Objectives Statin adherence is an essential problem although lifetime medication is recommended especially in patients with high cardiovascular risk. The importance of perceived risk as a predictor of adherence among cardiology patients has not been fully explored. This study aimed to test the importance of perceived risk as a predictor of statin adherence amongst hypercholesterolemic patients to identify predictors associated with poor adherence. Methods This cross-sectional study was conducted at cardiology outpatient clinics of the University hospital in Ankara, Turkey. A total of 327 consecutive patients with high CV risk were recruited. Self-reported Morisky Green Levine Medication Adherence Scale was used to assess statin adherence. Results Of the patients studied, 34.5% had concerns about side effects. Also, the mean age was 63.85 +/- 11.29 years, 66.1% were men, 32.4% applied non-drug alternative therapies, 53.2% had a Mediterranean-style diet and 20.8% checked their lipid values irregularly. Participants reported 50.2% high, 30% moderate, and 19.9% low statin medication adherence. Low-density lipoprotein cholesterol (LDL-C), Total Cholesterol (TC), Triglyceride (TG) and high-density lipoprotein (HDL) control rates were 44.6%, 74.3%, 61.5% and 41.6%. On multiple logistic regression, concern about side effects was associated with a statistically significant quadruple elevation of odds of non-adherence. Also, being male, former smokers, not having complementary interventions, having regular visits, being educated for more than 5 years, having low depressive symptom scores, living in a rural, being never or former smokers, employee were significant predictors of high medication adherence scores. Conclusion Approximately half of the patients reported high medication adherence. Proper strategies to improve adherence would include patient education efforts focused on patients with concerns about side effects and those who are female, less educated, current smokers, interested in complementary interventions, have irregular follow-up visits, and have depressive symptoms. Brief medication adherence scales may facilitate the assessment of patients' adherence.

The purpose of this retrospective study was to test the association of simple timeliness measures with academic performance in an online quantitative reasoning course using data extracted from gradebooks (N=157). Guided by the Social Cognitive Model, timeliness was assumed to be a consistent behavior chosen by the student based on personal goals and social patterning. Submission of assignments early in the first four weeks of the term proved to be a significant predictor of the final percentage grades (mean difference=5.02, p =0.006). Submitting assignments just-in-time was not significantly related to the final percentage grade. The significance of early submission of assignments persisted after adjusting for the effects of failing status. The results are useful for targeting students who may benefit from encouragement in the form of personal messages from the instructor.

Community hospitals may be able to increase revenue by diversifying into non-inpatient service lines. A model predicting this kind of diversification has not been developed. Data from community hospitals in Wisconsin was analyzed to explain diversification into non-inpatient service lines. Principal components analysis was applied to the services offered to identify factors. The derived factor scores were analyzed using multiple linear regression. Two distinct noninpatient identities were identified: a vertically integrated acute hospital and a hospital diversified into community-based services. Regression analysis revealed that horizontal integration was related to vertical integration into non-inpatient service lines. Community hospitals belonging to alliances and systems had lower vertical integration scores.

Science is objective. Analysis is rational. Not everyone wants to be objective and rational. If so, then scientific research is not a good career choice for them. Objectivity and rational analysis are difficult to achieve. We always must be on guard against biases in the work of the papers we review but also in our own research. Biases creep into the framing of research questions and the selection of variables. Where editors see often see bias is in the interpretation of findings. Authors sometimes choose to study a topic because they believe A influences B, their data does not support the hypothesis, but their conclusion proceeds to say A should be changed for the benefit of B. This is not good research practice. The COVID-19 Pandemic has, understandably, generated a lot of fear and panic. Researchers should be able to set aside those emotions so that they can rationally analyze the risks, harms and benefits of different diseases and health services. Understandably, many people will be driven by their emotions. This includes patients and those who care about them: their families, parents, teachers, and front-line health care workers. These people need and deserve objective analysis of health care data. They may not care about the results of objective analysis when in a crisis. Their instincts will be to insist that risks should be reduced to zero regardless of the cost. Unfortunately, we live in a universe where resources are not infinite. Furthermore, reducing one harm can have unexpected adverse consequences in terms of damage to health, education, social structures, mental health, personal liberty and civil rights. Unfortunately, a mantra came into popular use that asserted only one set of conclusions was scientific and other perspectives were not “based on science.” This is not how science works. Scientists always disagree about the interpretation of scientific data. Objective analysis, replication by independent investigators, the passage of time can eventually lead to the emergence of a consensus about the interpretation of scientific data. Decrying those who disagreed as ignorant and unscientific during the epidemic was in itself not scientific, but instead an exercise in political correctness. Conclusions charged ahead of the data and policies were based on those conclusions. Political correctness is a powerful force, even in science. Articles assuming that the benefits of masks and mandates exceeded the harms were easily published and those testing the evidence girding up the Group-Think had few outlets. This happened despite conflicting guidance from public health authorities. Should we wear 2 masks instead of one? Is mask wearing effective or only if you have one of the better masks? Was closing down in-person classes of benefit to children or did the harms exceed the reduction in risk? Were public school teachers justified in refusing to enter the classroom, despite the social and educational damage done to their students? Was the shuttering of businesses effective in altering the spread of virus? Would universal vaccination and mask-use really prevent the mutation of the virus? The last goal seems clearly unachievable to me. This journal has sought to be open-minded about COVID-19 research and even to give voice to investigators who challenged the standard perspective. I see an immediate need for objective studies retrospectively testing the benefits and harms of public health guidance during the pandemic. The 50 states and the various nations each crafted their own policies, with varying degrees of success. As researchers, we have a responsibility to analyze the data and learn from the mistakes made in the hope that more rational and more effective policies can be adopted in the future.

