Binomial Logistic Regression Analysis Research Articles

Chronic energy deficiency in young pregnant women in rural Indonesia: an analysis of basic health survey 2018

Introduction: Chronic energy deficiency (CED) significantly impacts maternal health and child development. Socioeconomic conditions and access to health services cause young mothers in rural areas to have different health problems from those in urban areas. The study aimed to analyze the factors associated with CED among young pregnant women in rural areas in Indonesia. Methods: Secondary data for this cross-sectional study were obtained from the 2018 Basic Health Research Survey. One thousand one hundred and thirty-nine pregnant women aged <25 years were involved as subjects. Age, number of family members, education, occupation, gravida, abortion, supplementary feeding, and iron tablets during pregnancy were included as independent variables. Binomial logistic regression analysis was performed to measure the association between the independent and dependent variables. The strength of the association was expressed by p-value <0.05. Results: The three factors associated with CED were age (p=0.001), education (p=0.013), and supplementary feeding (p<0.001). Conclusions: Equitable education, increasing the age at which moms can become pregnant, and efforts to fulfill the nutrition needs of pregnant women by providing supplemental food based on community empowerment are significant. Family and community involvement will ensure the sustainability of this CED prevention program.

Robotic radical prostatectomy (RALP) with pre-existing inflatable penile prosthesis (IPP): technical innovations to improve safety and outcomes.

Robotic-assisted laparoscopic radical prostatectomy (RALP) is the gold standard surgical approach for treatment of prostate cancer. Prostate cancer is often comorbid with erectile dysfunction (ED), and a small subgroup of men undergoing RALP have an indwelling inflatable penile prosthesis (IPP). In men with IPPs, we perform two techniques at the time of RALP to preserve the pelvic reservoir. In the No Touch Technique, we leave the pseudocapsule of the reservoir intact, electing to dissect the pelvic sidewall and lateral prostatic attachments away from the pseudocapsule. In the Safe Mobilization Technique, we sharply open the pseudocapsule overlying the reservoir and relocate the reservoir out of the pelvis. We retrospectively analyzed 155 cases (Group IPP) from a cohort of 1000 men who underwent RALP. These cases were compared to a randomly selected control group comprising 455 men with PCa who underwent RALP without prior IPP placement (Group NoIPP). We compared perioperative and functional outcomes. The overall incidence of positive surgical margins (PSM) did not significantly differ between the groups (14% in Group IPP and 12% in Group NoIPP, p = 0.4). Furthermore, there was no statistically significant difference in the incidence of PSM at the bladder neck between Group IPP (5.3%) and Group NoIPP (3.4%), p = 0.1. Binomial logistic regression analysis did not find prior IPP placement to be a significant predictor of continence at 3 and 6months or for BCR. All patients in Group IPP were able to successfully cycle their devices postoperatively and there were no reported device infections. The No Touch Technique and Safe Mobilization Technique are easy to perform and safe adjunct procedures at the time of RALP in men with pre-existing IPP.

A ferritin-related dietary pattern is positively associated with iron status but negatively associated with vitamin D status in pregnant women: a cross-sectional study

PurposeVitamin D supplementation positively impacts anemia, but the relationship between a ferritin-related dietary pattern, iron parameters, and vitamin D in anemia is unclear.MethodsThis cross-sectional study analyzed data from the 2017–2019 National Nutrition and Health Survey, including 1423 pregnant women over 15 years old. Dietary intake was assessed using a semi-quantitative food frequency questionnaire and a 24-hour dietary recall. The FrDP was identified using reduced rank regression with blood parameters as response variables and 32 food groups as predictors. Linear and binomial logistic regression analyses evaluated the associations between the FrDP and serum biomarkers, adjusting for demographic and dietary variables. Risk associations between the FrDP and vitamin D concentrations were also assessed.ResultsThe FrDP explained 18.5% of the variation in 6 response variables and was characterized by high consumption of fish, soy, gluten pasta, nuts, organ meat, pickled vegetables, and marine plants. The FrDP correlated positively with serum hemoglobin (r = 0.76), iron (r = 0.52), ferritin (r = 0.79), folate (r = 0.86), and vitamin B12 (r = 0.86). Linear regression revealed a positive association between the FrDP and serum iron. Women in the highest FrDP tertile were less likely to have low serum iron (OR = 0.65, 95% CI 0.50–0.85) but more likely to have low 25(OH) vitamin D concentrations (OR = 1.79, 95% CI 1.32–2.43).ConclusionsThe FrDP was positively associated with serum iron but negatively associated with serum 25(OH) vitamin D in pregnant women.Graphical

Factors influencing intentional self-harm in Chungcheongbuk Province relative to the Seoul region in the Republic of Korea: a retrospective study.

