Log-binomial Regression Models Research Articles

Association between differentiated HIV care delivery model and low-level viremia among people living with HIV in Rwanda

BackgroundLow-level viremia (LLV) (HIV-RNA 51–999 copies/mL) is associated with increased risk of non viral load suppression (HIV-RNA ≥ 1000 copies/mL). We assessed the association between differentiated service delivery model (DSDM) and LLV among people living with HIV (PLHIV) in Rwanda.MethodsWe conducted a retrospective cohort analysis using routinely collected data of adults living with HIV from 28-healthcare facilities in Rwanda before and after the introduction of DSDM. Under DSDM, PLHIV initiated treatment within seven days of HIV diagnosis and medication pick-up up to six months for those with sustained viral load suppression suppression. Proportions of LLV at 6,12 and 18 months were quantified. Multivariable log binomial regression models were used to assess the effect of DSDM on LLV. To handle missing data, multiple imputations was performed.ResultsOf 976 people living with HIV, 645(66.0%) were female and 463(47.4%) initiated treatment during DSDM. The median age was 37 (interquartile range: 32–43) years. LLV was 7.4%, 6.6% and 5.4%, at 6,12 and 18 months, respectively. Compared to those who initiated treatment before DSDM, starting treatment during DSDM increased six-month LLV [adjusted risk ratio (aRR) = 2.8: 95%CI (1.15–6.91)] but not at 12 [aRR = 2.3: 95%CI (0.93–5.75)] and 18 months [aRR = 0.3: 95%CI (0.09–1.20)]. Using imputed datasets, the association between DSDM and LLV persisted.ConclusionsDSDM was associated with increased risk of LLV at 6-months. possibly due to the minimal amount of time PLHIV had in pondering and accepting the HIV diagnosis. Continued support is needed among people receiving early antiretroviral therapy initiation to prevent development of LLV.

Disparities in cancer stage shifts associated with the COVID-19 pandemic in California, 2020-2021.

The COVID-19 pandemic and associated shutdowns disrupted healthcare access and resulted in decreased cancer screenings. Cancer diagnosis delays have concerning downstream effects on late-stage cancer, especially for marginalized populations. The study population included 349,458 adults in the California Cancer Registry diagnosed with cancer between January 2019-December 2021, during which California experienced two stay-at-home orders. We examined the percentage of late-stage (III-IV) cancer diagnoses across five periods: Pre-Pandemic (January 2019-February 2020), Shutdown #1 (March-June 2020), Post-Shutdown #1 (July-November 2020), Post-Shutdown #2 (December 2020-March 2021), and Post-Vaccine Rollout (April-December 2021). To examine the association between time-period and late-stage diagnoses, we conducted a multivariable log binomial regression model adjusted for sociodemographic and neighborhood factors. The percentage of late-stage cancer diagnoses increased during Shutdown #1 (+5.2%) and returned to baseline Post-Vaccine Rollout. Groups with notably higher increases in the percentage of late-stage cancer (vs. overall population) during Shutdown #1 include: Pacific Islander (+13.7%), Thai (+11.2%), Chinese (+8.1%), Native Hawaiian (+7.4%), Filipino (+6.6%), and uninsured (+7.4%). Uninsured (vs. private insurance) (PR: 1.41), low neighborhood SES (nSES) (vs. high) (PR: 1.19), and racial and ethnic minoritized groups (vs. NH White) (PR's: 1.04-1.19) had higher likelihood for late-stage cancer diagnosis. The pandemic exacerbated late-stage cancer disparities for racial and ethnic minoritized groups, underinsured, and low nSES communities in California (2020-2021). Interventions to improve cancer screening must be focused on racial and ethnic minoritized, underinsured, and low nSES communities, as they are likely to be more vulnerable to healthcare disruptions like the pandemic.

