Hierarchical Regression Models Research Articles

Effectiveness of using implementation frameworks to facilitate the implementation of a stroke management guideline in the traditional Chinese medicine hospitals in China: protocol for a factorial randomised controlled trial

IntroductionTraditional Chinese medicine (TCM) is commonly used alongside Western medicine for stroke management in China. However, there is significant variation in TCM practice, and the utilisation of evidence-based clinical practice...

Assessing Preferences of Patients with Chronic Spontaneous Urticaria for Injectable Treatment Profiles.

In the context of injectable biologic products approved or in development for chronic spontaneous urticaria (CSU), it is important to capture which treatment attributes matter most to patient and what trade-offs patients are willing to make. The CHOICE-CSU study aimed to quantify patient preferences toward injectable treatment attributes among patients with CSU, inadequately controlled by H1-antihistamines. This was a two-phase cross-sectional patient preference study in adult patients with a diagnosis of CSU, inadequately controlled by H1-antihistamines. A qualitative phase collected patients' insights and relevant treatment attributes that mattered to them, and the outputs were used for the quantitative phase to create the actual injectable treatment profiles with attributes and levels such as: efficacy, safety, and mode of administration. The quantitative phase used discrete choice experiment (DCE) methodology. Eligible patients were asked to make hypothetical choices between 12 treatment profile pairs, created by Sawtooth SoftwareTM. The DCE data were analyzed using hierarchical Bayesian logistic regression models, enabling the quantification of the relative importance of each attribute/level during the decision-making process. A total of 450 respondents participated in the DCE. The key attributes driving respondent preference amongst injectable treatment options were type of administration device (relative importance 18.5%), complete control of urticaria (relative importance 17.4%), and resolution of angioedema (relative importance 16.4%). Keeping all other attributes and levels equal, the predicted choice share was higher for a profile with an auto-injector versus one with a pre-filled syringe (72.9% versus 27.1%). The CHOICE-CSU study is the first study to provide a quantitative assessment of preferences that patients with CSU, inadequately controlled by H1-antihistamines, have for injectable treatment attributes. Symptom-free periods are the most important overriding therapy goal for patients, and patients will accept some inconveniences, such as administration mode, to achieve this. Additionally, when efficacy is equivalent, administration ease of injectable therapies is valued by patients. As new CSU oral treatment options emerge, additional testing of patient preference toward oral treatments will be required.

Comprehensive neuropsychological assessment and predictors of cognitive functioning at six months after COVID-19 in patients treated in the ICU, regular hospital ward, or isolated at home

Cognitive impairment in patients with COVID-19 has been reported, but findings are inconsistent. This study assessed cognitive functioning 6 months post-infection across three COVID-19 severity groups compared to non-COVID controls. Seventy-two ICU-treated, 49 ward-treated, and 44 home-isolated patients with COVID-19, along with 48 controls, underwent neuropsychological evaluation and assessment of subjective cognitive symptoms, depressive symptoms, and fatigue. Cognitive test scores were compared using ANCOVA. Associations between cognitive functioning and variables including demographics, illness severity, comorbidities, depressive symptoms, fatigue, and ICU-related factors were examined with hierarchical linear regression models. Results showed no significant differences in cognitive test performance of impairment frequencies between COVID-19 groups and controls. However, patients with COVID-19 reported higher levels of subjective cognitive symptoms, depressive symptoms, and fatigue compared to controls. Predictors of cognitive functioning included age, education, and, to a lesser extent, comorbidities. COVID-19 severity, depression, fatigue, or ICU-related variables did not significantly impact performance. These findings suggest that while individual cognitive impairments may exist, overall cognitive functioning in patients with COVID-19 was comparable to controls.

