Hierarchical Logistic Regression Research Articles

Domestic (re)infestation risk with the main vector Triatoma infestans increases with surrounding green vegetation and social vulnerability in the Argentine Chaco.

Chagas disease, caused by Trypanosoma cruzi, is still a public health problem in Latin America and in the Southern Cone countries, where Triatoma infestans is the main vector. We evaluated the relationships among the density of green vegetation around rural houses, sociodemographic characteristics, and domestic (re)infestation with T. infestans while accounting for their spatial dependence in the municipality of Pampa del Indio between 2007 and 2016. The study comprised sociodemographic and ecological variables from 734 rural houses with no missing data. Green vegetation density surrounding houses was estimated by the normalized difference vegetation index (NDVI). We used a hierarchical Bayesian logistic regression composed of fixed effects and spatial random effects to estimate domestic infestation risk and quantile regressions to evaluate the association between surrounding NDVI and selected sociodemographic variables. Qom ethnicity and the number of poultry were negatively associated with surrounding NDVI, whereas overcrowding was positively associated with surrounding NDVI. Hierarchical Bayesian models identified that domestic infestation was positively associated with surrounding NDVI, suitable walls for triatomines, and overcrowding over both intervention periods. Preintervention domestic infestation also was positively associated with Qom ethnicity. Models with spatial random effects performed better than models without spatial effects. The former identified geographic areas with a domestic infestation risk not accounted for by fixed-effect variables. Domestic infestation with T. infestans was associated with the density of green vegetation surrounding rural houses and social vulnerability over a decade of sustained vector control interventions. High density of green vegetation surrounding rural houses was associated with households with more vulnerable social conditions. Evaluation of domestic infestation risk should simultaneously consider social, landscape and spatial effects to control for their mutual dependency. Hierarchical Bayesian models provided a proficient methodology to identify areas for targeted triatomine and disease surveillance and control.

Risk factors of adult isoniazid-resistant and rifampicin-susceptible tuberculosis in Nanjing, 2019–2021

IntroductionThis study aimed to analyze the risk factors associated with isoniazid-resistant and rifampicin-susceptible tuberculosis (Hr-TB) in adults.MethodThe clinical data of 1,844 adult inpatients diagnosed with culture-positive pulmonary tuberculosis (PTB) in Nanjing Second Hospital from January 2019 and December 2021 were collected. All culture positive strain from the patient specimens underwent drug susceptibility testing (DST). Among them, 166 patients with Hr-TB were categorized as the Hr-TB group, while the remaining 1,678 patients were classified as having drug-susceptible tuberculosis (DS-TB). Hierarchical logistic regression was employed for multivariate analysis to identify variables associated with Hr-TB. Results: Multivariate logistic regression analysis revealed that individuals with diabetes mellitus (DM) (OR 1.472, 95% CI 1.037–2.088, p = 0.030) and a history of previous tuberculosis treatment (OR 2.913, 95% CI 1.971–4.306, p = 0.000) were at higher risk of developing adult Hr-TB, with this risk being more pronounced in male patients. Within the cohort, 1,640 patients were newly treated, and among them, DM (OR 1.662, 95% CI 1.123–2.461, p = 0.011) was identified as risk factors for Hr-TB. Conclusions: Diabetes mellitus is a risk factor for Hr-TB in adults, and the contribution of diabetes as a risk factor was more pronounced in the newly treatment or male subgroup. And previous TB treatment history is also a risk factor for Hr-TB in adults.

Rehabilitation success after psychosomatic rehabilitation as afunction of psychotherapy dose