Association between school commuting and adolescent mental health: Insights from a longitudinal study amid the pandemic

This study investigates the relationship between transportation modes and adolescent mental health, employing a natural experiment design to longitudinally track Brazilian high-school students amid the COVID-19 pandemic disruptions. We surveyed 213 students in the city of Curitiba during and after the COVID-19 lockdown period using the Depression, Anxiety, and Stress Scale (DASS-21) combined with a socioeconomic questionnaire. To analyze changes in DASS between these two times we used the paired-sample T-test, exploring association with school commuting modes through binomial logistic regression models. The use of public transportation emerges as a significant factor associated with a threefold odds of increasing depression levels among students (OR = 3.08). This likelihood nearly quadrupled (OR = 3.81) when considering students living 5 km or more from school. These findings unveil public transportation and home-school distance as critical factors in the development of depression among adolescents. For example, individuals who commute via individual motorized transportation demonstrate a markedly lower likelihood of experiencing depression, pointing to broader societal and environmental factors such as family income and access to opportunities. Despite appearing contradictory to the commonly understood impacts of car use on mental health, this observation may unveil overlapping layers of spatial inequality and underscore the nuanced dynamics between transportation modes and adolescent mental well-being.

Prescriber Adherence to Antihypertensive Prescription Guidelines and the Impact of Patient Socioeconomic Factors: A Cross-Sectional Study Using Data From the IrishLongitudinal Study on Ageing.

Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines. A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models. A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent). This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.

Ethically challenging situations in teachers’ work: role of school neighborhood socioeconomic status

Abstract Background Ethically challenging situations are common in the teaching profession and can lead to significant stress. In particular, teachers working in socially disadvantaged areas may face these kinds of situations more often due to conflicts between educational needs and available resources. We investigated the link between school neighborhood socioeconomic status (SES) and the prevalence of ethically challenging situations among teachers. Methods Data were from primary school teachers (n = 1265) participating to the Finnish Public Sector study in 2022. Experiences on ethically challenging situations were assessed with two questions: In your work how often do you feel that you have to 1) reflect on ethically challenging situations and 2) act contrary to rules, norms, or personal values (at least weekly vs. less frequently). Survey data were linked to information on school neighborhood SES obtained from national grid database. Log-binomial regression models were used to analyze the relationship between school neighborhood SES and ethically challenging situations. Results Of the respondents, 61% reported having to reflect on ethically challenging situations, and 18% felt they had to act against rules or personal values at least weekly. Teachers in schools located in the most disadvantaged areas were more likely to feel that they had to act against rules, norms, or values weekly compared to teachers in schools in the most advantaged areas (adjusted RR 1.43, 95% CI 1.01-2.02). No association was observed between reflecting on ethically challenging situations and school neighborhood (adjusted RR 0.98, 95% CI 0.87, 1.11). Conclusions School neighborhood SES appears to be associated with teachers’ possibilities to choose action in ethically challenging situations. Key messages • School neighborhood SES appears to be associated with teachers’ possibilities to choose action in ethically challenging situations. • It is essential to develop strategies to support teachers in managing ethically challenging situations in their work environments.

Changes in physical activity and sedentary behavior during COVID-19 pandemic restrictions in Germany

Abstract Background During the COVID-19 pandemic’s first wave, mobility restrictions and protective measures have impacted both public and private life. In Germany, the population was advised to stay home except for work, outdoor sport activities, and essential shopping. This study aims to evaluate how these measures affected physical activity and sedentary behavior, focusing on identifying the groups most affected. Methods In April and May 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). The questionnaire was specifically designed to assess changes in physical activity and sedentary behavior compared to pre-restriction levels, along with data on anxiety and depressive symptoms. Results Around 26 % of the 152,421 respondents reported increased sedentary time, and about 38 % reported reduced participation in sport activities compared to pre-restriction levels. Over one-third of those who previously met the WHO’s physical activity recommendation could not maintain it during the restrictions. There was also a notable decline in active transportation (M = - 0.12; 95% CI: -.126; -.117), whereas participants spent more time on recreational physical activities (M = 0.12; 95% CI: .117; .126). Based on multivariable linear and log-binomial regression models, we found that younger people were more affected by the restrictions than older adults. Factors such as transitioning to remote work, self-rated health, and depressive symptoms strongly correlated with changes in all physical activity domains, including sedentary behavior and adherence to physical activity guidelines. Conclusions The shift towards inactivity or low-intensity activities during the nationwide restrictions poses potential long-term health risks, highlighting the urgent need for public health policies to address the negative impact of COVID-19 restrictions on physical activity and sedentary behavior.

