Hierarchical Multiple Linear Regression Research Articles

Effects of Modifiable Activity-Related Health Behaviors on the Sleep-Pain Relationship in Adolescents.

Poor sleep and chronic pain are commonly related in adolescents. Only 5% of adolescents meet recommendations for physical activity and screen time, both of which impact the experience of sleep and pain disturbances. Research is needed to better understand the sleep-pain relationship in adolescents and to identify potential protective factors, such as activity-related health behaviors. This study examined sleep, behaviors that influence activity (i.e., physical activity, screen time), and their interaction as predictors of pain in a sleep-disordered sample of 105 adolescents aged 12-18 presenting for polysomnography. A hierarchical multiple linear regression was conducted to examine these relationships. Consistent with hypotheses, worse insomnia predicted worse pain. However, other activity-related health behaviors did not influence this relationship, ps > .05. Findings suggest that sleep should be the focus of treatment for adolescents with primary sleep disorders to prevent the onset or exacerbation of pain.

The relationship between perceived parenting practices and anxiety in adults with congenital heart disease

BackgroundPatients with congenital heart disease (CHD) and their parents face challenges throughout their lives that can lead to anxiety lasting into adulthood. We aim to assess the association between perceived parenting practices and anxiety beyond pediatric medical-surgical histories in adults with CHD. MethodsA cross-sectional study of adults with CHD was conducted at the Montreal Heart Institute (MHI). Perception of parental practices during childhood was retrospectively assessed using validated self-report questionnaires, while anxiety in adulthood was assessed with the Hospital Anxiety and Depression Scale (HADS). Sociodemographic and medical information were collected from a questionnaire and medical records. Hierarchical multiple linear regression was conducted. ResultsOf the 223 participants, 59% were female, and the mean age was 46 ± 14 years. Perceived parenting practices explained more variance (11%) in the anxiety score than pediatric medical-surgical history (2%). In our final model, anxiety was significantly associated with age, parental history of anxiety, and positive parenting practices, but not with overprotection. ConclusionsParenting practices are associated with anxiety in adults with CHD beyond pediatric medical-surgical history and sociodemographic. Positive parenting practices may be protective against anxiety in adulthood. Longitudinal studies are needed to determine causality.

Financial toxicity, family resilience and negative emotions among young and middle-aged breast cancer patients: A multicentre cross-sectional study

PurposeTo determine financial toxicity in young and middle-aged women with breast cancer and examine the associations between family resilience and negative emotions. MethodsA multicentre cross-sectional study was conducted, 538 women with breast cancer were recruited from four hospitals. FT, family resilience, and negative emotions were collected using the Comprehensive Score for FT, the Chinese version of the Family Resilience Assessment in Breast Cancer Patients, Patient Health Questionnaire-9 item, and Generalized Anxiety Disorder-7. This study adhered to the STROBE guidelines. ResultsThe valid response rate was 96.8 % (N = 521). Overall, the score for FT was 19.63 ± 10.13. FT was significantly correlated with family resilience (r = 0.30, p < 0.010) and depression (r = −0.11, p < 0.050). The hierarchical multiple linear regression analysis showed that career status, monthly income, religion, and family resilience were the main factors influencing FT in patients with breast cancer (R2 = 0.37; F = 6.83; p < 0.001). ConclusionsFT was more prevalent among women from low-income career. Women with poor family resilience, no religious also suffer greater financial toxicity. It is necessary to pay more attention of the financial toxicity of female’ low-income career, no religious belief and poor family resilience. Developing effective interventions based on family resilience might be helpful in promoting their well-being.