Psychosocial working conditions and violence prevention climate in German emergency departments – a cross-sectional study

BackgroundEmergency departments (EDs) are high pressure work environments with several psychosocial job demands, e.g., violence, and job resources, e.g., colleague support. So far, the perceptions of working conditions have been compared between doctors and nurses, but there is limited knowledge regarding their respective supervisors. In addition, the violence prevention climate has not been assessed in German EDs before. Thus, the current study focuses on differences in the perceptions of working conditions and the violence prevention climate between the groups of doctor-supervisors, doctor-employees, nurse-supervisors, and nurse-employees within the ED. Further analyses regarding the association between social relations and pressure for unsafe practices are performed, including the moderating role of belonging to one of the aforementioned groups.MethodsA cross-sectional online survey was carried out among N = 370 participants, who were doctors or nurses from German EDs. The Questionnaire for Psychosocial Risk Assessment (QPRA) and the Violence Prevention Climate Scale (VPCS) were applied. Kruskal-Wallis tests were performed for group comparisons, followed by a hierarchical multiple linear regression model and moderation analyses.ResultsStatistically significant differences between the groups were found for eight out of 13 variables. The highest number of significant pairwise comparisons was found between the groups of doctor-supervisors and nurse-employees. High job demands regarding work intensity and work interruptions became apparent across all groups. Nurse-employees reported the highest social and emotional demands as well as the highest pressure for unsafe practices regarding violence prevention, significantly differing from the other groups on these variables. The variables of supervisor support and social stressors were found to be significantly predictive of pressure for unsafe practices. Furthermore, there was no moderating effect of belonging to one of the above-mentioned groups in the relationships between variables of social relations and pressure for unsafe practices.ConclusionsDifferences found in the current study can help tailor preventive measures according to the needs of distinct professions and positions in order to improve working conditions and the violence prevention climate in EDs. Furthermore, supervisor support should be strengthened while social stressors should be resolved in order to decrease pressure for unsafe practices regarding violence prevention.

Temporal variation in nutritional status and preoperative anemia among patients with retroperitoneal soft tissue sarcoma: a retrospective longitudinal cohort study

PurposeOptimal management of retroperitoneal soft tissue sarcoma (RPS) often requires extensive tumor resections, frequently involving gastrointestinal organs. The impact of these procedures on the nutritional status and hemoglobin (Hb) levels of RPS patients remain unexplored. In this study, we aimed to evaluate preoperative nutritional status as well as the prevalence of anemia in RPS patients, and to investigate longitudinal changes throughout the disease course in order to identify potential strategies for prehabilitation.Materials and methodsPatients undergoing resection of primary and recurrent RPS at Heidelberg University Hospital were retrospectively analyzed. Changes in nutritional parameters and Hb levels throughout the disease course were analyzed using hierarchical linear regression models. Multivariable Cox regression analyses were performed to identify independent predictors of overall survival. Subgroup analyses were conducted for primary tumors, first, second and third recurrences.ResultsAmongst 370 patients analyzed, comprising 219 with primary disease, we observed neither a significant prevalence of preoperative malnutrition nor notable changes in BMI or serum albumin levels throughout the disease course. Preoperative anemia affected up to 40% of RPS patients, and Hb levels significantly decreased over the course of the disease (p = 0.022), particularly in correlation with the number of tumor resections performed (p = 0.010). Low preoperative Hb levels were associated with increased 30-day mortality and they were identified as an independent prognostic factor for shorter overall survival in primary RPS as well as in second and third recurrences.ConclusionAnemia screening should be performed preoperatively and during regular follow-ups to enable early-on therapy, thus potentially improving patient outcomes in RPS.

Prioritizing emergency department antibiotic stewardship interventions for skin and soft tissue infections using judgment analysis.

