Binary Logistic Regression Model Research Articles

Prediction of left ventricular thrombus after myocardial infarction: a cardiac magnetic resonance-based prospective registry

BackgroundLeft ventricular thrombus (LVTh) is a severe complication after ST-segment elevation myocardial infarction (STEMI). ObjectivesWe aim to predict LVTh occurrence by cardiac magnetic resonance (CMR) using clinical, echocardiographic, and electrocardiographic (ECG) variables readily available at admission. MethodsWe included 590 reperfused STEMI patients who underwent early (1-week) and/or late (6-month) CMR in our institution. Baseline clinical, echocardiographic (left ventricular ejection fraction -LVEF-) and ECG data (summatory of ST-segment elevation -sum-STE- and Q-wave and residual ST-elevation >1 mm -Q-STE-) during admission were registered. Multivariate binary logistic regression models and receiver operating characteristic curves were computed for LVTh prediction. ResultsLVTh was detected by CMR in 43 (7.3 %) patients and was predicted by previous chronic coronary syndrome (CCS, HR 4.74 [1.82–12.35], p = 0.001), anterior STEMI (HR 10.93 [2.47–48.31], p = 0.002), LVEF (HR 0.96 [0.93–0.99] per %, p = 0.008), maximum sum-STE (HR 1.04 [1.01–1.07] per mm, p = 0.04), and Q-STE (HR 1.31 [1.08–1.6] per lead, p = 0.008). High-risk patients with both major (anterior STEMI and Q-STE in ≥1 leads) and 1–3 minor (CCS, maximum sum-STE >10 mm, LVEF <50%) factors showed the highest LVTh risk (19.6 % within 6 months). The model showed excellent discrimination ability (area under the curve=0.85 [0.81–0.9], p < 0.001). Simplified 4-variable (excluding sum-STE) and 3-variable (also excluding CCS) risk scores showed similar discrimination ability and were externally validated. ConclusionsLVTh within 6 months post-STEMI can be predicted using pre-discharge clinical (anterior infarction and CCS), echocardiographic (LVEF), and ECG (sum-STE and Q-STE) data. Our results can help select patients who should undergo CMR after STEMI for LVTh detection.

The current status of primipara’s childbirth experience and its correlation with their reproductive intention: a cross-sectional survey study

BackgroundThe childbirth experience of primipara profoundly impacts her future physical and mental health, reproductive intention, and choice of childbirth mode. This study aimed to explore the current situation of primipara’s childbirth experience, to analyze the factors influencing negative childbirth experience, and to explore the relationship between childbirth experience and reproductive intention.MethodsA cross-sectional survey of a convenience sample of 522 primipara 1–5 days postpartum was conducted at five hospitals in Guangdong Province (May to July 2024). Data were collected using the General Information Questionnaire, the Social Support Rating Scale, the Childbirth Readiness Scale, the Caring Behaviors Inventory Scale, the Wijma Delivery Experience Questionnaire, and the Questionnaire on Reproduction Intention of Primipara.ResultsThe mean score of fear of childbirth was 68.86 ± 17.68. A total of 137 respondents met the clinical criteria for fear of childbirth (≥ 85 points), indicating that 26.2% of primipara had a negative experience of childbirth. Binary logistic regression model showed that elderly primipara [odds ratio (OR) (95% confidence interval (CI)): 11.167 (2.737–45.559)], pregnancy comorbidities or maternal childbirth complications [OR (95%CI): 6.596 (3.046–14.287)], childbirth intervention [OR (95%CI): 6.168 (2.869–13.258)], and severe pain [OR (95%CI): 4.660 (2.197–9.882)] were risk factors for negative childbirth experience. Childbirth accompaniment [OR (95%CI): 0.081 (0.018–0.368)], high level of social support [OR (95%CI): 0.768 (0.704–0.839)], and high level of childbirth readiness [OR (95%CI): 0.878 (0.812–0.950)] protected against a negative birth experience. There was a negative correlation between the fear of childbirth score and reproduction intention scores.ConclusionsChildbirth accompaniment and high levels of social support and childbirth readiness can reduce primipara’s perception of negative childbirth experience. Negative childbirth experience can reduce reproduction intention.

Knowledge and acceptability of the human papillomavirus vaccine and associated factors among adolescent girls in public primary schools in Dessie Town, South Wollo, Northeast Ethiopia, 2020: A cross-sectional study.

