Cross-sectional Analysis Research Articles

Association Between Non-HDL to HDL Cholesterol Ratio (NHHR) and Psoriasis in Adults: A Cross-Sectional Study Using 2009-2014 Data.

Because of its possible significance in metabolic diseases, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has garnered attention as a novel and trustworthy lipid biomarker. Psoriasis may be linked to metabolic problems and obesity, according earlier research. Uncertainty surrounds the relationship between NHHR and the onset of psoriasis, though. The primary aim of this investigation was to examine the relationship between NHHR and psoriasis. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2009 and 2014. The association between psoriasis and NHHR was examined using multivariate logistic regression, and smoothed curve fitting was done to explore the non-linear relationship. Furthermore, Subgroup and sensitivity studies were performed in order to confirm the robustness of the findings. Psoriasis and NHHR were shown to be positively correlated in 15,951 adult individuals who were at least 20 years old. Psoriasis risk rose by 7% for each unit increase in NHHR [1.07 (1.01, 1.14)]. Individuals in the highest NHHR tertile were 39% more likely compared to those in the bottom tertile to have psoriasis [1.39 (1.09, 1.78)]. Across subgroups, this favorable connection remained consistent. Elevated NHHR levels are positively correlated with an upsurge chance of psoriasis in the adult population in the United States. The significance of NHHR as an indication for early psoriasis risk assessment is shown by this study.

Climate policy uncertainty and enterprise labor outsourcing

This paper investigates the impact of climate policy uncertainty on labor outsourcing among Chinese-listed companies from 2012 to 2022. We find that increased climate policy uncertainty prompts firms to choose labor outsourcing. The results hold even after several robustness tests and controlling for endogeneity. Moreover, our cross-sectional analyses indicate that the main effect is more pronounced in non-state-owned enterprises and firms without government employment stability subsidies.

A link between systemic low-grade inflammation and frailty in older adults: clinical evidence from a nationwide population-based study.

Despite the possible role of systemic low-grade inflammation on frailty, the majority of previous studies have focused solely on the phenotypic frailty with limited participant numbers, thereby weakening the evidence supporting the notion that circulating C-reactive protein (CRP) could be a potential frailty biomarker. This study is a nationally representative, population-based, cross-sectional analysis from the Korea National Health and Nutrition Examination Survey, involving 5,359 participants aged 65 and older. We generated a deficit accumulation frailty index (FI) based on 38 items, encompassing physical, cognitive, psychological, and social status. Frailty was classified as non-frail (FI ≤ 0.15), pre-frail (0.15 < FI ≤ 0.25), or frail (FI > 0.25). Serum high-sensitivity CRP (hsCRP) levels were measured by immunoturbidometric method. After adjusting for confounders including age, sex, income, education, smoking, hypertension, diabetes, dyslipidemia, stroke, cardiovascular diseases, and body mass index, serum hsCRP levels were 29.4% higher in frail participants compared to their non-frail counterparts (p = 0.001). Additionally, circulating hsCRP concentrations positively correlated with the FI (p = 0.003), and the odds ratio for frailty per standard deviation increase in serum hsCRP was 1.18 (p = 0.001). Moreover, older adults in the highest hsCRP quartile exhibited a significant higher FI with a 1.59-fold increased odds ratio for frailty than those in the lowest quartile (p = 0.002 and 0.001, respectively). These findings validate the impact of age-related systemic low-grade inflammation on frailty and support the utility of serum hsCRP as a potential biomarker for detecting frailty in older adults.

Electronic Cigarette Use and Use of Evidence-Based Smoking Cessation Methods among American Indian Cigarette Smokers: A Cross-Sectional Analysis