Skin and soft tissue infections (SSTIs) account for over 2.8 million annual emergency department (ED) visits and often result in suboptimal antibiotic therapy. The objective of this study was to evaluate a set of interventions in minimizing inappropriate prescription of antibiotics for presumed SSTIs in the ED. Case vignette survey. A national sample of emergency medicine (EM) physicians. Each vignette described a clinical scenario of a presumed SSTI (cellulitis or abscess) and included a unique combination of zero to five interventions (outpatient follow-up, inappropriate antibiotic request flag, thermal imaging for cellulitis or rapid wound MRSA PCR for abscess, patient education/shared decision-making, and clinical decision support). Out of 64 possible vignettes, we asked participants to respond to eight vignettes. Following each vignette, we asked participants if they would prescribe an antibiotic in their everyday practice (yes/no). We built adjusted hierarchical logistic regression models to estimate the probability of prescribing an antibiotic for each intervention and vignette. Surveys were completed by 113 EM physicians. The thermal imaging, rapid wound MRSA PCR, and patient education/shared decision-making interventions showed the largest decrease (15-20%) in antibiotic prescribing probability. Vignettes with a combination of both a diagnostic intervention (thermal imaging or rapid wound MRSA PCR) and a patient education/shared decision-making intervention had the lowest prescribing probabilities. We recommend future research focuses on the development and integration of novel diagnostic tools to identify true infection and incorporate shared decision-making to improve diagnosis and management of SSTIs.

Social Work Students’ Perceptions of Sex Offender Management Policies

ABSTRACT Social work educators and curricula continue to struggle with educating students about sex offenders, including community policies that may have collateral consequences for sex offenders and minimal benefit to society. There have been no studies specifically examining social work students’ attitudes toward sex offender management policies and connecting them to the EPAS. Hierarchical linear regression models were estimated to examine the relationship between social work program level, demographics, and policy endorsement. BSW-level students were less supportive of adult sex offender management policies compared to MSW students. Given the charge of social workers to examine biases and how they relate to service delivery, identifying areas in which bias and fear have dictated public policy is concerning and should be considered.

The Association Between Father Support and Daughter Physical Activity: Insights From a Study Involving U.S. Latina Pre-Teens.

Social support, particularly from family, is crucial for physical activity (PA) among youth. This study examined the association between father support and moderate-to-vigorous physical activity (MVPA) in Latina pre-teens and explored the moderating role of body mass index (BMI). Cross-sectional analysis. Baseline data from a pilot randomized controlled trial in San Diego County. Sixty Latina pre-teen girls aged 8-11years. Girls' MVPA was measured via accelerometry. An exploratory factor analysis created a composite measure of father support, reported by mothers. Hierarchical linear regression models, adjusting for covariates, assessed the relationship between father support and MVPA. Interaction models tested the moderating effect of BMI z-score (zBMI). Father support was significantly associated with MVPA (b-range = 0.07 to 0.08, 95%CI = 0.02, 0.13) after adjusting for age, income, acculturation, and maternal support. However, this association became non-significant with the inclusion of zBMI (b = 0.06, 95%CI: -0.01, 0.11). The interaction model showed a significant positive association between father support and MVPA among girls with a healthy weight (b = 0.27, 95%CI: 0.27, 2.68) but not among those with overweight/obesity (b = 0.95, 95%CI: -0.38, 2.28). Our findings indicate a potential association between father support and daughters' MVPA among girls with a healthy weight. Further research is needed to understand why this association is not observed in girls with overweight/obesity.

Financial Literacy and Investment Decisions: A Study of Salaried Individuals in Kathmandu

Financial literacy refers to an individual's capacity to comprehend financial concepts, analyze financial information, and make informed financial decisions to attain financial objectives. This paper explores the relationship of financial literacy with the investment decisions made by salaried individuals in Kathmandu. It examined the effect of financial knowledge, financial attitude, and financial awareness on investment decisions. It explained whether there are any biases in terms of gender, monthly income, employment sector, employment level, and marital status when making investment decisions. A well-structured, close-ended questionnaire was conducted among 200 salaried people of Kathmandu working in different sectors. Analysis has been done using a hierarchical multiple regression model. The results show that financial attitude and financial awareness have a positive and significant impact on investment decisions. Surprisingly, financial knowledge, being positively correlated, does not have a substantial effect on investment decisions.None of the controlled variables were found to influence investment decisions significantly. Hence, financial attitude and awareness play a crucial role in salaried people's investment decisions.

