Cross-sectional Analysis Research Articles

Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory

ObjectiveTo investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia.DesignData for the study came from a series of...

Determinants of Achilles tendon thickness and their influence on knee function and foot alignment in knee osteoarthritis

Knee osteoarthritis (OA) significantly impacts the quality of life of individuals globally. However, the interconnections between Achilles tendon thickness, knee symptoms/functions, and foot alignment remain understudied in knee OA patients. This study determines the relationships between Achilles tendon thickness (ATT), knee symptoms/functions, and foot alignment in knee OA patients, considering their interconnected biomechanical nature. In a cross-sectional analysis involving 122 knee OA patients, Knee injury and Osteoarthritis Outcome Score (KOOS) assessed knee function and symptoms. Forefoot, midfoot, and rearfoot alignment were measured using hallux valgus angle, navicular/foot ratio, and rearfoot angle. The navicular/foot ratio represented the ratio of navicular height to total foot length. ATT was measured using a digital calliper. Pearson correlations and stepwise multiple linear regression models were employed to explore relationships and determinants. Out of 122 participants, 88 (72.1%) were females. ATT correlated significantly with ankle range of motion, forefoot alignment, and midfoot alignment. In stepwise multivariable regression, ankle range of motion, navicular/foot ratio, and age were significantly associated with ATT (adjusted R2 = 0.44). Similarly, KOOS-Symptoms scores were linked to the OA severity, navicular/foot ratio, ankle range of motion, gastrocnemius strength, and age (adjusted R2 = 0.22). KOOS-Function scores were significantly associated with knee OA severity, gastrocnemius strength, ankle range of motion, and age (adjusted R2 = 0.19). Midfoot alignment was significantly associated with ATT and knee symptoms in patients with Knee OA. This suggests potential benefits of interventions targeting both Achilles tendon properties and foot alignment for improved knee OA outcomes.

The Availability of Midwifery Care in Rural United States Communities.

Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics. Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%). More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.

Association of electronic-cigarette, number of cigarettes, and marijuana use with high-risk Human Papillomavirus (HPV) among men and women: A cross-sectional analysis of a nationally representative sample

BackgroundSmoking is associated with an increased risk of HPV infection. However, the use of e-cigarettes and marijuana, number of cigarettes, and serum cotinine concentrations in relation with HPV (6, 11, 16, 18) and high-risk HPV (16 or 18) infections in underserved and understudied populations remain poorly understood. MethodsData included 687 males and 664 females among whom 489 were White, 375 were Black and 342 were Hispanics from the NHANES 2013–2016 with HPV and high-risk HPV infections. Smoking history included current and past smokers, number of cigarettes, use of e-cigarettes, marijuana, and serum cotinine levels. Weighted multivariable-adjusted logistic regression models were conducted. ResultsHigh-risk HPV infection was associated with current smoking history plus ≥ 20 cigarettes/day (OR=1.92, 95 % CI=1.09, 3.37) in the overall population. E-cigarettes use (5 days) was positively associated with high-risk HPV infection (OR=2.43, 95 % CI=1.13, 5.22) in the overall population, with similar findings with e-cigarette (past 30 days) among women and Whites. ConclusionHigh number of cigarettes, e-cigarette usage and marijuana were associated with HPV and high-risk HPV infections in the overall population. Most of these associations remained significant when stratified by gender and race/ethnicity. Increasing use of e-cigarettes and marijuana in these population warrants further investigation for the prevention of HPV infection and related cancers.

The associations between interparental conflict and adolescent adjustment: a cross-lagged panel network analysis.

Extensively studied in interparental relationship literature suggests interparental conflict is a risk factor for adolescent adjustment, but the specific, dimension level relationships between interparental conflict and adolescent adjustment remain unclear. This study explored the interactions between the various dimensions of interparental conflict and adolescent adjustment in Chinese adolescents. A total of 1870 Chinese adolescents (42.27% males; Mage = 16.18, SD = 0.43, range = 15-18) completed a survey at two time points spaced three months apart. Data was analyzed using both cross-sectional and longitudinal network analysis. The cross-sectional network analysis found that resolution has the greatest connections with the dimensions of adolescent adjustment, suggesting that adolescents reporting high resolution are more prone to experience concurrent poor adjustment and therefore should be a primary focus of attention. The longitudinal network analysis revealed that, in general, previous hyperactivity-inattention is a significant and strong predictor of future interparental conflict, underscoring a child-driven effect. Meanwhile, prosocial behavior contributes to decreases in both interparental conflict and adjustment problems over time. These findings highlight the importance of addressing hyperactivity-inattention and cultivating prosocial behavior in adolescents as key intervention points-these can help resolve conflicts between parents and reduce adjustment problems for adolescents.

