable, EPS or full cohort DRS may be used to adjust for confounding to compare the effects of multiple drug exposures. However, our data also suggest that unexposed cohort DRS may be problematic when background risks differ between referent and exposed groups. Further empirical and simulation studies will help to clarify the generalizability of our findings.

Live birth sex ratio after in vitro fertilization and embryo transfer in China--an analysis of 121,247 babies from 18 centers.

PubMed

Bu, Zhiqin; Chen, Zi-Jiang; Huang, Guoning; Zhang, Hanwang; Wu, Qiongfang; Ma, Yanping; Shi, Juanzi; Xu, Yanwen; Zhang, Songying; Zhang, Cuilian; Zhao, Xiaoming; Zhang, Bo; Huang, Yuanhua; Sun, Zhengyi; Kang, Yuefan; Wu, Riran; Wu, Xueqing; Sun, Haixiang; Sun, Yingpu

2014-01-01

In order to study the impact of procedures of IVF/ICSI technology on sex ratio in China, we conducted this multi-center retrospective study including 121,247 babies born to 93,895 women in China. There were 62,700 male babies and 58,477 female babies, making the sex ratio being 51.8% (Male: Female  = 107:100). In univariate logistic regression analysis, sex ratio was imbalance toward females of 50.3% when ICSI was preformed compared to 47.7% when IVF was used (P<0.01). The sex ratio in IVF/ICSI babies was significantly higher toward males in transfers of blastocyst (54.9%) and thawed embryo (52.4%) when compared with transfers of cleavage stage embryo (51.4%) and fresh embryo (51.5%), respectively. Multiple delivery was not associated with sex ratio. However, in multivariable logistic regression analysis after controlling for related factors, only ICSI (adjusted OR =  .90, 95%CI: 0.88-0.93; P<0.01) and blastocyst transfer (adjusted OR = 1.14, 95% CI: 1.09-1.20; P<0.01) were associated with sex ratio in IVF/ICSI babies. In conclusion, the live birth sex ratio in IVF/ICSI babies was influenced by the use of ICSI, which may decrease the percentage of male offspring, or the use of blastocyst transfer, which may increase the percentage of male offspring.

Chronic periodontitis is associated with erectile dysfunction. A case-control study in european population.

PubMed

Martín, Amada; Bravo, Manuel; Arrabal, Miguel; Magán-Fernández, Antonio; Mesa, Francisco

2018-07-01

To determine the association between chronic periodontitis and erectile dysfunction adjusting for biochemical markers and other comorbidities. A case-control study was conducted on 158 male patients; 80 cases with erectile dysfunction according to the International Index of Erectile Function and 78 controls. Sociodemographic data were gathered, and a periodontal examination was performed. Testosterone, lipid profile, C-reactive protein and glycaemic parameters were assessed. All variables were compared between groups, and multivariate logistic regression analyses were performed. 74% of the cases were diagnosed with chronic periodontitis. Number of sites with pocket probing depth 4-6 mm (p = 0.05) and number of sites with clinical attachment loss >3 mm (p < 0.01) were higher in the cases. Triglycerides (p < 0.01), C-reactive protein (p = 0.02) and glycosylated haemoglobin (p = 0.04) were also higher in the cases. Logistic regression showed that patients with chronic periodontitis were more likely to have erectile dysfunction (OR=2.17; 95% CI (1.06-4.43); p = 0.03) independently of other confounders. Patients with erectile dysfunction showed worse periodontal condition. Chronic periodontitis seems to play a key role as a risk factor in the pathogenesis of erectile dysfunction independently of other morbidities. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Suicidal behavior among homeless people in Japan.

PubMed

Okamura, Tsuyoshi; Ito, Kae; Morikawa, Suimei; Awata, Shuichi

2014-04-01

The purpose of this study is to investigate the frequency and correlates of suicidal behavior among homeless people in Japan. A face-to-face survey was conducted in two districts of Tokyo, Japan, with 423 subjects who resided on streets and riversides and in urban parks and stations (street homeless) or who were residents of shelters, cheap hotels, or welfare homes for homeless people (sheltered homeless). When questioned about suicidal ideation in the previous 2 weeks, 51 subjects (12.2% of valid responses) had a recurring wish to die, 29 (6.9%) had frequent thoughts of suicide, and 22 (5.3%) had made suicide plans. In addition, 11 (2.9%) subjects had attempted suicide in the previous 2 weeks and 74 (17.7%) reported that they had ever attempted suicide. In univariate logistic regression analyses, street homelessness, lack of perceived emotional social support, poor subjective health perception, visual impairment, pain, insomnia, poor mental well-being, and current depression were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. Among these, current depression had the greatest significance. In multivariate logistic regression analyses after controlling for depression, street homelessness and lack of perceived emotional social support were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. Comprehensive interventions including housing and social support as well as mental health services might be crucial as effective strategies for suicide prevention among homeless people.

Seroprevalence of dengue IgG antibodies in symptomatic and asymptomatic individuals three years after an outbreak in Zhejiang Province, China.

PubMed

Luo, Shuying; Cui, Weihong; Li, Chan; Ling, Feng; Fu, Tao; Liu, Qiyong; Ren, Jiangping; Sun, Jimin

2018-02-23

Cross-reacting antibodies enhanced dengue infection in humans and antibody dependent enhancement (ADE) have been proposed as early mechanisms underlying DHF/DSS. However, the duration of dengue IgG antibodies in the body as well as factors associated with said duration remain unclear. Blood samples from 59 dengue symptomatic persons and 48 asymptomatic individuals were collected. Study participant demographic information (including age in 2009, gender, and place of residence) were also collected. Serum samples were tested for dengue specific IgG by Panbio dengue IgG indirect enzyme-linked immunosorbent assay (ELISA). Chi-square tests and logistic regression analysis of dengue IgG antibodies seroprevalence divided by gender, age groups, and symptomatic or asymptomatic infection were conducted using the Statistical Package for the Social Sciences. Overall, 70 (65.42%) blood samples were seropositive for dengue IgG antibodies with similar seroprevalences found when dividing by gender and different age groups. However, seroprevalence of dengue IgG antibodies in samples from dengue symptomatic persons was significantly higher than that in samples from asymptomatic individuals (96.61% vs 27.08%) according to multivariable logistic regression analysis, the odds ratio (OR) of the factor was 76.731. Dengue IgG antibodies were detectable in samples from most individuals three years after infection. Dengue symptomatic persons had a higher dengue IgG prevalence compared to asymptomatic individuals.

A binary logistic regression model with complex sampling design of unmet need for family planning among all women aged (15-49) in Ethiopia.

PubMed

Workie, Demeke Lakew; Zike, Dereje Tesfaye; Fenta, Haile Mekonnen; Mekonnen, Mulusew Admasu

2017-09-01

Unintended pregnancy related to unmet need is a worldwide problem that affects societies. The main objective of this study was to identify the prevalence and determinants of unmet need for family planning among women aged (15-49) in Ethiopia. The Performance Monitoring and Accountability2020/Ethiopia was conducted in April 2016 at round-4 from 7494 women with two-stage-stratified sampling. Bi-variable and multi-variable binary logistic regression model with complex sampling design was fitted. The prevalence of unmet-need for family planning was 16.2% in Ethiopia. Women between the age range of 15-24 years were 2.266 times more likely to have unmet need family planning compared to above 35 years. Women who were currently married were about 8 times more likely to have unmet need family planning compared to never married women. Women who had no under-five child were 0.125 times less likely to have unmet need family planning compared to those who had more than two-under-5. The key determinants of unmet need family planning in Ethiopia were residence, age, marital-status, education, household members, birth-events and number of under-5 children. Thus the Government of Ethiopia would take immediate steps to address the causes of high unmet need for family planning among women.

Factors related to clinical pregnancy after vitrified-warmed embryo transfer: a retrospective and multivariate logistic regression analysis of 2313 transfer cycles.

PubMed

Shi, Wenhao; Zhang, Silin; Zhao, Wanqiu; Xia, Xue; Wang, Min; Wang, Hui; Bai, Haiyan; Shi, Juanzi

2013-07-01

What factors does multivariate logistic regression show to be significantly associated with the likelihood of clinical pregnancy in vitrified-warmed embryo transfer (VET) cycles? Assisted hatching (AH) and if the reason to freeze embryos was to avoid the risk of ovarian hyperstimulation syndrome (OHSS) were significantly positively associated with a greater likelihood of clinical pregnancy. Single factor analysis has shown AH, number of embryos transferred and the reason of freezing for OHSS to be positively and damaged blastomere to be negatively significantly associated with the chance of clinical pregnancy after VET. It remains unclear what factors would be significant after multivariate analysis. The study was a retrospective analysis of 2313 VET cycles from 1481 patients performed between January 2008 and April 2012. A multivariate logistic regression analysis was performed to identify the factors to affect clinical pregnancy outcome of VET. There were 22 candidate variables selected based on clinical experiences and the literature. With the thresholds of α entry = α removal= 0.05 for both variable entry and variable removal, eight variables were chosen to contribute the multivariable model by the bootstrap stepwise variable selection algorithm (n = 1000). Eight variables were age at controlled ovarian hyperstimulation (COH), reason for freezing, AH, endometrial thickness, damaged blastomere, number of embryos transferred, number of good-quality embryos, and blood presence on transfer catheter. A descriptive comparison of the relative importance was accomplished by the proportion of explained variation (PEV). Among the reasons for freezing, the OHSS group showed a higher OR than the surplus embryo group when compared with other reasons for VET groups (OHSS versus Other, OR: 2.145; CI: 1.4-3.286; Surplus embryos versus Other, OR: 1.152; CI: 0.761-1.743) and high PEV (marginal 2.77%, P = 0.2911; partial 1.68%; CI of area under receptor operator characteristic curve (ROC): 0.5576-0.6000). AH also showed a high OR (OR: 2.105, CI: 1.554-2.85) and high PEV (marginal 1.97%; partial 1.02%; CI of area under ROC: 0.5344-0.5647). The number of good-quality embryos showed the highest marginal PEV and partial PEV (marginal 3.91%, partial 2.28%; CI of area under ROC: 0.5886-0.6343). This was a retrospective multivariate analysis of the data obtained in 5 years from a single IVF center. Repeated cycles in the same woman were treated as independent observations, which could introduce bias. Results are based on clinical pregnancy and not live births. Prospective analysis of a larger data set from a multicenter study based on live births is necessary to confirm the findings. Paying attention to the quality of embryos, the number of good embryos, AH and the reasons for freezing that are associated with clinical pregnancy after VET will assist the improvement of success rates.

Does Concern Motivate Behavior Change?: Exploring the Relationship between Physical Activity and Body Mass Index among Low-Income Housing Residents

ERIC Educational Resources Information Center

Tamers, Sara L.; Allen, Jennifer; Yang, May; Stoddard, Anne; Harley, Amy; Sorensen, Glorian

2014-01-01

Objective: To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population. Method: A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were…

A Statewide Study of Gang Membership in California Secondary Schools

ERIC Educational Resources Information Center

Estrada, Joey Nuñez, Jr.; Gilreath, Tamika D.; Astor, Ron Avi; Benbenishty, Rami

2016-01-01

To date, there is a paucity of empirical evidence that examines gang membership in schools. Using statewide data of 7th-, 9th-, and 11th-grade students from California, this study focuses on the prevalence of gang membership by county, region, ethnicity, and grade level. Bivariate and multivariate logistic regression analyses were employed with…

Unmet Dental Needs and Barriers to Dental Care among Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Lai, Bien; Milano, Michael; Roberts, Michael W.; Hooper, Stephen R.

