Performance of a household tuberculosis exposure survey among children in a Latin American setting

OBJECTIVE: To evaluate the performance of a survey that quantifies the intensity of household tuberculosis (TB) exposure among children.METHODS: Children aged 0–14 years in Lima, Peru, with ≥1 signs and/or symptoms of TB and a history of contact with an adult TB patient were included. The 10-question survey was administered to caregivers and addressed sleep proximity, frequency of exposure, and infectiousness of the contact. Infection status was determined using tuberculin skin tests (TSTs). The exposure scale was evaluated for association with TST positivity using mixed-effects regression analyses.RESULTS: The exposure score was significantly associated with TST positivity (age-adjusted odds ratio [aOR] 1.14, 95%CI 1.02–1.28). We observed a stronger association with TST positivity in children aged ≤5 years; (aOR 1.23, 95%CI 1.07–1.41) and no association in children 6–14 years of age (aOR 0.99, 95%CI 0.82–1.20).CONCLUSION: This survey was easy to use and modestly successful in predicting TST positivity in children aged ≤5 years. It may be a useful resource for clinicians for diagnosing TB in children, and for national TB programs aiming to scale up preventive therapy initiatives.

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Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa278 ◽

2020 ◽

Author(s):

Elaine C Khoong ◽

Valy Fontil ◽

Natalie A Rivadeneira ◽

Mekhala Hoskote ◽

Shantanu Nundy ◽

...

Keyword(s):

Logistic Regression ◽

Randomized Trial ◽

Odds Ratio ◽

Primary Outcome ◽

Mixed Effects ◽

Regression Analyses ◽

Diagnostic Confidence ◽

Diagnostic Uncertainty ◽

Intervention Impact ◽

High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

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22. Patient Satisfaction Remains Unchanged Following Implementation of an Antibiotic Stewardship Intervention in Primary Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.021 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S11-S12

Author(s):

Zachary Hostetler ◽

Keith W Hamilton ◽

Leigh Cressman ◽

McWelling H Todman ◽

Ebbing Lautenbach ◽

...

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Odds Ratio ◽

Logistic Regression Model ◽

Adjusted Odds Ratio ◽

Primary Care Providers ◽

Mixed Effects ◽

Antibiotic Prescribing ◽

Care Providers ◽

Targeted Intervention

Abstract Background Inappropriate prescription of antibiotics for respiratory tract infections (RTIs) in ambulatory care settings is common, increasing the risk of adverse health outcomes. Behavioral and educational interventions targeting primary care providers (PCPs) have shown promise in reducing inappropriate antibiotic prescribing for RTIs. While one perceived barrier to such interventions is the concern that these adversely impact patient satisfaction, few data exist in this area. Here, we examine whether a recent PCP-targeted intervention that significantly reduced antibiotic prescribing for RTIs was associated with a change in patient satisfaction. Methods The PCP-targeted intervention involved monthly education sessions and peer benchmarking reports delivered to 31 clinics within an academic health system, and was previously shown to reduce antibiotic prescribing. Here, we performed a retrospective, secondary analysis of Press Ganey (PG) surveys associated with the outpatient encounters in the pre- and post-intervention periods. We evaluated the impact on patient perceptions of PCPs based on provider exposure to the intervention using a mixed effects logistic regression model. Results There were 17,416 out of 197,744 encounters (8.8%) with associated PG surveys for the study time period (July 2016 to September 2018). In the multivariate model, patient satisfaction with PCPs was most strongly associated with patient-level characteristics (age, race, health status, education status) and survey-level characteristics (survey response time, patient’s usual provider) (Figure 1). Satisfaction with PCPs did not change following delivery of the provider-based intervention even after adjusting for patient- and survey-level characteristics [adjusted odds ratio (95% CI): 1.005 (0.928, 1.087)]. However, a small increase in satisfaction associated with receiving antibiotics during the entire study period was seen [adjusted odds ratio (95% CI): 1.146 (1.06, 1.244)]. Figure 1: Association of a provider-targeted intervention as well as patient, provider, and practice characteristics with patient satisfaction in a multivariable mixed effects logistic regression model Conclusion Patient perceptions of PCPs remain unchanged following the delivery of a behavioral and educational intervention to primary care providers that resulted in observable decreases in antibiotic prescribing practices for RTIs. Disclosures All Authors: No reported disclosures

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Early Neurological Complications after Cardiac/Aortic Surgery with Cardiopulmonary Bypass: Incidence and Risk Factors

