Cross-sectional Cohort Study Design Research Articles

Elevated perceived stress in university students due to the COVID-19 pandemic: Potential contributing factors in a propensity-score-matched sample.

Onset of the Coronavirus Disease 2019 (COVID) pandemic has increased students' perceived burdens. The current study aimed to examine COVID-related changes and to identify potential factors that contribute to students' stress. Adopting a cross-sectional cohort-study design, we examined perceived stress and depressive and anxiety symptoms with a specific focus on the role of study-related variables such as perceived study-related demands, study-related resources, academic procrastination, and stress-enhancing beliefs. Two cohorts (Npre-COVID = 2,175; NCOVID = 959) were recruited at the same university and matched with regard to their propensity score (age, gender, semester). Compared with the pre-COVID cohort, university students in the COVID cohort reported more perceived stress, more depressive and anxiety symptoms, more academic procrastination due to fear of failure, more stress-enhancing beliefs, more distress due to the housing situation, and more perceived study-related challenges (Cohen's d = 0.15-0.45). A stepwise regression analysis identified depressive symptoms, procrastination due to fear of failure, general self-efficacy, increased study demands, perceived difficulties with self-organized learning, distress due to housing, and stress-enhancing beliefs as predictors of perceived stress in the COVID cohort. Findings suggest that the switch to online-only education increased the study-related burden for students, primarily due to exams being replaced by a greater amount of regular coursework and imposing demands on self-organized learning. Possibly, stress-enhancing beliefs and procrastination due to fear of failure might have been elevated due to less opportunity for social referencing and lack of felt social support by peer students. Experienced increased burden in students during the COVID pandemic was mostly accounted for by a lack of perceived individual resources rather than by an increase in objective study-related demands.

Owner expectations and surprises of dog ownership experiences in the United Kingdom.

Although many owners are satisfied by dog ownership, large numbers of dogs are relinquished annually, with an estimated 130,000 dogs cared for each year by rescue organisations in the UK. Unrealistic ownership expectations are a potential factor in the decision to relinquish and therefore understanding what surprises owners about the realities of ownership and how this meets their expectations is vital. Using a retrospective cross-sectional cohort study design, as part of Dogs Trust's National Dog Survey 2021, owners were asked 'what has surprised you most about owning a dog?' and to classify how their experiences had compared with their expectations on a list of aspects of ownership as either more than, less than or as expected. Free text responses (n= 2,000) were analysed using reflexive thematic analysis in NVivo Pro (v.12 QSR) and a quantitative summary of classified expectations (n=354,224) was conducted in R. Many aspects of ownership were reported to be as expected, however a discrepancy between expectation and reality regarding some aspects was revealed. The cost of vet visits was greater than expected for the majority of respondents (52%), whilst other factors that often exceeded expectations included buying/rehoming cost (33%) and amount of patience needed (25%). Damage to furniture was less than expected for many (50%) as was damage to garden (33%). From the thematic analysis, four themes were generated that reflected what surprised owners most about ownership: emotional connectedness of human-dog relationships; dog's impact on human health/wellbeing; understanding what dogs are like; and meeting the demands of ownership. Overall these results aid our understanding of dog-human interactions, highlighting the complexity of the dog-owner relationship which may come with unanticipated costs. Whilst this study's results are reassuring given many aspects of ownership were as expected, and surprises were often positive, some areas had greater impacts than expected, raising opportunities for intervention, resources or support. The aim would be to manage owners' expectations prior to acquisition or ensure these are more realistically met, reducing the likelihood of negative welfare implications for both dog and owner.