Self-reported health effects from wildfire smoke: A cross-sectional study in New York State

Abstract Background Wildfires and exposure to wildfire smoke (WFS) are forecasted to increase, in part driven by climate change. As witnessed in 2023, regions in Europe and North America are facing more sustained periods of poor air quality due to WFS. Growing evidence suggests average daily WFS correlates with morbidity and mortality, but the impact of prolonged WFS exposure remains understudied, especially in areas where WFS is a newer occurrence. We examine associations between consecutive days of WFS experienced and self-reported health symptoms in the northeastern United States. Methods This retrospective cross-sectional study explored New York State (NYS) residents’ experience with WFS in summer 2023 via an online survey. Participants reported the longest period of consecutive WFS days and symptoms experienced. Log-binomial regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI). Results 553 NYS residents were included, representing a healthy, primarily female and White population, ranging from 18 to 86 years. 549 (99.3%) reported experiencing WFS, with the longest period of consecutive WFS days varying (≤3 days: n = 152; 4 to 6 days: n = 255; ≥7 days: n = 146). 490 (88.6%) reported ≥1 health symptom, with itchy/watery eyes, sore throat, and headache as the most frequent. Compared to ≤ 3 consecutive WFS days, symptom prevalence was 9.1% higher for those reporting 4 to 6 days (PR [95% CI]:1.09 [1.00, 1.19]) and 16.7% higher for ≥7 days (1.17 [1.07, 1.27]). The trend of increased symptom prevalence with longer WFS periods persisted and was pronounced for specific symptoms. Control for potential confounders did not appreciably change estimates. Conclusions Our findings suggest longer sustained WFS exposure associates with higher symptom prevalence, which may be precursors to more serious health conditions. As global populations face more WFS with climate change, public health professionals should prioritize strategies to mitigate prolonged exposure. Key messages • In a convenience sample of 553 primarily healthy New York State residents, 99.3% reported experiencing wildfire smoke and 88.6% reported at least 1 symptom of poor health during summer 2023. • Associations between consecutive days of wildfire smoke experienced and prevalence of any and specific symptoms tended to vary in a dose-response manner.

Health perceptions of adverse weather in older adults in England: analysis of 2019/20 survey data.

Risks to older adults (OA) (aged 65+ years) associated with hot and cold weather in the UK are well-documented. The study aim is to explore OA perception of health risks from high and low temperatures, health-protective measures undertaken, and implications for public health messaging. In 2019/20, Ipsos MORI conducted face-to-face surveys with OA in England (n = 461 cold weather survey, n = 452 hot weather survey). Participants reported temperature-related symptoms, risk perceptions for different groups, and behaviours during hot and cold weather. Analysis involved binomial logistic regression models to assess potential factors (demographics, vulnerability, behaviours) associated with older adults' health risk perception in hot and cold weather. Less than half of OA in both surveys agreed that hot or cold weather posed a risk to their health. OA with higher education, annual income >£25000 or home ownership were less likely to perceive their health at risk during cold weather and regional differences in hot weather were identified. OA who recognized those the same age or living alone as at an increased risk were more likely to perceive their own health as at risk. OA were more likely to self-identify health risks when reporting those aged 65 yrs+ to be at an increased risk in cold weather. Various temperature-related protective behaviours were associated with older adults' risk perception in hot and cold weather. These findings provide evidence for public health agencies to target high risk individuals, and modify temperature-related public health messaging to protect OA.

Associations between term cesarean delivery in the first pregnancy and second-pregnancy preterm delivery.