Birthweight trends and their explanatory factors in Hungary between 1999 and 2018: an analysis of the Hungarian Tauffer registry

BackgroundThe increasing birthweight trend stopped and even reversed in several high income countries in the last 20 years, however the reason for these changes is not well characterized. We aimed to describe birthweight trends of term deliveries in Hungary between 1999 and 2018 and to investigate potential maternal and foetal variables that could drive these changes.MethodsWe analysed data from the Hungarian Tauffer registry, a compulsory anonymized data collection of each delivery. We included all singleton term deliveries in 1999–2018 (n = 1,591,932). We modelled birthweight trends separately in 1999–2008 and 2008–2018 in hierarchical multiple linear regression models adjusted for calendar year, newborn sex, maternal age, gestational age at delivery, and other important determinants.ResultsMedian birthweights increased from 3250/3400 g (girl/boy) to 3300/3440 g from 1999 to 2008 and decreased to 3260/3400 g in 2018. When we adjusted for gestational age at delivery the increase in the first period became more pronounced (5.4 g/year). During the second period, similar adjustment substantially decreased the rate of decline from 2.5 to 1.4 g/year. Further adjustment for maternal age halved the rate of increase to 2.4 g/year in the first period. During the second period, adjustment for maternal age had little effect on the estimate.ConclusionsOur findings of an increasing birthweight trend (mostly related to the aging of the mothers) in 1999–2008 may forecast an increased risk of cardiometabolic diseases in offsprings born in this period. In contrast, the decreasing birthweight trends after 2008 may reflect some beneficial effects on perinatal morbidity. However, the long-term effect cannot be predicted, as the trend is mostly explained by the shorter pregnancies.

Body mass index assessment of preschool children during the COVID-19 pandemic

Introduction: the COVID-19 pandemic has brought socioeconomic, behavioral and clinical losses that can compromise the nutritional status of children, and studies on the subject are essential. Objective: to assess the Body Mass Index of preschool children during the COVID-19 pandemic. Methods: the data in this study comes from a cohort of children created to prospectively investigate determinants of growth and development in the period from birth to 1,000 days of life in a municipality in the interior of Paraíba, Brazil. For this study, data were collected from children at 4 years of age examining repercussions of the COVID-19 pandemic on maternal and child life. Data on the children (biological characteristics, health conditions, food consumption, screen time, behaviors during the COVID-19 pandemic, satisfaction with school and home life) and their mothers (overweight/obesity, sociodemographic characteristics, childcare, attitudes and practices related to the COVID-19 pandemic) were included, and the Body Mass Index-for-age average (Z-score) was compared using hierarchical multiple linear regression. Results: not breastfeeding in the first hour of life (p = 0.046) and regular consumption of filled cookies, sweets or candies (p = 0.042) were the characteristics of the children that represented the highest means of the outcome. Children whose mothers were diagnosed as overweight/obese (p = 0.034), who had not completed high school (p = 0.042), who had difficulty caring for the child and guiding them in health aspects (p = 0.010), as well as those whose mothers needed psychological care (p = 0.047) and mental health medication (p = 0.036) during the COVID-19 pandemic, also had higher mean scores. Conclusion: maternal mental health (psychological care and use of medication) during the COVID-19 pandemic had an impact on the child’s nutritional status.

Inhibitory control mediates the association between body mass index and math performance in children: A cross-sectional study.

Overweight and obesity affect more than 18% of children and adolescents in the world. Obesity-related associations with brain morphology might be associated with reduced efficiency of inhibitory control. This association highlights a possible mechanism by which obesity impacts intelligence and academic achievement. Prior work indicates a mediating effect of inhibitory control on the relationship between body mass index (BMI) and intelligence and academic achievement. However, although obesity is associated with impaired math performance, we do not know whether inhibitory control also mediates the relationship between BMI and math performance. This study tests the hypothesis that inhibitory control statistically mediates the relationship between BMI and math performance. 161 children (9 to 13 years old, 80 female) participated in the present study. We evaluated BMI; math performance, in a test composed of 20 arithmetic equations of the type x = (a × b) - c; and inhibitory control through the Flanker test. We carried out Spearman correlation tests, hierarchical multiple linear regression, and tested the confidence of the model where inhibitory control statistically mediates the indirect association between BMI and math performance. Mediation analysis in this cross-sectional study aimed to improve understanding of indirect relationships and offer insights into possible causal connections. Better math performance and lower BMI were associated with greater accuracy on the inhibitory control test and greater accuracy on the inhibitory control test was associated with better performance on math test. We found an indirect association between higher BMI in children and impairments in math performance, that was mediated by inhibitory control (a: -0.008, p = 0.025; b: 7.10, p = 0.0004; c: 0.05, p = 0.592; c': 0.11, p = 0.238; Indirect Effect: -0.0599, 95% CI: -0.13, -0.005). An indirect association between higher body mass indices in children and impairments in math performance was detected, through the impact that BMI has on inhibitory control.

