Log Link Research Articles

Insurer costs of COVID-19 by disease severity and duration.

To analyze US commercial insurance payments associated with COVID-19 as a function of severity and duration of disease. Retrospective database analysis. Patients with COVID-19 between April1, 2020, and June 30, 2021, in the Merative MarketScan Commercial database were identified and stratified as having asymptomatic, mild, moderate (with and without lower respiratory disease), or severe/critical (S/C) disease based on the severity of the acute COVID-19 infection. Duration of disease (DOD) was estimated for all patients. Patients with DOD longer than 12 weeks were defined as having post-COVID-19 condition (PCC). Outcomes were all-cause payments (ACP) and disease-specific payments (DSP) for the entire DOD. Variables included demographic and comorbidities at the time of acute disease. Adjusted payments by disease severity were estimated using generalized linear models (γ distribution with log link). A total of 738,339 patients were included (374,401 asymptomatic, 156,220 mild, 180,213 moderate, and 27,505 S/C cases). DSP increased from $217 (95% CI, $214-221) for asymptomatic cases to $2744 (95% CI, $2678-$2811) for moderate cases with lower respiratory disease and $28,250 (95% CI, $26,963-$29,538) for S/C cases. ACP increased from $505 (95% CI, $497-$512) for asymptomatic cases to $46,538 (95% CI, $44,096-$48,979) for S/C cases. The DSP and ACP further increased by $50,736 (95% CI, $45,337-$56,136) and $94,839 (95% CI, $88,029-$101,649), respectively, in S/C cases with PCC vs a DOD of fewer than4weeks. COVID-19 payments for S/C cases were more than 10-fold greater than those of moderate cases and further increased by nearly $95,000 in S/C cases with PCC vs a DOD of fewer than 4 weeks.

Association between intimate partner violence and pregnancy intention: evidence from the Peruvian demographic and health survey

BackgroundIntimate partner violence (IPV) in Peru represents a significant public health challenge. IPV can influence women’s reproductive and social behaviors, undermining fertility control, and exacerbating unintended pregnancies. Our objective was to assess the association between IPV and pregnancy intention among Peruvian women of reproductive age.MethodsWe conducted a secondary analysis of Peru’s 2020 Demographic and Family Health Survey data. The independent variable in this study was IPV against women, which includes psychological IPV, sexual IPV, and physical IPV. If a respondent experienced any of these three forms of IPV, the IPV variable was labeled as “yes”; if none were present, it was labeled as “no”. The dependent variable was pregnancy intention (no vs. yes). We utilized a generalized linear model (GLM) from the Poisson family with a log link function to assess the relationship between IPV occurrences (total and each IPV type) and pregnancy intention. We report crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI).ResultsWe analyzed data from 8466 women aged 15 to 49. The prevalence of any IPV was 49.6% (psychological IPV: 45.8%; physical IPV: 22.2%; and sexual IPV: 4.3%). Exposure to physical IPV (aPR: 1.05; 95% CI: 1.03–1.07), psychological IPV (aPR: 1.04; 95% CI: 1.02–1.06), and sexual IPV (aPR: 1.09; 95% CI: 1.04–1.13), as well as a history of any IPV (aPR: 1.05; 95% CI: 1.02–1.07), were associated with a higher probability of not intending to become pregnant. This association persisted after adjusting for confounders like age, marital status, educational attainment, education level of the child’s father, place of residence, wealth, ethnicity, and parity.ConclusionOne in two Peruvian women reported experiencing IPV. An association was observed between IPV exposure and a higher probability of not holding an intention to become pregnant.

Association of copayments with healthcare utilization and expenditures among Medicaid enrollees with a substance use disorder