RATIONALE, AIMS, AND OBJECTIVE:Bariatric surgery is an effective procedure for morbidly obese patients when all else fails. The purpose of this study was to compare the hospital length of stay (LOS) for two surgical procedures, laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG).METHODS:This study was a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who received bariatric surgery as indicated by International Classification of Diseases, Ninth Revision (ICD-9) procedure codes were selected (N = 4001). Cases were limited to uncomplicated diabetic patients. Differences in the odds of long vs short (2< and ≥2) stay for a patient receiving LSG were compared with LAGB while adjusting for hospital volume, hospital size, patient age, gender, ethnicity, season, and year using logistic regression analysis.RESULTS:The odds for LSG (odds ratio [OR] = 0.100, 0.066-0.150, P < 0.001) patients for long LOS are lower when compared with LAGB. In the stratified logistic regression model, both male (OR = 0.157, 0.074-0.333, P < 0.001) and female (OR = 0.077, 0.046-0.127, P < 0.001) had reduced odds of extended LOS for LSG. Discharged patients in the year 2012 (OR = 0.660, 0.536-0.813, P < 0.001) had decreased odds of having a longer LOS when compared with the year 2014. Both government, nonfederal (OR = 0.452, 0.251-0.816, P = 0.008), and private investor-owned (OR = 0.421, 0.244-0.726, P < 0.001) patients had similar odds for long duration of stay when compared with government or private. Urban non-teaching (OR = 1.954, 1.653-2.310, P < 0.001) patients had higher odds for long LOS in comparison with urban teaching. New England patients' (OR = 0.365, 0.232-0.576, P < 0.001) odds for extended LOS were lower when compared with pacific. Both patients who received care in low (OR = 1.330, 1.109-1.595, P = 0.002) and medium (OR = 1.639, 1.130-2.377, P = 0.009) volume hospital had increased odds for long duration of stay. Female patients in the stratified logistic regression model with high (OR = 1.330, 1.109-1.595, P < 0.002) volume had elevated odds of extended LOS when compared with very low volume hospital.CONCLUSION:Among the uncomplicated diabetic patients, LSG provides a substantially low odds of extended LOS after adjusting for covariates when compared with LAGB. The finding of the relative reduction in LOS for LSG suggests opportunities for improvement both for cost reduction for third party insurance payers and greater efficacy and outcomes for patients.

The aims of the present study were to evaluate possible associations between trait anxiety, dental fear and the predictors of these interactions including demographic characteristics and dental history of patients applied to the dental care center in Ankara, Turkey. A sample of 607 participants (mean age: 21.02 ± 2.32) responded to a Turkish version of the Modified Dental Fear Survey (MDFS), the State-Trait Anxiety Inventory (STAI-T) and a questionnaire regarding previous negative dental experience. Multiple logistic regression analysis was used to identify the association between dental fear and the independent variables including trait anxiety, age groups, education level, dental visit frequency, experience and the source of dental knowledge. There was a trend for increasing in trait anxiety scores with greater levels of dental fear in a medium level of the dental fear group (OR = 1.055, 95%CI [1.025-1.086]; p < 0.001) and in a high level of the dental fear group (OR = 1.090 [1.057-1.124]; p < 0.001). Comparing to the low level of dental fear group; participants of medium dental fear level intended more likely to go to the dentist when they have a complaint instead of regularly going (odds ratio; OR = 3.177, 95%CI [1.304-7.741]; p = 0.011). Participants of high dental fear level tended to be less likely to have experienced no problem (OR = 0.476, 95%CI [0.284-0.795]; p = 0.005) than the low level of the dental fear group. We strongly indicate that higher dental fear scores have a predisposition of having high trait anxiety scores. Unpleasant dental experiences increased the risk for high dental fear levels. Patients with dental fear tended only to visit a dentist when necessary, avoiding regular visits.