The oral health-related quality of life for individuals with fetal alcohol spectrum disorder – a cross-sectional study

BackgroundThe oral health status of an individual can dramatically influence quality of life. Most individuals in Canada report having good oral health, however, this is not true for individuals with developmental disabilities such as fetal alcohol spectrum disorder (FASD). The purpose of this study is to compare the oral health-related quality of life (OHRQoL) of individuals with FASD and the general population in Saskatoon, Saskatchewan. Additionally, it aims to suggest ways to improve the oral health status and OHRQoL of these individuals.MethodsFor this cross-sectional study, the Oral Health Impact Profile-14 (OHIP-14) survey was used to assess the impact that oral health related problems can have on an individual’s quality life. This study used a cross-sectional cohort study design with a survey methodology. The sample population compromised of 154 individuals with FASD along with a separate control group of 154 otherwise healthy adults.ResultsThe results of the study showed that most of the individuals in the FASD group experienced pain in the past month. In both groups, cost was most frequently cited as a barrier to accessing care. The majority of individuals in the control group experienced a low impact across all OHIP-14 domains except for physical disabilities. However, in the FASD group, most individuals experienced higher impact scores in some of the categories including functional limitation, psychological discomfort, psychological disability and handicap.ConclusionThe findings clearly demonstrate that there is a discernible effect on an individual’s quality of life if they have poor oral health. In conclusion, further research is required to determine the most effective methods to improve the OHRQoL of individuals with disabilities.

Utility of Opportunistic Infections, Joints’ Involvement and Accuracy of Various Screening Tests to Diagnose Rheumatoid Arthritis Patients

Background and Objectives: Rheumatoid Arthritis (RA) is an auto-immune disease in which the body mistakenly considers some parts of its own system as pathogens and attacks them. Prevalence is approximately 0.75% in India. About 40% of the diseased become work disabled within 5 years from the onset of symptoms. The objective of this paper is to assess the sign/symptoms, joints' involvement, difficulties in daily activities and screening accuracy of serology tests of clinically suspected RA patients. Material and Methods: A cross-sectional cohort study design was conducted on two hundred ninety clinically suspected subjects who were referred by different OPDs of hospitals for screening. The profiles of study subjects were carried through a semi-structured, pre-tested schedule method. About 2 mL of blood samples were collected in a plain vial from each patient and tested for diagnostic tests RF, CRP and AntiCCP by using RF-Latex, CRP Latex and ELISA method, respectively, by the laboratory persons. Results: Joint pain shows to be a leading problem in RA as compared to other signs and symptoms. The majority of the study subjects suffer from knee problems (62%). Approximately equal numbers of RA-positive cases were screened by RF and AntiCCP tests. The CRP test screened about one-third of cases. CRP+ AntiCCP, RF+ AntiCCP and RF + CRP all have good sensitivity, and RF+ AntiCCP + CRP has a very high sensitivity for diagnosing RA. Conclusions: This study found that a substantiation of a major proportion of clinically suspected RA patients were suffering from knee pain. Predication of AntiCCP increased the possibility for the diagnosis of RA. However, RF was also moderately related to the diagnosis of RA, and the combination of both tests was more valuable.

What is the relationship between the presence of hip/groin pain and hip range of motion in active, young adults?

Introduction: The relationship between the presence of hip/groin pain and hip range of motion (ROM) in active young people is currently unclear. With a cross-sectional cohort study design, we aimed to explore the relationship between hip/groin pain (present or absent) and hip joint ROM in sub-elite football players accounting for cam morphology, sex and age.

Cardio-Respiratory Fitness and Cardiovascular Disease Risk Factors Among South African Medical Students.

Cardiovascular disease (CVD) risk factors have been associated with CVD mortality, and physicians use CVD risk factor profiles (smoking, dyslipidemia, hypertension, etc.) to address patient health. Furthermore, cardio-respiratory fitness (CRF) has been shown to be an independent risk factor for CVD and all-cause mortality. Cardio-respiratory fitness is also the risk factor that contributes the highest percentage to all-cause deaths when compared to other traditional risk factors. In addition, studies have reported that adding CRF to established CVD risk factors improves the precision of prediction for CVD morbidity and mortality. Medical students tend to adopt sedentary and unhealthy lifestyles during the course of their education that negatively affect CVD risk factors and CRF. The majority of research on CVD risk, health status and lifestyle factors of medical students has used self-reported data and questionnaires for CVD risk factors and not included CRF in the health status measurements. In addition, studies have found that future medical doctors' own health and lifestyle practices influence their counselling activities. Allowing future medical doctors to assess their personal CVD risk factors and CRF may thus be important in their use of physical activity counselling with patients' lifestyle management for health benefits and improvement. A descriptive, cross-sectional cohort study design was used with the aim to determine CVD risk factors using CRF measures and physical activity levels in a cohort of South African medical students. The most significant finding was that they were not meeting the PA levels recommended to maintain health and lower CVD risk.