Cesarean delivery has been shown to increase the risk of preterm delivery in future pregnancies. The association could be a direct result of the procedure, or because the indications that led to the cesarean delivery also increase the risk of preterm delivery in later pregnancies. 298 901 mothers with first and second singleton deliveries from 1999 to 2020 were investigated using data from the Medical Birth Registry of Norway linked with Statistics Norway. The mothers were categorized by mode of cesarean delivery (total, emergency and planned) and vaginal delivery at term in the first pregnancy. We used log-binomial regression models to estimate relative risks with 95% confidence intervals (CI) of iatrogenic and spontaneous preterm delivery <37 gestational weeks in the second pregnancy. Second, we explored the role of recurrent placental disease in preterm delivery by comparing estimates in mothers with placental disease in neither or both pregnancies. 8243 mothers (2.8%) had a preterm delivery in the second pregnancy. The adjusted relative risk (aRR) of preterm delivery was 1.24 (95% CI 1.17-1.32) after cesarean compared with vaginal delivery in the first pregnancy. The association was stronger in previous planned compared with emergency cesarean delivery (aRR 1.52, 95% CI 1.30-1.77 and aRR 1.21, 95% CI 1.14-1.29, respectively). Spontaneous preterm delivery was not associated with the previous mode of delivery; the risk was confined to iatrogenic preterm delivery after both emergency and planned cesarean delivery (aRR 1.69, 95% CI 1.52-1.87 and aRR 2.65, 95% CI 2.12-3.30, respectively). Mothers with placental disease in both pregnancies had a sixfold increased risk of preterm delivery in the second pregnancy compared with mothers with no placental disease, however, the association between mode of delivery and subsequent preterm delivery was similar in mothers with and without placental disease in the pregnancies. Compared with vaginal term delivery in the first pregnancy, cesarean delivery increases the risk of iatrogenic, but not spontaneous preterm delivery in the next pregnancy. Although strongly associated with preterm delivery, placental disease had limited influence on the estimates.

Impacts of human behaviors involving sound and light exposure in sleep environments on sleep and mental disorders: A cross-sectional study

Creating an optimal sleeping environment is essential. Few studies have examined how common individual behaviors alter the daily sleep environment and the subsequent health impacts of these changes among the general population. This study presented a cross-sectional analysis of 13,157 Chinese college students, utilizing binomial logistic regression models and mediation effect analysis to elucidate the associations between human behaviors involving sound and light exposure in sleep environments and outcomes related to sleep disorders, depression, and anxiety. Our results indicated that noise exposure, listening to white noise and content-based audio (audiobooks, crosstalk, and radio) before sleep, watching electronic screens in a dim environment, using noise-canceling tools during sleep, adjusting room light to be on during sleep, and using light-blocking tools during sleep was associated with an increased risk of sleep disorders by 54.9–343.4 %. The risk of mental disorders increased by 0.325–4.379 times. Pathetic (odds ratio (OR) = 1.568) and stirring music (OR = 1.279) were associated with a higher risk of sleep disorders, while gentle music was correlated with a lower risk (OR = 0.842). Additionally, warm light and gentle/cheerful music were associated with lower depression and anxiety risks (OR = 0.635–0.733). Sleep quality was found to partially mediate the relationship between these human behaviors and mental disorders, and mental disorders also mediated the relationship between these behaviors and sleep disorders. The research findings offer a scientific foundation for optimizing sleeping environments through behavior control.

Hidradenitis Suppurativa and Maternal and Offspring Outcomes

Hidradenitis suppurativa (HS) is associated with morbidity in persons of reproductive age, but the effect on maternal and offspring outcomes is understudied. To determine the association of HS with pregnancy outcomes and maternal and child morbidity in the long term. This population-based longitudinal cohort study with up to 16 years of follow-up took place between 2006 and 2022 in Quebec, Canada. . Maternal HS. Outcomes included hypertensive disorders of pregnancy, gestational diabetes, and other birth outcomes as well as the long-term risk of hospitalization up to 16 years after delivery. The study used adjusted log-binomial and Cox proportional hazards regression models to estimate the association between maternal HS and pregnancy outcomes or hospitalization following pregnancy. Outcomes in both mothers and offspring were assessed. There were 1 324 488 deliveries during the study, including 1332 (0.1%) among mothers with HS. Compared with patients without HS, patients with HS had a greater risk of hypertensive disorders of pregnancy (risk ratio [RR], 1.55 [95% CI, 1.29-1.87]), gestational diabetes (RR, 1.61 [95% CI, 1.40-1.85]), and severe maternal morbidity (RR, 1.38 [95% CI, 1.03-1.84]). In neonates, maternal HS was associated with risk of preterm birth (RR, 1.28 [95% CI, 1.07-1.53]) and birth defects (RR, 1.29 [95% CI, 1.07-1.56]). In the long term, HS was associated with 2.29 times the risk of maternal hospitalization (95% CI, 2.07-2.55) and 1.31 times the risk of childhood hospitalization (95% CI, 1.18-1.45), including hospitalization for respiratory, metabolic, psychiatric, and immune-related morbidity over time. This cohort study found that HS is associated with adverse maternal and offspring outcomes in the peripartum period and in the long term. Early detection and management of HS may help mitigate these outcomes.

