Random Effects Logistic Models Research Articles

Early-onset sepsis as an early predictor for retinopathy of prematurity: a meta-analysis.

Objective Neonatal sepsis has been established as a risk factor of retinopathy of prematurity (ROP), but previous meta-analyses have predominately focused on late-onset sepsis. This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP. Study Design Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, EMBASE and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥ stage 3, type I, aggressive (posterior) ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birthweight, small for gestational age, maternal steroid use, necrotizing enterocolitis, late-onset sepsis and mechanical ventilation duration. Results Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (OR 1.90; 95% CI 0.96─3.79, p=0.067), but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR 2.21; 95% CI 1.68─2.90), and no significant confounders influencing this effect size were found in meta-regression analysis. Conclusion Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP.

Effectiveness of mass dengue vaccination with CYD-TDV (Dengvaxia®) in the state of Paraná, Brazil: integrating case-cohort and case-control designs

CYD-TDV (Dengvaxia®) was the first dengue vaccine approved, launched in Brazil in 2015 for individuals aged 9-44 years. We aimed to estimate the effectiveness of CYD-TDV in preventing symptomatic dengue cases during a campaign targeting individuals aged 15-27 years in selected municipalities in Paraná, Brazil. Additionally, we examined whether a history of dengue, as recorded by the surveillance system, modified the vaccine's effectiveness. We conducted a case-cohort analysis comparing the frequency of vaccination, with at least one dose of CYD-TDV, in individuals with dengue confirmed by RT-PCR, identified by the surveillance system during 2019 and 2020, with the vaccination coverage in the target population. Moreover, in a case-control design using weighted controls, we assessed the documented history of dengue as a modifier of the vaccine's effectiveness. We used a logistic random-effects regression model, with data clustered in municipalities and incorporating covariates such as the incidence of dengue before the campaign, age, and sex. We calculated vaccine effectiveness (VE) as (1-relative risk) x 100%. 1869 dengue cases were identified, which had a vaccination frequency significantly lower than the overall vaccination coverage in the target population (50.3% vs. 57.2%, respectively; overall VE: 21.3%; 95% confidence interval [CI]: 13.4%-28.4%). In individuals with a documented history of dengue, vaccination had a VE of 71% (95% CI: 58%-80%) in reducing the incidence of dengue. However, vaccination was not associated with a significant reduction in the overall dengue case risk in individuals without a documented history of dengue (VE: 12%; 95% CI:-21% to 36%). In this last stratum, vaccination was associated with reduced cases due to DENV-1 and DENV-4, but an excess of DENV-2 cases. Vaccination led to a significant reduction in reported dengue cases within the target population. The case-control design suggested that this reduction was primarily driven by the benefits observed in individuals with a documented history of dengue. In endemic regions with limited serological testing facilities, a previous history of dengue diagnosis recorded by epidemiological surveillance could be used to triage candidates for CYD-TDV vaccination. Research supported by Sanofi.

Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research

BackgroundHow epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined.MethodFor a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio...

Physical activity dose for generalized anxiety disorder & worry: Results from the Irish longitudinal study on ageing

The lowest moderate-to-vigorous physical activity (MVPA) dose that conveys protection for Generalized Anxiety Disorder (GAD) and worry is unknown. This study quantified associations of weekly accumulated MVPA doses with GAD and worry across 10 years using data from The Irish Longitudinal Study on Ageing (TILDA). Continuous MVPA (metabolic equivalent of task [MET] minutes per week [MET.min.week−1]; e.g., moderate-intensity brisk walking = 4METs), three-dose and, more precise, five-dose MVPA categories were examined. Worry symptoms and GAD status were measured using the Penn State Worry Questionnaire-Abbreviated and the Composite International Diagnostic Interview. Multivariable negative random effect binomial regression and logistic models adjusted for relevant covariates quantified associations across time. Among the 7,650 participants, compared to no MVPA (0 MET.min.week−1), 18 % (OR: 0.82; 95 %CI: [0.69–0.98]), 22 % (OR: 0.78; [ 0.64–0.95]) and 31 % (OR: 0.69; [0.59–0.79]) lower odds of GAD were found for the doses of 1-<600, 600-<1,200 and ≥2,400 MET.min.week−1 respectively. Post-hoc analysis demonstrated 47 % lower odds (OR: 0.53; (0.36–0.78) of GAD for 1-<200 MET.min.week1 compared to inactivity. Compared to no activity, engaging in even minimal physical activity equivalent of 10 min/day for five days/week of moderate-intensity activity (e.g., brisk walking), may lower the risk of GAD over time among older adults.

