Hierarchical Logistic Models Research Articles

Reciprocal relations between acute interpersonal negative life events and acute alcohol use: An examination of the 24 h preceding suicide attempts among hospitalized patients

ObjectiveTo examine the within-person relations between acute alcohol use and interpersonal negative life events (INLEs) in the 24 h preceding suicide attempts. MethodParticipants were 151 adult patients (67.55 % female; M age = 36.00) who were hospitalized within 24 h of a suicide attempt. Participants completed the Timeline Follow-back for Suicide Attempts interview to gather information about hourly events for the 24 h preceding their suicide attempt. Hierarchical logistic models were estimated to examine the influence of acute INLEs on next-hour alcohol use and acute alcohol use on next-hour INLEs. Biological sex and chronic alcohol use (past year) were evaluated as potential moderators. ResultsOverall, acute alcohol use was associated with increased odds of next-hour INLEs and acute INLEs were associated with increased odds of next-hour alcohol use. Moderator analyses indicated that the influence of alcohol use on INLEs increased as participants' level of chronic alcohol use decreased, and relations did not vary by biological sex. ConclusionsThere is a bidirectional relation between INLEs and alcohol use in the hours preceding suicide attempts. Understanding that these within-person interrelations may differ in strength depending on one's level of chronic alcohol use has practical utility for providers tasked with clinical decision making.

Cross-sectional study about suicide ideation and attempts among Brazilian pre-adolescents

BackgroundSuicide is a global public health problem. In childhood, the risk factors are less clear, highlighting family and individual factors. This study aims to investigate the prevalence and sociodemographic, social, family, and individual factors associated with suicide ideation and attempts in pre-adolescents in a Brazilian city.MethodsThe sample comes from a cohort of 500 schoolchildren of a city in Rio de Janeiro/Brazil. The data are analyzed cross-sectionally. The research incorporated data from the years 2005, 2006, and 2008 to evaluate suicide ideation and attempts in childhood, as reported by parents/caregivers, teachers and children. A hierarchical logistic model evaluated the association between the explanatory variables related to sociodemographic, social, family, and individual factors and the outcome.Results22.2% of the children (95% CI 18.0%-27.0%) had suicide ideation/attempts, reported either by their mothers, teachers, or the child at some point in a cohort. The following variables were associated with suicidal ideation/attempts in the final adjusted model: regular or poor quality of relationship with friends (OR = 1.84; 95% CI 1.31–2.58), having a family member incarcerated (OR = 1.44; 95% CI 1.07–1.92) and having worse performance in portuguese or mathematics than other students (OR = 2.05; 95% CI 1.29–3.26).ConclusionSuicidal behavior in childhood is severe and affects everyone around the case, demanding to promote friendships, helping with school activities, and providing greater support and attention to children at risk. Bad relationships with friends and incarcerated family members are particularly key risk factors for suicide ideation and attempts. It is essential to improve prevention policies and to disseminate protective behaviors. There is a critical need to augment community mental health resources, mainly in less developed countries and regions that lack these services.

Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves

BackgroundThe clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves. Methods The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500mg of intravenous sotrovimab (SOT) or 600mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI.Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixedeffects logistic model. These trials are registred with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021-004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2) Findings Between March 2022 and February 2023, 991 patients (SOT=332, TGM/CGM =327, NMV/r=332) were enrolled in 15 Italian centersThe overall mean age was 66 years; 482 participants (48.80%) were male and 856 vaccinated with at least a primary course ( 86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35-1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p=0.015) and 2.42 (95% CI 0.19 to infinity; p=0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032-1.83; p=0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the other two groups at the 21-day follow-up (P=0.039) and a higher prevalence of nausea at the 7-day follow-up in the NMV/r group compared to the mAbs group (p=0.036). Interpretation NMV/r was superior to TGM/CGM in reducing hospital admission or death in clinical vulnerable patients with SARS-CoV-2 infection treated within 5 days of symptoms’ onset. No significant difference in symptom prevalence over time across the arms was found. Funding: The trials were funded by the Italian Agency of Drugs (AIFA) in 2021.