Exploring the Differences in Types of Commodities and Delivery Methods among Online Shoppers during the Early Stage of the COVID-19 Pandemic

During the early phases of the COVID-19 pandemic, the temporary limitations to in-store shopping during the lockdown period generated a significant increase in online shopping. During that period, the total spending amount and the number of online purchases increased across the whole population, although with rather heterogeneous patterns among various groups of consumers. This research examines the factors that can help explain the differences between users and non-users of online shopping in the U.S.A. during April and May 2020 to help understand the barriers to home-based shopping accessibility. The study uses data collected in the first survey wave of a longitudinal mobility study to analyze individual commodities and delivery options chosen for goods purchased online. Binomial logistic regression and Poisson regression models reveal differences in adopting e-shopping across various delivery channels, the frequency of purchase, and shipping used across commodities. In addition, a latent class cluster analysis identifies three heterogeneous groups of shoppers whose members differ mainly in income, age, education, neighborhood type, and technology attitudes. The results also highlight several differences in usage across crowdshipping markets and novel delivery options, such as in-store or locker pickup. The results also show variation in home-based accessibility across numerous factors during the pandemic.

Parent-perceived oral habits among a group of school children: prevalence and predictors

PurposePracticing oral habits beyond the normal age range is assumed to be due to underlying psychological disturbance and could result in a deformation of the orofacial structure. The first step in managing such a health condition is to evaluate its size. Thus, this study aimed primarily to assess the prevalence of oral habits among a group of school children aged from 5 to 7 years, in Cairo, Egypt. The secondary aim of the study was to investigate some possible related predictors along with the mother’s perception of the child’s oral health-related quality of life.MethodsA Google form questionnaire was designed, utilizing the third domain of Nordic Orofacial Test-Screen (NOT-S), to assess the presence or absence of oral habits and their types, if reported. Also, there were two global rating items to test the child’s oral health-related quality of life from the mother’s prospection, along with one item to inquire if the mother thinks that the oral habits are harmful to the child. A total number of 23 schools in Cairo, Egypt were randomly selected, and the link to the Google form was distributed through the parent’s groups on social media. All high-quality complete responses were analyzed using the SPSS program, and a Log-binomial regression model was constructed, to determine the significant predictors of practicing oral habits in children.ResultsAmong the analyzed 1128 responses, the total number of answers to the third domain of interview part of NOT-S was 1235, with a response rate of (60.39%), no habits were reported in 635 children (51.4%), while nail biting was noted in 21.8%, bruxism in 17.9% and Sucking habits in 8.9%. In total, 63.8% of children who were reported by their parents to be the “only child” didn’t practice any habit, and a higher prevalence of oral habits was detected in children with siblings. There was no detectable association between the mother’s educational level and practicing any of the habits, although there was an association between the mother’s educational level and their awareness of the harmful effect of oral habits on the child. The mothers’ answers to the global rating items were not associated with any of the oral habits.ConclusionThe most prevalent oral habit in the current study was the nail-biting habit. The presence of other siblings and the number of siblings were contributory factors in the occurrence of oral habits, while mothers’ educational level was not associated with practicing oral habits. The mothers’ awareness of the harmful effect of oral habits on the children was not satisfactory, and there was no association between oral health-related quality of life and the children’s oral habits, from the mothers’ perspective.