This study investigated factors influencing intentional self-harm in Chungcheongbuk Province (hereinafter, Chungbuk) compared to Seoul in the Republic of Korea. Raw data from the Discharge In-depth Injury Survey conducted by the Korea Disease Control and Prevention Agency were utilized. From 2,329,149 cases recorded over 9 years (2013-2021), 911 were identified as intentional self-harm cases (248 from Chungbuk and 633 from Seoul). We analyzed the differences in and influencing factors of intentional self-harm in Chungbuk relative to Seoul using the independent sample t-test, chi-square test, and binomial logistic regression analysis. Intentional self-harm was found to be 1.232 times more prevalent among females than males (p<0.05); 2.327 times more prevalent among middle-aged and older adults, ages 50 to 64, compared to those under 50 years old (p<0.01); 8.603 times more prevalent among those using hospitals with fewer than 500 beds compared to those with 500 beds or more (p<0.001); 2.412 times more prevalent among individuals using hospitals in different regions compared to those within the same region (p<0.01); 2.217 times more prevalent among those attempting intentional self-harm during daily activities compared to other specified activities (p<0.01); and 6.987 times more prevalent among those using pesticides or herbicides compared to other poisons (p<0.001) in Chungbuk relative to Seoul. In the Chungbuk region, intentional self-harm prevention programs should be implemented, specifically targeting women, particularly those aged 50 to 64. Additionally, due to the high incidence of intentional self-harm involving pesticides or herbicides in Chungbuk, these substances should be stringently monitored to restrict access.

Chronic low back pain and decreased physical activity are associated with social frailty incidence among community-dwelling older adults.

Nearly half of older adults with frailty experience chronic pain. Chronic pain contributes to activity restrictions. Decreased physical activity with chronic pain is associated not only with physical dysfunction but also with reduced engagement in social activities. We aimed to verify the hypothesis that chronic pain and decreased physical activity are associated with social frailty incidence. The study included 1198 community-dwelling older adults (aged 70.2 ± 6.3 years) without social frailty at baseline. Chronic pain, physical activity and basic information were assessed at baseline. The participants were divided into two groups based on the presence (yes, n = 167) or absence (no, n = 1031) of chronic low back pain. The incidence of social frailty was investigated during the follow-up examination after 2.5 years. Binomial logistic regression analysis showed that older adults with chronic low back pain and low step counts had a higher odds ratio for the development of incident social frailty than older adults without chronic low back pain and high step counts (odds ratio 1.89, 95% confidence interval 1.03-3.46). Our results suggest that a combination of chronic low back pain and low step counts is associated with the incidence of social frailty. Further research is required to establish intervention methods for pain and decreased physical activity to prevent social frailty. Geriatr Gerontol Int 2024; ••: ••-••.

Contribution of Product, Price, Place, Promotion, and People (5P) Marketing Mix Strategy on Patients’ Interest To Revisit