To assess the knowledge and acceptability of the human papillomavirus (HPV) vaccine and the associated factors among adolescent girls in public primary schools in Dessie Town, South Wollo, Northeast Ethiopia in 2020. This was an institutional cross-sectional study conducted from 1 November to 30 November 2020 among 844 adolescent girls. A systematic random sampling method was used to select participants, who completed a pretested, self-administered questionnaire. Data were entered into EpiData V.4.6 and exported to SPSS V.25 for analysis. A binary logistic regression model identified the contributing factors to HPV vaccine knowledge and acceptance. Adjusted OR (AOR) and 95% CI computed at p<0.05 were used to assess significance levels. The primary outcomes of interest were knowledge and acceptability of the HPV vaccine. The HPV vaccine is known and acceptable to 47% and approximately 43% of the respondents, respectively. Age (AOR=3.51, 95% CI 1.62 to 7.6), father's educational level (AOR=2.62, 95% CI 1.57 to 4.38) and parent-child communication about sex and reproductive health (AOR=1.94, 95% CI 1.36 to 2.76) were associated with knowledge of the HPV vaccine. Acceptance of the HPV vaccine was significantly influenced by fathers' educational level (AOR=1.88, 95% CI:1.02 to 3.29), knowledge of Pap smear tests (AOR=2.54, 95% CI 1.79 to 3.62) and knowledge of the HPV vaccine (AOR=5.30, 95% CI 3.77 to 7.73). In this study, there was generally good and high acceptance of the HPV vaccine, respectively, compared with a study conducted in Southwest Ethiopia. The study, however, had limitations in terms of recall bias, assessment of coverage/effectiveness over time and generalisability due to the institutional sample used.

Night Eating Syndrome Among University Students in Bangladesh: Investigation of Prevalence and Associated Factors.

Night eating syndrome (NES) has been associated with psychological issues and academic performance among university students in several countries, yet research on NES in Bangladesh remains limited. Therefore, the purpose of the study was to examine the prevalence and factors associated with NES among university students in the country. This cross-sectional study included 500 students from five public universities in Bangladesh. A validated 14-item night eating questionnaire was used to assess NES as the outcome variable. Demographic factors, depressive symptoms measured via the Patient Health Questionnaire (PHQ-9), and internet addiction levels measured via Orman's Internet Addiction Survey (OIAS) were explored as predictor variables. A multiple binary logistic regression model was fitted to identify the correlation of NES and its associated factors, with results presented as adjusted odds ratio (AOR) and level of significance set at p values <0.05. The prevalence of NES among participants was 16.6% (mean age = 21.6 years, 53.6% male). Adjusted binary logistic regression revealed that male participants (AOR = 2.03, 95% CI = 1.09-3.74, p = 0.024), smoking (AOR = 1.92, 95% CI = 1.02-4.44, p = 0.044), depressive symptoms (AOR = 2.17, 95% CI = 1.26-3.72, p = 0.005), and severe internet addiction (AOR = 2.69, 95% CI = 1.28-5.62, p = 0.009) were significantly associated with increased odds of experiencing NES. These findings underscore the need for heightened healthy eating awareness programs along with targeted mental health interventions with students attending Bangladeshi universities. Further research that explores longitudinal patterns of NES and the risk factors addressed in this study is warranted to better understand and inform the development of future interventions to benefit the Bangladeshi university student population.

The influencing factors of willingness to participate in crop rotation and fallow: A behavioural economics perspective

AbstractCrop rotation and fallow practices are increasingly adopted to mitigate ecological resource pressures and accelerate the development of modern agriculture. These practices have significant implications for environmental protection, soil quality enhancement and the promotion of sustainable, high‐quality agricultural development. Despite their importance, empirical research on the factors influencing participation in crop rotation and fallow remains limited and comparative analyses of different compensation scenarios are scarce. This study, grounded in behavioural economics, utilizes data from the China Rural Revitalization Survey (CRRS) and employs propensity score matching (PSM) and binary logistic regression models to analyse farmers' behaviour regarding both induced and voluntary crop rotation and fallow. The research aims to identify the factors that influence farmers' decisions to engage in these practices. The findings indicate that, under a fixed subsidy standard, the participation rates for crop rotation and fallow were 14.5% and 5.4%, respectively. Among the farmers participating in crop rotation, 43.8% were induced, while 56.2% were voluntary. For fallow practices, 47.9% of the participants were induced and 52.1% were voluntary. In the context of induced crop rotation and fallow, ecological subsidies significantly increased farmers' willingness to participate (p‐value &lt;.001). Conversely, in voluntary contexts, resource endowment had a significantly positive impact on crop rotation behaviour (p‐value &lt;.1), whereas path dependence and policy awareness significantly constrained fallow behaviour (p‐value &lt;.05). The impact of ecological subsidies on farmers' crop rotation and fallow behaviour varied significantly across different ecological regions, with other factors also exhibiting notable heterogeneity. The results of this research offer valuable guidance for the implementation of future crop rotation and fallow programmes. Additionally, they provide insights into the relationship between ecological subsidy systems and farmers' welfare in other underdeveloped areas, suggesting improvements and offering new perspectives for further research.

