Log-binomial Models Research Articles

Early Life Disadvantage and the Risk of Depressive Symptoms among Young Black Women.

We examined the association between early-life socioeconomic disadvantage and depressive symptoms in adulthood and assessed whether social factors in adulthood modify the association. The11-item Center for Epidemiologic Studies-Depression Scale (CES-D) assessed adult depressive symptoms among 1612 Black women and other participants with a uterus (hereafter participants) in the Study of Environment, Lifestyle and Fibroids. Baseline self-reported childhood factors (i.e., parents in the household, mother's educational attainment, food insecurity, neighborhood safety, childhood income, and quiet bedroom for sleep) were included in a latent class analysis to derive an early life disadvantage construct. Multivariable log-binomial models estimated the association between early life disadvantage and adult depressive symptoms. Potential effect modifiers included adult educational attainment, social support, and financial difficulty. Participants classified as having high early life disadvantage had 1.34 times (95% CI: 1.20, 1.49) the risk of high depressive symptoms than those in the low early life disadvantage class after adjusting for age, first born status, and childhood health. Adult educational attainment and social support modified the association. Early life disadvantage increased the risk of depressive symptoms in adulthood. Participants with at least some college education and with high social support had greater risk than those with less than college education and low social support, respectively. Thus, the mental health ofBlack women and other participants with a uterusexposed to early life disadvantage do not necessarily benefit from higher education or from social support.

Substance use and other factors associated with COVID-19 vaccine uptake among people at risk for or living with HIV: Findings from the C3PNO consortium

ObjectiveWe describe the prevalence of COVID-19 vaccine uptake, substance use, and other factors associated with vaccine hesitancy among participants from nine North American cohort studies following a diverse group of individuals at risk for or living with HIV. MethodsBetween May 2021 and January 2022, participants completed a survey related to COVID-19 vaccination. Participants included those with and without substance use. Those responding as ‘no’ or ‘undecided’ to the question “Do you plan on getting the COVID-19 vaccine?” were categorized as vaccine hesitant. Differences between groups were evaluated using chi-square methods and multivariable log-binomial models were used to calculate prevalence ratios (PR) of COVID-19 vaccine hesitancy with separate models for each substance. ResultsAmong 1,696 participants, COVID-19 vaccination was deferred or declined by 16%. Vaccine hesitant participants were younger, with a greater proportion unstably housed (14.8% vs. 10.0%; p = 0.02), and not living with HIV (48.% vs. 36.6%; p <.01). Vaccine hesitant participants were also more likely to report cannabis (50.0% vs. 42.4%; p = 0.03), methamphetamine (14.0% vs. 8.2%; p <.01), or fentanyl use (5.5% vs. 2.8%; p = 0.03). Based on multivariable analyses methamphetamine or fentanyl use remained associated with COVID-19 vaccine hesitancy (Adjusted PR = 1.4; 95% CI 1.1–1.9 and Adjusted PR = 1.6; 95% CI 1.0–2.6, respectively). ConclusionAs new COVID-19 vaccines and booster schedules become necessary, people who use drugs (PWUD) may remain vaccine hesitant. Strategies to engage hesitant populations such as PWUD will need to be tailored to include special types of outreach such as integration with substance use programs such as safe injection sites or recovery programs.

Association between season of conception, month of conception with preterm birth in China: a population-based retrospective cohort study

BackgroundSeasonal patterns of preterm birth were identified in previous studies, but the effect of conception season on preterm birth has not been extensively studied. Based on the notion that the etiological roots of preterm birth lie in the beginning of pregnancy, we did a population-based retrospective cohort study in Southwest China to examine the effects of season of conception and month of conception on preterm birth.MethodsWe did a population-based retrospective cohort study in women (aged 18–49) who participated in the NFPHEP from 2010 to 2018, and had a singleton livebirth in southwest China. According to the time of the last menstruation reported by the participants, month of conception and season of conception were then ascertained. We used multivariate log-binomial model to adjust the potential risk factors for preterm birth and obtained adjusted risk ratio (aRR) and 95% confidence intervals (95%CI) for conception season, conception month and preterm birth.ResultsAmong 194 028 participants, 15 034 women had preterm birth. Compared with pregnancies that were conceived in the summer, pregnancies that were conceived in the spring, autumn and winter had the higher risk of preterm birth (Spring: aRR = 1.10, 95% CI: 1.04–1.15; Autumn: aRR = 1.14, 95% CI: 1.09–1.20; Winter: aRR = 1.28, 95% CI: 1.22–1.34) and also had a higher risk of early preterm birth (Spring: aRR = 1.09, 95% CI: 1.01–1.18; Autumn: aRR = 1.09, 95% CI: 1.01–1.19; Winter: aRR = 1.16, 95% CI: 1.08–1.25). Pregnancies in December, and January had a higher risk of preterm birth and early preterm birth than pregnancies that were conceived in July.ConclusionsOur study found that preterm birth was significantly related to season of conception. Preterm and early preterm birth rates were the highest among pregnancies that were conceived in winter, and the lowest among pregnancies in summer.

