Mixed-effects Logistic Regression Models Research Articles

The effect of a general practitioner's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point prevalence audit survey in 18 European countries.

Illness severity, comorbidity, fever, age and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing. To quantify the effect of general practitioners' (GPs') perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country. Prospective audit in 18 European countries. Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perception of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI). GPs who perceived a patient request for antibiotics were four times more likely to prescribe antibiotics (OR: 4.4, 95%CI: 3.4-5.5). This effect varied by country: lower in Spain (OR: 0.06), Ukraine (OR: 0.15), and Greece (OR: 0.22) compared to the lowest prescribing country. The effect was higher for ILI (OR: 13.86, 95%CI: 5.5-35) and throat infection (OR: 5.1, 95%CI: 3.1-8.4) than for LRTI (OR: 2.9, 95%CI: 1.9-4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased/purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils. GPs' perception of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.

Prevalence and determinants of unhealthy feeding practices among young children aged 6-23 months in five sub-Saharan African countries.

Despite the World Health Organization's advice against unhealthy feeding, many low- and middle-income countries, including sub-Saharan Africa (SSA) countries, are experiencing a nutritional transition to high in sugar, unhealthy fats, salts, and processed carbohydrates for younger children. However, there is a scarcity of recently updated multicounty information on unhealthy feeding practices and determinants in SSA countries. Therefore, this study aimed to assess the pooled prevalence of unhealthy feeding practices and determinants among children aged 6-23 months in five SSA countries. A cross-sectional study design was employed with the most recent demographic and health survey secondary data (DHS) from five SSA countries. This secondary data was accessed from the DHS portal through an online request. The DHS is the global data collection initiative that provides detailed and high-quality data on population demographics, health, and nutrition in low- and middle-income countries. We used a weighted sample of 14,064 children aged 6-23 months. A multilevel mixed-effect binary logistic regression model was fitted to identify significant factors associated with unhealthy feeding practices. The level of statistical significance was declared with p-value < 0.05. This study found that overall, 62.4% (95% CI: 61.62-63.17) of children aged 6-23 months in five SSA countries had unhealthy feeding practices. Rural residents, lower-middle-income SSA countries, and children aged above 12 months had lower odds of unhealthy feeding practices. On the other hand, richer households and women who had not had an optimal antenatal care visit had higher odds of unhealthy feeding practices. According to this study, nearly two out of three young children in five SSA countries had unhealthy feeding practices. Both individual and community-level factors are significantly associated with unhealthy feeding practices. As a result, responsible bodies shall make all efforts to reduce unhealthy feeding practices among young children in SSA countries.

Association Between Multimorbidity and End-of-Life Outcomes Among Middle-Aged and Older Adults: Evidence From 28 Countries.

Multimorbidity poses significant challenges to the well-being of middle-aged and older adults, but its impact on end-of-life experiences remains relatively underexplored and inconsistent. This study aims to investigate the association between the number of chronic conditions and 6 end-of-life outcomes across 28 countries. Longitudinal analyses. Data were drawn from 6625 participants in the Survey of Health, Ageing, and Retirement in Europe (SHARE). Information on 12 chronic non-communicable conditions was self-reported by participants in core interviews and categorized into 4 groups: 0, 1, 2, and ≥3 chronic conditions. Six end-of-life outcomes were reported by proxy respondents during end-of-life interviews after participants' deaths. These outcomes included the place of death, duration of hospital stays in the last year of life, hospice or palliative care utilization, and symptoms such as pain, breathlessness, and anxiety or sadness in the last month of life. Mixed-effects logistic regression models were conducted to examine the association between the number of chronic conditions and end-of-life outcomes. Among the included participants, having 3 or more chronic conditions was positively associated with dying in a hospital (odds ratio [OR], 1.31; 95% CI, 1.15-1.49), staying in hospitals for 3months or more during the last year of life (OR, 1.36; 95% CI, 1.04-1.78), and experiencing symptoms such as pain (OR, 1.67; 95% CI, 1.34-2.08), breathlessness (OR, 1.32; 95% CI, 1.08-1.60), and anxiety or sadness (OR, 1.43; 95% CI, 1.12-1.83) in the last month of life after adjusting for covariates. In addition, each additional chronic condition was associated with 6% to 12% increases in the odds of these end-of-life outcomes, except for hospice or palliative care utilization. Our findings underscore the significant impact of multimorbidity on end-of-life experiences and highlight the importance of coordinated care strategies to address the complex needs of patients with multimorbidity and alleviate their symptom burden.

Interactive effect of sleep duration, lifestyle factors and comorbidity on depressive symptoms: Insights from the China health and retirement longitudinal study.

