scholarly journals A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System

2019 ◽  
Vol 5 ◽  
pp. 233372141986288
Author(s):  
Natchaphon Auampradit ◽  
Patama Vapattanawong ◽  
Sureeporn Punpuing ◽  
Malee Sunpuwan ◽  
Tawanchai Jirapramukpitak
Keyword(s):  
Cognitive Impairment ◽  
Odds Ratio ◽  
Surveillance System ◽  
Wealth Index ◽  
Estimating Equation ◽  
Demographic Surveillance System ◽  
Generalized Estimating Equation ◽  
Delayed Recall ◽  
Longitudinal Effects ◽  
Working Status

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

scholarly journals Relapses and disease-modifying drug treatment in pregnancy and live birth in US women with MS

Neurology ◽  
2018 ◽  
Vol 91 (17) ◽  
pp. e1570-e1578 ◽  
Author(s):  
Maria K. Houtchens ◽  
Natalie C. Edwards ◽  
Amy L. Phillips
Keyword(s):  
Live Birth ◽  
Odds Ratio ◽  
Emergency Room Visit ◽  
Outpatient Visit ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Administrative Claims ◽  
Second Trimester ◽  
Disease Modifying ◽  
Relapse Rates

ObjectiveTo evaluate relapse rates and disease-modifying drug (DMD) treatment in US women with multiple sclerosis (MS) and a live birth.MethodsThis retrospective administrative claims database study used US commercial health plan data from women with MS and a live birth from January 1, 2006, to June 30, 2015. Relapses and DMD treatment were evaluated 1-year prepregnancy, during pregnancy, during puerperium (6 weeks postpregnancy), and 1-year postpregnancy. Relapse was defined as MS-related hospitalization, emergency room visit, or outpatient visit with corticosteroid prescription within 7 days. Generalized estimating equation models for longitudinal data tested for differences between prepregnancy vs the other time periods.ResultsA total of 2,158 patients were eligible. The odds of relapse declined during pregnancy (odds ratio [OR] 0.623, 95% confidence interval [CI] 0.521–0.744; p < 0.0001), increased during puerperium (OR 1.710, 95% CI 1.358–2.152; p < 0.0001), and ended at a higher level during the last 3 postpartum quarters (OR 1.216, 95% CI 1.052–1.406; p = 0.0081). The proportion of women with DMD treatment was rather low overall: approximately 20% prepregnancy, bottoming to 1.9% during the second trimester, and peaking at 25.5% 9 to 12 months postpartum. DMD treatment declined significantly during pregnancy (OR 0.171, 95% CI 0.144–0.203; p < 0.0001), remained lower during puerperium (OR 0.361, 95% CI 0.312–0.418; p < 0.0001), and ended at a higher level during the last 3 postpartum quarters (OR 1.259, 95% CI 1.156–1.371; p < 0.0001).ConclusionsThe rate of MS relapse decreased during pregnancy, increased 6 months postpartum, and decreased 6 to 12 months postpartum. DMD treatment was uncommon in the year before pregnancy, further decreased immediately prepregnancy and during pregnancy, and increased postpartum.

scholarly journals Risk factors of geriatric depression in rural China based on a generalized estimating equation

2018 ◽  
Vol 30 (10) ◽  
pp. 1489-1497 ◽  
Author(s):  
Dongdong Zhao ◽  
Caiyun Hu ◽  
Jian Chen ◽  
Bao Dong ◽  
Qiongqiong Ren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Chronic Diseases ◽  
Rural China ◽  
Economic Status ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Geriatric Depression ◽  
Elderly Individuals ◽  
Adl Disability