Obesity as a Predictor for Pulmonary Embolism and Performance of the Age-Adjusted D-Dimer Strategy in Obese Patients with Suspected Pulmonary Embolism.

Obesity is a risk factor for venous thromboembolism, but studies evaluating its association with pulmonary embolism (PE) in patients with suspected PE are lacking. To evaluate whether body mass index (BMI) and obesity (i.e., BMI ≥30 kg/m2) are associated with confirmed PE in patients with suspected PE and to assess the efficiency and safety of the age-adjusted D-dimer strategy in obese patients. We conducted a secondary analysis of a multinational, prospective study, in which patients with suspected PE were managed according to the age-adjusted D-dimer strategy and followed for 3 months. Outcomes were objectively confirmed PE at initial presentation, and efficiency and failure rate of the diagnostic strategy. Associations between BMI and obesity, and PE were examined using a log-binomial model that was adjusted for clinical probability and hypoxia. We included 1,593 patients (median age: 59 years; 56% women; 22% obese). BMI and obesity were not associated with confirmed PE. The use of the age-adjusted instead of the conventional D-dimer cut-off increased the proportion of obese patients in whom PE was considered ruled out without imaging from 28 to 38%. The 3-month failure rate in obese patients who were left untreated based on a negative age-adjusted D-dimer cut-off test was 0.0% (95% confidence interval: 0.0-2.9%). BMI on a continuous linear scale and obesity were not predictors of confirmed PE among patients presenting with a clinical suspicion of PE. The age-adjusted D-dimer strategy appeared safe in ruling out PE in obese patients with suspected PE.

Association between Livestock Ownership and Malaria Incidence in South-Central Ethiopia: A Cohort Study.

Zooprophylaxis is one of the possible environmental vector control strategies for malaria prevention. However, its effect on reducing malaria transmission has been questionable, requiring a detailed understanding of contextual factors. This study aims to evaluate the effect of keeping livestock on malaria incidence in south-central Ethiopia. A cohort of 34,548 people in a total of 6,071 households was followed for 121 weeks from October 2014 to January 2017. Baseline data were collected, including livestock ownership. Weekly home visits were done to actively search for malaria cases, and passive case detection was also carried out. Malaria was diagnosed with rapid diagnostic tests. Log binomial and parametric regression survival-time models were used to estimate effect measures. A total of 27,471 residents had complete follow-ups, and the majority (87.5%) lived in households owning livestock, including cattle, sheep, goats, and chickens. The overall incidence risk of malaria was 3.7%, and there was a 24% reduction in the risk of malaria among livestock owners. The total cohort contributed to 71,861.62 person-years of observation. The incidence rate of malaria was 14.7 cases per 1,000 person-years. There was a 17% reduction in the rate of malaria among livestock owners. Meanwhile, the protective effect of livestock ownership increased as the number of livestock or the livestock-to-human ratio increased. In conclusion, livestock owners had less malaria. In a setup where domestication of livestock is a common practice and the predominant malaria vector tends to feed more on livestock than humans, zooprophylaxis remains a promising strategy for malaria prevention.

Commercial vs. Medicaid insurance and use of high-priced anticancer treatments.

