Random Effects Logistic Regression Models Research Articles

The occurrence of and factors associated with mental ill-health amongst humanitarian aid workers: A systematic review and meta-analysis.

Humanitarian crises and disasters affect millions of people worldwide. Humanitarian aid workers are civilians or professionals who respond to disasters and provide humanitarian assistance. In doing so, they face several stressors and traumatic exposures. Humanitarian aid workers also face unique challenges associated with working in unfamiliar settings. To determine the occurrence of and factors associated with mental ill-health among humanitarian aid workers. CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2005-2020. Grey literature was searched on Google Scholar. PRISMA guidelines were followed and after double screening, studies reporting occurrence of mental ill-health were included. Individual narratives and case studies were excluded, as were studies that reported outcomes in non-humanitarian aid workers. Data on occurrence of mental ill-health and associated factors were independently extracted and combined in a narrative summary. A random effects logistic regression model was used for the meta-analysis. Nine studies were included with a total of 3619 participants, reporting on five types of mental ill-health (% occurrence) including psychological distress (6.5%-52.8%); burnout (8.5%-32%); anxiety (3.8%-38.5%); depression (10.4%-39.0%) and post-traumatic stress disorder (0% to 25%). Hazardous drinking of alcohol ranged from 16.2%-50.0%. Meta-analysis reporting OR (95% CI) among humanitarian aid workers, for psychological distress was 0.45 (0.12-1.64); burnout 0.34 (0.27-0.44); anxiety 0.22 (0.10-0.51); depression 0.32 (0.18-0.57) and PTSD 0.11 (0.03-0.39). Associated factors included young age, being female and pre-existing mental ill-health. Mental ill-health is common among humanitarian aid workers, has a negative impact on personal well-being, and on a larger scale reduces the efficacy of humanitarian organisations with delivery of aid and retention of staff. It is imperative that mental ill-health is screened for, detected and treated in humanitarian aid workers, before, during and after their placements. It is essential to implement psychologically protective measures for individuals working in stressful and traumatic crises.

A surge in food insecurity during the COVID-19 pandemic in a cohort in Mexico City.

The COVID-19 pandemic has not only caused tremendous loss of life and health but has also greatly disrupted the world economy. The impact of this disruption has been especially harsh in urban settings of developing countries. We estimated the impact of the pandemic on the occurrence of food insecurity in a cohort of women living in Mexico City, and the socioeconomic characteristics associated with food insecurity severity. We analyzed data longitudinally from 685 women in the Mexico City-based ELEMENT cohort. Food insecurity at the household level was gathered using the Latin American and Caribbean Food Security Scale and measured in-person during 2015 to 2019 before the pandemic and by telephone during 2020-2021, in the midst of the pandemic. Fluctuations in the average of food insecurity as a function of calendar time were modeled using kernel-weighted local polynomial regression. Fixed and random-effects ordinal logistic regression models of food insecurity were fitted, with timing of data collection (pre-pandemic vs. during pandemic) as the main predictor. Food insecurity (at any level) increased from 41.6% during the pre-pandemic period to 53.8% in the pandemic stage. This increase was higher in the combined severe-moderate food insecurity levels: from 1.6% pre-pandemic to 16.8% during the pandemic. The odds of severe food insecurity were 3.4 times higher during the pandemic relative to pre-pandemic levels (p<0.01). Socioeconomic status quintile (Q) was significantly related to food insecurity (Q2 OR = 0.35 p<0.1, Q3 OR = 0.48 p = 0.014, Q4 OR = 0.24 p<0.01, and Q5 OR = 0.17 p<0.01), as well as lack of access to social security (OR = 1.69, p = 0.01), and schooling (OR = 0.37, p<0.01). Food insecurity increased in Mexico City households in the ELEMENT cohort as a result of the COVID-19 pandemic. These results contribute to the body of evidence suggesting that governments should implement well-designed, focalized programs in the context of economic crisis such as the one caused by COVID-19 to prevent families from the expected adverse health and well-being consequences associated to food insecurity, especially for the most vulnerable.