Preventative self-regulatory primary care leadership in urban China: impact on physician well-being and medical service quality.

The study aims to address the gap between leaders' preventative self-regulatory focus and its impact on Chinese primary care physicians (PCPs) well-being, measured by work-family spillover stress and work exhaustion and on healthcare quality, measured by preventive service delivery and clinical guideline adherence. This paper conducted a cross-sectional in-person survey with 38 leaders and 224 PCPs in 38 primary health centers (PHCs) in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the regulatory focus theory, this paper built hierarchical linear regression models to examine the association between the leadership's regulatory focus and physician burnout, work-family conflict, clinic guideline adherence and preventive service delivery. This paper added the knowledge of leadership's regulatory focus impact on the well-being and medical service quality of PCPs. Prevention regulatory focus of leaders was significantly associated with work exhaustion and physicians' reported work-family conflict. There is no significant association between leadership's prevention regulatory focus and PCPs' preventive service delivery or clinical guideline adherence. Data on the regulatory focus of PCPs were not collected. Future studies should collect longitudinal data, allowing for exploration of the mechanism. This paper revealed that PHC leaders should restructure their leadership focus away from preventive regulatory behavior, promoting a team atmosphere and enhancing PCP attitudes, behaviors and well-being. To improve the well-being of PCPs and the quality of medical services, our results recommend a focus on establishing a positive organizational culture and addressing the emotional and professional needs of PCPs. To achieve these aims, policymakers should implement measures that promote a more comprehensive and balanced regulatory focus within PHC institutions. These measures should aim to create an environment that supports physician well-being and enhances the quality of healthcare services. Providing ample resources and support, promoting a collaborative team atmosphere and encouraging open communication are vital to empowering PCPs. This study examined the preventive regulatory focus of PHC leaders on the well-being and medical service quality of PCPs in China.

Estimating the burden of RSV- and influenza-associated hospitalizations, ICU admissions, and deaths across age and socioeconomic groups in New York State, 2005-2019.

Multiple prophylactic products are now available to protect against respiratory syncytial virus (RSV) in different age groups. Assessing the pre-intervention burden of RSV infections across various severity levels and risk groups is crucial, as it provides a baseline for evaluating the impact of these products. We obtained monthly time series data on hospitalizations, intensive care unit (ICU) admissions, and deaths by age group, ZIP code, and cause for New York state from 2005 to 2019. Socioeconomic status (SES) of the ZIP codes was classified using supervised principal component analysis (PCA). We estimated the incidence of hospitalizations, ICU admissions, and deaths attributable to RSV and to influenza using hierarchical Bayesian regression models. Additionally, we assessed severity, defined by ICU admission and mortality risks, as well as recording fraction (i.e., percent of estimated virus-associated hospitalizations recorded as being due to the specific virus), stratified by age, SES, and over time. The estimated annual incidence of RSV-associated hospitalizations and ICU admissions were highest in infants under 1 in the low SES group (2,240 [95% credible interval (CrI): 2,200-2,290] hospitalizations and 330 [95% CrI: 320-350] ICU admissions per 100,000 person-years). The incidence of RSV-associated deaths was highest among adults ≥85 years old (61 [95% CrI: 49-74] per 100,000 person-years). In contrast to RSV, the burden of influenza was greatest in age groups ≥65 years. The risk of ICU admission varied by patients' age and SES, and the mortality risk increased dramatically with age for both pathogens (RSV: 11.9% [95% CrI: 9.6-14.3%], influenza: 14.4% [95% CrI: 13.1-15.6%] among ≥85 year age group). Incidence varied by epidemic year and season, and we observed an increasing recording fraction of RSV among all age groups over the study period. RSV and influenza contribute significantly to the burden of hospitalizations, ICU admissions, and deaths, particularly among infants and older adults. Although the recording fraction of RSV increased over the study period, it remains lower, particularly for adults. Our findings reveal a disparity in hospitalization burden by SES, particularly among younger age groups.