2012-01-01

Mail-in pilot-tested questionnaires were sent to a stratified random sample of 1,500 families from the North Carolina Autism Registry. Multivariate logistic regression analysis was used to determine the significance of unmet dental needs and other predictors. Of 568 surveys returned (Response Rate = 38%), 555 were complete and usable. Sixty-five…

The College Application Gauntlet: A Systematic Analysis of the Steps to Four-Year College Enrollment

ERIC Educational Resources Information Center

Klasik, Daniel

2012-01-01

Few studies have examined the steps to college enrollment between college aspiration and college enrollment and how these steps might present a barrier to four-year college enrollment. This study used data from the Education Longitudinal Study: 2002 and employed a multivariate random effects logistic framework to examine the completion of nine…

Prevalence and Determinants of Suicide Ideation among Lebanese Adolescents: Results of the GSHS Lebanon 2005

ERIC Educational Resources Information Center

Mahfoud, Ziyad R.; Afifi, Rema A.; Haddad, Pascale H.; DeJong, Jocelyn

2011-01-01

The current study examined prevalence and risk factors for suicide ideation in 5038 Lebanese adolescents using Global School Health Survey data. Around 16% of Lebanese adolescents thought of suicide. Multivariate logistic regression models showed that risk factors for suicide ideation included poor mental health (felt lonely, felt worried, felt…

HIV Testing Behavior among Pacific Islanders in Southern California: Exploring the Importance of Race/Ethnicity, Knowledge, and Domestic Violence

ERIC Educational Resources Information Center

Takahashi, Lois M.; Kim, Anna J.; Sablan-Santos, Lola; Quitugua, Lourdes Flores; Lepule, Jonathan; Maguadog, Tony; Perez, Rose; Young, Steve; Young, Louise

2011-01-01

This article presents an analysis of a 2008 community needs assessment survey of a convenience sample of 179 Pacific Islander respondents in southern California; the needs assessment focused on HIV knowledge, HIV testing behavior, and experience with intimate partner/relationship violence. Multivariate logistic regression results indicated that…

A Multivariate Analysis of Personality, Values and Expectations as Correlates of Career Aspirations of Final Year Medical Students

ERIC Educational Resources Information Center

Rogers, Mary E.; Searle, Judy; Creed, Peter A.; Ng, Shu-Kay

2010-01-01

This study reports on the career intentions of 179 final year medical students who completed an online survey that included measures of personality, values, professional and lifestyle expectations, and well-being. Logistic regression analyses identified the determinants of preferred medical specialty, practice location and hours of work.…

SPSS Syntax for Missing Value Imputation in Test and Questionnaire Data

ERIC Educational Resources Information Center

van Ginkel, Joost R.; van der Ark, L. Andries

2005-01-01

A well-known problem in the analysis of test and questionnaire data is that some item scores may be missing. Advanced methods for the imputation of missing data are available, such as multiple imputation under the multivariate normal model and imputation under the saturated logistic model (Schafer, 1997). Accompanying software was made available…

Combination of c-reactive protein and squamous cell carcinoma antigen in predicting postoperative prognosis for patients with squamous cell carcinoma of the esophagus.

PubMed

Feng, Ji-Feng; Chen, Sheng; Yang, Xun

2017-09-08

We initially proposed a useful and novel prognostic model, named CCS [Combination of c-reactive protein (CRP) and squamous cell carcinoma antigen (SCC)], for predicting the postoperative survival in patients with esophageal squamous cell carcinoma (ESCC). Two hundred and fifty-two patients with resectable ESCC were included in this retrospective study. A logistic regression was performed and yielded a logistic equation. The CCS was calculated by the combined CRP and SCC. The optimal cut-off value for CCS was evaluated by X-tile program. Univariate and multivariate analyses were used to evaluate the predictive factors. In addition, a novel nomogram model was also performed to predict the prognosis for patients with ESCC. In the current study, CCS was calculated as CRP+6.33 SCC according to the logistic equation. The optimal cut-off value was 15.8 for CCS according to the X-tile program. Kaplan-Meier analyses demonstrated that high CCS group had a significantly poor 5-year cancer-specific survival (CSS) than low CCS group (10.3% vs. 47.3%, P <0.001). According to multivariate analyses, CCS ( P =0.004), but not CRP ( P =0.466) or SCC ( P =0.926), was an independent prognostic factor. A nomogram could be more accuracy for CSS (Harrell's c-index: 0.70). The CCS is a usefull and independent predictive factor in patients with ESCC.

Pediatric Irritable Bowel Syndrome Patient and Parental Characteristics Differ by Care Management Type.

PubMed

Hollier, John M; Czyzewski, Danita I; Self, Mariella M; Weidler, Erica M; Smith, E O'Brian; Shulman, Robert J

2017-03-01

This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assembled from a single metropolitan health care system. Baseline socioeconomic status (SES) and clinical symptom measures were gathered. Various instruments measured participant and parental psychosocial traits. Study outcomes were stratified by GI referral versus primary pediatrics care. Two separate analyses of SES measures and GI clinical symptoms and psychosocial measures identified key factors by univariate and multiple logistic regression analyses. For each analysis, identified factors were placed in unadjusted and adjusted multivariate logistic regression models to assess their impact in predicting GI referral. Of the 239 participants, 152 were referred to pediatric GI, and 87 were managed in primary pediatrics care. Of the SES and clinical symptom factors, child self-assessment of abdominal pain duration and lower percentage of people living in poverty were the strongest predictors of GI referral. Among the psychosocial measures, parental assessment of their child's functional disability was the sole predictor of GI referral. In multivariate logistic regression models, all selected factors continued to predict GI referral in each model. Socioeconomic environment, clinical symptoms, and functional disability are associated with GI referral. Future interventions designed to ameliorate the effect of these identified factors could reduce unnecessary specialty consultations and health care overutilization for IBS.

Factors affecting choice between ureterostomy, ileal conduit and continent reservoir after radical cystectomy: Japanese series.

PubMed

Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Fujimura, Tetsuya; Fushimi, Kiyohide; Yu, Changhong; Kattan, Michael W; Homma, Yukio

2014-12-01

Little is known about the disparity of choices between three urinary diversions after radical cystectomy, focusing on patient and institutional factors. We identified urothelial carcinoma patients who received radical cystectomy with cutaneous ureterostomy, ileal conduit or continent reservoir using the Japanese Diagnosis Procedure Combination database from 2007 to 2012. Data comprised age, sex, comorbidities (converted into the Charlson index), TNM classification (converted into oncological stage), hospitals' academic status, hospital volume, bed volume and geographical region. Multivariate ordinal logistic regression analyses fitted with the proportional odds model were performed to analyze factors affecting urinary diversion choices. For dependent variables, the three diversions were converted into an ordinal variable in order of complexity: cutaneous ureterostomy (reference), ileal conduit and continent reservoir. Geographical variations were also examined by multivariate logistic regression models. A total of 4790 patients (1131 cutaneous ureterostomies [23.6 %], 2970 ileal conduits [62.0 %] and 689 continent reservoirs [14.4 %]) were included. Ordinal logistic regression analyses showed that male sex, lower age, lower Charlson index, early tumor stage, higher hospital volume (≥3.4 cases/year) and larger bed volume (≥450 beds) were significantly associated with the preference of more complex urinary diversion. Significant geographical disparity was also found. Good patient condition and early oncological status, as well as institutional factors, including high hospital volume, large bed volume and specific geographical regions, are independently related to the likelihood of choosing complex diversions. Recognizing this disparity would help reinforce the need for clinical practice uniformity.

A mixed-effects regression model for longitudinal multivariate ordinal data.

PubMed

Liu, Li C; Hedeker, Donald

2006-03-01

A mixed-effects item response theory model that allows for three-level multivariate ordinal outcomes and accommodates multiple random subject effects is proposed for analysis of multivariate ordinal outcomes in longitudinal studies. This model allows for the estimation of different item factor loadings (item discrimination parameters) for the multiple outcomes. The covariates in the model do not have to follow the proportional odds assumption and can be at any level. Assuming either a probit or logistic response function, maximum marginal likelihood estimation is proposed utilizing multidimensional Gauss-Hermite quadrature for integration of the random effects. An iterative Fisher scoring solution, which provides standard errors for all model parameters, is used. An analysis of a longitudinal substance use data set, where four items of substance use behavior (cigarette use, alcohol use, marijuana use, and getting drunk or high) are repeatedly measured over time, is used to illustrate application of the proposed model.

Complementary nonparametric analysis of covariance for logistic regression in a randomized clinical trial setting.

PubMed

Tangen, C M; Koch, G G

1999-03-01

In the randomized clinical trial setting, controlling for covariates is expected to produce variance reduction for the treatment parameter estimate and to adjust for random imbalances of covariates between the treatment groups. However, for the logistic regression model, variance reduction is not obviously obtained. This can lead to concerns about the assumptions of the logistic model. We introduce a complementary nonparametric method for covariate adjustment. It provides results that are usually compatible with expectations for analysis of covariance. The only assumptions required are based on randomization and sampling arguments. The resulting treatment parameter is a (unconditional) population average log-odds ratio that has been adjusted for random imbalance of covariates. Data from a randomized clinical trial are used to compare results from the traditional maximum likelihood logistic method with those from the nonparametric logistic method. We examine treatment parameter estimates, corresponding standard errors, and significance levels in models with and without covariate adjustment. In addition, we discuss differences between unconditional population average treatment parameters and conditional subpopulation average treatment parameters. Additional features of the nonparametric method, including stratified (multicenter) and multivariate (multivisit) analyses, are illustrated. Extensions of this methodology to the proportional odds model are also made.

The use of logistic regression to enhance risk assessment and decision making by mental health administrators.

PubMed

Menditto, Anthony A; Linhorst, Donald M; Coleman, James C; Beck, Niels C

2006-04-01

Development of policies and procedures to contend with the risks presented by elopement, aggression, and suicidal behaviors are long-standing challenges for mental health administrators. Guidance in making such judgments can be obtained through the use of a multivariate statistical technique known as logistic regression. This procedure can be used to develop a predictive equation that is mathematically formulated to use the best combination of predictors, rather than considering just one factor at a time. This paper presents an overview of logistic regression and its utility in mental health administrative decision making. A case example of its application is presented using data on elopements from Missouri's long-term state psychiatric hospitals. Ultimately, the use of statistical prediction analyses tempered with differential qualitative weighting of classification errors can augment decision-making processes in a manner that provides guidance and flexibility while wrestling with the complex problem of risk assessment and decision making.

Conflict, Displacement, and IPV: Findings From Two Congolese Refugee Camps in Rwanda.

PubMed

Wako, Etobssie; Elliott, Leah; De Jesus, Stacy; Zotti, Marianne E; Swahn, Monica H; Beltrami, John

2015-09-01

This study describes the prevalence and correlates of past-year intimate partner violence (IPV) among displaced women. We used bivariate and multivariate analyses to assess the relationships between IPV and select variables of interest. Multivariate logistic regression modeling revealed that women who had experienced outsider violence were 11 times as likely (adjusted odds ratio [AOR] = 11.21; confidence interval, CI [5.25, 23.96]) to have reported IPV than women who had not experienced outsider violence. IPV in conflict-affected settings is a major public health concern that requires effective interventions; our results suggest that women who had experienced outsider violence are at greater risk of IPV. © The Author(s) 2015.

Unique Associations between Childhood Temperament Characteristics and Subsequent Psychopathology Symptom Trajectories from Childhood to Early Adolescence.

PubMed

Forbes, Miriam K; Rapee, Ronald M; Camberis, Anna-Lisa; McMahon, Catherine A

2017-08-01

Existing research suggests that temperamental traits that emerge early in childhood may have utility for early detection and intervention for common mental disorders. The present study examined the unique relationships between the temperament characteristics of reactivity, approach-sociability, and persistence in early childhood and subsequent symptom trajectories of psychopathology (depression, anxiety, conduct disorder, and attention-deficit hyperactivity disorder; ADHD) from childhood to early adolescence. Data were from the first five waves of the older cohort from the Longitudinal Study of Australian Children (n = 4983; 51.2% male), which spanned ages 4-5 to 12-13. Multivariate ordinal and logistic regressions examined whether parent-reported child temperament characteristics at age 4-5 predicted the study child's subsequent symptom trajectories for each domain of psychopathology (derived using latent class growth analyses), after controlling for other presenting symptoms. Temperament characteristics differentially predicted the symptom trajectories for depression, anxiety, conduct disorder, and ADHD: Higher levels of reactivity uniquely predicted higher symptom trajectories for all 4 domains; higher levels of approach-sociability predicted higher trajectories of conduct disorder and ADHD, but lower trajectories of anxiety; and higher levels of persistence were related to lower trajectories of conduct disorder and ADHD. These findings suggest that temperament is an early identifiable risk factor for the development of psychopathology, and that identification and timely interventions for children with highly reactive temperaments in particular could prevent later mental health problems.

Value of blood culture time to positivity in identifying complicated nontyphoidal Salmonella bacteremia.