Introduction: Tobacco use is the leading cause of death in the United States (US), and American Indian/Alaska Native (AI/AN) people have high rates of tobacco-related diseases. While US Food and Drug Administration approved products and evidence-based methods exist for smoking cessation, people who smoke might use electronic cigarettes (e-cigarettes) as cessation aids. Whether e-cigarette use is associated with the use of evidence-based methods is unknown, particularly among AI/AN individuals. Methods: Using survey data collected in 2016 from 289 adult AI people who smoke and who reported a previous cessation attempt, we conducted multivariate logistic regression analyses to assess associations between e-cigarette use and evidence-based cessation methods. Analyses were performed in 2023. Results: Individuals who currently or formerly used e-cigarettes compared to those who did not use e-cigarettes were significantly more likely to report using nicotine replacement therapy (NRT) during their last quit attempt (current vs never adjusted Odds Ratio (aOR)=4.6, 95% Confidence Interval (CI) (1.9-11.9); past vs never aOR=4.6, 95% CI (2.2-9.8); p<0.001). Current and former e-cigarette use were significantly associated with prescription use in the unadjusted analysis but lost significance in the adjusted analysis (current vs never aOR=3.1, 95% CI (1.0-10.5); past vs never aOR=2.7, 95% CI (1.1-7.9); p>0.05). Individuals with current or former use of e-cigarettes were significantly less likely than individuals who never used e-cigarettes to use the cold turkey method (unassisted cessation) (current vs never aOR=0.3, 95% CI (0.2-0.6); past vs never aOR=0.3, 95 %CI (0.1-0.7); p<0.01). Conclusions: These results suggest that persons who use e-cigarettes are more likely than individuals who do not use e-cigarettes to previously have tried NRT but less likely to use the cold turkey method. A larger study is needed to determine if individuals who use e-cigarettes are also more likely to have tried prescription medication for smoking cessation. Whether e-cigarette use impedes or encourages the use of evidence-based cessation methods is unknown. +

Gender differences in the relationship between depressive symptoms and diabetes associated with cognitive-affective symptoms.

Despite the frequent co-occurrence of depression and diabetes, gender differences in their relationship remain unclear. This exploratory study examined if gender modifies the association between depressive symptoms, prediabetes and diabetes with cognitive-affective and somatic depressive symptom clusters. Cross-sectional analyses were conducted on 29 619 participants from the 2007-2018 National Health and Nutrition Examination Survey. Depressive symptoms were measured by the nine-item Patient Health Questionnaire. Multiple logistic regression was used to analyse the relationship between depressive symptoms and diabetes. Multiple linear regression was used to analyse the relationship between depressive symptom clusters and diabetes. The odds of having depressive symptoms were greater in those with diabetes compared to those without. Similarly, total symptom cluster scores were higher in participants with diabetes. Statistically significant diabetes-gender interactions were found in the cognitive-affective symptom cluster model. Mean cognitive-affective symptom scores were higher for females with diabetes (coefficient = 0.23, CI: 0.10, 0.36, P = 0.001) than males with diabetes (coefficient = -0.05, CI: -0.16, 0.07, P = 0.434) when compared to the non-diabetic groups. Diabetes was associated with higher cognitive-affective symptom scores in females than in males. Future studies should examine gender differences in causal pathways and how diabetic states interact with gender and influence symptom profiles.

Social isolation and social cognition: A cross-sectional analysis.

The impact of social isolation on social cognition is not entirely clear. The aim of the study is to investigate the association between social isolation and social cognition. In a population-based sample of 83 individuals aged 50+ years without dementia, we assessed the relationship between social isolation (measured by the Lubben Social Network Scale - LSNS-6) and performance on emotional recognition (measured by the Emotion Recognition Task (ERT)) and on Theory of Mind (ToM) abilities (measured by the Reading the Mind in the Eyes Test (RMET)), two core aspects of social cognition. No significant association was found between social isolation and ToM abilities for both the unadjusted and adjusted models. Similarly, no significant association was observed between social isolation and emotion recognition. Further research is needed to understand the complex correlation between social relationships and cognitive health, particularly in different cognitive domains, adopting a life course perspective.

Household Pharmaceutical Disposal Practices, Community Understanding, and Readiness for Medicines Take-Back in Asmara, Eritrea: A Cross-Sectional Analysis.

Unused and/or expired pharmaceuticals stored in households are potential health and environment hazards that require safe disposal. In Eritrea, there has not been a proper household medicines disposal system and pharmaceutical wastes had been disposed of irrationally. The study was therefore conducted to assess community's understanding and disposal practices of unused/expired medications and willingness to participate in a household medicines take-back system. A cross-sectional study was conducted from January to February 2023 in randomly selected households of Asmara. The study participants were selected using a multi-stage-cluster sampling. Data, collected through face-to-face interview using a structured questionnaire, were double entered using CSPro version 7.3 software package and analyzed using SPSS version 26. A total of 327 participants were enrolled in the study with a predominance of female respondents (84%). The most commonly used disposal practices were throwing with household garbage (65.6%), followed by dumping under soil (38.7%) and flushing down the toilet/sink (15.2%). Around three-quarters (70.5%) of the households had unused/expired medicines stored at home during the data collection period with intention to use being the most common reason for storage (83.9%). Analgesics and anti-infectives were the most commonly stored classes of medicines, and more than half of the anti-infectives were stored for future use. The mean knowledge score of participants was 7.31/11 (95% CI: 7.09-7.52). Moreover, participants had a satisfactory willingness to participate in a household medicines take-back system, with a mean attitude score of 16.89/20 (95% CI: 16.45-17.29). Lack of awareness, negligence, time/health constraints, fear of accountability/stigma, accessibility and reluctance were reported as possible challenges in establishing a household medicines take-back system. Unnecessary storage and improper disposal of household unused/expired medicines along with inadequate knowledge on disposal mechanisms were common in households of Asmara. Hence, public education on proper disposal as well as coordinated efforts for the establishment of safe disposal mechanisms are recommended.

Disability and intimate partner violence experience among women in rural Samoa: A cross-sectional analysis

BackgroundWomen with disabilities experience higher rates of intimate partner violence (IPV). Evidence suggests this violence often manifests in more subtle and severe forms over longer periods of time. There is limited evidence on this association in the Pacific Islands region, despite facing one of the highest global prevalences of IPV. ObjectiveExamine the prevalence of disability and the association between disability and types of IPV experience among women in rural Samoa as part of the EVE Project. MethodsThis study analysed cross-sectional data collected with nine communities in rural Samoa between December 2022 and February 2023. Enumerators collected data with 707 women on tablets using REDCap. IPV was measured using the standardised Demographic and Health Survey (DHS) domestic violence methodology. Disability was assessed using the Washington Group questions. Logistic regression was conducted to examine the association between disability and experiences of IPV (physical, sexual, emotional and economic violence) among women. ResultsHaving a disability was significantly associated with increased IPV experience among women in this study. When controlling for age and education, women with severe disability were significantly more likely to experience sexual (OR 4.31; p = 0.01) and emotional (OR 2.87; p = 0.02) IPV, when compared to women with no disability. ConclusionsOur findings point towards a greater vulnerability of women with disabilities to IPV, and particularly sexual and emotional IPV, in rural Samoa. Qualitative research in partnership with women with disabilities is essential to inform the design of measurement tools and prevention programmes that are grounded in the context-specific experiences and needs of all women with disabilities.

Characterizing vascular and hormonal changes in women across the life span: a cross-sectional analysis.

Vascular dysfunction, marked by lower endothelial function and increased aortic stiffness, is a nontraditional risk factor that precedes the development of cardiovascular disease (CVD). However, the age at which these changes in vascular function occur in women and the degree to which reproductive hormones mediate these changes has not been characterized. Women free from major disease were enrolled across the adult life span (aged 18-70 yr, n = 140). Endothelial function was assessed as flow-mediated dilation (FMD) of the brachial artery during reactive hyperemia using duplex ultrasound and expressed as percent dilation. Aortic stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). Blood samples were obtained to quantify reproductive hormone concentration. Regression models determined age-related breakpoints and mediating factors between age and vascular outcomes. FMD declined with age with a breakpoint and steeper decline occurring at 47 yr of age. Thereafter, age was independently associated with lower FMD (B = -0.13, P < 0.001). cfPWV was relatively stable until a breakpoint at age 48, and age was independently associated with higher cfPWV thereafter (B = 0.10, P < 0.001). Path analysis revealed that the association between age and FMD was partially mediated by follicle-stimulating hormone (abind = 0.051, P = 0.01) and progesterone (abind = 0.513, P < 0.001) but not estradiol (abind = -0.004, P = 0.08). No mediation was present for cfPWV. Age was associated with endothelial dysfunction and aortic stiffness in women beginning at 47 and 48 yr old, respectively, 3 to 4 yr before the average age of menopause. The association between age and endothelial dysfunction was explained in part by elevations in follicle-stimulating hormone and progesterone, but not declining estradiol.NEW & NOTEWORTHY We demonstrate that the age at which endothelial function declines and aortic stiffness increases in healthy women is 47 and 48, respectively. The inflection point in flow-mediated dilation (FMD) is 6 yr earlier than previously reported, and the association between age and FMD was mediated by follicle-stimulating hormone (FSH) and progesterone (P4) but not estradiol (E2).

Development of a Frailty Prediction Model Among Older Adults in China: A Cross-Sectional Analysis Using the Chinese Longitudinal Healthy Longevity Survey.