Ecological predictors of cultural competence among nurses in the neonatal intensive care unit: A cross-sectional descriptive study.

Active migration and globalization have led to increased opportunities for critical care nurses to care for patients from diverse racial and cultural backgrounds. This study thus aimed to identify the individual, interpersonal, and organizational factors affecting cultural competence levels among neonatal intensive care unit (NICU) nurses based on an ecological model. This was a cross-sectional descriptive study that included 135 NICU nurses in South Korea. A hierarchical multiple linear regression analysis was conducted using the proposed ecological model, and a regression model for each of the four subdomains of cultural competence was constructed and compared. NICU nurses' cultural competencies were influenced not only by the "necessity of multicultural education" and "ethnocultural empathy" at the individual level but by the "hospital's readiness and support for cultural competencies" at the organizational level. To promote the cultural competence of nurses in critical care settings, environmental and organizational support should be improved, along with developing strategies that focus on nurses' individual characteristics. It is also necessary to investigate the "intersectionality" of the effects of individual and environmental factors on cultural competence.

Breastfeeding duration is associated with favorable body composition and lower glycoprotein acetyls in later life.

The aim of the present study was to investigate associations between lifetime breastfeeding behaviors and cardiovascular risk in later reproductive years. This was a prospective 10-year longitudinal cohort study of 168 parous women. Health, lifestyle and infant feeding questionnaires, blood samples, anthropometry and body composition were collected. Cardiovascular risk was estimated using QRISK®3 and hierarchical multiple linear regression analysis performed. Mean age was 42.4 years (SD 3.8; range 31-50) and 98.7% (n = 156/158) were premenopausal. Ever breastfeeding rates were 72.6% (n = 122/168) and 37.5% (n = 63/168) lifetime ≥12 months breastfeeding duration. Median durations were 5.5 weeks for exclusive breastfeeding (IQR 35.8; range 0-190) and 30.5 weeks for any breastfeeding (IQR 84.0; range 0-488). Breastfeeding duration was not associated with QRISK®3 scores in adjusted models. Lower glycoprotein acetyls were associated with ever breastfeeding (P = 0.03), and lifetime breastfeeding ≥12 months (P = 0.001). Lifetime breastfeeding ≥12 months and longer exclusive breastfeeding were associated with lower fat mass index (P = 0.03, P = 0.01), tissue percentage fat (P = 0.02, P = 0.009) and visceral adipose tissue volume (P = 0.04, P = 0.025) after correcting for confounders including body mass index. Longer breastfeeding is associated with favorable body composition and lower glycoprotein acetyls, a novel inflammatory biomarker associated with cardiometabolic risk. Breastfeeding is a low-cost, health promoting behavior for women and infants. Pregnant women, especially those at higher risk of cardiovascular disease, should be counseled about the potential benefits of exclusive and longer breastfeeding duration.

Spatial distribution and policy implications of the exhaust emissions of two-stroke motorcycle taxis: a case study of southwestern state in Nigeria

Two-stroke motorcycles emit harmful exhaust fumes because of incomplete combustion. Although they constitute the main fleet of motorcycle taxis in sub-Saharan Africa, monitoring, spatial assessment, and regulation are weak, leaving dire health consequences in cities. This study collected motorcycle raw exhaust emissions of 1,950 two-stroke petrol-driven motorcycle taxis, otherwise called okada, in Ogun State, Nigeria, using an idle mode test approach under 10 minutes and employed correlations, hierarchical multiple linear regression models, and spatial analysis. It was found that carbon monoxide (CO) and hydrocarbons (HC) were the most highly concentrated, and the latter were beyond allowable limits. The concentration of CO was found to be at the minimum of 0.00 % and the highest being at 6.40% (an average of 1.05%), while the HC concentration was reported at the minimum of 18.00 ppm and the highest at 15446 ppm (an average of 3560 ppm). Notably, Kriging interpolation analysis indicated that cumulative effects due to the clustering and operations of motorcycle taxis could increase these concentrations over time, extending their long-term impacts. Given the severe effects of these emissions on health and the wider environment, a DPSIR policy framework is proposed to regulate two-stroke motorcycle taxis in sub-Saharan Africa.