PubMed

Chen, Shang-Yu; Weng, Tzu-Hua; Tseng, Wen-Pin; Fu, Chia-Ming; Lin, Hui-Wen; Liao, Chun-Hsing; Lee, Tai-Fen; Hsueh, Po-Ren; Fang, Cheng-Chung; Chen, Shey-Ying

2018-02-13

Few studies analyzed the association between blood culture time to positivity (TTP) and risk of complicated nontyphoidal Salmonella (NTS) bacteremia. We conducted a retrospective study of 206 patients (aged 60.4 ± 17.4 years) with NTS bacteremia during a 30-month period. Complicated NTS bacteremia was defined as the presence of 30-day mortality, complicated infection requiring surgery or abscess drainage, or requirement of intensive care unit admission. Serogroup D (75.7%) was the predominant isolates. Malignancy (44.7%) was the most prevalent comorbidity. Patients with rapid TTP (<10 h) were more likely to have thrombocytopenia, septic shock, persistent bacteremia, complicated infection, and a higher intensive care unit admission rate. In multivariate logistic regression model, a TTP <10 h was an independent predictor for complicated NTS bacteremia (adjusted odd ratio, 5.683, 95% confidence interval, 2.396-13.482). Our study showed that blood culture TTP provides important diagnostic and prognostic information in the treatment of NTS bacteremia patients. Copyright © 2018. Published by Elsevier Inc.

Correlates of Mental Depression Among Female Sex Workers in Southern India.

PubMed

Patel, Sangram Kishor; Saggurti, Niranjan; Pachauri, Saroj; Prabhakar, Parimi

2015-11-01

Mental health is an integral part of overall health status but has been a largely neglected issue in the developing world especially among female sex workers (FSWs). This study examines the prevalence and correlates of major depression among FSWs in southern India. Major depression was assessed using Patient Health Questionnaire-2 depression scale data from a cross-sectional Behavioral Tracking Survey, 2010-2011 conducted among FSWs (n = 1986) in Andhra Pradesh, a state in southern India. Almost two-fifths of FSWs (39%) reported major depression. Multivariate logistic regression analysis shows a significant association between major depression and the following characteristics for FSWs: low autonomy, alcohol use, experience of violence, police arrest, inconsistent condom use with clients, mobility for sex work, and being HIV positive or not wanting to disclose HIV status. Research and advocacy efforts are needed to ensure that the mental health issues of marginalized groups are appropriately addressed in HIV prevention programs. © 2015 APJPH.

The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam.

PubMed

Biello, Katie B; Colby, Donn; Closson, Elizabeth; Mimiaga, Matthew J

2014-07-01

In Vietnam, the co-occurrence (i.e., "syndemic") of psychosocial factors (e.g., depression and substance use) may disproportionately burden male sex workers and increase their HIV risk. A comprehensive survey was conducted among 300 male sex workers in Ho Chi Minh City, Vietnam in 2010. We performed logistic regression to examine the association between the syndemic variable-a count score of the number of five psychosocial conditions endorsed-and unprotected anal sex (UAS) in the past. One-third of participants reported any UAS, and 42 % reported ≥2 psychosocial health problems. In multivariable models, experiencing ≥4 psychosocial health problems was significantly associated with UAS. Every unit increase in number of psychosocial health problems was associated with a 25-30 % increase in odds of UAS. Understanding the syndemic condition and its association with HIV risk among male sex workers in Vietnam may lead to the development of more effective, comprehensive interventions.

The association between overactive bladder and fibromyalgia syndrome: a community survey.

PubMed

Chung, Jae Hoon; Kim, Shin Ah; Choi, Bo Youl; Lee, Hye-Soon; Lee, Seung Wook; Kim, Yong Tae; Lee, Tchun Yong; Moon, Hong Sang

2013-01-01

Fibromyalgia syndrome (FMS) is the most common disease causing chronic generalized pain, and FMS patients often complain of urinary symptoms such as frequency or urgency. This study focuses on the association of overactive bladder (OAB) and FMS in adults aged 40 and over. A survey of adults aged 40s and over was conducted in the Guri and Yangpyeong areas of South Korea. The response rate was 74.2% (940/1,266). After excluding subjects with incomplete questionnaires (n = 20), 920 were included in the final analysis. The association of FMS and OAB was analyzed by univariate and multivariate logistic regression analysis. Individuals with FMS had a significantly increased symptoms of OAB after adjustment for gender, age group, and area of residence (odds ratio (OR) 3.39, 95% confidence interval (CI) 1.82-6.31). The association between FMS and severity of OAB was statistical significant (P for trend <0.0001). OAB is associated with FMS. Moreover FMS increases with severity of OAB. Copyright © 2012 Wiley Periodicals, Inc.

Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China.

PubMed

Liao, Meizhen; Su, Shengli; Yan, Ke; Zhu, Xiaoyan; Huang, Pengxiang; Li, Jinhai; Jiang, Zhenxia; Zhang, Xijiang; Zhang, Ning; Tao, Xiaorun; Kang, Dianming; Zhao, Jinkou

2016-03-01

Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.

Determinants of Poor Adherence to Anti-Tuberculosis Treatment in Mumbai, India

PubMed Central

Bagchi, Suparna; Ambe, Guirish; Sathiakumar, Nalini

2010-01-01

Objectives: In this study, we investigated the determinants of poor adherence with anti-tuberculosis therapy among pulmonary tuberculosis (TB) patients in Mumbai, India, receiving Directly Observed Treatment Short Course (DOTS) therapy. Methods: A cross-sectional study on 538 patients receiving DOTS I and II regimen was conducted. Patients were interviewed and clinical and laboratory data were collected. Eighty seven patients were considered non-adherent. Multivariable logistic regression was used to determine risk factors associated with non-adherence. Results: Factors associated with non-adherence were found to be different among the newly-diagnosed patients and all the other residual groups. Smoking during treatment and travel-related cost factors were significantly associated with non-adherence in the newly-diagnosed patients, while alcohol consumption and short-age of drugs were significant in the residual groups. Conclusions: An approach, targeting easier access to drugs, an ensured drug supply, effective solutions for travel-related concerns and modification of smoking and alcohol related behaviors are essential for treatment adherence. PMID:21566777

Psychiatric disorders and suicide attempts among adolescents victimized by school bullying.

PubMed

Bang, Young Rong; Park, Jae Hong

2017-08-01

We conducted a cross-sectional school-based study to investigate psychiatric disorders and suicide risk among adolescents victimized by bullying. The study was designed in two stages. In the screening stage, 33,038 middle school students were screened for psychopathology. Next, in the face-to-face interview stage, 1196 participants were assessed for psychiatric disorders using a structured diagnostic instrument. We also collected information about the participants' experiences of bullying and history of suicidal ideation/attempts. The results indicate that adolescents with a history of bullying victimization were more likely to be diagnosed with depression and psychosis than those without such a history. Multivariate logistic regression models revealed that bullying victimization was significantly associated with suicide attempts even after adjusting for demographic characteristics, depression and psychosis. Bullying victimization is a risk factor for depression, psychosis, and suicide ideation and attempts. The findings warrant an early intervention and suicide prevention program for victimized students and anti-bullying policies in schools.

Examining the Relationship Between Symptomatic Burden and Self-reported Productivity Losses Among Patients With Uterine Fibroids in the United States.

PubMed

Soliman, Ahmed M; Anand, Savita Bakhshi; Coyne, Karin S; Castelli-Haley, Jane; Snabes, Michael; Owens, Charlotte D

2017-10-01

To evaluate the impact of uterine fibroid symptoms on employment and household productivity. An online survey of US women between 18 and 54 was conducted. Productivity was assessed using the health related productivity questionnaire (HRPQ). Descriptive statistics and logistic multivariable regressions examined the relationship between uterine fibroids (UF) symptom experience and employment and household productivity. Of 1365 eligible women, 873 (64.0%) were employed. Women lost an average of 0.8 hours to employment-related absenteeism and 4.4 hours due to employment-related presenteeism for 5.1 hours of employment productivity lost/week. Women lost an average of 1.4 hours due to household-related absenteeism and 1.6 hours due to household-related presenteeism for a total of 3.0 hours of household lost productivity. Productivity losses increased with increases in symptom burden. UF has a substantial impact on employment-related and household-related productivity.

Who Benefits--Or Does not--From South Africa's Old Age Pension? Evidence from Characteristics of Rural Pensioners and Non-Pensioners.

PubMed

Ralston, Margaret; Schatz, Enid; Menken, Jane; Gómez-Olivé, Francesc Xavier; Tollman, Stephen

2015-12-25

Social protection grants play a critical role in survival and livelihoods of elderly individuals in South Africa. Rarely is it possible to assess how well a social program reaches its target population. Using a 2010 survey and Agincourt Health Demographic Surveillance System census data we conduct multivariate logistic regression to predict pension receipt in rural South Africa. We find only 80% of age-eligible individuals report pension receipt. Pension non-recipients tend to be male, have poor socio-economic status, live in smaller households, be of Mozambican origin, and have poorer physical function; while older persons living in households receiving other grants are more likely to report pension receipt. We conclude that a reservoir of older persons exists who meet eligibility criteria but who are not yet receiving pensions. Ensuring that they and their households are properly linked to all available social services--whether for child or old-age social grants--is likely to have beneficial and synergistic effects.

Who Benefits—Or Does not—From South Africa’s Old Age Pension? Evidence from Characteristics of Rural Pensioners and Non-Pensioners

PubMed Central

Ralston, Margaret; Schatz, Enid; Menken, Jane; Gómez-Olivé, Francesc Xavier; Tollman, Stephen

2015-01-01

Social protection grants play a critical role in survival and livelihoods of elderly individuals in South Africa. Rarely is it possible to assess how well a social program reaches its target population. Using a 2010 survey and Agincourt Health Demographic Surveillance System census data we conduct multivariate logistic regression to predict pension receipt in rural South Africa. We find only 80% of age-eligible individuals report pension receipt. Pension non-recipients tend to be male, have poor socio-economic status, live in smaller households, be of Mozambican origin, and have poorer physical function; while older persons living in households receiving other grants are more likely to report pension receipt. We conclude that a reservoir of older persons exists who meet eligibility criteria but who are not yet receiving pensions. Ensuring that they and their households are properly linked to all available social services—whether for child or old-age social grants—is likely to have beneficial and synergistic effects. PMID:26712777

Poverty is the main environmental factor for obesity in a Mexican-border city.

PubMed

Jiménez-Cruz, Arturo; Castañeda-Gonzalez, Lidia M; Bacardí-Gascón, Montserrat

2013-05-01

Obesity is a pandemic in Mexico. The purpose of this study was to assess the environmental factors that have the strongest association with obesity and abdominal obesity among adults in Tijuana. Four neighborhoods differing in socioeconomic status were chosen. A questionnaire for weekly walking, social cohesion, satisfaction with their community, weekly income, and convenience store, education, family income, crime safety, pedestrian safety, street connectivity, walking/cycling facilities, and sociodemographic characteristics was administered. Weight, height, and waist circumference were measured. Univariate and multivariate binomial logistic regressions were conducted. Three hundred and twenty-two (322) individuals, 70% females with a mean age of 39 years, were assessed. The prevalence of obesity and abdominal obesity was 27% and 43.5% respectively. The odds ratio for obesity and abdominal obesity among those living in the lowest-income neighborhood was 2.4 and 7.8 respectively, compared with those living in a middle-class neighborhood. Residence in a low-income neighborhood was a predictor for obesity.

Contextual predictive factors of child sexual abuse: the role of parent-child interaction.

PubMed

Ramírez, Clemencia; Pinzón-Rondón, Angela María; Botero, Juan Carlos

2011-12-01

To determine the prevalence of child sexual abuse in the Colombian coasts, as well as to assess the role of parent-child interactions on its occurrence and to identify factors from different environmental levels that predict it. This cross-sectional study explores the results of 1,089 household interviews responded by mothers. Descriptive analyses and multivariate logistic regressions were conducted, with child sexual abuse regressed on parent-child interactions, children's characteristics, maternal characteristics, family characteristics, and community characteristics. 1.2% of the mothers reported that their children had been sexually abused. Families that communicated with their children were less likely to report child sexual abuse, each additional standard deviation of communication reduced child sexual abuse 3.5 times. Affection and negative treatment to the children were not associated with child sexual abuse. Families who experienced intimate partner violence and violent communities were more likely to experience child sexual abuse. Interventions are needed to address the problem of child sexual abuse. Copyright © 2011 Elsevier Ltd. All rights reserved.

Anxiety sensitivity and racial differences in sleep duration: Results from a national survey of adults with cardiovascular disease.