Increasing the effectiveness of psychosomatic rehabilitation by prolonging the treatment is a subject of controversial debate. The number of sessions over time defines the dosage in psychotherapy. While the dose-response model assumes an optimal therapy dose, the good-enough level model assumes acorrelation of the rate of change with the total sessions. Arandomized control group study was conducted to investigate the extent to which an adaptive therapy concept with atwo-week intensive phase and early intervention could increase rehabilitation success. A total of 494 rehabilitants between the ages of 21 and 64 (47% women) who completed aclassical or an integrative psychosomatic rehabilitation at the Rehazentrum Oberharz between 2020 and 2022 were analysed. Rehabilitation success was mapped by the Reliable Change Index of individual symptom reduction (depression severity or psychological and somatoform disorders) and as asocio-medical parameter (physician's assessment of potential work ability (WA) after twoweeks). Two-factorial ANOVAs and hierarchical binary logistic regressions were calculated, and sick leave before rehabilitation was statistically controlled. Dosage showed no effect on symptom reduction (p = 0.29) and potential WA after twoweeks (p = 0.90). However, when stratified by disease severity, there was amean effect of dosage (p = 0.05) and twice the probability of WA after twoweeks (odds 2.13; p = 0.01) for those with mild disease at the start of measure (p = 0.05). In the early stages of an affective disorder, early and intensified intervention can counteract the chronification of mental disorders.

Home Health Care Use and Outcomes After Coronary Artery Bypass Grafting Among Medicare Beneficiaries.

Home health care (HHC) has been increasingly used to improve care transitions and avoid poor outcomes, but there is limited data on its use and efficacy following coronary artery bypass grafting. The purpose of this study was to describe HHC use and its association with outcomes among Medicare beneficiaries undergoing coronary artery bypass grafting. Retrospective analysis of 100% of Medicare fee-for-service files identified 77 331 beneficiaries undergoing coronary artery bypass grafting and discharged to home between July 2016 and December 2018. The primary exposure of HHC use was defined as the presence of paid HHC claims within 30 days of discharge. Hierarchical logistic regression identified predictors of HHC use and the percentage of variation in HHC use attributed to the hospital. Propensity-matched logistic regression compared mortality, readmissions, emergency department visits, and cardiac rehabilitation enrollment at 30 and 90 days after discharge between HHC users and nonusers. A total of 26 751 (34.6%) of beneficiaries used HHC within 30 days of discharge, which was more common among beneficiaries who were older (72.9 versus 72.5 years), male (79.4% versus 77.4%), White (90.2% versus 89.2%), and not Medicare-Medicaid dual eligible (6.7% versus 8.8%). The median hospital-level rate of HHC use was 31.0% (interquartile range, 13.7%-54.5%) and ranged from 0% to 94.2%. Nearly 30% of the interhospital variation in HHC use was attributed to the discharging hospital (intraclass correlation coefficient, 0.296 [95% CI, 0.275-0.318]). Compared with non-HHC users, those using HHC were less likely to have a readmission or emergency department visit, were more likely to enroll in cardiac rehabilitation, and had modestly higher mortality within 30 or 90 days of discharge. A third of Medicare beneficiaries undergoing coronary artery bypass grafting used HHC within 30 days of discharge, with wide interhospital variation in use and mixed associations with clinical outcomes and health care utilization.

Factors influencing menstrual regularity among female workers: a cross-sectional analysis study

BackgroundRegularity of menstrual cycles is an important indicator of women’s health and fertility, and female workers are exposed to several factors, such as sleep disorders, stress, and shift work, that affect their menstrual regularity. This makes it necessary to comprehensively identify the determinants of menstrual regularity. Therefore, this study identified the factors affecting menstrual regularity among female workers from physiological, psychological, and situational dimensions based on the theory of unpleasant symptoms.MethodsThis was a secondary analysis of the 2010–2012 Korea National Health and Nutrition Examination Survey and utilized the data of 2418 female workers. Based on the theory of unpleasant symptoms, physiological factors included age, age at menarche, childbirth experience, body mass index, and sleep duration. Psychological factors included stress level, depressive mood, and suicidal ideation. Situational factors included education level, household income, consumption of alcohol, engagement in smoking, and work schedule. The χ²-test and hierarchical logistic regression analysis were performed, reflecting the complex sample design.ResultsAge at menarche, childbirth experience, and body mass index among physiological factors and education level and work schedule among situational factors were found to be related to menstrual regularity. A higher risk of menstrual irregularities was found among those who had given birth (versus those who had not), had a high age at menarche (versus those with a low age at menarche), were obese (versus those who had a normal body mass index), had elementary school-level or lesser educational achievements (versus those with college graduate-level or higher educational achievements), and who had a shift work schedule (versus those with a fixed schedule).ConclusionsIntervention is needed for female workers who have these risk factors, and special attention must be paid to female workers who have a shift work schedule. Additionally, since body mass index can be controlled, intervention concerning body mass index is necessary to reduce menstrual irregularity.