RATIONALE, AIMS, AND OBJECTIVESImproving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improve nutritional status. Little information is available on ONS use and LOS among heart failure patients.METHODSThis study used a retrospective design to examine whether routine ONS use was associated with hospital LOS among 570 heart failure inpatients (89 ONS = yes; 481 ONS = no) at a regional medical center, adjusting for significant personal, locational, and time variables using multiple logistic regression analysis.RESULTSOral nutrition supplement use was associated with high LOS in this sample (odds ratio = 2.43). High LOS was also associated with higher Charlson comorbidity index values, discharge destination, hospital room location, and dietitian consults.CONCLUSIONSThese results show that ONS orders alone are not adequate to reduce LOS among heart failure patients. Continued research is needed on ways to improve care to reduce LOS among hospitalized patients.

Objective: The purpose of this commentary is to propose a flexible practice innovations decision model (PIDM) for use in health services planning and management. Method: This is an example of fuzzy decision analysis. The elements of the model are explained by applying it to the decision of whether to open a primary care clinic in retail space. The model contains 10 criteria, each of which scored as 1 (met) or 0 (not met). The scores are summed to guide the decision. Result: In this example, success was defined a priori as meeting 8 or more criteria. Sensitivity analysis and simulation can be used in practice to test the model. Conclusion: The PIDM appears to be applicable to a variety of decisions, and the fuzzy scoring combined with simulation and sensitivity analysis generates plausible results. The model should be modified as necessary for each situation in which it is applied.

Assessment of Postoperative and Postdischarge Wound Infection After Abdominal Hysterectomy by Jinni J. Amin MPH, Walden University, 2011 BS, Towson University, 2009 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health

BackgroundThe collaborative care model (CCM) has been consistently shown to achieve effectiveness in depression management compared to usual care. In the present study, we aimed to determine the impact of age on cost metrics in patients who were treated with CCM for 6 months after a diagnosis of depression.MethodsThe upper quartile of age was 50 years and older (n = 56), and the comparison group was composed of patients in the three younger quartiles, aged 18-49 years (n = 163).ResultsPatients in the older age group had an elevated median Current Procedure Terminology cost rank of 255.5 compared to 168.0 for the younger patients (P < 0.001). Multiple logistic regression analysis revealed that being in the upper quartile of age (50 years) (odds ratio = 2.272, 95% confidence interval: 1.064-4.851; P = 0.034) and having higher numbers of clinical visits 6 months prior to index (odds ratio = 1.209, 95% confidence interval: 1.118-1.307; P < 0.001) were significant predictor variables of being cost rank outliers (>80th percentile) in patients with CCM.ConclusionMedical cost utilization in the 6 months after diagnosis of depression was significantly higher in patients in the upper age quartile (50 years) enrolled in CCM than those in the lower quartiles (age <50).

Objective: The aim of the study is to evaluate the prevalence of habitual snoring (HS) and HS associated risk factors among children aged 6-12 years in Ankara, Turkey. Material and Method: Our cross sectional study sampled 2500 students from 3 primary schools selected randomly in Ankara between January-May 2011. The survey questionnaires including demographic characteristics and health conditions of the participants due to HS were delivered to parents. Results: Two thousand eighty-nine (83.56%) of questionnaires distributed to parents provided complete data. HS prevalence was 14.9 % (n=312). HS was significantly more prevalent in boys than girls (56.1 %, n=175 vs 43.9 %, n=137) (p=0.006). HS also was significantly more common in students with asthma, chronic allergies and parent-reported apnea (p=0.007, p=0.017, p<0.001). Multivariate logistic regression analysis revealed that the following independent risk factors such as younger ages (p=<0.001, OR=0.856; 95% CI [0.791-0.926]), greater BMI (p<0.001, OR=1.199; 95% CI [1.147-1.253]), having Upper Respiratory Tract Infection (URTI) 3-4 times per year (p=0.008, OR=2.084; 95% CI [1.210-3.588]) and 5-6 times per year (p=0.017, OR=2.239; 95% CI [1.156-4.339]), and having Acute Otitis Media (AOM) >6 times per year (p=0.036, OR=14.980 [1.186-189.157]) were significantly associated with HS. Conclusion: HS is a common health problem among children in Ankara, Turkey. Warning signs in childhood worthy of note by primary care providers include being younger age, having higher BMI, having frequent URTI and frequent AOM.