Exploring the Link Between Parental Sociodemographic Characteristics and Multiple Births: Insights from National Birth Data in Japan, 1995-2020.

This present study investigated the parental characteristics of multiple births using national birth data in Japan. This study included birth data from Vital Statistics: Occupational and Industrial Aspects every five fiscal years from 1995 to 2020. The multiple birth rates were defined as the number of live-birth deliveries with multiple fetuses (e.g., twins, triplets) per total live-birth deliveries. Parental ages, nationalities, occupations and household occupation (occupation of the top earner of the household) were considered as parental characteristics. The multiple birth rates were calculated based on parental characteristics for each year, and a log-binomial regression model was used to assess the association between parental characteristics and multiple births. The multiple birth rate for Japanese mothers consistently exceeded that for non-Japanese mothers over the years, and the rate increased progressively from manual workers to lower non-manual workers and then to upper non-manual workers for both maternal and paternal occupations. The regression results indicated that the risk ratio (RR) for multiple births among non-Japanese mothers was significantly lower than that among Japanese mothers. Moreover, concerning household occupation, the RRs of self-employed individuals, full-time employees at smaller companies, others, and the unemployed were significantly lower than those of full-time employees at larger companies. Furthermore, the RRs of lower non-manual and manual workers were significantly lower than those of upper non-manual workers in maternal and paternal occupations. The results suggested an association between multiple births and parental socioeconomic status in Japan.

Cost benefit analysis of reducing speed limits in Athens to 30 Km/h

The objective of this research is to investigate public acceptance and socio-economic feasibility of reducing speed limit from 50 km/h to 30 km/h in certain parts of the road network of Athens, Greece. A questionnaire was developed based on the method of stated preference for various hypothetical scenarios of time, fuel consumption and the probability of road crash to investigate road user preferences towards the reduction of speed limit and identify the most important influencing factors preferences. A total of 408 respondents were asked to choose among three alternative proposals: a) Reduce the speed limit to 30 km/h throughout the urban network except on major arteries, b) Reduce the speed limit to 30 km/h throughout the urban network and c) No Reduction (do nothing). For the analysis, two binomial logistic regression models and two multinomial logistic regression models were developed. The results indicate that increase in travel time, the importance of speed in causing a crash, the number of crashes the user has been involved in, the respondent’s driving habits are the main determinants of the users’ preferences. Furthermore, a Cost Benefit Analysis (CBA) was conducted to understand the sustainability implications of the implementation of lower speed limits (i.e., 50 to 30 km/h). In terms of socio-economic impacts, the CBA considered safety-related metrics, namely the number of road casualties of all severity levels, and environmental-related metrics, namely reductions in CO2, NOx, PM levels as well as in road user surplus metrics namely travel time increase and fuel consumption reduction. Costs considered in the analysis result from increased time spent on the road. Consequently, the investment and the operational costs along with the socio-economic impact are estimated and monetized, up to the year 2030. The positive Net Present Value (NPV) and the high Internal Rate of Return (IRR), i.e. 64.5 %, obtained as well as the sensitivity analysis results, indicate the feasibility of this policy over time. Therefore, speed limit reductions are economically viable and so, should be encouraged.

The impact of the COVID-19 pandemic on racial disparities in postoperative outcomes after bariatric surgery

