Log-binomial Regression Models Research Articles

Factors of progression to severity and death in COVID-19 patients at two health care sites in Bamako, Mali

ObjectivesTo analyze the clinical and biological characteristics and to evaluate the risk factors associated with the mortality of patients with COVID-19 in Commune IV of the District of Bamako.MethodsThe cohort consisted of COVID-19 patients managed from March 2020 to June 2022 at the Bamako Dermatology Hospital and the Pasteur Polyclinic in Commune IV in Bamako. The studied variables were sociodemographic, clinical, and biological. For the analysis of deaths, explanatory variables were grouped into sociodemographic factors, comorbidities and symptoms. Binomial logistic regression models were used to identify mortality associated risk factors.ResultsAmong the 1319 included patients, 38.4% were asymptomatic, 46% and 15.5% developed moderate or severe COVID-19 respectively. The predominant signs were cough (48.5%), respiratory difficulty (24.6%) and headache (19.7%). Male were more common (58.2%). High blood pressure (19.9%) and diabetes (10%) were the main comorbidities. D-dimers < 0.5 μg/l was found in 53.3% of cases and the mean hemoglobin level was 12.9 ± 1.7 g/l. The case fatality rate was 3.71% in our series. In bivariate analysis, age > 60 years, high blood pressure, diabetes, clinical severity, D-dimers < 0.5 μg/l were associated with death. Using binomial logistic regression method, age > 60 years, increased heart rate, disease severity level and mainly acute respiratory distress syndrome (polypnea, difficulty breathing) were the factors found associated with death. After adjusting for all the assessed factors, age < 60 years [aHR = 0.15 (0.06–0.35)] and administration of azithromycin [aHR = 0.31 (0.1–0.97)] were protective factors while higher respiratory rate [aHR = 1.14 (1.07–1.22)] and difficulty breathing [aHR = 3.06 (1.03–9.13)] were risk factors associated with death.ConclusionThese main findings elucidate the factors associated with severity and lethality external of health care system constraints. Advanced age, higher heart rate and the development of respiratory distress were the factors significantly associated with increased fatalities.

Increasing Risk of Gestational Diabetes in an Ethnocultural Minority of Canada.

We investigated whether ethnocultural inequality in rates of gestational diabetes was prevalent in Canada. We compared the Anglophone minority with the Francophone majority in Quebec. We conducted a retrospective cohort study of 853,595 pregnancies between 2008 and 2020 in Quebec, Canada. The exposure was ethnocultural status, with patients classified as either Anglophone or Francophone based on the maternal language. The outcome was gestational diabetes. We calculated risk ratios (RR) and 95% confidence intervals (CI) for the association between ethnocultural status and risk of gestational diabetes using log-binomial regression models adjusted for maternal age, parity, comorbidity, education, country of origin, material deprivation, urban residence, and time period. Anglophones had a higher rate of gestational diabetes compared with Francophones (99.0 vs 81.0 per 1000 pregnancies; RR 1.07, 95% CI 1.05-1.10). Anglophones aged less than 25years (RR 1.31, 95% CI 1.21-1.41), living in rural areas (RR 1.73, 95% CI 1.64-1.82), lacking a high school diploma (RR 1.48, 95% CI 1.37-1.61), or with material disadvantage (RR 1.33, 95% CI 1.27-1.39) had greater risks of gestational diabetes compared with Francophones. Risk of gestational diabetes among Anglophones increased over time, especially among disadvantaged subgroups of the population. The findings suggest that the Anglophone ethnocultural minority in Quebec has an increasing risk of gestational diabetes over time compared with the Francophone majority. Risks are particularly elevated for Anglophones from disadvantaged subgroups of the population.

Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus-Related Critical Illness.