In the National Health Insurance (JKN) era, hospitals in Indonesia rapidly grew in number and also developed. In order to stand out amongst the competition, hospitals often rely on marketing strategies through attractive advertisements, offering unique services, and also introducing their services to the public. One method often utilized in the 5P marketing mix consists of product, price, place, promotion, and people. This study aims to identify the impact of 5P marketing mix strategies on the patients’ interest in visiting Bandung Hospital in the city of Medan. Bandung Hospital in Medan conducted this quantitative study using a cross-sectional approach. This study involved 150 patients of Bandung Hospital’s inpatient unit, which is the whole outpatient clinic patient (total sampling) during the May 2023 period. Analysis was carried out using frequency distribution, chi-square, and binomial logistic regression analysis. This study found that the majority of patients visiting Bandung Hospital belong to the 30-39 years age group (62.0%), are female (58.7%), hold a bachelor's degree (48.0%), and are visiting Bandung Hospital for the first time (62.7%). Most of the patients in this study have a good perception toward all aspects of 5P marketing strategies in Bandung Hospital and are interested in visiting the hospital again in the future (p&lt;0.05), with place playing the biggest role in influencing patients’ interest (OR = 4.082). According to all findings in this study, it can be concluded that marketing strategies such as the 5P marketing mix strategy positively influence patients’ interest in visiting Bandung Hospital. It can also be inferred that this strategy would work in similar types of hospitals, not only in Bandung Hospital. Keywords: Marketing mix, Hospital, Product-Price-Place-Promotion-People (5P), Patients

Zebrafish Larvae as a Predictive Model for the Risk of Chemical-Induced Cholestasis: Phenotypic Evaluation and Nomogram Formation.

Chemical-induced cholestasis (CIC) has become a concern in chemical safety risk assessment in pharmaceutical, food, cosmetic, and industrial manufacturing. Currently, known animal and in vitro liver models are unsuitable as high-throughput screening tools due to their high cost, time-consuming, or poor screening accuracy. Herein, a cohort of chemicals validated as cholestatic hepatotoxic in humans, rodents, and in vitro liver models was established for testing. The accuracy and reliability of the detection of CIC in zebrafish larvae were assessed by liver phenotype, bile flow inhibition rate, bile acid distribution, biochemical indices, and RT-qPCR. In addition, the nomogram prediction model was constructed using binomial logistic regression analysis. The model was constructed with three variables: aspartate aminotransferase (AST.FC) level, total bile acid (TBA.FC) level, and fold change in the number of bile acid nodes per unit of bile ducts in the zebrafish liver (NPL.FC), which showed high predictive power (areas under the ROC curve: 0.983). Furthermore, this study demonstrated that zebrafish larvae have some model specificity for CIC risk assessment of estrogen endocrine disruptors and that testing after 10 dpf provides more scientific results. Overall, combining zebrafish larval phenotyping and nomograms is an efficient and powerful tool for CIC risk monitoring of chemicals.

Variation in general practitioners' follow-up of depressed patients starting antidepressant medication: a register-based cohort study.

Guidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners' (GPs) follow-up varies with patients' sociodemographic characteristics. To describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients' age and education. Registry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients' age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan-Meier survival curves. The study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated. Differences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.

Uptake and acceptability of oral HIV self-testing in the context of assisted partner services in Western Kenya: A mixed-methods analysis.

Integrating HIV self-testing (HIVST) into assisted partner services (APS) has potential to increase identification of people with HIV in the community, but little is known about acceptability of HIVST among partners traced via APS. We assessed characteristics of APS partners testing with HIVST, and factors influencing HIVST uptake and acceptability in a cluster-randomized control trial on APS+HIVST. Using convergent parallel mixed-methods design, we evaluated socio-demographic and behavioral characteristics of APS partners who were offered HIVST or provider-delivered testing, and purposively selected a sub-set of partners for in-depth interviews (IDIs). Descriptive and log-binomial regression analyses were performed controlling for health facility clusters, while IDIs were thematically analyzed applying the theoretical framework of acceptability. Among 3312 partners who were offered HIVST or provider-administered testing through APS, 2724 (82.2%) used HIVST. There was no association between partner demographics and HIVST uptake. HIVST use was less likely than provider-delivered testing among those identified as a casual (adjusted relative risk (aRR) = 0.93; 95% Confidence Interval (CI) 0.88-0.98) or transactional (aRR = 0.90; 95% CI 0.87-0.94) partner compared to those in a defined relationship. HIVST use was slightly lower among those offered the option of an additional kit when compared to those only offered one kit (aRR = 0.93; 95% CI 0.88-0.98). In the IDIs (N = 24), partners reported that HIVST was a viable option for individuals who do not find provider-delivered testing suitable or convenient. For the APS partners, 'intervention coherence', 'self-efficacy', and 'ethicality' presented as most significant theoretical framework of acceptability constructs. APS providers played a critical role in creating HIVST awareness and driving acceptability. Increasing HIVST awareness and providing tailored solutions will empower APS clients optimize their HIV testing decisions. Providers should consider context of the partner's sexual encounter and extend counselling support when recommending HIVST within APS.