PubMed

Alcántara, Carmela; Giorgio Cosenzo, Luciana Andrea; Fan, Weijia; Doyle, David Matthew; Shaffer, Jonathan A

2017-05-01

Although Blacks sleep between 37 and 75min less per night than non-Hispanic Whites, research into what drives racial differences in sleep duration is limited. We examined the association of anxiety sensitivity, a cognitive vulnerability, and race (Blacks vs. White) with short sleep duration (<7h of sleep/night), and whether anxiety sensitivity mediated race differences in sleep duration in a nationally representative sample of adults with cardiovascular disease. Overall, 1289 adults (115 Black, 1174 White) with a self-reported physician/health professional diagnosis of ≥1 myocardial infarction completed an online survey. Weighted multivariable logistic regressions and mediation analyses with bootstrapping and case resampling were conducted. Anxiety sensitivity and Black vs. White race were associated with 4%-84% increased odds, respectively, of short sleep duration. Anxiety sensitivity mediated Black-White differences in sleep duration. Each anxiety sensitivity subscale was also a significant mediator. Implications for future intervention science to address sleep disparities are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Correlates of Co-Occurring Diabetes and Obesity Among Community Mental Health Program Members With Serious Mental Illnesses.

PubMed

Cook, Judith A; Razzano, Lisa; Jonikas, Jessica A; Swarbrick, Margaret A; Steigman, Pamela J; Hamilton, Marie M; Carter, Tina M; Santos, Alberto B

2016-11-01

This study examined the prevalence and correlates of co-occurring obesity and diabetes among community mental health program members. Medical screenings of 457 adults with serious mental illnesses were conducted by researchers and peer wellness specialists in four U.S. states. Body mass index was measured directly. Diabetes was assessed via glycosylated hemoglobin and interview self-report. Multivariable logistic regression analysis examined associations with known predictors. In the sample, 59% were obese, 25% had diabetes, and 19% had both conditions. When gender, diagnosis, and site were controlled, co-occurring diabetes and obesity was almost three times as likely among African Americans (OR=2.93) as among participants from other racial groups and half as likely among smokers as among nonsmokers (OR=.58). Older persons and those with poorer self-rated physical health also were more likely to have these co-occurring conditions. Results support the need for culturally competent treatment and for smoking cessation options with sensitivity to the potential for weight gain.

The use of mifepristone in abortion associated with an increased risk of uterine leiomyomas

PubMed Central

Shen, Qi; Shu, Li; Luo, Hui; Hu, Xiaoli; Zhu, Xueqiong

2017-01-01

Abstract To investigate the association between widespread use of mifepristone in abortions and risk of uterine leiomyomas. We conducted a case-control study of 305 patients with uterine leiomyomas between January 2011 and July 2012; 311 women with ordinary vaginitis were selected as controls during the same period. Data were collected by questionnaires (including past history, life history, menstruation history, reproductive history, abortion history, the use of mifepristone, and uterine leiomyomas risk factors) and calculated by univariate and multivariate conditional logistic regression analyses; odds ratios and its 95% confidence interval were calculated to estimate the risk for uterine leiomyomas. Abortion with mifepristone was one of the risk factors for uterine leiomyomas, and the risk increased with increasing frequency of mifepristone use. Family history of uterine leiomyomas, body mass index, age at menarche, number of full-term delivery, and medical abortion history were also correlated with uterine leiomyomas. The use of mifepristone in abortion will increase the risk to develop uterine leiomyomas. PMID:28445268

Association of neck circumference and cognitive impairment among Chinese elderly.

PubMed

Chen, Jin-Mei; Li, Qing-Wei; Jiang, Guo-Xin; Zeng, Shu-Jun; Shen, Jun; Sun, Ji; Wu, Dan-Hong; Cheng, Qi

2018-03-01

To investigate the association between neck circumference (NC) and cognitive impairment and interactions between relevant variables to the risk of cognitive impairment. A population-based survey was conducted among elderly inhabitants aged 60 years and over from a community in Shanghai suburb. Multivariate logistic regression analyses were performed to evaluate associations and log likelihood ratio tests to examine interactions. Cognitive impairment was identified in 269 (10.8%) subjects from 2,500 participants. Higher BMI (OR = 1.55; 95% CI = 1.11-2.16), higher WHR (OR = 1.44; 95% CI = 1.07-1.95), and higher total cholesterol (TC) (OR = 1.52; 95% CI = 1.09-2.13) were significantly associated with the increased risk of cognitive impairment. Significant interactions were observed between TC and a few other relevant variables, respectively. NC was associated with the high risk of cognitive impairment. Additive effects of NC with TC on cognitive impairment were observed.

Postsurgical complications in patients with renal tumours with venous thrombosis treated with surgery.

PubMed

Caño-Velasco, J; Herranz-Amo, F; Barbas-Bernardos, G; Mayor-de Castro, J; Aragón-Chamizo, J; Arnal-Chacón, G; Lledó García, E; Hernández-Fernández, C

2018-04-06

Surgery on renal tumours with venous thrombosis suffers a high rate of complications and non-negligible perioperative mortality. Our objective was to analyse the postoperative complications, their relationship with the level of the thrombus and its potential predisposing factors. A retrospective analysis was conducted of 101 patients with renal tumours with venous thrombosis operated on between 1988 and 2017. Two patients were excluded because of intraoperative pulmonary thromboembolism and exitus (2%). The postsurgical complications were classified according to Clavien-Dindo. To compare the qualitative variables, we employed the chi-squared test. We performed a multivariate analysis using binary logistic regression to identify the independent predictors. Some type of postsurgical complication occurred in 34 (34.3%) patients, 11 (11.1%) of which were severe (Clavien III-V). There were significant differences in the total complications (P=.003) and severe complications (Clavien≥III; P=.03) depending on the level of the tumour thrombus. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Risk of mental health problems in adolescents skipping meals: The Korean National Health and Nutrition Examination Survey 2010 to 2012.

PubMed

Lee, Gyungjoo; Han, Kyungdo; Kim, Hyunju

Adolescents frequently skip meals, doing so even more than once per day. This is associated with more mental health problems. This study identified mental health problems' associations with skipping meals and the frequency thereof among adolescents. This cross-sectional population-based study used a data set of 1,413 adolescents from the 2010 to 2012 Korean National Health and Nutrition Examination Survey. Hierarchical multivariable logistic regression was conducted to determine the risk of mental health problems, including stress, depressive mood, and suicidal ideation in relation to skipping meals and the frequency thereof per day. Breakfast skipping significantly increased the risks of stress and depressive mood. Stress, depressive mood, and suicidal ideation were significantly prevalent as the daily frequency of skipping meals increased. Specific strategies should be developed at government or school level to decrease the frequency of skipping meals per day, associated with serious mental health problems in adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

The case for social marketing in gonorrhoea prevention: insights from sexual lifestyles in Glasgow genitourinary medicine clinic attendees.

PubMed

Scoular, Anne; Abu-Rajab, Kirsty; Winter, Andy; Connell, Judith; Hart, Graham

2008-08-01

We conducted a matched case-control study to investigate social factors associated with gonorrhoea acquisition among genitourinary (GU) medicine clinic attendees, designed to inform appropriate prevention strategies. Detailed social and behavioural data were elicited using a self-completed questionnaire. The effect sizes of these characteristics were quantified using univariate and multivariable conditional logistic regression in 53 cases and 106 matched controls. Homo-bisexual orientation was the strongest independent predictor of gonorrhoea acquisition (Adjusted odds ratio 31.1 (95% confidence intervals, 3.09-312.92). Other independent predictors were not currently being in a relationship and concordant residential characteristics. Three principal implications for sexual health policy were identified; social marketing approaches to gonorrhoea prevention should focus on gay men and individuals not in established relationships; gonorrhoea prevention should be more closely integrated with wider social inclusion policies; finally, more proactive, systematic and theory-based approaches should capitalize on opportunities for sexual health promotion in GU medicine clinic settings.

PREVALENCE AND PSYCHOSOCIAL CORRELATES OF ALCOHOL-RELATED SEXUAL ASSAULT AMONG UNIVERSITY STUDENTS

PubMed Central

Howard, Donna E.; Griffin, Melinda A.; Boekeloo, Bradley O.

2009-01-01

This study examined the psychosocial correlates of alcohol-related sexual assault. Undergraduate students (N = 551) were recruited to complete a web-based survey. The outcome was a composite of 2 items: “experienced an unwanted sexual advance” or “was the victim of sexual assault or date rape” as a result of another’s alcohol use. The predictors were substance use, other alcohol-related interpersonal violence victimization, and alcohol-related protective behaviors. Multivariate logistic regression analyses were conducted. Females reported higher prevalence of alcohol-related sexual assault than did males (20.4% vs. 6.6%). Females who reported binge drinking (OR = 7.74) and other alcohol-related interpersonal violence (OR = 5.03) were more likely to report alcohol-related sexual assault whereas only other alcohol-related interpersonal violence was associated with alcohol-related sexual assault (OR = 43.75) among males. The findings suggest that alcohol-related sexual assault is associated with other risk factors that deserve further attention through longitudinal research and intervention efforts. PMID:19149143

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina.

PubMed

Marshall, Brandon D L; Socías, María Eugenia; Kerr, Thomas; Zalazar, Virginia; Sued, Omar; Arístegui, Inés

2016-07-01

This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.

Visits on 'lamb-viewing days' at a sheep farm open to the public was a risk factor for Q fever in 2009.

PubMed

Whelan, J; Schimmer, B; de Bruin, A; van Beest Holle, M Robert-du Ry; van der Hoek, W; ter Schegget, R

2012-05-01

Between February and May 2009, 347 laboratory-confirmed cases of acute Q fever were reported in a southern municipal health service region in The Netherlands. Commercial dairy-goat farms were implicated and control measures were initially targeted there. A preliminary investigation also implicated a non-dairy sheep farm, open to the public on 'lamb-viewing days'. This study tested the association between visiting the non-dairy sheep farm and developing Q fever in residents of the region between February and May 2009. A case-control study of 146 cases and 431 address-matched controls was conducted. Multivariable logistic regression analysis confirmed the association between visiting to the sheep farm and Q fever disease (matched odds ratio 43, 95% confidence interval 9-200). Other risk factors were being a smoker, having a past medical history and being aged >40 years. Vaccination of sheep and goats on farms open to the public should help to reduce the number of future human cases.

Visual Acuity’s Association with Levels of Leisure-Time Physical Activity Among Community-Dwelling Older Adults

PubMed Central

Swanson, Mark W; Bodner, Eric; Sawyer, Patricia; Allman, Richard

2013-01-01

Little is known about the affect of reduced vision on physical activity in older adults. This study evaluates the association of visual acuity level, self-reported vision and ocular disease conditions with leisure-time physical activity and calculated caloric expenditure. A cross sectional study of 911 subjects 65 yr and older from the University of Alabama at Birmingham Study of Aging (SOA) cohort was conducted evaluating the association of vision-related variables to weekly kilocalorie expenditure calculated from the 17-item Leisure Time Physical Activity Questionnaire. Ordinal logistic regression was used to evaluate possible associations controlling for potential confounders. In multivariate analyses, each lower step in visual acuity category below 20/50 was significantly associated with reduced odds of having a higher level of physical activity OR 0.81, 95% CI 0.67, 0.97. Reduced visual acuity appears to be independently associated with lower levels of physical activity among community-dwelling adults. PMID:21945888

Interpretation of symptoms as a cause of delays in patients with acute myocardial infarction, Istanbul, Turkey.

PubMed

Koc, Sema; Durna, Zehra; Akin, Semiha

2017-06-14

This cross-sectional study aimed to assess interpretation of symptoms as a cause of delays in patients with acute myocardial infarction (AMI). It was conducted at a university hospital in Istanbul, Turkey. The sample included 93 patients: 73 male, mean age 57.89 (12.13) years. Prehospital delay time ranged from 15 minutes to 10 days, with a median of 2 hours (interquartile range: 9.50). Patients waited for pain to go away (48.4%) and tried to calm down (39.8%). Most patients attributed AMI-related symptoms to a reason other than heart disease. In a multivariate logistic regression analysis, the type of AMI was classified based on electrocardiography findings (odds ratio 5.18, 95% confidence interval: 1.69-15.91, P=0.004) and was independently associated with a long prehospital delay time, indicating that patients with ST segment elevation MI would seek early medical care. Misinterpretation of symptoms and misconceptions about emergency treatment during AMI cause delays in admission and may affect treatment.

