Incidence and predictors of anemia among adults on HIV care at South Gondar Zone Public General Hospital Northwest Ethiopia, 2020; retrospective cohort study

Background Anemia is a major public health problem worldwide which accounts 24.8% of the population. Subsequently, anemia is a leading killer of people living with human immunodeficiency virus and many of these deaths occur in developing countries including Ethiopia. Cross sectional studies have done on anemia and human immunodeficiency virus. However, there is limited study on incidence of anemia and its predictors among adults on HIV care, especially no survival study has been conducted in the study area. Objective To assess incidence and predictors of anemia among adults on Human immunodeficiency virus care. Methods An institution-based retrospective cohort study was conducted among 434 adults on HIV care from January 1st 2015 to December 30th 2019 at Debre Tabor Referral Hospital. A computer-generated simple random sampling technique was employed to select the study participants. Ethical clearance was obtained from the Institutional Review Board of Bahir Dar University, and also, we got implied consent to review charts from the concerned bodies in the hospital. Data were entered using Epi-data version 3.1 and analyzed by using STATA version 14.0. A Kaplan Meier survival curve was utilized to estimate anemia free survival time. Bivariable and Multivariable Cox proportional hazards model were fitted to identify predictors of anemia. Results The overall incidence density rate of anemia was 6.27 (95% CI: 0.051, 0.077) per 100 person years. Clinical stage III/IV (AHR = 1.04; 95% CI = 1.02, 1.06), Body Mass Index less than 18.5 kg/m2 (AHR = 3.11; 95% CI = 1.56, 6.22), serum creatinine greater than 1.1 IU/L(AHR = 2.07; 95% CI = 1.12, 3.81) and fair/poor level of adherence(AHR = 1.05; 95% CI = 1.03, 1.07) were statistically significant predictors of anemia while increased anti-retroviral treatment duration (AHR = 0.98; 95% CI = 0.97, 0.99) decrease the risk of anemia at 95% confidence level. Conclusion The overall incidence density rate of anemia was high. Patients with clinical stage III/IV, body mass index < 18.5 kg/m2, serum creatinine greater than 1.1 IU/L and fair/poor level of adherence were significant predictors of anemia while increased antiretroviral treatment duration had decreased the risk of anemia. Recommendation Even if the overall incidence rate of anemia was lower as compared to previous studies in Ethiopia, still the incidence of anemia was high. So, prevention measures should be taken beside with HIV care especially within 6-months ART initiation.

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p&lt;0.001, respectively).Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.

Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia

Background Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul’s Hospital Millennium Medical College, 2012 to 2019. Methods A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual. Results In this study, 61 (10%) children died making the incidence density rate of death 5.6 (95% CI: 4.4, 7.2) per 1000 child-days. Shock (Adjusted Hazard Ratio) [AHR] =3.2; 95% CI: 1.6, 6.3)), IV fluid infusion (AHR = 5.2; 95% CI: 2.4, 10.4), supplementing F100 (AHR = 0.12; 95%CI: 0.06, 0.23) and zinc (AHR = 0.45; 95% CI: 0.22, 0.93) were determinants of death. Conclusion The overall proportion of deaths was within the range put forth by the Sphere standard and the national SAM management protocol. Shock and IV fluid infusion increased the hazard of death, whereas F100 & zinc were found to decrease the likelihood death. Children with SAM presented with shock should be handled carefully and IV fluids should be given with precautions.

Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background. Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. Methods. Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. Results. Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. Conclusion. The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities.