COVID-19 vaccine fatigue in Scotland: how do the trends in attrition rates for the second and third doses differ by age, sex, and council area?

Abstract Vaccine fatigue is the propensity for individuals to start but not finish a vaccination program with several doses, which means they are less protected. Our study examines vaccine fatigue in the COVID-19 vaccination programme in Scotland. We model the attrition rates across multiple doses with a hierarchical binomial logistic regression model with correlated age- and area-specific random effects with conditional autoregressive priors, where inference uses integrated nested Laplace approximations. We find attrition rates smoothly decrease with increasing age, are much higher for the third dose than the second, and are generally higher for males than females.

Child maltreatment perpetration in Sarawak: predictors from the perpetrators’ perspective

ABSTRACT Child maltreatment, which encompasses harmful behaviour such as physical, sexual, psychological, and neglect, remains a global concern. In global efforts to prevent violence against women and girls, a strategic shift has emerged to actively engage men as key stakeholders. There is a growing recognition that men must be placed at the centre of these efforts. This study aimed to determine the predictors of child maltreatment perpetration in Sarawak based on retrospective recall of men’s childhood adversities, men’s gender roles, men’s attitudes, and men’s attachment styles. This cross-sectional study was conducted in Sarawak, Malaysia, from August 2022 to January 2023. The research used multistage cluster sampling to recruit 800 married men. The study findings showed 33.6% of the men admitted to having perpetrated one or more different forms of maltreatment on their children. Neglectful behaviours were the most prevalent with 27.3%, followed by physical and psychological perpetration. Through hierarchical logistic regression, men’s childhood adversities were a critical predictor (AOR = 1.0, 95% CI: .1.0, 1.1, p < .001). Men with avoidant attachment styles were less likely to admit to perpetration (AOR = 0.5, 95% CI:0.3, 0,8, p = .002). In conclusion, this study emphasises the need for prevention activities like childhood adversities screening among men to improve their well-being and help them heal from past trauma.

Contextualizing school discipline: Examining the role of general peer and teacher discrimination at the individual- and school-level on individual suspension.

Past research has linked peer and teacher discrimination to risk factors for school discipline, but few studies have examined whether peer and teacher discrimination have a direct impact on school discipline. This study examines the effects of general peer and teacher discrimination at the individual- and school-level on school suspension using nationally representative, secondary data on almost 12,000 youth across 131 schools. Hierarchical logistic regression models indicated that general teacher discrimination at the individual- and school-level-but not general peer discrimination-increased the odds of receiving school suspension. Findings suggest that general discrimination by direct learning instructors and teachers representing the broader school culture can shape student conduct. Reducing school discipline thus falls on teachers, staff, principals, and learners.

Using Artificial Intelligence Algorithms to Predict Self-Reported Problem Gambling Among Online Casino Gamblers from Different Countries Using Account-Based Player Data

AbstractThe prevalence of online gambling and the potential for related harm necessitate predictive models for early detection of problem gambling. The present study expands upon prior research by incorporating a cross-country approach to predict self-reported problem gambling using player-tracking data in an online casino setting. Utilizing a secondary dataset comprising 1743 British, Canadian, and Spanish online casino gamblers (39% female; mean age = 42.4 years; 27.4% scoring 8 + on the Problem Gambling Severity Index), the present study examined the association between demographic, behavioral, and monetary intensity variables with self-reported problem gambling, employing a hierarchical logistic regression model. The study also tested the efficacy of five different machine learning models to predict self-reported problem gambling among online casino gamblers from different countries. The findings indicated that behavioral variables, such as taking self-exclusions, frequent in-session monetary depositing, and account depletion, were paramount in predicting self-reported problem gambling over monetary intensity variables. The study also demonstrated that while machine learning models can effectively predict problem gambling across different countries without country-specific training data, incorporating such data improved the overall model performance. This suggests that specific behavioral patterns are universal, yet nuanced differences across countries exist that can improve prediction models.

