Multivariate General Linear Model Research Articles

Effectiveness of the school-based social and behaviour change communication interventions on insecticide-treated nets utilization among primary school children in rural Ethiopia: a controlled quasi-experimental design

BackgroundSchool-based behaviour change communication interventions could help to achieve behavioural changes in the school and enhance the enrollment of the students and teachers as health messengers to local communities. Evidence on the impacts of the school-engaged malaria preventive interventions are limited as far as the social and behaviour change communication (SBCC) is concerned. This study examined the effectiveness of the school-based SBCC approach on insecticide-treated nets (ITNs) utilization among primary school students in malaria-endemic settings of Ethiopia.MethodsVarious participatory, educational, and communication interventions were implemented from 2017 to 2019 in 75 primary schools and respective villages in Jimma to promote malaria preventive practices. A quasi-experimental design was conducted with randomly selected 798 students (i.e. 399 intervention and 399 control groups). Data were collected by trained interviewers using structured questionnaires. The SPSS version 26 software was used to analyse the data. Propensity score matching analysis was performed to control for possible confounding biases. The average effects of the intervention were estimated using multivariate general linear modelling to estimate for mean differences and odds ratio based on the nature of data.ResultsThe result showed that the ITNs utilization was 6.857 folds in the intervention groups compared to the counterpart; (OR = 6.857; 95% CI: (4.636, 10.1430); effect size = 39%). A mean differences (MD) of self-efficacy (MD = 15.34; 95% CI: 13.73 to 16.95), knowledge (MD = 5.83; 95% CI: 5.12 to 6.55), attitude (MD = 6.01; 95% CI: 5.26 to 6.77), perceived malaria risk (MD = 2.14; 95% CI: 1.53 to 2.76), and perceived family supports (MD = 6.39; 95% CI: 5.57 to 7.22) were observed favoring the intervention. Multivariable logistic regression modelling results showed that knowledge (β = 0.194, 95% CI: 1.09 to 1.35) and perceived family supports (β = 0.165, 95% CI: 1.11 to 1.25) and self-efficacy (β = 0.10, 95% CI: 1.22 to 2.32) predicted the ITN utilization among the school children.ConclusionsThe finding of this study suggested that the school-based SBCC approach combined with peer education activities advanced the malaria-related knowledge, attitude, self-efficacy, risk perceptions, and family supports and ultimately improved the sustained use of ITNs among school-going children. Further research should be conducted to understand the mechanism of these effects given the influences of social, health services, and school systems are considered.

Motives underlying water sport tourist behaviour: a segmentation approach

ABSTRACT Sport tourism is a heterogeneous phenomenon with diverse motivations. However, the field of water sport tourism has not yet been intensely analyzed. The purpose of this study was twofold. Firstly, the study aimed to unfold the consumer profile of water sport tourists. Secondly, the role of demographic variables and behavioural attributes concerning flow experience in the activities was unveiled. Since flow has the potential of sustaining participation in physical activity pursuits as well as raising destination loyalty, its analysis in the field of leisure and tourism is of utmost interest. A quantitative research method was chosen. The subjects were 297 Hungarian water sport participants. Data were analyzed through k-means clustering and a multivariate general linear model using SPSS software. First, the cluster analysis yielded four clusters based on sport and tourism motivations, namely: Sport-oriented, Leisure-ignoring, Leisure-oriented, Social-oriented groups. Second, in the “Absorption in the Activity” dimension of flow experience, females demonstrated higher scores than males, and participants showed significant differences according to their skill levels. Furthermore, as a predictor variable, flow Absorption influenced expenses on sport lessons, while desired skill level affected the frequency of practising. These findings contribute to reaching water sport tourists more adequately.

Effects of aerobic walking on cognitive function in patients with schizophrenia: A randomized controlled trial

Cognitive deficits, which are core manifestations in schizophrenia and exhibit a limited response to antipsychotic treatment, contribute to poor treatment outcomes and functional disability. Evidence on the effect of aerobic walking (AW) and exercise intensity on cognitive function in patients with schizophrenia is lacking. In total, 79 patients with schizophrenia were recruited for a 12-week randomized control trial and allocated to the treatment-as-usual (TAU, n = 38) and treatment-as-usual plus AW (TAW, n = 39) groups. The TAW participants joined a supervised 12-week AW program consisting of 30-min sessions five times per week while wearing a Fitbit Charge 2 device. Cognitive function was evaluated using the Brief Assessment of Cognition in Schizophrenia. After randomization, 67 (34 TAU and 33 TAW) participants joined the 12-week trial and were included in the intention-to-treat analysis. Multivariate general linear model repeated measures analysis revealed no significant time × group interaction effect on cognitive function changes between the TAU and TAW groups and a marginally significant group effect on verbal fluency (p = 0.09). The interaction effect of time and treatment group on verbal fluency (p = 0.05) was marginally significant between the high and low AW intensity groups, whereas a significant group effect on attention and processing speed (p = 0.04) was observed. Supervised 12-week AW of moderate intensity may have potential cognitive benefits for patients with schizophrenia.