BackgroundThe purpose of this study was to examine the association between copayments and healthcare utilization and expenditures among Medicaid enrollees with substance use disorders. MethodsThis study used claims data (2020−2021) from a private insurer participating in Arkansas's Medicaid expansion. We compared service utilization and expenditures for enrollees in different Medicaid program structures with varying copayments. Enrollees with incomes above 100 % FPL (N = 10,240) had copayments for substance use treatment services while enrollees below 100 % FPL (N = 2478) did not. Demographic, diagnostic, utilization, and cost information came from claims and enrollment information. The study identified substance use and clinical comorbidities using claims from July through December 2020 and evaluated utilization and costs in 2021. Generalized linear models (GLM) estimated outcomes using single equation and two-part modeling. A gamma distribution and log link were used to model expenditures, and negative binomial models were used to model utilization. A falsification test comparing behavioral health telemedicine utilization, which had no cost sharing in either group, assessed whether differences in the groups may be responsible for observed findings. ResultsSubstance use enrollees with copayments were less likely to have a substance use or behavioral health outpatient (−0.04 PP adjusted; p = 0.001) or inpatient visit (−0.04 PP; p = 0.001) relative to their counterparts without copayments, equal to a 17 % reduction in substance use or behavioral health outpatient services and a nearly 50 % reduction in inpatient visits. The reduced utilization among enrollees with a copayment was associated with a significant reduction in total expenses ($954; p = 0.001) and expenses related to substance use or behavioral health services ($532; p = 0.001). For enrollees with at least one behavioral health visit, there were no differences in outpatient or inpatient utilization or expenditures between enrollees with and without copayments. Copayments had no association with non-behavioral health or telemedicine services where neither group had cost sharing. ConclusionCopayments serve as an initial barrier to substance use treatment, but are not associated with the amount of healthcare utilization conditional on using services. Policy makers and insurers should consider the role of copayments for treatment services among enrollees with substance use disorders in Medicaid programs.

Effects of meteorological factors on influenza transmissibility by virus type/subtype

BackgroundQuantitative evidence on the impact of meteorological factors on influenza transmissibility across different virus types/subtypes is scarce, and no previous studies have reported the effect of hourly temperature variability (HTV) on influenza transmissibility. Herein, we explored the associations between meteorological factors and influenza transmissibility according to the influenza type and subtype in Guangzhou, a subtropical city in China.MethodsWe collected influenza surveillance and meteorological data of Guangzhou between October 2010 and December 2019. Influenza transmissibility was measured using the instantaneous effective reproductive number (Rt). A gamma regression with a log link combined with a distributed lag non-linear model was used to assess the associations of daily meteorological factors with Rt by influenza types/subtypes.ResultsThe exposure-response relationship between ambient temperature and Rt was non-linear, with elevated transmissibility at low and high temperatures. Influenza transmissibility increased as HTV increased when HTV < around 4.5 °C. A non-linear association was observed between absolute humidity and Rt, with increased transmissibility at low absolute humidity and at around 19 g/m3. Relative humidity had a U-shaped association with influenza transmissibility. The associations between meteorological factors and influenza transmissibility varied according to the influenza type and subtype: elevated transmissibility was observed at high ambient temperatures for influenza A(H3N2), but not for influenza A(H1N1)pdm09; transmissibility of influenza A(H1N1)pdm09 increased as HTV increased when HTV < around 4.5 °C, but the transmissibility decreased with HTV when HTV < 2.5 °C and 3.0 °C for influenza A(H3N2) and B, respectively; positive association of Rt with absolute humidity was witnessed for influenza A(H3N2) even when absolute humidity was larger than 19 g/m3, which was different from that for influenza A(H1N1)pdm09 and influenza B.ConclusionsTemperature variability has an impact on influenza transmissibility. Ambient temperature, temperature variability, and humidity influence the transmissibility of different influenza types/subtypes discrepantly. Our findings have important implications for improving preparedness for influenza epidemics, especially under climate change conditions.

Sleep duration has a limited impact on the prevalence of menstrual irregularities in athletes: a cross-sectional study.

This study aimed to investigate the relationship between the prevalence of menstrual irregularities, energy intake, and sleep deprivation among female athletes. A total of 128 female athletes, with an average age of 19.2 ± 1.2 years, participated in the study and tracked their food intake over a three-day period. Menstrual status and sleep duration were assessed using a questionnaire, and psychological anxiety was evaluated using the State and Trait Anxiety Inventory (STAI). These were measured once during the investigation. The impact of sleep status on state anxiety and daily energy intake was examined using the T-test. A generalized linear model (GLM) with a log link function was employed to investigate the effects of sleep deprivation on the presence of menstrual irregularities. As the results of the present study, sleep deprivation significant increased both state and trait anxiety (p < 0.05), as well as affecting energy intake (p < 0.05), particularly protein and carbohydrate intakes (p < 0.05). However, GLM analysis indicated that while sleep deprivation did not directly influence the prevalence of menstrual irregularities (p > 0.05), state anxiety emerged as a significant factor impacting the prevalence of menstrual irregularities (p < 0.05). The results of the present study suggest a potential pathway wherein sleep deprivation might elevate state anxiety levels, consequently indirectly contributing to an increase the probability of menstrual irregularities. In conclusion, the results of the presents study provide novels insights suggesting that sleep deprivation might directly increase state anxiety and indirectly affect the prevalence of menstrual irregularities. Hence, decreased sleep duration might be related to mental health issues and the prevalence of menstrual irregularities both significant concerns among female athletes. Future studies will play a crucial role in further elucidating how sleep patterns impact the health and well-being of female athletes.