Assessment of patient knowledge and perceptions towards orthodontic treatment in the Aljouf Region, Saudi Arabia: a cross-sectional study.

In orthodontic treatment, it is most important to assess the patient's perspective of malocclusion because these perceptions are fundamental to determining the patient's demands and level of treatment satisfaction. This study was done to assess the knowledge and perception of residents of the Aljouf Region of Saudi Arabia seeking orthodontic treatment. Furthermore, we determined the factors associated with the patients' knowledge and perception of orthodontic treatment. This cross-sectional study was conducted using a pre-tested and validated questionnaire among patients seeking orthodontic treatment who were registered at King Abdulaziz Hospital, Sakaka, and primary health centers. We identified the associated factors using binomial logistic regression analysis. Finally, we applied Spearman's correlation test to identify the correlation between knowledge and perception. A total of 282 individuals participated in the current study, of which 53.3% were female and 46.1% were male. About one-third (36.9%) of patients had a low level of knowledge, 35.5% had a medium level of knowledge, and 27.7% had a high level of knowledge regarding orthodontic treatment. A total of 20.6% had low perceptions, 42.9% had medium perceptions, and 36.5% had high perceptions of orthodontic care. A significant correlation was found between age and gender, knowledge (p = 0.001), and perception (p = 0.040). Moreover, we observed a positive correlation between knowledge and perception (Spearman's rho = 0.297, p = 0.001). People in Aljouf have poor knowledge and medium perception regarding orthodontic treatment. We recommend that the concerned authorities make a health educational plan for the patients seeking orthodontic treatment.

Cancer Information Seekers' Comprehension Level and the Association With Preventable Cancer Risk Factors: A Cross-Sectional Analysis From a Nationally Representative U.S. Adult Survey.

To examine the association between U.S. adult cancer information seekers' comprehension level and preventable cancer risk factors. Cross-sectional analysis. Health Information National Trends Survey-6, 2022. 2,453 cancer information seekers. Four cancer risk factors were dichotomized: cigarette smoking (have smoked ≥100 cigarettes and currently smoke every day/some days); experiencing sunburn (≥1 times/past 12 months); being overweight/obese (≥25 body mass index [kg/m2]); and binge drinking (≥5 [male] or ≥4 [female] alcoholic drinks on one occasion/past 30 days). Individuals who reported that cancer information was hard to understand were considered having comprehension difficulties. Binomial and multinomial logistic regression analyses were conducted to examine the association of cancer information comprehension level with individual and cumulative cancer risk factors, adjusting for sex, race/ethnicity, age, annual household income, education level, metropolitan status, depressed mood, and cancer diagnosis history. Cancer information seekers with comprehension difficulties had higher odds of binge drinking (aOR: 1.66, 95% CI: 1.12, 2.46), being overweight/obese (aOR: 1.46, 95% CI: 1.09, 1.96), and experiencing sunburn (aOR: 1.61, 95% CI: 1.23, 2.11), as well as having ≥3 (aOR: 3.38, 95% CI: 1.87, 6.09) cancer risk factors concurrently than cancer information seekers without comprehension difficulties. Dissemination of easy-to-understand cancer information would help better prevent cancer risk factors for cancer information seekers with comprehension difficulties.

Predictive Value of NT-proBNP, FGF21, Galectin-3 and Copeptin in Advanced Heart Failure in Patients with Preserved and Mildly Reduced Ejection Fraction and Type 2 Diabetes Mellitus.