Prevalence and psychosocial correlates of alcohol-related sexual assault among university students.

PubMed

Howard, Donna E; Griffin, Melinda A; Boekeloo, Bradley O

2008-01-01

This study examined the psychosocial correlates of alcohol-related sexual assault. Undergraduate students (N = 551) were recruited to complete a web-based survey. The outcome was a composite of 2 items: "experienced an unwanted sexual advance" or "was the victim of sexual assault or date rape" as a result of another's alcohol use. The predictors were substance use, other alcohol-related interpersonal violence victimization, and alcohol-related protective behaviors. Multivariate logistic regression analyses were conducted. Females reported higher prevalence of alcohol-related sexual assault than did males (20.4% vs. 6.6%). Females who reported binge drinking (OR = 7.74) and other alcohol-related interpersonal violence (OR = 5.03) were more likely to report alcohol-related sexual assault whereas only other alcohol-related interpersonal violence was associated with alcohol-related sexual assault (OR = 43.75) among males. The findings suggest that alcohol-related sexual assault is associated with other risk factors that deserve further attention through longitudinal research and intervention efforts.

The use of mifepristone in abortion associated with an increased risk of uterine leiomyomas.

PubMed

Shen, Qi; Shu, Li; Luo, Hui; Hu, Xiaoli; Zhu, Xueqiong

2017-04-01

To investigate the association between widespread use of mifepristone in abortions and risk of uterine leiomyomas.We conducted a case-control study of 305 patients with uterine leiomyomas between January 2011 and July 2012; 311 women with ordinary vaginitis were selected as controls during the same period. Data were collected by questionnaires (including past history, life history, menstruation history, reproductive history, abortion history, the use of mifepristone, and uterine leiomyomas risk factors) and calculated by univariate and multivariate conditional logistic regression analyses; odds ratios and its 95% confidence interval were calculated to estimate the risk for uterine leiomyomas.Abortion with mifepristone was one of the risk factors for uterine leiomyomas, and the risk increased with increasing frequency of mifepristone use. Family history of uterine leiomyomas, body mass index, age at menarche, number of full-term delivery, and medical abortion history were also correlated with uterine leiomyomas.The use of mifepristone in abortion will increase the risk to develop uterine leiomyomas.

A Survey of Out-of-Pocket Expenditures for Children with Autism Spectrum Disorder in Israel

ERIC Educational Resources Information Center

Raz, Raanan; Lerner-Geva, Liat; Leon, Odelia; Chodick, Gabriel; Gabis, Lidia V.

2013-01-01

We describe a survey of children with ASD aged 4-10 years. The main dependent variables were out-of-pocket expenditures for health services and hours of therapy. Multivariable logistic regression models were used in order to find independent predictors for service utilization. Parents of 178 of the children (87%) agreed to participate. The average…

The Effect of Exposure to Pro-Tobacco Advertising on Experimentation with Emerging Tobacco Products among U.S. Adolescents

ERIC Educational Resources Information Center

Agaku, Israel T.; Ayo-Yusuf, Olalekan A.

2014-01-01

Introduction: This study assessed the influence of exposure to pro-tobacco advertisements on experimentation with emerging tobacco products among U.S. adolescents aged =9 years, in Grades 6 to 12. Method: Data were obtained from the 2011 National Youth Tobacco Survey. Multivariate logistic regression was used to measure the association between…

Employment Status and Income Generation among Homeless Young Adults: Results from a Five-City, Mixed-Methods Study

ERIC Educational Resources Information Center

Ferguson, Kristin M.; Bender, Kimberly; Thompson, Sanna J.; Maccio, Elaine M.; Pollio, David

2012-01-01

This mixed-methods study identified correlates of unemployment among homeless young adults in five cities. Two hundred thirty-eight homeless young people from Los Angeles (n = 50), Austin (n = 50), Denver (n = 50), New Orleans (n = 50), and St. Louis (n = 38) were recruited using comparable sampling strategies. Multivariate logistic regression…

Using the Rural-Urban Continuum to Explore Adolescent Alcohol, Tobacco, and Other Drug Use in Montana

ERIC Educational Resources Information Center

Hanson, Carl L.; Novilla, M. Lelinneth L. B.; Barnes, Michael D.; Eggett, Dennis; McKell, Chelsea; Reichman, Peter; Havens, Mike

2009-01-01

The purpose of the study was to compare 30-day prevalence of alcohol, tobacco, and other drug use among twelfth-grade students in Montana across a rural-urban continuum during 2000, 2002, and 2004. The methods include an analysis of the Montana Prevention Needs Assessment (N = 15,372) using multivariable logistic regression adjusting for risk…

Another Way out: The Impact of Juvenile Arrests on High School Dropout

ERIC Educational Resources Information Center

Hirschfield, Paul

2009-01-01

This article suggests that contact with the legal system increased school dropout in a Chicago sample of 4,844 inner-city students. According to multilevel multivariate logistic models, students who were first arrested during the 9th or 10th grade were six to eight times more likely than were nonarrested students ever to dropout of high school and…

Correlates of 2009 H1N1 Influenza Vaccine Acceptability among Parents and Their Adolescent Children

ERIC Educational Resources Information Center

Painter, Julia E.; Gargano, Lisa M.; Sales, Jessica M.; Morfaw, Christopher; Jones, LaDawna M.; Murray, Dennis; DiClemente, Ralph J.; Hughes, James M.

2011-01-01

School-aged children were a priority group for receipt of the pandemic (2009) H1N1 influenza vaccine. Both parental and adolescent attitudes likely influence vaccination behaviors. Data were collected from surveys distributed to middle- and high-school students and their parents in two counties in rural Georgia. Multivariable logistic regression…

The Use of Female Commercial Sex Workers' Services by Latino Day Laborers

ERIC Educational Resources Information Center

Galvan, Frank H.; Ortiz, Daniel J.; Martinez, Victor; Bing, Eric G.

2009-01-01

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was used. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day…

Brief Report: Pregnant by Age 15 Years and Substance Use Initiation among US Adolescent Girls

ERIC Educational Resources Information Center

Cavazos-Rehg, Patricia A.; Krauss, Melissa J.; Spitznagel, Edward L.; Schootman, Mario; Cottler, Linda B.; Bierut, Laura Jean

2012-01-01

We examined substance use onset and associations with pregnancy by age 15 years. Participants were girls ages 15 years or younger (weighted n = 8319) from the 1999-2003 Youth Risk Behavior Surveillance System (YRBS). Multivariable logistic regression examined pregnancy as a function of substance use onset (i.e., age 10 years or younger, 11-12,…

Bicycle Use and Cyclist Safety Following Boston’s Bicycle Infrastructure Expansion, 2009–2012

PubMed Central

Angriman, Federico; Bellows, Alexandra L.; Taylor, Kathryn

2016-01-01

Objectives. To evaluate changes in bicycle use and cyclist safety in Boston, Massachusetts, following the rapid expansion of its bicycle infrastructure between 2007 and 2014. Methods. We measured bicycle lane mileage, a surrogate for bicycle infrastructure expansion, and quantified total estimated number of commuters. In addition, we calculated the number of reported bicycle accidents from 2009 to 2012. Bicycle accident and injury trends over time were assessed via generalized linear models. Multivariable logistic regression was used to examine factors associated with bicycle injuries. Results. Boston increased its total bicycle lane mileage from 0.034 miles in 2007 to 92.2 miles in 2014 (P < .001). The percentage of bicycle commuters increased from 0.9% in 2005 to 2.4% in 2014 (P = .002) and the total percentage of bicycle accidents involving injuries diminished significantly, from 82.7% in 2009 to 74.6% in 2012. The multivariable logistic regression analysis showed that for every 1-year increase in time from 2009 to 2012, there was a 14% reduction in the odds of being injured in an accident. Conclusions. The expansion of Boston’s bicycle infrastructure was associated with increases in both bicycle use and cyclist safety. PMID:27736203

Independent risk factors of morbidity in penetrating colon injuries.

PubMed

Girgin, Sadullah; Gedik, Ercan; Uysal, Ersin; Taçyildiz, Ibrahim Halil

2009-05-01

The present study explored the factors effective on colon-related morbidity in patients with penetrating injury of the colon. The medical records of 196 patients were reviewed for variables including age, gender, factor of trauma, time between injury and operation, shock, duration of operation, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), site of colon injury, Colon Injury Score, fecal contamination, number of associated intra- and extraabdominal organ injuries, units of transfused blood within the first 24 hours, and type of surgery. In order to determine the independent risk factors, multivariate logistic regression analysis was performed. Gunshot wounds, interval between injury and operation > or =6 hours, shock, duration of the operation > or =6 hours, PATI > or =25, ISS > or =20, Colon Injury Score > or = grade 3, major fecal contamination, number of associated intraabdominal organ injuries >2, number of associated extraabdominal organ injuries >2, multiple blood transfusions, and diversion were significantly associated with morbidity. Multivariate logistic regression analysis showed diversion and transfusion of > or =4 units in the first 24 hours as independent risk factors affecting colon-related morbidity. Diversion and transfusion of > or =4 units in the first 24 hours were determined to be independent risk factors for colon-related morbidity.

Nutrition knowledge, attitudes, behaviours and the influencing factors among non-parent caregivers of rural left-behind children under 7 years old in China.

PubMed

Tan, Cai; Luo, Jiayou; Zong, Rong; Fu, Chuhui; Zhang, Lingli; Mou, Jinsong; Duan, Danhui

2010-10-01

To explore and compare nutrition knowledge, attitudes and behaviours (KAB) between non-parent and parent caregivers of children under 7 years old in Chinese rural areas, and to identify the factors influencing their nutrition KAB. Face-to-face interviews were carried out with 1691 non-parent caregivers and 1670 parent caregivers in the selected study areas; multivariate logistic regression models were used to identify the factors influencing nutrition KAB in caregivers. The awareness rate of nutrition knowledge, the rate of positive attitudes and the rate of optimal behaviours in non-parent caregivers (52.2 %, 56.9 % and 37.7 %, respectively) were significantly lower than in the parent group (63.8 %, 62.1 % and 42.8 %, respectively). Multivariate logistic regression modelling showed that caregivers' family income and care will, and children's age and gender, were associated with caregivers' nutrition KAB after controlling the possible confounding variables (caregivers' age, gender, education and occupation). Non-parent caregivers had relatively poor nutrition KAB. Extra efforts and targeted education programmes aimed to improve rural non-parent caregivers' nutrition KAB are wanted and need to be emphasized.

Factors Influencing Cecal Intubation Time during Retrograde Approach Single-Balloon Enteroscopy

PubMed Central

Chen, Peng-Jen; Shih, Yu-Lueng; Huang, Hsin-Hung; Hsieh, Tsai-Yuan

2014-01-01

Background and Aim. The predisposing factors for prolonged cecal intubation time (CIT) during colonoscopy have been well identified. However, the factors influencing CIT during retrograde SBE have not been addressed. The aim of this study was to determine the factors influencing CIT during retrograde SBE. Methods. We investigated patients who underwent retrograde SBE at a medical center from January 2011 to March 2014. The medical charts and SBE reports were reviewed. The patients' characteristics and procedure-associated data were recorded. These data were analyzed with univariate analysis as well as multivariate logistic regression analysis to identify the possible predisposing factors. Results. We enrolled 66 patients into this study. The median CIT was 17.4 minutes. With univariate analysis, there was no statistical difference in age, sex, BMI, or history of abdominal surgery, except for bowel preparation (P = 0.021). Multivariate logistic regression analysis showed that inadequate bowel preparation (odds ratio 30.2, 95% confidence interval 4.63–196.54; P < 0.001) was the independent predisposing factors for prolonged CIT during retrograde SBE. Conclusions. For experienced endoscopist, inadequate bowel preparation was the independent predisposing factor for prolonged CIT during retrograde SBE. PMID:25505904

Relation between serum creatinine and postoperative results of open-heart surgery.

PubMed

Ezeldin, Tamer H

2013-10-01

To determine the impact of preoperative serum creatinine level in non-dialyzable patients on postoperative morbidity and mortality. This is a prospective study, where serum creatinine was used to give primary assessment on renal function status preoperatively. This study includes 1,033 patients, who underwent coronary artery bypass grafting, or valve(s) operations. The study took place at Al-Hada Military Hospital, Taif, Kingdom of Saudi between May 2008 and January 2012. Data were statistically analyzed using Chi square (x2) test and multivariable logistic regression, to evaluate the postoperative morbidity and mortality risks associated with low serum creatinine levels. Postoperative mortality increased with high serum creatinine level >1.8 mg/dL (p

Depression and poverty among African American women at risk for type 2 diabetes.