Comparison of Hospital Volume and Risk-Standardized Mortality Rate as a Proxy for Hospital Quality in Complex Oncologic Hepatopancreatobiliary Surgery.

Centralization of hepatopancreatobiliary procedures to more experienced centers has been recommended but remains controversial. Hospital volume and risk-stratified mortality rates (RSMR) are metrics for interhospital comparison. We compared facility operative volume with facility RSMR as a proxy for hospital quality. Patients who underwent surgery for liver (LC), biliary tract (BTC), and pancreatic (PDAC) cancer were identified in the National Cancer Database (2004-2018). Hierarchical logistic regression was used to create facility-specific models for RSMR. Volume (high versus low) was determined by quintile. Performance (high versus low) was determined by RSMR tercile. Primary outcomes included median facility RSMR and RSMR distributions. Volume- and RSMR-based redistribution was simulated and compared for reductions in 90-day mortality. A total of 106,217 patients treated at 1282 facilities were included; 17,695 had LC, 23,075 had BTC, and 65,447 had PDAC. High-volume centers (HVC) had lower RSMR compared with medium-volume centers and low-volume centers for LC, BTC, and PDAC (all p < 0.001). High-performance centers (HPC) had lower RSMR compared with medium-performance centers and low-performance centers for LC, BTC, and PDAC (all p < 0.001). Volume-based redistribution required 16.0 patients for LC, 11.2 for BTC, and 14.9 for PDAC reassigned to 15, 22, and 20 centers, respectively, per life saved within each US census region. RSMR-based redistribution required 4.7 patients for LC, 4.2 for BTC, and 4.9 for PDAC reassigned to 316, 403, and 418 centers, respectively, per life saved within each US census region. HVC and HPC have the lowest overall and risk-standardized 90-day mortality after oncologic hepatopancreatobiliary procedures, but RSMR may outperform volume as a measure of hospital quality.

Abstract PO1-09-10: County-level Social Vulnerability and Survival among Women with Inflammatory Breast Cancer

Abstract Purpose: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer with a poor overall prognosis compared to other forms of breast cancer. Advances in treatment have contributed to improvement in IBC survival rates in recent years, yet disparities in outcomes persist. It is unclear whether social determinants of health impact IBC prognosis independent of access to quality cancer care. Thus, the aim of this study was to examine whether the US county-level social vulnerability index (SVI) was associated with IBC stage at diagnosis and overall survival (OS) among women with IBC treated at a single institution. Methods: Patients enrolled in the IBC registry at Dana-Farber Cancer Institute (DFCI) were included in this study. We linked participant’s residential zip codes to the 2020 CDC’s county-level SVI, which is calculated from 15 social determinants of health attributes from the American Community Survey including socioeconomic status, household composition, language and minority status, and housing and transportation factors. The SVI value reflects the percentile of counties in the nation that are less vulnerable than the county of interest. We assessed associations between SVI and stage at diagnosis using t-tests. Kaplan-Meier curves and log-rank tests were used to assess survival across SVI quartiles based on distribution (1st [least vulnerable] and 4th [most vulnerable]). Using hierarchical logistic regression models and Cox proportional hazards models with mixed effects incorporating cluster-specific random effects that modify the baseline hazard function, we assessed whether SVI is associated with the presence of de novo metastatic disease and OS in IBC. Results: A total of 586 women (86% White) enrolled in the IBC registry at DFCI between 1986 and 2021 were included in this study. Of these, 69.1% had stage III and 30.9% had de novo metastatic disease. 280 deaths occurred in the study population over a mean follow-up of 4.1 years. SVI for the counties where study participants resided ranged from 2.6% to 95.8% (median=34.2%). The mean SVI did not significantly differ according to stage at diagnosis (41.6% in non-metastatic and 40.8% in metastatic at presentation; p=0.70). OS did not significantly differ across SVI quartiles (p-value=0.63). In the age-adjusted models, the SVI was not associated with the presence of de novo metastatic disease (odds ratio (OR (95% CI)=0.99 (0.84, 1.16)) or OS (HR (95% CI)=0.79 (0.46, 1.33). Conclusions: Our findings that residing in socially vulnerable US counties is not associated with the presence of de novo metastatic disease or IBC survival among a subset of women accessing high-quality cancer care suggest that improving access to quality cancer care may overcome underlying socioeconomic factors that contribute to disparities in IBC outcomes. Future studies are needed to confirm these findings in other settings. Citation Format: Kelly Hirko, Elizabeth Troll, Sean Ryan, Faina Nakhlis, Jennifer Bellon, Olga Kantor, Christina Minami, Eren Yeh, Ilana Schlam, Laura Warren, Caroline Block, Susan Schumer, Filipa Lynce. County-level Social Vulnerability and Survival among Women with Inflammatory Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-10.