Sibship Composition and BMI Z-Score Among Saudi Preschoolers: A Cross-Sectional Study.

Background and objective The association between sibship composition and child body mass index (BMI) has not been investigated in any Arab/Middle Eastern populations. In light of this, this study aimed to examine the association of the number of siblings, number of older siblings, and number of younger siblings with child BMI z-score (BMIz) among preschoolers in the Kingdom of Saudi Arabia (KSA). Methods A total of 209 mothers and their children were recruited from preschools in Jeddah, KSA. Mothers reported their responses to the study questionnaire via telephone. Child anthropometry was objectively measured; BMIz was calculated based on age- and sex-specific World Health Organization (WHO) growth standards and reference data. We used hierarchical multiple linear regression to examine the association between sibship composition variables and child BMIz, independent of the effect of potential confounders, and to evaluate changes in model fit. Results The number of siblings was negatively associated with child BMIz [b = -0.18, 95% confidence interval (CI) = -0.35, -0.06, p<0.01, adjusted R2= 0.16]. There was a negative association between the number of older siblings and child BMIz (b = -0.23, 95% CI = -0.38, -0.11, p<0.01, adjusted R2= 0.21) as well as between the number of older sisters and child BMIz (b = -0.18, 95% CI = -0.52, -0.09, p<0.01, adjusted R2= 0.19). However, there were no significant associations between the number of older brothers or the number of younger siblings and child BMIz. Conclusions Based on our findings, sibship composition was found to be associated with BMIz among a sample of preschoolers in KSA. More research is needed to further establish this association and to understand the underlying mechanism of the association of the greater number of older siblings and older sisters with lower BMIz.

Quantifying the relationship between gardening and health and well-being in the UK: a survey during the covid-19 pandemic

BackgroundRates of non-communicable diseases, including cardiovascular disease and type 2 diabetes, and mental health problems, such as anxiety and depression, are high and rising in the urbanising world. Gardening could improve both mental and physical health and help prevent a range of conditions by increasing fruit and vegetable (F&V) consumption, promoting physical activity, and reducing stress. However, good quality quantitative research in the area is scarce, and our understanding of the role of allotments and home gardens, and the effects of the level of engagement in gardening and involvement with food production has thus far been limited.MethodsWe quantitatively assess the relationship between home and allotment gardening and various indicators and predictors of health and well-being using an online survey of gardeners (n = 203) and non-gardeners (n = 71) in the UK. The survey was composed of multiple validated questionnaires (including the Short Form Food Frequency Questionnaire (SFFFQ), the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the Physical Health Questionnaire (PHQ) and the Self-Rated Health question (SRH)) and self-defined questions relating to participants’ involvement with gardening and food production, and relevant demographic and lifestyle factors. Data were analysed using a series of hierarchical logistic and multiple linear regression models adjusting for socio-demographic variables.ResultsAfter adjusting for relevant socio-demographic factors, gardening related variables were associated with better self-rated health, higher mental well-being, increased F&V consumption. Higher F&V intake was in turn also associated with better self-rated health and decreased odds of obesity. Thus, gardening had a positive association with four different aspects of health and well-being, directly or indirectly via increased F&V consumption.ConclusionsOur results suggest that gardening in UK allotments and domestic gardens may promote different aspects of health and well-being via multiple mechanisms. Improving access to growing space and promoting regular gardening could provide a range of benefits to public health. More research on how socio-economic factors influence the health and well-being benefits of gardening will help policymakers devise strategies to maximise these benefits.