823. How to Compare standardized Healthcare-associated Infection (HAI) Rates? Benchmark 2D and 3D

Background External benchmarking involves comparing standardized data on HAI rates in one hospital or healthcare facility in relation to others. Here we present two epidemiological graphical tools, 2D and 3D benchmarks, which summarize the efficiency in preventing main infections in a Medical/Surgical Intensive Care Unit (MSICU). Methods The 3D benchmark graph considers the incidence density rate of ventilator-associated pneumonias (VAP cases per 1,000 ventilator-days) as the X-Axis, the incidence density rate of central line-associated primary bloodstream infections (CLABSI cases per 1,000 central line-days) as the Y-Axis, and the incidence density rate of urinary catheter-associated urinary tract infections (CAUTI per 1,000 urinary catheter-days) as the Z-Axis. Efficiency in preventing infection (e) considers the zero rate to be 100% efficient (e=100%) and the highest available benchmark rate to be “zero” efficiency (RMax: e=0%). From this definition, the efficiency of any MSICU (0% ≤ e ≤ 100%) is obtained using a linear interpolation function, from the rate observed in the MSICU under evaluation (Rx): e = 100x(RMax – Rx)/RMax. If Rx &gt; RMax, then RMax = Rx. The 3D benchmark is build by calculating the preventing infection (e) for each infection (VAP, CLABSI, and CAUTI) for all benchmarks and for the MSICU under evaluation. In the 3D Benchmark, three control volumes are created: “Infection Control Urgency” volume, “Infection Control Excellence” volume, “Infection Prevention Opportunity” volume. Benchmark 2D considers only the VAP density rate as X-Axis, and the CLABSI density rate as Y-Axis. In this graph, five control regions are created: 1=excellence in the control of VAP+CLABSI; 2=excellence in VAP control and opportunity for CLABSI prevention; 3=excellence in CLABSI control and opportunity to prevent VAP; 4=opportunity to prevent VAP+CLABSI; 5=urgency in infection control. Results Graph parameters were based on NHSN data from the device-associated module, NOIS Project, Anahp, CQH, and GVIMS/GGTES/ANVISA (Brazilian benchmarks), and El-Saed et al. benchmarks. We applied the 2D/3D benchmarks to several Brazilian ICUs. 2D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019: UCO & UTI 19 =excellence in CLABSI control and opportunity to prevent VAP; UTI 20=excellence in VAP control and opportunity for CLABSI prevention; UTI 18=opportunity to prevent VAP+CLABSI. 3D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019 2D benchmark for the MSICUs from Vera Cruz Hospital, Brazil, Jan-Dez/2019: CTI 3.o Andar =excellence in the control of VAP+CLABSI; CTI 1.o Andar=excellence in VAP control and opportunity for CLABSI prevention. Conclusion 2D and 3D benchmarks are easy to understand and summarize the efficiency in prevention the mains infections of MSICU. Disclosures All Authors: No reported disclosures

Dementia and vagotomy in Taiwan: a population-based cohort study

ObjectiveTruncal vagotomy is associated with a decreased risk of subsequent Parkinson disease (PD), although the effect of vagotomy on dementia is unclear. In response, we investigated the risk of dementia in patients who underwent vagotomy.SettingPopulation-based cohort study.ParticipantsA total of 155 944 patients who underwent vagotomy (vagotomy cohort) and 155 944 age-matched, sex-matched and comorbidity-matched controls (non-vagotomy cohort) were identified between 2000 and 2011.Primary and secondary outcome measuresAll patient data were tracked until the diagnosis of dementia, death or the end of 2011. The cumulative incidence of subsequent dementia and HRs were calculated.ResultsThe mean ages of the study patients in the vagotomy and non-vagotomy cohorts were 56.6±17.4 and 56.7±17.3 years, respectively. The overall incidence density rate for dementia was similar in the vagotomy and non-vagotomy cohorts (2.43 and 2.84 per 1000 person-years, respectively). After adjustment for age, sex and comorbidities such as diabetes, hypertension, hyperlipidaemia, stroke, depression, coronary artery disease and PD, the patients in the vagotomy cohort were determined to not be at a higher risk of dementia than those in the non-vagotomy cohort (adjusted HR=1.09, 95% CI 0.87 to 1.36). Moreover, the patients who underwent truncal vagotomy were not associated with risk of dementia (adjusted HR=1.04, 95% CI 0.87 to 1.25), compared with the patients who did not undergo vagotomy.ConclusionVagotomy, either truncal or selective, is not associated with risk of dementia.