Association between programmed death protein 1-related single-nucleotide polymorphisms and immune-related adverse events induced by programmed death protein 1 inhibitors—a pilot study

Programmed death protein 1 (PD-1) inhibitors have potent anti-tumor activities. However, they often result in immune-related adverse events (irAEs) of varying severity. Therefore, the factors affecting the incidence of irAEs warrant urgent investigation. This study aimed to identify specific and sensitive predictors of irAEs in a Chinese population. We conducted a genome-wide association study (GWAS) comprising 80 patients with malignant tumors to evaluate single-nucleotide polymorphism (SNP) loci associated with the incidence of irAEs. The SNP rs2157775 on the LOC339166 gene had the lowest P value but did not reach the significance threshold after Bonferroni correction. Therefore, potentially associated SNPs were further investigated through the mechanism-related PD-1 pathway using the ImmPort and PathCards Human Gene Databases. A binary logistic regression model revealed that CD3E (rs3782040) A/A was associated with a lower incidence of irAEs in patients with malignant tumors who received PD-1 inhibitors. In contrast, PTPN11 (rs143894582) C/CA was associated with a higher incidence of irAEs. These findings provide a basis for the verification and identification of new loci to provide insight into the etiology of irAEs.

Individual and joint effects of diabetes and depression on incident cardiovascular diseases and all-cause mortality: Results from a population-based cohort study

AimsTo assess the individual and joint effects of diabetes and depression on all-cause mortality and cardiovascular disease (CVD) in the middle-aged and elderly Chinese populations. Methods9105 individuals without CVD from the China Health and Retirement Longitudinal Study (CHARLS) were included and followed up for 9 years. Participants were divided into four comparative groups: diabetes alone, depression alone, both conditions, and neither condition. Multivariate binary logistic regression models were performed to compare the risks of all-cause mortality and CVD among the four groups. ResultsWhen compared to those without diabetes and depression, the multivariate adjusted odds ratios (aORs) for CVD in individuals who had diabetes only, depression only, and both diabetes and depression were 1.245 (95 % CI 1.023 to 1.515), 1.318 (95 % CI 1.171 to 1.485) and 1.722 (95 % CI 1.361 to 2.178), respectively. The aORs for all-cause mortality were 1.366 (95 % CI 1.035–1.804) for diabetes alone, 1.082 (95 % CI 0.916–1.279) for depression alone, and 1.590 (95 % CI 1.152–2.195) for both conditions when compared with those with neither condition. ConclusionsIndividuals with both diabetes and depression had greater risk of CVD and all-cause mortality when compared to those with diabetes or depression alone, or those without either condition.

Menstrual hygiene management among reproductive-aged women with disabilities in Bangladesh.

Women with disabilities in low- and middle-income countries face unique challenges in managing menstruation, affecting their health, dignity, and quality of life. This study aimed to explore menstrual hygiene management (MHM) practices among reproductive-aged women with disabilities in Bangladesh and its impact on social participation. We analyzed data from 51,535 women from the 2019 Multiple Indicator Cluster Survey (MICS). The outcome variables were: (i) material used to manage blood flow while menstruating (appropriate, inappropriate), (ii) availability of a private place for washing and changing menstruation rags (yes, no), and (iii) impact on attendance of social activities, school, or work during menstruation (yes, no). Disability status was considered as a major explanatory variable and categorized as no disabilities, moderate disabilities, and severe disabilities. Associations of outcome variables with explanatory variables were determined using a multilevel mixed-effects binary logistic regression model adjusted for individual-level factors, household-level factors, and community-level factors. Among the sample, 2.7% reported severe disability and 19.2% moderate disabilities, with vision-related disabilities (12.2%) being the most prevalent, followed by cognitive (9.5%) and walking disabilities (8.2%). Overall, 4% reported using inappropriate materials for menstrual flow, rising to 8.0% among those with severe disabilities and 5.8% for moderate disabilities. Women with moderate to severe disabilities had 33%-47% lower odds of using appropriate materials and 34%-44% lower odds of having a private place to change at home. Additionally, women with severe disabilities were 1.66 times more likely to report that menstruation impacted their social activities. Women with disabilities in Bangladesh face significant barriers to effective MHM. Addressing these issues requires targeted interventions, including disability-inclusive menstrual health education, improved access to menstrual products and sanitation facilities, and community initiatives to reduce stigma.