Demographic inequities and cumulative environmental burdens within communities near superfund sites on Long Island, New York.

Nassau and Suffolk Counties of Long Island, New York are densely populated and contain 34 federally-designated and 449 state-designated Superfund sites, potentially exposing communities to toxic releases. We conducted a distributive justice analysis assessing proximity to Superfund sites, community socio-demographics, and other environmental burdens. Socio-demographic and environmental variables for 665 census tracts were obtained from the United States Census and Environmental Protection Agency's Environmental Justice Screening and Mapping Tool. Hierarchical Bayesian spatial Poisson regression models evaluated the relationship between socio-demographic and environmental variables and counts of Superfund sites per census tract. Analyses were further stratified by county and site type (Federal versus State). A 10% increase in low-income residents was associated with a 47% increase in Superfund sites (Risk Ratio [RR]: 1.47; 95% credible interval (CI): 1.20-1.81). A 10% increase in Hispanic/Latino residents was associated with a 20% increase (RR: 1.20; 95%CI: 1.02-1.42). Higher PM2.5 concentrations (RR:1.64, 95% CI: 1.09-2.48), higher toxic air releases (RR: 1.27, 95%CI: 1.03-1.61), and greater proximity to underground gas storage tanks (RR: 1.27, 95%CI: 1.09-1.48) were associated with increases in Superfund counts. Stratified analyses revealed that low-income residents are concentrated near state not federal Superfund sites. County stratification found that only Suffolk County residents near Superfund sites have increased lead exposure potential, and Black residents in Suffolk (not Nassau) were more likely to live near Superfund sites. We observed localized distributive inequities in community demographics near Superfund sites on Long Island, and communities near Superfund sites are more likely to experience other environmental burdens.

Analysis of drug pricing drivers under South Korea's pharmaco-economic evaluation exemption policy (2015-2022).

This study analysed the characteristics of new drugs listed under the pharmaco-economic evaluation exemption (PEE) system from 2015 to 2022 in South Korea and examined the factors influencing the pricing decisions under this system. A mixed-methods statistical approach was used to comprehensively evaluate the factors influencing drug pricing under PEE system. Descriptive statistics provide an overview of the dataset, while inferential statistics, including t-tests and Pearson's correlation analyses, are used to explore variable associations. Multiple and hierarchical regression models identify and quantify the key determinants of drug prices, controlling for multicollinearity among the variables. From 2015 to 2022, 30 new drugs were listed under the PEE system. The average annual number of new drugs was four, but this figure significantly increased to eight in 2022. The "KOR/A7 lowest" variable exhibited a strong negative correlation with the budget impact variable (coefficient: 0.838, P < 0.001), indicating that drugs with higher budget impact tend to have lower prices compared to the A7 countrie's lowest price. Since the introduction of the PEE system in South Korea, patient access to new drugs has significantly improved. However, the rising expenditure on pharmaceuticals has made budget impact a significant consideration in pricing decisions, highlighting the need for ongoing monitoring of drug expenditure by payers. As the system evolves, enhanced oversight and policy adjustments will be crucial for balancing cost containment with equitable patient access. Developing tiered RSA models based on drug classification or therapeutic impact could be a viable approach to achieving this balance.

Risk of Dementia and Its Associated Factors Among the Patients With Coronary Artery Disease Attending a Tertiary Cardiac Hospital of Dhaka City: A Cross-Sectional Study.