Bayesian and frequentist approaches to multinomial count models in ecology

Multinomial count data are common in trophic ecology, spatial ecology, and community ecology. Compared to generalized linear models (GLMs) for univariate data, fewer statistical programs have been developed for the multivariate counterpart of GLMs. Studies of spatiotemporal community dynamics and spatial ecology on large spatial scales may generate large or big data on compositional counts or proportions. Fast, reliable computational methods can promote applications of multivariate generalized linear models (MGLMs) in predictive ecology and ecological informatics. The main objective of this study was to build Dirichlet-multinomial (D-M) models for compositional counts using frequentist's maximum likelihood estimation (MLE) with template model builder (TMB), full Bayesian estimation with programs JAGS and Stan, and variational Bayes in Stan. Bayesian and frequentist D-M models were applied to the compositional counts of radio telemetry locations of ring-necked pheasants (Phasianus colchicus) and American beaver (Castor canadensis) in different habitat-cover types to estimate habitat selection index. Bayesian D-M models with JAGS and Stan produced similar estimates as TMB programs. However, TMB programs ran a few hundred times faster than the Bayesian models. Template model builder and Stan are flexible in building complex statistical models and can accommodate a large number of parameters and random effects. The joint use of TMB and Stan may help develop MGLMs and multivariate generalized linear mixed models for large ecological data.

Sources and Determinants of Wholegrain Intake in a Cohort of Australian Children Aged 12-14 Months.

In the first two years of life, exposure to wholegrain foods may help establish life‑long consumption patterns associated with reduced risk of chronic disease, yet intake data are lacking for this age group. This cross‑sectional analysis aimed to determine intakes and food sources of wholegrains in a cohort of 828 Australian children aged 12–14 months, and to identify determinants of wholegrain intake. Three non‑consecutive days of dietary intake data were collected using a 24‑h recall and 2‑day estimated food record. The multiple source method was used to estimate usual wholegrain intake, and the multivariable general linear model procedure used to identify associations between usual wholegrain intake and socio‑demographic determinants. The mean wholegrain intake was 19.5 (±14) g/day, and the major food sources were ready to eat breakfast cereals (40%) breads and bread rolls (26.6%), flours and other cereal grains (9.4%), and commercial infant foods (8.3%). Lower wholegrain intakes were observed for children whose mothers were born in China (p < 0.001) and other Asian countries (p < 0.001), with the exception of India (p = 0.193); those with mothers aged less than 25 years (p = 0.001) and those with two or more siblings (p = 0.013). This study adds to the weight of global evidence highlighting the need to increase children’s intake of foods high in wholegrain, including in the first few years of life.

Association between dietary branched-chain amino acid intake and skeletal muscle mass index among Korean adults: Interaction with obesity

BACKGROUND/OBJECTIVESThe branched-chain amino acids (BCAA), including isoleucine, leucine, and valine, promote muscle protein synthesis. However, obesity may interfere with protein synthesis by dysregulating mitochondrial function in the muscles. This study aimed to examine the association between dietary intake levels of BCAA and skeletal muscle mass index (SMI) in middle-aged participants, and the effect of obesity/abdominal obesity on this association.SUBJECTS/METHODSThe data of 3,966 men and women aged 50–64 years who participated in the 2008–2011 Korea National Health and Nutrition Examination Survey were analyzed. Intake levels of energy-adjusted dietary amino acids were obtained using a 24-hour dietary recall. SMI was calculated by dividing the appendicular skeletal muscle mass by body weight (kg) and multiplying the result by 100%. Multivariable general linear models were used to analyze the association of dietary BCAA intake levels with SMI.RESULTSThe beneficial effects of energy-adjusted dietary BCAA intakes on SMI were greater in the non-obesity/non-abdominal obesity groups; however, no significant associations were observed in the obesity/abdominal obesity groups (P > 0.05).CONCLUSIONSHealthy weight and sufficient intake of dietary BCAA are recommended to maintain muscle mass.

Dietary Habits and Psychological States during COVID-19 Home Isolation in Italian College Students: The Role of Physical Exercise.