Engaged robots, disengaged workers: Automation and political alienation

AbstractI investigate the impact of automation on political behavior in postindustrial societies, particularly focusing on political disengagement. I argue that structural changes in the labor market lead to political alienation due to increased economic insecurities, diminished resources from lower wages, and greater economic polarization. Using hierarchical logistic modeling with varying intercepts by country, I present evidence from survey data across several advanced democracies. I find that workers exposed to technological change are less likely to feel close to a political party, participate in elections, and take part in protests. The impact of automation on political engagement is smaller among wealthier citizens and in highly unionized environments. The political message from these interaction effects speaks to the reinforcing forces between economic inequality and automation and the role of collective organization. My findings have important implications for understanding the links between structural change in labor markets and politics, especially since disengaged workers are the reservoir for radical right parties.

Alcohol home delivery usage and its relationship to alcohol consumption in New South Wales during COVID-19

Background: Rapid growth in the use of alcohol home delivery services, combined with increases in home drinking during COVID-19, raises potential concerns around increased consumption. This paper aims to assess the relationship between alcohol home delivery use and consumption across levels of COVID-19 restrictions in New South Wales (NSW), Australia. Methods: A 5-wave longitudinal survey of 586 NSW residents (Mage = 35; 65.3% female) conveniently sampled across 2020. Home delivery usage and the number of daily standard drinks consumed during a typical week were assessed with a survey. Logistic regression models were estimated within each wave to identify predictors of home delivery usage, and hierarchical logistic mixed effects models were estimated to predict purchase source (home delivery vs other) at the occasion level. Results: From baseline, alcohol home delivery use rose significantly during lockdown (20% to 34%), with respondents using home delivery during lockdown and the partial re-opening wave consuming significantly more than those who were not. Use of home delivery was significantly higher during lockdown and the partial re-opening amongst people who drank more heavily, with respondents aged 36 or older more likely to use delivery services in all waves except lockdown. Conclusions: Alcohol home delivery usage increased during lockdown suggesting restrictions impeding on-premise consumption coincided with an increase in home delivery. Associations between persons who drink more heavily and use of home delivery during lockdown and the partial re-opening suggest a subset of the population that may be at increased risk of harmful consumption when accessing alcohol delivery services.

Differential Effect of Positive End-Expiratory Pressure Strategies in Patients With ARDS: A Bayesian Analysis of Clinical Subphenotypes

ARDS is a heterogeneous condition with two subphenotypes identified by different methodologies. Our group similarly identified two ARDS subphenotypes using nine routinely available clinical variables. However, whether these are associated with differential response to treatment has yet to be explored. Are there differential responses to positive end-expiratory pressure (PEEP) strategies on 28-day mortality according to subphenotypes in adult patients with ARDS? We evaluated data from two prior ARDS trials (Higher vsLower Positive End-Expiratory Pressures in Patients With the ARDS [ALVEOLI] and the Alveolar Recruitment in ARDS Trial [ART]) that compared different PEEP strategies. We classified patients into one of two subphenotypes as described previously. We assessed the differential effect of PEEP with a Bayesian hierarchical logistic model for the primary outcome of 28-day mortality. We analyzed data from 1,559 patients with ARDS. Compared with lower PEEP, a higher PEEP strategy resulted in higher 28-day mortality in patients with subphenotype A disease in the ALVEOLI study (OR, 1.61; 95%credible interval [CrI], 0.90-2.94) and ART (OR, 1.73; 95%CrI, 1.01-2.98), with a probability of harm resulting from higher PEEP in this subphenotype of 94.3%and 97.7%in the ALVEOLI and ART studies, respectively. Higher PEEP was not associated with mortality in patients with subphenotype B disease in each trial (OR, 0.95 [95%CrI, 0.51-1.73] and 1.00 [95%CrI, 0.63-1.55], respectively), with probability of benefit of 56.4%and 50.7%in the ALVEOLI and ART studies, respectively. These effects were not modified by Pao2 to Fio2 ratio, driving pressure, or the severity of illness for the cohorts. We found evidence of differential response to PEEP strategies across two ARDS subphenotypes, suggesting possible harm with a higher PEEP strategy in one subphenotype. These observations may assist with predictive enrichment in future clinical trials.