Ethnocultural disparities in loneliness among women in Israel: A population-based study.

Loneliness was predicted for women in three ethnocultural groups in Israel: native Jews, Israeli Arabs, and Former Soviet Union (FSU) immigrants. The study was based on Lund et al.'s (2018) conceptualization of social determinant domains of mental health disorders, as in the United Nations Sustainable Development Goals. Social determinants were demographic, economic, social-cultural, and neighborhood factors. We examined whether ethnocultural disparities in loneliness persist when controlling for social determinants in these four domains or whether ethnic disparities are related to other forms of inequality among the three study groups, as reflected in these four domains. Next, we explored associations between the co-occurrence of key social determinants with loneliness. We used cross-sectional representative data of working-age women from the Israeli Social Survey (N = 5,600). Hierarchical logistic regression analyses indicated a higher risk for loneliness among FSU immigrants and Israeli Arabs than among native Jews. Economic risk factors significantly increased the risk of loneliness. Social and cultural factors decreased the risk of loneliness, while discrimination increased it. Improved neighborhood conditions decreased the risk of loneliness. Ethnocultural disparities in loneliness diminished when economic determinants were controlled. Co-occurrence of risk factors greatly increased the risk for loneliness, demonstrating a stepped relationship. Developing supportive networks for women, mainly from minority groups, to increase trust and fight discrimination against any background is necessary. Moreover, significant efforts must be made to combat poverty and narrow socioeconomic inequalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development of Malaysian-MIND diet scores for prediction of mild cognitive impairment among older adults in Malaysia.

Mild Cognitive impairment (MCI) is a pre-demented state in the elderly populace. The Mediterranean & Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet has shown promise in reducing the risk of MCI and Alzheimer's disease in older people. Notably, the existing MIND diet is not adapted to the specific needs of older adults in Malaysia, considering distinct food cultures and availability. Consequently, this study aimed to develop the Malaysian version of the MIND diet (MY-MINDD) scores and investigate their association with MCI in the older adult populace of Malaysia. A comprehensive pooled data analysis was conducted on combined data from 810 participants sourced from the longitudinal Long-Term Research Grant Scheme-Towards Useful Aging (LRGS-TUA) and Fundamental Research Grant Scheme (FRGS) studies. The MY-MINDD scores were developed by incorporating existing MIND diet food groups, their corresponding scoring mechanisms, and consideration of common Malaysian foods which are proven to be beneficial and detrimental to cognitive function. To substantiate the MY-MINDD scoring system, its association with MCI was evaluated using a series of validated neuropsychological test batteries. MY-MINDD consists of seven food groups promote brain health and four food groups exert negative cognitive outcomes. The study participants had an average age of 67.9 ± 4.7 years. The collective MY-MINDD score for all participants was 6.4 ± 0.1 (out of a maximum 11 points), revealing a lower score in individuals with MCI at 6.0 ± 1.7 compared to those without MCI at 6.6 ± 1.6 (p < 0.001). According to hierarchical multivariate binary logistic regression analysis, being in the highest tertile of MY-MINDD score was linked to reduced odds of MCI (odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.26-0.72, p < 0.001) in the fully adjusted model in comparison to the lowest tertile. The development of the MY-MINDD scores for Malaysian older population revealed that a stronger adherence to this diet is linked to a reduced risk of MCI. Further substantiation of the MY-MINDD scores using more objective measures, such as neuroimaging approaches and other neuropsychological batteries, is necessary.

