Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies

BACKGROUND

Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes.

METHOD

We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings.

RESULTS

Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1).

CONCLUSIONS

Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing.

Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States

BACKGROUND

Stroke is a leading cause of morbidity and mortality in the United States among older adults. However, the impact of demographic and geographic risk factors remains ambiguous. A clear understanding of these associations and updated trends in stroke mortality can influence health policies and interventions.

METHODS

This study characterizes stroke mortality among older adults (age ≥55) in the US from January 1999 to December 2020, sourcing data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. Segmented regression was used to analyze trends in crude mortality rate and age-adjusted mortality rate (AAMR) per 100,000 individuals stratified by stroke subcategory, sex, ethnicity, urbanization, and state.

RESULTS

A total of 3,691,305 stroke deaths occurred in older adults in the US between 1999 and 2020 (AAMR = 233.3), with an overall decrease in AAMR during these years. The highest mortality rates were seen in nonspecified stroke (AAMR = 173.5), those 85 or older (crude mortality rate1276.7), men (AAMR = 239.2), non-Hispanic African American adults (AAMR = 319.0), and noncore populations (AAMR = 276.1). Stroke mortality decreased in all states from 1999 to 2019 with the greatest and least decreases seen in California (-61.9%) and Mississippi (-35.0%), respectively. The coronavirus pandemic pandemic saw increased stroke deaths in most groups.

CONCLUSIONS

While there's a decline in stroke-related deaths among US older adults, outcome disparities remain across demographic and geographic sectors. The surge in stroke deaths during coronavirus pandemic reaffirms the need for policies that address these disparities.

Association between intimate partner violence and pregnancy intention: evidence from the Peruvian demographic and health survey

BACKGROUND

Intimate partner violence (IPV) in Peru represents a significant public health challenge. IPV can influence women's reproductive and social behaviors, undermining fertility control, and exacerbating unintended pregnancies. Our objective was to assess the association between IPV and pregnancy intention among Peruvian women of reproductive age.

METHODS

We conducted a secondary analysis of Peru's 2020 Demographic and Family Health Survey data. The independent variable in this study was IPV against women, which includes psychological IPV, sexual IPV, and physical IPV. If a respondent experienced any of these three forms of IPV, the IPV variable was labeled as "yes"; if none were present, it was labeled as "no". The dependent variable was pregnancy intention (no vs. yes). We utilized a generalized linear model (GLM) from the Poisson family with a log link function to assess the relationship between IPV occurrences (total and each IPV type) and pregnancy intention. We report crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI).

RESULTS

We analyzed data from 8466 women aged 15 to 49. The prevalence of any IPV was 49.6% (psychological IPV: 45.8%; physical IPV: 22.2%; and sexual IPV: 4.3%). Exposure to physical IPV (aPR: 1.05; 95% CI: 1.03-1.07), psychological IPV (aPR: 1.04; 95% CI: 1.02-1.06), and sexual IPV (aPR: 1.09; 95% CI: 1.04-1.13), as well as a history of any IPV (aPR: 1.05; 95% CI: 1.02-1.07), were associated with a higher probability of not intending to become pregnant. This association persisted after adjusting for confounders like age, marital status, educational attainment, education level of the child's father, place of residence, wealth, ethnicity, and parity.

CONCLUSION

One in two Peruvian women reported experiencing IPV. An association was observed between IPV exposure and a higher probability of not holding an intention to become pregnant.

From complexity to clarity: how directed acyclic graphs enhance the study design of systematic reviews and meta-analyses

While frameworks to systematically assess bias in systematic reviews and meta-analyses (SRMAs) and frameworks on causal inference are well established, they are less frequently integrated beyond the data analysis stages. This paper proposes the use of Directed Acyclic Graphs (DAGs) in the design stage of SRMAs. We hypothesize that DAGs created and registered a priori can offer a useful approach to more effective and efficient evidence synthesis. DAGs provide a visual representation of the complex assumed relationships between variables within and beyond individual studies prior to data analysis, facilitating discussion among researchers, guiding data analysis, and may lead to more targeted inclusion criteria or set of data extraction items. We illustrate this argument through both experimental and observational case examples.

Determinants of oral health status: an ecological study in Iran

OBJECTIVES

The aim of this ecological study was to assess the association between behavioral, social position, circumstance factors, and caries experience in 35- to 44-year-old adults in Iran at a provincial level.

MATERIALS AND METHODS

The data from the 2011 Iranian Oral Health Survey were obtained from all 31 provinces across Iran on the population level. Oral health status was measured as the number of decayed, missing (MT), and filled (FT) teeth and the percentage of the population who were edentulous. Data were also gathered from each province on the percentage of smokers (Non-Communicable Diseases Risk Factors Surveillance Provincial Report 2009), per capita consumption of free sugars, concentration of fluoride in the drinking water (National and Sub-national Burden of Disease (NASBOD) Survey), number of dentists per 10,000 people, mean years of schooling of adults, expected years of schooling of children, life expectancy at birth and Gross National Income (Integrated Public Use Microdata Series, Global Data Lab). The data were analyzed using simple and multiple linear regression (α = 0.05).

RESULTS

Mean DMFT was positively associated with the percentage of smokers (B = 0.01 95%CI 0.01-0.14), and negatively with fluoride concentration (B =-2.6 95%CI -4.3- -0.96). The edentulousness percentage was positively associated with smoking (B = 0.2 (with 95%CI: 0.07-0.37) and negatively with mean years of education (B =-1.08 (with 95%CI: -2.04- -0.12). DT was associated with expected years of schooling (B =-0.6 (with 95%CI: -1.07- -0.17), negatively. Mt was negatively associated with life expectancy (B =-0.5 (with 95%CI: -1.1- -0.007), fluoride concentration (B =-3.4 (with 95%CI: -4.5- -1.5) and number of dentists per 10,000 people (B =-0.4 (with 95%CI: -0.8- -0.01). Mean Years of Schooling (B = 0.5 (with 95%CI: 0.2-0.8) and number of dentists per 10,000 people (B =-0.62 (with 95%CI: 0.51 - 0.48) were positively in associated with FT.