Emergency Department Volume and Delayed Diagnosis of Serious Pediatric Conditions

Diagnostic delays are common in the emergency department (ED) and may predispose to worse outcomes. To evaluate the association of annual pediatric volume in the ED with delayed diagnosis. This retrospective cohort study included all children younger than 18 years treated at 954 EDs in 8 states with a first-time diagnosis of any of 23 acute, serious conditions: bacterial meningitis, compartment syndrome, complicated pneumonia, craniospinal abscess, deep neck infection, ectopic pregnancy, encephalitis, intussusception, Kawasaki disease, mastoiditis, myocarditis, necrotizing fasciitis, nontraumatic intracranial hemorrhage, orbital cellulitis, osteomyelitis, ovarian torsion, pulmonary embolism, pyloric stenosis, septic arthritis, sinus venous thrombosis, slipped capital femoral epiphysis, stroke, or testicular torsion. Patients were identified using the Healthcare Cost and Utilization Project State ED and Inpatient Databases. Data were collected from January 2015 to December 2019, and data were analyzed from July to December 2023. Annual volume of children at the first ED visited. Possible delayed diagnosis, defined as a patient with an ED discharge within 7 days prior to diagnosis. A secondary outcome was condition-specific complications. Rates of possible delayed diagnosis and complications were determined. The association of volume with delayed diagnosis across conditions was evaluated using conditional logistic regression matching on condition, age, and medical complexity. Condition-specific volume-delay associations were tested using hierarchical logistic models with log volume as the exposure, adjusting for age, sex, payer, medical complexity, and hospital urbanicity. The association of delayed diagnosis with complications by condition was then examined using logistic regressions. Of 58 998 included children, 37 211 (63.1%) were male, and the mean (SD) age was 7.1 (5.8) years. A total of 6709 (11.4%) had a complex chronic condition. Delayed diagnosis occurred in 9296 (15.8%; 95% CI, 15.5-16.1). Each 2-fold increase in annual pediatric volume was associated with a 26.7% (95% CI, 22.5-30.7) decrease in possible delayed diagnosis. For 21 of 23 conditions (all except ectopic pregnancy and sinus venous thrombosis), there were decreased rates of possible delayed diagnosis with increasing ED volume. Condition-specific complications were 11.2% (95% CI, 3.1-20.0) more likely among patients with a possible delayed diagnosis compared with those without. EDs with fewer pediatric encounters had more possible delayed diagnoses across 23 serious conditions. Tools to support timely diagnosis in low-volume EDs are needed.

The Diagnostic Accuracy (DA) of ColonView Fecal Immunochemical Test (FIT) in Detecting Colorectal Adenoma (CRA) Can Be Improved by the Diagnostic Models (DM) that Include Triage and Risk Features of CRA.