As population aging intensifies, depression emerges as a major global public health issue, especially affecting middle-aged and elderly individuals. While studies have investigated factors like sleep duration, physical activity, smoking, drinking habits, and comorbidity, the complex interplay and cumulative effect of these factors on the risk of depressive symptoms remain not fully understood. This research utilizes data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing observations from 2015 to 2020. The subjects included 8234 middle-aged and elderly individuals, accounting for a total of 22,570 observations. Lifestyle factors were represented by physical activity, smoking, and drinking habits, with the volume of moderate-to-vigorous physical activity (MVPA) quantified by quoting metabolic equivalents (MET). Multivariate logistic regression models were conducted for baseline analysis, and mixed-effects logistic regression models with random participant intercepts were constructed for the longitudinal analysis of the cohort. Moreover, interaction terms between these factors were included to assess their combined impact on the risk of depressive symptoms. Longitudinal analysis revealed a notable correlation between short sleep duration (<7h) and an elevated risk of depressive symptoms, evidenced by an adjusted odds ratio (OR) of 3.13 (95% CI: 2.73-3.74). Conversely, long sleep duration (>9h) was not associated with a marked change in risk of depressive symptoms (OR=1.11, 95% CI: 0.78-1.59, p=0.59). High levels of physical activity (192-336 MET-h/week) were significantly linked to an elevated risk of depressive symptoms (OR=1.70, 95% CI: 1.19-2.42). Discontinuing smoking was significantly correlated with a lower risk of depressive symptoms (OR=0.68, 95% CI: 0.52-0.90). Subjects with two or more concurrent conditions exhibited a substantially higher risk of depressive symptoms (OR=3.19, 95% CI: 3.13-3.25). Investigating the combined influence of sleep duration, lifestyle elements, and concurrent conditions revealed that enhanced physical activity levels significantly decreased risk of depressive symptoms in participants with short sleep duration, adjusting the OR from 3.16 to 0.83 (95% CI, 0.53-1.30). Among participants with short sleep duration, smoking and alcohol consumption patterns were linked to a decreased risk of depressive symptoms, although these associations lacked statistical significance. Relative to subjects without concurrent conditions, those harboring two or more such conditions faced a significantly heightened risk of depressive symptoms in the context of short sleep duration (OR=3.00, 95% CI: 2.24-4.03), a risk not observed in subjects with extended sleep duration. Moderate napping (0.5-1h) among participants with short sleep duration was found to significantly mitigate risk of depressive symptoms (OR=0.64, 95% CI: 0.44-0.95), whereas in subjects with prolonged sleep duration, extended napping did not significantly alter risk of depressive symptoms. The results, derived from a middle-aged and elderly Chinese population, may not be generalizable to other demographic groups or cultural contexts. This study shows that short sleep duration, unhealthy lifestyle factors, and comorbidities significantly increase the risk of depressive symptoms in middle-aged and elderly individuals. Moderate physical activity, smoking cessation, moderate drinking, and appropriate napping can mitigate this risk, especially for those with short sleep duration. These findings highlight the need to address sleep quality, promote healthy habits, and manage comorbidities in mental health interventions for this population.

Effects of sex on imaging-based intravenous thrombolysis for ischaemic stroke with unknown onset time: a pooled analysis of clinical trials.

The effects of imaging-based intravenous thrombolysis on outcomes based on patient sex remain unclear. We aimed to investigate whether outcomes among patients with stroke with an unknown onset time and treated with imaging-based intravenous thrombolysis are influenced by their sex. This study was a pooled analysis of individual patient-level data acquired from the Evaluation of unknown Onset Stroke thrombolysis trials. Patients treated with imaging-based intravenous thrombolysis for stroke with an unknown onset time were included. The primary outcome was a favourable outcome (modified Rankin Scale score 0-1) at 90 days. The sex-based difference in outcomes was studied using mixed-effect logistic or ordinal regression models, considering potential heterogeneity across trials. Out of 509 patients in total, 204 (40.1%) were women. Compared with men, women were older and more likely to have atrial fibrillation. Baseline National Institutes of Health Stroke Scale score was higher and hours from last-known-well to treatment were longer for women than for men. Favourable outcomes occurred less often among women than among men. However, multivariate adjustment revealed a non-significant association between female sex and favourable outcome (adjusted odds ratio: 1.04 [95% confidence interval: 0.66-1.52], p = 0.98). Pooled data from the included clinical trials showed that women with ischaemic stroke with an unknown onset time had worse functional outcomes following imaging-based intravenous thrombolysis than did men. However, this sex-based difference can be explained by the higher age and more severe clinical status at onset among women.