Impact of Change in Allocation Score Methodology on Post Kidney Transplant Average Length of Stay.

BackgroundIn December 2014, a new Kidney Allocation System (KAS) was implemented nationwide to improve access and quality of care to historically disadvantaged patients. However, no study to date has examined the relationship between the KAS and potential changes in hospital length of stay (LOS). This study aimed to examine the relationship between the KAS implemented in December 2014 and potential changes in hospital LOS.MethodsWe used data from the Florida Agency for Health Care Administration on kidney transplant surgeries completed between 2011 and 2018. A cross-sectional cohort study design included seven hospitals that performed kidney transplants for the duration of the study. A propensity score matching approach was used to examine the relationship between KAS and LOS. All acute general medical and surgical hospitals in Florida that performed kidney transplant surgery were included in the analysis.ResultsWe included 7,795 patients, 6,119 discharged to home, and 1,676 discharged to home with home health services after transplant. The average LOS prior to KAS was 6.52 days and 6.08 days post KAS. Propensity matched results show that patients transferred to home experienced a decrease in the LOS (coefficient (β) = -0.68; 95% confidence interval (CI): -0.95, -0.42) after the new allocation score was implemented. Similarly, patients transferred to home with home health experienced a decrease in the LOS (β = -1.90; 95% CI: -2.69, -1.11) after the new allocation was implemented.ConclusionIn conclusion, results indicate that KAS implementation did not add a burden on the health system by increasing LOS when considering patients with similar characteristics before and after KAS implementation. KAS is an important policy change that appears to not negatively affect the LOS when sicker patients could receive a kidney transplant. Our findings improve our understanding of the KAS policy and its influence on the health system.

Efficient estimation of human immunodeficiency virus incidence rate using a pooled cross-sectional cohort study design.

Development of methods to accurately estimate human immunodeficiency virus (HIV) incidence rate remains a challenge. Ideally, one would follow a random sample of HIV-negative individuals under a longitudinal study design and identify incident cases as they arise. Such designs can be prohibitively resource intensive and therefore alternative designs may be preferable. We propose such a simple, less resource-intensive study design and develop a weighted log likelihood approach which simultaneously accounts for selection bias and outcome misclassification error. The design is based on a cross-sectional survey which queries individuals' time since last HIV-negative test, validates their test results with formal documentation whenever possible, and tests all persons who do not have documentation of being HIV-positive. To gain efficiency, we update the weighted log likelihood function with potentially misclassified self-reports from individuals who could not produce documentation of a prior HIV-negative test and investigate large sample properties of validated sub-sample only versus pooled sample estimators through extensive Monte Carlo simulations. We illustrate our method by estimating incidence rate for individuals who tested HIV-negative within 1.5 and 5 years prior to Botswana Combination Prevention Project enrolment. This article establishes that accurate estimates of HIV incidence rate can be obtained from individuals' history of testing in a cross-sectional cohort study design by appropriately accounting for selection bias and misclassification error. Moreover, this approach is notably less resource-intensive compared to longitudinal and laboratory-based methods.

How is vasospasm screening using transcranial Doppler associated with delayed cerebral ischemia and outcomes in aneurysmal subarachnoid hemorrhage?