ABSTRACTBackground:The number of elderly individuals living in China is increasing rapidly. The aim of this study was to examine the potential risk factors of geriatric depression in rural areas.Methods:A repeated cross-sectional study was conducted between January 2015 and October 2016 in rural China. Nine hundred forty-five elderly individuals were included in both investigations. A generalized estimating equation (GEE) was used to examine the relationships between geriatric depression and socio-demographics, the number of chronic diseases, ADL (Activity of Daily Living) disability, cognitive impairment, and anxiety.Results:Among the participants, the majority was female (61.4%) and illiterate (81.5%) and had a general economic status (63.0%) and more than two kinds of chronic diseases (62.9%). The bivariate analysis indicated that geriatric depression was associated with social support, education level, economic status, ADL disability, anxiety disorders, and cognitive impairment at both survey time points. The GEE results showed that poor economic status (OR = 8.294, p < 0.001), the presence of more than two chronic diseases (OR = 1.681, p = 0.048), ADL disability (OR = 2.184, p < 0.001), cognitive impairment (OR = 1.921, p < 0.001), and anxiety (OR = 5.434, p < 0.001) were risk factors for geriatric depression in rural China; better social support (OR = 0.924, 95% CI = 0.899–0.949, p < 0.001) was found to be a protective factor.Conclusions:Geriatric depression in rural China was associated with several socio-demographic, physical, and mental factors. Targeted interventions are essential to improve the psychological health of aged individuals in rural China.

scholarly journals Persistence of child marriage in rural Bangladesh and impact on maternal and perinatal health: findings from a health and demographic surveillance system

2021 ◽  
Author(s):  
Kyu Han Lee ◽  
Atique I. Chowdhury ◽  
Qazi S. Rahman ◽  
Solveig A. Cunningham ◽  
Shahana Parveen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Perinatal Mortality ◽  
Adolescent Girls ◽  
Odds Ratio ◽  
Surveillance System ◽  
Perinatal Death ◽  
Temporal Trends ◽  
Demographic Surveillance System ◽  
Child Marriage ◽  
First Marriage

ABSTRACTObjectivesTo describe temporal trends in child marriage between 1990 and 2019 in a rural sub-district of Bangladesh and characterize relationships between age, time to pregnancy, complications during delivery, and perinatal mortality.DesignHealth and demographic surveillance system.SettingBaliakandi sub-district, Bangladesh.Participants56,155 female residents.Main outcome measuresAnnual proportion of marriages to female residents under 18 years of age, time between first marriage and pregnancy, proportion of births with complications during delivery, and odds of perinatal mortality.ResultsBetween 1990 and 2010, the proportion of marriages to female residents under 18 years of age decreased from 71% to 57%. Most notably, marriages to females aged 10 to 12 years dropped from 22% of all marriages to 3%. In 2019, 53% of all marriages were to females under 18 years. The estimated time between first marriage and pregnancy did not differ by female age at marriage. By 365 days after marriage, the cumulative incidence of pregnancy was approximately 50% for each age group. Adolescent girls were more likely to experience complications during delivery with at least one complication reported for 36% of mothers aged 13 to 15 years, 32% of mothers aged 16 to 17 years, and 23% of mothers aged 18 to 34 years (χ2 test, P<0.001). Compared to adults, births among females aged 13 to 15 years were more likely to result in stillbirths (odds ratio 2.23, 95% confidence interval 1.19 to 4.16) and births among females 16-17 years were more likely to result in early neonatal deaths (odds ratio 1.57, 95% confidence interval 1.01 to 2.42).ConclusionsChild marriage persists in Baliakandi. Over half of all marriages were to child brides and only minor reductions were seen over the past decade. Pregnancies were common among adolescent girls with no evidence of delayed pregnancy after marriage. Compared to adults, adolescents were more likely to experience complications during delivery and perinatal death. Preventing child marriage has substantial social and health benefits for girls and, by doing so, will also contribute to Bangladesh’s commitment to reduce child mortality.

scholarly journals Quality improvement teams, super-users, and nurse champions: a recipe for meaningful use?

2016 ◽  
Vol 23 (6) ◽  
pp. 1195-1198 ◽  
Author(s):  
Christopher M Shea ◽  
Kristin L Reiter ◽  
Mark A Weaver ◽  
Jordan Albritton
Keyword(s):  
Quality Improvement ◽  
Correlation Matrix ◽  
Odds Ratio ◽  
Meaningful Use ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Clinical Data Warehouse ◽  
Working Correlation ◽  
Stage 1 ◽  
Super Users