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.07.11427 ◽

2021 ◽

Vol 104 (7) ◽

pp. 1060-1066

Keyword(s):

Cardiopulmonary Bypass ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Artery Bypass ◽

Aortic Surgery ◽

Neurological Complications ◽

Serum Lactate ◽

Valve Surgery ◽

History Of ◽

Bypass Technique

Objective: To examine the incidence and risk factors of early neurological complications after cardiac or aortic surgery using cardiopulmonary bypass technique in King Chulalongkorn Memorial Hospital, Thailand. Materials and Methods: The present study was a retrospective cohort study. Clinical data of adult patients that underwent cardiac or aortic surgery using cardiopulmonary bypass technique in 2018 were reviewed from the electronic medical record in the authors’ center. Results: Early postoperative neurological complications occurred in 33 (8.3%) of the 400 patients. Twenty of them (60.6%) had non-specific encephalopathy, three (9.1%) had hypoxic-ischemic encephalopathy, five (15.2%) had provoked seizure, four (12.1%) had cerebral infarction, and one (3.0%) had intracranial hemorrhage. Associated clinical factors included history of essential hypertension [adjusted odds ratio 3.448 (95% CI 1.266 to 9.391)], combined coronary artery bypass grafting and valve surgery [adjusted odds ratio 4.759 (95% CI 1.182 to 19.170)], multi-valve surgery [adjusted odds ratio 5.201 (95% CI 1.227 to 22.049)], aortic surgery [adjusted odds ratio 17.260 (95% CI 4.168 to 71.468)], higher midazolam dosage [adjusted odds ratio 1.009 (95% CI 1.002 to 1.015)], higher serum lactate prior to discontinuing cardiopulmonary bypass [adjusted odds ratio 1.263 (95% CI 1.093 to 1.460)], and presence of intraoperative intra-aortic balloon pump use [adjusted odds ratio 6.160 (95% CI 1.883 to 20.150)]. Conclusion: Early postoperative neurological complications rate of cardiac or aortic surgery using cardiopulmonary bypass technique in the present study settings was 8.3%. Preoperative and intraoperative clinical factors associated with such complications were the history of essential hypertension, the type of surgery such as combined coronary artery bypass grafting and valve surgery, multi-valve surgery, and aortic surgery, the higher midazolam dosage, the higher serum lactate prior to discontinuing cardiopulmonary bypass, and the presence of intraoperative intra-aortic balloon pump use. Keywords: Cardiac surgery; Aortic surgery; Cardiopulmonary bypass; Postoperative neurological complications; Encephalopath

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Relationship between Periodontitis and Glaucoma: A Cross-Sectional Study

Journal of Ophthalmology ◽

10.1155/2020/5384602 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Soo Hwan Byun ◽

Dae Myoung Yoo ◽

Minwook Chang ◽

Hyo Geun Choi ◽

Seok Jin Hong

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Epidemiological Data ◽

Cross Sectional Study ◽

Sectional Study ◽

Epidemiology Study ◽

Chi Square ◽

Cross Sectional ◽

History Of ◽

And Control

The objective of this cross-sectional study was to evaluate the association between periodontitis and glaucoma. This prospective cohort study used epidemiological data from the Korean Genome and Epidemiology Study performed between 2004 and 2016. Among 173,209 participants, 9572 patients with periodontitis and 115,332 controls (nonperiodontitis) were selected. We analysed the history of glaucoma in periodontitis and control participants. The participants were interviewed regarding their history of hypertension, diabetes mellitus, hyperlipidaemia, periodontitis, glaucoma, smoking, and alcohol consumption by trained interviewers. A logistic regression model was created to analyse the odds ratio of having a history of glaucoma among patients with periodontitis. Two-tailed analyses using chi-square and independent t-tests were used for statistical analysis. The adjusted odds ratio of periodontitis as a risk factor for glaucoma was 3.44 (95% confidence interval = 2.99–3.97, p < 0.001 ). This study demonstrated that glaucoma was associated with periodontitis.