Shift-Level Team Familiarity Is Associated with Improved Outcomes in Mechanically Ventilated Adults.

Rationale: Organizing ICU interprofessional teams is a high priority because of workforce needs, but the role of interprofessional familiarity remains unexplored. Objectives: Determine if mechanically ventilated patients cared for by teams with greater familiarity have improved outcomes, such as lower mortality, shorter duration of mechanical ventilation (MV), and greater spontaneous breathing trial (SBT) implementation. Methods: We used electronic health records data of five ICUs in an academic medical center to map interprofessional teams and their ICU networks, measuring team familiarity as network coreness and mean team value. We used patient-level regression models to link team familiarity with patient outcomes, accounting for patient and unit factors. We also performed a split-sample analysis by using 2018 team familiarity data to predict 2019 outcomes. Measurements and Main Results: Team familiarity was measured as the average number of patients shared by each clinician with all other clinicians in the ICU (i.e., coreness) and the average number of patients shared by any two members of the team (i.e., mean team value). Among 4,485 encounters, unadjusted mortality was 12.9%, average duration of MV was 2.32 days, and SBT implementation was 89%; average team coreness was 467.2 (standard deviation [SD], 96.15), and average mean team value was 87.02 (SD, 42.42). A 1-SD increase in team coreness was significantly associated with a 4.5% greater probability of SBT implementation, 23% shorter MV duration, and 3.8% lower probability of dying; the mean team value was significantly associated with lower mortality. Split-sample results were attenuated but congruent in direction and interpretation. Conclusions: Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution.

Impact of the COVID-19 vaccination campaigns in Argentina during 2021: An observational quantification of the death probability for confirmed cases in Buenos Aires province

BackgroundA SARS-CoV-2 (COVID-19) vaccination campaign was launched in Argentina in January 2021. The vaccines then available were administered to the population in several different schemes. This observational study presents a quantification of the impact of the different schemes on the probability of death for confirmed COVID-19 cases in Argentina's Buenos Aires Province. The results provide a local measure of the schemes' effectiveness that heretofore has been lacking. MethodsThe study's main source of information is the Integrated Health Information System database, which contains 1,538,113 records of confirmed SARS-CoV-2 (COVID-19) cases reported in 2021 in the Province. To assess the real-world effectiveness of the vaccination campaign, two categorical variables representing vaccination status were defined. Probability of death was formulated as a generalized linear model with a logistic link and includes variables for geography, a socio-economic level index, symptom onset, sex, and vaccination status. The effectiveness level was derived from the death probability estimates. FindingsThe study's findings indicated that the most effective vaccine was rAd26-rAd5 (Sputnik), with ChAdOx1-S (AZ/Covishield) and BBIBP-CorV (Sinopharm) following in efficacy, for both single and multiple doses. The effectiveness of a single dose was consistently below 50%, while it ranged from 50% to 90% for two or more doses. Notably, the analysis of variables such as the municipality of residence of the infected persons and the season of symptom onset yielded particularly intriguing insights. The socioeconomic level of a municipality emerged as a moderately strong predictor of the probability of death, which was marginally higher in municipalities with lower-income populations. Additionally, the data revealed an increased probability of death during the winter season. InterpretationThe vaccination campaigns carried out in Buenos Aires Province in 2021 significantly contributed to reducing the number of deaths due to SARS-CoV-2 (COVID-19) among its population. However, the extent of this impact varied considerably depending on individual characteristics such as age, health status, and vaccination schedule adherence.

A comparison of clinical, utilization, and cost outcomes between oral treatments for multiple sclerosis.