Predictors of accessing seasonal malaria chemoprevention medicines through non-door-to-door distribution in Nigeria

BackgroundIn Nigeria, seasonal malaria chemoprevention (SMC) is typically administered door-to-door to children under five by community medicine distributors during high transmission seasons. While door-to-door distribution (DDD) is exclusively employed in Nigeria as part of standard operating procedures of SMC programmes, some households access SMC through non-DDD channels, such as fixed-point distributions, health facilities, and private purchase. However, analysis of access to SMC medicines through non-DDD has been limited, with little evidence of its outcomes on adherence to the three-day complete course of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines.MethodsData were obtained from SMC end-of-round coverage surveys conducted in Nigeria in 2021 and 2022, including 25,278 households for the analysis. The proportion of households accessing SMC medicine through non-DDD and the distribution of various non-DDD sources of SMC medicines were described. Multivariate random-effects logistic regression models were performed to identify predictors of accessing SMC medicines through non-DDD. The associations between non-DDD, and caregiver-reporting of adherence to complete administration of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines were also assessed.ResultsLess than 2% (314/24003) of households accessed SMC medicines through non-DDD in the states surveyed. Over 60% of non-DDD access was via health facility personnel and community medicine distributors from different locations. Variables associated with non-DDD access included heads of household being born in the local state (OR = 0.68, 95% CI 0.47 to 0.90), households residing in the study state since the first cycle of the SMC round (OR = 0.39, 95% CI 0.17 to 0.88), households with high wealth index (OR = 1.36, 95% CI 1.01 to 1.82), and caregivers hearing about date of SMC delivery in the previous cycle (OR = 0.18, 95%CI 0.14 to 0.24). Furthermore, non-DDD was associated with reduced SMC adherence and higher caregiver non-reporting of adverse reactions to SMC medicines in children compared with DDD.ConclusionThis study provides evidence on the characteristics of households accessing SMC medicines through non-DDD and its potential negative outcomes on adherence to SMC medicine and adverse reaction reporting, underscoring potential implementation issues that may arise if non-DDD delivery models are adopted in SMC, particularly in places where DDD had been firstly used.

Modeling the impact of driving aggression on lane change performance Measures: Steering compensatory Behavior, lane change execution duration and crash probability

The current study aimed to investigate the influence of driving aggression on lane change behavior. Drivers belonging to three levels of aggressive driving styles (aggressive, moderately aggressive, and non-aggressive) participated in lane change experiments, and 232 lane change maneuvers were recorded. Steering behavior during lane change maneuvers was investigated using three steering performance measures, including the standard deviations of steering angle, steering reversal rates, and maximum steering swerve. Three separate generalized estimating equation models were developed to analyze the effects of aggressive driving behavior on the standard deviation of steering angle, steering reversal rates, and maximum steering swerve. A Weibull accelerated failure time model with clustered heterogeneity was developed to analyze the effect of aggressive driving behavior on lane change execution duration. Additionally, to model the crash probability during lane change, a random effects logistic regression model was developed. The findings indicate that aggressive and moderately aggressive drivers completed lane changes 59% and 38% faster, respectively, compared to non-aggressive drivers. This implies a propensity for aggressive and moderately aggressive drivers to execute lane changes more swiftly than non-aggressive drivers. Aggressive drivers increased their standard deviation of steering angle, steering reversal rates, and maximum steering swerves by 180%, 60%, and 62%, respectively, compared to non-aggressive drivers. This implies that aggressive drivers engaged in extreme steering behavior as a compensatory measure for their reckless driving in order to avoid a collision during lane change maneuvering. However, despite their vigorous compensatory steering behavior, the crash rate (number of crashes observed) increased by 5.10 and 2.83 times for aggressive and moderately aggressive drivers, respectively, compared to non-aggressive drivers. The findings have implications for developing driving assistance systems and lane change simulation models.

Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis.

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal.

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

Human Papillomavirus-Attributable Head and Neck Cancers in India-A Systematic Review and Meta-Analysis.

Head and neck cancer accounts for about one third of the global burden in India. Mucosal high-risk human papillomavirus (HPV) has been hypothesized as a contributory risk factor for head and neck cancer (HNC) but its prevalence in Indian patients is not well established. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of HPV in HNC in India and their attributable fraction by considering the biomarkers of carcinogenesis, p16, and HPV E6/E7 mRNA. A systematic literature search was done in Medline via PubMed, Embase, Scopus, ScienceDirect, ProQuest, and Cochrane to identify studies on HPV and HNC in the Indian population, published between January 1990 and October 2022. Fifty-four eligible studies were identified and relevant clinical information was collected. Meta-analysis was conducted to estimate the pooled prevalence of HPV DNA, p16INK4a, and E6/E7 mRNA percent positivity by random-effect logistic regression model using Metapreg, STATA 18. Thirty-four high-quality studies were taken for meta-analysis. The pooled prevalence of HPV in HNC was 20% (95% CI, 12 to 32) with a high level of heterogeneity (I2 = 90.79%). The proportion of HPV in oropharyngeal cancer (OPC; 22% [95% CI, 13 to 34]) and laryngeal cancer (LC; 29% [95% CI, 17 to 46]) was higher than in oral cancer (OC; 16% [95% CI, 8 to 30]). The HPV-attributable fraction of OPC, considering the E6/E7 mRNA and p16 positivity, was 12.54% and 9.68%, respectively, almost similar to LC (11.6% and 9.57%), while it was much lower in OC (3.36% and 4%). The HPV-attributable fraction is considerably lower for OC, suggesting a negligible causative role of HPV in OC. A significant proportion of OPC and LC are attributed to HPV; however, their exact causative role is unclear because of the presence of other known risk factors.