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Association Study between the Polymorphisms of Matrix Metalloproteinase (MMP) Genes and Idiopathic Recurrent Pregnancy Loss

Genes ◽

10.3390/genes10050347 ◽

2019 ◽

Vol 10 (5) ◽

pp. 347 ◽

Cited By ~ 2

Author(s):

Han Sung Park ◽

Ki Han Ko ◽

Jung Oh Kim ◽

Hui Jeong An ◽

Young Ran Kim ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Pregnancy Loss ◽

Adjusted Odds Ratio ◽

Recurrent Pregnancy Loss ◽

Proteolytic Enzymes ◽

Nucleotide Polymorphisms ◽

Genotype Combination ◽

History Of ◽

Consecutive Pregnancy

Recurrent pregnancy loss (RPL) refers to two or more consecutive pregnancy losses. It is estimated that fewer than 5% of women experience RPL. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that play important roles in providing a safe and conducive environment for the stable development of the fetus. In this case-control study, we evaluated the associations between RPL and single nucleotide polymorphisms (SNPs) in MMP-8 and MMP-27. We recruited 375 Korean women with a history of RPL and 240 ethnically-matched healthy parous controls, and we performed genotyping for the MMP-8 rs2509013 C>T, MMP-8 rs11225395 G>A, and MMP-27 rs3809017 T>C polymorphisms. All SNPs were genotyped via the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) assay. In the genotype frequency analyses, the TT genotype of the MMP-8 rs2509013 C>T (age-adjusted odds ratio, 0.415; 95% confidence interval, 0.257–0.671; P = 0.0003) and TC genotype of MMP-27 rs3809017 T>C (age-adjusted odds ratio, 0.681; 95% confidence interval, 0.483–0.961; P = 0.029) were associated with decreased RPL susceptibility. Moreover, these trends were maintained in the haplotype and genotype combination analyses. Interestingly, amongst the RPL patients, higher levels of homocysteine (P = 0.042) and uric acid (P = 0.046) were associated with MMP-27 rs3809017 T>C. In conclusion, the two polymorphisms of MMP-8 and MMP-27 were significantly associated with RPL risk, both individually and in combination. Therefore, these two polymorphisms are potential biomarkers for RPL susceptibility.

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Predicting Smoking Status by Symptoms of Depression for U.S. Adolescents

Psychological Reports ◽

10.2466/pr0.1994.75.2.911 ◽

1994 ◽

Vol 75 (2) ◽

pp. 911-914 ◽

Cited By ~ 18

Author(s):

Min Qi Wang ◽

Eugene C. Fitzhugh ◽

R. Carl Westerfield ◽

James M. Eddy

Keyword(s):

Logistic Regression ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Smoking Status ◽

National Sample ◽

Regression Analyses ◽

Symptoms Of Depression ◽

The Future ◽

Predictive Relationships

This study examined the predictive relationships between adolescents' smoking and symptoms of depression. A national sample of 6,900 adolescents, ages 14 to 18 years, were selected for analysis. Variables of interest included measures for smoking status and symptoms of depression. Odds ratio and adjusted odds ratio from logistic regression analyses indicated that more of the 885 smokers than of the 6,015 nonsmokers reported feelings of unhappiness, sadness, or depression, hopelessness about the future, and having trouble going to sleep.

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Effect of Immediate Resuscitation on Children With Submersion Injury

PEDIATRICS ◽

10.1542/peds.94.2.137 ◽

1994 ◽

Vol 94 (2) ◽

pp. 137-142

Author(s):

Demetrios N. Kyriacou ◽

Edgardo L. Arcinue ◽

Corinne Peek ◽

Jess F. Kraus

Keyword(s):

Neurological Outcome ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Neurological Impairment ◽

Study Objective ◽

Paramedical Personnel ◽

Anoxic Encephalopathy ◽

History Of ◽

And Gender ◽

Historical Accounts

Study objective. To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury. Design. A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio. Participants. The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California. Measurements and main results. All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 < OR < 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy. Conclusion. Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.

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Timing of β-Blocker Reintroduction and the Occurrence of Postoperative Atrial Fibrillation after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000003064 ◽

2020 ◽

Vol 132 (2) ◽

pp. 267-279 ◽

Cited By ~ 4

Author(s):

Camille Couffignal ◽

Julien Amour ◽

Nora Ait-Hamou ◽

Bernard Cholley ◽

Jean-Luc Fellahi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Postoperative Atrial Fibrillation ◽

Secondary Outcome ◽

Outcome Relationship ◽

History Of ◽

Β Blocker ◽

Β Blockers

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of β-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. Methods This multicenter prospective French cohort study included patients on β-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of β-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of β-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). Results Of 663 patients, β-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of β-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. Conclusions β-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) β-blocker reintroduction after cardiac surgery.