In Bangladesh, data related to the future risk of dementia and its associated factors are scarce. Furthermore, no dementia risk prediction tool has yet been applied to estimate the risk in any population in Bangladesh. Therefore, our objective was to assess the risk of dementia and its associated factors among patients with coronary artery disease (CAD). This cross-sectional study conveniently recruited 280 stable patients with CAD who were admitted for coronary revascularization at a tertiary cardiac hospital situated in Dhaka, Bangladesh. Data were collected face-to-face using a pretested questionnaire adapted from the WHO STEP-wise Approach to Surveillance (STEPS) of Noncommunicable Diseases Risk Factors questionnaire (Version 3.2). The questionnaire included background information (sociodemographic, comorbidity), behavioral and metabolic risk factors, physical and biochemical measurements. The next 20 years' risk of dementia was estimated using the "Cardiovascular Risk Factors, Aging, and Incidence of Dementia" score. The risk score, risk levels, and risk factors were presented descriptively. The associated factors of dementia risk were elucidated using hierarchical multiple regression analysis. The mean ( ± standard deviation) risk score for dementia was 6.26 ± 2.28. The predicted "at-risk" population was 63.6%. The prevalent risk factors were unhealthy diets (84.3%) presented by inadequate fruit/vegetable consumption (70%) and added salt intake (46.4%). In the final model of hierarchical multiple regression, the risk score showed a significant association with several risk factors: family history of diabetes (p = 0.03), alcohol intake (p = 0.03), current smoking (p = 0.03), estimated glomerular filtration rate (p = 0.001), and diastolic blood pressure (p = 0.02). A substantial proportion of patients with CAD had a future risk of dementia which demands an urgent risk reduction strategy in Bangladesh. Future longitudinal studies may more precisely justify the current findings.

Preparing adolescents and young adults with epilepsy for transitioning health care (PATH) study: The important role of age and self-efficacy

BackgroundAt least 30 % of youth with epilepsy will require transition from pediatric to adult neurology care. Many adolescents and young adults (AYAs) with epilepsy are inadequately prepared for health care transition, which may contribute to health care disruptions and decreased quality of life. The current study aimed to add to the growing body of literature on health care transition in epilepsy by characterizing a sample of AYAs with epilepsy and assessing the relationship between pre-existing and behaviorally modifiable factors and epilepsy-specific transition readiness. Methods103 AYAs (Mage = 17.56; range = 14–21; 54 % female; 85 % White) with epilepsy and 84 of their caregivers were enrolled from two pediatric hospitals in the United States. Participants provided sociodemographic and medical information and completed questionnaires assessing functioning, epilepsy management, and transition readiness. Data were analyzed using a two-step hierarchical multiple linear regression model with epilepsy-specific transition readiness as the outcome: 1) pre-existing factors (i.e., age, insurance, seizure severity); and 2) behaviorally modifiable factors (i.e., cognitive functioning, medication self-management, epilepsy self-efficacy). ResultsOnly 44 % of AYAs had discussed health care transition with their pediatric neurologist. The final model was significant, ΔF (3, 90) = 13.45, p < 0.001. Older age and greater epilepsy self-efficacy were associated with greater epilepsy-specific transition readiness. ConclusionAYAs with greater epilepsy self-efficacy may be better prepared for the transition from pediatric to adult neurology care. Routine assessment of epilepsy self-efficacy and transition readiness starting in early adolescence may help to identify individuals who could benefit from targeted interventions.

Teammate Communication, Loneliness, and Contagion of Athlete Burnout.