Diffusion of medications for opioid use disorder treatment in jail settings: a convergent mixed methods study of jail staff perspectives

BackgroundImplementation of medications for opioid use disorder (MOUD) in jails varies by facility and across states. Organizational climate, including staff attitudes toward change and exposure to education, can influence perceptions of innovations like MOUD in jails. Using a mixed methods design, we aimed to understand the association between organizational climate and jail staff perceptions of MOUD.MethodsJail staff (n = 111) who operate MOUD programs in 6 Massachusetts jails completed surveys that included the Organizational Readiness for Implementing Change (ORIC) survey. Random effects logistic regression models assessed associations between organizational climate and several outcomes of perceived MOUD efficacy, acceptability, and knowledge, while controlling for covariates. Jail staff (N = 61) participated in qualitative interviews and focus groups focused on organizational climate and knowledge diffusion, which we analyzed using inductive and deductive methods.ResultsThe results indicate that organizational change readiness on the ORIC was associated with positive perceptions of MOUD, and educational resources facilitated MOUD implementation. Greater ORIC was associated with higher perception of methadone as highly acceptable for jail populations (Odds ratio [OR] 2.3, 95% Confidence Interval [CI] 1.2 to 4.4), and high knowledge of methadone (OR 2.3, 95% CI 1.1 to 4.9), with similar magnitude of effects for buprenorphine. High levels of training for jail staff on methadone and buprenorphine were also associated with higher knowledge of these medications (Methadone: OR 7.2, 95% CI 2.2 to 23.2; Buprenorphine: OR 3.4, 95% CI 1.2 to 9.5). Qualitative results point towards the importance of organizational climate and elucidate educational strategies to improve staff perceptions of MOUD.ConclusionResults underscore the importance of organizational climate for successful implementation of jail MOUD programs and provide support for medication-specific educational resources as a facilitator of successful MOUD implementation in jail settings. Findings highlight implementation strategies that may improve jail staff perceptions of MOUD.

Neuropsychiatric Adverse Effects of Synthetic Glucocorticoids: A Systematic Review and Meta-Analysis.

Synthetic glucocorticoids are widely used to treat patients with a broad range of diseases. While efficacious, glucocorticoids can be accompanied by neuropsychiatric adverse effects. This systematic review and meta-analysis assesses and quantifies the proportion of different neuropsychiatric adverse effects in patients using synthetic glucocorticoids. Six electronic databases were searched to identify potentially relevant studies. Randomized controlled trials, cohort studies, and cross-sectional studies assessing psychiatric side effects of glucocorticoids measured with validated questionnaires were eligible. Risk of bias was assessed with RoB 2, ROBINS-I, and AXIS appraisal tool. For proportions of neuropsychiatric outcomes, we pooled proportions, and when possible, differences in questionnaire scores between glucocorticoid users and nonusers were expressed as standardized mean differences (SMD). Data were pooled in a random-effects logistic regression model. We included 49 studies with heterogeneity in study populations, type, dose, and duration of glucocorticoids. For glucocorticoid users, meta-analysis showed a proportion of 22% for depression (95% CI, 14%-33%), 11% for mania (2%-46%), 8% for anxiety (2%-25%), 16% for delirium (6%-36%), and 52% for behavioral changes (42%-61%). Questionnaire scores for depression (SMD of 0.80 [95% CI 0.35-1.26]), and mania (0.78 [0.14-1.42]) were higher than in controls, indicating more depressive and manic symptoms following glucocorticoid use. The heterogeneity of glucocorticoid use is reflected in the available studies. Despite this heterogeneity, the proportion of neuropsychiatric adverse effects in glucocorticoid users is high. The most substantial associations with glucocorticoid use were found for depression and mania. Upon starting glucocorticoid treatment, awareness of possible psychiatric side effects is essential. More structured studies on incidence and potential pathways of neuropsychiatric side effects of prescribed glucocorticoids are clearly needed.