Rationale, aims and objectivesTo examine if initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers increased after a change in hospital policy increased reporting requirements about breastfeeding by new mothers.MethodsFive hundred women that gave birth to their first child were studied, with half giving birth prior to reporting requirements and half giving birth after the reporting began. After implementing mandatory reporting requirements through an accrediting body, an increase in maternity care practices designed to promote breastfeeding was expected. Medical records of those women were reviewed to identify key variables, including age, race/ethnicity, marital status, education level, health insurance, type of delivery, gestational age, initiation of breastfeeding and exclusive breastfeeding throughout the hospital stay.ResultsThere was an 18.7% increase in initiation of breastfeeding the year the mandatory reporting began. However, there was a 5.9% decrease in exclusive breastfeeding that year. The odds of initiating breastfeeding were greater after implementation of mandatory reporting measures (OR=2.07; P=0.0007), yet the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR=0.94; P=0.7507). Other variables that had a significant effect on both initiation and exclusive breastfeeding included being non-Hispanic white, other race/ethnicity category, marital status and type of insurance (exclusive breastfeeding only).ConclusionProfessional support that can be offered to new mothers may have a positive effect on their decision to breastfeed. However, a hospital policy change that increases reporting requirements may not have long-term impact on breastfeeding. Longer term studies and multisite studies are needed.

RATIONALE, AIMS AND OBJECTIVES:Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals.METHODS:We conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model.RESULTS:Follow-up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow-up visit achieved the overall SBP/DBP targets specified by the JNC-8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P < 0.001, P < 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (β = 8.410, P = 0.003; β = 0.692, P < 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (β = -7.968, P = 0.005; β = -5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (β = 4.539, P = 0.012; β = 0.702, P < 0.001; β = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (β = -5.682, P = 0.002; β = -0.098, P = 0.005; respectively).CONCLUSIONS:Although the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

Objectives: The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both adenotonsillectomy (T&A) among 6-12 years old children. In addition, we tried to find out the predictors associated with these previous upper respiratory tract (URT) surgeries.Methods: This cross-sectional study consisted of 1900 children educated in 3 different elementary schools in Ankara, Turkey. Data about demographics and health conditions were obtained from survey questionnaires completed by parents.Results: Of the 1900 children, 15 children (0.8%) previously underwent tonsillectomy, 43 children (2.3%) had adenoidectomy and 80 children (4.2%) had T&A surgical histories. Multiple logistic regression analysis revealed that older students compared to younger ones [odds ratio (OR) = 1.15, p = 0.0111, and those who had parent-reported apnea compared to subjects without apnea were more likely to have URT surgery histories [OR = 2.34, p = 0.0011. Those children with surgery histories were more likely to have fathers with a higher educational level [medium level: OR = 2.07, p = 0.012; high level: OR = 2.79, p = 0.001 vs. low level) and the subjects had greater BMI percentiles [overweight: OR = 1.71, p = 0.036; obesity: OR = 2.32, p = 0.003 vs. healthy weight]. Children who had 1-2 URT infections per year [OR = 0.47, p = 0.019] had less probability of URT surgery histories, whereas those children with AOM >= 3 times per year [OR = 2.52, p = 0.003] had more probability of URT surgery history.Conclusions: We conclude that a reasonable explanation for higher rates of URT surgery among children with a high level of paternal education may originate from their awareness about URT associated diseases and possibly due to the ease of access to health care services. (C) 2015 Published by Elsevier Ireland Ltd.