6599 Background: Financial incentives presented by the larger markups on cancer drugs among commercial payors may result in increased use of high-priced drugs among commercially insured vs. Medicaid insured patients. We evaluated the association between patient insurance type and the likelihood of receiving higher-priced treatments. Methods: We linked cancer registry, administrative claims, and demographic data for individuals diagnosed with cancer in North Carolina from 2004-2011, who had either commercial or Medicaid insurance. We selected cancer types with multiple FDA-approved, guideline-recommended chemotherapy options, and large differences in price between the higher-priced and lower-priced options during the study period: advanced colorectal, lung, and head-and-neck cancer (HNC). The primary outcome was receipt of the higher-priced treatment option, and the primary exposure was insurance type: commercial vs. Medicaid. We estimated risk ratios (RR) for the association between insurance type and higher-priced treatment using log binomial models with inverse probability of exposure weights to control confounding by age, county-level poverty prevalence, and selected comorbidities. We assessed for potential modification of the RR by setting (hospital outpatient vs. physician office) and academic designation (NCI-designated comprehensive cancer center vs. other); these were exploratory analyses due to sparse data and subsequently limited confounding control. Results: Of 812 patients: 209 (26%) had Medicaid insurance; 311 (38%) had NHC, 263 (32%) colon or rectal cancer, and 238 (29%) lung cancer. The crude risk of higher-priced treatment was 36% (215/603) for commercially insured and 27% (57/209) for Medicaid insured (RR:1.31, 95%CI 1.02-1.67). After weighting the association was attenuated (RR:1.15, 95%CI 0.81-1.65). While limited by imprecision and the potential for uncontrolled confounding, exploratory subgroup analysis suggested that, compared to Medicaid insurance, commercial insurance was associated with numerically higher risk of higher-priced treatment among patients treated by non-NCI designated providers (RR:1.53, 95%CI 1.14-2.04), and within both the physician office (RR:1.36, 95%CI 0.95-1.95) and hospital outpatient (RR:1.08, 95%CI 0.58-2.02) settings, but lower risk of high-priced treatment within NCI cancer centers (RR:0.39, 95%CI 0.22-0.71). Conclusions: Individuals with Medicaid vs. commercial insurance access high-priced treatments at a similar proportion after accounting for differences in case mix, morbidity, and SES. However, modification of the association by and academic setting, observed in exploratory subgroup analysis, suggests the possibility that insurance type may affect treatment for some patient groups. This study was limited by focus on a single state and the potential for residual confounding.

Physical activity for depression among the chronically Ill: Results from older diabetics in the Irish longitudinal study on ageing

Among chronically-ill older adults, the benefits of moderate-to-vigorous physical activity (MVPA) are established. Comorbid depressive symptoms and Major Depression are prevalent among the chronically-ill, but how different doses of MVPA may protect against depression remains understudied. Thus, using 10 years of data from The Irish Longitudinal Study on Ageing, we quantified longitudinal associations between MVPA doses and depressive symptoms and Major Depression among chronically-ill older adults living with type 2 diabetes (T2DM). Continuous MVPA (MET.min.week−1), three dose and five dose MVPA categories were examined. Depressive symptoms and Major Depression were measured using the center for Epidemiological Studies Depression and the Composite International Diagnostic Interview for Major Depressive Episode. Negative binomial regression and logistic models, adjusted for covariates, quantified associations across time. Among the 2,262 participants, those adhering to the WHO guidelines of 600-<1,200 MET.min.week−1 had 28% lower odds of Major Depression compared to those not achieving the guidelines (OR: 0.72; 95%CI: 0.53–0.98). For depressive symptoms, a higher MVPA dose was required with a 13% (IRR: 0.87; 95%CI: 0.82–0.93) lower rate of symptoms among those exceeding recommendations (1200-<2,400 MET.min.week−1). Interventions should focus on enhancing achievability of and compliance with these MVPA doses among the chronically-ill, including T2DM, to protect against depression.

Adverse birth outcomes among offspring born to women diagnosed with cancer: a population-based cohort study