The added value of frailty assessment as the premorbid stroke status on activities of daily living in patients with acute stroke, stratified by stroke severity

BackgroundThe modified Rankin scale (mRS) is extensively used for premorbid evaluation in patients with stroke; however, its limited capacity to assess functional status highlights the need for additional indicators such as frailty. AimsThis study aimed to assess the impact of the premorbid mRS score and frailty on daily living (ADL) activities at hospital discharge, focusing on varying stroke severities. MethodsThis single-centre, prospective cohort study included patients with acute stroke aged ≥60 years. Key metrics included the frailty index for frailty assessment or mRS for functional status premorbid and the functional independence measure of the motor domain (FIM-M) at discharge for ADL outcomes. The patients were categorized into mild (0–4), moderate (5–15), and severe (16–42) groups based on the National Institute of Health Stroke Scale. Multiple hierarchical linear regression analyses were performed for each group to evaluate the influence of mRS and frailty on FIM-M scores. ResultsIn the mild stroke group, significant associations were observed with premorbid mRS3 (β = −0.183, p = 0.004), mRS4 (β = −0.234, p < 0.001), and frailty status (β = −0.227, p = 0.005) and FIM-M scores. Premorbid frailty did not show a significant association with the FIM-M scores in the moderate or severe stroke group. Frailty status notably contributed to changes in R², particularly in the mild stroke group (R² change = 0.031, p = 0.002). However, such changes were not evident in the other stroke severity groups. ConclusionThis study emphasizes the importance of incorporating frailty assessments into premorbid evaluations, particularly when considering ADL outcomes in patients with mild stroke. Conversely, the significance of frailty in moderate-to-severe stroke was less evident.

Self-Care and General Well-Being in Postpartum Mothers

INTRODUCTION:Mothers are crucial to society, yet they may experience depression or other mental illnesses during pregnancy and after birth. Preventative programs to reduce postpartum mental illness lack a clear evidence base, and a strength-based approach focusing on well-being is generally not provided. This study aims to explore postpartum mothers’ self-care practices and well-being from the perspective of a strength-based approach. Rather than rely on a deficit approach and further problematize the experiences of postpartum women, this study aimed to identify the relationship and predictability of self-care with general well-being for postpartum mothers.METHODS:This study was a quantitative, cross-sectional survey design using an online survey with women aged 18 years and older who had given birth in Australia to a child between 6 weeks and 12 months (N =140) regarding their self-care practices and general well-being.RESULTS:A hierarchical multiple linear regression found a strong relationship between self-care behaviors and well-being during the first year of motherhood. Findings also revealed that significant confounding factors impacted the relationship between self-care and well-being with the number of complications experienced during pregnancy to postpartum and prior experiences of “baby blues.”DISCUSSION:Findings from the current study provide evidence of the importance of self-care, and a strength-based approach for enhancing self-care skills may assist in improving the well-being of postpartum mothers. Further research is needed to identify other interactions affecting the relationship and to investigate causality.

Factors associated with physical activity following total knee arthroplasty for knee osteoarthritis: a longitudinal study.

After total knee arthroplasty (TKA), patients' physical activity (PA) levels at 6 months are lower than those of healthy subjects. Few studies have investigated the factors associated with PA at 6 months after TKA by objectively measuring preoperative and postoperative PA intensity using an accelerometer and knee function using a goniometer and dynamometer. The purpose of this study was to determine the factors associated with PA levels at 6 months after TKA based on objective data. Eighty-two patients (mean [SD] age 74.5 [6.4] years) with moderate-to-severe knee osteoarthritis (OA) who were scheduled for TKA at the Nagoya Orthopaedic and Joint Replacement Clinic from July 2018 to July 2019 were enrolled in this longitudinal study. All patients underwent evaluations of knee function, including range-of-motion and knee-extension muscle strength; knee pain; performance in the timed up-and-go test; and accelerometer-measured PA both preoperatively and 6 months postoperatively. Factors associated with PA at 6 months after TKA were assessed using a hierarchical multiple linear regression analysis adjusted for age, sex, body mass index, and presence of diabetes mellitus. A higher average daily step count at 6 months after TKA was significantly associated with greater preoperative knee-extension muscle strength on the operated side (β = 0.155, p = 0.028) as well as a higher preoperative average daily step count (β = 0.834, p < 0.001). Furthermore, average daily time spent in moderate-to-vigorous-intensity PA postoperatively was significantly associated only with time spent in moderate-to-vigorous-intensity PA preoperatively (β = 0.723, p < 0.001). These findings indicate that a higher preoperative daily step count and greater preoperative knee-extension muscle strength on the operated side may be associated with a higher daily step count at 6 months after TKA. Factors associated with PA differed by the PA intensity level. Rehabilitation and interventions for psychosocial factors before TKA beginning when mild knee OA first occurs are expected to lead to increased PA in TKA patients.