Women's informal group participation and intimate partner violence in Mwanza, Tanzania: A longitudinal study.

Women's groups have emerged as an essential platform for implementing violence prevention interventions across diverse settings because they can serve as a powerful catalyst for promoting gender equality, empowering women, and providing a safe space for them. Given the limited empirical evidence on the impact of women's informal group participation on male-perpetrated intimate partner violence, this longitudinal study examines how such participation influences women's experiences of physical, emotional, sexual, and economic IPV in Mwanza, Tanzania. Data from four waves of the MAISHA study, which followed up the control groups (n=1122) of the two MAISHA trials, were analysed. Women aged 18-70 who had been in a relationship within the last 12 months were included. Using mixed effects logistic regression models, we examined the association between women's active participation in religious, ethnic, microcredit, street and support groups and community meetings, with four types of IPV, adjusting for cohabitation status, age and enrolment in previous MAISHA trials. Participants' unique identification number was used as a random effect variable, and dummies for each survey round were used to account for time. The prevalence of religious, ethnic, microcredit, support and street groups, and community meeting participation at baseline were 41.8%, 17.5%, 41.1%, 20.1%, 42.9%, and 20.1%, respectively. Adjusted multivariable models showed that participants who engaged in community meetings reported lower odds of experiencing economic IPV (AOR=0.68, CI: 0.56-0.82) and higher odds of experiencing emotional IPV (AOR=1.21, CI: 1.00-1.46). Further, active participants of support groups reported lower odds of experiencing both economic (AOR=0.77, CI: 0.60-0.99) and sexual IPV (AOR=0.72, CI: 0.58-0.90). Participants in ethnic groups also reported lower odds of economic IPV (AOR=0.79, CI: 0.62-1.00). No predictor was associated with physical IPV. This study underscores the potential of informal community group participation to mitigate sexual and economic IPV among women in Mwanza, Tanzania, while also indicating a possible increase in the risk of emotional IPV. It emphasises the necessity for tailored, context-sensitive, and gender-transformative interventions to address power imbalances and restrictive norms effectively. Future research should delve into nuanced measures of group participation, including attendance, meeting frequency and duration, participants' influence within groups, the strength of social ties, and their implications for IPV experiences.

Photon-Counting CT Effects on Sensitivity for Liver Lesion Detection: A Reader Study Using Virtual Imaging.

Background Detection of hepatic metastases at CT is a daily task in radiology departments that influences medical and surgical treatment strategies for oncology patients. Purpose To compare simulated photon-counting CT (PCCT) with energy-integrating detector (EID) CT for the detection of small liver lesions. Materials and Methods In this reader study (July to December 2023), a virtual imaging framework was used with 50 anthropomorphic phantoms and 183 generated liver lesions (one to six lesions per phantom, 0.4-1.5 cm in diameter). Virtual CT platforms simulated PCCT and EID CT scanners. Phantoms were virtually scanned using routine (6 mGy) and low-dose (1.5 mGy) conditions and reconstructed with three kernels. A subset of 300 scans (150 PCCT vs EID CT pairs) were selected. Four radiologists independently reviewed all scans to mark liver lesions, assigned confidence scores for detection, and rated scan quality. Analysis was performed on a per-lesion basis to determine sensitivity for several variables and on a per-scan basis for scan quality. The McNemar test, two-sided paired t tests, and mixed-effects logistic regression models were fitted; P < .05 was considered indicative of statistically significant difference. Results Consensus reader sensitivity in detecting lesions was 82.1% (451 of 549) for PCCT versus 77.6% (426 of 549) for EID CT (P < .001), with a mean sensitivity gain of 4.3 percentage points ± 1.3 (P < .001 to P = .02 per reader). Readers had better subjective confidence for lesions at PCCT (mean score, 61.5 ± 22 vs 56.1 ± 24 [on a 101-point scale]; P < .001). Sensitivity was lower for lesions smaller than 1 cm, with more pronounced difference between PCCT and EID CT (74.0% [271 of 366] vs 67.2% [246 of 366]; P < .001). At the lower dose level, PCCT showed higher sensitivity than EID CT (68.9% [168 of 244] vs 61.1% [149 of 244]; P < .001) for subcentimeter lesions. In a multivariable model, PCCT was independently associated with increased odds of lesion detection (odds ratio, 1.55; P < .001). Image quality was slightly higher for PCCT (mean score, 55.3 vs 50.6 [on a 101-point scale]; P < .001). Conclusion Compared with EID CT, PCCT showed better sensitivity in the detection of small liver lesions. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Menu in this issue.