BackgroundThe COVID-19 pandemic has affected the outcomes and access to elective surgery across the United States. This study hypothesized that preexisting racial and ethnic disparities were exacerbated by the pandemic for bariatric surgery. MethodsThis retrospective cohort study evaluated the outcome disparities in 1,046,578 patients who underwent bariatric surgery from 2016–2019 (before the COVID-19 pandemic) to 2020–2021 (during the COVID-19 pandemic) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. The primary outcomes of interest, Clavien-Dindo (CD) scores (0−5) and extended length of stay (eLOS; >90th percentile), were compared between non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian/American Indian/Pacific Islander (A/AI/PI) patients using ordinal and binomial logistic regression models, respectively. In addition, the modifying effect of COVID-19 on racial disparities in these outcomes was assessed. ResultsOverall, patients during the COVID-19 pandemic had higher odds of a higher CD score (odds ratio [OR], 1.05; 95% CI, 1.04–1.06; P < .001) than patients before the COVID-19 pandemic on adjusted multivariate analysis. NHB patients were more likely to experience postoperative complications as characterized by higher CD scores (OR, 1.37; 95% CI, 1.35–1.39; P < .001) than NHW patients, and COVID-19 was a contributory factor (ratio of ORs, 1.07; 95% CI, 1.05–1.10). There was no significant difference in CD scores in Hispanic (OR, 1.00; 95% CI, 0.98–1.03; P = .800) and A/AI/PI (OR, 0.98; 95% CI, 0.92–1.06; P = .651) patients compared with NHW patients, and COVID-19 did not have a modifying effect on these patients. All non-White patients had a higher likelihood of eLOS before the COVID-19 pandemic, but COVID-19 had a modifying effect of decreased odds of eLOS for all races (ratio of ORs, 0.60–0.69; 95% CI, 0.56–0.80). DiscussionNHB patients had inferior perioperative outcomes than patients of other races after bariatric surgery during the COVID-19 pandemic. In addition, all races/ethnicities had decreased odds of eLOS during the COVID-19 pandemic.

Risk of Colorectal Cancer among Patients with One or Multiple Metabolic Syndrome Components

Background/Objectives: Dysfunctions of metabolic syndrome (MetS) have been identified as a significant risk factor for colorectal cancer (CRC). However, current colon cancer guidelines do not classify patients with MetS as high risk, thereby leaving these individuals vulnerable. Consequently, we explored the relationship between MetS, its individual components, and the development of CRC in a cohort of patients with MetS to assess the necessity for CRC screening in these individuals. Methods: This study included patients ages 18 and older that received a service from the Marshall-Health (MH) practice plan, Cabell-Huntington Hospital (CHH), MU/JCESOM’s Edwards Comprehensive Cancer Center (ECCC), or the University of Kentucky HealthCare (UKHC) system between 2010 and 2018. We implemented log-binomial regression models to assess the individual and collective effects of MetS components after adjusting other CRC risk factors. Results: Given that CRC prevalence increases in the older population (aged 65 years and above), and that multiple components of MetS are observed within the same population, we analyzed the concurrent impact of all MetS components on CRC. Log-binomial regression models were implemented to assess the risk of CRC due to MetS components after adjusting other risk factors. Conclusions: We identified specific components that markedly increased CRC risk, suggesting that individuals with these components should be prioritized for early screening. These findings could significantly influence early CRC screening protocols, with the ultimate aim to reduce mortality associated with the disease.

Factors Influencing Farmers’ Adoption of Climate Smart Agriculture Practices in the Case of Ilu Aba Bora Zone, South West Ethiopia

To overcome the challenges of climate change, this study was intended to identify factors that affect the farmers’ adoption of CSA in the Ilu Aba Bora Zone of Southwest Ethiopia across varying agro-ecological zones. A mixed research design was used for this study. During this study, representative districts (Bure, Hurumu, and Nono Sale) were selected purposely based on their differences in agro-ecology, while rural kebeles and respondents were selected randomly from the districts to minimize the biases of the data. Data collection tools employed were a questionnaire, KKI, FGD, and field observations. A binomial logistic regression model was used to identify the interaction of response and explanatory variables and to draw a conclusion. The findings of this study revealed the majority (63.1%) of farmers did not have an understanding of the meaning, function, and goals of CSA practices. Existing CSA options in the study area were conservation agriculture, crop diversification, agro-forestry, early warning system, livelihood diversification, and improved livestock feed, which were practiced at different levels and by a few households. In particular, the early warning system and improved livestock feed were the least implemented CSA options, whereas livelihood diversification, conservation agriculture, and agro-forestry were the highly adopted practices in the area. Independent variables including on-farm income, farming experience, weather information, agro-ecology, farm land size, age, extension service, marital status, and off-farm income were the factors significantly affecting the adoption of CSA practices in the study area. Experts, governments, and nongovernmental organizations should improve farmers’ awareness of the benefits of CSA practices in ensuring food security, climate mitigation and adaptation through training and capacity building. The result of this study will show the direction for farmers, policy makers, planners, and other stakeholders to set up a solution in order to promote CSA practices and technologies based on agro-ecology.