Categorical and resource inequalities in self-reliant internet use and use-by-proxy among older adults in Slovenia during the COVID-19 pandemic

The COVID-19 pandemic had considerable impact on how older adults engaged online, with many using the internet for the first time or relying on family, friends, and peers to perform an activity online on their behalf, a form of internet use known as use-by-proxy. Since we lack large-scale research that compares what factors influence self-reliant internet use and use-by-proxy in older adults during the pandemic, this study seeks to fill this gap. Drawing on resources and appropriation theory, we examine how categorical (e.g., age, gender, education) and resource inequalities (e.g., social, material) shape internet use among older adults as well as the availability and activation of use-by-proxy among older internet non-users. We conducted three binary logistic regression models to analyze survey data collected in 2021 during the fourth wave of pandemic public health measures in Slovenia from a sample of 701 older adults aged 65+. The results show that personal and positional categorical disparities among older adults were significantly associated with their internet use during the pandemic, whereas bridging social capital was the only social resource positively associated with internet use. Conversely, categorical inequalities played a less important role in the availability of use-by-proxy than social resources. In fact, apart from occupation, bonding and bridging social capital were the only positive correlates of availability of proxy users among older internet non-users. Surprisingly, neither type of social capital was linked with the activation of use-by-proxy, which was only associated with two positional categorical disparities: marital status and residential area. Our findings suggest that addressing age-related digital inequalities after the pandemic requires a diversified approach that considers the heterogeneity of categorical and resource inequalities shaping older adults' self-reliant internet use and use-by-proxy.

Breast Cancer and Risk of Depression: A Comparative Cross-Sectional Study Among Women With and Without Breast Cancer in Addis Ababa, Ethiopia.

The extent of symptoms of depression among patients with breast cancer compared with those without the disease is not well documented in Ethiopia and other sub-Saharan African countries. This study examines the prevalence of symptoms of depression in women with breast cancer (n = 436) compared with those without breast cancer (n = 856) in Addis Ababa, Ethiopia, through a comparative cross-sectional study using a validated questionnaire, the Patient Health Questionnaire-9. The association between breast cancer diagnosis and symptoms of depression was evaluated using a multivariable binary logistic regression model. About 39.2% of women with breast cancer had some level of symptoms of depression compared with 23.8% of women without the disease. By severity of symptoms of depression, 13.1% of women with breast cancer reported moderate to severe symptoms of depression compared with 6.8% of women without the disease. Sixty-three percent of women with breast cancer reported difficulties performing routine daily activities, compared with 36.7% of women without the disease. In the multivariable-adjusted model, women with breast cancer were 2 times (adjusted odds ratio, 2.26 [95% CI, 1.49 to 3.44]) more likely to report symptoms of depression compared with those without the disease. Likewise, women with breast cancer were 4.78 (95% CI, 3.51 to 6.52) times more likely to report difficulty in performing routine daily activities compared with women without the disease. Four in 10 women with breast cancer in Addis Ababa reported having symptoms of depression, which was considerably higher than women in the general population. This finding emphasizes the importance of addressing psychosocial needs among women with breast cancer to enhance quality of life and potentially extend longevity.

The impact of the COVID-19 pandemic on the country's national economy: The Indonesian experience

Purpose: This study aims to examine the effects of inflation, exchange rates, and the Covid-19 pandemic on Indonesia's trade balance position and to develop an empirical estimation model to predict its position. Method: The data used in this research are the inflation rate, exchange rate of rupiah to the US dollar, export value, and import value of Indonesia from January 2012 to March 2021. The econometric model used in this study was a binary logistic regression model. Results: The results indicate that The regression coefficient of the inflation rate is negative at 0.3621, with an odds ratio of 0.696. This suggests that 1 percent in inflation reduces the probability of a trade balance surplus of 0.696. The regression coefficient for the exchange rate was positive at 2.18, with an odds ratio of 8.85. This means that every 2.72 rupiah increase in the exchange rate raises the probability of a trade balance surplus of 8.85 times. However, this study does not find empirical evidence that inflation, exchange rates, and pandemic of Covid-19 have no impact on the position of Indonesia's trade balance. Limitations: This study focuses on two factors believed to influence the position of trade balance in Indonesia: the inflation rate and foreign exchange rates. Contributions: This study provides insights into government policy.