US-Guided Thermal Ablation for Secondary Hyperparathyroidism: A Prospective Multicenter Study.

Background Interest in microwave ablation (MWA) and radiofrequency ablation (RFA) use for treating secondary hyperparathyroidism (SHPT) is rising; however, ablation outcomes in patients with SHPT are not well characterized. Purpose To assess the response of parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels to US-guided parathyroid MWA and RFA and the safety of these treatments in participants with SHPT. Materials and Methods This prospective multicenter cohort study, conducted from September 2017 to March 2022, included participants with SHPT. The primary end point was the proportion of participants achieving the target PTH level (≤585 pg/mL). The secondary end points included PTH, calcium, phosphorus, and ALP levels before ablation and time points for follow-up assessments after ablation (2 hours, 1 day, 1 month, 3 months, and 6 months, and then every 6 months) and complications and technical success rates. Mixed-effects logistic regression models were used to identify factors associated with treatment failure. Results A total of 215 participants (median age, 53 years [IQR, 43-60 years]; 109 [50.7%] male participants) were evaluated, and 183 (85.1%) achieved target PTH levels. Compared with baseline levels, there was an 85.9%, 6.3%, 15.3%, and 37.4% reduction in PTH, calcium, phosphorus, and ALP levels at 24 months after ablation, respectively. For major complications, one (0.5%) participant experienced persistent hoarseness, and severe hypocalcemia (<1.87 mmol/L) was present in 74 (34.4%) participants. After adjustments, predictors associated with treatment failure included the preablation PTH level (adjusted odds ratio [OR], 3.78; 95% CI: 1.19, 12.04; P = .03), maximum tumor volume (adjusted OR, 5.02; 95% CI: 1.74, 14.53; P = .003), and number of glands ablated (adjusted OR, 0.32; 95% CI: 0.11, 0.98; P = .046). The prediction model showed good discrimination ability in the development and validation cohorts (area under the receiver operating characteristic curve, 0.78 [95% CI: 0.66, 0.90] and 0.73 [95% CI: 0.55, 0.91], respectively). Conclusion US-guided thermal ablation techniques were effective and safe treatments in participants with SHPT because they effectively reduced PTH, calcium, phosphorus, and ALP levels. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.

Socioeconomic Disparities in Exposures to PFAS and Other Unregulated Industrial Drinking Water Contaminants in US Public Water Systems.

Unregulated contaminants in drinking water, such as per- and polyfluoroalkyl substances (PFAS), can contribute to cumulative health risks, particularly in overburdened and less-advantaged communities. To our knowledge, there has been no nationwide assessment of socioeconomic disparities in exposures to unregulated contaminants in drinking water. The goals of this study were to identify determinants of unregulated contaminant detection among US public water systems (PWSs) and evaluate disparities related to race, ethnicity, and socioeconomic status. We gathered data from the US Environmental Protection Agency's (US EPA's) Third Unregulated Contaminant Monitoring Rule (2013-2015), PWS characteristics, sociodemographic data, and suspected pollution sources from regulatory databases. We included four target contaminants (or classes) with industrial sources: PFAS, 1,4-dioxane, 1,1-dichloroethane, and chlorodifluoromethane (HCFC-22). Associations were evaluated with pairwise comparison tests and generalized logistic mixed-effects regression models for six dichotomous outcomes: detection of each of four target contaminants, detection of target contaminant, and PWS exceedance of US EPA health reference level that was in effect in 2017. More than 97 million US residents were served by a PWS with detectable levels of 1,4-dioxane (22% of PWSs), HCFC-22 (5.8%), 1,1-dichloroethane (4.7%), and/or PFAS (4.0%). Unregulated contaminant detection was more frequent among large systems, urban systems, and systems using groundwater or a combination of groundwater and surface water. In comparison with PWSs with no detectable levels of these unregulated contaminants, PWSs with detectable levels served counties with higher proportions of Hispanic residents (17% vs. 13%), as did PWSs that exceeded EPA health reference levels in comparison with PWSs with no exceedances (18% vs. 14%). There were persistent positive associations between proportions of Hispanic residents and detections of target contaminants, even after accounting for pollution sources. Previously, inequities in exposures to drinking water contaminants were underestimated because prior studies have focused on regulated contaminants. PWSs serving counties with more Hispanic residents, non-Hispanic Black residents, and urban households may benefit from additional resources to proactively mitigate unregulated chemical contamination. Future studies should evaluate factors underlying these disparities to promote actions that protect water quality for all residents. https://doi.org/10.1289/EHP14721.

