1195. Where You Live Matters: United States Region as a Significant Predictor of Mortality for ESBL Infection Based on a Descriptive Study Using NIS Database

Abstract Background Extended-spectrum β-lactamase (ESBL) enzymes are produced by multidrug-resistant (MDR) pathogens and confer resistance to β-lactam antibiotics. Infections due to MDR organisms, particularly those ESBL producing pathogens, are of major concern worldwide and are associated with prolonged hospital stay and increased case-fatality rate. Carbapenems are the treatment of choice for severe infections however overuse of this class of antibiotics is leading Carbapenemase-producing pathogens. Variations have been observed in the prevalence of ESBL strains from different US regions; however, it is unclear whether morbidity and mortality follow a similar pattern. This study was conducted to explore the incidence of ESBL infections in the inpatient setting and factors that affect morbidity/mortality. Methods The National Inpatient Sample (NIS) was used to identify all hospitalizations during 2002 to 2014; all primary and secondary diagnoses were searched to identify-resistant infection that utilized the ICD-9 code “V091.” All hospitalizations were stratified based on the indication of resistant infection, and comparisons were made with the chi-square test and linear regression for categorical and continuous variables, respectively. A multivariable binary logistic regression model was used to examine survival for those with ESBL infection. All analyses were conducted with SAS version 9.4; P < 0.005 was considered significant. Results The analysis identified 320,888,511 hospitalizations with 17,732 identified with ESBL infection. Significant differences for those with and without an ESBL infection were found based on the US region with the pertinent results as follows; Northeast: 19.95% vs. 23.30%, Midwest: 14.71% vs. 16.81%, South: 25.14% vs. 40.53%, and West: 40.20% vs. 19.35%; P < 0.001. Results indicated the US region as a significant predictor of mortality for those with ESBL infection. Regions identified in Figure 1. Conclusion Notable findings from this study include a statistically significant variation in mortality risk between US regions. Comparatively lower risk of mortality as related to ESBL infection was noted in the Midwest region when compared with the West region. A greater understanding of the regional epidemiology of β-lactamases is needed to clarify why this disparity exists. Figure 1 Disclosures All authors: No reported disclosures.

Download Full-text

Prevalence of facemask use among general public when visiting wet market during Covid-19 pandemic: An observational study. (Preprint)

10.2196/preprints.20555 ◽

2020 ◽

Author(s):

Gobi Hariyanayagam ◽

Sera Selvanthan Sundram Gunasekaran ◽

Shargunan Selvanthan Gunasekaran ◽

Nur Syafina Insyirah Zaimi ◽

Nor Amirah Abdul Halim

Keyword(s):

High Risk ◽

General Population ◽

Binary Logistic Regression ◽

Final Analysis ◽

High Risk Population ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Hygiene Measures ◽

Wet Market ◽

Medical Grade

BACKGROUND In late December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was epidemiologically linked to seafood and wet animal market in Wuhan, Hubei, China. This event has instigated negative stigma among the general population to view the wet market as a high-risk location for potential transmission of coronavirus. OBJECTIVE This study investigated the prevalence of facemask use among general population visiting the wet market as well as factors contributing to unacceptable facemask practice. Setting The visitors to a district wet market selling range of live or freshly slaughtered animals during COVID-19 pandemic outbreak was observed for facemask practice. METHODS All Individuals visiting the market were observed for the type, category and practice of wearing facemas. Subjects were categorized into two groups of acceptable and unacceptable facemask practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting and Binary Logistic regression model was used in the multivariate setting. Main outcome measure Prevalence, acceptance practice and odds ratio of unacceptance of facemask use. RESULTS Among 1697 individuals included in the final analysis, 1687 (99.7%) was observed wearing facemask with 1338 (78.8%) using medical-grade facemask. Among them, 1615 (95.7%) individuals facemask practice was acceptable while the reaming 72 (4.3%) individuals were observed with unacceptable facemask practice. Individuals using medical-grade facemask and high-risk age group are 6.4 times (OR=6.40; 95% CI, 2.00-20.43; p=.002) and 2.06 times practice (OR=2.06; 95% CI, 1.08-3.94; p=.028) more likely to have unacceptable facemask practice respectively. CONCLUSIONS High saturation of facemask among the general population is an adequate indicator of public hygiene measures strategy which can help to mitigate the COVID-19 epidemic impact. Alarmingly, the unacceptable facemask practice among high-risk population raises the need for a targeted approach by healthcare authorities to ensure satisfactory facemask use.