With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and oncology management. However, the effects of different types of cancer at different gestational stages have not been widely reported. To describe the epidemiological characteristics of pregnancy-associated cancers (during and one year after pregnancy) and evaluate the association between adverse birth outcomes and maternal cancers. Of 983,162 children, a history of maternal cancer, including pregestational cancer, pregnancy-associated cancer and subsequent cancer, was identified in 16,475 cases using a health information network. The incidence and 95% confidence interval (CI) of pregnancy-associated cancer were calculated with the Poisson distribution. The adjusted risk ratio (RRadj) with 95%CI of the association between adverse birth outcomes and maternal cancer were estimated using the multilevel log binomial model. A total of 38,295 offspring were born to mothers with a cancer history. Of these, 2,583 (6.75%) were exposed to pregnancy-associated cancer, 30,706 (80.18%) had a subsequent cancer diagnosis, and 5006 (13.07%) were exposed to pregestational cancer. The incidence of pregnancy-associated cancer was 2.63/1000 pregnancies (95%CI: 2.53-2.73‰), with cancer of the thyroid (1.15‰), breast (0.25‰), and female reproductive organs (0.23‰) being the most common cancer types. The increased risks of preterm birth and low birth weight were significantly associated with cancer diagnosed during the second and third trimester of pregnancy, while increased risks of birth defects (RRadj=1.48, 95%CI: 1.08-2.04) were associated with cancer diagnosed in the first trimester. An increased risk of preterm birth (RRadj=1.16, 95%CI: 1.02-1.32), low birth weight (RRadj=1.24, 95%CI: 1.07-1.44), and birth defects (RRadj=1.22, 95%CI: 1.10-1.35) was observed in thyroid cancer survivors. Careful monitoring of fetal growth should be implemented for women diagnosed with cancer in the second and third trimester, to ensure timely delivery and balance the benefits of neonatal health and cancer treatment. The higher incidence of thyroid cancer and increased risk of adverse birth outcomes among thyroid cancer survivors suggested that the regular thyroid function monitoring and regulation of thyroid hormone levels are important in maintaining pregnancy and promoting foetal development among thyroid cancer survivors before and during pregnancy.

Differential in-hospital mortality and intensive care treatment over time: Informing hospital pathways for modelling COVID-19 in South Africa.

There are limited published data within sub-Saharan Africa describing hospital pathways of COVID-19 patients hospitalized. These data are crucial for the parameterisation of epidemiological and cost models, and for planning purposes for the region. We evaluated COVID-19 hospital admissions from the South African national hospital surveillance system (DATCOV) during the first three COVID-19 waves between May 2020 and August 2021. We describe probabilities and admission into intensive care units (ICU), mechanical ventilation, death, and lengths of stay (LOS) in non-ICU and ICU care in public and private sectors. A log-binomial model was used to quantify mortality risk, ICU treatment and mechanical ventilation between time periods, adjusting for age, sex, comorbidity, health sector and province. There were 342,700 COVID-19-related hospital admissions during the study period. Risk of ICU admission was 16% lower during wave periods (adjusted risk ratio (aRR) 0.84 [0.82-0.86]) compared to between-wave periods. Mechanical ventilation was more likely during a wave overall (aRR 1.18 [1.13-1.23]), but patterns between waves were inconsistent, while mortality risk in non-ICU and ICU were 39% (aRR 1.39 [1.35-1.43]) and 31% (aRR 1.31 [1.27-1.36]) higher during a wave, compared to between-wave periods, respectively. If patients had had the same probability of death during waves vs between-wave periods, we estimated approximately 24% [19%-30%] of deaths (19,600 [15,200-24,000]) would not have occurred over the study period. LOS differed by age (older patients stayed longer), ward type (ICU stays were longer than non-ICU) and death/recovery outcome (time to death was shorter in non-ICU); however, LOS remained similar between time periods. Healthcare capacity constraints as inferred by wave period have a large impact on in-hospital mortality. It is crucial for modelling health systems strain and budgets to consider how input parameters related to hospitalisation change during and between waves, especially in settings with severely constrained resources.

Evaluation of workplace infection prevention and control measures for COVID-19: A prospective cohort study in Japan

BackgroundEncouraging the implementation of infection prevention and control (IPC) measures has been necessary to prevent workplace infections caused by the coronavirus disease 2019 (COVID-19). However, the effectiveness of these measures in reducing infections has not been thoroughly evaluated. We evaluated employees’ COVID-19 infection rates in relation to the implementation of IPC measures at their workplaces to identify effective workplace measures. MethodsThis prospective cohort study was conducted between December 2020 and December 2021 using Internet-based self-assessment questionnaires, with 11,982 participants included from the baseline. To estimate whether implementing workplace IPC measures was associated with COVID-19 incidence rates among participants, we estimated multivariate-adjusted relative risk (RR) using a log-binomial model. ResultsAfter adjusting for sex, age, education, household members, occupation-related factors, and personal preventive behaviors, requesting ill employees to refrain from going to work showed significantly lower COVID-19 infection rates than not requesting it (RR: 0.56, 95% CI: 0.34–0.91, p = 0.019). ConclusionsEmployees restricted from reporting to work when ill had significantly lower COVID-19 infection rates than those who did not follow this measure. The results indicated that not coming to work when ill was effective in reducing COVID-19 infections at the workplace. We suggest that companies proactively adopt this policy and encourage their employees to comply with it.