Pediatric respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (LRTI) commonly requires hospitalization. The Clinical Progression Scale Pediatrics (CPS-Ped) measures level of respiratory support and degree of hypoxia across a range of disease severity, but it has not been applied in infants hospitalized with severe RSV-LRTI. We analyzed data from a prospective surveillance registry of infants hospitalized for RSV-related complications across 39 U.S. PICUs from October through December 2022. We assigned CPS-Ped (0=discharged home at respiratory baseline to 8=death) at admission, days 2-7,10, and 14. We identified predictors of clinical improvement (CPS-Ped≤2 or 3-point decrease) by day 7 using multivariable log-binomial regression models and estimated the sample size (80% power) to detect 15% between-group clinical improvement with CPS-Ped versus hospital length of stay (LOS). Of 585 hospitalized infants, 138 (23.6%) received invasive mechanical ventilation (IMV). Of the 49 (8.4%) infants whose CPS-Ped score worsened by 2 points after admission, one died. Failure to clinically improve by day 7 occurred in 205 (35%) infants and was associated with age <3 months, prematurity, underlying respiratory condition, and IMV in the first 24 hours in the multivariable analysis. The estimated sample size per arm required for detecting a 15% clinical improvement in a potential study was 584 using CPS-Ped clinical improvement versus 2,031 for hospital LOS. CPS-Ped can be used to capture a range of disease severity and track clinical improvement in infants who develop RSV-related critical illness and could be useful for evaluating therapeutic interventions for RSV.

Correlates of suicidal ideation and suicide attempts among bisexual+, gay/lesbian, and heterosexual young adults.

Compared to their exclusively gay/lesbian or heterosexual identifying peers, young people identifying as bisexual+ (e.g. bisexual, pansexual, asexual, queer or questioning) are at elevated risk for suicidal ideation (SI) and attempts (SA). The present study aimed to establish whether the prevalence of, and psychosocial risk factors for, SI and SA vary as a function of sexual identity. Young adults (N = 274; 18-29 years old) were recruited via online crowdsourcing. They completed questionnaires assessing adverse childhood experiences (ACEs), emotion dysregulation, impulsivity, depression symptoms and lifetime history of SI and SA. Spearman correlations, Kruskal-Wallis H-tests and binomial logistic regression models were used. No variable was associated with SI. Bisexual+ individuals reported greater SA than the heterosexual group, though statistically similar to the gay/lesbian group. A similar pattern emerged for ACEs. The bisexual+ group reported greater depression symptoms than the gay/lesbian group. Impulsivity and emotion dysregulation did not vary by sexual identity. Controlling for these psychosocial and sociodemographic variables did not alter results: bisexual+ individuals were almost three times more likely to report SA than heterosexual individuals, OR = 2.93 95% CI [1.16, 7.44]; gay/lesbian and heterosexual individuals had a statistically similar likelihood of reporting SA, OR = 1.09, 95% CI [0.27, 4.37]. This is the first study to establish that young adults identifying as bisexual+ are at greater risk for SA after controlling for well-established psychosocial correlates; this was not the case for SI. Further work is needed to establish the aetiology of this risk.

Risk of adverse birth outcomes and birth defects among women living with HIV on antiretroviral therapy and HIV-negative women in Uganda, 2015-2021.

We assessed the risk of adverse pregnancy and birth outcomes and birth defects among women living with HIV (WLHIV) on antiretroviral therapy (ART) and HIV-negative women. We analyzed data on live births, stillbirths, and spontaneous abortions during 2015-2021 from a hospital-based birth defects surveillance system in Kampala, Uganda. ART regimens were recorded from hospital records and maternal self-reports. Using a log-binomial regression model, we compared the prevalence of 16 major external birth defects and other adverse birth outcomes among WLHIV on ART and HIV-negative women. A total of 203,092 births were included from 196,373 women of which 15,020 (7.6%) were WLHIV on ART. During pregnancy, 15,566 infants were primarily exposed to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART (n=13,614; 87.5%). After adjusting for maternal age, parity, and number of antenatal care (ANC) visits, WLHIV on NNRTI were more likely than HIV-negative women to deliver preterm (adjusted prevalence ratio [aPR]=1.27, 95% confidence interval [CI]: 1.21,1.32), post-term (aPR=1.23, 95% CI: 1.16,1.32), or small for gestational age infants (aPR=1.35, 95% CI: 1.30,1.40). Spina bifida was more prevalent among infants born to WLHIV on ART periconceptionally compared to HIV-negative women (aPR=2.45, 95% CI 1.27,4.33). The prevalence of the other selected birth defects were similar between infants from WLHIV on ART and HIV-negative women. In Uganda, WLHIV on ART were more likely than HIV-negative women to experience selected adverse birth outcomes. Further surveillance of maternal ART exposure, including by drug class and ART regimen, is needed to monitor and prevent adverse birth outcomes in WLHIV.

Trends of adverse pregnancy outcomes and its determinants in Arba Minch Zuria and Gacho Baba Woredas from 2018 to 2022: Analysis of health and demographic surveillance data.