Download Full-text

A Tale of Two Cities: What’s Driving the Firearm Mortality Difference in Two Large Urban Centers?

The American Surgeon ◽

10.1177/0003134820945258 ◽

2021 ◽

pp. 000313482094525

Author(s):

Jessica K. Friedman ◽

Elizabeth Mytty ◽

Scott Ninokawa ◽

Tara Reza ◽

Elinore Kaufman ◽

...

Keyword(s):

Injury Severity ◽

Univariate Analysis ◽

Case Fatality ◽

Bivariate Analysis ◽

Continuous Variables ◽

Urban Centers ◽

Chi Square ◽

Police Data ◽

Lower Blood ◽

Mortality Difference

Introduction Per police data, the case fatality rate (CFR) of firearm assault in New Orleans (NO) over the last several years ranged between 27% and 35%, compared with 18%-22% in Philadelphia. The reasons for this disparity are unknown, and potentially reflect important system differences with broader implications for the reduction of firearm mortality. Methods A retrospective analysis of police and city-specific trauma databases between 2012 and 2017 was performed. Victims of firearm assaults within city limits were included. Univariate analysis was performed using chi-square for categorical and t-test for continuous variables. Bivariate analysis was conducted using logistic regression. Results Per police data, the CFR of firearm assault was 31% in NO and 20% in Philadelphia. However, per trauma registry data, the CFR of firearm assault was 14% in NO and 25% in Philadelphia. Patients in Philadelphia were older, had higher injury severity score, and lower blood pressure. Patients in NO had higher rates of head injury. 51% of patients in Philadelphia arrived via police compared to <1% in NO. There was no mortality difference between police and emergency medical service (EMS) transport. Longer EMS prehospital times were associated with increased mortality in NO but not Philadelphia. A much larger percentage of patients died on-scene in NO than Philadelphia. Conclusions Our findings suggest that the major driver of increased mortality following firearm assault in NO compared with Philadelphia is death prior to the arrival of first responders. Interventions that shorten prehospital time will likely have the greatest impact on mortality in NO. This should include the consideration of police transport.

Download Full-text

Appraisal of Issues Influencing Soil-Steps Application for Sustainable Farmland Management in High-Potential District, Ethiopia

Environmental Management and Sustainable Development ◽

10.5296/emsd.v7i3.13535 ◽

2018 ◽

Vol 7 (3) ◽

pp. 102

Author(s):

Mehretie Belay

Keyword(s):

Smallholder Farmers ◽

Group Discussion ◽

Household Head ◽

Binary Logistic Regression ◽

Northwest Ethiopia ◽

Study Data ◽

High Potential ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Chi Square Test

Soil damage by moving water is a somber predicament on farmlands in highland Ethiopia. Sizeable number of trial in farmland preservation has been executed to handle the crisis during the last tens of years. However, the attempts have not been vibrant to trim-down the danger to an attractive extent. This paper evaluates factors contributing to application of soil-steps (bunds) as sustainable farmland management technology (SFLMT) by smallholder farmers in one of the high-potential districts of northwest Ethiopia named Dangila Woreda (District). Mixed method triangulation designs involving concurrent acquisition and interpretation of quantitative and qualitative data were used in the study. Data were acquired from randomly chosen 201 farming households during the harvest seasons of 2011 and 2012. Ordered questionnaire, participatory field observation, key informant interview and focus group discussion were mechanisms employed during the data acquisition. Descriptive statistics (means, standard deviations and percentiles), Chi-square test, t-test and the binary logistic regression model were used to analyze the quantitative data. The qualitative information was textually narrated to augment the quantitative results. Findings of the investigation confirm that age of the household head, the number of household members, slope of the farmland, the size of the farmland held, households’ participation in indigenous labour-sharing activities and the number of farm tools owned were significantly increasing the building of soil-steps as SFLMT in the study district. Involvement in off-farm activities and pest invasions were considerably hindering farmers from building soil-steps on their farmlands. The results in general indicated that households’ access to livelihood assets are key promoters for farmers’ implementation of soil-steps on their farmlands. Local resource preservation and improvement trials should thus ponder on convalescing farmers’ material endowments to improve their capability to use soil-steps as SFLMT in their farming activities.