The Monocyte-to-Lymphocyte Ratio Was Associated With Intraplaque Neovascularization of the Carotid Artery on AngioPLUS.

The monocyte-lymphocyte ratio (MLR) is a hematological test parameter that reflects the status of both monocytes and lymphocytes as inflammatory cells. This study aims to investigate the relationship between MLR and carotid intraplaque neovascularization (IPN) in patients with asymptomatic carotid stenosis. We performed the Angio Planewave Ultrasensitive (AngioPLUS) screening for patients with carotid plaques. The carotid plaque stability was evaluated by semiquantitative visual grading of carotid IPN. Binary logistic regression models were performed to determine the associations between different clinical and laboratory indicators and the presence of high IPN. A total of 160 patients were eventually enrolled with 99 in the low IPN group (Scores 0-1) and 61 in the high IPN group (Score 2). Univariate logistic regression showed that age, monocytes, lymphocytes, glycated hemoglobin (HbA1c), fibrinogen, d-dimmer, and MLR were significantly associated with the presence of high IPN (all p<0.05). Multivariate logistic regression models showed that MLR was significantly associated with the presence of high IPN after adjusting for other covariates. An MLR value of 32.9 was the optimal cutoff value to differentiate high and low IPN. High MLR was also significantly correlated with the presence of high IPN (odds ratio [OR]=4.08, 95% confidence interval [CI]: 1.69-9.88, p=0.002) when included in the above multivariate logistic regression model. Elevated MLR is closely associated with the presence of high IPN and may serve as a surrogate biomarker for carotid IPN.

Traumatic brain injury outcomes at the “epicenter of the epicenter” of the united states COVID-19 pandemic amidst ongoing socio-demographic challenges

Abstract Introduction Traumatic brain injury (TBI) poses a significant public health challenge with profound impacts at individual, family, community, and societal levels. Early during the COVID-19 pandemic, the neighborhood of Elmhurst, Queens in New York City was a hotspot dubbed the “epicenter of the epicenter” of the crisis in the United States, requiring major changes in healthcare resource allocation. This study investigates how different phases of the COVID-19 pandemic affected the incidence, severity, and clinical outcomes of TBI in this geographical area. Methods TBI admissions to NYC Health + Hospitals/Elmhurst, a Level 1 Trauma Center, during the first six months of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: pre-pandemic (1/1/19–6/30/19 and 1/1/20–2/29/20) [Group 1], first COVID-19 wave (3/1/20–6/30/20) [Group 2], and second COVID-19 wave (1/1/21–6/30/21) [Group 3]. Univariate analyses were conducted to explore factors potentially associated with TBI outcomes; variables that reached statistical significance (p &lt; 0.05) were included in a binary logistic regression analysis dichotomized into good outcome (discharge to home or acute rehabilitation disposition) and poor outcome (discharge to skilled nursing facility/subacute rehabilitation, hospice, or in-hospital mortality). Results Analysis of 443 TBI patients (median age 56 [range 38, 73]; mean admissions/week 5.6 ± 2.7) demonstrated no significant variance in age (H = 0.92; p = 0.63), sex (χ2 = 1.4, p = 0.51), or ethnicity (χ2 = 17.1; p = 0.07) across groups. Group 2 had significantly fewer weekly admissions (3.9 ± 2.6) compared to Groups 1 (5.9 ± 2.2; p = 0.02) and 3 (6.1 ± 2.9; p = 0.01). Over the course of the pandemic, the proportion of uninsured patients decreased from 15 to 4%, while Medicaid and Medicare coverage rates rose from 25 to 41% and 20% to 28%, respectively (p &lt; 0.001). A binary logistic regression model dichotomized by discharge outcome for all 443 TBI patients confirmed that increasing age (OR = 0.95; 95% CI 0.93–0.97; p &lt; 0.001) and Injury Severity Score (OR = 0.88; 95% CI 0.83–0.93; p &lt; 0.001) were inversely correlated with good outcome, while higher Glasgow Coma Scale (OR = 1.26; 95% CI 1.17–1.36; p &lt; 0.001) was positively correlated. Of particular interest, Black/Hispanic ethnicity (OR = 0.36; 95% CI 0.19–0.66; p = 0.002) and public health insurance (Medicaid/Medicare) coverage (OR = 0.83; 95% CI 0.68–1.00; p = 0.05) were both associated with less favorable outcomes. Neither group designation, patient sex, COVID-19 status, or need for neurosurgical intervention was correlated with outcome (p &gt; 0.05). Conclusion Despite the changes in TBI admission patterns throughout New York City during the COVID-19 pandemic, the quality of patient outcomes at our institution remained relatively consistent across the pandemic’s different phases, as assessed by discharge disposition. However, two important socioeconomic factors—ethnicity and health insurance status—were significantly associated with outcome, underscoring the need for systemic changes to address ongoing disparities in neurotrauma care.