Many family members and the expectant mother view pregnancy as a time of joyful anticipation. However, it can also bring about a range of issues that may pose serious and potentially life-threatening risks for both the mother and the unborn child. Adverse pregnancy outcomes are an alarming public issue in different parts of the world and have a seriously harmful influence on both their health and well-being. Nevertheless, less is known about trends and determinates of adverse pregnancy outcomes in the Arba Minch zuria and Gacho Baba districts in southern Ethiopia. Therefore, this study aimed to fill these gaps in the study setting. An open, dynamic cohort study design was employed among 8885 pregnancies from 2018 to 2022, health and demographic surveillance data were involved. Data to be collected at Arba Minch Health and Demographic Surveillance Site (HDSS) using a structured questionnaire. A log-binomial regression model was used to identify determinates. A P-value of less than 0.05 was considered to declare a statistically significant association. In this study, the overall adverse pregnancy outcomes were 8.89 per 1000 live births [95%CI: 6.93, 10.84]. The stillbirth and abortion rates were 5.74 per 1000 live births (95%CI: 4.36, 7.54) and 3.15 per 1000 live births [95%CI: 1.97, 4.02], respectively. The trends of adverse pregnancy outcomes showed 11.1/1000 in 2018 and 14.1/1000 in 2022. Age > 34 years old (aPPR = 2.93, 95%CI: 1.67, 5.17), antenatal care (aPPR = 0.52, 95%CI: 0.33, 0.83), and history of pregnancy loss (aPPR = 2.68, 95%CI: 1.36, 5.29) were identified as determinates for adverse pregnancy outcomes. The prevalence of adverse pregnancy outcomes is still high, and trends vary from time to time. As such, attention is needed for the women who had a previous history of pregnancy loss, and addressing those determinants could potentially reduce the rates of stillbirths and abortions, ultimately promoting healthier pregnancies and better pregnancy outcomes.

Business internationalization and intellectual capital components: the case of the Colombian manufacturing sector exports

PurposeThis paper aims to understand the impact of intellectual capital components (human, structural and relational capital) on business internationalization through exports, analyzing the Colombian manufacturing sector.Design/methodology/approachA binomial logistic regression model was used in which the export propensity was the dependent variable. The explanatory variables consisted of the human capital, including training and managerial characteristics; the structural capital, including innovation, intellectual property, certifications and management and the relational capital, encompassing relationships with other companies, public entities and the domestic market. The Survey of Development and Technological Innovation - EDIT - Industry 2018, carried out by the National Administrative Department of Statistics of Colombia, was used to collect data from 7,529 companies in 24 manufacturing subsectors.FindingsThe research findings suggest that there is a positive relationship between internationalization and human capital (postgraduate, university and school training), with structural capital (innovation in organizational processes, ownership of patents, software rights, industrial rights, trademark registration, obtaining intellectual property rights, complexity in design, process certifications, compliance with technical requirements and the existence of production goals) and with relational capital (confidentiality agreements with other companies and contracts with the international public sector).Originality/valueThis article contributes to the literature generating knowledge on the relationship between intellectual capital and the internationalization of Colombian industrial companies. It will also have managerial and social implications serving as input for the decision-making process of firms undergoing internationalization, and for policymakers.

Effects of Rurality, Socioeconomic Status, and Race on Head and Neck Squamous Cell Carcinoma Outcomes.

To examine how rural residence interacts with SES and race/ethnicity relative to Head and neck squamous cell carcinoma (HNSCC) treatment delay and outcomes. The SEER database was queried for patients aged ≥18 with HNSCC. Out of 164,337 cases, 126,052 remained after exclusions for missing data. Statistical tests performed included Chi-squared tests, log-binomial regression models, and parametric accelerated failure time (AFT) models, with a significance level of α < 0.05. About 38% of patients residing in lowest SES census tracts were rural, whereas over 98% of patients from highest SES tracts were urban. Delayed treatment was associated with shorter median survival [aTR = 0.968, 95% confidence interval (CI): 0.939, 0.999]. Risk for treatment delay increased with decreasing SES and was greater for those with minoritized race/ethnicity status. Rurality was associated with a lower risk [aRR: 0.917, 95% CI: 0.892, 0.946] of treatment delays but was not predictive for patient survival (aTR: 1.019 [0.978, 1.061]). Cancer-specific mortality increased with decreasing SES and was higher in patients with minoritized race/ethnicity status. Rurality was associated with decreased risk for treatment delay but not with worse survival relative to urban residence, whereas low SES and minority status remained predictive for poor outcome regardless of geographic context (level of evidence: 4). Although these findings argue against HNSCC survival deficits specific to rural populations, there remains concern regarding potential care shortfalls in rural populations not detected in this sample. Confirmatory patient-level analysis should be prioritized to optimize support along the rural/urban divide. IV Laryngoscope, 2024.