Social isolation has adverse effects on mental health, physical exercise, and dietary habits. This longitudinal observational study aimed to investigate the effects of mood states and exercise on nutritional choices, on 176 college students (92 males, 84 females; 23 ± 4 years old) during the COVID-19 lockdown. During 21 days, nutrition and exercise were daily monitored, and the mood states assessed. A factor analysis was used to reduce the number of nutritional variables collected. The relationships between exercise, mood and nutrition were investigated using a multivariate general linear model and a mediation model. Seven factors were found, reflecting different nutritional choices. Exercise was positively associated with fruit, vegetables and fish consumption (p = 0.004). Depression and quality of life were, directly and inversely, associated with cereals, legumes (p = 0.005; p = 0.004) and low-fat meat intake (p = 0.040; p = 0.004). Exercise mediated the effect of mood states on fruit, vegetables and fish consumption, respectively, accounting for 4.2% and 1.8% of the total variance. Poorer mood states possibly led to unhealthy dietary habits, which can themselves be linked to negative mood levels. Exercise led to healthier nutritional choices, and mediating the effects of mood states, it might represent a key measure in uncommon situations, such as home-confinement.

Plasma and water fluoride levels and hyperuricemia among adolescents: A cross-sectional study of a nationally representative sample of the United States for 2013–2016

Exposure to excessive fluoride has been associated with a number of adverse health outcomes; however, there is a lack of evidence on the relation between fluoride exposure and serum uric acid levels, especially in human populations. The present study examined a potential relationship between fluoride exposure, measured as both plasma and water fluoride concentrations, and uric acid levels in an adolescent population. A nationally representative subsample of 1933 adolescents, aged 12–19 years, in the 2013–2016 National Health and Nutrition Examination Survey was analyzed for the association of fluoride concentrations with serum uric acid levels using multivariate general linear and logistic regression models, adjusting for potential confounders. Since uric acid levels change during development, hyperuricemia was defined in this study as over the mean plus one standard deviation for each sex and age group of adolescents. Of the study participants, 276 adolescents (weighted prevalence, 16.56%) had hyperuricemia. A significant and dose-dependent increase in prevalence of hyperuricemia was seen among the participants cross increasing quartiles of plasma fluoride (p-trend = 0.0017). After adjusting for potential confounders, we found that adolescents in the higher quartiles of plasma fluoride (≥0.32 µmol/L) and in the highest quartile of water fluoride (≥0.73 mg/L) had significantly increased odds of hyperuricemia compared with those in the lowest quartile. A 1.95-fold increased odds (95% CI: 1.37, 2.77) of hyperuricemia was also observed when analyzing plasma fluoride concentrations as continuous variable. A general linear model revealed that a 1 µmol/L increase in ln-plasma fluoride was associated with a 0.212 mg/dL (p < 0.0001) increased serum uric acid level. Furthermore, a positive relationship was observed between water and plasma fluoride concentrations (β = 0.1907; p < 0.0001). Our study demonstrates a potential relation between fluoride exposure and hyperuricemia in adolescents. Further studies are warranted to overcome the limitations of this study to examine the impact of long-term exposure to low levels of fluoride during development on hyperuricemia and its related health outcomes.

Hepatitis B and HIV coinfection in Northern Uganda: Is a decline in HBV prevalence on the horizon?

The available data concerning hepatitis B virus (HBV) infection in Uganda are limited, particularly in the case of people living with HIV/AIDS (PLWH). HBV is not routinely tested when starting antiretroviral therapy (ART). We aimed to determine the prevalence, the correlates of the risk of HBV infection, and the association with outcomes of ART among PLWH attending a busy HIV clinic in a referral hospital in Northern Uganda. From April to June 2016, a random sample of 1000 PLWH attending the outpatients' clinic of St. Mary's Hospital, Gulu, Uganda were systematically selected to undergo a rapid hepatitis B surface antigen (HBsAg) test after administering a questionnaire in this cross-sectional study. HIV care parameters were obtained from client files. Multivariate logistic regression and general linear model were used for the analysis. 950 of the 985 evaluable patients (77% females; mean age 42.8 years) were receiving ART. The overall prevalence of HBsAg was 7.9% (95% confidence interval [CI] 6.2-9.6%), and was significantly lower among the females (6.8% vs 11.7%; p = 0.020). The factors independently associated with higher HBV infection were having lived in an internally displaced persons' camp (adjusted odds ratio [aOR] 1.76, 95% CI 1.03-2.98; p = 0.036) and having shared housing with HBV-infected people during childhood (aOR 3.30, 95% CI 1.49-7.32; p = 0.003). CD4+ T cell counts were significantly lower in HBV patients (p = 0.025), and co-infection was associated with a poorer CD4+ T cell response to ART (AOR 0.88; 95% CI 0.79-0.98; p = 0.030). The observed prevalence of HBV among the PLWH may be underestimated or a signal of HBV decline in the region. The factors favouring horizontal HBV transmission identified suggest extending HBV screening and vaccine prophylaxis among PLWH.