CONCLUSIONS

The present findings indicate that there were differences in the oral health measures and their social determinants among the provinces of Iran. Regarding the limitations of the study especially the limitation of the number of independent variables, it seems, this discrepancy could be better explained by social variables of the provinces such as income than by environmental factors.

Comparison of epidemiologic factors and eye manifestations of twin children with controls

PURPOSE

The present study was aimed to compare the epidemiological and ocular findings of twin children in comparison with non- twin age matched individuals as their control.

METHODS

In this cross sectional study, a total of 90 twins (180 cases) were compared with 182 non- twin matched children. All the study participants were examined by a comprehensive ophthalmic examination including measurement of the best corrected visual acuity (BCVA), cycloplegic refraction, ocular deviation, strabismus as well as the anterior and posterior ophthalmic examinations. Demographic information of children were collected by using an organized questionnaire. Monozygotic twins were considered if there were similarity of their phenotypic characteristics and gender, otherwise the twins were considered as dizygotic.

RESULTS

The mirror- image twins (MIT) was defined according to the laterality of symmetrical ocular characteristics of twins. In this study, the mean age of the study participants was 7.08±4.42 and 7.58±3.99 years in twins and non-twins groups, respectively (P=0.253). Among the twins, 27 (30%) were monozygotic. Refractive form of MIT was seen in 5 twins (2.8%). The spherical refractive error was more hyperopic in twins compared to non- twins (P=0.041). BCVA in the twin group (0.07±0.16LogMAR) was significantly worse than non-twins (0.03±0.08LogMAR, P < 0.001) and higher percentage of them were amblyopic (37.2% versus 10.4%, P=0.005). Twin and controls had strabismus in 17.2% and 1.6%, respectively (P < 0.001). Regarding the comparison between mono- and dizygotic twins, more significant percentage of monozygotic twins had amblyopia (P=0.004) and strabismus (P=0.047). Multivariate analysis showed significant correlation among low gestational age and female gender, low birth weight and seizure.

CONCLUSION

Female sex, less gestational age, low birth weight, amblyopia and strabismus were significantly higher in twins. Therefore, it is important to check their refractive error, amblyopia and strabismus to prevent their further complications.

Epidemiologic Aspects of Animal Bite, Rabies, and Predictors of Delay in Post-exposure Prophylaxis: A National Registry-based Study in Iran

BACKGROUND

The increasing trend in animal bites and rabies in recent years makes the disease a public health concern in Iran. The objectives of the current study were to investigate the epidemiologic aspects of the animal bite and determine the associated risk factors of the delay in initiation of post-exposure prophylaxis (PEP) against rabies in Iran.

STUDY DESIGN

National registry-based cross-sectional study.

METHODS

This study included all registered cases of animal bites between March 2021 and March 2022 at the Ministry of Health and Medical Education in Iran. We retrieved epidemiologic data on person, time, place, and PEP outcome.

RESULTS

A total of 260470 animal bite cases (approximately 334 per 100000 populations, and 11 deaths) were registered during the study period. About 77.2% of them were reported in males, 4.3% in children aged less than 5 years, 56.4% occurred in urban areas, 98% in domestic animals, and mostly in north and northeast areas of Iran. Additionally, 2.8% of cases had a delay of more than 48 hours in the initiation of PEP. Significant determinants of the increase in delay were female gender (OR=1.43, 95% CI: 1.36, 1.51, P<0.001), foreign nationality (OR=1.19, 95% CI: 1.01, 1.12, P=0.001), rural residence (OR=1.07, 95% CI: 1.01, 1.12, P=0.010), and the wild animals (OR=1.22, 95% CI: 1.12, 1.34, P<0.001).

CONCLUSION

The observed frequency of animal bites in a year indicates a serious public health concern and the need for targeted interventions, especially in at-risk areas and vulnerable populations.

[Analysis of verification results of protective effects of hearing protectors in different industries]

Objective: To get insight into the current practice of noise reduction effect of workers as they wore hearing protectors in different domestic enterprises and the possible affected factors. Methods: From October 2020 to April 2021, using a random sampling method, 1197 workers exposed to noise in petrochemical factories, textile factories, and parts manufacturing factories were selected as the study subjects. The noise reduction effect of hearing protectors worn by workers in daily use was tested using a hearing protector suitability testing system. The personal sound attenuation level (PAR) was compared among workers in three enterprises, Targeted intervention and repetitive testing were conducted for workers who did not meet the noise reduction effect required by the enterprise, and the changes in PAR of workers before and after the intervention were compared. The comparison of baseline PARs between two or more groups was performed using the Mann Whitney test, the comparison of baseline PARs with post intervention PARs was performed using the Wilcoxon signed rank sum test, and the comparison of qualitative data between two or more groups was performed using the Chi square test. Results: The median baseline PAR for all workers was 15 dB. Men, age<30 years old, education level at or above college level, working experience of 5 to 15 years, and those who used hearing protectors for 5 to 15 years had higher PARs, with statistically significant differences (P<0.05). The median difference in baseline PAR among workers from three enterprises was statistically significant (H=175.06, P<0.01). The median PAR of subjects who did not pass the baseline increased from 3 dB to 21 dB after intervention (Z=-27.92, P<0.01) . Conclusion: Some workers wearing hearing protectors do not meet the required PAR, and low PARs may be related to incorrect wearing methods and incorrect selection of hearing protectors. As a tool for testing, training, and assisting in selection, the hearing protector suitability testing system is of great significance for worker hearing protection.