Exploring The Prevalence And Underlying Causes Of Anemia In Hemodialysis Patients. A Cross-Sectional Study

Background: Anemia is a common complication among patients with chronic kidney disease (CKD), especially those who are on hemodialysis. It also has a marked effect on their Quality of Life and with it, the morbidity-morbility. This research aimed to evaluate the frequency and incidence of anemia in hemodialysis patients at MMC. Objectives: to find out the incidence and etiological factors responsible for anemia in hemodialysis patients at MMC. Study design: a cross-sectional study Duration and place of study. From June 2023 to Aug 2023 department of nephrology mmc mardan Methods This study was designed as a cross-sectional analysis on 200 hemodialysis patients of MMC. Demographics, clinical parameters and laboratory values were collected. Anemia was characterized by an hemoglobin <13 g/dL in men and <12 g/dL for women. Statistical Analysis: Descriptive statistics, including mean and standard deviation assisted by the p-value for determining significance. Results Out of 200 Patients had a mean age of 58.4 years (SD =12.6). 85% of patients had anemia, with a mean hemoglobin 10.2 g/dL (SD 1.4) in anaemic patient's. The main causes of anemia were iron deficiency (60%), inflammatory states (40%) and erythropoietin resistance(alone or in combinations) for 25%, respectively. Anemia prevalence was significantly associated with all the comorbidities and with increased duration of hemodialysis. Conclusion Anemia is highly prevalent among hemodialysis patients at MMC, most often attributed to iron deficiency and inflammation. Treatments are effective as long the condition can be caught early and so, regular monitoring is vital for a more positive prognosis. Additional investigation is necessary to improve anemia care in this population. Keywords: Anemia, Hemodialysis, Prevalence, Causes

Current Status of Hospitalist Practice and Factors Influencing Job Satisfaction in Korea.

Although the roles and responsibilities of hospitalists have grown considerably in recent years, research on the current job status and satisfaction levels of Korean hospitalists is lacking. We investigate the present state of Korean hospitalists and the factors influencing their job satisfaction 6 years after the pilot program's launch. This cross-sectional analysis was based on an online survey conducted from January 30 to February 18, 2023. Korean hospitalists (N = 303) MAIN MEASURES: The survey encompassed participant demographics, hospital information, education, clinical practice, research involvement, and job satisfaction. We employed multiple logistic regression analyses to identify determinants of satisfaction as a hospitalist. The analysis was based on 79 hospitalists' responses (response rate 26%). Respondents had a median age of 39 years; approximately half were male internal medicine specialists, possessing over 3 years of hospitalist experience. Most respondents were interested in clinical work (94.4%), with only 21.5% interested in research and evidence-based medicine. Over two-thirds indicated that non-clinical duties occupied less than 20% of their time. Overall, job satisfaction among hospitalists averaged 51.9%. Notably, the availability of a research mentor was significantly associated with job satisfaction (P = .011). While hospitalists with more than 3 years of experience, more hospitalists per facility, and autonomy were associated with increased job satisfaction, these associations were not statistically significant. Furthermore, there was no association between night shift work, work type, or work hours and job satisfaction. Although Korean hospitalists primarily focus on clinical practice, our study underscores the positive impact of mentorship from research mentors on job satisfaction, supported by comprehensive univariate and multivariate analyses. These findings signal a progressive transformation in the role of Korean hospitalists, as they increasingly engage in research alongside patient care.

Influence of Nb/V on the corrosion behavior of high-strength anti-seismic rebar in marine environments

In this study, the immersion test, surface analysis, cross-section analysis, quantitative analysis and electrochemical analysis were used to study the influence of Nb/V on the corrosion behavior of high-strength anti-seismic rebar in marine environments. The corrosion results clarified that the addition of Nb/V improved the corrosion resistance of the rebar, thereby reducing the corrosion rate of the rebar and improving the stability of corrosion layers. Firstly, the addition of Nb/V promoted the transformation of unstable Fe oxyhydroxides to stable Fe oxyhydroxides in the surface corrosion layers of the rebar, thus increasing the α/(β + γ) ratio, corrosion potential and total impedance value. Secondly, the addition of Nb/V induced the formation of Nb oxides and V oxides in the surface corrosion layers of the rebar, and the existence of these oxides repaired the surface defects of corrosion layers, thus enhancing the corrosion resistance performance of surface corrosion layers of the rebar.