Evaluating the Impact of Maternal Exposure to Ozone on Twin Fetal Growth in China.

Unlike singletons, twins require attention not only to the birth weight of the fetuses but also to discordance (i.e., the differences between weights) because twin growth discordance is a significant factor contributing to perinatal mortality and morbidity in twin pregnancies. However, the impact of maternal air pollution exposure on twin growth discordance has rarely been investigated. We examined the association of long-term ozone exposure during preconception and pregnancy with the birth weight of twins and twin growth discordance among 35,795 twins from the National Free Preconception Health Examination Project between January 2010 and December 2019. Linear mixed-effect models and random-effect logistic regression models were used to examine the associations of ozone exposure with the birth weight-related outcomes (i.e., birth weight of twins and within-pair birth weight difference) and risk of twin growth discordance, respectively, after adjustment for demographic characteristics and lifestyle. We found that an interquartile range (IQR) increase (15 μg/m3) in ozone exposure during the entire pregnancy was associated with a reduction (-28.96g, 95% confidence interval [CI]: -46.37, -11.56) in the total birth weight of twins, and ozone had a more pronounced impact on the birth weight of the smaller fetuses (-18.28 g, 95% CI: -27.22, -9.34) compared to the larger fetuses (-9.88 g, 95% CI: -18.84, -0.92) in twin pregnancies. An IQR increase in ozone exposure during the entire pregnancy was associated with a significant increase (8.41 g, 95% CI: 4.13, 12.69) in the within-pair birth weight difference; the odds ratio (OR) of twin growth discordance related to ozone exposure increased by 9% (OR = 1.09, 95% CI: 1.01, 1.18). However, no consistently significant associations were observed for ozone exposure during prepregnancy. Male-male twin pairs and those who were born prematurely appeared to be more susceptible to ozone exposure than their counterparts. Long-term ozone exposure during pregnancy was associated with twin growth discordance, and our findings provide reference data for future studies.

The Clinical Picture of Castleman Disease: A Systemic Review and Meta-Analysis of Almost 2000 Patients

Background: Castleman disease (CD) encompasses a spectrum of rare disorders with characteristic histopathological features, including unicentric (UCD), idiopathic multicentric (iMCD) and cases that are associated with the human herpesvirus 8 (HHV8+ MCD). As treatment options for each type of CD vary, it is important to be able to distinguish their clinical presentation from their subtypes and determine the correct diagnosis. To our knowledge, there are no major review articles summarising the clinical features of different CD subtypes. The aim of this study was to describe and compare the clinical presentation of different CD subtypes reported in the literature. Methods: We performed a systematic review of publications reporting ≥5 cases of CD between 1995 and 2021, following the PRISMA guidelines. Publications were cross-checked by study location, data collection period and investigators to identify duplicated patients. Where a patient may have been included in &amp;gt;1 study, the publication with the fewest patients or least symptom data was excluded. For each subtype of CD within each study, we extracted data on demographics, clinical symptoms and laboratory parameters as stated in the international consensus diagnostic criteria for iMCD. We estimated the mean percentage of patients meeting each diagnostic criterion for each CD subtype using meta-analyses conducted with random-effects logistic regression models. Results: We analysed 32 studies with 1998 patients from 16 countries, including 559 UCD, 1023 iMCD and 416 HHV8+ MCD cases. There was a predominance of males not only in HHV8+ MCD (88.5% males) but also in iMCD (59.1% males). Patients with UCD tended to be younger than patients with iMCD and HHV8+ MCD. Most patients with iMCD (91.8%) and UCD (84.7%) were of Asian ethnicity. Only 58 patients (6.4%) with iMCD were White. In contrast, almost all patients with HHV8+ MCD (93.7%) were White or Black/African American. Many symptoms and laboratory abnormalities occurred at similar rates in patients with iMCD and HHV8+ MCD (Table 1). There were no significant differences in laboratory findings between patients with iMCD and HHV8+ MCD. However, compared with patients with HHV8+ MCD, patients with iMCD had significantly lower rates of constitutional symptoms (46.6% vs 98.6%, p=0.038) and splenomegaly (48.2% vs 89.2%, p=0.031). In contrast, renal dysfunction seemed to appear more commonly in iMCD (36.9% vs 17.4%, not statistically significant). Patients with UCD had significantly lower rates of laboratory abnormalities vs those with iMCD and HHV8+ MCD (p&amp;lt;0.05 for all parameters listed in Table 1). Except for cutaneous findings, patients with UCD had significantly lower rates of symptoms than patients with either iMCD or HHV8+ MCD (p&amp;lt;0.05 for all non-cutaneous parameters in Table 1). However, elevated C-reactive protein (CRP), anaemia and hypergammaglobulinaemia occurred in almost 20% of patients with UCD and pulmonary findings were observed in 15.3% of cases. We identified five additional publications including 88 paediatric patients with UCD. Paediatric patients with UCD had more signs of systemic inflammation than adult UCD patients. Elevated CRP was reported in 45.1% (95% CI 20.9-71.8, n=50) of paediatric UCD patients (vs 19.7% of adults [95% CI 11.2-30.9]). Constitutional symptoms were reported in 44.4% (95% CI 21.5-69.2, n=18) of patients - significantly higher than the rate reported in adult patients with UCD (4.5%, 95% CI 1.6-12.3; p=0.0005). Conclusions: This systematic review complements the diagnosis and management guidelines for iMCD and UCD and provides a detailed description of the clinical presentation of HHV8+ MCD. We found several distinct differences between iMCD and HHV8+ MCD, probably reflecting the heterogeneity of the underlying pathomechanisms and/or different comorbidity burdens of these CD subtypes. We confirmed that systemic symptoms may be present in up to 20% of patients with UCD. Whether these cases represent a distinct entity and whether intermediate CD cases require systemic therapy beyond surgery remains to be elucidated.