To identify the risk factors associated with frailty among older adults in China and develop a predictive model for assessing their frailty risk. Secondary cross-sectional analysis. The 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) provided data for this study. A total of 9006 participants were included in the analysis. Their general demographic, socioeconomic status and health behaviour risk factors were collected in the CLHLS. Frailty was assessed using the Frailty Index. A visual nomogram model was constructed based on independent predictors identified using multivariate analysis. The nomogram's discrimination and calibration capabilities were evaluated using the C-statistics and calibration curves. A 1000-times resampling enhanced bootstrap method was performed for internal validation of the nomogram. The results showed that living in rural settings, having a primary education level, having a spouse, having basic living security, smoking, drinking, exercising and social activities were protective factors against frailty. Increasing age, being underweight or obese, adverse self-assessed economic status and poor sleep quality were risk factors of frailty. The AUC values of the internal validation set were 0.830. The calibration curve was close to ideal. The Brier score was 0.122. The above results showed that the nomogram model had a good predictive performance. A simple and fast frailty risk prediction model was developed in this study to help healthcare professionals screen older adults at high risk of frailty in China. The frailty risk prediction model will assist healthcare professionals in risk management and decision-making and provide targeted frailty prevention interventions. Screening high-risk older adults and early intervention can reduce the risk of adverse outcomes and save medical expenses for older adults and society, thereby realising cost-effective planning of health resources and healthy ageing. No patient or public contribution. This study was a cross-sectional, secondary analysis of the CLHLS data.

CEOs' narcissism and opportunistic insider trading

Narcissism is a multifaceted personality trait that profoundly influences individuals' cognition, emotions, and actions. This study investigates the relationship between narcissistic CEOs and their engagement in opportunistic insider trading. Utilizing a quantitative measure of CEOs' narcissism derived from textual analysis, we find that CEOs with a higher level of narcissism engage in opportunistic insider trading more intensely. To mitigate endogeneity concerns, we employ various rigorous approaches, including matching, instrumental variable, Heckman's two-step sample selection model, and falsification tests. Through cross-sectional analysis, we find that the impact of CEOs' narcissism on opportunistic insider trading is more pronounced among CEOs with limited legal knowledge, facing weaker external and internal monitoring pressure, working at larger firms, and being male. In addition, we demonstrate that the insider trades of narcissistic CEOs are less profitable and less informative than those of non-narcissistic CEOs, as evidenced by subsequent stock performance.

Early employment after childbirth: A cross-sectional analysis using data from the National Maternity Survey in England

BackgroundEarly participation in paid work after childbirth may have long-lasting health and socioeconomic impacts for women and their families, yet there has been little research on women's early postpartum employment behaviours in England since the 2000s. We investigated women's employment patterns within six months of childbirth and the factors that influence them. MethodsUsing data from a population-based national maternity survey in England in 2018, employment status at six months postpartum was assessed. Descriptive analysis was used to explore employment characteristics of women in paid work. Logistic regression was used to explore sociodemographic, pregnancy- and birth-related factors associated with postpartum employment status. FindingsOf the 4313 participants included, 7·7% were in paid work within six months of childbirth. The most frequently reported motivation for being in paid work was needing the money (76%), followed by wanting to work (41%). The median time for (re)entering paid work was 17 weeks (IQR 13–26 weeks) and the median weekly hours worked was 24 (IQR 12–36 hours). The childcare option most frequently reported was the baby's grandparent(s) (47·8%), followed by spouses/partners (44·5%). Maternal age ≥35 years (compared to 30–34 years) was positively associated with being in paid work within six months of childbirth (aOR: 1·37, 95% CI 1·02–1·84), while not living with a partner (aOR 0·50, 95% CI 0·28–0·90), and having a pre-term birth (aOR 0·38, 95% CI 0·20–0·69) were negatively associated with being in paid work within six months. InterpretationThe low prevalence of women in paid employment within six months of childbirth aligns with recent downward trends. Factors associated with early postpartum employment show mixed patterns, however, which may reflect variation in financial pressures and opportunities. Our findings may assist policymakers when evaluating current and future family-based policies such as amendments to state-funded childcare and paid parental leave allowance. FundingThis research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. GF is funded by a Clinical Research Fellowship awarded by the Nuffield Department of Population Health, University of Oxford.

12292 Gender Bias in Patient Ratings of FMIGS Graduates: A Cross-Sectional Analysis

12292 Gender Bias in Patient Ratings of FMIGS Graduates: A Cross-Sectional Analysis

Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life.