Multilevel factors influencing falls of older patients in hospital: The risk of hospital-induced delirium and the impact of nurse staffing

ObjectiveThis study aimed to explore the individual and organizational factors influencing falls among older inpatients, with a particular focus on the risk posed by hospital-induced delirium and the effect of nurse staffing levels. MethodsThis retrospective cohort study utilized data from a national healthcare database to examine falls in hospitalized older adults, applying a mixed-effect logistic regression model ResultsData from 391,902 patients across 580 hospitals revealed that 1.2 % of older inpatients experienced falls. Influential factors for falls included advanced age, the use of multiple medications and treatments, impaired mobility, and hospital-induced delirium. Nurse staffing levels markedly influenced the reduction of fall risks among older patients. ConclusionFalls among hospitalized older adults are a frequent consequence of multifaceted risk components, highlighting the need for comprehensive fall prevention strategies and adequate.

The burden, clinical features and outcomes of SARS-CoV-2, Influenza and co-infections during concurrently out-of-season outbreaks in Brazil

Little is known about the burden and the clinical presentation and prognosis of individuals with Influenza and SARS-CoV-2 during concurrent outbreaks. We aimed to describe the burden, clinical characteristics and outcomes of hospitalized adults during the Influenza A/H3N2 and Omicron outbreaks in Brazil. Cross-sectional analysis of national surveillance data. We described the health system burden and clinical features of confirmed cases of Influenza and/or SARS-CoV-2 reported in the national surveillance system during the Influenza A H3N2 out-of-season outbreak and the first Omicron surge between November 2021 and March 2022 in Brazil. A multilevel mixed-effects logistic regression model adjusted by a priori defined confounders was used to evaluate the association between the infection type and resource use and mortality. The outbreaks occurred simultaneously across all Brazilian regions. Coinfected patients had clinical features from both infections. Influenza coinfected cases had similar odds for requiring ICU admission (adjusted odds ratio, aOR 0.96, 95% CI, 0.80-1.15, p=0.634), mechanical ventilation (aOR 0.88, 95% CI, 0.70-1.11, p=0.290), and in-hospital mortality (aOR 1.02, 95% CI, 0.84-1.23, p=0.847) compared to COVID-19 only. Influenza had lower odds for requiring ICU admission, mechanical ventilation and in-hospital mortality compared to COVID-19 only. Simultaneous surges of Influenza and SARS-CoV-2 increased the pressure on the health system of Brazil. Coinfection was not associated with higher resource use or death; Influenza was associated with better outcomes, compared to COVID-19.

WORK TOLL: AN INTERSECTIONAL ANALYSIS ON ABSENTEEISM AND PRESENTEEISM AMONG FAMILY CAREGIVERS FOR PLWD

Abstract Working family caregivers for PLwD experience higher rates of work productivity loss—absenteeism and presenteeism—compared to their non-caregiving counterparts. Accessible workplace supports remain out of reach for many caregivers making them vulnerable for compensation loss. Only recently has an intersectionality approach been used in quantitative research to address persistent inequalities across disciplines. This cross-sectional study examined 1) relationship between caregivers’ intersecting social identities and access to flexible hours; and 2) extent caregivers’ intersecting social identities impact experiences of absenteeism and presenteeism. Dyads (n=891) from 2017 wave of National Health and Aging Trends Study (NHATS) and National Survey of Caregivers (NSOC) were analyzed using the validated WPAI-CG measure. Mixed-effect logistic regression models and generalized linear models were conducted. Findings suggest caregivers with one full-time job were less likely to have flexible hours compared to caregivers with part-time or multiple jobs (p&amp;lt;.05). Black female caregivers were more likely to have flexible hours compared to Black male caregivers (OR=9.3, p=.024), but the opposite relationship was found for White caregivers (OR=0.19, p=.002). Caregivers who were female, post-HS education, with flexible hours, and multiple health conditions had greater presenteeism (p&amp;lt;.05). Caring for someone with dementia was associated with greater presenteeism (p&amp;lt;.05). Caregiving situations vary drastically. Flexible hours are popular but may not adequately address work productivity loss; furthermore, findings suggest disparate access to them. As the number of PLwD is expected to rise over the next 25 years, policies and workplaces need to consider inclusive solutions to meet the needs of working family caregivers.