Associations of Multimorbidity with Cerebrospinal Fluid Biomarkers for Neurodegenerative Disorders in Early Parkinson's Disease: A Cross-sectional and Longitudinal Study.

The study aims to determine whether multimorbidity status is associated with cerebrospinal fluid (CSF) biomarkers for neurodegenerative disorders. A total of 827 patients were enrolled from the Parkinson's Progression Markers Initiative (PPMI) database, including 638 patients with early-stage Parkinson's disease (PD) and 189 healthy controls (HCs). Multimorbidity status was evaluated based on the count of long-term conditions (LTCs) and the multimorbidity pattern. Using linear regression models, cross-sectional and longitudinal analyses were conducted to assess the associations of multimorbidity status with CSF biomarkers for neurodegenerative disorders, including α-synuclein (αSyn), amyloid-β42 (Aβ42), total tau (t-tau), phosphorylated tau (p-tau), glial fibrillary acidic protein (GFAP), and neurofilament light chain protein (NfL). At baseline, the CSF t-tau (p = 0.010), p-tau (p = 0.034), and NfL (p = 0.049) levels showed significant differences across the three categories of LTC counts. In the longitudinal analysis, the presence of LTCs was associated with lower Aβ42 (β < -0.001, p = 0.020), and higher t-tau (β = 0.007, p = 0.026), GFAP (β = 0.013, p = 0.022) and NfL (β = 0.020, p = 0.012); Participants with tumor/musculoskeletal/mental disorders showed higher CSF levels of t-tau (β = 0.016, p = 0.011) and p-tau (β = 0.032, p = 0.044) than those without multimorbidity. Multimorbidity, especially severe multimorbidity and the pattern of mental/musculoskeletal/ tumor disorders, was associated with CSF biomarkers for neurodegenerative disorders in early-stage PD patients, suggesting that multimorbidity might play a crucial role in aggravating neuronal damage in neurodegenerative diseases.

Impact of Inaccurate Clinical Coding on Financial Outcome: A Study in a local hospital in Najran, Saudi Arabia.

Background Coding in medical procedures is crucial for patients, and errors made by hospital administration during the coding process can have an impact on both the financial results and the course of therapy. The present study aims to assess the accuracy of diagnostic and procedural codes as recorded by the hospital’s coders and to also evaluate their impact on the hospital’s revenue. Methods In a local hospital in Najran, Saudi Arabia, a cross-sectional observational analysis was conducted on patients with a clinical coder. The percentage of precision and error following the re-coding of cases was calculated using a statistical analysis. Results Primary diagnosis was incorrectly coded in 57 (26 per cent) records, and secondary diagnosis was incorrectly coded in 21 (9.9 per cent) records. Inaccurate medical labelling has been seen in emergency rooms, operating rooms, and gynaecology facilities. Discussion The percentage of records with the most incorrect coding was found to be 16 (7.5 per cent) in the emergency room, 10 (4.7 per cent) in the surgical clinic, and 5 (2.3 per cent) in the gynaecology/OBS clinic. Six (2.8 per cent) records in the private clinic had inaccurate secondary diagnoses, followed by four (1.9 per cent) and two (1 per cent) records in nephrology. Conclusion The percentage of inaccurate clinical codes in primary diagnoses reached (26.8 per cent) and the percentage of incorrect clinical codes in secondary diagnoses reached (9.9 per cent).

Alcohol-Specific Inpatient Diagnoses in Germany: A Retrospective Cross-Sectional Analysis of Primary and Secondary Diagnoses from 2012 to 2021.