Download Full-text

Factors Influencing in Early Childbearing and Its Consequences on Nutritional Status of Bangladeshi Mothers: Nationally Representative Data

10.21203/rs.3.rs-67538/v1 ◽

2020 ◽

Author(s):

Khirujjaman Sumon ◽

Md. Abu Sayem ◽

Abu Sayed Md Al Ma ◽

Premananda Bharati ◽

Suman Chakrabarty ◽

...

Keyword(s):

Nutritional Status ◽

Binary Logistic Regression ◽

Household Wealth ◽

Medical Problem ◽

Early Marriage ◽

Binary Logistic Regression Model ◽

Early Childbearing ◽

Chi Square ◽

Modifiable Factors ◽

Nationally Representative

Abstract Background: Early marriage and early pregnancy is a social as well as medical problem in developing countries, which may have an impact on health and nutritional status of teenage mothers. Therefore, the objective of this study was to determine the influencing factors of early childbearing (ECB) and its consequences on nutritional status of Bangladeshi mothers. Methods: Data was extracted from the last survey of Bangladesh Demographic and Health Survey (BDHS-2014). Women who delivered their first baby before their age 20 years are considered as ECB mothers. Nutritional status was measured by body mass index (BMI) which was categorized as (i) under nutrition (BMI<18.5 kg/m2), (ii) normal (18.5≤BMI<25 kg/m2) and (iii) over nutrition BMI≥25 kg/m2). Chi-square test and both univariable and multivariable logistic regressions, and z-proportional test were used in this study. Results: This study revealed that the prevalence of ECB among currently non-pregnant mothers in Bangladesh was 83% (urban: 77% and rural: 85.8%). A multivariable binary logistic regression model provided the following six risk factors of ECB: (i) living location (division), (ii) respondents’ education, (iii) husbands’ education, (iv) household wealth quintiles, (v) respondents’ age at first marriage, and (vi) number of family members. Still 17.6% mothers were undernourished in Bangladesh; among them 18.5% and 13.4% were ECB and non- ECB mothers respectively, while 25.5% mothers were over nourished. Univariable model demonstrated that ECB mothers had a greater risk to be undernourished than non-ECB mothers [COR=1.26, 95% CI: 1.11-1.43; p<0.01]. Conclusions: In this study, some modifiable factors were found as predictors of ECB in Bangladesh. ECB mothers were more prone to become under-nourished. These findings can be considered to reduce the number of ECB mothers in Bangladesh consequently to improve their nutritional status.

Download Full-text

Factors influencing early initiation of breastfeeding among mothers in Rajshahi district, Bangladesh

10.21203/rs.3.rs-34757/v3 ◽

2020 ◽

Author(s):

Ummay Ayesha ◽

Abu Sayed Md. Al M ◽

Md. Nurul Islam ◽

Md. Ripter Hossain ◽

Samme Amena Tasmia ◽

...

Keyword(s):

Binary Logistic Regression ◽

Influential Factors ◽

Immune Defense ◽

Early Initiation ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Early Initiation Of Breastfeeding ◽

Level Ii ◽

Chi Square Test ◽

Initiation Of Breastfeeding

Abstract Background: Early initiation of breastfeeding (EIBF) act as the first immunization for the newborns, fortify their immune defense system and eventually reduce the mortality rate. This study aimed to identify the influential factors of EIBF among mothers in Rajshahi district, Bangladesh.Methods: A total number of 421 mothers living in Rajshahi district who had at least one child aged 6-24 months were considered as sample. Mothers were selected using multistage random sampling. This study was conducted from January to March, 2019. The EIBF was measured by a principal question, “Did you provide your breast milk to your newborns within one hour after delivery?” Frequency distribution and Chi-square test and multivariable binary logistic regression model were utilized in this study for getting prevalence and influential factors of EIBF respectively. Results: This study revealed that the prevalence of EIBF among mothers in Rajshahi district was 88.4%. Multivariable logistic model provided eight influential factors of EIBF: (i) husbands’ education level, (ii) husbands’ occupation, (iii) family monthly income, (iv) mothers’ age, (v) mothers’ BMI, (vi) place of delivery, (vii) getting pregnancy with planning, and (viii) mothers taking advice regarding the benefit of breastfeeding during their pregnancy. Conclusions: This study identified several modifiable influential factors of EIBF. The customs, culture and other characteristics are almost the same across the country. These factors could be considered to increase the rate of EIBF among mothers in Bangladesh.