Communication among teammates can influence sport experiences of athletes, including burnout. This might occur through sharing of burnout perceptions, fostering development of burnout perceptions in teammates (i.e., contagion). Contagion of burnout may depend on communication frequency with teammates as well as intrapersonal social constructs like loneliness, which can impact attentiveness to or interpretation of communication from others. Our study purpose was to (a) examine if exposure to teammate burnout predicted athlete burnout later in the season and (b) examine if loneliness moderated this relationship. Twice across their season, adolescent softball and baseball athletes (N = 176; 15 teams) completed two network questions about the frequency of speaking with teammates and closest friends on the team, respectively, and established measures of loneliness and burnout. Hierarchical linear regression models were estimated, one for each network question, for global burnout and burnout dimensions. Initial burnout perceptions (βs = .58-.72, ps < 0.001) predicted burnout perceptions at time two. Loneliness (βs = .15-.20 p< .05) predicted global, exhaustion, and reduced accomplishment burnout perceptions at time two. Exposure to teammates' global burnout (β = .12, p< .05) predicted global burnout perceptions at time two. Exposure to closest friends' burnout did not predict burnout at time two and loneliness did not moderate exposure-burnout relationships. Results offered some support for burnout contagion among adolescent athletes through spoken communication with teammates at practice. Future work should examine communication content to assess if and how particular messages from teammates contribute to athlete burnout perceptions.

Characterizing autogenous and reactive obsessions using theta and beta oscillations under inhibitory demands.

Obsessive-Compulsive Disorder (OCD) is a heterogenous mental health condition that causes significant impairment and is often associated with poor treatment outcomes. The aim of the current study was to examine the association between electroencephalographic (EEG) oscillatory power during inhibitory task performance and obsessive-compulsive symptoms (OCS). OCS was assessed using the well-established the Autogenous-Reactive Obsession (AO-RO) model as the main framework to address its heterogeneous clinical manifestations. The severity of AO and RO, as primary outcome measures, was indexed using the Revised Obsessive Intrusion Inventory (ROII). Cognitive- and behavioral inhibition (CI; BI) tasks were administered while EEG data were recorded from an analogue sample of 63 undergraduate students with OCS assessed along a dimensional spectrum. Oscillatory power was computed from frontal-central electrodes Fz and Cz for theta and beta frequency bands, using event-related spectral perturbations (ERSPs), which were entered into two hierarchical linear regression models to predict the severity of AO and RO, respectively, while controlling for covariates (i.e., sex, age, ethnicity, anxiety, depression, worry, and behavioral task performance). Theta power during CI (Theta-CI) was the only significant EEG predictor of AO severity, whereas beta power during BI (Beta-BI) was the only significant EEG predictor of RO severity. These results suggest that AO severity is primarily associated with an overactive neural correlate of cognitive control, whereas RO severity is primarily associated with an overactive neural correlate of behavioral cancellation. These results agree with previous literature suggesting overactive band power representing the dysfunction within OCD. Theta-CI and Beta-BI may serve as potential biomarkers differentially associated with AO and RO among undiagnosed individuals displaying varying levels of OCS, which warrants further investigation.

Understanding the Impact of Upper Extremity Musculoskeletal and Comorbid Health Conditions on Physical and Mental Health and Quality of Life in 956 Adults Aged 50 to 65

The objective of the study was to examine the relationship and impact of comorbidity, pain, and function on quality of life in people aged 50-65 with upper extremity musculoskeletal disorders (UED), controlling for sex, occupational status, and age. This was a cross-sectional study. We performed hierarchical linear regression models to assess the extent that comorbidity and injury-related pain and disability affected overall health-related quality of life measured by the SF-36. We included 956 patients, of whom 601 were female. Physical and mental disability were associated significantly with lower levels of UE functional capacity (effect &lt;sub&gt;physical health &lt;/sub&gt;&amp;#61; 0.24, SE &amp;#61; 0.10, &lt;i&gt;P&lt;/i&gt; &amp;#60; 0.001; effect&lt;sub&gt; mental health&lt;/sub&gt; &amp;#61; 0.17, SE &amp;#61; 0.09, &lt;i&gt;P&lt;/i&gt; &amp;#60; 0.05). Comorbidity, pain, and occupational status have indirect relationships with UED, such that greater pain, a larger burden of comorbid health conditions, and less participation in the workforce, is associated with poorer physical and mental health. Mobility is key in promoting health and quality of life while contributing towards a successful transition into retirement.