Background and Objectives: Heart failure (HF) is one of the most common initial presentations of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). There are different cardiac biomarkers related to the pathophysiological mechanisms of HF in T2DM. The current research aims to identify additional biomarkers that could improve the diagnosis and prognosis of HFpEF, which is currently assessed using NT pro-BNP levels. NT pro-BNP is a valuable tool for diagnosing heart failure but may not always correlate with clinical symptom severity or can present normal levels in certain cases, such as obesity. Biomarkers like FGF-21 and galectin-3 could provide greater insight into heart failure severity, especially in diabetic patients. The main objective of the current study is to assess the performance of NT-proBNP, FGF21, Galectin-3 and Copeptin to discriminate between advanced and mild HF. Materials and Methods: A total of 117 patients were enrolled in this study and divided into two groups: 67 patients in NYHA functional class I-II (mild HF) and 50 patients in NYHA III-IV (advanced HF). NT-pro BNP, FGF21, Galectin 3 and Copeptin serum levels were determined with the ELISA method. Receiver operating characteristic (ROC) analysis and binomial logistic regression analysis were used to measure the ability of the studied biomarkers to distinguish between advanced and mild HF patients. Results: In patients with T2DM with advanced HF, serum FGF21 level was significantly positively correlated with eGFR (ρ = 0.35, p = 0.0125) and triglycerides (ρ = 0.28, p = 0.0465) and significantly negatively correlated with serum levels of HDL cholesterol (ρ = -0.29, p = 0.0386) and with RV-RA gradient (ρ = -0.30, p = 0.0358). In patients with mild HF, serum FGF21 level was significantly negatively correlated with NT-proBNP levels (ρ = -0.37, p = 0.0022), E/e' ratio (ρ = -0.29, p = 0.0182), TR velocity (ρ = -0.24, p = 0.0470) and RV-RA gradient (ρ = -0.24, p = 0.0472). FGF21 (AUC = 0.70, 95% CI: 0.60-0.79) and NT-proBNP (AUC = 0.73, 95% CI: 0.63-0.82) demonstrated significant predictive value to discriminate T2DM patients with advanced HF from those with mild HF. Elevated values for FGF21 (≥377.50 ng/mL) or NTproBNP (≥2379 pg/mL) were significantly associated with increased odds of advanced HF after adjusting for demographic and clinical covariates. Conclusions: NTpro-BNP and FGF21 have a similar ability to discriminate T2DM patients with advanced HF from those with mild HF. Univariable and multivariable logistic models showed that, FGF21 and NTproBNP were independent predictors for advanced HF in patients with preserved and mildly reduced ejection fraction and T2DM.

Unilateral molar Incisor hypomineralization influences the chewing side? an observational study in children.

The aim of this observational study was to compare the chewing patterns of children with unilateral Molar Incisor Hypomineralization (MIH) to those of children without MIH and to assess how the MIH severity influences the risk of chewing deviation. The hypothesis was that children with unilateral MIH would prefer to chew on the side opposite the defect. A total of 121 children were included in this investigation and evaluated for their preferred chewing side (PCS). This study population comprised 45 children with unilateral mild MIH (G1), 42 with unilateral severe MIH (G2), and 34 children in the control group (CG) who had no MIH but presented with unilateral chewing complaints. The PCS pattern differed among the groups, with 31% of the children with MIH and 55.9% of the CG showing bilateral chewing. The chewing deviation prevalence was 24% in the CG and 52% in G2 (χ2 test; p = 0.03). Binomial logistic regression analysis revealed that both severities of MIH influenced the likelihood of chewing deviation (χ2 = 7.33, p = 0.026). Children with unilateral severe MIH were 3.57 times more likely to exhibit chewing deviation than were those without MIH. The null hypothesis was rejected, indicating that unilateral MIH affects children's masticatory patterns, increasing the risk of chewing deviation. Unilateral chewing may be associated with various health issues, such as temporomandibular disorders (TMDs), decreased hearing, and vision problems. Unilateral MIH is a potential risk factor for unilateral chewing.

Association of laughter and social communication with oral frailty among residents in Fukushima: a cross-sectional study.

