Predictors of time to first symptomatic recovery of major depressive disordered patients: a case study at Jimma University Medical Center.

BACKGROUND: Major Depressive Disorder is one of the most common mental disorders, and it is the main cause of disability worldwide with a prevalence ranging from 7 to 21%. OBJECTIVE: The goal of this study was to predict the time it took for patients with severe depressive disorders at Jimma University Medical Center to experience their initial symptomatic recovery. STUDY DESIGN: The researchers utilized a prospective study design. METHODS: Patients with major depressive disorder were followed up on at Jimma University Medical Center from September 2018 to August 2020 for this study. The Gamma and Inverse Gaussian frailty distributions were employed with Weibull, Log-logistic, and Log-normal as baseline hazard functions. Akaike Information Criteria were used to choose the best model for describing the data. RESULTS: This study comprised 366 patients, with 54.1% of them experiencing their first symptomatic recovery from a severe depressive disorder. The median time from the onset of symptoms to symptomatic recovery was 7 months. In the study area, there was a clustering effect in terms of time to first symptomatic recovery from major depressive disorder. According to the Log-normal Inverse-Gaussian frailty model, marital status, chewing khat, educational status, work status, substance addiction, and other co-variables were significant predictors of major depressive disorder (p-value < 0.05). CONCLUSION: The best model for describing the time to the first symptomatic recovery of major depressive disorder is the log-normal Inverse-Gaussian frailty model. Being educated and working considerably were the variables that reduces the time to first symptomatic recovery from major depressive disorder; whereas being divorced, chewing khat, substance abused and other co-factors were the variables that significantly extends the time to first symptomatic recovery.

Application of Parametric Shared Frailty Models to Analyze Time-to-Death of Gastric Cancer Patients.

BACKGROUND: Despite its declining incidence, gastric cancer (GC) is one of the world's leading malignancies and a major global health concern due to its high prevalence and fatality rate. Furthermore, it is the world's fourth most common cancer and the second leading cause of cancer death. Studying the determinants of time to death of gastric cancer patients will give clinicians more information to develop specific treatment plans, forecast prognosis, and track the progress of death cases. The application of the frailty model can help account for random variation in survival that may exist due to unobserved factors, as well as show the impact of latent factors on death risk. As a result, the purpose of this study was to assess the determinants of time to death of GC patients' by applying the parametric shared frailty models. METHODS: The data for this study were obtained from gastric cancer patients admitted to the Tikur Anbesa Specialized Hospital, Addis Ababa, from January 1, 2015, to February 29, 2020. With the aim of coming up with an appropriate survival model that determines factors that affect the time to death of gastric cancer patients, various parametric shared frailty models were compared. In all of the frailty models, patient regions were used as a clustering variable. The current study implemented exponential, Weibull, log-logistic, and lognormal distributions for baseline hazard functions with gamma and inverse Gaussian's frailty distributions. The performance of all models was compared using the AIC and BIC criteria. R statistical software was used to conduct the analysis. RESULTS: A retrospective study was undertaken on a total of 407 gastric cancer patients under follow-up at Tikur Anbesa Specialized Hospital. Of all 407 GC patients, 56.3% died while the remaining 43.7% were censored. The patients' median time to death was 21.9 months, with a maximum survival time of 49.6 months. In the current study, the clustering effect was significant in modeling the time to death from gastric cancer. The Weibull model with inverse Gaussian frailty has the minimum AIC and BIC value among the candidate models compared. The dependency within the clusters for the Weibull-inverse Gaussian frailty model was [Formula: see text] (13.4%). According to the results of our best model (Weibull-inverse Gaussian), the sex of the patient, the smoking status, the tumor size, the treatment taken, the vascular invasion, and the disease stage was found to be statistically significant at an alpha = 0.05 significance level. CONCLUSION: Time to death of GC patient's data set was well described by the Weibull-inverse Gaussian shared frailty. Furthermore, Weibull baseline distribution best fits the GC data set as it enables proportional hazard and accelerated failure time model, for time to failure data. There is unobserved heterogeneity between clusters (patient regions), indicating the need to account for this clustering effect. In this study, survival time to death among GC patients was discovered to be small. Covariates like older age, being male, having higher (advanced) stage of GC disease (stage three and stage four), advanced tumor size, being smoker, infected by Helicobacter pylori, and existence of vascular invasion significantly accelerate the time to death of GC patients. In contrast, talking combination of more treatments prolongs the time to death of patients. To improve the health of patients, interventions should be taken based on significant prognostic factors, with special attention dedicated to patients with such factors to prevent GC death.