Innovation’s Performance: A Transnational Analysis Based on the Global Innovation Index

The pandemic marked the beginning of a succession of events on a global scale (not the least of which is a greater concern for the environment and for quality of life/distance work) with a major impact on the economy. Innovation plays a key role in meeting the challenges of the future, but despite investment in innovation, global economic growth has fallen short of the expected performance. The aim of this study is to identify the factors with the greatest impact on the performance of innovation ecosystems based on the performance of the innovation ecosystems of 64 countries assessed by the Global Innovation Index 2022. The methodology consists of multiple hierarchical linear regressions, in which the impact factors on innovation ecosystems, measured through indicators, are the independent variables and innovation performance, in knowledge and technology and in creativity, are the dependent variables in an iterative process, using STATA/MP 18.0 data analysis software. The results indicate that human capital and research (the basis of business and innovative products aimed at filling gaps in the market are people with a good higher education, which is also linked to local university rankings) and business sophistication (highly qualified work, leveraging strategic partnerships, and with knowledge absorption capacity) are the main pillars determining innovation performance at a global level. Education (an educated workforce is of growing importance in the knowledge era), R&amp;D investment (including support from the state in the form of tax incentives for whoever invests in R&amp;D), innovation partnerships (for a faster, more open innovation effort), ecological sustainability (a new reinforced priority after COVID-19) and knowledge absorption (to absorb one must first detain valuable knowledge in the area) are the variables with the greatest impact on innovation performance. The work provides guidance on which areas should be prioritized in the development of policies and strategies to accelerate innovation in countries. The study is limited by the time frame and reveals, by comparison with pre-pandemic studies, that the determinants of innovation can be dynamic, varying according to the countries and, consequently, the global context of the analysis.

Associations of nuptiality perceptions, financial difficulties, and socio-demographic factors with mental health status in Australian adults: Analysis of the Household, Income and Labour Dynamics in Australia (HILDA) survey.

This study examined the association of nuptial/relationship factors, financial difficulties, and socio-demographic factors with the mental health status of Australian adults. Cross-sectional quantitative study design. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey wave 19, 6846 adults were included in the analysis. Mental health was measured using the mental component summary (MCS) subscale of the Short-Form Health Survey SF-36. Hierarchical multiple linear regressions were used to examine the predictors of mental health status. Overall, 7.1% of the participants reported poor mental health status. Individual financial difficulty factors explained 3.2% (p<0.001) of the variance in mental health scores. In addition, financial difficulties were negatively associated with mental health status. Nuptiality and relationship factors accounted for 9.8% (p<0.001) of the variance in mental health status. The study suggests negative marital or relationship perceptions and financial difficulties are significant factors accounting for poor mental health. This finding suggests the need for more policy attention toward the social determinants of poor mental health especially nuptiality or relationship perceptions which have received less policy and research attention in Australia.

How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay.

As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.