Determinants and Reference Ranges of Serum Immunoglobulins in Middle-Aged and Elderly Individuals: a Population-Based Study

Purpose

In clinical practice, currently one reference range for serum immunoglobulin (Ig) A, G, and M is applied to all adults, although various factors may influence Ig serum levels. Population-based data on determinants of IgA, IgG, and IgM and recommendations for subgroup specific reference ranges are lacking. We aimed to provide an overview of determinants of IgA, IgG, and IgM in community-dwelling middle-aged and elderly individuals and explore determinants that influence Ig reference ranges.

Methods

Within the Rotterdam Study, we performed linear regression analyses for the association of demographic, lifestyle, and cardiovascular factors with serum IgA, IgG, and IgM. We furthermore calculated Ig reference ranges (based on percentiles), both overall and within relevant subgroups.

Results

We included 8768 participants (median age 62 years). IgA and IgG increased non-linearly with higher age (P < .0001 for both). Women had lower IgA (beta: − 0.24; 95% confidence interval [95% CI]: − 0.29; − 0.20) and IgG (beta: − 0.33; 95% CI: − 0.44; − 0.23), but higher IgM levels (beta: 0.08; 95% CI: 0.04;0.13) than men. Former and particularly current smoking were associated with lower IgA and IgG (betas between − 0.07 and − 1.03). Higher alcohol consumption was associated with lower IgG (beta for heavy drinking: − 0.70; 95% CI: − 0.91; − 0.48). Corticosteroid use was associated with lower IgG (beta: − 1.12; 95% CI: − 1.58; − 0.66). Associations with cardiovascular factors were heterogeneous and differed between sexes.

Conclusion

Age, sex, smoking, alcohol consumption, corticosteroid use, and cardiovascular factors are determinants that should be considered when interpreting serum Ig levels in middle-aged and elderly individuals and may require adjusted reference ranges.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10875-021-01120-5.

Epidemiologic and biologic correlates of serum HE4 and CA125 in women from the National Health and Nutritional Survey (NHANES)

OBJECTIVES

In women with ovarian cancer, tumor features largely determine serum HE4 and CA125 levels, but non-tumor factors may also influence levels and be better understood by studying determinants in a well-characterized sample of women without cancer.

METHODS

Serum HE4 and CA125 were measured in 2302 women from the 2001-2002 cohort of the National Heath and Nutritional Survey (NHANES). Publicly-available data on this cohort included demographic/reproductive variables, blood counts, and measurements of C-reactive protein (CRP), total homocysteine (tHcy), cotinine, and creatinine which were examined as predictors of HE4 and CA125 using multivariate models and correlational analyses.

RESULTS

HE4 increased non-linearly by age and current smokers had higher HE4. CA125 was lower in postmenopausal women and non-whites and trended downward with increasing BMI. Current-users of oral contraceptives (OCs) had lower HE4 and CA125; and a downward trend for CA125 was seen with increasing OC use. Pregnant women had higher CA125 and nursing women higher HE4. HE4 and CA125 were positively correlated with neutrophils, monocytes, and the neutrophil-to-lymphocyte ratio and inversely correlated with lymphocytes and the lymphocyte-to-monocyte ratio. CRP was positively correlated with both HE4 and CA125 in postmenopausal women. Strong positive correlations existed for HE4 with both tHcy and creatinine.

CONCLUSIONS

Serum levels of HE4 and CA125 are influenced by several hormonal or environmental stimuli which affect non-cancerous tissues normally expressing HE4 or CA125. Cytokine co-expression in those tissues may, in turn, affect white cell counts and account for their correlation with HE4 or CA125 levels.

[The botellón phenomenon. Descriptive analysis and possible implications from a sample of galician teenagers.]

OBJECTIVE

Botellón has established itself as a recreational ritual of great importance in the leisure of young people and it has contributed to the expansion of a worrying pattern of alcohol and other substances consumption. However, there are few papers that take an integrated approach to this issue. The aim of this work was to have new data to characterize this practice, while providing evidence of its consequences and identifying relevant prognostic factors for prevention.

METHODS

A cross-sectional study was carried out with a sample of 4,867 Galician adolescents between 12 and 18 years of age (Mean=14.68; SD=1.67). Data were collected in schools through an ad hoc questionnaire and they were analyzed through of a bivariate tabulation, with the application of the opportune contrasts according to the nature of the variables.

RESULTS

27.3% of the teenagers in the sample went to botellón during the last year. 96.6% admitted to drinking alcohol when they went to a botellón, 53.4% alcohol and tobacco and 30.2% three or more substances. This practice was associated with significantly higher rates of Intensive Alcohol Consumption (28% vs. 0.9%), as well as of consumption of risk of alcohol, cannabis and drugs in general. The modulating role of variables such as risk perception and beliefs and expectations associated with consumption, money available or time of arrival at home was also found.

CONCLUSIONS

At least 1 in 4 teenagers continue to go to botellones. This practice associated with risky consumption. The evidence found reinforces the multidimensional nature of the problem and suggests reorienting prevention policies.

Factors associated with bronchiectasis in Korea: a national database study

Background

Many important clinical features of bronchiectasis have been reported. However, the factors were evaluated using a specific disease cohort. Thus, clinical factors associated with bronchiectasis have not been well assessed in comparison to the general population. The aim of this study was to evaluate the factors associated with bronchiectasis using a national representative database.

Methods

We conducted a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey 2007–2009. To evaluate factors associated with bronchiectasis, a multivariable logistic analysis was used with adjustment for demographic and socioeconomic factors.