Abstract Objective This study assessed whether having an electronic health record (EHR) super-user, nurse champion for meaningful use (MU), and quality improvement (QI) team leading MU implementation is positively associated with MU Stage 1 demonstration. Methods Data on MU demonstration of 596 providers in 37 ambulatory care clinics came from the clinical data warehouse and administrative systems of UNC Health Care. We surveyed the 37 clinics about champions, super-users, and QI teams. We used generalized estimating equation methods with an independence working correlation matrix to account for clustering within clinics and to weight contributions from each clinic according to clinic size. Results Having a QI team lead MU implementation was significantly associated with MU demonstration (odds ratio, OR = 3.57, 95% CI, 1.83-6.96, P &lt; .001, Table 2 ). Having neither a nurse champion nor an EHR super-user was significant. Conclusion Our findings support the alignment of MU with QI efforts by having the QI team lead MU implementation.

scholarly journals Unusually High Incidences of Pseudomonas Bacteremias Within Topical Polymyxin–Based Decolonization Studies of Mechanically Ventilated Patients: Benchmarking the Literature

2018 ◽  
Vol 5 (11) ◽  
Author(s):  
James C Hurley
Keyword(s):  
Odds Ratio ◽  
Observational Studies ◽  
Prolonged Mechanical Ventilation ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Control Groups ◽  
Intervention Component ◽  
Mechanically Ventilated ◽  
The Mean ◽  
Summary Odds Ratio

Abstract Background Topical polymyxin (PM)–based regimens to decolonize patients receiving prolonged mechanical ventilation (MV) have been widely studied. However, paradoxical bacteremia incidences remain unexplained. Methods The literature was searched for studies of topical PM–based regimens used to decontaminate MV patients reporting incidences of overall and Pseudomonas bacteremia data. In addition, observational groups without any intervention and trials of various interventions other than topical PM (non-PM studies) served to provide external benchmarks and additional points of reference, respectively. The bacteremia incidences were extracted from the control and intervention (component) groups of these studies and compared with metaregression using generalized estimating equation methods. Results The summary odds ratio derived from studies of topical PM–based interventions against overall bacteremia was 0.60 (95% confidence interval [CI], 0.53–0.69). Benchmark incidences per 100 MV patients for overall (mean, 8.9%; 95% CI, 6.9% to 10.9%) and Pseudomonas (mean, 0.7%; 95% CI, 0.5% to 1.1%) bacteremia were derived from 16 observational studies. By contrast, among 17 studies of topical PM, the mean incidences among control groups for overall (mean, 15.3%; 95% CI, 11.5% to 20.3%) and Pseudomonas (mean, 1.6%; 95% CI, 0.9% to 3.1%) bacteremia were both higher, whereas these incidences in the intervention groups for both topical PM and non-PM studies were in each case more similar to the respective benchmarks. These paradoxical incidences cannot readily be explained in metaregression models. Conclusions Paradoxically, despite an apparent prevention effect of topical PM–based methods against bacteremia overall, the incidences of Pseudomonas bacteremia within the component groups of these studies are unusually high vs literature-derived benchmarks.

scholarly journals Contemporary Trends in the Treatment of Mild Ischemic Stroke with Intravenous Thrombolysis: Paul Coverdell National Acute Stroke Program

2021 ◽  
pp. 1-7
Author(s):  
Ganesh Asaithambi ◽  
Xin Tong ◽  
Sallyann M. Coleman King ◽  
Mary G. George
Keyword(s):  
Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Estimating Equation ◽  
National Institutes Of Health ◽  
Generalized Estimating Equation ◽  
Mild Stroke ◽  
The Impact ◽  
Program Data

<b><i>Background:</i></b> Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time. <b><i>Methods:</i></b> Using the Paul Coverdell National Stroke Program data, we examined trends in IVT utilization from 2010 to 2019 among AIS patients presenting with National Institutes of Health Stroke Scale (NIHSS) scores ≤5. Outcomes adjudicated included rates of discharge to home and ability to ambulate independently at discharge. We used generalized estimating equation models to examine the effect of IVT on outcomes of AIS patients presenting with mild symptoms and calculated adjusted odds ratio (AOR) with 95% confidence intervals (CI). <b><i>Results:</i></b> During the study period, 346,762 patients presented with mild AIS symptoms. Approximately 6.2% were treated with IVT. IVT utilization trends increased from 3.7% in 2010 to 7.7% in 2019 (<i>p</i> &#x3c; 0.001). Patients treated with IVT had higher median NIHSS scores upon presentation (IVT 3 [2, 4] vs. no IVT 2 [0, 3]). Rates of discharge to home (AOR 2.06, 95% CI: 1.99–2.13) and ability to ambulate at time of discharge (AOR 1.82, 95% CI: 1.76–1.89) were higher among those treated with IVT. <b><i>Conclusion:</i></b> There was an increased trend in IVT utilization among AIS patients presenting with mild symptoms. Utilization of IVT increased the odds of being discharged to home and the ability to ambulate at discharge independently in patients with mild stroke.