Food Deserts Are Associated with Acute Care Utilization Among Preschool Children with Sickle Cell Disease

Introduction Individuals with sickle cell disease (SCD) experience recurrent acute vaso-occlusive events (VOE) beginning in infancy, that can be prevented with hydroxyurea therapy (Wang W. Lancet 2011), while chronic organ dysfunction becomes evident in adolescence and progresses with age. Nutritional insufficiencies and deficiencies occur in SCD (e.g., zinc, vitamin D and B6), and are associated with greater frequency of VOE (McCaskill M. Nutrients 2018, Martyres D. PBC 2016, Schall J. J Pediatr 2004). While infants and young children (age &amp;lt;6) are particularly vulnerable to the effects of malnutrition (e.g., developmental delay and cognitive impairment), the environmental components leading to decreased food access have not been investigated relative to the impact on their healthcare outcomes. We tested the hypothesis that restricted access to healthy food sources is associated with increased SCD-related acute care utilization among children with SCD younger than age 6 years, despite treatment with hydroxyurea. Methods Participants were recruited from the IRB-approved longitudinal clinical cohort study, Sickle Cell Clinical Research and Intervention Program (Hankins J. PBC 2018). Home addresses were mapped to census-tract environmental data from the US Food Access Research Atlas (USDA ERS 2017). Food deserts were defined as "low income census tracts where at least 33% (minimum of 500 people/tract) of the population live &amp;gt;1.0 (urban area) or &amp;gt;10 (rural area) miles from a grocery store or a supermarket" (Food Access, USDA ERS 2019). Three main outcomes: emergency department (ED) visits, hospitalizations, and acute care utilization (ACU=ED + hospitalizations) from a VOE, were collected from birth to age 6 and analyzed as cross-sectional outcomes at age 6-years. Generalized linear models (GLM) were used to associate environmental factors as continuous and categorical variables with the outcomes adjusted for sickle genotype and hydroxyurea exposure. False discovery rate (FDR)-adjusted p-values (pFDR) were calculated to account for multiple comparisons. Environmental factors with pFDR&amp;lt;0.1 were assessed in multivariate GLM. The area under ROC curves (AUC) were generated to estimate how environmental data can improve the accuracy of predicting the acute care utilization outcomes. Results 523 children with SCD, all African American, were included. The median age at last follow-up was 5.5 years (range 1- 6), 51.7% were girls (Table 1). Differences in health care utilization and hydroxyurea use were observed according to SCD genotype. A total of 33.5 % of the studied population resided in census tracts considered food deserts. The average distance to the nearest supermarket from participants' household was 2.8 miles. Except for % of children per census tract, there were no neighborhood differences by SCD genotype (Table 1). Participant neighborhoods had on average 14.7% unemployment rate, while 30.8% of individuals were under the federal poverty threshold and received Food and Nutrition Services. 7.9% of adults had a bachelors' degree. Among the tracts where the population was considered low income, 9% did not own a car, and the proportion of those living &amp;gt;0.5 and &amp;gt;1.0 miles from a supermarket was 37% and 16%, respectively. Living in a household without a vehicle and located &amp;gt;0.5 miles from a supermarket was associated with increased hospitalizations and ACU (Figure 1). The odds ratio (OR) of experiencing &amp;gt;0 hospitalizations or ACU were 1.3 (95%CI: 1.0-1.8) or 1.5 (95%CI: 1.1-2.0), for those living in a household without a vehicle and &amp;gt;0.5 miles from a supermarket, respectively. Living in a household with children and &amp;gt;1.0 mile from a supermarket was associated with high risk of experiencing &amp;gt;0 hospitalizations (OR: 1.5; 95%CI: 1.2-1.8) and &amp;gt;0 ACU (OR: 1.3; 95%CI: 1.1-1.7) (Figure 2). The accuracy of predicting a SCD-related acute event by age 6 years significantly improved when adding markers of poor food access to the predictive model (AUC increase: ≥0.06, p=0.01) (Figure 3). Conclusion Living in food deserts limits access to affordable and nutritious foods. Food deserts are associated with poor health outcomes among pre-school children with SCD. The prediction of acute care utilization in young childhood increases when food access is considered. Treatment with hydroxyurea did not mitigate the effects of reduced food access on the frequency of acute care utilization of young children with SCD. Disclosures Estepp: ASH, NHLBI: Research Funding; Daiichi Sankyo, Esperion, Global Blood Therapeutics: Consultancy; Global Blood Therapeutics, Forma Therapeutics, Pfizer, Eli Lilly and Co: Research Funding. Hankins:LINKS Incorporate Foundation: Research Funding; National Heart, Lung, and Blood Institute: Honoraria, Research Funding; Novartis: Research Funding; UptoDate: Consultancy; MJH Life Sciences: Consultancy, Patents &amp; Royalties; Global Blood Therapeutics: Consultancy, Research Funding; American Society of Pediatric Hematology/Oncology: Honoraria.