Results

In the present study, the prevalence of bronchiectasis was 0.4%. Compared with subjects without bronchiectasis, subjects with bronchiectasis were older (55.1 vs. 44.4 years, P<0.001) and had lower body mass index (BMI) (23.2 vs. 24.2 kg/m², P<0.001). The proportions of low family income (70.5% vs. 40.2%, P<0.001) and low educational level (less than high school) (85.3% vs. 70.6%, P=0.041) were higher in subjects with bronchiectasis than in subjects without bronchiectasis. Regarding comorbidities, subjects with bronchiectasis were more likely to have asthma (17.8% vs. 2.9%, P<0.001), previous history of pulmonary tuberculosis (TB) (43.5% vs. 5.0%, P<0.001), osteoporosis (19.1% vs. 7.8%, P=0.002), and depression (9.3% vs. 3.0%, P=0.015) compared with subjects without bronchiectasis. In addition, subjects with bronchiectasis had more respiratory symptoms and poorer quality of life measured using the EuroQoL five dimensions questionnaire (EQ-5D) index (0.87 vs. 0.93, P<0.001) than subjects without bronchiectasis. In multivariable logistic regression analysis, low family income (adjusted odds ratio, OR =3.83, 95% confidence interval, CI: 1.46–10.03), asthma (adjusted OR =3.73, 95% CI: 1.29–10.79), pulmonary TB (adjusted OR =7.88, 95% CI: 2.65–23.39), and the presence of airflow limitation (adjusted OR =2.98, 95% CI: 1.01–8.98) were independently associated with bronchiectasis.

Conclusions

Subjects with bronchiectasis suffered from more respiratory symptoms with limited physical activity and poorer quality of life than the general population. Factors independently associated with bronchiectasis were lower family income and comorbid pulmonary conditions, such as previous pulmonary TB, asthma, and airflow limitation.

A novel framework for classification of selection processes in epidemiological research

BACKGROUND

Selection and selection bias are terms that lack consistent definitions and have varying meaning and usage across disciplines. There is also confusion in current definitions between underlying mechanisms that lead to selection and their consequences. Consequences of selection on study validity must be judged on a case-by-case basis depending on research question, study design and analytical decisions. The overall aim of the study was to develop a simple but general framework for classifying various types of selection processes of relevance for epidemiological research.

METHODS

Several original articles from the epidemiological literature and from related areas of observational research were reviewed in search of examples of selection processes, used terminology and description of the underlying mechanisms.

RESULTS

We classified the identified selection processes in three dimensions: i) selection level (selection at the population level vs. study-specific selection), ii) type of mechanism (selection in exposure vs. selection in population composition), iii) timing of the selection (at exposure entry, during exposure/follow-up or post-outcome).

CONCLUSIONS

Increased understanding of when, how, and why selection occur is an important step towards improved validity of epidemiological research.

Incidence and risk factors for race-day jockey falls over fourteen years

OBJECTIVES

To determine the incidence of, and risk factors for, race-day jockey falls occurring in Thoroughbred flat and jumps (hurdle and steeplechase) racing.

DESIGN

Retrospective cohort study.

METHODS

Incidence rates for race-day jockey falls over 14 racing seasons in New Zealand (n=421,596 race-day starts) were calculated per 1000 rides. Univariable and multivariable analyses of jockey, horse and race level risk factors were conducted with Poisson regression in a generalized linear mixed model.

RESULTS

Most races (97%, n=407,948 race starts) were flat racing with 10 races/race-day, whilst most jumps races were longer and had 2 races/race-day. The rate of jockey falls was higher in steeplechase racing (99.9/1000, 95% CI 92.2-108.4) than hurdle (53.2/1000, 95% CI 48.7-58.3) and flat racing (1.2/1000, 95% CI 1.1-1.3, p<0.001). Experienced athletes (both horse and jockey) had lower IRR. In flat racing, IRR increased linearly with the number of race-day rides by the jockey. In jumps races, IRR increased with a fall in a previous race (IRR 1.5/1000, 95% CI 1.3-1.7, p<0.001). A shorter jumps race distance reduced the IRR of a jockey fall.

CONCLUSIONS

Athlete experience was associated with risk of jockey falls. The linearity of race ride number with IRR and longer distance in jumps racing, indicated that cognitive or physiological fatigue may play a role in the risk of a race-day fall. This data highlights the role sport-specific conditioning programmes may have on reducing risk.

Relevance of the first thousand days of life to the development of wheezing in children aged 6-7 years

INTRODUCTION

The first thousand days of life are a critical stage for the development of respiratory and immune systems. Many events in this period may be associated with wheezing in childhood.

OBJECTIVE

This study aimed to investigate the association between early life determinants and wheezing in children aged 6-7 years.

MATERIALS AND METHODS

Population-based case-control study using early-life related questions. We used the International Study of Asthma and Allergies in Childhood questionnaire to assess wheezing symptoms. Multiple logistic regressions were performed according to a hierarchical framework, considering the complex dynamic of wheezing/asthma and potential interaction between different levels of determination.

RESULTS

A total of 820 children were included, from which 162 reported wheezing symptoms (19.7%). Multivariable analysis identified socioeconomic conditions (OR 2.08, 95% CI 1.08-4.00), family history of asthma (OR 2.28, 95% CI 1.37-3.75), vaginal discharge that required treatment during pregnancy (OR 1.68, 95% CI 1.00-2.83), neonatal hyperbilirubinemia (OR 2.00, 95% CI 1.17-3.42), anemia and intestinal parasitosis in the first two years (OR 2.28, 95% CI 1.22-4.25; OR 1.72, 95% CI 1.02-2.92, respectively) independently associated to wheezing at 6-7 years. Intended pregnancy was associated with reduced wheezing (OR 0.47, 95% CI 0.28-0.77).

CONCLUSIONS

Several factors were associated with wheezing in childhood. Considering that intended pregnancy reduced wheezing and other associated exposures are considered modifiable, these findings may guide the planning of strategies to decrease the susceptibility to asthma symptoms in childhood.

Clinical evaluation of a novel press-fit acetabular cup using "Ein-Bild-Roentgen-Analysis" (EBRA): A positive short-term prognosis

Introduction

Demographic change and demand for high quality of life lead to increasing implantation numbers. Aim of this study was to compare the Plasmafit® cup to Allofit® and Plasmacup®.