scholarly journals Excess mortality among people with podoconiosis: secondary analysis of two Ethiopian cohorts

2020 ◽  
Vol 114 (12) ◽  
pp. 1035-1037
Author(s):  
Hannah Masraf ◽  
Temesgen Azemeraw ◽  
Meseret Molla ◽  
Christopher Iain Jones ◽  
Stephen Bremner ◽  
...  
Keyword(s):  
General Population ◽  
Surveillance System ◽  
Excess Mortality ◽  
Secondary Analysis ◽  
Demographic Surveillance System ◽  
Northern Ethiopia ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Standardised Mortality Ratios ◽  
Patients Experience

Abstract Background While morbidity attributable to podoconiosis is relatively well studied, its pattern of mortality has not been established. Methods We compared the age-standardised mortality ratios (SMRs) of two datasets from northern Ethiopia: podoconiosis patients enrolled in a 1-y trial and a Health and Demographic Surveillance System cohort. Results The annual crude mortality rate per 1000 population for podoconiosis patients was 28.7 (95% confidence interval [CI] 17.3 to 44.8; n=663) while that of the general population was 2.8 (95% CI 2.3 to 3.4; n=44 095). The overall SMR for the study period was 6.0 (95% CI 3.6 to 9.4). Conclusions Podoconiosis patients experience elevated mortality compared with the general population and further research is required to understand the reasons.

scholarly journals Severe stunting and its associated factors among children aged 6–59 months in Ethiopia; multilevel ordinal logistic regression model

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Amare Muche ◽  
Reta Dewau
Keyword(s):  
Logistic Regression ◽  
Odds Ratio ◽  
Associated Factors ◽  
Logistic Regression Model ◽  
Adjusted Odds Ratio ◽  
Wealth Index ◽  
Maternal Height ◽  
Severe Stunting ◽  
Mothers And Children ◽  
Ordinal Logistic Regression Model

Abstract Background In Ethiopia, stunting is the most common form of undernutriton. Identifying the determinants of severe stunting among children is crucial for public health interventions to improve child health. Therefore, this study aimed to identify the determinants of severe stunting among under-five children in Ethiopia. Methods A community-based cross-sectional study design was employed. A two stage stratified cluster sampling technique was used. A multilevel ordinal logistic regression model was fitted to identify independent determinants. Adjusted odds ratio (AOR) and median odds ratio (MOR) with its 95% confidence interval at p-value< 0.05 were used to declare statistical significance. Results The result of this study showed that about 18% of the children were severely stunted. Being male increased the severity of stunting in children by 26% adjusted odds ratio (AOR): 1.26 (95% CI: 1.09–1.46), compared to female sex; over-weight mothers increased the severity of stunting in their children AOR: 3.43 (95% CI: 2.21–5.33) compared to normal BMI mothers; and children from middle, poorer, and poorest wealth index households were 1.84 (95% CI:1.27–2.67), 2.13 (95% CI, CI:1.45–3.14) and 2.52 (95% CI,1.72–3.68). In contrast, severe stunting was reduced by 62% (AOR: 0.38, 95% CI: 0.20–0.74) and 48% (AOR = 0.52, 95% CI: 0.37–0.72) in children of educated mothers compared to children of uneducated mothers and children of underweight mothers compared with those children of normal BMI mothers respectively. For each one-unit increase in maternal height, there is a 5% significant reduction in the child’s odds of being severely stunted. After controlling for other factors, the effect of predictors on the likelihood of stunting in high risk clusters increased by a median odds ratio (MOR) of 1.83 (95% CI: 1.69–2.00). Conclusions The magnitude of severe childhood stunting was still high with regional variation in Ethiopia. Child age, sex, maternal height, age, education and household wealth index as well as administrative regions were significantly associated factors with severe stunting. Significant interventions shall be implemented at the individual, household and community levels in order to reduce the problem.