Background/Objectives: Bowel endometriosis (BE) is characterized by the presence of endometrial-like tissue within the muscular layer of the bowel wall. When BE does not result in the severe obstruction to fecal transit and in the absence of (sub)occlusive symptoms, the decision to perform surgery can be challenging, as intestinal procedures are associated with higher complication rates and long-term bowel dysfunction. This cross-sectional study aims to evaluate the quality of life (QoL) in patients with BE who avoided surgery, as well as to investigate the impact of the characteristics of BE nodules on the QoL and intestinal function. Methods: A retrospective cross-sectional analysis was conducted involving 580 patients with BE who did not undergo surgery but were treated conservatively with medical therapy or expectant management between January 2017 and August 2022. The diagnosis of BE was established through transvaginal ultrasound and confirmed via double contrast barium enema. After at least one year of follow-up, the QoL and intestinal function were assessed using the Endometriosis Health Profile-5 (EHP-5) questionnaire and the Bowel Endometriosis Symptom (BENS) score, while pain symptoms were quantified with the Visual Analog Scale (VAS 0-10). Statistical analyses were performed to explore potential associations between the QoL and the characteristics of BE nodules (size, location, and evidence of stenosis), as well as the type and duration of medical therapy. Results: Patients with BE reported a satisfactory overall QoL, with a mean EHP-5 score of 105.42 ± 99.98 points and a VAS score below three across all pain domains. They did not demonstrate significant impairment in bowel function, as indicated by a mean BENS score of 4.89 ± 5.28 points. Notably, patients receiving medical therapy exhibited a better QoL compared to those not receiving treatment (p < 0.05), with the exception of postmenopausal patients, who reported the highest QoL overall (p < 0.05). Among the characteristics of BE, nodule location significantly impacted the QoL and symptom intensity, with low (rectal or rectosigmoid) nodules less tolerated compared to sigmoid nodules, particularly regarding non-menstrual pelvic pain (NMPP), dyschezia, and psychological impact on daily life (p < 0.05). Conclusions: Women can effectively manage BE conservatively in the absence of (sub)occlusive symptoms, even when large nodules are present, causing significant radiological stenosis. The characteristics of BE nodules do not significantly affect the QoL or symptom intensity; however, the location of BE nodules is a crucial factor negatively influencing these outcomes. Medical therapy may confer a beneficial impact on patients of reproductive age with BE, but its use should be carefully considered for those approaching menopause, weighing the risks and benefits.

Cardiovascular Risk Factors and Genetic Risk in Transthyretin V142I Carriers.

Nearly 3% to 4% of Black individuals in the United States carry the transthyretin V142I variant, which increases their risk of heart failure. However, the role of cardiovascular (CV) risk factors (RFs) in influencing the risk of clinical outcomes among V142I variant carriers is unknown. This study aimed to assess the impact of CV RFs on the risk of heart failure in V142I carriers. This study included self-identified Black individuals without prevalent heart failure from 6 TOPMed (Trans-Omics for Precision Medicine) cohorts, the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, and the All of Us Research Program. The cohort was stratified based on the V142I genotype and the number of CV RFs (hypertension, diabetes, obesity, and hypercholesterolemia). Adjusted Cox models were used to assess the association of heart failure with the V142I genotype and CV RF profile, taking noncarriers with a favorable CV RF profile as reference. The cross-sectional analysis, including 1,625 V142I carriers among 48,365 Black individuals, found that the prevalence of CV RFs did not vary by V142I carrier status. In the longitudinal analysis, there were 587 (3.2%) V142I carriers among 18,407 Black individuals (median age: 60 years [Q1-Q3: 52-68 years], 63.0% female). Among carriers, the heart failure risk was attenuated with a favorable (0 or 1 RF) CV RF profile (adjusted HR: 2.26; 95%CI: 1.58-3.23) compared with an unfavorable (3 or 4 RFs) CV RF profile (adjusted HR: 4.14; 95%CI: 2.79-6.14). A favorable CV RF profile lowers but does not abrogate V142I variant-associated heart failure risk. This study highlights the importance of having a favorable CV RF profile among V142I carriers for risk reduction of heart failure.