Modeling Time to Blindness of Glaucoma Patients: A Case Study at Jimma University Medical Center.

BACKGROUND: Glaucoma is a significant public health problem due to its substantial increase in the projected number of glaucoma cases. In Ethiopia, glaucoma accounts for 5.2% of irreversible blindness and is the fifth main cause of blindness. The main objective of this study was to modeling time to blindness of left and right eyes of glaucoma patients. STUDY DESIGN: An institution-based retrospective cohort study. METHODS: This study was conducted among 315 glaucoma patients admitted to the Ophthalmology Department of Jimma University Medical Center (JUMC), Southwest Ethiopia, from January 1, 2016, to August 30, 2020. Kaplan-Meier survival analysis and semiparametric and parametric copula models were applied to identify factors that affect time to the blindness in glaucoma patients and the dependence between time to the blindness of the left and right eyes, respectively. An Akaike information criterion (AIC) was used to select the best non-nested model. RESULTS: In total, 211 (66.9%) out of 315 glaucoma patients were blind, whereas 104 (33.1%) patients were censored. The median time to the blindness of the left and right eyes was determined to be 12 months. The result suggested that the risk of the blindness in male patients was 1.005 (P = 0.01) times higher than that in female patients, and the risk of the blindness in patients who had early, moderate, and advanced glaucoma was estimated to be 0.582 (P = 0.002), 0.485 (P = 0.001) and 0.887 (P = 0.003) times less than that in the patients with absolute glaucoma, respectively. CONCLUSIONS: Age, place of residence, gender, type of medication, diabetes disease, stage of glaucoma, duration of treatment, intraocular pressure (IOP), and cup-disk ratio were significantly associated with and affected by the time to the blindness of left and right eyes in glaucoma patients. Awareness should be given to the community to reduce the burden of glaucoma.

Environmental and biotic factors affecting freshwater snail intermediate hosts in the Ethiopian Rift Valley region.

BACKGROUND: Knowledge of the distribution and habitat preference of freshwater snail intermediate hosts can provide information to initiate and set-up effective snail control programmes. However, there is limited research conducted on the factors driving the occurrence and abundance of freshwater snail intermediate hosts in the Ethiopian Rift Valley. Hence, in this study, we investigated how environmental and biotic factors influence the occurrence and abundance of the snail intermediate hosts in Ethiopian Rift Valley region. METHODS: Data on freshwater snails, physico-chemical water quality parameters, physical characteristics of habitat, predators and competitors, and anthropogenic activity variables were collected from 174 sampling sites during the wet season of 2017 and 2018. Generalized linear models were used to identify the main environmental and biotic factors affecting the occurrence and abundance of the snail species. RESULTS: It was found that Bulinus globosus (31.7%) was the most abundant snail species followed by Lymnaea natalensis (21.6%), Lymnaea truncatula (15.1%) and Biomphalaria pfeifferi (14.6%). Generalized linear models indicated that physico-chemical parameters (water temperature, turbidity, chlorophyll-a, dissolved oxygen, chemical oxygen demand, alkalinity, calcium, magnesium, nitrate and ammonia), physical habitat characteristics (water depth, canopy cover, macrophyte cover and substrate type) and biotic factors (abundance of predators and competitors) were found to be the main variables determining the occurrence and abundance of snail species in the Ethiopian Rift Valley region. In terms of anthropogenic activities, human settlement, farming, bathing and swimming, clothes washing, grazing, drainage of land, car washing, boating, fishing and silviculture were also important variables determining the occurrence and abundance of snail species in the region. CONCLUSIONS: The findings reported herein suggest that integrated snail control strategies should be considered to control snails via protection of water bodies from disturbance by anthropogenic activities. In this way, it is possible to reduce the concentration of organic matter and dissolved ions in aquatic ecosystems which are conducive for the presence of snails.