PubMed

de Groot, Mary; Auslander, Wendy; Williams, James Herbert; Sherraden, Michael; Haire-Joshu, Debra

2003-01-01

Poverty is associated with negative health outcomes, including depression. Little is known about the specific elements of poverty that contribute to depression, particularly among African American women at risk for type 2 diabetes. This study examined the relationships of economic and social resources to depression among African American women at high risk for the development of type 2 diabetes (N = 181) using the Conservation of Resources theory as a conceptual framework. Women were assessed at 3 time points in conjunction with a dietary change intervention. At baseline, 40% of women reported clinically significant depression, and 43.3% were below the poverty line. Depressed women reported fewer economic assets and greater economic distress than nondepressed peers. Multivariate logistic regression analyses indicated that nonwork status, lack of home ownership, low appraisal of one's economic situation, low self-esteem, and increased life events were significantly associated with depression at baseline. Longitudinal multivariate logistic regression models indicated that income, home ownership, future economic appraisal, life events, and self-esteem predicted depression trajectories at Time 3. These results speak to the multifaceted sources of stress in the lives of poor African American women. Interventions that address the economic and social factors associated with depression are needed.

Multivariate prediction of upper limb prosthesis acceptance or rejection.

PubMed

Biddiss, Elaine A; Chau, Tom T

2008-07-01

To develop a model for prediction of upper limb prosthesis use or rejection. A questionnaire exploring factors in prosthesis acceptance was distributed internationally to individuals with upper limb absence through community-based support groups and rehabilitation hospitals. A total of 191 participants (59 prosthesis rejecters and 132 prosthesis wearers) were included in this study. A logistic regression model, a C5.0 decision tree, and a radial basis function neural network were developed and compared in terms of sensitivity (prediction of prosthesis rejecters), specificity (prediction of prosthesis wearers), and overall cross-validation accuracy. The logistic regression and neural network provided comparable overall accuracies of approximately 84 +/- 3%, specificity of 93%, and sensitivity of 61%. Fitting time-frame emerged as the predominant predictor. Individuals fitted within two years of birth (congenital) or six months of amputation (acquired) were 16 times more likely to continue prosthesis use. To increase rates of prosthesis acceptance, clinical directives should focus on timely, client-centred fitting strategies and the development of improved prostheses and healthcare for individuals with high-level or bilateral limb absence. Multivariate analyses are useful in determining the relative importance of the many factors involved in prosthesis acceptance and rejection.

A comparison between univariate probabilistic and multivariate (logistic regression) methods for landslide susceptibility analysis: the example of the Febbraro valley (Northern Alps, Italy)

NASA Astrophysics Data System (ADS)

Rossi, M.; Apuani, T.; Felletti, F.

2009-04-01

The aim of this paper is to compare the results of two statistical methods for landslide susceptibility analysis: 1) univariate probabilistic method based on landslide susceptibility index, 2) multivariate method (logistic regression). The study area is the Febbraro valley, located in the central Italian Alps, where different types of metamorphic rocks croup out. On the eastern part of the studied basin a quaternary cover represented by colluvial and secondarily, by glacial deposits, is dominant. In this study 110 earth flows, mainly located toward NE portion of the catchment, were analyzed. They involve only the colluvial deposits and their extension mainly ranges from 36 to 3173 m2. Both statistical methods require to establish a spatial database, in which each landslide is described by several parameters that can be assigned using a main scarp central point of landslide. The spatial database is constructed using a Geographical Information System (GIS). Each landslide is described by several parameters corresponding to the value of main scarp central point of the landslide. Based on bibliographic review a total of 15 predisposing factors were utilized. The width of the intervals, in which the maps of the predisposing factors have to be reclassified, has been defined assuming constant intervals to: elevation (100 m), slope (5 °), solar radiation (0.1 MJ/cm2/year), profile curvature (1.2 1/m), tangential curvature (2.2 1/m), drainage density (0.5), lineament density (0.00126). For the other parameters have been used the results of the probability-probability plots analysis and the statistical indexes of landslides site. In particular slope length (0 ÷ 2, 2 ÷ 5, 5 ÷ 10, 10 ÷ 20, 20 ÷ 35, 35 ÷ 260), accumulation flow (0 ÷ 1, 1 ÷ 2, 2 ÷ 5, 5 ÷ 12, 12 ÷ 60, 60 ÷27265), Topographic Wetness Index 0 ÷ 0.74, 0.74 ÷ 1.94, 1.94 ÷ 2.62, 2.62 ÷ 3.48, 3.48 ÷ 6,00, 6.00 ÷ 9.44), Stream Power Index (0 ÷ 0.64, 0.64 ÷ 1.28, 1.28 ÷ 1.81, 1.81 ÷ 4.20, 4.20 ÷ 9.40). Geological map and land use map were also used, considering geological and land use properties as categorical variables. Appling the univariate probabilistic method the Landslide Susceptibility Index (LSI) is defined as the sum of the ratio Ra/Rb calculated for each predisposing factor, where Ra is the ratio between number of pixel of class and the total number of pixel of the study area, and Rb is the ratio between number of landslides respect to the pixel number of the interval area. From the analysis of the Ra/Rb ratio the relationship between landslide occurrence and predisposing factors were defined. Then the equation of LSI was used in GIS to trace the landslide susceptibility maps. The multivariate method for landslide susceptibility analysis, based on logistic regression, was performed starting from the density maps of the predisposing factors, calculated with the intervals defined above using the equation Rb/Rbtot, where Rbtot is a sum of all Rb values. Using stepwise forward algorithms the logistic regression was performed in two successive steps: first a univariate logistic regression is used to choose the most significant predisposing factors, then the multivariate logistic regression can be performed. The univariate regression highlighted the importance of the following factors: elevation, accumulation flow, drainage density, lineament density, geology and land use. When the multivariate regression was applied the number of controlling factors was reduced neglecting the geological properties. The resulting final susceptibility equation is: P = 1 / (1 + exp-(6.46-22.34*elevation-5.33*accumulation flow-7.99* drainage density-4.47*lineament density-17.31*land use)) and using this equation the susceptibility maps were obtained. To easy compare the results of the two methodologies, the susceptibility maps were reclassified in five susceptibility intervals (very high, high, moderate, low and very low) using natural breaks. Then the maps were validated using two cumulative distribution curves, one related to the landslides (number of landslides in each susceptibility class) and one to the basin (number of pixel covering each class). Comparing the curves for each method, it results that the two approaches (univariate and multivariate) are appropriate, providing acceptable results. In both maps the distribution of high susceptibility condition is mainly localized on the left slope of the catchment in agreement with the field evidences. The comparison between the methods was obtained by subtraction of the two maps. This operation shows that about 40% of the basin is classified by the same class of susceptibility. In general the univariate probabilistic method tends to overestimate the areal extension of the high susceptibility class with respect to the maps obtained by the logistic regression method.

Stapedotomy in osteogenesis imperfecta: a prospective study of 32 consecutive cases.

PubMed

Vincent, Robert; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

2014-12-01

To prospectively evaluate hearing outcomes in patients with osteogenesis imperfecta undergoing primary stapes surgery and to isolate prognostic factors for success. A nonrandomized, open, prospective case series. A tertiary referral center. Twenty-five consecutive patients who underwent 32 primary stapedotomies for osteogenesis imperfecta with evidence of stapes fixation and available postoperative pure-tone audiometry. Primary stapedotomy with vein graft interposition and reconstruction with a regular Teflon piston or bucket handle-type piston. Preoperative and postoperative audiometric evaluation using conventional 4-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gap were measured. The overall audiometric results as well as the results of audiometric evaluation at 3 months and at least 1 year after surgery were used. Overall, postoperative air-bone gap closure to within 10 dB was achieved in 88% of cases. Mean (standard deviation) gain in air-conduction threshold was 22 (9.4) dB for the entire case series, and mean (standard deviation) air-bone gap closure was 22 (9.0) dB. Backward multivariate logistic regression showed that a model with preoperative air-bone gap closure and intraoperatively established incus length accurately predicts success after primary stapes surgery. Stapes surgery is a feasible and safe treatment option in patients with osteogenesis imperfecta. Success is associated with preoperative air-bone gap and intraoperatively established incus length.

Impact of a multidisciplinary rehabilitation nutrition team on evaluating sarcopenia, cachexia and practice of rehabilitation nutrition.

PubMed

Kokura, Yoji; Wakabayashi, Hidetaka; Maeda, Keisuke; Nishioka, Shinta; Nakahara, Saori

2017-01-01

To determine whether the presence of a multidisciplinary rehabilitation nutrition team affects sarcopenia and cachexia evaluation and practice of rehabilitation nutrition. A cross-sectional study using online questionnaire among members of the Japanese Association of Rehabilitation Nutrition (JARN) was conducted. Questions were related to sarcopenia and cachexia evaluation and practice of rehabilitation nutrition. 677 (14.7%) questionnaires were analysed. 44.5% reported that their institution employed a rehabilitation nutrition team, 20.2% conducted rehabilitation nutrition rounds and 26.1% conducted rehabilitation nutrition meetings. A total of 51.7%, 69.7%, 69.0% and 17.8% measured muscle mass, muscle strength, physical function and cachexia, respectively. For those with a rehabilitation nutrition team, 63.5%, 80.7%, 82.4% and 22.9% measured muscle mass, muscle strength, physical function and cachexia, respectively, whereas 46.7%, 78.0% and 78.1% of the respondents reported implementation of nutrition planning strategies in consideration of energy accumulation, rehabilitation training in consideration of nutritional status and use of dietary supplements, respectively. Multivariate logistic regression analysis showed that the use of a rehabilitation nutrition team independently affected sarcopenia evaluation and practice of rehabilitation nutrition but not cachexia evaluation. The presence of a multidisciplinary rehabilitation nutrition team increased the frequency of sarcopenia evaluation and practice of rehabilitation nutrition. J. Med. Invest. 64: 140-145, February, 2017.

Household food insecurity and its association with school absenteeism among primary school adolescents in Jimma zone, Ethiopia.

PubMed

Tamiru, Dessalegn; Argaw, Alemayehu; Gerbaba, Mulusew; Ayana, Girmay; Nigussie, Aderajew; Belachew, Tefera

2016-08-17

Household food insecurity and lack of education are two of the most remarkable deprivations which developing countries are currently experiencing. Evidences from different studies showed that health and nutrition problems are major barriers to educational access and achievement in low-income countries which poses a serious challenge on effort towards the achieving Sustainable Development Goals. Evidence on the link between food security and school attendance is very important to address this challenge. This study aimed to assess to what extent food insecurity affects school absenteeism among primary school adolescents. A school based cross-sectional study was conducted among primary school adolescents in Jimma zone from October-November, 2013. Structured questionnaire was used to collect data on the household food security and socio-demographic variables. Data were analyzed using SPSS for windows version 16.0 after checking for missing values and outliers. Multivariable logistic regression analyses were used to determine the association of school absenteeism and food insecurity with independent variables using odds ratio and 95 % of confidence intervals. Variables with p ≤ 0.25 in the bivariate analyses were entered into a multivariable regression analysis to control for associations among the independent variables. The frequency of adolescent school absenteeism was significantly high (50.20 %) among food insecure households (P < 0.001) compared to their peers whose households were food secure (37.89 %). Findings of multivariable logistic regression analysis also showed that household food insecurity [AOR = 2.81 (1.70, 4.76)] was positively associated with poor school attendance while female-headed household [AOR = 0.23 (0.07, 0.72)], urban residence [AOR = 0.52 (0.36, 0.81)] and male-gender [AOR = 0.64 (0.54, 0.74)] were inversely associated with school absenteeism. Household food insecurity was positively associated with lack of maternal education [AOR = 2.26 (0.57, 8.93)] and poor household economic status [AOR = 1.39 (1.18, 2.83)]. However, livestock ownership [AOR = 0.17 (0.06, 0.51)] was negatively associated with household food insecurity. Findings of this study showed that household food insecurity has strong linkage with adolescent school absenteeism. Maternal education and household economic status were significantly associated with household food security status. Therefore, national policies and programs need to stress on how to improve family income earning capacity and socioeconomic status to handle household food insecurity which is a key contributor of adolescent school absenteeism.