Association between chronotype and metabolic-associated fatty liver disease in employed adults: A longitudinal study in Southwestern China

ABSTRACT The circadian system is an essential physiological regulator of mammals, and sleep chronotype may be associated with the risk of metabolic disorders. However, evidence regarding the role of sleep chronotype in the development of metabolic-associated fatty liver disease (MAFLD) is scarce, particularly in employed adults. We conducted a longitudinal study of 1,309 employed adults in Southwestern China with a five-year follow-up from 2017 to 2021. MAFLD was assessed by the presence of hepatic steatosis using abdominal ultrasonography, overweight/obese status, diabetes mellitus, metabolic dysregulation, or elevation of high-sensitivity C-reactive protein. Chronotype was assessed by the Morning and Evening Questionnaire-5 (MEQ-5). The logistic random effects model was applied to analyze the 5-year panel data to estimate the association between chronotype and MAFLD, and the potential effect modification of demographics on such association. The MAFLD prevalence of participants was 38.6% at baseline and showed an increasing trend during follow-up (p for trends < 0.05). Compared with morning chronotype, evening chronotype was positively associated with MAFLD (OR = 2.19, 95%CI: [1.09, 4.40]) after controlled for covariates. Age, sex, ethnicity, and educational level did not modify the association between chronotype and MAFLD. These findings suggest that improving circadian rhythms could reduce the risk of MAFLD and chronic disease burden among employed adults.

Association between an anesthesia department development program for junior faculty and long-term production of publications: A longitudinal cohort study

BackgroundAn important mission of academic medical departments is to further the scholarship and education of its junior faculty. In 2013, Hindman et al. described the design and initial outcomes of a faculty development program for junior faculty at the University of Iowa Department of Anesthesia. In the current study, we reassessed whether the program increased the production of publications long-term. We included all department faculty, years before joining the department, and years after leaving the department, to control for the effects of simply being current faculty in the department, benefiting from its resources, and having had progressively more experience working. MethodsThe population studied was the faculty for any period between January 2006 and December 2022. The dependent variable was the count of publications in Scopus each year with the faculty member's Scopus identifier, 1996 through 2022. The two-year faculty development program included non-clinical time, two mentors, defined mentorship plan, didactic program, and financial support for clinical and/or laboratory studies. Statistical analyses were with logistic and Poisson random effect models for panel data, with standard errors estimated using jackknife resampling. ResultsAmong the 128 distinct faculty in the department from 2006 through 2022, the 10% with the most publications per year accounted for 54% of the total annual publications. The two-year program was completed by 41% (53/128). Completion of the faculty development program was associated with a 17% absolute increase in the predicted marginal probability of one or more publications per year, from 25% to 41%. The 95% confidence interval for the 17% absolute increase was 9% to 24% (P < .0001). The predictive marginal effect of completing the program was 1.7 more publications per year per faculty (95% confidence interval 1.1 to 2.4, P < .0001). The estimate was also 1.7 more publications per year while limiting consideration to the 108 faculty who joined the department after 1996 and including as an independent variable the count of publications the year before joining the department. ConclusionsA faculty development program for junior faculty can reliably increase the production of publications in an anesthesiology department by at least one per year. However, there is considerable heterogeneity in publication production among faculty.

Association between obesity and urinary incontinence in older adults from multiple nationwide longitudinal cohorts

BackgroundObesity and urinary incontinence (UI) among older adults, particularly older men, are yet to be fully explored. Utilizing multiple nationwide prospective longitudinal cohorts representative of the US, UK, and European samples, we examined the association of body mass index (BMI) and waist circumference (WC) with UI among both older women and men.MethodsWe derived the data from multiple longitudinal cohorts that surveyed UI. Participants were asked if they had experienced urine leakage within the past 12 months or within the past six months. The measure of obesity was based on BMI and WC. We employed a random-effect logistic model to associate BMI and WC with UI, adjusting for covariates including age, race, education, residence area, marital status, number of children, smoking, drinking, hypertension, diabetes, cancer, stroke, functional ability, and cognitive impairment. We visualized the associations by using restricted cubic spline curves.ResultsA total of 200,717 participants with 718,822 observations are included in the baseline analysis. Compared to those without UI, both female and male participants with UI demonstrate a higher BMI and WC. Among females, the fully adjusted models show linear associations between BMI, WC, and UI (Ps < 0.001). However, we observe U-shaped associations of BMI, WC with UI among males. The lowest likelihood of having UI is found among male participants with a BMI between 24 and 35 kg/m2.ConclusionsInterventions aimed at preventing UI among older adults must take sex into account. Weight loss intervention could be an effective treatment among older females who are overweight and with obesity as well as older males with obesity rather than all older males.