The mental health impact of the October 7th terror attack on Jews and Arabs in Israel: A nationwide prospective study

IntroductionOn October 7, 2023, Israeli citizens came under an unprecedented terrorist attack that impacted the entire country. Recent research has begun to document the mental health impact of the attack but has yet to address the question of whether the attack had a differential impact across ethnic communities. In this nationwide prospective cohort study, we aimed to determine possible differences in psychopathology between Jews and Arabs in the post-October 7th attack. Specifically, we aimed to understand the role ethnicity may play in changes in probable PTSD, depression, and anxiety diagnoses from pre- to post-attack. MethodsThe sample comprised 656 participants (332 female, 50.7%) aged 18-85 (M = 41.01, SD = 13.72). Of this cohort, 557 participants (84.9%) were Jews, and 99 (15.1%) were Arabs, reflecting their national proportionality. Validated self-report questionnaires were completed to assess PTSD, depression, and anxiety at two time points: August 20 to 30th, 2023 (T1; 6–7 weeks before the attack) and November 9–19, 2023 (T2; 5–6 weeks after the attack). ResultsAt T2, Arab Israeli participants reported significantly higher prevalences of probable PTSD, depression, and anxiety diagnoses than Jewish Israeli participants. A series of hierarchical logistic regressions revealed that, compared with Jews, Arab participants presented with higher prevalence of probable PTSD (OR = 2.53 95% CI = 1.46-4.37, p < 0.0001), depression (OR = 1.68 95% CI = 1.35-3.01, p < 0.0001) and anxiety (OR = 6.42 95% CI = 3.95-10.52, p < 0.0001), controlling for prevalences of probable diagnoses at T1 as well as for trauma-related variables. DiscussionCitizens belonging to the Arab ethnic minority in Israel were found to be at higher risk for psychopathology in the aftermath of the October 7, 2023, terrorist attack compared with their Jewish majority counterparts. Thus, it becomes critical to employ culturally sensitive assessments and interventions following the attack to prevent the development of chronic symptoms and disorders.

Correlates of Domestic Violence Victimization Among Immigrants During COVID-19 in the United States

ABSTRACT Domestic violence has been a cause of concern during the pandemic. Immigrants have been more vulnerable to the impacts of COVID-19, given systemic and cultural barriers. Utilizing a bio-psycho-social framework, the goal of this exploratory cross-sectional study was to examine the correlates of DV victimization among immigrants (N = 419, 41.5% male and 56.8% female) across the United States. Gender, age and race were included as biological and demographic factors (model 1); mental health and psychological stress were included as psychological factors (model 2); and generational position, household income, and family connections were included as social factors (model 3). A hierarchical logistic regression was performed. The sample comprised male and female participants. About 31.3% of participants were White, while the remaining were from diverse racial groups and 43.5% were 1st generation. We observed that 35.1% (60) men and 28.3% (66) women experienced at least one form of DV victimization. Women and those who were older were less likely to experience victimization. An increase in mental health distress and limited family connections were associated with a higher likelihood of DV victimization. This study examined the rates of physical, sexual, verbal, emotional, financial and immigration-related abuse experiences of immigrants in the United States. Our findings point to the need for services to be offered to all genders and the need for more social support for immigrants. The inclusion of male and female survivors of DV adds to the novelty of this study. Practitioners in particular can play an important role in providing culturally responsive support to immigrants experiencing victimization.

Factors influencing the utilisation of anti-HBs titre testing services among nursing students in Northwest Ghana: A cross-sectional study.