Associations between body condition, rumen fill, diarrhoea and lameness and ruminal acidosis in Australian dairy herds.

PubMed

Bramley, E; Costa, N D; Fulkerson, W J; Lean, I J

2013-11-01

To investigate associations between ruminal acidosis and body condition score (BCS), prevalence of poor rumen fill, diarrhoea and lameness in dairy cows in New South Wales and Victoria, Australia. This was a cross-sectional study conducted in 100 dairy herds in five regions of Australia. Feeding practices, diets and management practices of herds were assessed. Lactating cows within herds were sampled for rumen biochemistry (n = 8 per herd) and scored for body condition, rumen fill and locomotion (n = 15 per herd). The consistency of faecal pats (n = 20 per herd) from the lactating herd was also scored. A perineal faecal staining score was given to each herd. Herds were classified as subclinically acidotic (ACID), suboptimal (SO) and non-acidotic (Normal) when ≥3/8 cows per herd were allocated to previously defined categories based on rumen biochemical measures. Multivariate logistic regression models were used to examine associations between the prevalence of conditions within a herd and explanatory variables. Median BCS and perineal staining score were not associated with herd category (p >0.05). In the multivariate models, herds with a high prevalence of low rumen fill scores (≤2/5) were more likely to be categorised Normal than SO with an associated increased risk of 69% (p = 0.05). Herds that had a greater prevalence of lame cows (locomotion scores ≥3/5), had 103% higher risk of being categorised as ACID than SO (p = 0.034). In a multivariate logistic regression model, with herd modelled as a random effect, an increase of 1% of pasture in the diet was associated with a 5.5% increase in risk of high faecal scores (≥4/5) indicating diarrhoea (p = 0.001). This study confirmed that herd categories based on rumen function are associated with biological outcomes consistent with acidosis. Herds that had a higher risk of lameness also had a much higher risk of being categorised ACID than SO. Herds with a high prevalence of low rumen scores were more likely to be categorised Normal than SO. The findings indicate that differences in rumen metabolism identified for herd categories ACID, SO and Normal were associated with differences in disease risk and physiology. The study also identified an association between pasture feeding and higher faecal scores. This study suggests that there is a challenge for farmers seeking to increase milk production of cows on pasture to maintain the health of cattle.

Identification of Users for a Smoking Cessation Mobile App: Quantitative Study.

PubMed

Chevalking, S K Leon; Ben Allouch, Somaya; Brusse-Keizer, Marjolein; Postel, Marloes G; Pieterse, Marcel E

2018-04-09

The number of mobile apps that support smoking cessation is growing, indicating the potential of the mobile phone as a means to support cessation. Knowledge about the potential end users for cessation apps results in suggestions to target potential user groups in a dissemination strategy, leading to a possible increase in the satisfaction and adherence of cessation apps. This study aimed to characterize potential end users for a specific mobile health (mHealth) smoking cessation app. A quantitative study was conducted among 955 Dutch smokers and ex-smokers. The respondents were primarily recruited from addiction care facilities and hospitals through Web-based media via websites and forums. The respondents were surveyed on their demographics, smoking behavior, and personal innovativeness. The intention to use and the attitude toward a cessation app were determined on a 5-point Likert scale. To study the association between the characteristics and intention to use and attitude, univariate and multivariate ordinal logistic regression analyses were performed. The multivariate ordinal logistic regression showed that the number of previous quit attempts (odds ratio [OR] 4.1, 95% CI 2.4-7.0, and OR 3.5, 95% CI 2.0-5.9) and the score on the Fagerstrom Test of Nicotine Dependence (OR 0.8, 95% CI 0.8-0.9, and OR 0.8, 95% CI 0.8-0.9) positively correlates with the intention to use a cessation app and the attitude toward cessation apps, respectively. Personal innovativeness also positively correlates with the intention to use (OR 0.3, 95% CI 0.2-0.4) and the attitude towards (OR 0.2, 95% CI 0.1-0.4) a cessation app. No associations between demographics and the intention to use or the attitude toward using a cessation app were observed. This study is among the first to show that demographic characteristics such as age and level of education are not associated with the intention to use and the attitude toward using a cessation app when characteristics related specifically to the app, such as nicotine dependency and the number of quit attempts, are present in a multivariate regression model. This study shows that the use of mHealth apps depends on characteristics related to the content of the app rather than general user characteristics. ©S K Leon Chevalking, Somaya Ben Allouch, Marjolein Brusse-Keizer, Marloes G Postel, Marcel E Pieterse. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.04.2018.

Essential neonatal care utilization and associated factors among mothers in public health facilities of Aksum Town, North Ethiopia, 2016.

PubMed

Berhe, Megbey; Medhaniye, Araya Abraha; Kahsay, Gizienesh; Birhane, Ermyas; Abay, Mebrahtu

2017-01-01

Globally, neonatal death accounts about 44% of child death in 2013. Ethiopia is one of the ten countries with the highest number of neonatal death. Worldwide, more than 43% of deaths among under five year children is contributed by neonates. Half of the neonatal death occur in the first day of life. Recommendations about newborn care practices may conflict with local beliefs and practices. So, it is important to understand the existing newborn care practice and factors affecting it in order to take interventions so as to decrease neonatal death. To assess magnitude of essential neonatal care utilization and associated factors among women visiting public health facilities in Aksum Town, Tigray, Northern Ethiopia, 2015. Facility based cross sectional study was conducted from December 30, 2015 to January 31, 2016.The sampled population are 423 women who gave live births within the last 6 months prior to data collection. Systematic random sampling technique was employed. Data were entered, coded and cleaned using Epi info version 7, and SPSS Version 21 software was used for analysis. Both bivariable and multivariable logistic regression models were used to determine factors associated with essential neonatal care utilization. Variables with P-value <0.2 in the bivariable logistic regression model were included in to multivariable logistic regression model, and finally variables with P-value <0.05 were considered as independent factors. Odds ratio was used to measure strength of association at 95% confidence level. A total of 423 mothers included in the study. Prevalence of safe cord care, optimal breast feeding, thermal care and baby received Tetracycline eye ointment and vaccine at birth were 42.8%, 63.1%, 32.6% and 44.7% among the respondents respectively. Only 113(26.7%) of the participants fulfilled essential new born care practice. Occupation, parity and counseling on essential new born care during delivery were significantly associated with utilization of essential new born care. Employed women (AOR = 7.08; 95% CI (2.21, 12.72), 2-3 number of deliveries (AOR = 1.84; 95% CI (1.04, 3.26) and received counseling about essential new born car during delivery (AOR = 3.36; 95% CI (1.86, 6.08) were more likely to practice essential neonatal care practice than their counterparts. Around three-fourth of mothers were not practicing Essential Newborn Care (ENC). Occupation, parity and essential new born care counseling during delivery were significantly associated with utilization of ENC. Promotion of information at community level, women empowerment and staff training is recommended.

Comparing the Discrete and Continuous Logistic Models

ERIC Educational Resources Information Center

Gordon, Sheldon P.

2008-01-01

The solutions of the discrete logistic growth model based on a difference equation and the continuous logistic growth model based on a differential equation are compared and contrasted. The investigation is conducted using a dynamic interactive spreadsheet. (Contains 5 figures.)

Multinomial Logistic Regression Predicted Probability Map To Visualize The Influence Of Socio-Economic Factors On Breast Cancer Occurrence in Southern Karnataka

NASA Astrophysics Data System (ADS)

Madhu, B.; Ashok, N. C.; Balasubramanian, S.

2014-11-01

Multinomial logistic regression analysis was used to develop statistical model that can predict the probability of breast cancer in Southern Karnataka using the breast cancer occurrence data during 2007-2011. Independent socio-economic variables describing the breast cancer occurrence like age, education, occupation, parity, type of family, health insurance coverage, residential locality and socioeconomic status of each case was obtained. The models were developed as follows: i) Spatial visualization of the Urban- rural distribution of breast cancer cases that were obtained from the Bharat Hospital and Institute of Oncology. ii) Socio-economic risk factors describing the breast cancer occurrences were complied for each case. These data were then analysed using multinomial logistic regression analysis in a SPSS statistical software and relations between the occurrence of breast cancer across the socio-economic status and the influence of other socio-economic variables were evaluated and multinomial logistic regression models were constructed. iii) the model that best predicted the occurrence of breast cancer were identified. This multivariate logistic regression model has been entered into a geographic information system and maps showing the predicted probability of breast cancer occurrence in Southern Karnataka was created. This study demonstrates that Multinomial logistic regression is a valuable tool for developing models that predict the probability of breast cancer Occurrence in Southern Karnataka.

Pattern of Utilisation of Dental Health Care Among HIV-positive Adult Nigerians.

PubMed

Adedigba, Michael A; Adekanmbi, Victor T; Asa, Sola; Fakande, Ibiyemi

2016-01-01

To determine the pattern of dental care utilisation of people living with HIV (PLHIV). A cross-sectional questionnaire survey of 239 PLHIV patients in three care centres was done. Information on sociodemographics, dental visit, risk groups, living arrangement, medical insurance and need of dental care was recorded. The EC Clearinghouse and WHO clinical staging was used to determine the stage of HIV/AIDS infection following routine oral examinations under natural daylight. Multivariate logistic regression models were created after adjusting for all the covariates that were statistically significant at univariate/bivariate levels. The majority of subjects were younger than 50 years, about 93% had not seen a dentist before being diagnosed HIV positive and 92% reported no dental visit after contracting HIV. Among nonusers of dental care, 14.3% reported that they wanted care but were afraid to seek it. Other reasons included poor awareness, lack of money and stigmatisation. Multivariate analysis showed that lack of dental care was associated with employment status, living arrangements, educational status, income per annum and presenting with oral symptoms. The area under the receiver operating curve was 84% for multivariate logistic regression model 1, 70% for model 2, 67% for model 3 and 71% for model 4, which means that the predictive power of the models were good. Contrary to our expectations, dental utilisation among PLHIV was generally poor among this group of patients. There is serious and immediate need to improve the awareness of PLHIVs in African settings and barriers to dental care utilisation should also be removed or reduced.

Calculating the individual probability of successful ocriplasmin treatment in eyes with VMT syndrome: a multivariable prediction model from the EXPORT study.

PubMed

Paul, Christoph; Heun, Christine; Müller, Hans-Helge; Hoerauf, Hans; Feltgen, Nicolas; Wachtlin, Joachim; Kaymak, Hakan; Mennel, Stefan; Koss, Michael Janusz; Fauser, Sascha; Maier, Mathias M; Schumann, Ricarda G; Mueller, Simone; Chang, Petrus; Schmitz-Valckenberg, Steffen; Kazerounian, Sara; Szurman, Peter; Lommatzsch, Albrecht; Bertelmann, Thomas

2017-10-31

To evaluate predictive factors for the treatment success of ocriplasmin and to use these factors to generate a multivariate model to calculate the individual probability of successful treatment. Data were collected in a retrospective, multicentre cohort study. Patients with vitreomacular traction (VMT) syndrome without a full-thickness macular hole were included if they received an intravitreal injection (IVI) of ocriplasmin. Five factors (age, gender, lens status, presence of epiretinal membrane (ERM) formation and horizontal diameter of VMT) were assessed on their association with VMT resolution. A multivariable logistic regression model was employed to further analyse these factors and calculate the individual probability of successful treatment. 167 eyes of 167 patients were included. Univariate analysis revealed a significant correlation to VMT resolution for all analysed factors: age (years) (OR 0.9208; 95% CI 0.8845 to 0.9586; p<0.0001), gender (male) (OR 0.480; 95% CI 0.241 to 0.957; p=0.0371), lens status (phakic) (OR 2.042; 95% CI 1.054 to 3.958; p=0.0344), ERM formation (present) (OR 0.384; 95% CI 0.179 to 0.821; p=0.0136) and horizontal VMT diameter (µm) (OR 0.99812; 95% CI 0.99684 to 0.99941, p=0.0042). A significant multivariable logistic regression model was established with age and VMT diameter. Known predictive factors for VMT resolution after ocriplasmin IVI were confirmed in our study. We were able to combine them into a formula, ultimately allowing the calculation of an individual probability of treatment success with ocriplasmin in patients with VMT syndrome without FTHM. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Predictive factors for rebleeding and death in alcoholic cirrhotic patients with acute variceal bleeding: a multivariate analysis.