Frontostriatal White Matter Integrity Relations with "Cool" and "Hot" Self-Regulation after Pediatric Traumatic Brain Injury.

Traumatic brain injury (TBI) produces microstructural damage to white matter pathways connecting neural structures in pre-frontal and striatal regions involved in self-regulation (SR). Dorsal and ventral frontostriatal pathways have been linked to cognitive ("cool") and emotional ("hot") SR, respectively. We evaluated the relation of frontostriatal pathway fractional anisotropy (FA) 2 months post-TBI on cool and hot SR assessed 7 months post-TBI. Participants were 8-15 years of age, including children with uncomplicated mild TBI (mTBI; n = 24), more severe TBI (complicated-mild, moderate, severe [cms]TBI; n = 60), and typically developing (TD) children (n = 55). Diffusion tensor tractography was used to map frontostriatal pathways. Cool SR included focused and sustained attention performance, and parent-reported attention, whereas hot SR included risk-taking performance and parent-reported emotional control. Multivariate general linear models showed that children with cmsTBI had greater parent-reported cool and hot SR difficulties and lower dorsal and ventral FA than TD children. Focused attention, risk taking, and emotional control correlated with FA of specific dorsal and ventral pathways; however, only the effect of TBI on focused attention was mediated by integrity of dorsal pathways. Results suggest that frontostriatal FA may serve as a biomarker of risk for SR difficulties or to assess response to interventions targeting SR in pediatric TBI and in broader neurodevelopmental populations.

Association of prenatal exposure to phthalates with measures of cognition in 4.5-month-old infants

Background: Phthalates are endocrine disrupting chemicals found in consumer products. Previous studies reported associations of prenatal phthalate exposure with adverse child neurodevelopment, but few assessed the impact on cognitive development in early infancy. Methods: As part of a prospective cohort study, physical reasoning was assessed in 159 (78 female; 81 male) 4.5-month-old infants. Phthalate metabolites were quantified in urine collected at 16-18 weeks of pregnancy and a pool of five urines collected across pregnancy. Infants’ looking times to a physically impossible and a possible event were recorded via infrared eye-tracking. At 4.5 months, females recognize this impossible event, as indicated by longer looking at the impossible versus possible event. Males demonstrate this knowledge 4-6 weeks later. Associations of phthalate biomarkers with looking time differences (impossible - possible) were adjusted for infant age, household income, maternal age, education, and order of event presentation and assessed with multivariable general linear models stratified by sex. Results: Mothers were mostly white and college educated with household incomes &gt;$60,000. Each interquartile range (IQR) increase of the sum of di(2-ethylhexyl) phthalate metabolites at 16-18 weeks (0.054 µmol/L) was associated with females’ 1.7 seconds (95%CI=0.2, 3.1) increased looking to the impossible event. For males, an IQR increase in the sum of di(isononyl) phthalate metabolites at 16-18 weeks and the pooled sample (β=-1.1; 95%CI=-1.9,-0.4 and β=-1.2; 95%CI=-2.3,-0.05 seconds per 0.035-0.036 µmol/L, respectively), the sum of Anti-Androgenic phthalate metabolites in the pooled sample (β=-3.8; 95%CI=-6.4, -1.2 seconds per 0.17 µmol/L), and the sum of metabolites at 16-18 weeks (β=-3.1; 95%CI=-5.3, -0.9 seconds per 0.37 µmol/L) were associated with increased looking to the possible event— typical behavior of early learning stages about a physical event. Conclusion: Results need corroboration in a larger sample, but suggest that higher prenatal phthalate exposure may be associated with delays in males’ physical reasoning. ES007326;ES022848;RD83543401;OD023272.

Effect of mood and anxiety disorders on health care utilization in multiple sclerosis

Background: Little is known about the effects of changes in the presence or absence of psychiatric disorders on health care utilization in multiple sclerosis (MS). Objective: To evaluate the association between “active” mood and anxiety disorders (MAD) and health care utilization in MS. Methods: Using administrative data from Manitoba, Canada, we identified 4748 persons with MS and 24,154 persons without MS matched on sex, birth year, and region. Using multivariable general linear models, we evaluated the within-person and between-person effects of any “active” MAD on annual physician visits, hospital days, and number of drug classes dispensed in the following year. Results: Annually, the MS cohort had an additional two physician visits, two drug classes, and nearly two more hospital days versus the matched cohort. Individuals with any MAD had more physician visits, had hospital days, and used more drug classes than individuals without a MAD. Within individuals, having an “active” MAD was associated with more utilization for all outcomes than not having an “active” MAD, but the magnitude of this effect was much smaller for visits and drugs than the between-person effect. Conclusion: Within individuals with MS, changes in MAD activity are associated with changes in health services use.

The impact of the shift system on health and quality of life of sleep technicians

BackgroundSleep technicians are at high risk of shift work sleep disorders. We therefore aimed to identify the optimal shift system for sleep technicians. MethodsWe performed a nationwide survey of the work schedules, health and quality of life of sleep technicians using e-mail questionnaires including the Insomnia Severity Index (ISI), Epworth Sleep Scale (ESS), Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), Short Form-12 Health Survey (SF-12), and Hospital Anxiety and Depression Scale (HADS) in Korea. A multivariate general linear model was used to assess the effect of shift schedules on health and quality of life. ResultsFifty-four technicians from 30 sleep laboratories participated. Their work schedules were classified as fixed night (F) (n = 18), slow rotation alternating from a night-only to a day-only schedule with a 3-months to one-year interval (S) (n = 20), rapid rotation within a week (R) (n = 5), night once a week (D+) (n = 5) and day (D) (n = 6). The adjusted ISI and HADS-anxiety scores were higher in F, S, and R than D and D+. Among night shift-dominant schedules, a less favorable profile was observed for R followed by F, and S regarding the ISI, FOSQ-10, mental SF-12 and HADS-depression. The physical SF-12 was lower in the order of R, S and F. The HADS-anxiety score was higher in the order of F, R and S. ConclusionsThe S system appears to have the least negative effect on health and quality of life among night shift-dominant systems. The development of consensus guidelines for scheduling shifts in sleep laboratories is urged.

Establishing and comparing reference preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores in patients undergoing shoulder surgery

The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular among orthopedic surgeons treating shoulder pathology. Despite this, there have been few studies that have described and compared preoperative reference scores for specific shoulder surgical procedures. The primary purpose of this study was to establish and compare baseline preoperative PROMIS scores for 3 common types of shoulder surgery: rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and labral repair (LR). The secondary goal was to stratify these operative groups by diagnosis and compare preoperative PROMIS scores. In this cross-sectional study, adult and pediatric patients who underwent surgery for either RCR, TSA, or LR were included. PROMIS-Upper Extremity (UE), PROMIS-Pain Interference (PI), and PROMIS-Depression (D) scores that were collected at each patient's preoperative visit were reviewed. Continuous and categorical variables were compared between operative groups using analysis of variance and χ2 or Fisher exact tests, respectively. Multivariable general linear models were used to identify significant independent predictors of PROMIS scores when controlling for age, sex, and body mass index. A total of 413 patients were included in the study: 272 in the RCR group, 84 in the TSA group, and 57 in the LR group. The average PROMIS-UE score was 39.8 in the LR group vs. 29.9 in the RCR group (P < .001) and 29.6 in the TSA group (P < .001). There was no difference between the mean RCR and TSA PROMIS-UE scores (P = .93). The average PROMIS-PI score was 56.6 in the LR group vs. 62.8 in the RCR group (P < .001) and 63.9 in the TSA group (P < .001). There was no difference between RCR and TSA PROMIS-PI scores (P = .09). The average PROMIS-D score was 43.5 in the LR group vs. 47.7 in the RCR group (P = .004) and 50.3 in the TSA group (P < .001). The TSA group had a higher mean PROMIS-D score than the RCR group (P = .03). For PROMIS-UE scores, age and body mass index were not found to be significant independent predictors (P = .98 and P = .88, respectively). For PROMIS-PI scores, age, body mass index, and sex were not found to be significant independent predictors (P = .31, P = .81, and P = .48, respectively). Patients undergoing shoulder LR had higher preoperative function scores and lower pain interference and depression scores than those undergoing TSA and RCR. These baseline PROMIS scores should be taken into consideration when tracking a patient's outcomes after surgery, as a certain score could mean drastically different functional and pain outcomes depending on the underlying pathology.

Elevated Serum Ceruloplasmin Levels Are Associated with Higher Impulsivity in People with Parkinson's Disease.

Background Heightened impulsivity has been reported in a subset of people with Parkinson's disease (PwP) and is considered a risk factor for the development of impulse control disorders (ICDs). However, at present, there are no recognised biochemical markers of heightened impulsivity. Objectives To determine if ceruloplasmin, a serum marker involved in the regulation of iron and copper homeostasis, is associated with trait impulsivity in PwP. Methods The study measured serum ceruloplasmin and impulsivity using the Barratt Impulsiveness Scale (BIS-11) in an Australian cohort of 214 PwP. Multivariate general linear models (GLMs) were used to identify whether higher serum ceruloplasmin levels (>75th percentile) were significantly predictive of BIS-11 scores. Results Serum ceruloplasmin was higher in females with PD (p < 0.001) and associated with MDS-UPDRS III, Hoehn and Yahr, and ACE-R scores (p < 0.05). When correcting for covariates, higher serum ceruloplasmin concentrations were associated with the 2nd order nonplanning impulsivity and with the 1st order self-control and cognitive complexity impulsivity domains. Conclusions Higher serum ceruloplasmin levels are independently associated with heightened nonplanning impulsivity in PwP. Thus, serum ceruloplasmin levels may have clinical utility as a marker for heightened impulsivity in PD.

Serum 25-hydroxyvitamin D levels and psychological distress symptoms in patients with affective disorders during the COVID-19 pandemic

Background. The COVID-19 pandemic has given rise to stress worldwide, especially in vulnerable people like those suffering from mental illness. This study aims to investigate the psychological distress perceived by a cohort of patients with Major Depressive Disorder (MDD) or Bipolar Disorder (BD) after a seven-week period of lockdown measures, and to analyze serum 25-hydroxyvitamin D [25(OH)D] levels as a potential predictor of distress severity.Methods. Fifty-nine remitted MDD and fifty-three euthymic BD patients were enrolled. An online dedicated survey was administered to obtain lockdown-related information and to evaluate COVID-19 related distress by using the Kessler 10 Psychological Distress Scale (K10). Patients’ medical records were reviewed to collect sociodemographic and clinical data, including serum 25(OH)D levels dosed in the three months preceding the outbreak. A multivariate general linear model was adopted to test the effect of factors of interest on psychological distress.Results. In our sample (n = 112), 29 subjects (25.9 %) reported no likelihood of psychological distress, whereas 35 (31.2 %) and 48 (42.9 %) displayed mild and moderate-to-severe likelihood of psychological distress, respectively. Low serum 25(OH)D levels (p = 0.005) and MDD diagnosis (p = 0.001) specifically predicted the severity of psychological distress. Living alone during the lockdown, a longer duration of illness, and smoking habits were more frequently detected in subjects with COVID-19 related distress.Conclusions. Low serum 25(OH)D levels and MDD diagnosis predicted an increased vulnerability to the stressful impact of the COVID-19 outbreak. Our results suggest that vitamin D may represent a biological factor mediating the psychological response to stress in individuals with affective disorders and provide further insight into tailoring intervention strategies.

Evaluation of the birth plan implementation: a parallel convergent mixed study

BackgroundPregnancy, birth, and motherhood are among the most important events of every woman’s life. Training and participation of mothers in the decision-making process of delivery play an essential role in physical as well as psychosocial preparation of the mother. The healthcare system can improve and enhance the level of care by involving the patient in their self-care process. The aim of the present study is to assess the implementation of the birth plan for the first time in Iran in Tabriz city.Methods/designThe present study uses a mixed-method with a parallel convergence approach, including both quantitative and qualitative phases. The quantitative phase is a randomized controlled clinical trial performed on 106 pregnant women, 32–36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city. The participants will be assigned into intervention and control groups using a randomized block method. A training session will be held about the items of the birth plan checklist at weeks 32–36 of gestation for the participants in the intervention group, whereby a mother-requested birth plan will be developed. It will then be implemented by the researcher after admitting them to the delivery ward. Also, those in the control group will receive routine care. During and after the delivery, the questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) will be completed. Also, a partogram will be completed for all participants by the researcher. The participants in both groups will be followed up until six weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire (CEQ2.0), Edinburgh’s Postpartum Depression Scale and PTSD Symptom Scale 1 (PSS-I) will be completed six weeks 4–6 weeks postpartum by the researcher through an interview with participants in Taleghani educational hospital. The general linear model and multivariate logistic regression model will be used while controlling the possible confounding variables.The qualitative phase will be performed to explore the women’s perception of the effect of the birth plan on childbirth experience within 4–6 weeks postpartum. The sampling will be of a purposeful type on the women who would receive the birth plan and will continue until data saturation. In-depth, semi-structured individual interviews would be used for data collection. The data analysis will be done through content analysis with a conventional approach. The results of the quantitative and qualitative phases will be analyzed separately, and then combined in the interpretation stage.DiscussionBy investigating the effect of implementing the birth plan on the childbirth experience of women as well as other maternal and neonatal outcomes, an evidence-based insight can be offered using a culturally sensitive approach. The presentation of the results obtained from this study using the mixed method may be effective in improving the quality of care provided for women during labor.Trial registrationIranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: July 7, 2020. URL: https://en.irct.ir/user/trial/47007/view