Understanding the impact of hepatitis B testing, vaccination, the number of vaccine doses, and socio-demographics on post-vaccination anti-HBs titre testing, is essential for hepatitis B prevention. The aim of the study was to determine the prevalence of hepatitis B testing, hepatitis B vaccination, number of vaccine doses received, socio-demographic characteristics, and their impact on anti-HBs titre testing among nursing students in Northwest Ghana. A stratified sample of 402 nursing students from Wa and Lawra nursing colleges in Ghana's Upper West Region was surveyed in November 2020 using an online cross-sectional design. STATA 13 was used to analyse the data, which described socio-demographics, hepatitis B testing, hepatitis B vaccination, and post-vaccination anti-HBs titre testing with frequencies and percentages. Hierarchical binary logistic regression models were used to investigate the relationships between post-vaccination anti-HBs titre testing and hepatitis B testing, vaccination, the number of vaccine doses, and their socio-demographics. The study discovered that while hepatitis B testing was high (89.0%), rates for hepatitis B vaccination (72.1%), obtaining the recommended vaccine doses (59.5%), and post-vaccination anti-HBs titre testing (19.4%) were lower. Nursing students who accepted hepatitis B vaccination were significantly more likely to undergo anti-HBs titre testing [aOR = 12.34; 95% CI = 1.80-84.54; p < 0.05]. Those who received ≥ 3 vaccine doses were over 8 times more likely to utilise anti-HBs titre testing [aOR = 8.31; 95% CI = 2.73-25.34; p < 0.001]. Wa NTC students were 74% less likely to access anti-HBs titre testing [aOR = 0.26; 95% CI = 0.15-0.47; p < 0.001]. Students with parents who had tertiary education were significantly more likely to undergo anti-HBs titre testing [aOR = 2.50; 95% CI = 1.42-4.42; p < 0.01]. The study reveals high hepatitis B testing but low vaccination rates, emphasizing the need for required vaccine doses and post-vaccination anti-HBs testing. Key predictors include hepatitis B vaccination, ≥3 doses, Wa NTC enrollment, and parental education. The study advocates mandatory testing, vaccination, and affordable access to anti-HBs titre testing. Unvaccinated students, those with <3 doses, Wa NTC attendees, and those with lower parental education for nursing school admission should be prioritised.

Disparities in clinical trial enrollment at a Canadian comprehensive cancer center: A 15-year retrospective study.

Disparities in clinical trials (CTs) enrollment perpetuate inequities in treatment access and outcomes, but there is a paucity of Canadian data. The objective of this study was to examine disparities in cancer CT enrollment at a large Canadian comprehensive cancer center. Retrospective study of CT enrollment among new patient consultations from 2006 to 2019, with follow-up to 2021 (N=154,880), with the primary outcome of enrollment as a binary variable. Factors associated with CT enrollment were evaluated using multivariable Bayesian hierarchical logistic regression with random effects for most responsible physician (MRP) and geography, adjusted for patient characteristics (sex, age, language, geography, and primary care provider [PCP]), area-level marginalization (residential instability, material deprivation, dependency, and ethnic concentration), disease (cancer site and stage), and MRP (department, sex, language, and training). A sensitivity analysis of the cumulative incidence of enrollment was conducted to account for differences in disease type and follow-up length. CT enrollment was 11.2% overall, with a 15-year cumulative incidence of 18%. Lower odds of enrollment were observed in patients who were female (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.78-0.86), ≥65 years (AOR vs.<40, 0.61; 95% CI, 0.56-0.66), non-English speakers (0.72; 95% CI, 0.67-0.77), living ≥250 km away (AOR vs.<15 km, 0.71; 95% CI, 0.62-0.80), and without a PCP. Disease characteristics accounted for the largest proportion of observed variation (20.8%), with significantly greater odds of enrollment in patients with genitourinary cancers and late-stage disease. Significant sociodemographic disparities were observed, suggesting the need for targeted strategies to increase diversity in access to cancer CTs in Canada.

Association between lipoprotein(a) and cardiovascular disease in patients undergoing coronary angiography.