This study assessed whether the diagnostic accuracy (DA) of ColonView (CV) fecal immunochemical test (FIT) in detecting colorectal adenoma (CRA) can be improved by the diagnostic models (DM) that include triage and risk features of CRA. A total of 5,090 participants of colorectal neoplasia (CRN) screening were recruited prospectively between January 2014 and December 2016. The CRN cohort of 486 patients included 222 CRA patients and 264 non-CRA patients of whom three consecutive fecal samples were analyzed by two fecal occult blood (FOB) assays (CV FIT test, HemoccultSENSA test). Hierarchical multilevel logistic models were used to test the DA of CV test and DMs, visualised as hierarchical summary receiving operating characteristic (HSROC) curves. In conventional receiving operating characteristic (ROC) analysis, the area under the curve (AUC) values of the age, height, weight, and body mass index (BMI) were 0.60, 0.57, 0.54, and 0.51, respectively. The AUC values for different DMs ranged from 0.69 (for DM without triage I/II and SENSA), and the highest AUC value of 0.70 was reached for DM with all variables included. In HSROC analysis, the AUC values for i) lowR variables, ii) highR variables, and ii) DMs were as follows: i) AUC=0.506, ii) AUC=0.566 and iii) AUC=0.732. The differences in AUC values were: between i) and ii) p=0.008; between i) and iii) p<0.0001; between ii) and iii) p<0.0001. The results demonstrated that DMs, particularly those including risk factors, significantly improved the DA of the CV FIT test in detecting CRA compared to traditional low-risk (lowR) and high-risk (highR) features alone. This study provides novel evidence supporting the enhanced diagnostic performance of DMs in combination with CV FIT testing for the detection of CRA.

Triage Process at Endoscopy With ColonView Fecal Immunochemical Test (FIT) Will Enhance Diagnostic Accuracy (DA) of Colorectal Cancer Screening.

This study assessed the diagnostic accuracy (DA) of the predictive features of colorectal cancer (CRC, predictCRC), triage process (triage), and ColonView (CV) fecal immunochemical test (FIT) in a CRC screening setting. The diagnostic score models (DMs) including predictCRC with triage and CV test were also calculated. The study cohort of 544 patients included 58 CRC patients and 486 non-CRC patients who submitted three consecutive fecal samples for analysis, by two fecal occult blood (FOB) assays (CV FIT test, HemoccultSENSA test). Hierarchical multilevel logistic models were used to test the DA (for CRC) of each item of predictCRC (with triage I and II) and DMs, visualized as hierarchical summary receiving operating characteristic (HSROC) curves. The DA of the predictCRC location of neoplasm (Loc), triage I, and triage II showed 49%, 41%, and 93% sensitivity (Se), and 70%, 99.5%, and 88% specificity (Sp), respectively. The PPV+ of triage I (92%) was higher than that of Loc (22%) or triage II test (45%). In the conventional receiver operating characteristic (ROC) analysis, the area under the curve (AUC) values for the different DMs ranged from 0.880 (for DM without triage I and II), whereas the highest AUC value of 0.960 was reached for DM with triage I and II included in the formula. In the HSROC analysis, the AUC values were as follows: i) with all predictCRCs, AUC=0.717 and ii) with DMs, AUC=0.937. In the roccomp analysis, the difference in AUC values between i) and ii) was statistically significant (p<0.0001). In the detection of CRC, the DA of the new DMs with triage was far superior to that of DMs without triage. This is the first study to report evidence of improved DA in the detection of CRC using DMs including predictCRC with triage and CV FIT test.

The importance of increasing primary vaccinations against COVID-19 in Europe

In the European Union, mass vaccination against COVID-19 staved off the strict restrictions that had characterized early epidemic response. Now, vaccination campaigns are focusing on booster doses, and primary vaccinations have all but halted. Still, 52 million European adults are unvaccinated.We investigated if reaching the still unvaccinated population in future vaccination campaigns would substantially decrease the current burden of COVID-19, which is substantial. We focused on vaccination homophily, whereby those who are unvaccinated are mostly in contact with other unvaccinated, making COVID-19 circulation easier. We quantified vaccination homophily and estimated its impact on COVID-19 circulation.We used an online survey of 1,055,286 people from 22 European countries during early 2022. We computed vaccination homophily as the association between reported vaccination status and perceived vaccination uptake among one's own social contacts, using a case-referent design and a hierarchical logistic model. We used this information in an analysis of the COVID-19 reproduction ratio to determine the impact of vaccine homophily in transmission.Vaccination homophily was present and strong everywhere: the average odds ratio of being vaccinated for a 10-percentage-point increase in coverage among contacts was 1.66 (95% CI=(1.60, 1.72)). Homophily was positively associated with the strictness of COVID-19-related restrictions in 2020 (Pearson = 0.49, P = .03). In the countries studied, 12%-to-18% of the reproduction ratio would be attributable to vaccine homophily.Reducing vaccination homophily may curb the reproduction ratio substantially even to the point of preventing recurrent epidemic waves. In addition to boosting those already vaccinated, increasing primary vaccination should remain a high priority in future vaccination campaigns, to reduce vaccination homophily: this combined strategy may decrease COVID-19 burden.

Thinking beyond the virus: perspective of patients on the quality of hospital care before and during the COVID-19 pandemic.

The COVID-19 pandemic has a huge impact on the healthcare system and affects the normal delivery of routine healthcare services to hospitalized patients. This study aimed to examine the differences in patient experience of hospital service before and during COVID-19 among the discharged adult population. A territory-wide patient experience survey was conducted before and during COVID-19 (between October 2019 and April 2020) among patients discharged from the main acute and rehabilitation public hospitals in Hong Kong. A hierarchical ordinal logistic model was employed to examine the difference in multiple dimensions of patient experience, with adjustments of covariates. In total, 9,800 participants were recruited. During the pandemic, there was a marginally significant increase in overall care rating (AOR: 1.12, 95% CI: 0.99-1.27), and an improvement in the timeliness of admission. However, significant reductions in patients' confidence in nurses were observed. Communication of information regarding medication side effects reduced significantly (AOR: 0.72, 95% CI: 0.64-0.82). The patients hospitalized during the pandemic reported worse responsiveness in communication in their patient journey than those admitted before the pandemic. These findings will help develop appropriate strategies to address patients' concerns in the new normal.

Serum 25-hydroxyvitamin D, genetic susceptibility, and the risk of incident type 2 diabetes: A prospective cohort in East China.

The serum vitamin D level varies widely by population, and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus (T2DM). However, the relationship is inconsistent and the impact of vitamin D on T2DM among East Chinese adults is unclear. The study aimed to investigate the association between serum 25-hydroxyvitamin D (25[OH]D) levels and the risk of T2DM and evaluated whether the association is modified by genetic predisposition. In the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) cohort, 1862 participants free of T2DM at baseline were included. A weighted genetic risk score was calculated with 28 variants associated with T2DM. Hierarchical logistic models were used to examine the association of serum 25(OH)D and genetic risk with T2DM. After a 5-year follow-up, 132 cases of T2DM were documented. We observed no significant association between quartiles of serum 25(OH)D and T2DM risk after multivariable adjustment (χ 2 = 0.571, Pfor trend = 0.426). Compared to those in the lowest quartile of 25(OH)D, the odds ratios (ORs) (95% confidence interval [CI]) for participants with increased quartiles were 1.29 (0.74-2.25), 1.35 (0.77-2.36), and 1.27 (0.72-2.24), respectively. We observed a positive association of glycated hemoglobin (HbA1c) with 25(OH)D at baseline (β = 1.752, P = 0.001) and after follow-up (β = 1.385, P = 0.003), and a negative association of ln conversion homeostasis model assessment (HOMA)-β with 25(OH)D at baseline (β = -0.982, P = 0.021). There was no significant interaction between 25(OH)D and diabetes genetic predisposition on the risk of T2DM (χ 2 = 2.710, Pfor interaction = 0.100). The lowest OR (95% CI) of T2DM was among participants with low genetic risk and the highest quartile of 25(OH)D (0.17 [0.05-0.62]). Serum 25(OH)D may be irrelevant to the risk of incident T2DM among East Chinese adults regardless of genetic predisposition.

Maternal healthcare utilization in rural Bangladesh: A comparative analysis between high and low disaster-prone areas.

This study examined the disparity in antenatal care (ANC) visits and institutional delivery between high-disaster-prone (HDP) and low-disaster-prone (LDP) areas, defined based on multi-hazards, in Bangladesh and assessed the influencing factors using Andersen's behavioral model. In this study, cross-sectional data of 345 mothers, who had live birth the year preceding the survey, were used from the second-round multipurpose survey of a longitudinal research project conducted in May-June 2011. Hierarchical multinomial logistic and binary logistic models were respectively used to assess the determinants of ANC contacts and choice of childbirth place. We found very low utilization of 4+ ANC visits in both HDP (20%) and LDP (15%) areas. The difference is also not significant. The strong influencing factors of receiving 4+ ANC were mother's education, household size, income, and proximity to health facility. The level of institutional delivery was also low (21%), and no significant difference between HDP (15.2%) and LDP (25.7%) was found. However, in the case of institutional delivery, significant (p-value ≤ .01) difference was found in C-section between HDP (42%) and LDP (79%). A significant (p-value ≤ .05) difference was also found in the attendance of graduate doctors/gynecologists between HDP (58%) and LDP (88%). Mothers of HDP areas were 52 percent less likely to choose institutional delivery compared to those of LDP areas. Moreover, there was 30 percent less likelihood of choosing institutional delivery with an increase in distance to the nearest health facility. Specific demand-side (e.g., awareness raising, expanding maternal voucher scheme, covering more mothers under maternal allowance, and facilitating more income-generating activities especially off-farm ones) and supply-side interventions (e.g., providing training to local traditional birth attendants, and deployment of boat-based medical teams in coastal and char areas) need to be undertaken to increase institutional delivery, especially in HDP areas. However, the ultimate solution depends on adopting long-term measures to prepare facilities ready by filling the vacant posts and reducing absenteeism. Public-private partnerships modality can also be introduced especially in the HDP areas. Policy attention is needed to introduce such interventions.

Pragmatic clinic-based investigation of echocardiogram parameters in asymptomatic patients with type 2 diabetes in routine clinical practice and its association with suggestive coronary artery disease: a pilot study

BackgroundPatients with diabetes mellitus (DM) have cardiovascular diseases (CVD) as a major cause of mortality and morbidity. The primary purpose of this study was to assess the echocardiographic parameters that showed alterations in patients with type 2 diabetes mellitus(T2DM) with suggestive coronary artery disease (CAD) determined by electrocardiography and the secondary was to assess the relationship of these alterations with established cardiovascular risk factors.MethodsThis cross-sectional, observational pilot study included 152 consecutive patients with T2DM who attended a tertiary DM outpatient care center. All patients underwent clinical examination and history, anthropometric measurements, demographic survey, determination of the Framingham global risk score, laboratory evaluation, basal electrocardiogram, echocardiogram, and measurement of carotid intima-media thickness (CIMT).ResultsFrom the overall sample, 134 (88.1%) patients underwent an electrocardiogram. They were divided into two groups: patients with electrocardiograms suggestive of CAD (n = 11 [8.2%]) and those with normal or non-ischemic alterations on electrocardiogram (n = 123 [91.79%]). In the hierarchical multivariable logistic model examining all selected independent factors that entered into the model, sex, high triglycerides levels, and presence of diabetic retinopathy were associated with CAD in the final model. No echocardiographic parameters were significant in multivariate analysis. The level of serum triglycerides (threshold) related to an increased risk of CAD was ≥ 184.5 mg/dl (AUC = 0.70, 95% IC [0.51–0.890]; p = 0.026.ConclusionOur pilot study demonstrated that no echocardiogram parameters could predict or determine CAD. The combination of CIMT and Framingham risk score is ideal to determine risk factors in asymptomatic patients with T2DM. Patients with diabetic retinopathy and hypertriglyceridemia need further investigation for CAD. Further prospective studies with larger sample sizes are needed to confirm our results.

