Structural equation modeling of latent growth curves of weight gain among treated tuberculosis patients

Latent class trajectories of biochemical parameters and their relationship with risk of mortality in ICU among acute organophosphorus poisoning patients

Acute poisoning is a global public health challenge. Several factors played role in high mortality among acute organophosphorus poisoning (OP) poisoning patients including clinical, vitals, and biochemical properties. The traditional analysis techniques use baseline measurements whereas latent profile analysis is a person-centered approach using repeated measurements. To determine varying biochemical parameters and their relationship with intensive care unit (ICU) mortality among acute organophosphorus poisoning patients through a latent class trajectory analysis. The study design was a retrospective cohort and we enrolled data of 299 patients admitted between Aug’10 to Sep’16 to ICU of Dr. Ruth K. M. Pfau, Civil Hospital, Karachi. The dependent variable was ICU-mortality among OP poisoning patients accounting for ICU stay, elapsed time since poison ingestion, age, gender, and biochemical parameters (including electrolytes (potassium, chloride, sodium), creatinine, urea, and random blood sugar). Longitudinal latent profile analysis is used to form the trajectories of parameters. In determining and comparing the risk of ICU-mortality we used Cox-Proportional-Hazards models, repeated measures and trajectories were used as independent variables. The patients’ mean age was 25.4 ± 9.7 years and ICU-mortality was (13.7%, n = 41). In trajectory analysis, patients with trajectories (normal-increasing and high-declining creatinine, high-remitting sodium, normal-increasing, and high-remitting urea) observed the highest ICU-mortality i.e. 75% (6/8), 67% (2/3), 80% (4/5), 75% (6/8), and 67% (2/3) respectively compared with other trajectories. On multivariable analysis, compared with patients who had normal consistent creatinine levels, patients in normal-increasing creatinine class were 15 times [HR:15.2, 95% CI 4.2–54.6], and the high-declining class was 16-times [HR 15.7, 95% CI 3.4–71.6], more likely to die. Patients in with high-remitting sodium, the trajectory was six-times [HR 5.6, 95% CI 2.0–15.8], normal-increasing urea trajectory was four times [HR 3.9, 95% CI 1.4–11.5], and in extremely high-remitting urea trajectory was 15-times [HR 15.4, 95% CI 3.4–69.7], more likely to die compared with those who were in normal-consistent trajectories of sodium and urea respectively. Among OP poisoning patients an increased risk of ICU-mortality were significantly associated with biochemical parameters (sodium, urea, creatinine levels) using latent profile technique.

Emotional Well-being During the First Four Months of COVID-19 in the United States

Relative to younger adults, older adults have demonstrated higher emotional well-being in the face of the threats of COVID-19 (e.g., Bruine de Bruin in J Gerontol 10.1093/geronb/gbaa074, 2020) and other events (Bonanno and Diminich in J Child Psychol Psychiatry 54:378–401, 2013). Thus, we predicted that levels of well-being would show minimal change in the first 4 months of COVID-19, with older adults faring better than younger adults. Adults (N = 325, M age = 39.7, SD = 12.3) were surveyed before the pandemic began and at four additional time points throughout the first 4 months of the COVID-19 outbreak in the United States. Participants provided demographic information and completed measures of positive and negative affect. Latent growth curves were used to analyze changes in well-being over time, with age as a covariate. There was a significant linear increase in positive affect. Older age was positively associated with initial levels, but age was not associated with the slope. There was a significant curvilinear pattern in negative affect, with an initial increase, which, although remaining elevated, exhibited slow decreases over time. Age was significantly and negatively associated with initial negative affect, but age did not influence the shape or rate of change over time. We detected changes in both positive affect and negative affect during the first 4 months of COVID-19. The magnitude of these changes suggests that the stress of COVID-19 does not lead to an immediate decrease in well-being. Moreover, although older adults showed higher positive affect and lower negative affect relative to other adults, age differences in the trajectory of change did not emerge. Delayed and long-term effects on well-being and whether those effects are age-invariant should be examined over longer periods of time.

Trajectories of vital status parameters and risk of mortality among acute organophosphorus poisoning patients - a latent class growth analysis

Background

Acute organophosphorus (OP) poisoning is one of the major causes of mortality among patients presenting to emergency departments in developing countries. Although various predictors of mortality among OP poisoning patients have been identified, the role of repeated measurements of vital signs in determining the risk of mortality is not yet clear.