ERP adoption of SMEs in Romania: An IT innovation step or a business transactional necessity?

AbstractThe study aims to determine the influencing factors of Enterprise Resource Planning (ERP) systems adoption in the Romanian small and medium companies (SMEs). Our research is based on a national level representative survey with 374 personal interviews of CEOs. The conceptual framework is based on a detailed literature review and adopts the main dimensions of the Technological Organisational and Environmental (TOE) model. Applying a binomial logistic regression model, the significant factors for ERP adoption are identified. The main result is that the ERP system is an operative, necessary tool of business transactions for SMEs, not a cutting edge, IT innovative implementation. The adoption of ERP is positively impacted by a wider market scope since ERP systems support the expanded business partnerships and market extension procedures. Further results of the model show that business performance indicators do not affect ERP adoption, however the managers' perception of the competitive pressure and the top management support toward IT applications increase the likelihood of adoption.

Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany.

Wearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context. This study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator. A cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use. Overall, 24% (223/932) of participants (52% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1-2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18-40: 36%; 41-64: 26%; 65+:14%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95% CI: 0.94 to 1.07 in age group 18-40; OR = 1.07, 95% CI: 1.03 to 1.12 in age group 41-64; OR = 1.11, 95% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95% CI: -0.0244 to -0.00791, p <.001). This study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.

Factors associated with Onchocerca volvulus transmission after 20 years of community treatment with ivermectin in savanah and forest areas in Central African Republic: A Cross Sectional Study.

The Central African Republic has endemic onchocerciasis in 20 health districts in savannah and forest areas. The country organised a mass distribution campaign of invermectin in 2023 through the National Onchocerciasis Control Programme. The objectives of this study were to identify factors of persistent Onchocerca volvulus transmission. A cross-sectional study was carried out in Bossangoa (savannah area) and Kémo (forest area) health districts. Using kelsey'formula 1600 respondents were recruited. Dependent variable is onchocerciasis status. Bivariate analysis was carried out to determine the differential risks for onchocerciasis infection, each variable being taken separately. The strength of statistical associations was measured by prevalence rates (PR) from log-binomial regression model and their 95% confidence intervals. Onchocerciasis prevalence is 26.45% in Bossangoa (95% CI = 23.76-29.14), and 14.79% (84/568) in Kémo (95% CI = 23.53-29.37). In both savannah and forest areas, the common factors incriminated in the transmission of onchocerciasis after several years of community distribution of ivermectin were: young age (PR = 2.44 (1.97-3.03), p < 0.001; 3.63 (2.32-5.70), p < 0.001 respectively), not taking ivermectin (PR = 2.31 (1.86-2.87), p < 0.001; 6.84 (4.42-10.57), p < 0.001 respectively), male sex (PR = 2.54 (2.04-3.16), p <0.001; 1.79 (1.19-2.69), p = 0.002 respectively), living near rivers and in rural areas. Despite efforts, the prevalence of onchocerciasis remained high in the 2 districts. The main factors incriminated in the persistence of transmission were failure to take ivermectin, male sex and young age. The National Onchocerciasis Control Programme needs to review its planning of activities, ensuring that the population is constantly made aware before drugs are distributed, and increasing the number of days of community-based distribution in order to improve therapeutic coverage.

Regional deprivation and diabetic ketoacidosis at type 1 diabetes diagnosis in children and adolescents: International comparison among 6 countries.