Intimate Partner Violence among women living in families with children under the poverty line and its association with common mental disorders during COVID-19 pandemics in Ceará, Brazil

BackgroundIntimate partner violence (IPV) is a pervasive public health issue that affects millions of women worldwide. Women living below the poverty line experience higher rates of violence and fewer resources to escape or cope with the abuse, and the COVID-19 pandemic has significantly impacted women’s economic well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on women in families with children living below the poverty line at the peak of the second wave of COVID to assess the prevalence of IPV and its association with common mental disorders(CMD).MethodsThe study population comprised families with children up to six years of age who participated in the cash transfer program “Mais Infância”. The families selected to participate in this program must meet a poverty criterion: families must live in rural areas, in addition to a monthly per capita income of less than US$16.50 per month. We applied specific instruments to evaluate IPV and CMD. To access IPV, we used the Partner Violence Screen (PVS). The Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the association between IPV and the other evaluated factors with CMD, simple and hierarchical multiple logistic models were used.ResultsOf the 479 participant women, 22% were positively screened for IPV (95% CI 18.2–26.2). After multivariate adjustment, the chances of CMD are 2.32 higher in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30–4.13), p value = 0.004). CMD was also associated with job loss during the COVID-19 pandemic (ORa 2.13 (95% CI 1.09–4.35), p-value 0.029). In addition to these, separate or single marital status, as well as non-presence of the father at home and food insecurity were associated with CMD.ConclusionWe conclude that the prevalence of intimate partner violence in families with children up to six years of age living below the poverty line in Ceará is high and is associated with greater chances of common mental disorders in mothers. Also, job loss and reduced access to food caused by the Covid 19 pandemic exacerbated both phenomena, constituting a double burden generator factor on mothers.

Winter storm risk assessment in forests with high resolution gust speed data

Winter storms pose a major threat to forest management in Central Europe. They affect forests at a large spatial scale and produce large losses in standing and merchantable timber within few hours. The assessment of winter storm vulnerability by statistical modelling serves as an important tool to tackle uncertainities about the damage risk and to inform management decision processes. This study made use of an extensive forest inventory data set from South-West Germany before and after winter storm Lothar in 1999, one of the most severe storm events in Germany over the last decades. Hierarchical logistic models were fitted to relate storm damage probability on individual tree level to features of dendrometry, site, orography, and storm-specific high resolution data of maximum gust speed. We developed two different approaches to implement gust speed as a predictor and compared them to a baseline model with a structured spatial effect function with no gust speed information. Regional and local variability which could not be described by the predictors was modelled by multi-level group effects. Generalisation performance was tested with a spatially and temporally independent data set on storm separation between explicit spatial gust speeds and unknown variability achieved with the parametric multi-level approach led to a higher degree of transparency and utilisability.

Trust and COVID precautionary measures during the early days of the COVID-19 pandemic: Evidence from two African countries

This study examines how trust was associated with social distancing during the early days of the COVID-19 pandemic in Burkina Faso and Kenya. It fills gaps in previous research on trust and health by 1) simultaneously considering the relationship of individual- and aggregate-level indicators of trust, and 2) evaluating trust in local government and national government separately. Performance Monitoring for Action (PMA) data on COVID-precautionary measures and individual-level trust measures were spatially linked with aggregated trust data from the Afrobarometer to create a multilevel dataset. PMA data show that women in Kenya were generally more likely to report taking COVID-precautionary measures relative to Burkinabé women, although levels of these measures were high in both countries. Hierarchical logistic models for each country show levels of interpersonal trust mattered more in Burkina Faso. Although the association between individual-level trust in government and social distancing was not statistically significant, overall levels of trust in the region where an individual lived were associated with social distancing. We found a significant interaction effect between regional trust in the national government and regional trust in local government: individuals in regions where trust was high in both national and local government were the most likely to socially distance; individuals in regions with low local government trust but high national government trust were less likely to report social distancing. We unpack possible implications of these findings; they point to the importance of a unified government front within African countries in promoting health safety measures during a pandemic.