Trends in prevalence of adverse childhood experiences by sociodemographic factors in the United States: Behavioral Risk Factor Surveillance System 2009–2022

BackgroundLimited data exists on trends in prevalence of adverse childhood experiences (ACE) at the national level and sociodemographic correlates of having ACEs. This study examined trends in ACE prevalence and sociodemographic correlates in US adults over 14 years using nationally representative data.MethodsData on 447,162 adults from the Behavioral Risk Factor Surveillance System (BRFSS) across four timepoints (2009–2010; 2011–2012; 2019–2020; 2021–2022) was analyzed and weighted for population estimates. The primary outcome was ACEs with 3 groups used (0 vs. 1 + ACEs; <4 vs. 4 + ACEs; 0 vs. 1 vs. 2 vs. 3 vs. 4 + ACEs). Sociodemographic factors included age, sex, race/ethnicity, employment, education, marital status, income and insurance status. Prevalence trends were examined by estimating prevalence of ACE groupings (0/1+; <4/4+; 0,1,2,3,4+) across the four timepoints and trend analysis was performed to determine if the differences over time were statistically significant. Unadjusted and adjusted prevalence ratios were estimated using log-binomial regression models with ACE groupings as the outcome and timepoints as the primary independent variable with sociodemographic factors as covariates.ResultsAcross the four time points, prevalence of ACEs was higher across groupings of ACEs by time. For ACEs 1+, prevalence was 62.2% (2009–2010); 62.2% (2011–2012); 64.5% (2019–2020); and 67.2% (2021–2022). For ACEs 4+, prevalence was 17.4% (2009–2010); 18.1% (2011–2012); 20.4% (2019–2020); and 22.6% (2021–2022). Prevalence of ACE 1 + was higher for older adults, Non-Hispanic Black adults, Non-Hispanic Other adults, and those with higher education. Prevalence of 4 + ACEs was higher for females, and lower for those with higher education and those with higher annual incomes.ConclusionThis study shows an increased prevalence of having ACEs over a 14-year period and identified independent sociodemographic correlates of having ACEs in a nationally representative study. Targeted interventions are needed to reduce burden of ACEs using population-based approaches.

Plasma atherogenicity index is a powerful indicator for identifying metabolic syndrome in adults with type 2 diabetes mellitus: A cross-sectional study.

Metabolic syndrome (MetS) is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). Elevated triglyceride (TG) levels and decreased high-density lipoprotein levels (HDL-C) are predisposing factors for the development of ASCVD. Evidence on the association between atherosclerotic index of plasma [AIP = log (TG/HDL-C)] and MetS is limited. Our study aimed to investigate the association between AIP and MetS. This is a cross-sectional study that determines the presence of MetS by assessing anthropometric and biochemical parameters. Multivariate log-binomial regression models were used to analyze the relationship between AIP and MetS risk. To further test the stability of the results, we performed sensitivity analyses in young, non-obese, and normal lipid population. Smoothing plots explored the potential nonlinear relationship between the AIP index for MetS and the estimated potential risk threshold. Predictive power of AIP for MetS using respondent operating characteristic (ROC) curves. The prevalence of MetS was 67.35%. Multivariate logistic regression analysis showed an independent and positive association between AIP and MetS (Per 1 SD increase, PR = 1.31, 95% CI: 1.15-1.47). Sensitivity analysis demonstrated the stability of the results. Smoothing plot showed a nonlinear relationship between AIP and MetS, with an inflection point of 0.66. ROC curve analysis, AIP was an accurate indicator for assessing MetS in type 2 diabetics (AUC = 0.840, 95% CI: 0.819-0.862). AIP is a stable and independently powerful predictor of MetS in T2DM patients. AIP can be used as a simple assessment tool for the early detection of MetS and disease management for the prevention of cardiovascular disease.