Our study aimed to a) describe the distribution of hospital discharges with primary and secondary alcohol-specific diagnoses by sex and age group, and b) describe how the number of hospital discharges with primary and secondary alcohol-specific diagnoses have changed across different diagnostic groups (categorized by primary International Classification of Diseases, 10th Revision [ICD-10] diagnosis) over time. Retrospective cross-sectional analysis. German hospital settings between 2012 and 2021. All persons aged 15-69 admitted to hospitals as registered in a nationwide data set. We counted a) the number of all hospital discharges and b) the number of hospital discharges with at least one alcohol-specific secondary diagnosis (secondary alcohol-specific diagnosis) by year, sex, age group, and diagnostic group. One diagnostic group included all primary alcohol-specific diagnoses, while 13 additional groups aligned with ICD-10 chapters (e.g., neoplasms). Alcohol-involvement was defined as either a primary or secondary alcohol-specific diagnosis. Of 95 417 204 recorded hospital discharges between 2012 and 2021, 3 828 917 discharges (4.0%; 2 913 903 men (6.4%); 915 014 women (1.8%)) involved either a primary or at least one secondary diagnosis related to alcohol. Of all alcohol-involved hospital discharges, 56.8% (1 654 736 discharges) had no primary but only a secondary alcohol-specific diagnosis. Secondary alcohol-specific diagnoses were particularly prevalent in hospital discharges due to injuries. With rising age, alcohol-involvement in hospital discharges due to digestive or cardiovascular diseases increased. Between 2012 and 2021, the rate of alcohol-involved hospital discharges has decreased more in younger as compared with older adults (average change between 2012 and 2021: 15-24: -55%; 25-34: -41%; 35-44: -23%; 45-54: -31%; 55-64: -21%; 65-69: -8%). The number of alcohol-involved hospital discharges in Germany from 2012 to 2021 more than doubles (from 1 654 736 to 3 828 917) when including secondary alcohol-specific diagnoses. More pronounced declines among younger adults may be attributed to unequal changes in alcohol consumption patterns across the population and to the hazardous effects of long-term alcohol use.

Automated diffusion-weighted image analysis along the perivascular space index reveals glymphatic dysfunction in association with brain parenchymal lesions.

Brain glymphatic dysfunction is critical in neurodegenerative processes. While animal studies have provided substantial insights, understandings in humans remains limited. Recent attention has focused on the non-invasive evaluation of brain glymphatic function. However, its association with brain parenchymal lesions in large-scale population remains under-investigated. In this cross-sectional analysis of 1030 participants (57.14 ± 9.34 years, 37.18% males) from the Shunyi cohort, we developed an automated pipeline to calculate diffusion-weighted image analysis along the perivascular space (ALPS), with a lower ALPS value indicating worse glymphatic function. The automated ALPS showed high consistency with the manual calculation of this index (ICC = 0.81, 95% CI: 0.662-0.898). We found that those with older age and male sex had lower automated ALPS values (β = -0.051, SE = 0.004, p < .001, per 10 years, and β = -0.036, SE = 0.008, p < .001, respectively). White matter hyperintensity (β = -2.458, SE = 0.175, p < .001) and presence of lacunes (OR = 0.004, 95% CI < 0.002-0.016, p < .001) were significantly correlated with decreased ALPS. The brain parenchymal and hippocampal fractions were significantly associated with decreased ALPS (β = 0.067, SE = 0.007, p < .001 and β = 0.040, SE = 0.014, p = .006, respectively) independent of white matter hyperintensity. Our research implies that the automated ALPS index is potentially a valuable imaging marker for the glymphatic system, deepening our understanding of glymphatic dysfunction.

A Retrospective Cross-Sectional Analysis of the Effects of Peripheral Maternal Systolic and Diastolic Blood Pressure on Birth Weight

A Retrospective Cross-Sectional Analysis of the Effects of Peripheral Maternal Systolic and Diastolic Blood Pressure on Birth Weight

Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

Extreme Weather and Firm Market Value: Roles of Corporate Social Responsibility and Stock Analyst Attention

ABSTRACT The outbreak of extreme weather events is increasing in frequency for the last decade, resulting in tremendous human and industrial losses worldwide. Evaluating and managing the effects of such events are highly urgent matters for firms, but the literature on this topic is limited. In this study, the effects of extreme weather events on the stock market performance of firms were estimated to provide a foundation for exploring how to manage such effects. From the perspective of the shareholder view, the heterogeneous effect of corporate social responsibility (CSR) on stock performance associated with extreme weather events were examined. Data on natural disasters that were caused by six types of extreme weather and occurred between 2001 and 2021 in China were used to construct a database of 2,718 Chinese listed manufacturing firms and 23,529 observations regarding the potential effects by extreme weather events. An event analysis indicated that the extreme weather events bring an average of 0.97% drop in the stock performance of potentially affected firms for the month that the event starts and the next month. A subsequent cross-sectional analysis revealed that a high CSR level is associated with low market value during extreme weather events, while a high level of stock analyst attention alleviates the negative effect of CSR on the stock performance of extreme weather events. This study enriches the existing literature and offers practical insights for managers in the fields of CSR and operations management, highlighting the complex dynamics between CSR activities, analyst attention, and stock market performance during extreme weather events.