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A novel adipose hormone asprosin as a potential breast cancer marker

10.21203/rs.3.rs-897211/v1 ◽

2021 ◽

Author(s):

Sibel OZCAN ◽

Nilgun YILDIRIM ◽

Mesut YUR ◽

Mehmet Ridvan OZDEDE ◽

Mete OZCAN

Keyword(s):

Breast Cancer ◽

Odds Ratio ◽

Roc Analysis ◽

Gynecological Cancer ◽

Multivariable Analysis ◽

Serum Levels ◽

Regression Analyses ◽

Obese Adults ◽

Potential Association ◽

History Of

Abstract PurposeAsprosin is a recently discovered hormone released by white adipose tissue (WAT) that is typically significantly elevated in obese adults. Consequently, the adverse effects of increasing WAT in obesity during breast cancer (BC) development and progression have attracted interest of researchers and clinical practitioners. Thus, the aim of the present study was to determine whether the asprosin levels are associated with the probability of women having BC. MethodsThe study sample comprised of 45 female patients diagnosed with invasive BC and 42 healthy women that served as controls. Asprosin serum level was quantified in all subjects by ELISA, whereas serum levels of CEA and CA 15–3 were measured using an immunology analyzer. The potential association between asprosin and BC was examined through logistic regression analyses, while samples provided by BC patients were further subjected to ROC analysis to assess the diagnostic accuracy of asprosin. ResultsAsprosin levels were significantly higher in BC patients compared to healthy controls (2.38 ± 0.54 vs. 1.39 ± 0.53 ng/mL, p < 0.001). Multivariable analysis showed that the increased asprosin levels were associated with a significantly higher risk of breast cancer after adjustments for family history of breast and/or gynecological cancer, dyslipidemia, and BMI (odds ratio = 157.92; 95% confidence interval = 17.22−1447.96). When 1.78 ng/mL was adopted as the cut-off value, AUC, sensitivity, and specificity of asprosin for BC were 0.943, 91.1%, and 88.1%, respectively. ConclusionsOur findings demonstrate that asprosin is elevated in BC and can thus be an appropriate candidate for breast cancer diagnosis.

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Effectiveness of antiviral treatment in preventing death in severe hospitalised influenza cases over six seasons

Epidemiology and Infection ◽

10.1017/s0950268818000663 ◽

2018 ◽

Vol 146 (7) ◽

pp. 799-808 ◽

Cited By ~ 10

Author(s):

A. Domínguez ◽

A. Romero-Tamarit ◽

N. Soldevila ◽

P. Godoy ◽

M. Jané ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Odds Ratio ◽

Clinical Characteristics ◽

Adjusted Odds Ratio ◽

Clinical Symptoms ◽

Antiviral Treatment ◽

Neuraminidase Inhibitor ◽

Mixed Effects ◽

Hospitalised Patients

AbstractWe investigated the predictors of neuraminidase inhibitor (NAI) treatment in severe hospitalised influenza cases and the association between antiviral treatment and mortality. An observational epidemiological study was carried out in Catalonia (Spain) during 2010–2016 in patients aged ⩾18 years. Severe hospitalised cases of laboratory-confirmed influenza requiring hospitalisation were included. We collected demographic, virological and clinical characteristics. Mixed-effects logistic regression was used to estimate crude and adjusted odds ratio (aOR). We included 1727 hospitalised patients, of whom 1577 (91.3%) received NAI. Receiving NAI ⩽48 h after onset of clinical symptoms (aOR 0.37, 95% confidence interval (CI) 0.22–0.63), ⩽3 days (aOR 0.49, 95% CI 0.30–0.79) and ⩽5 days (aOR 0.50, 95% CI 0.32–0.79) was associated with a reduction in deaths. In patients admitted to the intensive care unit (ICU) (595; 34.5%), treatment ⩽48 h (aOR 0.32, 95% CI 0.14–0.74), ⩽3 days (aOR 0.44, 95% CI 0.20–0.97) and ⩽5 days (aOR 0.45, 95% CI 0.22–0.96) was associated with a reduction in deaths. Receiving treatment >5 days after onset of clinical symptoms was not associated with the reduction in deaths in hospitalised patients or those admitted to the ICU. NAI treatment of hospitalised patients with severe confirmed influenza was effective in avoiding death, mainly when administered ⩽48 h after symptom onset, but also when no more than 5 days had elapsed.

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