Oral frailty (OF) is a form of frailty. Laughter and social communication such as talking and participating in community activities, contribute to extending healthy life expectancy by reducing stress and increasing physical activity. However, limited research exists on the association between laughter and social communication and OF. This cross-sectional study aimed to explore the association of laughter and social communication with the risk of developing OF using the eight-item OF Index among Fukushima residents. In 2020-2021, 916 residents aged 60-79 were surveyed regarding OF and psychosocial factors. Binomial logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for psychosocial factors associated with the OF prevalence. The OF prevalence was 41.5%. The sex- and age-adjusted ORs (95% CIs) for psychosocial factors associated with OF prevalence were 0.38 (0.26-0.57) for daily laughter, 0.51 (0.35-0.76) for laughter 1-5 times/week, 0.42 (0.20-0.89) for daily talking, 0.40 (0.22-0.72) for participating in community activities more than once/week, and 0.29 (0.20-0.43) for no depressive symptoms. After multivariate adjustment, only daily laughter and no depressive symptoms were associated with OF. As a public health strategy, increasing laughter and social communication frequencies, along with reducing depressive symptoms, may enhance healthy life expectancy through improved frailty.

Injury Characteristics Among Japanese International Athletes: Report on the Pre-competition Medical Check-Up Data of the Japanese Olympic Committee.

Introduction Injury trends among international athletes across sports remain underexplored in out-of-competition settings, particularly among Asians. The aim of this descriptive epidemiological study is to investigate the characteristics of injuries among Japanese international athletes during pre-competition medical check-ups from 2008 to 2019. Methods We analyzed the medical check-up data of candidates for international multi-sport events according to the International Olympic Committee consensus statement. At the medical check-up, athletes' injuries were categorized into two groups based on clinical assessment. "Injuries" refer to conditions that necessitate immediate treatment or further detailed examination. On the other hand, "complaints" encompass both such "injuries" and conditions for which treatment has already commenced, allowing athletes to continue participating in competitions or training while still requiring ongoing medical monitoring. The cohort was categorized into youth and adult groups, with adults defined as those aged ≥18 years. Results Overall, 10,854 athletes (4,966 females, 45.8%; 5,888 males, 54.2%; median age 22.0 {20.0-25.0} years, 56 sports) were enrolled; 2,333 "injuries" were registered (21.5 "injuries" per 100 athletes). The "injury" prevalence was 16.2% (95% CI, 0.16-0.17) and significantly associated with females (odds ratio {OR} 1.21; 95% CI, 1.09-1.34) and adult group (OR, 1.35; 95% CI, 1.08-1.69) based on binomial logistic regression analysis. Of a total of 10,027 "complaints" (92.4 "complaints" per 100 athletes), the "complaint" prevalence was 55.3% (95% CI, 0.54-0.56) and higher in females (OR, 1.44; 95% CI, 1.33-1.55) and adult group (OR, 1.50; 95% CI, 1.29-1.75). Stratified by sport, male soccer players had a higher "injury" prevalence than females (95% CI, 0.45-0.98), whereas females had a higher "injury" prevalence in hockey (1.70-7.29) and fencing (1.12-5.44). The "complaint" prevalence was higher in females for athletics, skiing, swimming, hockey, judo, badminton, fencing, water polo, weightlifting, and golf. There was no significant difference between the sexes in other sports. The knee ("injury," 20.1%; "complaint," 20.2%), lumbosacral (15.5%; 17.0%), ankle (13.0%; 15.4%), and shoulder (13.0%; 12.1%) were most commonly affected. The injury proportion ratio for the ankle was "injury"/"complaint" 0.82 (95% CI, 0.72-0.94), with the ankle "complaint" proportion being higher than "injury." When stratified by injury location and sex, knee "injury" was more common in males (206 in females vs. 262 in males; 95% CI, 0.59-0.88), whereas ankle "complaint" was more common in females (842 in females vs. 700 in males; 95% CI, 1.04-1.29). Conclusion This is the first cross-sectional report of injuries in Asian international athletes outside of competition periods. Injury prevalence was higher in females than in males and in adults than in youths. Sex differences in injury varied by site and severity. These findings may suggest the need for more tailored injury prevention and performance support strategies for international competitions.