Epigenome-wide association study of fluoride exposure during early adolescence and DNA methylation among U.S. children

Exposure to fluoride in early childhood has been associated with altered cognition, intelligence, attention, and neurobehavior. Fluoride-related neurodevelopment effects have been shown to vary by sex and very little is known about the mechanistic processes involved. There is limited research on how fluoride exposure impacts the epigenome, potentially leading to changes in DNA methylation of specific genes regulating key developmental processes. In the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), urine samples were analyzed using a microdiffusion method to determine childhood urinary fluoride adjusted for specific gravity (CUFsg) concentrations. Whole blood DNA methylation was assessed using the Infinium MethylationEPIC BeadChip 850 k Array. In a cross-sectional analysis, we interrogated epigenome-wide DNA methylation at 775,141 CpG loci across the methylome in relation to CUFsg concentrations in 272 early adolescents at age 12 years. Among all participants, higher concentrations of CUF were associated with differential methylation of one CpG (p < 6 × 10−8) located in the gene body of GBF1 (cg25435255). Among females, higher concentrations of CUFsg were associated with differential methylation of 7 CpGs; only three CpGs were differentially methylated among males with no overlap of significant CpGs observed among females. Secondary analyses revealed several differentially methylated regions (DMRs) and CpG loci mapping to genes with key roles in psychiatric outcomes, social interaction, and cognition, as well as immunologic and metabolic phenotypes. While fluoride exposure may impact the epigenome during early adolescence, the functional consequences of these changes are unclear warranting further investigation.

The Role of Fair Value Accounting in Debt Structure Decisions: Evidence from Priority Structure and Financial Flexibility

Synopsis The research problem This study investigates whether the debt structure of a firm — that is, how a firm organizes its debt contracts — depends on the extent to which fair value measurement is applied to the balance sheet. Motivation Most public firms have a nontrivial percentage of balance sheet items measured at fair value under the mixed attribute accounting, and there is a lack of understanding of its effect on the reporting entity’s debt structure. This study focuses on two aspects of the debt structure that have both practical and theoretical relevance, namely the priority structure and the financial flexibility. A priority structure involves the simultaneous use of different priorities of debt and is common among risky borrowers. Survey results show that financial flexibility is of first-order importance regarding the debt policy of firms. Here, financial flexibility refers to a firm’s ability to pursue new investment opportunities via debt issuance. The test hypotheses The first hypothesis states that a borrower with a higher percentage of balance sheet items measured at fair value is less likely to have a priority structure. The second hypothesis states that a borrower with a higher portion of balance sheet items measured at fair value likely has a debt structure that is more financially flexible. The third hypothesis states that the fair value of liabilities and the fair value of assets are equally relevant to debt structure decisions. Target population This study focuses on nonfinancial firms in North America that are subject to the mixed attribute accounting, which measures a certain percentage of assets and liabilities at fair value. Adopted methodology The main tests use multivariate analysis that includes both logistic regressions and OLS regressions. Additional tests include cross-sectional analyses and the Granger causality test. Analysis Using a sample constructed from Compustat North America and Capital IQ (6,220 firms and 36,487 firm-year observations), the main tests regress dependent variables, namely the priority structure measures and financial flexibility, on the exposure to fair value measurement. Findings Results show that fair value measurement reduces information asymmetry and has favorable effects on the debt structure. A high exposure to fair value measurement reduces the need for a priority structure. A high exposure to fair value measurement also enhances financial flexibility. Additional analyses reveal that the favorable effect mainly comes from assets measured at fair value. The effect becomes weaker with respect to liabilities measured at fair value.