PubMed

Krige, Jake E J; Kotze, Urda K; Distiller, Greg; Shaw, John M; Bornman, Philippus C

2009-10-01

Bleeding from esophageal varices is a leading cause of death in alcoholic cirrhotic patients. The aim of the present single-center study was to identify risk factors predictive of variceal rebleeding and death within 6 weeks of initial treatment. Univariate and multivariate analyses were performed on 310 prospectively documented alcoholic cirrhotic patients with acute variceal hemorrhage (AVH) who underwent 786 endoscopic variceal injection treatments between January 1984 and December 2006. All injections were administered during the first 6 weeks after the patients were treated for their first variceal bleed. Seventy-five (24.2%) patients experienced a rebleed, 38 within 5 days of the initial treatment and 37 within 6 weeks of their initial treatment. Of the 15 variables studied and included in a multivariate analysis using a logistic regression model, a bilirubin level >51 mmol/l and transfusion of >6 units of blood during the initial hospital admission were predictors of variceal rebleeding within the first 6 weeks. Seventy-seven (24.8%) patients died, 29 (9.3%) within 5 days and 48 (15.4%) between 6 and 42 days after the initial treatment. Stepwise multivariate logistic regression analysis showed that six variables were predictors of death within the first 6 weeks: encephalopathy, ascites, bilirubin level >51 mmol/l, international normalized ratio (INR) >2.3, albumin <25 g/l, and the need for balloon tube tamponade. Survival was influenced by the severity of liver failure, with most deaths occurring in Child-Pugh grade C patients. Patients with AVH and encephalopathy, ascites, bilirubin levels >51 mmol/l, INR >2.3, albumin <25 g/l and who require balloon tube tamponade are at increased risk of dying within the first 6 weeks. Bilirubin levels >51 mmol/l and transfusion of >6 units of blood were predictors of variceal rebleeding.

Logistics planning for phased programs.

NASA Technical Reports Server (NTRS)

Cook, W. H.

1973-01-01

It is pointed out that the proper and early integration of logistics planning into the phased program planning process will drastically reduce these logistics costs. Phased project planning is a phased approach to the planning, approval, and conduct of major research and development activity. A progressive build-up of knowledge of all aspects of the program is provided. Elements of logistics are discussed together with aspects of integrated logistics support, logistics program planning, and logistics activities for phased programs. Continuing logistics support can only be assured if there is a comprehensive sequential listing of all logistics activities tied to the program schedule and a real-time inventory of assets.

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

PubMed Central

Krige, Jake E; Jonas, Eduard; Thomson, Sandie R; Kotze, Urda K; Setshedi, Mashiko; Navsaria, Pradeep H; Nicol, Andrew J

2017-01-01

AIM To benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries. METHODS A prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied. RESULTS Overall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant. CONCLUSION This ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons. PMID:28396721

Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda.

PubMed

Krebs, Elizabeth; Gerardo, Charles J; Park, Lawrence P; Nickenig Vissoci, Joao Ricardo; Byiringiro, Jean Claude; Byiringiro, Fidele; Rulisa, Stephen; Thielman, Nathan M; Staton, Catherine A

2017-06-01

Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with mortality for patients with TBI at University Teaching Hospital of Kigali, Kigali, Rwanda. A prospective consecutive sampling of patients with TBI presenting to University Teaching Hospital of Kigali Accident and Emergency Department was screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, and visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, and repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in a multivariate logistic regression model and refined via backward elimination. Between October 7, 2013, and April 6, 2014, 684 patients were enrolled; 14 (2%) were excluded because of incomplete data. Of patients, 81% were male with mean age of 31 years (range, 10-89 years; SD 11.8). Most patients (80%) had mild TBI (Glasgow Coma Scale [GCS] score 13-15); 10% had moderate (GCS score 9-12) and 10% had severe (GCS score 3-8) TBI. Multivariate logistic regression determined that GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were significantly associated with death. GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

KSC ISS Logistics Support

NASA Technical Reports Server (NTRS)

Tellado, Joseph

2014-01-01

The presentation contains a status of KSC ISS Logistics Operations. It basically presents current top level ISS Logistics tasks being conducted at KSC, current International Partner activities, hardware processing flow focussing on late Stow operations, list of KSC Logistics POC's, and a backup list of Logistics launch site services. This presentation is being given at the annual International Space Station (ISS) Multi-lateral Logistics Maintenance Control Panel meeting to be held in Turin, Italy during the week of May 13-16. The presentatiuon content doesn't contain any potential lessons learned.

[Change of awareness level of the Japanese Food Guide Spinning Top and relation with sociodemographic and health-related characteristics].

PubMed

Takaizumi, Kanae; Harada, Kazuhiro; Nakamura, Yoshio

2011-11-01

The purpose of this study was to examine the sociodemographic and health-related characteristics of those who are unaware of the Japanese Food Guide Spinning Top (Food Guide). A longitudinal study was conducted using an Internet-based questionnaire with 1,012 Japanese adults (40.2 +/- 10.0 years, mean +/- SD) recruited from registrants of a Japanese social research company. Conducted between November 2007 (T1) and December 2008 (T2), the survey included items on awareness level ("I know the contents." "I have heard of this Guide." or "I have not heard of this Guide.") of the Food Guide as the dependent variable, and demographics factors (e.g., age, education status, marital status, household income, and employment status) and health-related characteristics (obesity, abdominal obesity, and insufficient physical activity) as the independent variables. Multivariate logistic regression analysis was used to analyze the relation between awareness level and each variable. The relation between change of awareness level (T1-T2) and each variable was analyzed using a chi-square test. All the analyses were stratified by gender. In the multivariate logistic regression analysis adjusted for all variables, men with a household income of 5,000,000-10,000,000 yen (OR=1.78; 95% CI=1.10-2.88) were positively associated with awareness level ("I have heard of this Guide."). In contrast, unmarried women were negatively associated with awareness level in T1 ("I know the contents"; OR=0.35; 95% CI=0.17-0.70. "I have heard of this Guide"; OR=0.50; 95% CI=0.27-0.92). In men, the awareness level of the Food Guide increased from T1 to T2, change of awareness level (T1; "I have not heard of this Guide") and education status being related (P=0.023). In women, the awareness levels overall did not improve from T1 to T2, but change of awareness level (T1; "I have heard of this Guide") was associated with household income (P<0.001). In both men and women, change of awareness level was not associated with health-related characteristics. The results of this study suggest that awareness of the Food Guide has increased among those with health risk factors, such as obesity and low levels of physical activity. The promotion strategy of the Food Guide might need to target males with low-level education, unmarried women, and women with a high household income.

Comparison of Logistic Regression and Random Forests techniques for shallow landslide susceptibility assessment in Giampilieri (NE Sicily, Italy)

NASA Astrophysics Data System (ADS)

Trigila, Alessandro; Iadanza, Carla; Esposito, Carlo; Scarascia-Mugnozza, Gabriele

2015-11-01

The aim of this work is to define reliable susceptibility models for shallow landslides using Logistic Regression and Random Forests multivariate statistical techniques. The study area, located in North-East Sicily, was hit on October 1st 2009 by a severe rainstorm (225 mm of cumulative rainfall in 7 h) which caused flash floods and more than 1000 landslides. Several small villages, such as Giampilieri, were hit with 31 fatalities, 6 missing persons and damage to buildings and transportation infrastructures. Landslides, mainly types such as earth and debris translational slides evolving into debris flows, were triggered on steep slopes and involved colluvium and regolith materials which cover the underlying metamorphic bedrock. The work has been carried out with the following steps: i) realization of a detailed event landslide inventory map through field surveys coupled with observation of high resolution aerial colour orthophoto; ii) identification of landslide source areas; iii) data preparation of landslide controlling factors and descriptive statistics based on a bivariate method (Frequency Ratio) to get an initial overview on existing relationships between causative factors and shallow landslide source areas; iv) choice of criteria for the selection and sizing of the mapping unit; v) implementation of 5 multivariate statistical susceptibility models based on Logistic Regression and Random Forests techniques and focused on landslide source areas; vi) evaluation of the influence of sample size and type of sampling on results and performance of the models; vii) evaluation of the predictive capabilities of the models using ROC curve, AUC and contingency tables; viii) comparison of model results and obtained susceptibility maps; and ix) analysis of temporal variation of landslide susceptibility related to input parameter changes. Models based on Logistic Regression and Random Forests have demonstrated excellent predictive capabilities. Land use and wildfire variables were found to have a strong control on the occurrence of very rapid shallow landslides.

Prevalence and Correlates of Physical Spousal Violence against Women in Slum and Nonslum Areas of Urban Bangladesh

ERIC Educational Resources Information Center

Sambisa, William; Angeles, Gustavo; Lance, Peter M.; Naved, Ruchira T.; Thornton, Juliana

2011-01-01

This study explores the prevalence and correlates of past-year physical violence against women in slum and nonslum areas of urban Bangladesh. The authors use multivariate logistic regression to analyze data from the 2006 Urban Health Survey, a population-based survey of 9,122 currently married women aged between 15 and 49 who were selected using a…

Evolution of the Marine Officer Fitness Report: A Multivariate Analysis

DTIC Science & Technology

This thesis explores the evaluation behavior of United States Marine Corps (USMC) Reporting Seniors (RSs) from 2010 to 2017. Using fitness report...RSs evaluate the performance of subordinate active component unrestricted officer MROs over time. I estimate logistic regression models of the...lowest. However, these correlations indicating the effects of race matching on FITREP evaluations narrow in significance when performance-based factors

Graduate Views on Access to Higher Education: Is It Really a Case of Pulling up the Ladder?

ERIC Educational Resources Information Center

Webb, Rob; Watson, Duncan; Cook, Steve; Arico, Fabio

2017-01-01

Using as a starting point in the recent work of Mountford-Zimdars et al., the authors analyse attitudes towards expanding higher education (HE) opportunities in the UK. The authors propose that the approach of Mountford-Zimdars et al. is flawed not only in its adoption of a multivariate logistic regression but also in its interpretation of…

Disentangling the Effects of Violent Victimization, Violent Behavior, and Gun Carrying for Minority Inner-City Youth Living in Extreme Poverty

ERIC Educational Resources Information Center

Spano, Richard; Bolland, John

2013-01-01

Two waves of longitudinal data were used to examine the sequencing between violent victimization, violent behavior, and gun carrying in a high-poverty sample of African American youth. Multivariate logistic regression results indicated that violent victimization T1 and violent behavior T1 increased the likelihood of initiation of gun carrying T2…

Period of residence in prefabricated temporary housing and psychological distress after the Great East Japan Earthquake: a longitudinal study

PubMed Central

Tanji, Fumiya; Tomata, Yasutake; Sekiguchi, Takuya; Tsuji, Ichiro

2018-01-01

Objectives Previous studies have reported that displacement from one’s own home after a natural disaster is associated with a higher degree of psychological distress. The present study investigated the longitudinal association between the period of residence in prefabricated temporary housing and psychological distress after the Great East Japan Earthquake. Design, setting and participants We conducted a longitudinal observation of 284 adults (aged ≥18 years) who had lived in prefabricated temporary housing in Miyagi, Northeastern Japan. The period of residence in prefabricated temporary housing was classified into three categories: <3, 3–4 and >4 years (ie, still living in prefabricated temporary housing). Outcomes The Kessler 6-item Psychological Distress Scale (K6) was assessed in both a baseline survey (2011) and a follow-up survey (2016). Higher psychological distress was defined by a K6 score of ≥5. We used Firth’s penalised likelihood method in the multivariate logistic regression model to estimate the adjusted ORs and 95% CIs. Results Among the total participants, the proportion of individuals with higher psychological distress at the follow-up survey was significantly higher in the >4 years category (multivariate OR=4.00, 95% CI 1.67 to 10.16) than in the <3 years category. Among participants who had a lower degree of psychological distress at the baseline, the proportion of those whose psychological distress deteriorated was significantly higher in the >4 years category (multivariate OR=4.87, 95% CI 1.26 to 20.28) than in the <3 years category. On the other hand, among the participants who had a higher degree of psychological distress at the baseline, the proportion of those whose psychological distress ameliorated was significantly lower in the >4 years category (multivariate OR=0.26, 95% CI 0.06 to 0.85) than in the <3 years category. Conclusions The proportion of individuals with more severe psychological distress was higher among participants who had lived in prefabricated temporary housing for a long period. PMID:29730612