Many previous studies reported the relationship between lipoprotein(a) and cardiovascular disease, but the conclusions were controversial. The aim of our study was to retrospectively investigate the association between lipoprotein(a) and cardiovascular disease in patients undergoing coronary angiography. We collected and compared clinical information of patients hospitalized for coronary angiography. Multivariable hierarchical logistic regression was used to evaluate the association between lipoprotein(a) and cardiovascular disease in patients undergoing coronary angiography. There were no significant differences in gender, hypertension, APOA1, smoking, hyperuricemia, obesity, acute myocardial infarction (AMI), cardiac insufficiency, family history of diabetes, or family history of hyperlipidemia among the four groups of lipoprotein(a). Elevated lipoprotein(a) does not increase the risk of hypertriglyceridemia, while elevated lipoprotein(a) increases the risk of high total cholesterol and high low-density lipoprotein cholesterol (LDL-c). Elevated lipoprotein(a) increases the risk of diabetes and premature coronary artery disease (CAD). Elevated lipoprotein(a) increases the incidence of CAD, multivessel lesions, and percutaneous coronary intervention (PCI). Multivariate logistic regression analysis further showed that elevated lipoprotein(a) increases the incidence of high total cholesterol, high LDL‑c, diabetes, CAD, premature CAD, multivessel lesions, and PCI. The findings indicated that elevated lipoprotein(a)had no obvious relationship with hypertension and obesity. Elevated lipoprotein(a)increases the risk of high total cholesterol, high LDL‑c, and premature CAD, and increases the occurrence and severity of coronary heart disease.

Reward responsivity and habit formation in the co-occurrence of restrictive eating and nonsuicidal self-injury

Dysfunctions in reward and/or habit formation have been proposed as factors contributing individually to the maintenance of restrictive eating and nonsuicidal self-injury (NSSI). However, despite the high comorbidity between these behaviors, the associations between reward and habit formation in their co-occurrence remains unclear. This study examined self-reported reward responsivity and habit strength among individuals with co-occurring restrictive eating and NSSI (Comorbid group; n = 108) and those with one behavior only (One-behavior group; n = 113). Hierarchical logistic regression analyses assessed the association between reward and habit features and the co-occurrence of restrictive eating and NSSI, accounting for the effects of impulsivity (a characteristic commonly considered to underlie co-occurring disordered eating and NSSI). Partial correlations examined the relationships between these features and the severity of eating disorder and NSSI symptoms, also controlling for impulsivity. Lower reward responsivity was associated with the co-occurrence of restrictive eating and NSSI, even after accounting for impulsivity (p = 0.017). In exploratory analyses, this relationship was no longer significant after accounting for self-reported depression. No significant associations were found regarding habit formation and restrictive eating and NSSI co-occurrence. Lower reward responsivity was linked to increased NSSI frequency and versatility in both groups and associated with severity of eating pathology in the Comorbid group (ps < 0.05). Our findings suggest that blunted reward responsivity may relate to the co-occurrence of restrictive eating, NSSI, and depressive symptoms, as well as the severity of restrictive eating and NSSI. Reward disturbances may serve as a crucial target in the treatment of multiple self-destructive behaviors.

Emergency physician gender and head computed tomography orders for older adults who have fallen.

Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen. This was a secondary analysis of a prospective observational cohort study conducted in 11 hospital emergency departments (EDs) in Canada and the United States. The primary study enrolled patients who were 65 years and older who presented to the ED after a fall. The analysis evaluated treating physician gender adjusted for multiple clinical variables. Primary analysis used a hierarchical logistic regression model to evaluate the association between treating physician gender and the patient receiving a head CT scan. Secondary analysis reported the adjusted odds ratio (OR) for diagnosing intracranial bleeding by physician gender. There were 3663 patients and 256 physicians included in the primary analysis. In the adjusted analysis, women physicians were no more likely to order a head CT than men (OR 1.26, 95% confidence interval 0.98-1.61). In the secondary analysis of 2294 patients who received a head CT, physician gender was not associated with finding a clinically important intracranial bleed. There was no significant association between physician gender and ordering head CT scans for older emergency patients who had fallen. For patients where CT scans were ordered, there was no significant relationship between physician gender and the diagnosis of clinically important intracranial bleeding.