The incidence of diabetic ketoacidosis (DKA) at the time of diagnosis of type 1 diabetes in youth varies between countries and is influenced by socioeconomic factors. We investigated the relationship between regional deprivation indices and DKA at diagnosis of type 1 diabetes in six countries. We analyzed children 0.5 to 17.0 years old diagnosed with type 1 diabetes between 2019-2022 across six diabetes registries. Regional deprivation index within each country was standardized to compare each individual's socioeconomic status internationally. Log-binomial regression models assessed the association between the standardized deprivation index and DKA, with sex, age group, and year as covariates. Among 21,020 children (mean age 9.08 [SD 4.19] years) the DKA rate of 36.5%. Cohorts were: Germany (n=13,561, DKA 32.5%), Italy (4,659, 42.5%), Colorado USA (1,318, 54.9%), Wales (769, 35.2%), New Zealand (407, 43.7%), and Slovenia (306, 37.6%). Deprivation was associated with increased risk of DKA in children 0.5-< 6 (OR 1.16 [95% CI 1.10 - 1.23], p < 0.0001) and 6-<12 years of age (1.05 [1.05 - 1.11], p = 0.02). Female sex increased risk of DKA (1.06, [1.00 - 1.13], p = 0.04). The proportion of DKA was lower in 2019 than in 2020, 2021, and 2022 (each p < 0.0001). Deprivation was significantly associated with the risk of DKA at the diagnosis of type 1 diabetes, and DKA was more common during the pandemic years 2020-2022 than in 2019. Younger children appear to be more vulnerable to deprivation than older patients. Understanding and reducing local and demographic-specific disparities is essential for effective intervention.

Predicting PTSD and complex PTSD from interpersonal violence in Japanese school-based extracurricular sports activities: using the International Trauma Questionnaire (ITQ).

Victims of interpersonal violence in sports show various mental health concerns. However, no studies have quantitatively examined their primary complaints, considering psychological symptoms such as denial of self-concept and interpersonal challenges not captured by conventional post-traumatic stress disorder (PTSD). Recently, an association between interpersonal violence victimization and complex PTSD (CPTSD) has been noted in Japanese sports coaching situations, specifically for extracurricular sports activities. This study aimed to examine the applicability of the International Trauma Questionnaire (ITQ) and determine whether interpersonal violence victimization and related risk factors predicted PTSD and CPTSD in extracurricular sports activities in Japan. This study included 651 adults aged 18-25 who had previously participated in extracurricular sports activities in junior high and high school. The ITQ was examined using confirmatory factor analysis with maximum likelihood with robust standard errors, fit indices comparisons, a graded response model, differential item functioning, and rank correlation designs. A binomial logistic regression model with robust standard errors examined the association of PTSD and CPTSD with interpersonal violence victimization and related risk factors. The optimal factor structure, measurement precision, and validity of the ITQ were confirmed. Physical and psychological violence victimization and the ITQ were positively correlated with PTSD, difficulties in emotion regulation, self-disgust, and interpersonal problems subscales, respectively. A high frequency of psychological and physical violence victimization experiences and self-identified LGB (lesbian, gay, or bisexual) were associated with PTSD and CPTSD diagnosability. Additionally, being a woman and in school life away from parents were associated solely with PTSD diagnosability. This is the first quantitative study to examine CPTSD in a study on interpersonal violence in sports. Our findings can provide insights into desirable victim support and enhanced clinical care in interpersonal violence in a sports context.

Outcomes of Postpartum Preeclampsia: A Retrospective Cohort Study of 1.3 Million Pregnancies.

We assessed the association between postpartum preeclampsia and the risk of adverse maternal and neonatal outcomes. Evidence suggests that postpartum preeclampsia is initiated antenatally, but the impact on birth outcomes is unclear. Retrospective cohort study. All deliveries in hospitals of Quebec, Canada. 1 317 181 pregnancies between 2006 and 2022. We identified patients who developed preeclampsia in the postpartum period. Using log-binomial regression models, we estimated adjusted risk ratios (RR) and 95% confidence intervals (CI) for the association of postpartum or antepartum preeclampsia with adverse pregnancy outcomes relative to no preeclampsia. Preterm birth, placental abruption, severe maternal morbidity and recurrent preeclampsia. Postpartum preeclampsia was less frequent than antepartum preeclampsia (n = 4123 [0.3%] vs. 51 269 [3.9%]). Postpartum preeclampsia was associated with preterm birth (RR 1.45, 95% CI 1.34-1.57), placental abruption (RR 1.36, 95% CI 1.16-1.59) and severe maternal morbidity (RR 6.48, 95% CI 5.87-7.16) compared with no preeclampsia. Antepartum preeclampsia was also associated with these outcomes. Moreover, patients with postpartum preeclampsia in a first pregnancy were at risk of adverse outcomes in a subsequent pregnancy, particularly recurrent preeclampsia (RR 7.77, 95% CI 6.54-9.23). Postpartum preeclampsia is associated with adverse outcomes at delivery, despite being detected only postnatally. Our findings suggest that patients with adverse birth outcomes may benefit from blood pressure measurements up to 6 weeks following delivery.