The Relationship Between Patient Experience Special Care Measures and Joint Commission Accreditation Standards Compliance

Accreditation evaluates healthcare organization quality of care and patient safety processes, but the influence of this activity on the patient experience is not well understood. This study was designed to explore the relationship between accreditation survey scoring and patient experience of care using a subset of The Joint Commission (TJC) accreditation standards that are conceptually aligned with the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Special Care Issues composite. This was an observational study that used 2018 to 2019 CMS HHCAHPS data and TJC survey findings for 1464 accredited HHAs. The presence or absence of Requirements for Improvement (RFIs) indicating observed noncompliance and the Survey Analysis for Evaluating Risk (SAFER) score were used as independent variables in the analysis. Dependent variables included 3 HHCAHPS composite measures and 2 global rating measures. Data were analyzed using 2 sets of random effects logistic regression models. We found that an increase in RFIs scored on an HHA survey was associated with lower HHCAHPS score on all measures. When the frequency of RFIs and SAFER scores increased, there was a corresponding decline in HHCAHPS ratings, suggesting that patient experience ratings can potentially identify quality of care issues, when experience questions and quality concepts are sufficiently aligned. Adherence to Joint Commission accreditation standards may positively influence some aspects of the patient experience of care. While causality remains uncertain, accreditation appears to play a role in contributing to these outcomes.

Change in Hospital Risk-standardized Stroke Mortality Performance With and Without the Passive Surveillance Stroke Severity Score

Background: Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke. Methods: We used linked administrative data to identify adults who were hospitalized with ischemic stroke or intracerebral hemorrhage across 157 hospitals in Ontario, Canada between 2014 and 2019. We fitted a random effects logistic regression model using Markov Chain Monte Carlo methods to estimate hospital-specific 30-day RSMR and 95% credible intervals with adjustment for age, sex, Charlson comorbidity index, and stroke type. In a separate model, we additionally adjusted for stroke severity using PaSSV. Hospitals were defined as low-performing, average-performing, or high-performing depending on whether the RSMR and 95% credible interval were above, overlapping, or below the cohort’s crude mortality rate. Results: We identified 65,082 patients [48.0% were female, the median age (25th,75th percentiles) was 76 years (65,84), and 86.4% had an ischemic stroke]. The crude 30-day all-cause mortality rate was 14.1%. The inclusion of PaSSV in the model reclassified 18.5% (n=29) of the hospitals. Of the 143 hospitals initially classified as average-performing, after adjustment for PaSSV, 20 were reclassified as high-performing and 8 were reclassified as low-performing. Of the 4 hospitals initially classified as low-performing, 1 was reclassified as high-performing. All 10 hospitals initially classified as high-performing remained unchanged. Conclusion: PaSSV may be useful for risk-adjusting mortality when comparing hospital performance. External validation of our findings in other jurisdictions is needed.