Therefore, the present study examined the relationship between trajectories of vital signs and mortality among OP poisoning patients using latent class growth analysis (LCGA).

Methods

This was a retrospective cohort study using data for 449 OP poisoning patients admitted to Civil-Hospital Karachi from Aug’10 to Sep’16. Demographic data and vital signs, including body temperature, blood pressure, heart rate, respiratory rate, and partial-oxygen pressure, were retrieved from medical records. The trajectories of vital signs were formed using LCGA, and these trajectories were applied as independent variables to determine the risk of mortality using Cox-proportional hazards models. P-values of < 0.05 were considered statistically significant.

Results

Data for 449 patients, with a mean age of 25.4 years (range 13–85 years), were included. Overall mortality was 13.4%(n = 60). In trajectory analysis, a low-declining systolic blood pressure, high-declining heart rate trajectory, high-remitting respiratory rate trajectory and normal-remitting partial-oxygen pressure trajectory resulted in the greatest mortality, i.e. 38.9,40.0,50.0, and 60.0%, respectively, compared with other trajectories of the same parameters. Based on multivariable analysis, patients with low-declining systolic blood pressure were three times [HR:3.0,95%CI:1.2–7.1] more likely to die compared with those who had a normal-stable systolic blood pressure. Moreover, patients with a high-declining heart rate were three times [HR:3.0,95%CI:1.5–6.2] more likely to die compared with those who had a high-stable heart rate. Patients with a high-remitting respiratory rate were six times [HR:5.7,95%CI:1.3–23.8] more likely to die than those with a high-stable respiratory rate. Patients with normal-remitting partial oxygen pressure were five times [HR:4.7,95%CI:1.4–15.1] more likely to die compared with those who had a normal-stable partial-oxygen pressure.

Conclusion

The trajectories of systolic blood pressure, heart rate, respiratory rate and partial-oxygen pressure were significantly associated with an increased risk of mortality among OP poisoning patients.

Business Owner-Managers' Job Autonomy and Job Satisfaction: Up, Down or No Change?

The current study developed a dynamic model which identified a pattern of change in small business owner-managers' job autonomy and job satisfaction separately through the trend analyses (linear, quadratic, and cubic trends). The current study then tested the associations between the growth models of job autonomy and job satisfaction. The study utilized data from an Australian sample over 9 years with a total sample of 1,044 self-employed individuals. In brief, the findings illustrate a curvilinear relationship (cubic and non-monotonic) between changes in job autonomy and job satisfaction. Further, the change rate of job satisfaction was faster among small business owner-managers who perceived greater fluctuation of job autonomy, compared to those who perceived lesser shifts in job autonomy.

BIOIMPEDANCE MARKERS AND TUBERCULOSIS OUTCOME AMONG HIV-INFECTED PATIENTS

Background

The changes in body composition markers (weight, fat mass, lean mass, and BMI) over time can be associated with TB treatment outcome among HIV-infected patients. The aim of this study was to investigate whether changes in fat mass and lean mass were associated with the treatment response among patients with HIV infection and pulmonary tuberculosis.

Materials and Methods

This was a prospective cohort study. Data from HIV-infected patients commencing TB therapy were analyzed. This included body weight measurement using bioimpedance equipment at baseline, one month, and two months after starting TB treatment.

Results

The study was conducted in 125 patients, 17 patients (13.6%) died during treatment, of which 5 died during the first month of treatment, 4 during the second month and 8 after the second month. The group of patients with good response, increased their weight by 1.3 kg (p <0.001) at the end of the first month of TB treatment and 2.6 kg in the second month (p <0.001), and body fat increase was 1.2 Kg (p <0.001) and 2.3 kg (p <0.001), the first and second month respectively. The group of patients who died had lost 2.1 kg fat mass after the first month (p <0.001) and 3.7 kg in the second month (p <0.001).

Conclusions

Our results show that the weight change during TB treatment (increased fat mass) helps us predict therapeutic response. Weight loss during the first month of starting therapy should be evaluated thoroughly to identify the probable cause of treatment failure.