Download Full-text

Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001097 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001097

Author(s):

Chikondi Sharon Chimbatata ◽

Master RO Chisale ◽

Alfred Bornwell Kayira ◽

Frank Watson Sinyiza ◽

Balwani Chingatichifwe Mbakaya ◽

...

Keyword(s):

Hospital Stay ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Binary Logistic Regression ◽

Predictor Variables ◽

Prolonged Hospital Stay ◽

Cell Disease ◽

Exact Test ◽

Prolonged Hospital ◽

Painful Crisis

IntroductionSickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking.MethodsA retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ2 or Fisher’s exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ2 or Fisher’s exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay.ResultsThere were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×109/L) 358.8 (SD=200.9) while median value for white cell count (×109/L) was 23.5 (IQR: 18.0–31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication.ConclusionAnaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made.

Download Full-text

Factors influencing early initiation of breastfeeding among mothers in Rajshahi district, Bangladesh

10.21203/rs.3.rs-34757/v2 ◽

2020 ◽

Author(s):

Ummay Ayesha ◽

Abu Sayed Md. Al M ◽

Md. Nurul Islam ◽

Md. Ripter Hossain ◽

Samme Amena Tasmia ◽

...

Keyword(s):

Breast Milk ◽

Binary Logistic Regression ◽

Influential Factors ◽

Early Initiation ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Early Initiation Of Breastfeeding ◽

Protective Antibodies ◽

Chi Square Test ◽

Initiation Of Breastfeeding

Abstract Background: Early initiation of breastfeeding (EIBF) is referred to as providing breast milk to the newborn within one hour of birth. EIBF ensures that the infant receives the colostrum containing highly protective antibodies. This study aimed to identify the influential factors of EIBF among mothers in Rajshahi district, Bangladesh. Methods: The data was collected from mothers living in Rajshahi district who had at least one child aged 6-24 months. This study was conducted from January to March, 2019. The EIBF was measured by a principal question, “Did you provide your breast milk to your infant within one hour after delivery?” Frequency distribution and Chi-square test and multivariable binary logistic regression model were utilized in this study for getting prevalence and influential factors of EIBF respectively. Results: This study revealed that the prevalence of EIBF among mothers in Rajshahi district was 88.4%. Multivariable logistic model provided eight influential factors of EIBF: (i) place of delivery, (ii) family monthly income, (iii) husbands’ education level, (iv) mothers’ nutritional status, (v) mothers’ age, (vi) husbands’ occupation, (vii) getting pregnancy with planning, and (viii) mothers taking advice regarding the benefit of breastfeeding during their pregnancy. Conclusions: This study identified several modifiable influential factors of EIBF. The customs, culture and other characteristics are almost the same across the country. These factors could be considered to increase the rate of EIBF among mothers in Bangladesh.

Download Full-text

Prevalence and Risk Factors of Microalbuminuria in Nondiabetic Hypertensive Patients

Community Based Medical Journal ◽

10.3329/cbmj.v3i2.53399 ◽

2014 ◽

Vol 3 (2) ◽

pp. 15-22

Author(s):

Amdadul Haque ◽

Mahmud Javed Hasan ◽

Md Asaduzzaman Raja ◽

Md Aminul Islam

Keyword(s):

Laboratory Data ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Patients ◽

Medical College ◽

Low Hdl ◽

History Of

The aim of this study to determine the prevalence of microalbuminuria as well as associated factors in non-diabetic hypertensive patients. Hospital-based cross sectional study. Main outcome of measure is microalbuminuria. A total of 100 nondiabetic hypertensive patients age 18 years without a history of pre-existing kidney disease attending the outpatient department of Community Based Medical College Bangladesh, Mymensingh over a period 6 months from June to December 2014 and who consented and met the criteria were enrolled in this study. A questionnaire including clinical and laboratory data was completed for all cases. The survey data were checked, coded and entered into a SPSS statistical package (Version 11.5). All variables were tested for normal distribution of the data. The data were then cleaned and analyzed using Chi-square (x2) Test, One-Way ANOVA statistics and Binary logistic regression model. Results were considered statistically significant for two-sided P values of <0.05. The overall prevalence of microalbuminuria was 17% of patients (11(64.7%) were male and 6(35.3%) female). The mean age and BMI were 49.2±9.1 years and 23.5±3.8 kg/m2 respectively. There were only 2(2%) patients whose systolic BP and diastolic BP were both well controlled (<140/˂90 mmHg), while normalization rates of either systolic BP (<140 mmHg) or diastolic BP (<90 mmHg) were 10% and 26% respectively. Age 50 years, low HDL, duration of HTN and triglyceride >150 mg/dl were found independent predictors of elevated UAE with ORs being 0.18, 3.9, 0.13 and 0.49 respectively. Microalbuminuria was not uncommon in non-diabetic hypertensive patients and older age, low HDL, high LDL, raised triglyceride and duration of HTN were significant predictors of microalbuminuria. There is an urgent need to screening of microalbuminuria should be mainstreamed into routine investigation and follow-up of patients with HBP. CBMJ 2014 July: Vol. 03 No. 02 P: 15-22