Experiences of Discrimination and Treatment Outcomes Among Pregnant and Postpartum People With Opioid Use Disorder [ID: 1376917

INTRODUCTION: Experiences of discrimination among pregnant and postpartum people with opioid use disorder (OUD) are common and likely affect utilization of medication for OUD (MOUD), which is associated with reduced risk of overdose and death. We aimed to examine experiences of discrimination by prenatal care (PNC) and substance use disorder (SUD) treatment settings and estimate its effect on the risk of various MOUD utilization outcomes. METHODS: Patient-stakeholders co-designed survey questions to measure self-reported outcomes related to MOUD treatment utilization, return to substance use, and overdose. First, we examined the proportion of participants who endorsed items on a modified Healthcare Discrimination Scale and summed the total scores. Next, we quantified the effect of discrimination experienced by health care setting on postpartum MOUD utilization, return to use, and overdose using log-binomial models to calculate relative risk (RR) and 95% CIs. RESULTS: Among the 100 participants enrolled in the study, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD treatment settings. Discrimination within PNC (RR 2.6, CI 1.06–6.40) and SUD treatment (RR 3.26, CI 1.59–6.70) were associated with increased risk of not using MOUD as prescribed. Discrimination within SUD treatment settings correlated with an increased risk of MOUD discontinuation (RR 2.56, CI 1.19–5.54) and return to use (RR 2.36, CI 1.18–4.73). CONCLUSION: Experiences of discrimination were common, especially within prenatal care settings, and discrimination was associated with poor MOUD treatment outcomes and risk of return to use. Interventions to address discrimination within health care settings can improve outcomes for pregnant and postpartum people with OUD.

Self-efficacy in predicting smoking cessation: A prospective study in Italy.

Predicting the success of smoking cessation might be crucial to guide towards the treatment of smoking dependence in a clinical setting. We analyzed the potential determinants of successful smoking cessation with a specific focus on self-efficacy in predicting quitting smoking. All consecutive smokers (n=478; 224 men and 254 women) attending the Careggi University Hospital Smoking Cessation Service in Florence (Italy) in 2018-2019 provided information on self-efficacy in predicting smoking cessation, using a 1-10 rating scale during their first visit. Patients were followed up for success in quitting smoking at 3, 6 and 12 months, validated through CO exhaled measurement. To evaluate the association between self-efficacy and the probability of success, we estimated multivariable relative risks (RRs) and corresponding 95% confidence intervals (CIs) through log-binomial models for longitudinal data. Overall, 47.9% of smokers succeeded in their attempt to quit at 3 months, 40.2% at 6 months, and 33.9% at 12 months. Compared to low self-efficacy (rating scale 1-5), the RR of success in quitting smoking was 1.40 (95% CI: 1.06-1.85) for intermediate self-efficacy (scale 6-7) and 1.64 (95% CI: 1.28-2.12) for high self-efficacy (scale 8-10). Self-efficacy is an independent determinant of smoking cessation. We recommend to systematically collect self-efficacy, together with other relevant variables, to predict successful smoking cessation. Moreover, strategies to develop and maintain high levels of self-efficacy are essential to increase quit success and improve treatment.

Socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada.

Pacifier use can interfere with nurturing care practices such as breastfeeding, soothing, and sleeping. Due to contradicting beliefs, recommendations, and the high frequency of pacifier use, understanding its associations may support shaping equitable public health recommendations. This study explored the socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada. Cross-sectional survey was conducted in 2021 with a sample of mothers (n = 276) of infants under six months old in Clark County, Nevada. Participants were recruited through advertisements in birth, lactation, pediatric care centers, and social media. We used binomial and multinomial logistic models to assess the association between pacifier use and the age of pacifier introduction, respectively, with household, maternal, infant, healthcare characteristics, and feeding and sleeping practices. More than half of the participants offered pacifiers (60.5%). Pacifier use was higher among low-income households (OR (95% CI) 2.06 (0.99-4.27)), mothers who identified as non-Hispanic (OR (95% CI) 2.09 (1.22-3.59)), non-first-time mothers (OR (95% CI) 2.09 (1.11-3.05)), and bottle-feeding infants (OR (95% CI) 2.76 (1.35-5.65)). Compared to those who did not introduce a pacifier, non-Hispanic mothers (RRR (95% CI) 2.34 (1.30-4.21)) and bottle-fed infants (RRR (95% CI) 2.71 (1.29-5.69)) had a higher risk of introducing pacifier within two weeks. Likewise, infants living in food insecure households (RRR (95% CI) 2.53 (0.97-6.58)) and mothers who have more than one child (RRR (95% CI) 2.44 (1.11-5.34)) had a higher risk of introducing a pacifier after two weeks. Pacifier use is independently associated with maternal income, ethnicity, parity, and bottle feeding among six-month-old infants living in Clark County, Nevada. Household food insecurity increased the relative risk of introducing a pacifier after two weeks. Qualitative research on pacifier use among families with diverse ethnic/racial backgrounds is needed to improve equitable interventions.