Age and cohort trends in disability among Chinese older adults.

This study aimed to examine age and cohort trends in disability among Chinese older adults and explore the disablement process factors that may explain the cohort trends in disability. This study used data from five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A hierarchical logistic growth model was used to analyze the A-P-C effects and the contributors of cohort trends. ADL, IADL, and FL among Chinese older adults showed increasing age and cohort trends. FL was more likely to result in IADL disability than ADL disability. Among the disablement process factors, gender, residence, education, health behavior, disease, and family income contributed to most of the cohort trends in disability. As older adults face increasing disability trends, it is necessary to distinguish age and cohort trends and develop more effective interventions according to relative contributors to prevent disability among them.

Examining Differences in the Individual and Contextual Risk Factors for Police Officer, Correctional Officer, and Non-Protective Service Suicides

Suicide rates vary across occupational groups, with protective service occupations at elevated risk for suicide. Yet, research on correctional officer suicide remains sparse, as does research linking the broader social context to police officer suicides and correctional officer suicides. This study examines differences in the individual and contextual risk factors for police officer suicides, correctional officer suicides, and non-protective service suicides in the U.S. from 2003 to 2018 using data from the National Violent Death Reporting System and the American Community Survey. Descriptive analysis and logistic hierarchical models indicated that police officer suicides, correctional officer suicides, and non-protective service suicides had distinct etiologies. Additionally, the broader social context had an appreciable impact on occupation-specific suicide. Ultimately, interventions to address suicidality, including among public safety professionals, should be occupation-specific and consider both individual and contextual risk factors.

The Impact of Academic, Sociodemographic, and Program Growth Factors on Admission Offers to U.S. Graduate Education Programs in Communication Sciences and Disorders: National Trends in 2016-2020 Cycles.

The purpose of this study was to investigate the impact of academic factors and sociodemographic factors on offers of admission to graduate education programs in communication sciences and disorders (speech-language pathology and audiology) in the United States. A retrospective analysis of extant data from undergraduate students applying to graduate education programs through the Communication Sciences and Disorders Centralized Application Service (CSDCAS) was conducted. Descriptive, parametric, nonparametric, and multivariate hierarchical logistic modeling analyses were applied to data from 38,625 unique applicants across four consecutive application cycles from 2016 to 2020 to assess relationships between admission offers, and academic and sociodemographic factors. The academic factors included Graduate Record Examination (GRE) and grade point average (GPA; cumulative undergraduate GPA and cumulative communication sciences and disorders [CSD] GPA), and sociodemographic factors included race/ethnicity, age, disadvantaged socioeconomic status, first-generation status, and multilinguistic status. The rate of receiving an offer of admission continuously increased from 59.4% in the 2016-2017 cycle to 75.4% in the 2019-2020 cycle (p < .001). The significant predictors for admission offers across all four application cycles were GPA, GRE, and applicant age. While the odds ratios of GRE and age were relatively stable, the odds ratios of GPA had a decreasing trend. Bivariate analyses showed that students who were non-White, older, socioeconomically disadvantaged, first-generation, and nonmultilingual were significantly less likely to receive offers of admission than their counterparts, but the relationships between those sociodemographic factors, except for age, and admission offers diminished when all factors were considered in the logistic regression analyses. Academic and sociodemographic factors significantly affected the likelihood of obtaining at least one offer of admission to a graduate program in CSD at different levels. While the effect sizes were variable, these findings provide evidence-based guidance for admission committees seeking to improve the inclusiveness of admission processes and the realization of greater diversity across multidimensional domains (e.g., race/ethnicity, socioeconomic status, age).