Long COVID and financial hardship: A disaggregated analysis at income and education levels.

To examine how long COVID is associated with financial hardship (food insecurity, inability to pay bills, or threat of losing service) across income and education levels, and to assess the role of employment loss or reduced work hours in this hardship. We used nationally representative data on 271,076 adults from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). We used multivariable binomial logistic regression models to estimate the average marginal effect of long COVID on financial hardships across multiple income and education groups. In general, we found a significant positive association between long COVID and the three measures of financial hardships across income and education groups (1-11 percentage points increase, 95% CI 0.00-0.02 and 0.07-0.14, respectively). Mediation analysis showed that lost or reduced hours of employment accounted for a significant portion (6%-20%) of the changes in financial distress. Long COVID has affected the economic wellbeing of people from all socioeconomic statuses, although at a higher rate for lower income groups. Policy attention is needed to address its economic impacts across income and education levels.

ANALYZING THE IMPACT OF DEMOGRAPHIC FACTORS AND URBAN DENSITY ON MODE CHOICE IN THE GREATER BRISBANE AREA

Understanding the influence of demographic factors and urban density on transportation mode choice is crucial for promoting sustainable mobility in urban areas. This study examines these influences in the Greater Brisbane Area using data from the Queensland Household Travel Survey (QHTS) collected between 2018 and 2023. We apply binomial logistic regression models to analyze how age, gender, employment status, presence of children, and urban density at origin and destination locations affect the likelihood of choosing transportation modes, including car, walking, bicycling, public transport, and Mobility as a Service (MaaS). The results indicate that higher urban density is significantly associated with reduced car usage and increased use of sustainable modes such as walking, public transport, and bicycling. Older individuals are more likely to use cars and less likely to choose active modes, while males have a higher propensity to bicycle compared to females. Employment status also influences mode choice, with employed individuals more likely to drive or use public transport and less likely to walk. Although the number of MaaS users in the dataset is limited, preliminary findings suggest potential higher adoption in high-density areas and among older individuals. These insights provide empirical evidence from Brisbane and have practical implications for urban planners and policymakers. Enhancing infrastructure for sustainable transportation in densely populated areas and considering demographic factors can promote sustainable mobility patterns. Future research should include additional variables such as transportation supply factors and use longitudinal data to explore causal relationships. Investigating the barriers to MaaS adoption in Brisbane would also be valuable for shaping future urban mobility strategies.

Assessing Attention-Deficit/Hyperactivity Disorder in Post-9/11 Veterans: Prevalence, Measurement Correspondence, and Comorbidity With Posttraumatic Stress Disorder.

Attention-deficit/hyperactivity disorder (ADHD) is common among Veterans but overlapping symptoms with other prevalent psychiatric disorders (e.g., posttraumatic stress disorder [PTSD]) complicate diagnosis. This study aims to (1) assess the prevalence of ADHD, (2) evaluate the correspondence between ADHD self-report measures, and (3) examine the association between ADHD and PTSD in a sample of combat-deployed post-9/11 Veterans. A total of 332 combat-deployed post-9/11 Veterans from VA Boston Healthcare System completed the Clinician-Administered PTSD Rating Scale, 2 ADHD self-report questionnaires (Wender Utah Rating Scale-25 and the Adult ADHD Self-Report Scale v1.1), and report of the presence/absence of a historical ADHD diagnosis. Attention-deficit/hyperactivity disorder status via Wender Utah Rating Scale ([WURS-25] criterion standard) was compared to historical ADHD diagnosis and the ASRSv.1.1 screener. Log-binomial regression models assessed the relationship between ADHD and PTSD. This study was reviewed and approved by the VA Boston Institutional Review Board. In all, 12.7% of the sample met criteria for ADHD per the WURS-25. The WURS-25 demonstrated poor sensitivity with historical ADHD diagnosis (27.7%) but adequate specificity (90.3%). Poor sensitivity (60.7%) and specificity (60.8%) were observed between the WURS-25 and the ASRS-v.1.1. The prevalence of ADHD was 2.5 times as high for Veterans with a history of PTSD (Prevalence Ratio [PR] = 2.53, 95% CI: 1.11, 7.28) and over twice as high for those with current PTSD (PR = 2.19, 95% CI: 1.17, 4.38). Attention-deficit/hyperactivity disorder is prevalent in this sample of Veterans and is associated with an increased risk of current and lifetime PTSD. The low correspondence across self-report ADHD measures illustrates the complexity of assessing ADHD in this highly comorbid population. When evaluating ADHD in Veterans, clinicians should carefully consider alternative and contributory symptom etiologies, such as PTSD, to ensure accurate diagnosis and treatment.