Multilevel and geographically weighted regression analysis of factors associated with full immunization among children aged 12–23 months in Ethiopia

Immunization is the process of building immunity or resistance to an infectious disease, typically through administering a vaccine. It is one of the most effective strategies for lowering child morbidity and death. It protects against more than 20 potentially fatal diseases, increasing longevity and health. Despite progress, Ethiopia failed to meet its vaccination coverage target. The magnitude of full immunization is different across areas. Therefore, conducting geographically weighted regression to identify the local factors and multilevel analysis to investigate and identify factors associated with full immunization coverage among children aged 12–23 months is necessary. The study was conducted using the 2019 Ethiopian Mini Demographic Health Survey dataset. A sample of 1028 weighted children aged 12–23 months were included in the analysis. Descriptive statistics were used to describe variables. For the spatial analysis, Arc-GIS version 10.8 statistical software was used. Spatial regression (geographically weighted regression) was done to identify factors associated with the proportion of full immunization, and model comparison was based on adjusted R2 and Akaike Information Criteria (AICc). Multilevel mixed-effect binary logistic regression models were fitted to identify factors associated with full immunization. The fitted models were compared based on log-likelihood, deviance, median odds ratio, and Proportional Change in Variance. Finally, statistically significant factors were reported using an adjusted odd ratio (AOR) with a 95% Confidence Interval for fixed effect. All variables with a p-value less than 0.05 in the final model were considered statistically significant factors. In Ethiopia, the overall full immunization coverage among children aged 12–23 months was 40.58%, with spatial variation across regions in Ethiopia. The significant spatial distribution of full immunization coverage among children aged 12–23 months was detected in northern Tigray, Addis Ababa, central Oromia, and southeastern Amhara regions. The proportion of rural residents,the proportion of women aged 35–44 years, the proportion of women who had ANC 4 and above andthe proportion of women who had PNC were local factors associated with the proportion of full immunization among children aged 12–23 months. Rural residence [AOR 0.27 (95% CI 0.10, 0.70)], family size 4 and above[AOR 0.41 (95% CI 0.17, 0.96)], never breastfeed [AOR 0.026(95% CI 0.003, 0.21)], 1–3 times ANC visit [AOR 0.45 (95% CI 0.23, 0.86)], being from Oromia region [AOR 0.23 (95% CI 0.05, 0.97)], Eastern pastoralist region [AOR 0.09 (95% CI 0.023, 0.35)], age 35–44 years [(AOR 6 (95% CI 1.57, 22.9)], and PNC [AOR 2.40 (95% CI 1.24, 4.8)] were significant factors associated with fully immunization in multilevel mixed effect analysis. Full immunization coverage in Ethiopia is below the global target with significant geographical variation. The high proportion of rural residents, the high proportion of women who had ANC 4 and above, mothers who had a high proportion of PNC, and the high proportion women age 35-44 years were local geographical factors for the proportion of full immunization among children age 12–23 months in Ethiopia. Women who had PNC, ANC visits four or more times, and increased maternal age were positively associated, whereas larger family size, no breastfeeding, rural residence, and being from Oromia and eastern pastoralist region were negatively associated with full immunization. Strengthening maternal and child health services, focusing on rural areas and low-coverage regions, is essential to increase immunization coverage in Ethiopia.