Methods

The study included 174 patients who had received 33 Plasmacup®, 68 Allofit® and 73 Plasmafit® cup implants. These were reviewed postoperatively, after 6 months control and after 12 months.

Results

No significant progressive migration could be discovered in any of the cup systems. At each follow-up the cups showed nearly constant values.

Conclusions

All examined acetabular cups showed excellent migration behavior within the first 12 postoperative months.

Association between lifestyle, dietary, reproductive, and anthropometric factors and circulating 27-hydroxycholesterol in EPIC-Heidelberg

PURPOSE

Given that 27-hydroxycholesterol (27HC) is the first identified endogenous selective estrogen receptor modulator, the aim of this study was to investigate the extent to which dietary or lifestyle factors impact circulating 27HC concentrations in a large-scale setting.

METHODS

This cross-sectional analysis included 1,036 women aged 35-65 years who served as controls in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg breast cancer case-control study. Circulating 27HC was quantified in serum using liquid chromatography/tandem mass spectrometry. Generalized linear models were used to investigate the association between 27HC concentrations and dietary habits, and lifestyle, reproductive, and anthropometric factors.

RESULTS

Higher concentrations of 27HC were observed among postmenopausal relative to premenopausal women (geometric mean 200.5 vs. 188.4 nM, p = 0.03), whereas women reporting ever full-term pregnancy had lower concentrations of 27HC relative to never (191.4 vs. 198.6; p = 0.03). Significant trends were observed showing higher concentrations with relatively high levels of physical activity (p_trend = 0.03) and alcohol consumption (p_trend = 0.01), and women currently smoking at blood collection (p_trend < 0.01). Of the investigated dietary factors, starch (p_trend < 0.01) and thiamine (p_trend < 0.01) intakes were inversely associated with 27HC. Circulating lipid concentrations were positively associated with 27HC concentrations (all p_trend < 0.01). No significant associations were found between 27HC and factors including age at blood collection, body mass index, or use of hormone therapy or cholesterol-lowering medications.

CONCLUSION

27HC is of increasing interest for multiple chronic disease pathways. Despite significant associations found between circulating 27HC and dietary habits, reproductive factors, and modifiable lifestyle factors, circulating cholesterol, mostly low-density lipoprotein cholesterol, accounted for the majority of the variability in circulating 27HC.

Prevalence of hearing impairment and associated factors in school-aged children and adolescents: a systematic review

Introduction

Hearing impairment is one of the communication disorders of the 21st century, constituting a public health issue as it affects communication, academic success, and life quality of students. Most cases of hearing loss before 15 years of age are avoidable, and early detection can help prevent academic delays and minimize other consequences.

Objective

This study researched scientific literature for the prevalence of hearing impairment in school-aged children and adolescents, with its associated factors. This was accomplished by asking the defining question: “What is the prevalence of hearing impairment and its associated factors in school-aged children and adolescents?”

Methods

Research included the databases PubMed/MEDLINE, LILACS, Web of Science, Scopus and SciELO, and was carried out by two researchers, independently. The selected papers were analyzed on the basis of the checklist provided by the report Strengthening the Reporting of Observational Studies in Epidemiology.

Results

From the 463 papers analyzed, 26 fulfilled the criteria and were included in the review presented herein. The detection methods, as well as prevalence and associated factors, varied across studies. The prevalence reported by the studies varied between 0.88% and 46.70%. Otologic and non-otologic factors were associated with hearing impairment, such as middle ear and air passage infections, neo- and post-natal icterus, accumulation of cerumen, family history, suspicion of parents, use of earphones, age and income.

Conclusion

There is heterogeneity regarding methodology, normality criteria, and prevalence and risk factors of studies about hearing loss in adolescents and school-aged children. Nevertheless, the relevance of the subject and the necessity of early interventions are unanimous across studies.

[Socioeconomic health inequalities in the Catalan population aged 50+ during the last economic crisis]

OBJECTIVE

The short- and medium-term consequences of the economic crisis since 2008 has become a cause of concern for population health. The study's objective was to analyse health inequalities according to the socioeconomic profile of the Catalan population aged 50 year and older.

METHODS

Cross-sectional study using data from the Catalan Health Survey (ESCA) for the periods 2006 (N=6667), 2010-12 (N=4458) y 2013-15 (N=5469). The dependent variables were self-perceived health, mental health, medication intake and sedentary lifestyle and the independent variables: labour force activity status, educational level, health care coverage, household social class and household monthly income. On each dependent variable multivariate logistic analysis was conducted using Stata 14, adjusting for the remaining socioeconomic factors and other demographic variables, and estimating the average marginal effects for each socioeconomic category in the three observation moments.

RESULTS

Between 2006 and 2013-15 the difference in the probability of having less than good self-perceived health among the population with or without double health coverage reduced from 0.06 to 0.04; between the most and least educated from 0.12 to 0.08; but did not reduce between workers and non-workers. The gap according to employment status, educational levels and income in the risk of poor mental health increased between 2006 and 2010-12 from 0.08 to 0.10, from 0.10 to 0.12 and from 0.10 to 0.13, although subsequently, inequality decreased. Difference in medication intake increased by employment status (from 0.07 to 0.10) and educational level (from -0.01 to 0.03) and in sedentary lifestyles between workers and non-workers (from 0, 05 to 0.06). Socioeconomic conditions had more impact on 50-64 year olds, especially women, while social inequality declined among men.

CONCLUSIONS

Despite the crisis health generally improved, while socioeconomic health inequalities remained or reduced, barring few exceptions.