Salmonella Control in Fattening Pigs through the Use of Esterified Formic Acid in Drinking Water Shortly before Slaughter.

The presence of Salmonella in pig feces is a major source of abattoir and carcass contamination, and one of the main sources of human salmonellosis. This study assessed whether using a form of esterified formic acid (30% formic acid) in drinking water (10 kg/1000 L) 5 days before slaughter could be a helpful strategy to mitigate this public health issue. Thus, 240 pigs from three Salmonella-positive commercial fattening farms were selected. From each farm, 40 pigs were allocated to a control group (CG) and 40 to a treatment group (TG). At the abattoir, fecal samples from both groups were collected for Salmonella detection (ISO 6579-1:2017) and quantification (ISO/TS 6579-2:2012). Salmonella was present in 35% (95% IC = 29.24-41.23) of the samples collected. The prevalence was significantly higher in the CG than in the TG (50% vs. 20%; p < 0.001). In all farms, the TG showed a lower percentage of shedders than the CG. A random-effects logistic model showed that the odds of shedding Salmonella were 5.63 times higher (95% CI = 2.92-10.8) for the CG than for the TG. Thus, the proportion of pigs shedding Salmonella that was prevented in the TG due to the use of this form of organic acid was 82.2%. In addition, a Chi-squared analysis for trends showed that the higher the Salmonella count, the higher the odds of the sample belonging to the CG. These results suggest that adding this type of acid to drinking water 5 days before slaughter could reduce the proportion of Salmonella-shedding pigs and the Salmonella loads in the guts of shedder pigs.

Turning the Tables: Military Intervention and the Onset of Negotiations in Civil War

When do negotiations occur in civil war? How does military intervention alter this process? While the existing literature presents models of the onset of negotiations – both mediated and unassisted – they are incomplete if they do not consider third-party states involved in the conflict prior to negotiations. I argue that military intervention impacts negotiation onset by adjusting barriers to negotiation through three pathways: the likelihood of military victory, the risk of signaling weakness, and the presence of additional veto players. I examine these mechanisms using logistic random effects models on a dataset of African civil wars. An extension of the argument addresses how expectations of intervention shape conflict behavior. Rebel-supporting interventions, interventions with independent interests, and asymmetric interventions lead to an increase in the likelihood of negotiations occurring. Models controlling for expectations of intervention also suggest that third parties can impact belligerents’ behavior through both expectations and follow-through.

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy.

Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum. This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs). At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5). This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.

Food Insecurity and Intimate Partner Violence in Mwanza, Tanzania: A Longitudinal Analysis

Food insecurity is a potential predictor of intimate partner violence. This study (1) describes the prevalence of food insecurity and various forms of intimate partner violence experience among women in Mwanza, Tanzania; and (2) assesses the effect of food insecurity and hunger on various forms of women's experience of intimate partner violence longitudinally. Women (aged 18-70 years) who reported being in a relationship in the past 12 months, who had participated in the control arms of two randomized controlled trials conducted as part of the MAISHA study were interviewed at four time points (N=1,004 at baseline in 2017). Analyses were conducted in 2022. Associations between food insecurity exposures and intimate partner violence outcomes were assessed, and univariate random effect logistic models were conducted to identify relevant sociodemographic variables (including age, education level, and SES) that were statistically significant. Multivariable random effects logistic models were conducted, including time as a fixed effect, to calculate odds ratios indicating associations between food insecurity exposures and intimate partner violence outcomes. Prevalence of food insecurity was 47.7%, 55.6%, 47.2%, and 50.8% for each of the 4 waves, respectively, with significant difference in proportion of food insecurity between baseline and Wave 2. Multivariable random effects models indicated that food insecurity was associated with increased odds of exposure to all forms of intimate partner violence outcomes, and hunger was significantly associated with increased odds of experience of all intimate partner violence outcomes, apart from controlling behaviors. Results from this longitudinal analysis of food insecurity and women's reports of intimate partner violence experience in a low- and middle-income country setting indicate that food insecurity is significantly associated with all forms of intimate partner violence, apart from controlling behaviors, among women in this sample in Mwanza, Tanzania. Policy and programmatic implications include the need for integrated intimate partner violence prevention programming to take into account household food needs.