The analysis of hospital-acquired urinary tract infections. A 10 year longitudinal study in Małopolska (the Lesser Poland province)

Introduction: Hospital-acquired infections are one of the most serious health threats during a patient’s stay in hospital, including healthcare associated infections (HAI). The most typical form of hospital-acquired infections is urinary tract infection (UTI). Objective: To examine the frequency of appearing UTIs, the structure of UTIs in in-patients in the department of internal medicine and nephrology at Saint Lucas’s general hospital in Tarnów was analysed. Materials and methods: Data analysis of 13 965 in-patients staying in the department of internal medicine and nephrology from 2006 to 2015 was carried out. To investigate these data epidemiological methods and standard definitions of hospital- acquired infections issued by European Center for Disease Prevention as well as Control and Centers for Disease Control and Prevention were used. Results: 237 hospital-acquired UTIs were revealed, which is 33% of all UTIs revealed in the investigated ward. The UTI incidence rate was 1.7% including 1.5% for microbiologically confirmed symptomatic UTIs and 0.2% not microbiologically confirmed symptomatic UTIs. The incidence density rate per 1 000 person-days was 0.2 over 1 000. The number of revealed catheter-related cases was 168, and not catheter-related cases – 69. The incidence density rate of UTIs associated with urinary catheters was 3.3 per 1 000 person-days. The dominant etiological factors, which were taken to be detected from the infected patients’ specimens, were: Escherichia coli 63 (29%), Enterococcus spp. 37(16%), Klebsiella spp. 23 (11%). Conclusions: A 10 year observation of UTIs, which have appeared in the department of internal medicine and nephrology, allowed to conduct the accurate analysis of these infections. The comparison of urinary tract infection rates done in the investigated ward, and recorded in the Research Participation Programs at the Centers for Disease Control and Prevention (CDC), allows to draw the conclusion that the presented epidemiological situation does not differ significantly from other countries.

Description and Rate of Musculoskeletal Injuries in Air Force Basic Military Trainees, 2012−2014

Context: Musculoskeletal injuries are common in military trainees and have significant medical and operational effects. Objective: To provide current musculoskeletal injury epidemiology data for US Air Force basic military trainees. Design: Descriptive epidemiologic study with cross-sectional features. Setting: US Air Force Basic Military Training, Joint Base San Antonio-Lackland, Texas. Patients or Other Participants: All recruits who entered training between July 1, 2012, and June 30, 2014. Main Outcome Measure(s): Incidence density rate of all musculoskeletal injuries (stratified by body region and type) and factors and costs associated with injuries. Results: Of the 67 525 trainees, 12.5% sustained 1 or more musculoskeletal injuries. The overall incidence density rate was 18.3 injuries per 1000 person-weeks (15.1 for men and 29.4 for women). The most common diagnosis (n = 2984) was Pain in joint, lower leg, as described in the International Classification of Diseases, Ninth Revision, Clinical Modification, code 719.46. Injuries were more common among those with lower levels of baseline aerobic and muscular fitness. Injured trainees were 3.01 times (95% confidence interval = 2.85, 3.18) as likely to be discharged, and injured trainees who did graduate were 2.88 times (95% confidence interval = 2.72, 3.04) as likely to graduate late. During the surveillance period, injuries resulted in more than $43.7 million in medical ($8.7 million) and nonmedical ($35 million) costs. Conclusions: Musculoskeletal injuries, predominantly of the lower extremities, have significant fiscal and operational effects on Air Force Basic Military Training. Further research into prevention and early rehabilitation of these injuries in military trainees is warranted.

Investigation ofAnaplasma marginaleSeroprevalence in a Traditionally Managed Large California Beef Herd

Recent observations by stakeholders suggested that ecosystem changes may be driving an increased incidence of bovine erythrocytic anaplasmosis, resulting in a reemerging cattle disease in California. The objective of this prospective cohort study was to estimate the incidence ofAnaplasma marginaleinfection using seroconversion in a northern California beef cattle herd. A total of 143 Black Angus cattle (106 prebreeding heifers and 37 cows) were enrolled in the study. Serum samples were collected to determineAnaplasma marginaleseroprevalence using a commercially available competitive enzyme-linked immunosorbent assay test kit. Repeat sampling was performed in seronegative animals to determine the incidence density rate from March through September (2013). Seroprevalence of heifers was significantly lower than that of cows at the beginning of the study (P<0.001) but not at study completion (P=0.075). Incidence density rate ofAnaplasma marginaleinfection was 8.17 (95% confidence interval: 6.04, 10.81) cases per 1000 cow-days during the study period. Study cattle becameAnaplasma marginaleseropositive and likely carriers protected from severe clinical disease that might have occurred had they been first infected as mature adults. No evidence was found within this herd to suggest increased risk for clinical bovine erythrocytic anaplasmosis.