[Health literacy level and influence factors of occupational population in one province]

Objective: To understand health literacy (HL) status of occupational population in work place and provide the basis of developing for HL standards and specific intervention strategies. Methods: Being selected by stratified cluster sampling, 3507 employees in 13 companies wthin Hebei Province were investigated by questionnaire. Results: The survey was conducted with 3507 questionnaires, the valid rate was about 97.83%. There were a total of 2629 men (76.62%) and 802 women (23.38%) . The overall level of HL was 32.24%. Health literacy level (HLL) of three aspects are: basic knowledge and concepts 52.03%, healthy life-style and behavior 26.00%, and health related skills 40.25%, the HL rate of six health issues as scientific view of health, prevention of communicable diseases, prevention of chronic diseases, safety and first aid, basic medical care and health information are 61.59%, 28.62%, 21.95%, 75.20%, 32.99% and 49.17% respectively. The group aged 25-34 had the highest HLL (43.95%) ; the higher culture degree, the higher the level of health literacy (P<0.05) . The HLL of the occupational population in Hebei province was 32.24%, which was close to the HLL of the national occupational population, but higher than that of general population in Hebei province and in the whole country. Conclusions: The HLL of the occupational population in Hebei province which was close to the HLL of the national occupational population. HLL of basic knowledge and concepts is higher than that of healthy life-style and behavior and health related skills, the health literacy rate of prevention of communicable diseases and chronic diseases were low. Age, culture degree and type of industry are important influence factors.

Effects of behavioural risk factors on high-cost users of healthcare: a population-based study

OBJECTIVES

High-cost users (HCUs) are known to disproportionally incur the majority of healthcare utilization costs relative to their counterparts. A number of studies have highlighted the detrimental effects of risky health behaviours; however, only a few have demonstrated the link to HCUs, a meaningful endpoint for program and policy decision-makers. We investigated the association between health behaviour risks and downstream high-cost healthcare utilization.

METHODS

A combined cohort of participants from the Canadian Community Health Survey (CCHS) cycles 2005-2009 was linked to future population-based health administrative data in Ontario. Using person-centered costing methodology, CCHS respondents were ranked according to healthcare utilization costs and categorized as ever having HCU status in the 4 years following interview. Logistic regression models were used to estimate the association between various health behaviours on future HCU status.

RESULTS

Models estimated that smoking and physical inactivity were associated with a significant increase in the odds of becoming an HCU. Compared to individual behaviours, increasing the number of health behaviour risks significantly strengthened the odds of becoming an HCU in subsequent years.

CONCLUSION

The analyses provide evidence that upstream health behaviours affect high-cost healthcare utilization. Health behaviours are a meaningful target for health promotion programs and policies. These findings can inform decision-makers on appropriate behavioural targets for those on an HCU trajectory and promote public health efforts to support healthcare system sustainability.

A higher number of school meals is associated with a less-processed diet

OBJECTIVE

To compare the participation of food groups - fresh and minimally processed, processed, and ultra-processed - in the diet of students (n=1357) from Belo Horizonte, MG, Brazil, in accordance with the number of school meals consumed daily.

METHODS

Four groups were defined: children that did not consume school meals and children that consumed one, two, or three school meals daily. Food groups participation, in g/1000kcal, was obtained using two 24-hour recalls. Three linear regression models were analyzed, in which the consumption of each of the food groups was the dependent variable, the number of school meals was the independent variable, and sociodemographic data (gender, age, health vulnerability) and overweight condition were the control variables.

RESULTS

Children that consumed 2 or 3 school meals daily showed, respectively, 7.3% and 10.5% higher ingestion of fresh and minimally processed food in comparison to children that did not consume school meals. Moreover, ultra-processed food participation was 18.0% lower among students that consumed two school meals and 26.0% lower among children that consumed three meals daily, in comparison to students that did not consume school meals.

CONCLUSION

The study showed a possible dose-response effect in children's daily diets with two or three school meals and highlighted the relevance of the prolonged stay at school for healthy eating promotion in children.

[Studies on behavior change and related factors among female sex workers in Qingdao city of Shandong province, between 2006 and 2015]

Objective: This study aimed to analyze the behavior change and related factors regarding HIV/STD epidemics among female sex workers (FSWs) in Qingdao city. Methods: According to the requirements set by the"National HIV/AIDS sentinel surveillance program", information on demographics, sexual and drug use behaviors, and HIV-related services among female sex workers (FSWs) was collected from ten consecutive annual cross-sectional surveys from 2006 to 2015. Blood samples were drawn for serological tests on both HIV and syphilis antibodies. Results: Data from the sampled FSWs over the ten years, a higher proportion of participants who were aged 30 or more, married or cohabited and on-call FSW were followed. The prevalence of syphilis increased significantly from 1.0% (4/420) in 2006 to 13.3% (53/400) in 2015 (trend χ(2)=54.22, P<0.001). Rates on illicit drug use were ranging from 12.0% (48/400) and 55.5% (222/400) while the rate on consistent condom use with clients in the last month showed decreasing, with trend χ(2)=170.62, P<0.001. The proportion of HIV-related knowledge score ≥6 (trend χ(2)=152.96, P<0.001), or ever been tested for HIV (trend χ(2)=114.87, P<0.001) were both significantly increased over the last ten years. Between 2009 and 2015, results from the annual stratified analysis showed that the FSWs who used drugs were more likely than the FSWs who were non-drug users less consistently using condoms with clients in last month and being syphilis positive (P<0.05). On-call FSWs were more likely to be syphilis positive (P<0.05) than the non on-call FSWs. Conclusions: The prevalence of syphilis among FSWs in Qingdao city had been rising over the last ten years, with synthetic drug abuse as an important risk factor. Better targeted surveillance and intervention efforts among those drug-using FSWs seemed important to reduce the epidemics.

Factors associated with breastfeeding maintenance for 12 months or more: a systematic review

OBJECTIVE

Synthesize the information about the factors associated with maintenance of breastfeeding for 12 months or more.