Delayed cerebral ischemia (DCI) is an independent predictor of an unfavorable outcome after aneurysmal subarachnoid hemorrhage (aSAH). Many centers, but not all, use transcranial Doppler (TCD) to screen for vasospasm to help predict DCI. We used the United Kingdom and Ireland Subarachnoid Haemorrhage (UKISAH) Registry to see if outcomes were better in centers that used TCD to identify vasospasm compared to those that did not. TCD screening practices were ascertained by national survey in 13 participating centers of the UKISAH. The routine use of TCD was reported by 5 "screening" centers, leaving 7 "non-screening" centers. Using a cross-sectional cohort study design, prospectively collected data from the UKISAH Registry was used to compare DCI diagnosis and favorable outcome (Glasgow Outcome Score 4 or 5) at discharge based on reported screening practice. A cohort of 2028 aSAH patients treated ≤ 3days of hemorrhage was analyzed. DCI was diagnosed in239/1065 (22.4%) and 220/963 (22.8%) of patients innon-screening and screening centers respectively while 847/1065 (79.5%) and 648/963 (67.2%) achieved a favorable outcome. Odds ratios adjusted for age, injury severity, comorbidities, need for cerebrospinal fluid diversion, and re-bleed returned neutral odds of diagnosing DCI of 0.90 (95% CI 0.72-1.12; p value = 0.347) in screening units compared to those of non-screening units but significantly decreased odds of achieving a favorable outcome 0.56 (95% CI 0.42-0.82; p value < 0.001). Centers that screened for vasospasm using TCD had poorer in-hospital outcomes and similar rates of DCI diagnosis compared to centers that did not.

Predictors of women's positive childbirth pain experience: Findings from an Icelandic national study.

Pain in childbirth has been identified as one of the major components in the childbirth experience and an important topic that needs to be addressed during pregnancy, birth and the after-birth period. The aim of the study was to describe women's childbirth pain experience and to identify predictors of women's positive childbirth pain experience. A population-based cross-sectional cohort study design was implemented, with convenient consecutive sampling, stratified according to residency. Pregnant women were recruited through 26 health care centers. Participants were sent a questionnaire by mail during early pregnancy and another one five to six months after childbirth. A multiple regression analysis was done, with women's childbirth pain experiences as the dependent variable. Altogether 726 women participated in the study, with a response rate of 68%. The strongest predictors for women's positive childbirth pain experience were positive attitude to childbirth during pregnancy; support from midwife during childbirth; use of epidural analgesia and low intensity of pain in childbirth. The majority of the women in the study experienced childbirth pain as a positive experience, which is in line with studies that have demonstrated that pain in childbirth is different from other kinds of pain. In addition to epidural use as a predictor for positive childbirth pain experience, many other strong predictors exist and must be acknowledged. When planning pregnancy and childbirth services, predictors of positive experience of childbirth pain should be considered and investigated further.

Community DSPD pilot services in South London: Rates of reconviction and impact of supported housing on reducing recidivism

The effectiveness of community services in reducing recidivism by men in the 'dangerous and severe personality disorder' framework--with personality disorder and at high risk of recidivism--is unknown. To conduct a preliminary examination of the characteristics and reconviction rates of male offenders with personality disorder accessing two South London community dangerous and severe personality disorder pilot outpatient services and to evaluate the role of supported housing for them. Reoffending outcomes of 107 high risk offenders with personality disorder were assessed using a cross-sectional cohort study design. Participants were allocated to outpatient only (non-residential) or outpatient with supported housing groups. Self-reported, collateral and criminal justice data and Offender Group Reconviction Scale III predictors of reoffending were used to describe the samples. The overall reconviction rate over the entire study period was 11%. At 12 months following acceptance to the service, reoffending for the entire sample was significantly lower (5%) than mean Offender Group Reconviction Scale III scores predicted (51%). Multivariate analyses confirmed that those also in receipt of supportive housing were significantly less likely to reoffend than those without. Although there was no difference between groups in violent reconviction specifically, only five men in total reoffended violently. Although findings appear promising, this was a naturalistic study. The sample size was small, but represented all men accepted into the two pilot services. Further evaluation of the role of supported housing and perhaps other details of community supervision should follow.