Urinary Incontinence in Men with Stroke: A Cross-Sectional Study.

Background and Objectives: To evaluate urinary incontinence (UI) and its effect on quality of life (QoL) in male stroke patients. Materials and Methods: A quantitative cross-sectional study was conducted with 103 adult male stroke survivors. The individuals' degree of disability was evaluated using the Modified Rankin Scale (MRS) and Barthel Index (BI). The UI assessment was performed with the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7). In addition, the QoL was questioned with EuroQoL 5-Dimension 3-Level (EQ-5D-3L)". Results: The mean age of the participants was 68.4 ± 9.9 years. The average scores of the IIQ-7 and UDI-6 were 9.7 ± 7.2 and 36.6 ± 26.3, respectively. According to these scores, both UI questionnaire results were slightly above the reference cut-off value. According to the UDI-6 scores, 52.4% of the participants exhibited symptoms, while 55.3% demonstrated symptoms according to the IIQ-7 scores. The IIQ-7 was strongly correlated with the MRS (p < 0.001, r = 0.740), BI (p < 0.001, r = -0.770), EQ-5D-3L Index (p < 0.001, r = -0.804), and EQ-5D-3L VAS (p < 0.001, r = -0.679) scores. In addition, the UDI-6 was strongly correlated with the MRS (p < 0.001, r = 0.697), BI (p < 0.001, r = -0.730), EQ-5D-3L Index (p < 0.001, r = -0.726), and EQ-5D-3L VAS (p < 0.001, r = -0.623) scores. Furthermore, the IIQ-7 and UDI-6 scores were statistically higher in patients with cortical-level involvement (p < 0.05). Regression results showed that the IIQ-7 was associated with the MRS, BI, EQ-5D-3L Index, and EQ-5D-3L VAS scores (R2 = 0.627, p < 0.001). Similarly, the UDI-6 was significantly associated with the MRS, BI, EQ-5D-3L Index, and EQ-5D-3L VAS scores in a multiple hierarchical regression model (R2 = 0.423, p < 0.001). Conclusions: The severity of UI was classified as high. As expected, UI was higher in individuals with increased disability. The QoL of individuals with UI is more negatively affected. Finally, the severity of UI was higher in individuals with cortical stroke.

PERSONALITY TRAITS AS PREDICTORS OF BURNOUT IN SANDWICH GENERATION CAREGIVERS

Abstract Informal caregiving increases the risk for burnout (i.e., emotional exhaustion, detachedness in caregiving relationships, reduced sense of accomplishment through helping). Sandwich generation caregivers, individuals who provide care for their children and older parents, face unique challenges and experience greater burnout than individuals caring for children alone. However, little research has examined what factors are associated with outcomes such as burnout in sandwich generation caregivers. Furthermore, studies on sandwich generation caregivers rarely utilize a resiliency-based approach. This study aimed to examine whether Big Five personality traits (i.e., openness, conscientiousness, extraversion, agreeableness, neuroticism) predicted burnout in sandwich generation caregivers (N = 102). A hierarchical regression model controlling for demographics, R² =.007, F(3, 98) =.222, p =.881, indicated that openness, conscientiousness, agreeableness, and neuroticism explained an additional 32.9% of the variance. This change in R² was significant, F(4, 94) = 11.628, p &amp;lt;.001, with openness (β = -.215), conscientiousness (β = -.265), and neuroticism (β =.257) the only significant independent predictors, R² =.336, F(7, 94) = 6.781, p &amp;lt;.001. In a different regression model, which controlled for depression, neuroticism was no longer a significant independent predictor. These results suggest that sandwich generation caregivers with higher levels of openness and conscientiousness and lower levels of neuroticism may experience lower levels of burnout. Findings from this study enhance our understanding of sandwich generation caregivers and what personality traits may serve as resiliency factors towards decreasing burnout. Further research can examine modifiable elements of these traits to increase resiliency.