Systems delay in women with breast cancer – A sequential explanatory mixed-methods study from central rural India

ABSTRACT Background: Globally, breast cancer is the most common malignant tumor in both developed and developing nations, with an incidence of 2 million cases every year and around 6 lakh deaths. Even after the availability of healthcare facilities, delays in the management of breast cancer are seen in both developed and developing countries. Objectives: To assess the patient and system-level delays and to determine the factors that cause the identified delays in women with breast cancer from central rural India. Methodology: The present Mixed-method study was conducted in a tertiary care hospital in central rural India among 128 female breast cancer patients. Socio-demographic and clinical information of the patients was summarized using frequency and proportions. Delays were reported using a median number of days and interquartile range. To assess the factors associated with the delays, we used Negative log-binomial regression analysis. Qualitative data analysis was done by manual thematic analysis. Results: The mean age of the study participants was 50.54, SD was 10.46, Median was 50, and the Interquartile range (IQR) was 43-58 years. A median patient delay of 45 days, and IQR was 15-120. A median system delay of 19 days and IQR was 7-35 days. We identified seven themes addressing the factors influencing delays at various levels by thematic analysis. Negative log-binomial regression models were built for the association of the socio- demographic and clinical variables with patient and system delays. Conclusion: Our study concludes that there is a substantial delay at patient level reporting to healthcare care providers, which needs an increase in awareness levels in the community through dedicated Behavior Change Communication strategies along with addressing identified socio-cultural and economic determinants influencing delay at various levels.

Prevalence and Risk Factors of Self-Reported Sarcopenia and Its Association With Multimorbidity in Community-Dwelling Older Adults: A Cross-Sectional Study.

This cross-sectional study aimed to identify the impact of multimorbidity on self-reported sarcopenia and compare the differences in the prevalence and associated factors of sarcopenia in community-dwelling older adults with and without multimorbidity. We enrolled 876 community-dwelling older adults in South Korea. Multimorbidity was defined as the coexistence of two or more chronic diseases, and sarcopenia was evaluated using the Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falling Questionnaire. Binomial logistic regression analyses were performed. Our study revealed that the prevalence of sarcopenia was significantly higher (43.5%) in older adults with multimorbidity than in those without multimorbidity (20.8%). This finding underscores the significant impact of multimorbidity on sarcopenia. We also found that poor perceived health status was the strongest predictor of sarcopenia in older adults with multimorbidity, while oldest-old age (≥ 85 years) was the strongest predictor of sarcopenia in those without multimorbidity. Large prospective cohort studies using objective sarcopenia screening tools are needed to demonstrate the synergistic effects of multimorbidity and sarcopenia on health outcomes among community-dwelling older adults.

Social-Economic Factors and Secondary School Dropout among Girls in Mariani Ward, Tharaka-Nithi County, Kenya

This study investigated the high dropout rates among girls in secondary schools in Mariani Ward, a critical issue observed in many developing regions. The specific objectives of the study were to assess how household income, parental education, and family structure influence girls’ dropout rates. The study was grounded in the Relative Deprivation theory and utilized a descriptive survey design, involving a sample of 385 respondents selected from a larger population of 10,202 through cluster sampling method to ensure representation of various groups within the population. Within the target population, five clusters or sub-locations were identified based on their diverse characteristics. The sample included female dropouts as well as key informants such as head teachers, household heads, and local leaders. Data collection was achieved through questionnaires and interviews, and quantitative analysis was performed using SPSS version 25. The study employed inferential statistical methods, including correlation analysis, chi-square tests, and binomial logistic regression, to assess the impact of socio-economic factors on dropout rates. The results revealed significant positive correlations between dropout rates and household income (0.684), parental education status (0.547), and family structure (0.761). Binomial logistic regression analysis further confirmed the substantial influence of these factors on dropout rates. In addition to these factors, the study also indicated the presence of other unidentified variables affecting dropout rates. This highlights the necessity for further research to explore these additional influences. Based on these findings, the study recommends implementing targeted interventions to address the identified socio-economic challenges. These recommendations include developing financial support programs for low-income families, enhancing parental education and involvement, and fostering supportive family environments. Such measures are essential for reducing dropout rates and promoting sustained educational participation among girls in Mariani Ward. The study provides actionable insights for educators, policymakers, and stakeholders to effectively improve girls' access to education and support their academic persistence.