Decreased prevalence of atopic features in patients with psoriatic arthritis, but not in psoriasis vulgaris

The prevalence of atopic disorders is reduced in patients with various autoinflammatory diseases but, to our knowledge, this association has not been studied in psoriasis vulgaris or psoriatic arthritis (PSA). Prevalence of hay fever, asthma, and sensitization to common aeroallergens was compared in patients with psoriasis vulgaris to patients with PSA and control subjects; we also investigated whether atopy influences the arthritis activity and severity scores in patients with PSA. In a cross-sectional cohort study design, the differences in patient-reported lifetime prevalence of atopic disorders and serum IgE directed against common aeroallergens were compared. The effect of atopy on arthritis severity was assessed using the 28-joint Disease Activity Score and Health Assessment Questionnaire. Logistic regression models were used to calculate crude and adjusted odds ratios with 95% confidence intervals (CI) for presence of atopy. A total of 168 patients with PSA, 133 patients with psoriasis vulgaris, and 147 control subjects were included. The lifetime prevalence of hay fever did not differ across groups. Patients with PSA were less likely to have had asthma than control subjects (adjusted odds ratio 0.20; 95% CI 0.04-0.92) and they were less likely to be sensitized (adjusted odds ratio 0.50; 95% CI 0.25-0.99). Health Assessment Questionnaire-visual analog scales for pain and for patient global score were significantly reduced by sensitization to common aeroallergens (beta-coefficients -0.54 [95% CI -0.84 to -0.25] and -18.4 [95% CI -28.5 to -8.25], respectively.) This was a cross-sectional, small-numbered study. Atopy may protect against development of PSA and diminish its severity.

Taekwondo training improves the neuromotor excitability and reaction of large and small muscles

ObjectivesThis study measured the neuromotor excitability and reaction time in professional and amateur Taekwondo (TKD) practitioners and compared them with non-athletes. DesignA cross-sectional cohort study design. SettingExercise laboratory setting. Participants40 TKD practitioners (20 professionals, 20 amateurs) and 20 non-athletes. Main outcome measuresNeuromotor excitability (rheobase), premotor reaction time (PRT), total reaction time (TRT) and electromechanical delay (EMD) of rectus femoris (RF) and flexor pollicis brevis (FPB) in response to audio and visual stimuli were measured. The professional TKD practitioners have shorter TRT than non-athletes with sport-specific visual stimuli but they have longer PRT and TRT in response to audio stimuli than the amateur practitioners and non-athletes. ResultsThe professional practitioners have longer EMD than the amateurs in responding to audio (p = 0.032) and sports-specific visual stimuli (p = 0.03) in FPB. Professional practitioners have higher excitability in RF (p < 0.001) than the amateurs and non-athletes. ConclusionWe conclude that professional TKD practitioners have better neuromotor ability in both large and small muscles with faster reactions to sport-specific stimuli, suggesting a generalized training effect across muscles. They react slower to non-sport specific stimuli, which suggested a decreased sensitivity to irrelevant sensory inputs after intensive TKD training.

Using the concept of resilience to explain entrepreneurial success in China

This paper aims (1) to explore resilience among Chinese entrepreneurs and its correlation with entrepreneurial types; (2) to examine the relationship between entrepreneurial type and other factors including locus of control, education and experience. A cross–sectional cohort study design was used. Fifty thousand entrepreneurs were randomly selected from 228 cities across 31 provinces in China, of which 38,890 agreed to participate in this study. Results indicated that entrepreneurs who founded a resource–based business had higher resilience scores than those who founded risk or knowledge–based ventures. The resource–based and skill–based entrepreneurs were similar to each other in terms of creativity and innovation, need for achievement, flexibility and knowledge seeking. The findings of this study suggest that institutions and small business support agencies need to provide training opportunities for entrepreneurs to develop resilience characteristics before they commence establishing business ventures.

The assessment of metabolic syndrome in UK patients with HIV using two different definitions: CREATE 2 study