Abstract 407: The Efficacy and Frequency of Early Left Heart Catheterization After Out of Hospital Cardiac Arrest Over That Last Decade

Background: The efficacy of early coronary intervention after return of spontaneous circulation (ROSC) from out of hospital cardiac arrest, (OHCA) is debated. A recent review of the Wayne County, (Mi) CARES dataset from 2014-18 noted that early LHC maintained the strongest correlation to survival to discharge with good neurological outcome, for all-cause OHCA. Though the overall rate of LHC remained relatively stable, there was a sizable reduction in early LHC and a comparable increase in late LHC in those with CPC 1 and 2 at discharge [ 12 ] Our objective is to utilize the national CARES data to analyze the effect of early LHC on survival with good neurological outcome and to describe the frequency and timing of LHC in OHCA. Methods: This observational study included patients enrolled in the national CARES registry from 2013-21. For the outcome of LHC by year, chi square analysis was performed. Outcome was cerebral performance category, (CPC) (good &lt;3 vs. poor &gt; 3) at hospital discharge. A propensity score (PS) model was constructed using variables predictive of LHC and good outcome to determine probability of LHC. The PS was then used in an inverse weighted random effects logistic regression model to determine the independent effect of early LHC on outcome. Results: 132,758 individual cases were identified. Median age was 60.3 years (s.d. 16.6), 61.8% were male. Early coronary angiography was performed in 26,999 (20.3%) patients. Patients who underwent early angiography often had shockable rhythms (78.% vs 34%), suffered the OHCA in a public location (36.9% vs 26.1%%), and were witnessed cardiac arrests (80% vs 48%). For the full model the odds ratio for a good outcome after early LHC was 2.54 (95% CI 2.36 - 2.73). Only initial shockable rhythm was more predictive of a good outcome with an OR of 3.9. The proportion undergoing early catheterization declined from 27.6 % to 17.3% from 2013 to 2021; p &lt; 0.0001), though the overall catheterization rate remained the same. Conclusion: In patients with OHCA, early left heart catheterization retains a strong association with good neurological outcome at hospital discharge. The use of early left heart catheterization has declined significantly over the last 9 years.

Sex-Specific Obesity and Cardiometabolic Disease Risks in Low- and Middle-Income Countries: A Meta-Analysis Involving 3 916 276 Individuals.

There is limited knowledge about the disparities between the sexes in obesity prevalence and associated cardiovascular complications in low- and middle-income countries (LMICs). We undertook a systematic review and meta-analysis to assess sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, the burden in women, and variations by region, country's income status, setting, and time. We searched major databases from inception to March 2023. Two independent reviewers selected the studies, assessed their quality, and extracted data. We used DerSimonian and Laird random-effects models to obtain pooled estimates of odds ratios and 95% CI for the association between sex and obesity and cardiometabolic diseases, and multilevel random-effects logistic regression models to estimate the prevalence of relevant outcomes (PROSPERO CRD42019132609). We included 345 studies (3 916 276 individuals). The odds of obesity were 2.72-fold higher in women than men (OR 2.72; 95% CI, 2.54-2.91). The sex-specific disparities varied by region, with the greatest disparities in Sub-Saharan Africa (OR 3.91; 95% CI, 3.49-4.39). Among women in LMICs, 23% (95% CI, 21%-25%) had obesity, 27% (95% CI, 24%-29%) had hypertension, and 7% (95% CI, 6%-9%) had type 2 diabetes. The prevalence of obesity and type 2 diabetes in women varied by region, country's income, and setting, with the highest prevalence in the Middle East and North Africa, upper-middle-income countries and urban settings. The odds of hypertension (OR 2.41; 95% CI, 1.89-3.08) and type 2 diabetes (OR 2.65; 95% CI, 1.76-3.98) were doubled in women with vs without obesity. There is an urgent need for a women-centred and region-stratified approach to tackle obesity awareness, treatment, and prevention in women in LMICs.

An HIV prevention intervention helps immigrants open up about transactional sex. The Makasi study

Abstract Background Transactional sex is known to be an exposure factor for HIV acquisition among immigrants in France. We analysed the factors associated with the increase in the proportion of transactional sex among African immigrant men and women living in precarious situations in the greater Paris area. Methods Data were collected in the Makasi research project. Participants were recruited in public places based on their precarious situations, they were randomised into two groups (intervention and control) followed during six months between 2019 and 2021. We described the levels of transactional sex at each follow-up time (0, 3, 6 months) and used random-effects logistic regression models to analyse factors associated with the evolution of transactional sex participants. Results The majority of participants were men (76.5% (470/614)) and almost half of them arrived in France in two years prior to inclusion (49.8%). Transactional sex increased in both study groups: at inclusion, 1% of men in the control group and 0% in the intervention group reported having had transactional sex. At the six-month follow-up, 15% and 8% of men in the control and intervention groups respectively reported transactional sex. Among women, 7% in the control group and 8% in the intervention group reported transactional sex at baseline. They were 27% and 24% respectively to report transactional sex at the six-month follow-up in each group. We find that exposure to the intervention liberate the speech about transactional sex, especially among men. Conclusions Our results suggest that the proportion of transactional sex seems to be important among immigrants in precarious situations, especially among men, and that the empowerment intervention facilitated participants’ openness about their sexual activities. These results suggest that the social hardships and structural barriers faced by immigrants in precarious situations limit the effect of HIV prevention interventions in this population. Key messages • Social hardships experienced by immigrants must be addressed to reduce their exposure to HIV. • An empowerment-based outreach intervention facilitated participants’ openness about transactional sex.