Factors Associated with Positive Religious Coping in Diabetic Foot Ulcer Patients in Indonesia

Purpose: To analyze factors associated with positive religious coping among diabetic foot ulcer (DFU) patients based on demographic factors, disease characteristics, and patient factors.Methods: This study was conducted in two hospitals in Indonesia. Patients (&lt;i&gt;N&lt;/i&gt;=173) were selected through convenience sampling. The Multidimensional Scale of Perceived Social Support, the Brief RCOPE, and the Diabetes Distress Scale (DDS) were questionnaires employed in this study. The test of a binary logistic regression model was used.Results: There was a significant relationship between positive religious coping and diabetes distress (&lt;i&gt;p&lt;/i&gt;=.037). However, positive religious coping showed no significant relationship with demographic factors (age, education level) or disease characteristics (duration and degree of DF) (all &lt;i&gt;p&lt;/i&gt;&gt;0.05). Binary logistic regression results showed that family support (OR=4.09) and spiritual experience (OR=2.74) had the greatest strengths of relationship among factors influencing positive religious coping.Conclusion: Efforts to improve positive religious coping in DFU patients can be made by optimizing their family support and spiritual experiences to improve their resilience and quality of life.

Gender differences in factors associated with rural health care practice in Minnesota.

To understand gender differences in factors affecting rural health care workforce to inform the development of effective policies and recruitment strategies to address rural health care workforce shortages. A cross-sectional survey of health care professionals (including Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs)) in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022, during their professional license renewal. The main outcome was whether or not the respondent was practicing in a rural area. The effects of factors associated with rural practice were estimated using binary logistic regression models, and subsequently subgroup analysis was conducted by gender across the four health care professions. Results show that although there were significant gender differences in some factors (growing up in a rural area and family considerations were more likely to influence women's decisions than men's, whereas men were more likely to be influenced by the prospect of having autonomy and broad scope of practice than women), these differences became insignificant when the four health care professionals were analyzed separately suggesting that overall gender differences observed were almost entirely explained by profession differences. Gender differences do not significantly influence the factors impacting rural practice. However, being raised in a rural environment emerges as the most influential predictor of rural practice underscoring the importance of involving rural residents of all genders in health care practice.

Association of multiple urinary metals/metalloids with obesity defined by body fat percentage: A cross-sectional study among Guangxi Zhuang ethnic in China

BackgroundPrevious studies confirmed a link between urinary metals/metalloids and obesity; however, the majority of these studies defined obesity using body mass index (BMI) or waist circumference (WC), and their results were not constantly consistent. Studies defining obesity based on body fat percentage (BFP) is less reported. MethodsA total of 5405 participants aged 35–74 from Guangxi Zhuang ethnic group in China were included in the analysis. Inductively coupled plasma mass spectrometry (ICP-MS) was used to detect the concentrations of 22 metals/metalloids in urine. Using a binary logistic regression model, the impact of individual metal/metalloid on the risk of BFP/obesity was analyzed, and the LASSO regression model was employed to choose metals/metalloids independently related with BFP/obesity to construct a multiple-metal models. The quantile g-computation model was used to evaluate the combined impacts of metals/metalloids on BFP/obesity. ResultsIn multiple-metal models, compared with the lowest quartile, the highest quartile of urinary concentrations of Mg, Cd, and Ti was significantly associated with a reduced risk of BFP/obesity (Mg: OR=0.66, 95 %CI: 0.51, 0.85; Cd: OR=0.63, 95 %CI: 0.49, 0.82; Ti: OR=0.73, 95 %CI: 0.57, 0.93). Conversely, the highest quartiles of urinary concentrations of Zn, V, and Sb was significantly associated with an increased risk of BFP/obesity (Zn: OR=1.75, 95 %CI: 1.39, 2.22; V: OR=1.63, 95 %CI: 1.25, 2.14; Sb: OR=1.38, 95 %CI: 1.06, 1.79). In quantile g-computation analysis, Mg, Cd, and Sn were the main contributors to negative effects, while Zn, V, and Sb were the main contributors to positive effect, although no significant relationship was observed between the multiple metal/metalloid mixtures and BFP/obesity. ConclusionsAccording to our study, urinary Mg, Cd, and Ti levels were negatively associated with BFP/obesity risk, and Zn, V, and Sb levels were positively associated with BFP/obesity risk. However, these associations need to be further verified by longitudinal studies, and the molecular mechanisms need to be further explored by animal and cell experiments.