Seroprevalence of SARS-CoV-2 and risk factors for infection among children in Uganda: A serial cross-sectional study

Background Understanding COVID-19’s impact on children is vital for public health policy, yet age-specific data is scarce, especially in Uganda. This study examines SARS-CoV-2 seroprevalence and risk factors among Ugandan children at two timepoints, along with COVID-19-related knowledge and practices in households, including adult vaccination status. Methods Baseline surveys were conducted in 12 communities from April to May 2021 (post-Alpha wave) and follow-up surveys in 32 communities from November 2021 to March 2022 (Omicron wave). Household questionnaires and blood samples were collected to test for malaria by microscopy and for SARS-CoV-2 using a Luminex assay. Seroprevalence was estimated at both the survey and community level. Mixed-effects logistic regression models assessed the association between individual and household factors and SARS-CoV-2 seropositivity in children, adjusting for household clustering. Results More households reported disruptions in daily life at baseline compared to follow-up, though economic impacts lingered. By the follow-up survey, 52.7% of adults had received at least one COVID-19 vaccine dose. Overall seroprevalence in children was higher at follow-up compared to baseline (71.6% versus 19.2%, p &lt; 0.001). Seroprevalence in children ranged across communities from 6–37% at baseline and 50–90% at follow-up. At baseline, children from the poorest households were more likely to be infected. Increasing age remained the only consistent risk factor for SARS-CoV-2 seroconversion at both timepoints. Conclusions Results indicate that a larger number of children were infected during the Delta and Omicron waves of COVID-19 compared to the Alpha wave. This study is the largest seroprevalence survey in children in Uganda, providing evidence that most children were infected with SARS-CoV-2 before the vaccine was widely available to pediatric populations. Pediatric infections were vastly underreported by case counts, highlighting the importance of seroprevalence surveys in assessing disease burden when testing and reporting rates are limited and many cases are mild or asymptomatic.

Postcertification Wages Among Certified Peer Specialists Working in Peer Support and Other Occupations.

Although certification can raise the status of peer support work, certified peer specialists (CPSs) may continue to face financial hardship that affects their employment choices. This study aimed to explore how wages and financial well-being changed for CPSs over a 3-year postcertification period. This study examined wages, job characteristics, and financial well-being for a cohort of 448 employed CPSs working in peer support (PS) or other, nonpeer (NP) jobs during the study period. Self-report survey data were collected on current jobs, hours worked, and job tenure. Financial well-being was assessed by using the Consumer Financial Protection Bureau's Financial Well-Being Scale. Differences in job characteristics over time were described by using chi-square and t tests, and mixed-effects logistic regression models were used to model job attributes and financial well-being. Hourly wages for both PS and NP jobs increased significantly between 2020 and 2022, with smaller increases for PS than for NP positions. Individuals with PS jobs were significantly more likely to have longer job tenures than those with NP jobs. Higher hourly wages were associated with a greater likelihood of longer job tenure. Financial well-being did not improve significantly over time. The larger wage increases and shorter tenures characteristic of NP jobs, relative to PS positions, suggest that workers may have switched from PS jobs to other jobs to improve their financial and career mobility opportunities. CPSs are part of a trend in the general U.S. adult population of declining financial well-being, despite increased wages.

Poor access to breastfeeding counseling services and associated factors among lactating mothers who had optimal antenatal care follow-up in Sub-saharan Africa: a multilevel analysis of the recent Demographic and Health Survey

BackgroundInadequate access to services for breastfeeding counseling results in poor breastfeeding practices and adverse health consequences. Although poor access to breastfeeding counseling services is a major challenge, its magnitude and determinantes are not well studied in developing countries. Therefore, this study assessed the magnitude and determinants of poor access to breastfeeding counseling services among lactating mothers who had optimal antenatal care follow-up in Sub-Saharan Africa.MethodsData from the recent Demographic and Health Surveys, involving a total of 289,929 women, were used for analysis. The determinants of poor access to breastfeeding counseling services were examined using a multilevel mixed-effects logistic regression model. Significant factors associated with poor access to breastfeeding counseling services were declared significant at p-values < 0.05. The adjusted odds ratio and confidence interval were used to interpret the results. A model with the lowest deviance and highest log likelihood ratio was selected as the best-fit model.ResultsIn Sub-Saharan Africa, nearly one in two women with optimal antenatal care follow-up had poor access to breastfeeding counseling services. Maternal age (AOR = 1.18, 95% CI: 1.02, 1.38), maternal education (AOR = 1.128, 95% CI: 1.22, 1.35), distance to health facility (AOR = 1.17, 95% CI: 1.13, 1.21), media exposure (AOR = 1.12, 95% CI: 1.08, 1.17), wealth index (AOR = 1.05, 95% CI: 1.00, 1.10), place of delivery (AOR = 4.31, 95% CI: 4.11, 4.52), PNC (AOR = 3.92, 95% CI: 3.78, 4.07), mode of delivery (AOR = 1.88, 95% CI: 1.76, 2.02), birth interval (AOR = 1.12, 95% CI: 1.07, 1.17), residence (AOR = 1.14, 95% CI: 1.09, 1.18), community poverty (AOR = 1.09, 95% CI: 1.03, 1.15), community institutional delivery (AOR = 1.06, 95% CI: 1.01, 1.12), country category (AOR = 2.23, 95% CI: 2.10, 2.37), had higher odds of poor access to breastfeeding counseling services.ConclusionsPoor access to breastfeeding counseling services among lactating mothers was found to be high. Both individual and community-level factors were determinants of poor access to breastfeeding counseling services. The Ministry of Health in Sub-Saharan Africa should give attention to those women who have not had a postnatal check-up and give birth at home while designing policies and strategies.