Empowerment-based intervention and immigrant awareness of biomedical HIV prevention tools in France

Abstract Background Sub-Saharan African immigrants are particularly affected by HIV in France and social hardship is an indirect factor of HIV acquisition. While biomedical HIV prevention tools are available for HIV prevention, evidence suggests a lack of knowledge of these tools among immigrants from Sub-Saharan Africa. We analysed the impact of an empowerment-based intervention on the knowledge of treatment as prevention (TasP), Pre Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) among a population of precarious sub-Saharan African immigrants. Methods Data were collected in the Makasi research project. Participants were recruited in public places based on their precarious situations, they were randomised into two groups (intervention and control) followed during six months between 2018 and 2021. We described the knowledge of biomedical HIV prevention tools at each follow-up time (0, 3, 6 months) and used random-effects logistic regression models to analyse the intervention effect on the level of knowledge of these tools. Results The majority of the participants were men (77.5%) and almost half of them arrived in France within 2 years prior to inclusion (49.3%). At the time of inclusion, 56% of participants knew about TasP, 6% knew about PEP and 4% knew about PrEP. Receiving the intervention increased the odds of knowing PEP (aOR=2.02 [1.09-3.75]; p &amp;lt; 0.026). Intervention effect were observed for TasP and PrEP only after 6 six months. We observed significant time effect for PEP (at 3 months aOR=4.26 [2.33-7.80]; p &amp;lt; 0.001; at 6 months aOR=18.28 [7.39-45.24]; p &amp;lt; 0.001) and PrEP (at 3 months aOR=4.02 [2.10-7.72]; p &amp;lt; 0.001; at 6 months aOR=28.33 [11.16-71.91]; p &amp;lt; 0.001). This time effect is linked to the associations outreach activities. Conclusions Our results suggest that exposure to the Makasi intervention combined with associations activities contributed to increase knowledge of biomedical HIV prevention tools among precarious sub-Saharan African immigrants. Key messages • The Makasi intervention improved the knowledge of biomedical HIV prevention tools. • One-shot empowerment-based intervention shows encouraging result for HIV prevention.

Toothache and its Determinants in 12-Year-Old Iranian Children: A Cross-sectional Study

Background: Toothache is a common condition among children that often leads to school absenteeism. However, there is limited information on the prevalence of toothache and its associated factors in Iranian children. Objectives: This study aimed to assess the prevalence of toothache and related factors in 12-year-old Iranian children. Methods: This was a cross-sectional population-based study. Multistage cluster sampling was used to recruit the participants from three provinces (Tehran, Kerman, and Fars). Parents of 1,468 students aged 12 years completed a valid questionnaire that assessed their socioeconomic status and the children’s oral hygiene behavior, toothache, and absenteeism in the last 6 months. A multivariate random effects logistic regression model was adopted to analyze the effect of demographic, geographic, and oral hygiene practice factors on toothache prevalence. Results: The prevalence of toothache in children was high, with 41% (95% CI = 38.4, 43.5) of the children reporting toothache. Of the children who had a toothache, 12.8% missed 1 to 7 school days. The prevalence of toothache was significantly higher in children living in cities compared to those living in towns (P &lt; 0.001). Additionally, toothache prevalence had a significant association with the fathers’ educational level (P = 0.003) and the children’s toothbrushing and flossing practices (P &lt; 0.001). Conclusions: The high prevalence of toothache among Iranian children highlights the need for effective health interventions to control this condition. These interventions can focus on improving oral hygiene practices and increasing access to dental care in both urban and rural areas. Moreover, targeting families with lower educational levels could be an effective approach to reducing the prevalence of toothache in children.