Sensory impairment and algorithmic classification of early cognitive impairment.

Sensory impairment (SI) is linked to cognitive decline, but its association with early cognitive impairment (ECI) is unclear. Sensory functions (vision, hearing, vestibular function, proprioception, and olfaction) were measured between 2012 and 2018 in 414 Baltimore Longitudinal Study of Aging (BLSA) participants (age 74±9 years; 55% women). ECI was defined as 1 standard deviation below age-, sex-, race-, and education-specific mean performance in Card Rotations or California Verbal Learning Test immediate recall. Log binomial models (cross-sectional analysis) and Cox regression models (time-to-event analysis) were used to examine the association between SI and ECI. Cross-sectionally, participants with ≥3 SI had twice the prevalence of ECI (prevalence ratio=2.10, p=0.02). Longitudinally, there was no significant association between SI and incident ECI over up to 6 years of follow-up. SI is associated with higher prevalence, but not incident ECI. Future studies with large sample sizes need to further elucidate the relationship between SI and ECI. Sensory impairment is associated with high prevalence of early cognitive impairmentMultisensory impairment may pose a strong risk of early changes in cognitive functionIdentifying multisensory impairment may help early detection of dementia.

Adolescent Girls’ Early Marriage Intention and its Determinants in Eastern Ethiopia: A Social Norms Perspective

This study aimed to identify the association of perceived social norms with intention of early marriage practice among unmarried adolescent girls (13–17 years) in Kersa Demographic and Health Surveillance System. A community-based cross-sectional study was conducted during September–November 2019. Adolescent girls’ marriage intention was assessed using social norm measuring tools. The log-binomial model was used to identify factors associated with girls’ intention. Adjusted prevalence ratio along with 95% CIs was executed to determine the association of main independent variables with girl’s intention. A total of 859 adolescent girls participated in the study. The prevalence of intention to marry before the age of 18 years among adolescent girls was 44.47% (95% CI [0.41%, 0.48%]). The intention for an early marriage was higher among those with positive attitude toward early marriage, in those who believe that most people in their reference group conform to early marriage norms (empirical expectation), in those who believe that most people in their reference group expect them to conform to early marriage norms (normative expectation) and who fear sanction related to early marriage practices. Moreover, residence in urban areas and high educational level by girls and their parents was associated with reduced prevalence ratio. There is strong social norm in the community that promotes intention for an early marriage among adolescent girls in the study area. Hence, interventions that aim to reduce early marriage need to address local social norms.

Evaluation of the Thoracic Surgery Integrated Care Program at the University Health Network

Introduction: In 2019, the University Health Network (UHN) implemented the Integrated Care (IC) program in the Thoracic Surgery Department. This program aims to facilitate the transition from hospital to community care for patients by providing support including accessible communication with an IC lead. Based on surgical procedure, patients were placed into low, medium, or high care paths. The IC program evaluation investigated risk of readmission and emergency department (ED) visits up to 90 days post-discharge in thoracic surgery patients. Methods and Analysis: This retrospective cohort study used IC cohorts: 1) Original IC patients discharged from June 2019 - Feb 2020, 2) New IC patients discharged from March 2020 – March 2022 3) Combined IC patients discharged from June 2019 – March 2022. These cohorts were compared to historical patients discharged from June 2018 - Feb 2019. Stratified by care path, readmission and ED visit risk were modelled using log-binomial models, adjusting for age, sex, and residence status. Outcomes: The new IC cohort had higher proportions of ED visits and readmissions compared to all other IC cohorts. In the low care path, there was a 15% reduction in readmission risk (RR: 0.85; 95% CI: 0.56, 1.28) in the new IC cohort compared to historical while there was a 20% reduction in readmission risk (RR: 0.81; 95% CI: 0.55, 1.19) in the combined IC cohort compared to historical. Similar trends followed for ED visits. Confidence intervals indicated insufficient evidence to conclude statistically significantly differences between cohorts. Conclusion: When comparing the results with the original IC cohort, there were higher proportions of readmission and ED visits in the new IC cohort. The attenuation of the risk ratio in the new IC cohort compared to the combined IC cohort (RR: 0.85 vs 0.81) suggests the IC program is less effective with new patients.