Overseas Strategic Communication Strategies of New Energy Enterprises: Media Image Analysis of BYD and CATL in Hungary

The 2024 Government Work Report released by the State Council pointed out that the export of “new trio” - electric vehicles, lithium-ion batteries, and photovoltaic products has witnessed a year-on-year increase of nearly 30%, showcasing that the momentum of Chinese new energy enterprises going global is thriving. Hungary, ranking among the top three lithium-ion battery producing countries globally, with its automotive industry accounting for 10% of its GDP and 20% of its total exports, serves as a crucial market. Since 2022, Chinese leading battery enterprises represented by CATL and electric passenger vehicle enterprises represented by BYD have successively established factories in Hungary, drawing extensive attention from local media and the public. These flagship enterprises of the “new trio” have become important symbols of China’s high-quality development, and their media image in host countries can to some extent represent the overseas image of Chinese new energy enterprises, holding significant implications for the construction of China’s national image. Leveraging the author’s language expertise, this paper selects and analyzes 220 relevant reports from three mainstream media outlets in Hungary through a combination of qualitative and quantitative methods, supplemented by longitudinal and cross-sectional analysis. Additionally, considering the enterprises’ overseas social media operations, the paper examines the external communication images of the two Chinese new energy enterprises and the challenges they face, concluding with tailored recommendations.

No Association Between Medicare Advantage Providers' Network Restrictiveness and Star Rating Between 2013 and 2017: An Observational Study.

Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks. We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Medicare Advantage contracts with health maintenance organization (HMO), local preferred provider organization (PPO), and point of service (POS) plans with available data. A cross-sectional analysis using multivariable linear regressions to assess the relationship between provider network restrictiveness and contract quality scores in 2013 through 2017. Statistical significance in the relationship between network restrictiveness and contract performance on quality measures. Across all study years, we included 562 unique contracts and 2801 contract-years. We find no evidence of consistent relationships between MA physician network restrictiveness and contract star rating. For primary care, psychiatry, and endocrinology, respectively, a 10 percentage point increase in restrictiveness was associated with a 0.02 (95% confidence interval [CI] -0.01 to 0.04), 0.0008 (95% CI, -0.01 to 0.02), and -0.01 (95% CI, -0.01 to 0.001) difference in star rating (p-value > 0.05 for all). Similarly, we find no evidence of consistent relationships between network restrictiveness and access to care measures. Our findings suggest that existing MA contract quality measures are not useful for indicating differences in network restrictiveness. Given the importance of provider choice to beneficiaries, more specific metrics may be needed to facilitate informed decisions about MA coverage.

Comparison of the EQ-5D-5L and the patient-reported outcomes measurement information system preference score (PROPr) in the United States

BackgroundIn contrast to prior research, our study presents longitudinal comparisons of the EQ-5D-5L and Patient-Reported Outcomes Measurement Information System (PROMIS) preference (PROPr) scores. This fills a gap in the literature, providing a much-needed understanding of these preference-based measures and their applications in healthcare research. Furthermore, our study provides equations to estimate one measure from the other, a tool that can significantly facilitate comparisons across studies.MethodsWe administered a health survey to 4,098 KnowledgePanel® members living in the United States. A subset of 1,256 (82% response rate) with back pain also completed the six-month follow-up survey. We then conducted thorough cross-sectional and longitudinal analyses of the two measures, including product-moment correlations between scores, associations with demographic variables, and health conditions. To estimate one measure from the other, we used ordinary least squares (OLS) regression with the baseline data from the general population.ResultsThe correlation between the EQ-5D-5L and PROPr scores was 0.69, but the intraclass correlation was only 0.34 because the PROPr had lower (less positive) mean scores on the 0 (dead) to 1 (perfect health) continuum than the EQ-5D-5L. The associations between the two preference measures and demographic variables were similar at baseline. The product-moment correlation between unstandardized beta coefficients for each preference measure regressed on 22 health conditions was 0.86, reflecting similar patterns of unique associations. Correlations of change from baseline to 6 months in the two measures with retrospective perceptions of change were similar. Adjusted variance explained in OLS regressions predicting one measure from the other was 48%. On average, the predicted values were within a half-standard deviation of the observed EQ-5D-5L and PROPr scores. The beta-binomial regression model slightly improved over the OLS model in predicting the EQ-5D-5L from the PROPr but was equivalent to the OLS model in predicting the PROPr.ConclusionDespite substantial mean differences, the EQ-5D-5L and PROPr have similar cross-sectional and longitudinal associations with other variables. We provide the OLS regression equations for use in cost-effectiveness research and meta-analyses. Future studies are needed to compare these measures with different conditions and interventions to provide more information on their relative validity.