DATA SOURCE

A systematic review was conducted in the Pubmed/Medline, Scielo, and Lilacs databases, including articles published in Portuguese or English since 2004 on the factors associated with breastfeeding maintenance for at least 12 months; review articles and those with qualitative design were excluded. The factors were organized into four levels, according to the chronological proximity to the outcome: distal, distal intermediate, proximal intermediate, and proximal; nationality and place/area of residence were considered contextual factors.

SUMMARY OF DATA

1174 articles were identified, of which 19 were included in this review, comprising seven cohort studies and 12 cross-sectional studies. A total of 39 of the 75 assessed factors were associated with the outcome at least once. The factors with the highest percentages of associations with maintenance of breastfeeding for 12 months or more, considering the number of times they were tested were: children whose parents are the caregivers (100%), none type of maternal exposure to smoke (54%), children and/or parents are immigrants/foreigners (50%), live in urban areas (42.9%), older maternal age (40%), married women (37.5%), higher level of maternal education (31.3%), greater parity (30.8%), and lower income (30%).

CONCLUSIONS

The maintenance of breastfeeding for 12 months or more is associated with multiple factors, emphasizing the contextual factors and those related to some maternal sociodemographic characteristics. Associations differ in effect and magnitude between the different populations studied.

Male sex and poverty predict abrupt health decline: Deficit accumulation patterns and trajectories in the KORA-Age cohort study

Ageing individuals differ both in their deficit accumulation (DA) trajectories and resulting DA patterns (improvement, stability, gradual or abrupt decline). This heterogeneity is still incompletely understood. The objectives of this study were thus to identify determinants of DA trajectories and DA patterns in people aged 65 and older. Data originates from the 2009 baseline assessment and 2012 follow-up of the KORA (Cooperative Health Research in the Region of Augsburg)-Age study from Southern Germany. DA was measured with a Frailty Index (FI). The effects of socio-demographic, socio-economic and lifestyle factors were analyzed using generalized linear mixed models and multinomial regressions. FI scores were available for 1076 participants at baseline (mean age 76years, 50% female) and 808 participants at follow-up. Higher baseline FI levels were significantly associated with higher age, female sex, lower physical activity, moderate alcohol consumption and obesity. Longitudinal increase in FI levels over 3years was 31% (CL: [-3%; 77%]) independent of all examined predictors. The most frequent DA patterns were stability (59%) and gradual decline (30%). Compared to stability, higher age, male sex and low income predicted (mostly fatal) abrupt decline. In conclusion, several factors are associated with FI levels at baseline whereas the change in FI levels over time seems hardly modifiable. Thus, future research should investigate if the same factors predicting older-age FI levels constitute predictors of DA onset earlier in life. Towards the end of life, being male with low income may increase the risk for abrupt decline, indicating need for early detection.

Correlates associated with participation in physical activity among adults: a systematic review of reviews and update

BACKGROUND

Understanding which factors influence participation in physical activity is important to improve the public health. The aim of the present review of reviews was to summarize and present updated evidence on personal and environmental factors associated with physical activity.

METHODS

MEDLINE and EMBASE were searched for reviews published up to 31 Jan. 2017 reporting on potential factors of physical activity in adults aged over 18 years. The quality of each review was appraised with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. The corrected covered area (CCA) was calculated as a measure of overlap for the primary publications in each review.

RESULTS

Twenty-five articles met the inclusion criteria which reviewed 90 personal and 27 environmental factors. The average quality of the studies was moderate, and the CCA ranged from 0 to 4.3%. For personal factors, self-efficacy was shown as the strongest factor for participation in physical activity (7 out of 9). Intention to exercise, outcome expectation, perceived behavioral control and perceived fitness were positively associated with physical activity in more than 3 reviews, while age and bad status of health or fitness were negatively associated with participation in physical activity in more than 3 reviews. For environmental factors, accessibility to facilities, presence of sidewalks, and aesthetics were positively associated with participation in physical activity.

CONCLUSIONS

The findings of this review of reviews suggest that some personal and environmental factors were related with participation in physical activity. However, an association of various factors with physical activity could not be established because of the lack of primary studies to build up the organized evidence. More studies with a prospective design should be conducted to understand the potential causes for physical activity.

Quality of life after liver transplantation: State of the art

Quality of life (QoL) after deceased donor liver transplantation is increasingly recognized as a major outcome parameter. We reviewed recent publications in this rapidly evolving field in order to summarize recent achievements in the field and to define opportunities and perspectives for research and improvement of patient care. QoL does improve after liver transplantation according to a typical pattern. During the first year, there is a significant improvement in QoL. After one year, the improvement does stabilise and tends to decline slightly. In addition to the physical condition, different psychological parameters (such as depression, anxiety, sexual function) and sociodemographic elements (professional state, sex, marital state) seem to impact QoL. Opportunities for further research are the use of dedicated questionnaires and identification of influencing factors for QoL.

Guidelines for reporting methodological challenges and evaluating potential bias in dementia research

Clinical and population research on dementia and related neurologic conditions, including Alzheimer's disease, faces several unique methodological challenges. Progress to identify preventive and therapeutic strategies rests on valid and rigorous analytic approaches, but the research literature reflects little consensus on "best practices." We present findings from a large scientific working group on research methods for clinical and population studies of dementia, which identified five categories of methodological challenges as follows: (1) attrition/sample selection, including selective survival; (2) measurement, including uncertainty in diagnostic criteria, measurement error in neuropsychological assessments, and practice or retest effects; (3) specification of longitudinal models when participants are followed for months, years, or even decades; (4) time-varying measurements; and (5) high-dimensional data. We explain why each challenge is important in dementia research and how it could compromise the translation of research findings into effective prevention or care strategies. We advance a checklist of potential sources of bias that should be routinely addressed when reporting dementia research.