Anemia prevalence and its predictors among children under‐five years in Ghana. A multilevel analysis of the cross‐sectional 2019 Ghana Malaria Indicator Survey

AbstractBackground and AimsDespite the implementation of anemia control interventions in Ghana, anemia prevalence is still high in children under‐fives. Reducing the prevalence of anemia requires identifying and targeting associated critical risk factors. This study seeks to identify predictors of anemia among children under‐fives in Ghana.MethodsNationally representative data from the 2019 Ghana Malaria Indicator Survey was used in this study. Both fixed and random effects (multilevel) logistic regression models were applied to 2434 children to identify critical factors associated with anemia.ResultsIn this study, 54% (95% confidence interval [CI] 52.0–57.0) of children under‐5 years were anemic. Infants were more likely to be anemic (66.7%) compared with other children below 5 years. In the multivariable multilevel model, the risk of anemia was found to be higher in younger children especially 6–11 months old (adjusted odds ratio [aOR] = 3.59, CI: 2.54–5.08) and 12–23 months old (aOR = 2.97, CI: 2.08–4.23), children who had malaria (aOR = 1.53, CI: 1.13–2.06), children whose mothers were not registered but not covered with health insurance (aOR = 1.45, CI: 1.21–1.74) or were not even registered for insurance (aOR = 1.49, CI: 1.15–1.93), children born to adolescent mothers (aOR = 2.21, CI: 1.36–3.57), children born to non‐Christian mothers (Islam [aOR = 1.53, CI: 1.17–2.00]), children born to families of poorer households (poorest [aOR = 3.01, CI: 1.64–5.51]; poorer [aOR = 2.56, CI: 1.65–3.98]); middle (aOR = 2.03, CI: 1.32–3.11) and richer (aOR = 1.78, CI: 1.19–2.64), and children who lived in either Upper East (aOR = 2.03, CI: 1.26–3.26) or Central (aOR = 2.52, CI: 1.42–4.47) regions. Significant unobserved community‐level differences in anemia prevalence were observed.ConclusionThe probability of anemia in children under‐fives differs substantially from one community to another, and the prevalence remains high. The identified critical risk factors should be addressed. Multifaceted and targeted approaches are needed to help reduce the anemia prevalence in this setting to achieve the multiple United Nation's Sustainable Development Goals, which are related to risk and prevalence of anemia by 2030.

Interpersonal communication, cultural norms, and community perceptions associated with care-seeking for fever among children under age five in Magoé district, Mozambique

BackgroundMalaria is endemic throughout Mozambique, contributing significantly to the country’s burden of disease. Prompt and effective treatment for fevers in children can limit the mortality and morbidity impacts of the disease but many children in the country are not taken for formal care when ill. Using an ideational model of behaviour, this study assesses the magnitude of the relationships for potential drivers of care-seeking, including interpersonal communication, malaria messaging, and knowledge and attitudes about malaria, with actual care-seeking behaviours for under-five children with fever in Magoé district, Mozambique.MethodsData on the care-seeking behaviours for fever come from a 2019 household malaria survey in Magoé district. Households were randomly selected for interview from among those with at least one child under age five and one net for every two household members. From 1621 mother-child dyads, the analytical sample consists of 300 children under age five with a fever in the 2 weeks prior to the survey. Multilevel random effects logistic regression models are estimated to test for associations between care-seeking behaviours and hypothesized behavioural determinants, including interpersonal communication (IPC), malaria messaging, ideational factors (e.g., norms, attitudes, beliefs, risk perceptions), and community characteristics.ResultsOverall, 18.5% of children under age five (N = 300) were reported to have fever in the previous 2 weeks and, of these, 68.5% were taken to a formal sector health care provider. Multivariate models highlight significant roles for interpersonal communication; care-seeking was highest among mothers who spoke only with friends/community members about malaria (94.0%, p < 0.001), followed by those who spoke only with their husband (78.6%, p = 0.015), relative to 63.3% who spoke with no one. Care-seeking decisions made by a child’s grandmother were associated with a 25.0% point (p = 0.001) greater likelihood of seeking care relative to decisions made by the mother alone. Exposure to any malaria messaging was also positively associated with care-seeking (90.5% versus 62.7%, p < 0.001). In contrast, among all individual- and community-level ideational factors, only perceptions of self-efficacy to seek care were related to care-seeking behaviours.ConclusionsThese results suggest that social and behaviour change interventions that focus on encouraging families and community members to talk about malaria and the need to promptly seek treatment for fevers in children may be particularly effective at increasing this behaviour in this and similar settings. Such messaging and IPC should consider grandmothers as a target audience, as they appear to be perceived as highly influential in care-seeking decision-making in this community.