OBJECTIVE:Elevated aminotransferase levels indicating liver function, even in the normal range, have attracted great concern as potential novel markers of cardiovascular risk assessment. We hypothesized the possibility that liver function test variations in the normal range might be meaningfully associated to coronary artery disease (CAD).METHOD:Eighty-eight patients were randomly selected from those who underwent coronary angiography from June 2010 to June 2011 after applying to the outpatient cardiology clinic in Gulhane Military Medical Academy. According to the results of angiographies, patients were classified into three groups as normal, non-critical (< 50% involvement in coronaries), and critical (≥ 50% involvement in coronaries). In addition to angiographic intervention, measurements of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations, albumin and the other serum parameters were performed in all patients.RESULTS:The patient groups of CAD were balanced (28 critical cases, 30 non-critical cases and 30 normal cases). Mean age was 51.93 ± 9.3 (range 32-65) years and 19.3 per cent (n = 17) were females. Multiple linear regression analysis of all three liver function tests explained a significant portion of the variance, but adjusted r-squares were small (AST = 0.174, ALT = 0.242, albumin = 0.124). Albumin was significantly higher for patients with critical CAD than for patients with no CAD (beta = 3.205, p = 0.002). Non-critical CAD was not significantly different from no CAD for any of the dependent variables. Mean AST was significantly higher for patients taking aspirin (beta = 0.218, p = 0.049), as was mean ALT (beta = 0.264, p = 0.015).CONCLUSION:Alanine aminotransferase and AST may not be associated with angiographically determined coronary atherosclerosis. Albumin may be more sensitive to demonstrate the burden of atherosclerosis. These results indicate that the association between the liver function tests and coronary atherosclerosis may be more complex than generally appreciated.

Individuals with impaired renal function are at increased risk of coronary artery disease (CAD). CAD is also associated with an increased likelihood of having chronic kidney disease (CKD). In the present study, we sought to determine the association between impaired renal function with CAD presence and CAD severity based on four different estimated glomerular filtration rate (eGFR) equations.

Rationale, aims and objectivesAchieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-cholesterol, is an acknowledged quality indicator in primary care. The Centers for Disease Control and Prevention (CDC)'s model for investigation of outbreaks (person-place-time) can be applied to the analysis of quality indicators.MethodsA sample of 322 family medicine patients for whom lipid levels were ordered was extracted. LDL>100mg/dL was cross-tabulated by personal characteristics [age group, gender, body mass index (BMI), diagnoses], month (time) and ordering department (place).ResultsAge (except one age category), gender, time and location were not related to LDL>100mg/dL after adjustment for covariates. All levels of BMI above normal elevated the risk of LDL>100mg/dL [BMI 25-29.9: odds ratio (OR)=3.41, confidence interval (CI)=1.61-7.23, P=0.0014; BMI 30-34.9: OR=2.93, CI=1.28-6.70, P=0.0109; BMI35: OR=2.75, CI=1.19-6.37, P=0.0181]. Patients with coronary artery disease (CAD) and diabetes mellitus (DM) were at reduced risk for LDL>100mg/dL (CAD: OR=0.47, CI=0.24-0.91, P=0.0254; DM: OR=0.28, CI=0.14-0.55, P=0.0002).ConclusionAn outbreak investigation model is useful for analysing variations in this quality indicator. Patients with higher BMI and those not diagnosed with CAD or DM type I/II may be considered for intensified lipid lowering using quality improvement efforts. These might include counselling for lifestyle changes or medication therapy depending upon their calculated cardiac risk.

Background and Objectives: Online university students are a growing population whose health has received minimal attention. The purpose of this cross-sectional Internet survey was to identify risk factors for the health status among online university students. Methods: This online survey collected data from 301 online university students through a large, US-based participant pool and LinkedIn. Health status was measured using 3 elements of health-related quality of life (HRQOL): self-rated overall health (SRH), unhealthy days, and recent activity limitation days. All 3 measures were dichotomized. Results: The odds of poor SRH were higher for people who reported a body mass index in the overweight and obese categories (odds ratio [OR] = 2.99, P < .05) and for those who reported being smokers (OR = 2.52, P = .03). The odds of frequent unhealthy days were lower for those who made more than $35 000 compared with those who reported making less (OR = 0.50, P = .03) and those who exercised 4 or more times a week compared with those who exercised less (OR = 0.28, P < .05). The odds of frequent activity limitation were lower for those who reported an income of more than $35 000 (OR = 0.29, P = .04) and higher for persons who reported belonging to “other” race (OR = 14.75, P = .00). Conclusions: Universities might fruitfully target health promotion programs for online students who are low income, in disadvantaged racial groups, who are overweight, smoke, and who do not exercise.