Preoperative Physical Therapy Is Protective From Construct Failure in Anterior Cruciate Ligament Reconstruction.

Risk factors for anterior cruciate ligament reconstruction (ACLR) construct failure have been studied extensively. However, while some studies account for variables such as activity level, construct types, preoperative physical therapy, or patient demographics individually, comprehensive studies that control for all these factors simultaneously are scarce. By utilizing a robust multivariable analysis, the factors associated with an increased risk of ACLR construct failure can be determined. A single-center, retrospective cohort study was conducted, encompassing patients who underwent primary ACLR between January 2015 and December 2021. Level 3. Eligible patients were identified using the current procedural terminology code 29888. Datapoints collected included demographics, body mass index, injury setting, graft type, graft size, fixation type, concomitant ligamentous injuries, notchplasty, operating surgeon, preoperative physical therapy, and instances of construct failure. The prevalence of construct failure was analyzed using chi-square tests, comparing across all graft and fixation type combinations in ACLR procedures. A mixed-effects logistic regression model was utilized to account for the potential influence of all relevant variables on construct failure. Out of 1245 patients, the construct failure rate was 5.62% (n = 70), with >95% of patients having >2 years of retrospective follow-up (95% CI [4.34-6.90]), with a median failure time of 502.5 days (interquartile range [265.5-1033.8]). The mixed-effect logistic model identified preoperative physical therapy (odds ratio, 0.404, 95% CI [0.193-0.844]) as the only significant factor in possibly preventing construct failure. Contrary to conventional focus on graft and fixation types, this study emphasizes the protective role of preoperative physical therapy in reducing ACLR construct failure. Our findings suggest the integration of preoperative physical therapy in clinical practices to mitigate ACLR construct failure risk, warranting further exploration in future studies.

Naming Ability in the Chronic Phase of Moderate-Severe Traumatic Brain Injury.

Naming difficulties are commonly reported in the acute and subacute stages of recovery of traumatic brain injury (TBI) and across severity levels. Previous studies, however, have used samples of mixed chronicity (acute and chronic) and severity (mild and severe) and then aggregated data across individuals from these distinct groups. Thus, we have little knowledge about the persistence of naming difficulties into the chronic stage of recovery in individuals with moderate-severe TBI. To increase the rigor and reproducibility of naming research in TBI, the present study sought to determine the presence and profile of naming disruptions into the chronic stage of moderate-severe TBI using a confrontation naming assessment. Thirty-three individuals aged 24-55 years in the chronic epoch of moderate-severe TBI and 33 demographically matched noninjured comparison (NC) participants completed the Philadelphia Naming Test (PNT). A mixed-effects logistic regression model predicting the probability of a correct response as a function of group was fit to the data. Participants with TBI performed well on the PNT (all participants with TBI had over 90% accuracy). However, participants with TBI were statistically less likely to correctly name an item relative to demographically matched NC participants. This study provides empirical evidence that naming difficulties persist into the chronic epoch of moderate-severe TBI. Despite high accuracy on the PNT, nearly 60% of these individuals with TBI reported continued difficulty with word finding in their daily lives. This discrepancy leaves open the possibility that, at this stage of injury, word-finding issues may be more reliably evoked and studied when the assessment is embedded within cognitively demanding and ecologically valid contexts (i.e., discourse, conversation). Further investigation of naming deficits in chronic moderate-severe TBI using a more naturalistic assessment is warranted.

CKD Progression following Acute Kidney Injury: A Secondary Analysis of the STARRT-AKI Trial.