Download Full-text

Drug utilization study of off-label drug use in outpatient department of psychiatry: a prospective study at a tertiary care teaching hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170817 ◽

2017 ◽

Vol 6 (3) ◽

pp. 581

Author(s):

Meeta D. Vadher ◽

Kamlesh Patel ◽

D. K. Vadher ◽

Sujal Parkar ◽

Chintan Raval

Keyword(s):

Prospective Study ◽

Psychiatric Patients ◽

Tertiary Care ◽

Binary Logistic Regression ◽

Outpatient Department ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Case Record ◽

Off Label ◽

A Prospective Study

Background: In the absence of standard psychiatric prescribing information, physician often use drugs in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian Drug Formulary.Methods: After taking permission from Institutional Ethics Committee (IEC), a prospective study was conducted among 285 patients attending Psychiatry outpatient department for the period of 4 months. Data related to demographic parameters, diagnosis of psychiatry conditions and drugs details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India. Multivariate binary logistic regression model was used to determine the predictors of off- label drug prescribing. The data were statistically analyzed using SPSS version 19 and chi-square test.Results: A total of 285 patients (169 males, 116 females) were included in the study with mean age of 36.54±13.91 years. Most of the patients (n=65, 22.8%) were diagnosed as schizophrenic. Out of 285 patients, 133(46.6%) received at least one off-label drug. A total 841 drugs were prescribed out of which 167(19.85%) were off-label. The drug most frequently prescribed as off-label were trihexiphenidyl HCL 29 (10.2%), clozapine 23 (8.1%) and clonazepam 13 (4.6%).Conclusions: Off label drugs used among psychiatry patients was 19.85%. The most frequently used off-label drugs was trihexiphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

Download Full-text

Energy expenditure per minute in different activities and body positions and its association with the classification as physically active or inactive in daily life in individuals with COPD

Chronic Respiratory Disease ◽

10.1177/14799731211053331 ◽

2021 ◽

Vol 18 ◽

pp. 147997312110533

Author(s):

Igor L Brito ◽

Lorena Schneider ◽

Raquel P Hirata ◽

Juliana Fonseca ◽

Thais Paes ◽

...

Keyword(s):

Energy Expenditure ◽

Sports Medicine ◽

Logistic Regression Model ◽

Daily Life ◽

Binary Logistic Regression ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Physically Active ◽

Body Postures ◽

Inactive Group

Objective: To describe and compare energy expenditure (EE)/minute walking and in different body postures in individuals with COPD; and to investigate if EE/minute walking is a predictor of their classification as physically active or inactive. Methods: Physical activity (PA) in daily life was objectively assessed using two PA monitors for 7 days and data were analyzed on a minute-by-minute basis. Predominant minutes were separated into walking, standing, sitting, and reclined, and EE/minute (a reflection of PA intensity) was then calculated in each of these four activities and postures. Participants were classified as active and inactive according to the criteria proposed by the American College of Sports Medicine (ACSM). Results: 43 individuals were evaluated (65±8 years; FEV1 50±14% predicted). A binary logistic regression model yielded that, regardless of the time spent walking/day, EE/minute walking was a significant predictor of the classification as physically active (OR=18.2 [2 – 165]; p=0.01), together with BMI (OR=0.68 [0.5 - 0.9]; p=0.008) (model: Chi-square = 22.431, p< 0.05; R2 [Nagelkerke] = 0.556). In the active group, significantly higher EE/minute was observed for walking and standing in comparison both to sitting and reclined. However, in the inactive group, there were significant differences in EE/minute only when comparing walking versus reclined and standing versus reclined. Conclusion: In individuals, with COPD, EE/minute walking is a significant predictor of being classified as physically active, independently of the time spent walking/day. Each additional kilocalorie/minute spent walking increases in 18 times the chances to be classified as physically active in daily life.

Download Full-text