A cross‐sectional study on predictors of patients' tinnitus severity

AbstractObjectiveTo identify factors that influence the severity of tinnitus via a hierarchical multiple linear regression model.MethodsThe study was a retrospective cross‐sectional analysis. The study included 331 patients experiencing tinnitus as their primary concern, who visited Shanghai Changzheng Hospital of the Navy Medical University between 2019 and 2021. Data on general health status and disease characteristics were collected from all patients. With their consent, participants underwent audiological evaluatons and completed questionnaires to analyze the characteristics of their tinnitus and the factors influencing its severity.ResultsThe correlation analysis showed a positive relationship between tinnitus frequency, tinnitus loudness, SAS scores, and PSQI scores with THI scores (P &lt; 0.05) among nine examined variables (gender, handedness, employment status, age, BMI, tinnitus frequency, tinnitus loudness, SAS scores, and PSQI scores). The variables that were extracted from the multiple regression were; for the constant; β = −51.797, t = −4.484, P &lt; 0.001, variable is significant; for the tinnitus loudness; β = 0.161, t = 2.604, P &lt; 0.05, variable is significant; for the tinnitus frequency; β = 0.000, t = 1.269, P = 0.206, variable is not significant; for the SAS scores; β = 1.310, t = 7.685, P &lt; 0.001, variable is significant; for the PSQI scores; β = 1.680, t = 5.433, P &lt; 0.001, variable is significant. Therefore, the most accurate model for predicting severity in tinnitus patients is a linear combination of the constant, tinnitus loudness, SAS scores, and PSQI scores, Y(Tinnitus severity) = β0 + β1(Tinnitus loudness) + β2(SAS scores) + β3(PSQI scores). β0, β1, β2, and β3 are −51.797, 0.161, 1.310 and 1.680, respectively.ConclusionTinnitus severity is positively associated with loudness, anxiety levels, and sleep quality. To effectively manage tinnitus in patients, it is essential to promptly identify and address these accompanying factors and related symptoms.

Predictors of Sleep Quality Among Type 2 Diabetes Mellitus Patients

One of the health problems experienced by patients with type 2 diabetes mellitus is poor sleep quality. Poor sleep quality is an important factor in poor blood sugar regulation. This study aims to determine the predictors of sleep quality in patients with type 2 diabetes mellitus at a private hospital in Yogyakarta. This research was conducted using a cross sectional approach on 150 type 2 diabetes mellitus patients who were recruited at the Endocrine Clinic at a private hospital in Yogyakarta. The questionnaires used in this research were demographic data questionnaires, Perceived Stress Scale (PSS-10), Pittsburgh Sleep Quality Index (PSQI). Data analysis was carried out using Multiple hierarchical linear regression. The research results show that the average stress score of respondents in this study was 16.13 (SD = 4.59), which is in the medium category. Global PSQI showed that respondents experienced poor sleep quality (mean = 5.33, SD = 1.79). The Perceived Stress Scale score contributed 23.6% to the sleep quality score. The higher the respondent's stress level, the lower the respondent's sleep quality. Nurses can develop interventions to improve the sleep quality of type 2 diabetes mellitus patients.

Oral Contraceptives Interact with Adiposity-Associated Markers in Patients with Multiple Sclerosis.

Growing evidence suggests the involvement of adipose tissue in modulating the clinical course of relapsing-remitting multiple sclerosis (RRMS). This study aimed to investigate whether the intake of combined oral contraceptives (COCs) affects body weight and leptin and adiponectin (APN) blood levels in these patients. Clinical data from 62 women (M = 33.23 year) were recorded prior to the initiation of disease-modifying therapy. Patients who were taking COCs at the time of experiencing the first symptoms of disease (COC user) were compared with those who never used these formulations or stopped taking them before disease onset (COC non-user). Bivariate Pearson's correlations and hierarchical multiple linear regressions analysis were conducted. Normalized APN levels were lower in the COC-using patients (p = 0.013). Negative correlations between waist circumference and normalized APN (p = 0.001) were observed only in the COC non-user patients. A longer duration of COC intake was associated with increased body mass index and waist circumference (p = 0.003). Normalized APN predicted the MS Severity Score (MSSS) (p = 0.020), but this correlation was lost in the COC user patients. After adjusting for confounders, only age (p = 0.027) and, later, disease onset (p = 0.014) were correlated with the MSSS. Larger and prospective studies are needed to investigate the interactions of sex steroids with adipose metabolism in modulating disease progression.