The Association Between Surgical Axillary Staging, Adjuvant Treatment Use and Survival in Older Women with Early Stage Breast Cancer: A Population-Based Study.

Choosing Wisely guidelines recommend against surgical axillary staging (AS) in women ≥70 years with ER+/HER2- early stage breast cancer (BC). This study examined the impact of AS omission on survival in older patients with BC. This was a population-based cohort study using health administrative data in Ontario, Canada. We identified women aged 65-95 years who underwent surgery for Stage I/II BC between 2010 and 2016. Patients were weighted by propensity scores for receipt of AS that included patient and disease characteristics using overlap weights. Association with overall survival (OS) was calculated using weighted Cox models, and breast cancer-specific survival (BCSS) was calculated using weighted Fine and Gray models, adjusting for biomarkers and adjuvant treatments. Adjuvant treatment receipt was modelled with weighted log-binomial models. Among 17,370 older women, the 1771 (10.2%) who did not undergo AS were older, more comorbid, and less likely to undergo mastectomy. Women who did not undergo AS were less likely to receive adjuvant chemotherapy (RR 0.68, 95% CI 0.57-0.82), endocrine therapy (RR 0.85, 95% CI 0.81-0.89) or radiotherapy (RR 0.69, 95% CI 0.65-0.74). After weighting and adjustment, there was no significant difference in BCSS (sdHR 0.98, 95% CI 0.77-1.25), but women who did not undergo AS had worse OS (HR 1.14, 95% CI 1.04-1.25). The results among 6215 ER+/HER2- women ≥70 years undergoing SLNB vs no AS were similar. The omission of AS in older women with early stage BC was not associated with adverse BCSS, although OS was worse.

Perceived exercise benefits and barriers and their association with physical activity time in Chinese Han children and adolescents aged 9 to 18 years

Objective: To analyze the perceived exercise benefits and barriers and their association with physical activity time in Chinese Han children and adolescents aged 9-18 years. Methods: Data were extracted from the 2019 Chinese National Survey on Students' Constitution and Health and a total of 163 656 children and adolescents aged 9-18 years in Han ethnic group were included in the analysis. Mann-Whitney U test and Kruskal-Wallis test were used to compare the perceived exercise benefits score, perceived exercise barriers score and perceived exercise benefits to barriers ratio in the children and adolescents with different demographic characteristics and physical activity time. The differences in physical activity time in subgroups were compared with χ2 tests. log-binomial regression model was used to evaluate the association between physical activity time and perceived exercise benefits and barriers. Results: The M (Q1,Q3) of the perceived exercise benefits score, perceived exercise barriers score, and perceived exercise benefits to barriers ratio in the children and adolescents were 4.11 (3.78, 4.78), 2.70 (2.10, 3.20) and 1.55 (1.22, 2.07), respectively. Children and adolescents living in urban area, boys, those at younger age and those with physical activity time ≥1 hour had higher perceived exercise benefits score and perceived exercise benefits to barriers ratio, but lower perceived exercise barriers score (all P<0.001). The prevalence of physical activity time ≥1 hour was 41.4% in the children and adolescents. In the log-binomial model with two variables of perceived exercise benefits score and perceived exercise barriers score, for each 1-point increase in the perceived exercise benefits, the possibility of physical activity time ≥1 hour increased by 11% (OR=1.11, 95%CI: 1.10-1.12), and for each 1-point increase in the perceived exercise barriers, the possibility of physical activity time ≥1 hour decreased by 15% (OR=0.85, 95%CI: 0.84-0.85). In the log-binomial model with variable of perceived exercise benefits to barriers ratio, for each 1-point increase in the perceived exercise benefits to barriers ratio, the possibility of physical activity time ≥1 hour increased by 12% (OR=1.12, 95%CI: 1.11-1.12). Conclusion: The perceived exercise benefits and barriers are significantly associated with physical activity time in children and adolescents in China.

Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles-Rubella Supplementary Immunization Activity during the COVID-19 Pandemic.

Measles-rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey in Zambia to measure the proportion of measles zero-dose and under-immunized children who were reached by the 2020 MR-SIA and identified reasons associated with persistent inequalities following the MR-SIA. Children between 9 and 59 months were enrolled in a nationally representative, cross-sectional, multistage stratified cluster survey in October 2021 to estimate vaccination coverage during the November 2020 MR-SIA. Vaccination status was determined by immunization card or through caregivers' recall. MR-SIA coverage and the proportion of measles zero-dose and under-immunized children reached by MR-SIA were estimated. Log-binomial models were used to assess risk factors for missing the MR-SIA dose. Overall, 4640 children were enrolled in the nationwide coverage survey. Only 68.6% (95% CI: 66.7%, 70.6%) received MCV during the MR-SIA. The MR-SIA provided MCV1 to 4.2% (95% CI: 0.9%, 4.6%) and MCV2 to 6.3% (95% CI: 5.6%, 7.1%) of enrolled children, but 58.1% (95% CI: 59.8%, 62.8%) of children receiving the MR-SIA dose had received at least two prior MCV doses. Furthermore, 27.8% of measles zero-dose children were vaccinated through the MR-SIA. The MR-SIA reduced the proportion of measles zero-dose children from 15.1% (95% CI: 13.6%, 16.7%) to 10.9% (95% CI: 9.7%, 12.3%). Zero-dose and under-immunized children were more likely to miss MR-SIA doses (prevalence ratio (PR): 2.81; 95% CI: 1.80, 4.41 and 2.22; 95% CI: 1.21 and 4.07) compared to fully vaccinated children. The MR-SIA reached more under-immunized children with MCV2 than measles zero-dose children with MCV1. However, improvement is needed to reach the remaining measles zero-dose children after SIA. One possible solution to address the inequalities in vaccination is to transition from nationwide non-selective SIAs to more targeted and selective strategies.

Organizational features of mental health facilities and adequacy of treatment. Multilevel analysis from the italian region lombardy

IntroductionMental healthcare represents a significant issue for the Healthcare System [1]: one of the major causes is the high heterogeneity in the provision of care, due to the differences among the Departments of Mental Health (DMHs).ObjectivesTo identify the predictors of an adequate treatment for patients with severe mental disorders (SMDs), both at an individual and structural level, the latter considering the major features of the Psychiatric Operative Units (POUs), in the Italian region Lombardy.MethodsHealthcare Utilization Databases, collecting data on the services provided to beneficiaries of the National Health Service (NHS), have been used to retrieve data.Patients that during 2015 were resident in Lombardy; suffered from depressive, bipolar or schizophrenic disorder; were in contact with the DMHs, have been identified.Adequateness of treatment has been evaluated according to the Minimally Adequate Treatment (MAT) [2,3]: a combination of psychiatric visits and specific pharmacological treatment, or psychotherapeutic sessions. Having received a MAT has been assessed during a one-year period.Predictive factors have been classified into two hierarchical levels: individual (first) level and structural (second) level. At the first level, clinical and socio-demographics characteristics have been evaluated for each patient. At the second level, the organizational structure of each POU has been examined: the number of patients taken in care, number of community-care facilities, and hours worked by each class of healthcare providers (psychiatrists, nurses, psychologists, psychosocial staff ).A log-binomial model has been used to evaluate the association between the first-level factors and having received a MAT; a multilevel log-binomial model for the second-level factors considered the hierarchical structure of data.Results72115 patients have been identified: 33974 (47.1%), 28407 (39.4%) and 9734 (13.5%) suffering from depressive, schizophrenic or bipolar disorder respectively; 45.4% of them (32773 patients) received a MAT.Compared with patients affected by depression, those with bipolar or schizophrenic disorder show a higher probability of receiving a MAT (+23%, +11% respectively).Patients living alone have a lower probability of receiving a MAT, unlike patients with a higher level of education or employment, underlining the social burden related to SMDs.Organizational features have proven significant: centres with a higher activity volume and with more community-care facilities seem more likely to guarantee MAT. Moreover, the higher the hours worked by psychiatrists, nurses and psychologists, the higher the probability of providing MAT.ConclusionsPatients with SMDs are still untreated in an appropriate way. Results highlight the importance of the community-care facilities, as well as of the composition of the multidisciplinary teams working there.Disclosure of InterestNone Declared