Racial, gender, and psychosocial disparities in viral suppression trends among people receiving coordinated HIV care in Los Angeles County.

To longitudinally evaluate differences in HIV viral suppression (<200 copies/ml) by intersections of race/ethnicity, gender, and psychosocial issues in people with HIV in the Los Angeles County Medical Care Coordination Program. We analyzed 74 649 viral load measurements over 10 184 people with HIV enrolled in the Medical Care Coordination Program between January 1, 2013 and March 1, 2020.Methods: We fit Bayesian logistic hierarchical random effects models to test interactions between gender, race/ethnicity, and a psychosocial acuity score on viral suppression over time from 1 year prior to program enrollment to 24 months after enrollment. The probability of viral suppression declined prior to enrollment, then increased and stabilized by 6 months after enrollment. Black/African American patients with low and moderate psychosocial acuity scores did not achieve the same increase in percentage of viral suppression as those in other racial/ethnic groups. Transgender women with high psychosocial acuity scores took longer (about 1 year) to achieve the same percentage of viral suppression as clients of other gender identities. Some racial/ethnic and gender disparities in viral suppression persisted after enrollment in the Los Angeles County Medical Care Coordination Program while accounting for psychosocial acuity score, which may be explained by factors not assessed in the program.

Does investment stimulate or inhibit CSR transparency? The moderating role of CSR committee, board monitoring and CEO duality

This study examined the potential relationship between different facets of firm investment (i.e., sales growth, R&D intensity, and total tangible and intangible assets) and CSR reporting, assurance and GRI adoption. Also, it further explored the conditions under which investing firms can encourage or discourage their CSR transparency. Our sample included 44,996 firm-year observations from 2004 to 2019 across 61 countries. Using a random-effects logistic model, our results indicate that corporate investments reduce firms’ CSR reporting and assurance tendency, which implies that a tradeoff exists between these two aspects of firm investment worldwide. Our moderation analysis outlined the contingent role of board-specific characteristics in the link between firm investment and CSR transparency. It appears that the CSR committee generates greater moderating effects on the firm investment–CSR transparency nexus than board monitoring and CEO duality. This empirical evidence also suggests several practical implications and future research agendas.

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994–2020

BackgroundBased on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality.MethodsThis is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60–99 (53% women). Primary outcome measures: Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020. Predictor: Average weekly alcohol consumption (non-drinker, < 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses.ResultsWe found that women who consumed ≥100 g/week had better SRH than those who consumed < 100 g/week; OR 1.85 (1.46–2.34). This pattern was not found in men OR 1.18 (0.99–1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73–1.22) and HR 0.89 (0.77–1.03), respectively.ConclusionsThere was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age.

A longitudinal study of the role of spousal relationship quality and mother-in-law relationship quality on women’s depression in rural Nepal

Nepal has high prevalence of early marriage and remains a patrilocal society with women moving into their husbands' home after marriage. Spousal relationship quality can be an important predictor of health and mental well-being of married women in a patriarchal setting like Nepal but is understudied in this population. We examined the association between spousal relationship quality, mother-in-law relationship quality and mental health among newly married women in Nepal. We recruited 200 newly married women aged 18–25 years within 4 months of their marriage cohabiting with their mothers-in-law and collected four rounds of data at 6-month intervals between 2018 and 2020 in Nawalparasi district of Nepal. Depressive symptom severity was measured using Hopkins Symptom Checklist Depression and relationship quality with spouse was measured using Couples' Relationship Quality scale. We fitted a random effects linear regression model to estimate if women’s spousal relationship quality and mother-in-law relationship quality were associated with depressive symptom severity, controlling for socio-demographic covariates and secular trends. We conducted a sensitivity analysis using linear fixed effects and logistic random effects models. Our results suggest that better relationship quality with the spouse was positively associated with reduced depression among women, and greater relationship quality with the mother-in-law was also positively associated with lower levels of depression. Furthermore, our results suggest that the relationship with mothers-in-law moderates the association between spousal relationship quality and depression. This highlights the importance of considering the interplay of these relationships among this vulnerable population who are faced with multiple stressors, including the risk of depression and strained marital relationships. Our results underscore the importance of addressing the role of both husbands and mothers-in-law as key stakeholders in advancing the mental health outcomes of newly married women.