The social gradient in institutional trust from 2011–2019 in the general population in Norway

Abstract Background Trust is described as the glue of healthy societies. Although Norway is among the countries with the highest levels of trust in public institutions, the increasing socioeconomic differences observed may threaten levels of institutional trust. Therefore, we aimed to investigate such differences in the general population between 2011 and 2019. Methods A repeated cross-sectional study was conducted using data on the general population in Østfold county from 2011 (N = 16673) and 2019 (N = 15935). Differences in trust toward five public institutions (healthcare system, school system, labour and welfare administration (NAV), police, and municipal council) by educational level were investigated with Chi-square tests. Logbinomial regression analyses were used to examine potential changes in high trust over time. Gender and age were included in the analyses as control variables. Results A relatively high proportion of the general population reported high levels of trust to the health care system (2011: 71%; 2019:80%), police (2011: 73%; 2019:77%), and the school system (2011: 64%; 2019:66%), whereas a lower proportion reported high levels of trust to NAV (2011: 37%; 2019:41%) and the municipal council (2011: 45%; 2019:36%). Both in 2011 and 2019 a clear social gradient in institutional trust was found for all institutions (p &amp;lt; 0.05). There was a significant increase in the level of trust in the health care system (low education:RR=1,10; middle:RR=1,12; high:RR=1.06) and a significant decrease in trust in the community council (low:RR=0,77; middle:RR=0,80; high:RR=0,83) in all educational groups from 2011 to 2019. The level of trust in NAV increased significantly in the highest education groups, while a non-significant decrease was shown in the low educational group. Conclusions The persisting social gradient in institutional trust is worrying as trust is an important factor in ensuring inclusion, social capital, democracy, and health and wellbeing. Key messages • Institutional trust is an important factor in ensuring inclusion, social capital, democracy, and health and wellbeing. • The lower levels of institutional trust found in low educational groups could be of particular concern as these groups might be more dependent on the different parts of the welfare system.

The Potential of Aloe Vera in Solution and in Blended Nanofibers Containing Poly (3-Hydroxybutyrate-Co-3-Hydroxyvalerate) as Substrates for Neurite Outgrowth.

This pilot study investigated the potential of aloe vera (AV) to promote neurite outgrowth in organotypic dorsal root ganglia (DRG) explants (n = 230) from neonatal rats (n = 15). Using this invitro model of acute axotomy, we assessed neurite outgrowth exceeding 1.5 times the explant diameter (viable explants) and measured the longest neurite length. These parameters were evaluated under control conditions and in cultures supplemented with commercial AV and four aligned scaffolds: poly-L-lactate (PLLA), polydioxanone (PDS), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), and blended PHBV/AV. After 6 days of culture, explants were immunostained using neuron-specific marker Tuj1 and Schwann cell marker S100. Measurements were obtained with Image J software and analyzed using Jamovi 2.3. In control and AV dilution media, the study revealed radial tissue growth from the explant body with randomly oriented neurites, whereas in all scaffolds, bidirectional tissue growth occurred parallel to nanofibers. Binomial logistic regression analyses indicated that viable explants were more likely in the control group compared to PDS (p = 0.0042) and PHBV (p < 0.0001), with non-significant differences when compared to AV dilution, PLLA, and PHBV/AV. AV dilution showed a greater association with viable explants than PLLA (p = 0.0459), while non-significant difference was found between AV dilution and PHBV/AV. Additionally, the PHBV/AV scaffold predicted higher odds of viable explants than PLLA (p = 0.0479), PDS (p = 0.0001), and PHBV (p < 0.0001). Groups with similar probabilities of obtaining viable explants (control, AV dilution, and PHBV/AV) exhibited non-significant differences in their longest neurite lengths. In conclusion, control, AV dilution, and PHBV/AV yielded the highest probability of developing viable explants and the longest neurite lengths. This is the first study demonstrating the direct permissiveness of AV for axonal outgrowth. Furthermore, the blended PHBV/AV scaffold showed significant potential as a suitable scaffold for axonal regrowth and Schwann cell migration, ensuring controlled tissue formation for tissue engineering applications.