Cross-Sectional Cost Analysis of Finasteride for Androgenetic Alopecia via Direct-to-Consumer Pharmacies Compared to Online Wholesale Pharmacies

Cross-Sectional Cost Analysis of Finasteride for Androgenetic Alopecia via Direct-to-Consumer Pharmacies Compared to Online Wholesale Pharmacies

A biopsychosocial approach to phenotyping people with knee osteoarthritis awaiting total knee arthroplasty: A secondary cohort analysis

BackgroundPrevious research showed chronic post-total knee arthroplasty (TKA) pain in 20% of people with knee osteoarthritis (KOA). Various preoperative biopsychosocial-related factors have been described, but phenotyping people with KOA awaiting TKA based on these factors is still lacking. This could be relevant to understanding differences in TKA surgery responses. ObjectiveTo identify phenotypes in people with KOA awaiting TKA and differences in post-TKA pain based on preoperative biopsychosocial factors. MethodsPeople with KOA awaiting TKA in 4 hospitals in Belgium and the Netherlands were included. A cross-sectional latent profile analysis was conducted on structural, metabolic, functional, pain-related, psychological and social variables. Concurrent validity was tested using 3-step multinomial logistic regression. The difference in one-year post-TKA pain was examined with linear mixed model analysis. ResultsTwo hundred and seventeen participants were included in the latent profile analysis with a mean (SD) age of 65.5 (7.7) years, including 109 women. A model with 2 phenotypes differed in 14 out of 21 variables. Participants with phenotype 2 (28%) had a higher body mass index (BMI), higher chance of having less structural damage (KOA grade), lower mean quadriceps strength and physical function (Knee Society Scoring System functional and 30-second chair stand test), higher pain intensity, number of pain locations, and indices of central sensitisation (temporal summation, central sensitisation inventory score, and lower pressure pain thresholds), higher pain catastrophising, anxiety and depression, and higher post-TKA pain intensity compared to phenotype 1 (72%). Concurrent validity was confirmed in 3 out of 4 variables. ConclusionsPhenotype 2 (28%) with nociplastic pain characteristics in combination with worse psychological factors, BMI, functional and structural factors, and phenotype 1 (72%) not representing these characteristics were identified. Phenotype 2 had worse pain intensity scores after TKA compared to phenotype 1. Attention to the characteristics of phenotype 2 is warranted concerning post-TKA pain. Database registrationThe protocol is registered at ClinicalTrials.gov (NCT05380648).

Psychological distress in active-duty U.S. service members who utilized mental health services: Data from a 2018 DoD survey

BackgroundMilitary personnel face unique stressors to their mental health. ObjectivesTo estimate the prevalence of serious psychological distress among active-duty U.S. service members who utilized mental health services, and to identify related risk factors. MethodsWe applied a cross-sectional secondary data analysis design utilizing the 2018 DoD Health Related Behaviors Survey. The primary outcome was serious psychological distress during the past 12 months as measured by the Kessler 6-item Psychological Distress Scale. ResultsThe weighted prevalence of past-year serious psychological distress among service members utilizing mental health services was 39.1 % (95 % CI: 36.7–41.6 %). Significantly increased odds of serious psychological distress were seen among those who were separated, widowed, or divorced, and those in the Army, Navy, or Marine Corps. Decreased odds were seen for those in higher paygrades and those with at least a bachelor's degree (p < 0.05 for all). Smoking, binge drinking, illicit drug use, and sleeping ≤6 h per night were associated with serious psychological distress (p < 0.05 for all). ConclusionAmong active-duty service members who utilized mental health services, 39.1 % reported serious psychological distress over the past year. Being separated, widowed, or divorced and having a lower education level were associated with serious psychological distress. Sex, race/ethnicity, and lesbian/gay/bisexual identity were not found to be correlated with the outcome. Additional research is needed to further explore these correlations to enhance military readiness.

Therapeutic approaches and conceptions of practice of osteopaths in Australia - a national cross-sectional study and exploratory factor analysis of the Osteo-TAQ

BackgroundHealth professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia.MethodsA cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald’s omega calculated as the reliability estimation statistic.Results691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was ‘only talking’ with their patients.ConclusionsThis study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths’ conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath’s conception of practice, and their associations with other measures of practice including clinical outcomes.

Trends and patterns of antimicrobial consumption at Benjamin Mkapa Zonal Referral Hospital, Dodoma, Tanzania: a cross-sectional retrospective analysis

ObjectiveThis study assessed the trends and patterns of antimicrobial consumption (AMC) from 2020 to 2021, 2021–2022 and 2022–2023 at the Benjamin Mkapa Zonal Referral Hospital (BMH) in Dodoma, Tanzania.DesignA retrospective...