Antibiotic treatment of bacterial vaginosis to prevent preterm delivery: Systematic review and individual participant data meta-analysis.

Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD. Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time-to-delivery. Cochrane Systematic Review (2013), MEDLINE, EMBASE, journal searches, and searches (January 2013-September 2022) ("bacterial vaginosis AND pregnancy") of (i) clinicaltrials.gov; (ii) Cochrane Central Register of Controlled Trials; (iii) World Health Organization International Clinical Trials Registry Platform Portal; and (iv) Web of Science ("bacterial vaginosis"). Studies randomising asymptomatic pregnant individuals with BV to antibiotics or control, measuring delivery gestation. Extraction was from original data files. Bias risk was assessed using the Cochrane tool. Analysis used "one-step" logistic and Cox random effect models, adjusting gestation at randomisation and PTD history; heterogeneity by I2 . Subgroup analysis tested interactions with treatment. In sensitivity analyses, studies not providing IPD were incorporated by "multiple random-donor hot-deck" imputation, using IPD studies as donors. There were 121 references (96 studies) with 23 eligible trials (11,979 participants); 13 studies (6915 participants) provided IPD; 12 (6115) were incorporated. Results from 9 (4887 participants) not providing IPD were imputed. Odds ratios for PTD for metronidazole and clindamycin versus placebo were 1.00 (95% CI 0.84, 1.17), I2 = 62%, and 0.59 (95% CI 0.42, 0.82), I2 = 0 before; and 0.95 (95% CI 0.81, 1.11), I2 = 59%, and 0.90 (95% CI: 0.72, 1.12), I2 = 0, after imputation. Time-to-delivery did not differ from null with either treatment. Including imputed IPD, there was no evidence that either drug was more effective when administered earlier, or among those with a PTD history. Clindamycin, but not metronidazole, was beneficial in studies providing IPD, but after imputing data from missing IPD studies, treatment of BV during pregnancy did not reduce PTD, nor prolong pregnancy, in any subgroup or when started earlier in gestation.

Propensity Score Matching with Cross-Classified Data Structures: A Comparison of Methods

In the current study, we compare propensity score (PS) matching methods for data with a cross-classified structure, where each individual is clustered within more than one group, but the groups are not hierarchically organized. Through a Monte Carlo simulation study, we compared sequential cluster matching (SCM), preferential within cluster matching (PWCM), greedy matching (GM), and optimal full matching (OFM), using propensity scores from four different models. The results indicated that the four matching methods performed well when PSs were estimated with logistic regression containing both level-1 and level-2 covariates. When the level-2 covariates were omitted in the logistic regression PS model, matching methods resulted in biased treatment effect estimates. However, omission of level-2 covariates did not result in biased estimates when the PS model was a logistic cross-classified random effects model (CCREM). SCM and PWCM outperformed GM and OFM with a logistic CCREM that included level-1 and level-2 covariates.

Effectiveness of seasonal malaria chemoprevention in three regions of Togo: a population-based longitudinal study from 2013 to 2020

BackgroundIn 2012, the World Health Organization (WHO) recommended seasonal malaria chemoprevention (SMC) in areas of high seasonal transmission. Though implemented since 2013, the effectiveness of SMC in Togo was never evaluated.MethodsThis study concerned routine data from 2013 to 2020 mass SMC campaigns for children under five in all health facilities of three Regions of Togo. Treatment coverage, reasons for non-treatment, and SMC-attributable adverse reactions were analysed per year and treatment round. Random effect logistic models estimated SMC effectiveness per health district, year, and treatment round.ResultsThe overall coverage was 98% (7,971,877 doses for 8,129,668 children). Contraindication was the main reason for non-administration. Over the study period, confirmed malaria cases decreased from 11,269 (1st round of 2016) to 1395 (4th round of 2020). Only 2,398 adverse reactions were reported (prevalence: 3/10,000), but no severe Lyell syndrome or Stevens-Johnson-type skin reaction. Compared to 2016, malaria prevalence decrease was estimated at 22.6% in 2017 (p < 0.001) and 75% in 2020 (p < 0.001). SMC effectiveness ranged from 76.6% (2nd round) to 96.2% (4th round) comparison with the 1st round.ConclusionsSMC reduced significantly malaria cases among children under five. The results reassure all actors and call for effort intensification to reach the WHO goals for 2030.