Objective:To determine the prevalence and clinical associations of the metabolic syndrome (M-IRS) in an HIV cohort.Methods and design:Data was collected prospectively on demographics, anthropometry, HIV disease, drug regimens and cardiometabolic risk factors using a two-centre cross-sectional cohort study design. M-IRS was diagnosed by National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria.Results:The prevalence of M-IRS in 678 subjects was 14% by NCEP and 10% by IDF. One feature of the M-IRS was present in 68%, while 37% had two or more features. Increased waist circumference was found in 32% by NCEP or by IDF criteria, hypertriglyceridaemia in 32%, reduced HDL-C in 27%, 18% had raised systolic blood pressure and 13% had dysglycaemia. Protease inhibitor (PI) usage was similar in both M-IRS categories (43 vs. 38%; p = 0.38) but increased use of efavirenz was seen in M-IRS (47 vs. 36%; p = 0.07) and nevirapine in the non-M-IRS groups (10 vs. 20%; p = 0.05). Multiple drug therapies were associated with raised triglyceride levels while nevirapine therapy was associated with raised HDL-C and abacavir with dysglycaemia.Conclusions:The prevalence of M-IRS in this HIV cohort was similar to the general population and independent of current or previous highly active antiretroviral therapy (HAART) or its duration. Given the relationship between individual drugs and features of M-IRS its significance must be interpreted in the light of probable accrual bias in prescribing. Prospective studies are required to ascertain the cardiometabolic risk factors to include in a prognostically useful HIV disease-specific definition of M-IRS.

Cognitive changes in amnestic mild cognitive impairment:a follow-up study

Objective To investigate outcome and cognitive changes of amnestic mild cognitive impairment (aMCI) in a follow-up study. Methods A cross-sectional and longitudinal parallel cohort study design was conducted among 109 aMCI patients and 104 matched normal controls. Multi-dimension neuropsychologic tests were used to extensively assess the cognitive function. Results The scores of neuropsychologic tests in aMCI patients were significantly lower than those in the normal controls( all P＜0.01 ) ,with the largest impairment on 20minutes delayed recall of the auditory verbal memory test ( AVMT), which reflects episodic memory ( aMCI pa-tients :2.50 ± 1.48, normal controls :7.85 ± 1.59, Z = - 12.697, P ＜ 0.01 ); AD was diagnosed in 15 of the 69aMCI patients with a prevalence rate of 22% ,but none was converted to AD in the normal controls. The cognitivechanges of performance in AVMT, CDT, MMSE of the patients in aMCI group (( 3.77 ± 60.83 )%, (6.89 ±28.24) %, (6.13 ± 16.89) % respectively) were significantly poorer than those of the controls group(( - 10.75 ±27.46) %, ( - 5.23 ± 14.05 ) %, ( - 1.11 ± 8.26 ) % respectively) ( all P ＜ 0.05 ). At baseline, demented aMCIperformed poorer in AVMT, CFT, TMT, SDMT, CDT, MMSE when compared to stable. During the follow-up, demented aMCI groups performed significantly poorer than did stable subjects in AVMT, CFT, DST, VFT, SDMT,MMSE ( all P ＜ 0.05 ). Conclusion aMCI is a prodromal period of AD and characterized by episodic memory impairment. The neuropsychologic test is a predictive factor for aMCI to develop AD. Key words: Amnesia; Mild cognitive impairment; Dementia; Neuropsychologic test

Dementia assessment in primary care: results from a study in three managed care systems.

Prior research has found that dementia is often undiagnosed in primary care, but there has been limited research on whether physicians respond to symptoms, behaviors, or other events that may be indicators of dementia. A cross-sectional cohort study design was used to screen 553 patients aged 75 years or older for dementia in 3 managed health care systems in Portland, Oregon. For participants determined to be cognitively impaired, their medical charts were reviewed to determine if they had experienced adverse events, had been clinically evaluated for possible dementia, had received a diagnosis of dementia, or had been offered treatment. Nearly 43% of participants were identified as cognitively impaired: 29.7% were classified as mildly cognitively impaired (MI) and 13.7% as moderately to severely cognitively impaired (MSI). Eighteen percent of the MI group and 34.8% of the MSI group had evidence in their medical chart of having been clinically evaluated for dementia. None of the MI group and only 4.3% of the MSI group had been offered a cholinesterase inhibitor. Nearly two thirds (61.6%) of the MI and three fourths (75.4%) of the MSI participants had experienced 1 or more adverse events. Of those who had experienced adverse events, less than one quarter (23.7%) in the MI group and less than one half (44.2%) in the MSI group had received a clinical evaluation for dementia. These findings suggest the need for greater attention by primary care physicians to the cognitive functioning of older patients, especially patients who experience adverse events that may be indicators of dementia.