scholarly journals Lower-caloric intake but different nutrient profiles in cognition impaired and in frail elderlies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Y Wu ◽  
W H Pan
Keyword(s):  
Body Weight ◽  
Cognitive Impairment ◽  
Dietary Fiber ◽  
Energy Intake ◽  
Odds Ratio ◽  
Nutrient Intake ◽  
Lower Energy ◽  
Trend Test ◽  
Impairment Score ◽  
Cognition Impairment

Abstract Background Frailty and dementia are two common geriatric syndromes associated with poor nutritional status. The nutritional role in the pathogenesis of frailty and dementia remains unclear. We examined the associations between energy intake and frailty/cognition impairment and also compared the nutrient intake between frail and cognition impaired elderlies by sex. Methods Data of 1,920 elderly adults (≧65y) from the 2014-2017 Nutrition and Health Survey in Taiwan was used. Frailty was defined using modified L. Fried criteria. The Chinese Mini-Mental State Examination score was grouped into tertiles: cognitive impairment (score ≦ 23), mild cognitive impairment (score = 24-27), and the normal (score ≧28). Total energy intake was grouped into tertiles. Logistic regression adjusted for age, sex, and sampling strata was used for association test. The trend test was performed using generalized linear model with age adjustment to examine whether various nutrient intake indicators had an ordered relationship with the severity of frailty and cognitive impairment. Results Lower energy intake (men &lt;1540 Kcal or women&lt;1182 Kcal) was significantly associated with frailty (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.45-2.66) and cognition impairment (OR: 1.88; 95%CI: 1.43-2.47), respectively. Larger number of micronutrients and food substances per Kg body weight exhibited decreasing trends with MCI (protein, fat, carbohydrate, vitamins B1, B2, B3, B6, B12, C, E, Ca, P, Fe, Mg, K, Zn, dietary fiber, and cholesterol) than with frailty (protein, vitamin B1, B3, B6, C, P, Mg, K, Zn, polyunsaturated fatty acids, and dietary fiber). Conclusions The lower the energy intake, the higher the odds ratio for frailty and for dementia. Dietary quality expressed by nutrient intake per Kg body weight was poorer in elderlies with cognition impairment than those with frailty. Key messages Lower energy intake is associated with MCI and with frailty, respectively. The MCI elderlies involve more micronutrient deficiencies than the frail counterpart.

scholarly journals A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

2013 ◽  
Vol 5 (3) ◽  
pp. 16 ◽  
Author(s):  
Fábio Henrique De Gobbi Porto ◽  
Lívia Spíndola ◽  
Maira Okada De Oliveira ◽  
Patrícia Helena Figuerêdo Do Vale ◽  
Marco Orsini ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Characteristic Curve ◽  
Neuropsychological Testing ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Elderly Subjects ◽  
Subjective Memory ◽  
Delayed Recall ◽  
Memory Complaints

It is not easy to differentiate patients with mild cognitive impairment (MCI) from subjective memory complainers (SMC). Assessments with screening cognitive tools are essential, particularly in primary care where most patients are seen. The objective of this study was to evaluate the diagnostic accuracy of screening cognitive tests and to propose a score derived from screening tests. Elderly subjects with memory complaints were evaluated using the Mini Mental State Examination (MMSE) and the Brief Cognitive Battery (BCB). We added two delayed recalls in the MMSE (a delayed recall and a late-delayed recall, LDR), and also a phonemic fluency test of letter P fluency (LPF). A score was created based on these tests. The diagnoses were made on the basis of clinical consensus and neuropsychological testing. Receiver operating characteristic curve analyses were used to determine area under the curve (AUC), the sensitivity and specificity for each test separately and for the final proposed score. MMSE, LDR, LPF and delayed recall of BCB scores reach statistically significant differences between groups (P=0.000, 0.03, 0.001 and 0.01, respectively). Sensitivity, specificity and AUC were MMSE: 64%, 79% and 0.75 (cut off &lt;29); LDR: 56%, 62% and 0.62 (cut off &lt;3); LPF: 71%, 71% and 0.71 (cut off &lt;14); delayed recall of BCB: 56%, 82% and 0.68 (cut off &lt;9). The proposed score reached a sensitivity of 88% and 76% and specificity of 62% and 75% for cut off over 1 and over 2, respectively. AUC were 0.81. In conclusion, a score created from screening tests is capable of discriminating MCI from SMC with moderate to good accurancy.

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