Psychological and Behavioral Responses to the COVID-19 Pandemic in Greece.

ObjectiveFear of COVID-19 was associated with more severe depressive and anxiety symptoms. This study aimed to explore COVID-19-related fear, depressive and anxiety symptoms, social responsibility, and behavioral responses during the COVID-19 pandemic in Greece.MethodA cross-sectional study was conducted from April 10 to April 13, 2020. Members of the Greek general population completed anonymously an online survey, distributed through the social media. Among the 3,700 adult respondents, 3,029 fulfilled inclusion criteria. The survey included sociodemographic questions, questions exploring potential risk factors for increased fear of COVID-19, questions about the employment of safety and checking behaviors, and questions about compliance with public health guidelines. In addition, four psychometric scales were used, the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), and Steele’s Social Responsibility Motivation scale. Multivariate General Linear Models (GLM) were used to depict significant differences among dependent variables (FCV-19S, PHQ-9, GAD-7) and independent variables (potential risk factors, safety and checking behaviors, compliance with guidelines). The relationship between the FCV-19S total score and influencing factors was quantified by linear regression analysis.ResultsSeveral participants reported high levels of COVID-19-related fear (35.7%) and moderate to severe depressive symptoms (22.8%), while a significant proportion reported moderate to severe anxiety symptoms (77.4%). Women scored altogether significantly higher than men. Respondents under the age of 30 reported less fear and depressive symptoms and showed the least social responsibility. Based on GLM, a significant other’s COVID-19 illness, being on psychiatric medication, employment of safety and checking behaviors, and compliance with guidelines were associated with higher COVID-19-related fear. Linear regression analysis revealed that gender, age, depressive, and anxiety symptoms modified levels of COVID-19-related fear.ConclusionsGreater behavioral responses to the pandemic, that is, excessive employment of safety/checking behaviors and greater compliance with guidelines, were shown to amplify fear, potentially due to increased contamination awareness. In addition, female gender, older age, and more severe anxiety symptoms were related with higher COVID-19-related fear. Describing and weighing carefully the psychosocial and behavioral impact of the pandemic will enable the implementation of both supportive and preventive interventions.

Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke.

We aim to examine effects of collateral status and post-thrombectomy reperfusion on final infarct distribution and early functional outcome in patients with anterior circulation large vessel occlusion ischemic stroke. Patients with large vessel occlusion who underwent endovascular intervention were included in this study. All patients had baseline computed tomography angiography and follow-up magnetic resonance imaging. Collateral status was graded according to the criteria proposed by Miteff et al and reperfusion was assessed using the modified Thrombolysis in Cerebral Infarction (mTICI) system. We applied a multivariate voxel-wise general linear model to correlate the distribution of final infarction with collateral status and degree of reperfusion. Early favorable outcome was defined as a discharge modified Rankin Scale score ≤2. Of the 283 patients included, 129 (46%) had good, 97 (34%) had moderate, and 57 (20%) had poor collateral status. Successful reperfusion (mTICI 2b/3) was achieved in 206 (73%) patients. Poor collateral status was associated with infarction of middle cerebral artery border zones, whereas worse reperfusion (mTICI scores 0-2a) was associated with infarction of middle cerebral artery territory deep white matter tracts and the posterior limb of the internal capsule. In multivariate regression models, both mTICI (P<0.001) and collateral status (P<0.001) were among independent predictors of final infarct volumes. However, mTICI (P<0.001), but not collateral status (P=0.058), predicted favorable outcome at discharge. In this cohort of patients with large vessel occlusion stroke, both the collateral status and endovascular reperfusion were strongly associated with middle cerebral artery territory final infarct volumes. Our findings suggesting that baseline collateral status predominantly affected middle cerebral artery border zones infarction, whereas higher mTICI preserved deep white matter and internal capsule from infarction; may explain why reperfusion success-but not collateral status-was among the independent predictors of favorable outcome at discharge. Infarction of the lentiform nuclei was observed regardless of collateral status or reperfusion success.