Sweetener Purchases in Chile before and after Implementing a Policy for Food Labeling, Marketing, and Sales in Schools

BackgroundChile’s landmark food labeling and advertising policy led to major reductions in sugar purchases. However, it is unclear whether this led to increases in the purchases of nonnutritive sweeteners (NNS). ObjectivesThe objective of this study was to assess the changes in NNS and caloric-sweetened (CS) products purchased after the law’s first phase. MethodsLongitudinal data on food and beverage purchases from 2,381 households collected from January 1, 2015 to December 31, 2017, were linked to nutritional information and categorized into added sweetener groups (unsweetened, NNS-only, CS-only, or NNS with CS). Logistic random-effects models and fixed-effects models were used to compare the percentage of households purchasing products and the mean volume purchased by sweetener category to a counterfactual based on pre-regulation trends. ResultsCompared with the counterfactual, the percentage of households purchasing any NNS beverages (NNS-only or NNS with CS) increased by 4.2 percentage points (pp) (95% CI: 2.8, 5.7; P < 0.01). This increase was driven by households purchasing NNS-only beverages (12.1 pp, 95% CI: 10.0, 14.2; P < 0.01). The purchased volume of beverages with any NNS increased by 25.4 mL/person/d (95% CI: 20.1, 30.7; P < 0.01) or 26.5%. Relative to the counterfactual, there were declines of -5.9 pp in households purchasing CS-only beverages (95% CI: −7.0, −4.7; P < 0.01). Regarding the types of sweeteners purchased, we found significant increases in the amounts of sucralose, aspartame, acesulfame K, and steviol glycosides purchased from beverages. Among foods, differences were minimal. ConclusionsThe first phase of Chile’s law was associated with an increase in the purchases of beverages containing NNS and decreases in beverages containing CS, but virtually no changes in foods.

Anemia, Thrombocytopenia, and Changes in Biochemical Parameters Occurring in Patients with Uncomplicated Plasmodium falciparum Malaria: Data Analysis from Antimalarial Efficacy-Randomized Trials in Dakar and Kaolack Regions, Senegal.

Artemisinin-based Combination Therapies (ACTs) are widely used in the treatment of uncomplicated malaria. Plasmodium falciparum infection is often accompanied by disturbances of hematological and biochemical parameters. The objective of this study was to evaluate the changes in biochemical and hematological parameters during uncomplicated malaria in patients treated with ACTs. Data from patient with uncomplicated Plasmodium falciparum malaria were pooled from different open-randomized trial evaluating the efficacy of Artesunate-Mefloquine (ASMQ), Artesunate-Amodiaquine (ASAQ), Artemether-Lumefantrine (AL), and Dihydro-artemisinin-Piperaquine (DHAPQ) combinations. Biochemical (transaminases, creatinine, and bilirubin) and hematological (hemoglobin and platelet levels) parameters were performed at baseline (D0) and at day 7 after treatment (D7). Data were analyzed as both continuous and categorical variables with 95% confidence interval. Risks and trends were calculated using multivariate logistic random effect models. A total of 720 patients with completed biological data were included in the analysis (320 in the AL arm, 160 in the ASMQ arm, 120 in the DHAPQ arm, and 88 in the ASAQ arm). The mean age of the patients was 9.43 ± 9.1 years. Male subjects represented 58.47% (sex ratio was 1.4 for males). The mean hemoglobin level at inclusion (D0) was 9.79 g/dl and anemia (Hb < 11 g/dl) was 71.43% (aOR = 1.16 [0.68 - 1.98]p = 0.57). At D7, hemoglobin level was 9.63 g/dl and anemia was significantly more frequent (78.29% [p = 0.002]). The mean platelet count at day 0 was 154075.5 platelets/mm3 of blood and 339328.7 platelets/mm3 at day 7. Thrombocytopenia was about 53.61% and was associated with malaria (aOR = 3.4 [2.18 - 5.3]p < 10-3). 19.58% of patients had abnormal ALT and 40.28% had abnormal AST at D0. 27.22% of patients had normal bilirubin at D0. Renal function was normal in all patients in the study. Normalization of transaminases was noted between D0 and D7. The percentage of subjects with normal bilirubin increased between D0 and D7. Renal function did not vary significantly between D0 and D7. Results from this analysis showed that subjects with high parasitaemia had a greater risk of anemia and thrombocytopenia. Artemisinin combinations were well-tolerated as no major biological disturbances were noted. The effects of ACTs on hematologic and biochemical parameters were not different.