MRI-Based Circumferential Strain in Boys with Early Duchenne Muscular Dystrophy Cardiomyopathy.

Background: In boys with Duchenne muscular dystrophy (DMD), cardiomyopathy has become the primary cause of death. Although both positive late gadolinium enhancement (LGE) and reduced left ventricular ejection fraction (LVEF) are late findings in a DMD cohort, LV end-systolic circumferential strain at middle wall (Ecc) serves as a biomarker for detecting early impairment in cardiac function associated with DMD. However, Ecc derived from cine Displacement Encoding with Stimulated Echoes (DENSE) has not been quantified in boys with DMD. We aim to: (1) use cine DENSE to quantify regional Ecc in LGE negative (-) boys with DMD and healthy controls; and (2) compare Ecc with LVEF in terms of differentiating DMD boys with LGE (-) from healthy boys. Methods: 10 LGE (-) boys with DMD and 12 healthy boys were enrolled prospectively in an IRB-approved study for CMR at 3T. Navigator-gated cine DENSE was used to obtain short-axis mid-ventricular data and estimate global and regional Ecc. Group-wise differences were tested via a Wilcoxon rank-sum test. Within-group differences were tested via a Skillings-Mack test followed by pairwise Wilcoxon signed-rank tests. A binomial logistic regression model was adopted to differentiate between DMD boys with LGE (-) and healthy boys. Results: When compared to healthy boys, LGE (-) boys with DMD demonstrated significantly impaired septal Ecc [-0.13 (0.01) vs. -0.16 (0.03), p = 0.019]. In comparison to the Ecc in other segments, both groups of boys exhibited significantly reduced septal Ecc and significantly elevated lateral Ecc. Septal Ecc outperformed LVEF in distinguishing DMD boys with LGE (-) from healthy boys. Conclusions: Reduced septal Ecc may serve as an early indicator of cardiac involvement in LGE (-) DMD boys prior to reduced LVEF and a positive LGE finding.

Enhanced Positioning Strategies to Reduce Pneumothorax in CT-Guided Lung Biopsies.

This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning. We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pneumothorax. Variations in patient positioning (prone, supine, lateral, lesion in decubitus biopsy-side-down [LD BSD] and the dependent area [L DA M], and access route beginning in the dependent area [AR LD M]) were compared using the chi-square, Fisher's exact, and Mann-Whitney U tests. Performance metrics were evaluated. Univariate and binomial logistic regression models assessed the influence of these factors and other patient-related and interventional parameters on pneumothorax occurrence. Three positional variants (AR DA M, L DA M, and L LD BSD; p < 0.001), general emphysema (p = 0.009), emphysema in the access route (p = 0.025), greater needle size (18G vs. 20G; p < 0.001), and the use of a side-cut instead of a full-core system (p = 0.002) were significantly linked to lower peri-interventional pneumothorax incidence. Even after adjusting for various factors, AR DA M and general emphysema remained independently associated with a reduced pneumothorax risk (OR 0.168, p < 0.001; OR 2.72, p = 0.034). Assessing the dependent zones showed superior performance regardless of the patient's position, with the best performance demonstrated for AR DA M (AUC 0.705; sensitivity 60%, specificity 81.8%). Focusing on the dependent zones of each lung and adjusting the access route accordingly can significantly reduce the risk of pneumothorax compared to conventional positioning techniques.

Increased adverse pregnancy outcomes among decreased assisted reproductions during the COVID-19 pandemic: insights from a birth cohort study in Southwest China

ObjectivesWe elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes.MethodsA total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled.ResultsART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32–3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78–3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05–2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of − 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from − 0.21% (P = 0.646) in 2018–2019 to an increase of + 0.89% (P = 0.030) in 2019–2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of − 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57–4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78–3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42–4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65–2.97).ConclusionART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes.