scholarly journals Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simon Allan ◽  
Ifedayo M. O. Adetifa ◽  
Kaja Abbas
Keyword(s):  
Logistic Regression ◽  
Birth Order ◽  
Wealth Quintile ◽  
Place Of Birth ◽  
Immunisation Coverage ◽  
Multivariate Logistic Regression ◽  
Childhood Immunisation ◽  
Lower Odds ◽  
Full Immunisation ◽  
Birth Characteristics

Abstract Background The global Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12–23 months in Kenya. Methods We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3943 children aged 12–23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. Results Immunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics through multivariate logistic regression, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings had 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions Children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order are associated with lower rates of full immunisation. Targeted programmes to reach under-immunised children in these subpopulations will lower the inequities in childhood immunisation coverage in Kenya.

scholarly journals Childhood Immunisation Coverage in Kenya by Socioeconomic, Geographic, Maternal, Child, and Place of Birth Characteristics: Equity Impact Analysis

2021 ◽  
Author(s):  
Simon Allan ◽  
Ifedayo M. O. Adetifa ◽  
Kaja Abbas
Keyword(s):  
Birth Order ◽  
Wealth Quintile ◽  
Household Wealth ◽  
Eastern Region ◽  
Place Of Birth ◽  
Immunisation Coverage ◽  
Lower Odds ◽  
Full Immunisation ◽  
Birth Characteristics ◽  
Maternal Child

Abstract Background: The WHO Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12-23 months in Kenya. Methods: We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12–23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. Results: Immunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions: The inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order.

scholarly journals Childhood immunisation coverage in Kenya by socioeconomic, geographic, maternal, child, and place of birth characteristics: equity impact analysis

2021 ◽  
Author(s):  
Simon Allan ◽  
Ifedayo M. O. Adetifa ◽  
Kaja Abbas
Keyword(s):  
Birth Order ◽  
Wealth Quintile ◽  
Household Wealth ◽  
Vaccine Uptake ◽  
Place Of Birth ◽  
Immunisation Coverage ◽  
Lower Odds ◽  
Full Immunisation ◽  
Birth Characteristics ◽  
Maternal Child

AbstractBackgroundImmunisation of children is a highly cost-effective public health intervention and fosters health equity for the overall population. The WHO Immunisation Agenda 2030 highlights coverage and equity as one of the strategic priority goals to reach high equitable immunisation coverage at national levels and in all districts. We analysed full immunisation coverage among children aged 12-23 months in Kenya and estimated the inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics using data from the 2014 Kenya Demographic and Health Survey.MethodsWe analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12–23 months. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics. We conducted bivariate and multivariate logistic regression to assess associations between full immunisation coverage and socioeconomic, geographic, maternal, child, and place of birth characteristics.ResultsImmunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children.ConclusionsThe inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order. Further, the COVID-19 pandemic has disrupted routine and campaign immunisation services in 2020 and enhances the risk of vaccine-preventable disease outbreaks, but it also presents an opportunity to tackle the identified inequities in vaccine uptake as immunisation services are restored to capacity.

scholarly journals Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Joan Carpenter ◽  
Winifred Scott ◽  
Mary Ersek ◽  
Cari Levy ◽  
Jennifer Cohen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Multivariate Logistic Regression ◽  
Comfort Care ◽  
Lower Odds ◽  
Medicare Data ◽  
Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

scholarly journals Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ishwar Tiwari ◽  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Bhim Prasad Sapkota ◽  
Ramesh Babu Kafle
Keyword(s):  
Logistic Regression ◽  
Mass Media ◽  
Birth Order ◽  
Statistical Significance ◽  
Household Survey ◽  
Wealth Quintile ◽  
Public Health Issue ◽  
Sampling Weights ◽  
Cross Sectional ◽  
Childhood Undernutrition

Abstract Background Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study. Methods We used the Nepal Demographic and Health Survey (NDHS) 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p < 0.001. Results The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under 5 years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of the interval between birth and subsequent birth (IBBSB). The association between the children’s birth order and the prevalence of undernutrition had strong statistical significance. Mother’s age at marriage (p = 0.001), underweight mother, mother’s education, father’s education, wealth quintile, no exposure to mass media, children’s age, and place of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12–24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4–0.9). Conclusion The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12–24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal’s government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

scholarly journals Clinical and Genomic Factors Are Predictive of Response and Prognostic of Progression-Free Survival in Patients with Waldenström Macroglobulinemia Treated with Ibrutinib

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2823-2823
Author(s):  
Jorge J. Castillo ◽  
Joshua Gustine ◽  
Maria Demos ◽  
Andrew Keezer ◽  
Kirsten Meid ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Serum Albumin ◽  
Research Funding ◽  
Regression Models ◽  
Progression Free Survival ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Free Survival ◽  
Lower Odds

Introduction: The Bruton tyrosine kinase inhibitor ibrutinib is the only FDA approved therapy for the treatment of symptomatic Waldenstrom macroglobulinemia (WM), and has been associated with high response rates and durable progression-free survival (PFS). Factors associated with depth of response and PFS duration are not well established. We performed a retrospective study aimed at identifying predictive and prognostic factors in WM patients treated with ibrutinib. Methods: We included consecutive patients with a diagnosis of WM treated with ibrutinib monotherapy evaluated at the Dana-Farber Cancer Institute since January 2012 through March 2019. Patients with Bing-Neel syndrome (WM involving the central nervous system) were excluded. Baseline clinical and laboratory characteristics were gathered. MYD88 and CXCR4 mutations were assessed using polymerase chain reaction assays and Sanger sequencing. Responses at 6 months were assessed using criteria from IWWM3. PFS was defined as the time from ibrutinib initiation until last follow-up, death or progression. Univariate and multivariate logistic regression models were fitted for partial response (PR) and very good partial response (VGPR) at 6 months, and Cox proportional-hazard regression models were fitted for PFS. Results: A total of 252 patients were included in our analysis. Selected baseline characteristics include: age ≥65 years (60%), hemoglobin <11.5 g/dl (68%), platelet count <100 K/uL (12%), albumin <3.5 g/dl (39%), b2-microglobulin ≥3 mg/l (70%), serum IgM level ≥7,000 mg/dl (6%), bone marrow involvement ≥60% (54%), previously untreated for WM (33%), time to ibrutinib <3 years (46%). MYD88 L265P and CXCR4 mutations were detected in 98% and 38% of patients, respectively. At 6 months, 71% of patients obtained PR, and 17% VGPR. Multivariate logistic regression analyses showed higher odds of PR at 6 months for hemoglobin <11.5 g/dl (78% vs. 56%; OR 2.8, 95% CI 1.1-6.9; p=0.03) and serum albumin <3.5 g/dl (90% vs. 66%; OR 3.2, 95% CI 1.0-10; p=0.045), while CXCR4 mutations associated with lower odds (44% vs. 82%; OR 0.15, 95% CI 0.06-0.37; p<0.001). Multivariate logistic regression analyses showed higher odds of VGPR at 6 months for b2-microglobulin ≥3 mg/l (21% vs. 3%; OR 3.3, 95% CI 1.1-10; p=0.04) and lower odds for serum IgM level ≥4,000 mg/dl (9% vs. 23%; OR 0.3, 95% CI 0.1-0.8; p=0.02). The median follow-up was 30 months, and the median PFS has not yet been reached. The 5-year PFS rate was 60% (95% CI 48-69%). In the multivariate Cox regression analysis, worse outcomes were seen with CXCR4 mutations (5-year PFS: 45% vs. 71%; HR 2.8, 95% CI 1.4-5.8; p=0.004) and serum albumin <3.5 g/dl (5-year PFS: 36% vs. 68%; HR 2.7, 95% CI 1.3-5.5; p=0.007). A novel PFS risk score was designed using CXCR4 mutational status and serum albumin (Figure), which divided patients into 3 distinct groups: low risk (no risk factors: 43%; 5-year PFS 81%), intermediate risk (1 risk factor: 46%; 5-year PFS 51%) and high risk (2 risk factors: 11%; median PFS 25 months). The PFS difference between groups was statistically significant (p<0.001). The PFS risk score showed consistent results when evaluating previously treated and untreated patients, as well as patients on and off clinical trials. Conclusion: Serum albumin and CXCR4 mutations emerge as important factors predictive of PR at 6 months and also prognostic of PFS in WM patients treated with ibrutinib. A novel PFS stratification tool that separates patients into 3 risk groups was established and would need further validation. Figure Disclosures Castillo: Abbvie: Research Funding; Janssen: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Beigene: Consultancy, Research Funding; TG Therapeutics: Research Funding. Hunter:Janssen: Consultancy. Treon:Pharmacyclics: Research Funding; BMS: Research Funding; Janssen: Consultancy.

scholarly journals Planning of Births and Childhood Undernutrition in Nepal: Evidence from a 2016 National Survey

2020 ◽  
Author(s):  
Ishwar Tiwari ◽  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Bhim Prasad Sapkota ◽  
Ramesh Babu Kafle
Keyword(s):  
Logistic Regression ◽  
Mass Media ◽  
Birth Order ◽  
Statistical Significance ◽  
Household Survey ◽  
Wealth Quintile ◽  
Public Health Issue ◽  
Sampling Weights ◽  
Cross Sectional ◽  
Childhood Undernutrition

Abstract Background Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aim to investigate the relationship between PoB and childhood undernutrition in the current study. Methods We used the Nepal Demographic Health Survey 2016 data, which is a nationally representative cross-sectional household survey. We used two common anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor of interest. Binary logistic regression with sampling weights was used to estimate adjusted odds ratios (OR) and 95% confidence intervals to examine the association between the PoB and childhood undernutrition. Results The overall prevalence of stunting was 35.8%, and underweight was 27.1% in under-five children in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of interval between birth and subsequent birth (IBBSB). The association between the birth order of children and the prevalence of undernutrition had strong statistical significance (p < 0.001). Mother’s age at marriage (p = 0.001), underweight mother (p < 0.001), mother’s education (p < 0.001), father’s education (p < 0.001), wealth quintile (p < 0.001), no exposure to mass media (p < 0.001), children’s age (p < 0.001), area of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12–24 months of interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting as compared to those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4–0.9). Conclusion The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12–24 months after marriage was found to be associated with reduced odds of childhood stunting. To mitigate childhood undernutrition, Nepal’s government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

scholarly journals Sex Workers’ Access to Police Assistance in Safety Emergencies and Means of Escape from Situations of Violence and Confinement under an “End Demand” Criminalization Model: A Five City Study in Canada

2021 ◽  
Vol 10 (1) ◽  
pp. 13
Author(s):  
Anna-Louise Crago ◽  
Chris Bruckert ◽  
Melissa Braschel ◽  
Kate Shannon
Keyword(s):  
Logistic Regression ◽  
Confidence Interval ◽  
Sex Workers ◽  
Racial Profiling ◽  
Descriptive Statistics ◽  
Multivariate Logistic Regression ◽  
Lower Odds ◽  
The Past ◽  
Police Harassment ◽  
Police Protection

There is limited available evidence on sex workers (SW) ability to access police protection or means of escaping situations of violence and confinement under an “end demand” criminalization model. Of 200 SW in five cities in Canada, 62 (31.0%) reported being unable to call 911 if they or another SW were in a safety emergency due to fear of police detection (of themselves, their colleagues or their management). In multivariate logistic regression, police harassment–linked to social and racial profiling in the past 12 months (being carded or asked for ID documents, followed by police or detained without arrest) (Adjusted Odd Ratio (AOR): 5.225, 95% Confidence Interval (CI): 2.199–12.417), being Indigenous (AOR: 2.078, 95% CI: 0.849–5.084) or being in Ottawa (AOR: 2.317, 95% CI: 0.865–6.209) were associated with higher odds of being unable to call 911, while older age was associated with lower odds (AOR: 0.941 per year older, 95% CI: 0.901–0.982). In descriptive statistics, of 115 SW who had experienced violence or confinement at work in the past 12 months, 19 (16.52%) reported the incident to police. Other sex workers with shared expenses were the most commonly reported group to have assisted sex workers to escape situations of violence or confinement in the past 12 months (n = 13, 35.14%). One of the least commonly reported groups to have assisted sex workers to escape situations of violence or confinement in the past 12 months were police (n = 2, 5.41%). The findings of this study illustrate how the current “end demand” criminalization framework compromises sex workers’ access to assistance in safety emergencies.

Association of Follow-up Care Characteristics and Outcomes According to Number of Follow-up Providers Among Survivors of Hematologic Malignancies.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1375-1375
Author(s):  
Anthony J. Cannon ◽  
Deborah L. Darrington ◽  
Linda K. Bauer ◽  
James O. Armitage ◽  
Julie M. Vose ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Logistic Regression ◽  
Patient Satisfaction ◽  
Hematologic Malignancies ◽  
Multivariate Logistic Regression ◽  
Lower Odds ◽  
Follow Up Care ◽  
Single Versus

Abstract Abstract 1375 Poster Board I-397 Objectives: There is a critical need to have a better understanding of the role health providers play and the need to develop clinical tools to help clinicians identify patients who after completion of treatment for hematologic malignancies may benefit from a more intense follow-up care. The primary purpose of this study was to examine if number of follow-up providers (FUPs) - single versus multiple, influence healthcare utilization (HCU), quality of life and patient satisfaction at 6 months in a cohort of patients who completed treatment for hematologic malignancies. A secondary purpose was to evaluate characteristics of follow-up care that may identify patients at risk for urgent care or hospitalization within 6 months. Methods: We utilized data from CANCER-CARES, a longitudinal prospective study of 928 patients with various cancers evaluating follow-up care after completing cancer treatment from a university-based hospital. This study was confined to 314 (52%) patients who had leukemia, lymphoma or multiple myeloma with available 6 month follow-up information. The cohort was divided according to the number of FUPs - single versus multiple. FUP is defined as a physician(s) responsible for managing any aspect of patient's health after cancer treatment. Single FUP may consist solely of a university or community oncologist or other physicians, while multiple FUP may be any combination of the above. Outcomes evaluated included healthcare utilization (HCU) - defined as an emergency room visit or hospitalization within 6 mos, quality of life (SF-12) and patient satisfaction (PSQ-18). Characteristics of follow-up care assocatied with HCU were determined using multivariate logistic regression. Factors determined to be predictive of HCU were assigned one point each. The summated score was used to represent the Follow-up Index Score (FUIS). We used the median FUIS of ≤ 2 to dichotomize the cohort to low vs high scores. The association of the FUIS according to single or multiple FUP with HCU was evaluated using multivariate logistic regression to adjust for patient characteristics. Results: Of the 314 patients, 214 (68%) sought follow-up care with a single FUP (80% remained with university providers, 20% moved back to community providers), while 100 (32%) sought follow-up care with multiple FUPs. Patients seen by single FUP were more likely to be older (median 59y vs 55y), live closer to their FUP (median 60 mi vs 150 mi), less likely to have prescription drug insurance (85% vs 94%), and were less likely to have undergone stem-cell transplantation. Patients seen by single FUP chose their physician more because of preference and quality of care than because of proximity, and were seen less frequently by their FUP as compared to the multiple FUPs. In addition, patients of single providers were seen shorter on their follow-up visits and were less likely to call their FUP with health-related questions. Five patterns of follow-up care were associated with HCU within 6 mos: 1) consult made for cancer-related problems, 2) consult made for other medical problems, 3) referral to another specialist, 4) call made to FUP for medical questions, and 5) ancillary procedures performed (ct, x-ray, ultrasound). In the multivariate analysis, patients seen by single or multiple FUP did not differ in HCU, quality of life and patient satisfaction. However, patients who were seen either by a single or multiple FUP and with low FUIS had significantly lower odds of HCU compared with single FUP with high FUIS [OR 0.11 (95%CI 0.05-0.25), p<0.001; OR 0.26 (95% CI 0.09-0.71), p<0.001) respectively. Patients seen by multiple FUP and have low FUIS also had lower odds of HCU compared with patients with multiple FUP and have high FUIS (OR 0.30, 95% CI 0.10-0.85, p<0.001). We failed to detect differences between patients seen by single or multiple FUPs with low FUIS. No differences in quality of life or patient satisfaction were noted. Conclusion: In summary, patients with hematologic malignancies do not differ between patients who sought follow-up care from single or multiple FUP on HCU, quality of life or patient satisfaction. However, the FUIS shows potential to identify patients who may benefit from an intensive follow-up care plan geared towards preventing hospitalization because it demonstrated that high FUIS scores were associated with increased HCU within a 6 mo. period. The utility of the FUIS in predicting HCU between 6 and 12 months and in different types of malignancies should also be evaluated. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey

2020 ◽  
Author(s):  
Ishwar Tiwari ◽  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Bhim Prasad Sapkota ◽  
Ramesh Babu Kafle
Keyword(s):  
Logistic Regression ◽  
Mass Media ◽  
Birth Order ◽  
Statistical Significance ◽  
Household Survey ◽  
Wealth Quintile ◽  
Public Health Issue ◽  
Sampling Weights ◽  
Cross Sectional ◽  
Childhood Undernutrition

Abstract Background: Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study.Methods: We used the Nepal Demographic and Health Survey 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p<0.001.Results: The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under five years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order >3 and <2 years of the interval between birth and subsequent birth (IBBSB). The association between the children’s birth order and the prevalence of undernutrition had strong statistical significance. Mother’s age at marriage (p=0.001), underweight mother, mother’s education, father’s education, wealth quintile, no exposure to mass media, children’s age, and place of residence(p=0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and <12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9). Conclusion: The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

scholarly journals Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database

2015 ◽  
Vol 39 (6) ◽  
pp. E9 ◽  
Author(s):  
Matthew J. McGirt ◽  
Saniya S. Godil ◽  
Anthony L. Asher ◽  
Scott L. Parker ◽  
Clinton J. Devin
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Quality Improvement ◽  
Ambulatory Surgery ◽  
Cost Of Care ◽  
Anterior Cervical Discectomy ◽  
Multivariate Logistic Regression ◽  
Major Morbidity ◽  
Lower Odds ◽  
Cervical Discectomy

OBJECT In an era of escalating health care cost and universal pressure of improving efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed and is rapidly increasing with an expanding aging population. While ASCs offer cost advantages for ACDF, there is a scarcity of evidence that ASCs allow for equivalent quality and thus superior health care value. Therefore, the authors analyzed a nationwide, prospective quality improvement registry (National Surgical Quality Improvement Program [NSQIP]) to compare the quality of ACDF surgery performed in the outpatient ASC versus the inpatient hospital setting. METHODS Patients undergoing ACDF (2005-2011) were identified from the NSQIP database based on the primary Current Procedural Terminology codes. Patients were divided into 2 cohorts (outpatient vs inpatient) based on the acute care setting documented in the NSQIP database. All 30-day surgical morbidity and mortality rates were compared between the 2 groups. Propensity score matching and multivariate logistic regression analysis were used to adjust for confounding factors and to identify the independent association of outpatient ACDF with perioperative outcomes and morbidity. RESULTS A total of 7288 ACDF cases were identified (inpatient = 6120, outpatient = 1168). Unadjusted rates of major morbidity (0.94% vs 4.5%, p < 0.001) and return to the operating room (OR) within 30 days (0.3% vs 2.0%, p < 0.001) were significantly lower in outpatient versus inpatient ACDF. After propensity matching 1442 cases (inpatient = 650, outpatient = 792) based on baseline 32 covariates, rates of major morbidity (1.4% vs 3.1%, p = 0.03), and return to the OR (0.34% vs 1.4%, p = 0.04) remained significantly lower after outpatient ACDF. Adjusted comparison using multivariate logistic regression demonstrated that ACDF performed in the outpatient setting had 58% lower odds of having a major morbidity and 80% lower odds of return to the OR within 30 days. CONCLUSIONS An analysis of a nationwide, prospective quality improvement registry representing more than 250 hospitals demonstrates that 1- to 2-level ACDF can be safely performed in the outpatient ambulatory surgery setting in patients who are appropriate candidates. In an effort to decrease cost of care, surgeons can safely consider performing ACDF in an ASC environment.

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