What determines health-related quality of life among people living with HIV: an updated review of the literature

BACKGROUND

As infection with the Human Immunodeficiency Virus (HIV) has evolved to a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. Literature discusses different factors influencing HRQoL in this population, however, currently no consensus exists about the main determinants. In this review a clear, up-to-date overview of the determinants influencing HRQOL among people living with HIV is provided.

METHODS

All studies published before July 2013 that identified determinants of HRQoL among people living with HIV in high-income countries, were considered in this narrative review. PubMed, Web of Science and The Cochrane Library were consulted using the keywords 'determinants', 'quality of life', 'HIV' and 'AIDS'. To be included, studies should have reported overall health and/or physical/mental health scores on a validated instrument and performed multivariable regression analyses to identify determinants that independently influence perceived HRQoL.

RESULTS

In total, 49 studies were included for further analysis and they used a variety of HRQoL instruments: Medical Outcomes Study Short Form-36 or variants, Medical Outcomes Study-HIV, HIV Cost and Services Utilization Study measure, Multidimensional Quality of Life Questionnaire, HIV targeted quality of life instrument, Functional Assessment of Human Immunodeficiency Virus Infection, HIV Overview of Problems Evaluation System, EuroQol, Fanning Quality of Life scale, Health Index and PROQOL-HIV. In this review, the discussed determinants were thematically divided into socio-demographic, clinical, psychological and behavioural factors. Employment, immunological status, presence of symptoms, depression, social support and adherence to antiretroviral therapy were most frequently and consistently reported to be associated with HRQoL among people living with HIV.

CONCLUSIONS

HRQoL among people living with HIV is influenced by several determinants. These determinants independently, but simultaneously impact perceived HRQoL. Most HRQoL instruments do not capture all key determinants. We recommend that the choice for an instrument should depend on the purpose of the HRQoL assessment.

Study of risk factors for gastric cancer by populational databases analysis

AIM: To study the association between the incidence of gastric cancer and populational exposure to risk/protective factors through an analysis of international databases.

METHODS: Open-access global databases concerning the incidence of gastric cancer and its risk/protective factors were identified through an extensive search on the Web. As its distribution was neither normal nor symmetric, the cancer incidence of each country was categorized according to ranges of percentile distribution. The association of each risk/protective factor with exposure was measured between the extreme ranges of the incidence of gastric cancer (under the 25^th percentile and above the 75^th percentile) by the use of the Mann-Whitney test, considering a significance level of 0.05.

RESULTS: A variable amount of data omission was observed among all of the factors under study. A weak or nonexistent correlation between the incidence of gastric cancer and the study variables was shown by a visual analysis of scatterplot dispersion. In contrast, an analysis of categorized incidence revealed that the countries with the highest human development index (HDI) values had the highest rates of obesity in males and the highest consumption of alcohol, tobacco, fruits, vegetables and meat, which were associated with higher incidences of gastric cancer. There was no significant difference for the risk factors of obesity in females and fish consumption.

CONCLUSION: Higher HDI values, coupled with a higher prevalence of male obesity and a higher per capita consumption of alcohol, tobacco, fruits, vegetables and meat, are associated with a higher incidence of gastric cancer based on an analysis of populational global data.

Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008-2009 Korea National Health and Nutrition Examination Survey

AIM

We examined the prevalence and factors associated with diabetic retinopathy (DR) in a Korean adult population.

METHODS

Fundus examination data from 10,345 people in the fourth Korea National Health and Nutrition Examination Survey from 2008 to 2009 were examined. For each participant, one 45° nonmydriatic digital retinal image, centered on the fovea, was taken per eye. DR was defined as the presence of one or more retinal microaneurysms or retinal blot hemorrhages with or without more severe lesions.

RESULTS

The weighted prevalence of DR was 0.9% (95% CI, 0.7-1.1) in a Korean adult population and 11.0% (95% CI, 8.9-13.6) in Korean adults with diabetes. In a logistic regression analysis, only HbA1c and diabetes duration were independently associated with DR; the other variables examined, including age, gender, exercise, current smoking, heavy alcohol drinking, presence of hypertension, total cholesterol, triglycerides, high-density lipoprotein cholesterol, anti-lipid medication, oral anti-diabetes treatment, and insulin treatment, were not associated with DR.

CONCLUSIONS

According to these national survey data, 1 in 10 people with diabetes has diabetic retinopathy. Glycemic control is the most important factor for preventing retinopathy in patients with diabetes.

Performance of six diagnostic tests to screen for Chagas disease in blood banks andprevalence of Trypanosoma cruzi infection among donors with inconclusive serologyscreening based on the analysis of epidemiological variables

OBJECTIVE

The frequent occurrence of inconclusive serology in blood banks and the absence of a gold standard test for Chagas'disease led us to examine the efficacy of the blood culture test and five commercial tests (ELISA, IIF, HAI, c-ELISA, rec-ELISA) used in screening blood donors for Chagas disease, as well as to investigate the prevalence of Trypanosoma cruzi infection among donors with inconclusive serology screening in respect to some epidemiological variables.

METHODS

To obtain estimates of interest we considered a Bayesian latent class model with inclusion of covariates from the logit link.

RESULTS

A better performance was observed with some categories of epidemiological variables. In addition, all pairs of tests (excluding the blood culture test) presented as good alternatives for both screening (sensitivity > 99.96% in parallel testing) and for confirmation (specificity > 99.93% in serial testing) of Chagas disease. The prevalence of 13.30% observed in the stratum of donors with inconclusive serology, means that probably most of these are non-reactive serology. In addition, depending on the level of specific epidemiological variables, the absence of infection can be predicted with a probability of 100% in this group from the pairs of tests using parallel testing.

CONCLUSION

The epidemiological variables can lead to improved test results and thus assist in the clarification of inconclusive serology screening results. Moreover, all combinations of pairs using the five commercial tests are good alternatives to confirm results.