Estimation and modeling of pedestrian dilemma zone at uncontrolled intersections under mixed traffic conditions

Objectives Pedestrian gap acceptance (PGA) theory is the basic concept for pedestrian dilemma zone (PDZ) analysis and modeling and their gap acceptance behavior depends on dilemma behavior also. Uncontrolled intersections are one of the major locations where pedestrians have more dilemma and there is a possibility of an interaction between the pedestrian and vehicle due to the incorrect decision taken by the pedestrian when the vehicle lies within the limits of PDZ. Elimination and modeling of spatial boundaries of pedestrian dilemma stage improve the PGA. Methods The present study is intended to quantify and model the pedestrian dilemma zone (PDZ) boundaries at uncontrolled X-intersections under mixed traffic conditions. Video data were collected from four four-legged uncontrolled intersections in India. Pedestrian and vehicle information was extracted using DataFromSky software and manually from video. The Cumulative Gap Distribution (GCD) and Support Vector Machine (SVM) methods were used to estimate the boundaries of PDZ and developed a binary logistic regression model to estimate the PDZ boundary limits. Results The lower boundary limits of PDZ using GCD and SVM methods are 9.0 m and 6.0, respectively, and the upper boundary limits of PDZ using GCD and SVM methods are 16.5 and 18.5 m, respectively. The GCD method overestimated the lower limit and underestimated the upper limit compared with the SVM method. The binary logistic regression model results confirmed that pedestrian age, gender and crossing speed have a negative correlation and location of pedestrian crossing, vehicle type, and approaching speed have a positive correlation with the boundary limits of PDZ. Conclusions From the present study, it is concluded that SVM better estimated the PDZ boundary limits with the largest margin compared to the GCD method. It is concluded that the boundary limits shift away from the intersection in the case of female and old-age pedestrians compared to male and young-age pedestrians, respectively. The size benefit in the case of 2Ws is the reason for shifting the PDZ boundary limits close to the crosswalk. The lower approaching speeds of the vehicles at uncontrolled intersections are the reason for pedestrians accept the gap at shorter distances.

Linkages between consanguinity, pregnancy outcomes and offspring mortality in twenty-first century India.

We hypothesized that consanguineous marriage will remain a risk factor for pregnancy outcome and offspring mortality, but the development in demographic, socioeconomic conditions and increased utilization of maternal and child health care services during postglobalization era would work as a buffer in the reduction of child mortality rates. Data fromNational Family Health Surveys 4(2015-2016) and 5(2019-2021) were pooled and used for the analysis. Binary logistic regression and Cox proportional hazard regression models were used to examine the effects of close (CC) and distant (DC) consanguinity on spontaneous abortion, stillbirth, neonatal mortality, post-neonatal, and child mortality respectively compared to non-consanguinity (NC). The final model showed that the risk of spontaneous abortion (both CC and DC, p < 0.001) and neonatal mortality (DC, p < 0.001) were significantly higher compared to NC. No significant association was found between consanguinity and child mortality. We conclude that the endogenous effect of consanguinity still pose a serious challenge to the survival of fetus and new born; but exogenous effect reduces the risk of child death. We propose to incorporate socially entrenched practice of consanguinity explicitly into Mosley and Chen's (1984) framework for the aid in understanding child survival in developing countries.

Validation of the Chinese version of the vaccine conspiracy beliefs scale during COVID-19 pandemic and its correlates

ObjectiveTo validate the Chinese version of the vaccine conspiracy beliefs scale (VCBS) and to investigate and compare its correlates among healthcare workers and non-healthcare workers during COVID-19 pandemic. MethodsFrom March 19 to April 05, 2021, a nationwide cross-sectional online survey was administered to Chinese individuals aged 16 and above. The study aimed to assess the reliability and validity of the Chinese version of the VCBS. A binary logistic or linear regression model, along with mediation analysis, was employed to explore the relationship between vaccine conspiracy beliefs and its correlates among healthcare workers. ResultsThe VCBS demonstrated robust psychometric properties, showing satisfactory results from both exploratory and confirmatory factor analyses, strong internal consistency (KR-20 = 0.947), and calibration validity. Measurement invariance (MI) was also observed. Additionally, individuals' vaccine conspiracy beliefs, as measured by the VCBS, mediate the relationship between occupation and COVID-19 vaccine hesitancy (95 % CI [−2.229, −1.060]), as well as COVID-19 (95 % CI [0.096, 0.304]), influenza (95 % CI [0.075, 0.304]), and HPV (95 % CI [0.009, 0.236]) vaccination uptakes. ConclusionThe Chinese adaptation of the VCBS proves adept at assessing vaccine conspiracy beliefs among Chinese individuals aged 16 and above. Notably, the healthcare workers are less likely to exhibit COVID-19 vaccine hesitancy and are more likely to receive COVID-19, influenza, and HPV vaccines. This tendency is partly related to their weaker conspiracy beliefs about vaccination.