Chronic kidney disease (CKD) is a common complication after acute kidney injury (AKI). We aimed to evaluate whether RRT initiation strategy had an effect on CKD progression. Secondarily, we aimed to identify factors that influenced the development or progression of CKD following severe AKI. This secondary analysis of the STARRT-AKI trial included participants with outpatient serum creatinine values available in the year prior to hospitalization and who were alive at 90 days following randomization. Our main analysis focused on patients who had definitive assessment of kidney function at 90 days following randomization. Predictor markers included patient demographics, co-morbidities, markers of acute illness, laboratory values, receipt of renal replacement therapy (RRT), and RRT treatment strategy (accelerated versus standard). The primary outcome was CKD progression, a composite of de novo CKD, defined as new eGFR < 60 ml/min/1.73 m2 if baseline eGFR was ≥ 60 ml/min; a decline in eGFR ≥ 25% if baseline eGFR was < 60 ml/min, or RRT dependence at day 90. The association of RRT treatment strategy with CKD progression was assessed in an unadjusted mixed-effect logistic regression model. Of the 401 surviving patients with a baseline serum creatinine, 39% experienced CKD progression. RRT initiation strategy had no effect on CKD progression (accelerated arm (41%), vs. the standard arm (38%), Odds ratio 1.13, (95% confidence interval 0.75 to 1.72)). Receipt of RRT and aortic surgery were the most potent risks of CKD progression. These findings suggest that CKD progression is common after severe AKI. Risk factors for CKD progression included receipt of RRT and aortic surgery, suggested that these individuals should be prioritized for dedicated kidney follow up after hospital discharge.

Digital dermatitis in dairy cattle in Egypt: herd-level risk factors and Treponema spp. prevalence across lesion M-scores.

Digital dermatitis (DD) is an infectious disease of the digital skin of dairy cows that is associated with compromised animal welfare and significant economic losses. The hind feet of 16,098 dairy cows from 55 herds were examined in the milking parlor, and DD lesions identified were classified using the M-score system and swabbed for PCR testing. Swabs were also collected from hind feet with normal digital skin for comparison. Data on farm construction and lameness prevention measures were collected through direct observation and in-person interviews with farm managers. Herd-level risk factors for DD were investigated using mixed-effects logistic regression models, with Farm ID included as a random-effects variable. The average within-herd and herd prevalence of DD were 6.4% (95% CI: 4.9-8.0%) and 92.7% (n=51, 95% CI: 85.9-99.6%), respectively. Among the investigated DD lesions, DD-associated treponemes were identified at frequencies of 87% for Treponema spp., 87.5% for T. medium, 86.2% for T. phagedenis-like, and 78.3% for T. pedis. Additionally, Fusobacterium necrophorum and Dichelobacter nodosus were identified at frequencies of 37% and 15.4%, respectively. Samples from normal digital skin exhibited substantially lower frequencies for all bacterial species investigated. Risk factors significantly associated with DD in the final multivariable model included practice of preventive early lactation trimming (OR=0.45, 95% CI: 0.26-0.78) and the presence of an abrasive bedding on farms (OR=1.6, 95% CI: 1.01-2.6). This comprehensive molecular and epidemiological analysis enhances understanding of DD etiology in Egypt and contributes to the development of effective control programs to improve cow welfare and support the sustainability of milk production.

Study of association between embryo growth arrest (EGA) and atmospheric fine particulate matter pollution (PM2.5) and spatial metabolomics of villi derived from pregnant women.

Fine particulate matter (PM2.5) is related to embryo growth arrest (EGA). In this study, we collected demographic information from EGA cases and early pregnancy controls in Taiyuan, China, between 2022 and 2023 and obtained villi and serum samples from these participants. We employed multilevel mixed-effects logistic regression models to estimate the odds ratios (ORs). Subsequently, we examined the associations between PM2.5 and its components and the EGA-related biomarkers in the serum of the case-control groups. Additionally, we performed spatial metabolomics on villi using mass spectrometry imaging. Our results indicated that PM2.5 levels during pregnancy were higher in the EGA group compared to the control, increasing the risk by 17 % (OR=1.17, 95 %CI: 1.06-1.30, p = 0.001). PM2.5 and its components (Ni, Pb, ANY, NAP, ANT, PYR, and BaP) showed significant negative correlations with biomarkers (PAPP-A, VEGF, and PROG). Furthermore, EGA induced histopathological changes in the villi alongside differential spatial distribution of metabolites. Key metabolites, including 2'-deoxyinosine triphosphate, cytidine triphosphate, uridine triphosphate, guanosine-5'-triphosphate, guanosine diphosphate, and deoxyguanosine-5'-triphosphate, were predominantly involved in purine and pyrimidine metabolism pathways. It provides evidence of the association between PM2.5 and EGA and demonstrates the utility of spatial metabolomics in elucidating the metabolic alterations induced by PM2.5 in EGA.