Multiple sclerosis (MS) affects nearly 1 million people in the United States and causes significant disability and economic loss. Among the first available oral MS treatment options, clinical outcome comparisons and associated health care resource utilization are not clearly defined. To compare MS outcomes, health care resource utilization, and relative costs across treatment with dimethyl fumarate (DMF), fingolimod (FG), or teriflunomide (TERI) among Medicare Advantage Prescription Drug (MAPD) plan and commercially insured beneficiaries. This retrospective cohort study used the Humana Research Database. Eligible study patients had their first MS medication claim for oral DMG, FG, or TERI between January 1, 2013, and December 31, 2018. Patients were followed for a minimum of 12 months (mean follow-up = 3.8 years), until the earliest of the following occurred: health plan disenrollment, the end of the study period, or death. Study cohorts were balanced with inverse probability of treatment weighting. All-cause and MS-related health care resource utilization, time on therapy, and time after therapy were compared using inverse probability of treatment-adjusted multivariate generalized linear models across treatment groups. Relative costs were compared using a generalized linear model with a gamma distribution and log link. We identified 1,442 patients in 3 medication groups: DMF (n = 843), FG (n = 213), and TERI (n = 386). After weighting, there were no significant differences between the medication groups on demographic and clinical characteristics. Time on therapy (days) was significantly different across medication groups (P < 0.001). Time on therapy was longest for FG compared with the DM and TERI groups (644 vs 462 vs 521). The number discontinuing the index medication was significantly different for FG vs DMF vs TERI (74.7% vs 85.3% vs 80.7%; P < 0.001). FG had the lowest discontinuation rate. The mean (SD) annualized relapse rates (ARRs) were 0.47 (0.80), 0.42 (1.3), and 0.53 (1.3) (P = 0.037) for DMF, FG, and TERI, respectively. The percentage of those experiencing inpatient stays and the number of stays (mean [SD]) were significantly different among the FG group vs DMF vs TERI (29.9% vs 34.1% vs 40.9%; P < 0.001) and (0.57 [2.9] vs 0.74 [1.9] vs 0.91 [3.5]; P = 0.007), respectively. All-cause emergency department visits and the number of visits (mean [SD]) were significantly different for the FG cohort vs DMF vs TERI (46% vs 54.3% vs 61%; P < 0.001) and (1.84 [7.7] vs 2.38 [5.9] vs 2.87 [8.8]; P = 0.002), respectively. FG had the lowest impatient stays and emergency department visits of the 3 groups. Patients with MS initiated on FG used fewer health care resources and experienced lower ARR compared with patients on DMF and TERI.

Direct benefit transfer for nutritional support of patients with TB in India—analysis of national TB program data of 3.7 million patients, 2018–2022

BackgroundPatients with TB have additional nutritional requirements and thus additional costs to the household. Ni-kshay Poshan Yojana(NPY) is a Direct Benefit Transfer (DBT) scheme under the National Tuberculosis Elimination Programme(NTEP) in India which offers INR 500 monthly to all notified patients with TB for nutritional support during the period of anti-TB treatment. Five years after its implementation, we conducted the first nationwide evaluation of NPY.MethodsIn our retrospective cohort study using programmatic data of patients notified with TB in nine randomly selected Indian states between 2018 and 2022, we estimated the proportion of patients who received at least one NPY instalment and the median time to receive the first instalment. We determined the factors associated (i) with non-receipt of NPY using a generalised linear model with Poisson family and log link and (ii) with time taken to receive first NPY benefit in 2022 using quantile regression at 50th percentile.ResultsOverall, 3,712,551 patients were notified between 2018 and 2022. During this period, the proportion who received at least one NPY instalment had increased from 56.9% to 76.1%. Non-receipt was significantly higher among patients notified by private sector (aRR 2.10;2.08,2.12), reactive for HIV (aRR 1.69;1.64,1.74) and with missing/undetermined diabetic status (aRR 2.02;1.98,2.05). The median(IQR) time to receive the first instalment had reduced from 200(109,331) days in 2018 to 91(51,149) days in 2022. Patients from private sector(106.9;106.3,107.4days), those with HIV-reactive (103.7;101.8,105.7days), DRTB(104.6;102.6,106.7days) and missing/undetermined diabetic status (115.3;114,116.6days) experienced longer delays.ConclusionsThe coverage of NPY among patients with TB had increased and the time to receipt of benefit had halved in the past five years. Three-fourths of the patients received at least one NPY instalment, more than half of whom had waited over three months to receive the first instalment. NTEP has to focus on timely transfer of benefits to enable patients to meet their additional nutritional demands, experience treatment success and avoid catastrophic expenditure.

Racial-Ethnic Differences in ADHD Diagnosis and Treatment During Adolescence and Early Adulthood.

This study examined racial-ethnic differences in attention-deficit hyperactivity disorder (ADHD) diagnosis and treatment during adolescence and early adulthood. A national health care claims database was used to identify a cohort of 4,216,757 commercially insured youths with at least 1 year of coverage during 2014-2019. Racial-ethnic differences in the prevalence of visits with a recorded ADHD diagnosis (identified through ICD-9-CM and ICD-10-CM codes) and of ADHD treatment (identified through medical claims for psychosocial treatments and pharmacy claims for ADHD medications) were examined. Period prevalence rates were determined within five age categories, stratified by race-ethnicity. Poisson regression with a natural log link was used within each age category to estimate prevalence ratios (PRs) comparing prevalence in each racially and ethnically minoritized group with prevalence in the White group. The overall prevalence of ADHD diagnosis was 9.1% at ages 12-14 and 5.3% at ages 24-25. In each age category, Asian, Black, and Hispanic youths had lower prevalence of ADHD diagnosis than did White youths (PR=0.29-0.77). Among youths with an ADHD diagnosis, relative racial-ethnic differences in treatment were small (PR=0.92-1.03). Throughout adolescence and early adulthood, racially and ethnically minoritized youths were less likely than White youths to have health care visits with recorded ADHD diagnoses and, among those with diagnoses, were also slightly less likely to receive treatment. More research is needed to understand the processes underlying these differences and their potential health consequences among racially and ethnically minoritized youths.

Access to HIV/STI testing among male and female Venezuelan migrants in Peru: evidence from a nationwide survey

BackgroundHuman immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) are major global public health issues. Migrants represent a vulnerable group that faces multiple barriers to access to healthcare services, including HIV/STI testing. This study aimed to assess the factors associated with access to HIV/STI testing in male and female Venezuelan migrants in Peru.MethodsThis was a cross-sectional study involving secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. The study was conducted in the eight most populated cities inhabited by Venezuelan migrants and refugees. For each city, the sampling design was probabilistic, stratified, and independent. The outcome variable was whether participants had access to HIV or other STI testing during their stay in Peru. Statistical analysis was stratified by sex owing to potential effect modification. Crude and adjusted prevalence ratios were calculated using generalized linear models Poisson family with log link function. Confidence intervals were calculated to 95%.ResultsA total of 3,723 male and 3,984 female migrants were included. Access to HIV/STI testing among male and female migrants was 19.85% and 25.16%, respectively. Among male migrants, being LGBTI, health insured, and married or cohabiting were associated with increased access to HIV/STI testing. Among females, those aged 18–44 years, those who were married or cohabiting and were health insured, and those residing for more than 1 year in Peru were significantly more likely to have access to HIV/STI testing. Moreover, physical/mental disability and unemployed status were associated with a lower probability of HIV/STI testing in females.ConclusionsOnly two in ten Venezuelan migrants and refugees in Peru were screened for HIV/STI, with fewer males than females. Sex-specific sociodemographic, health-related, and migration-related variables were independently associated with access to HIV/STI testing.

Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals

BackgroundDuring the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic.MethodsThe study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR).Results1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals’ EDs.ConclusionIn the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.

Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World's Highest Hospital Mortality Populations.

COVID-19 vaccines primarily prevent severe illnesses or hospitalization, but there is limited data on their impact during hospitalization for seriously ill patients. In a Mexican cohort with high COVID-19 mortality, a study assessed vaccination's effects. From 2021 to 2022, 462 patients with 4455 hospital days were analyzed. The generalized multivariate linear mixed model (GENLINMIXED) with binary logistic regression link, survival analysis and ROC curves were used to identify risk factors for death. The results showed that the vaccinated individuals were almost half as likely to die (adRR = 0.54, 95% CI = 0.30-0.97, p = 0.041). When stratifying by vaccine, the Pfizer group (BNT162b2) had a 2.4-times lower risk of death (adRR = 0.41, 95% CI = 0.2-0.8, p = 0.008), while the AstraZeneca group (ChAdOx1-S) group did not significantly differ from the non-vaccinated (adRR = 1.04, 95% CI = 0.5-2.3, p = 0.915). The Pfizer group exhibited a higher survival, the unvaccinated showed increasing mortality, and the AstraZeneca group remained intermediate (p = 0.003, multigroup log-rank test). Additionally, BNT162b2-vaccinated individuals had lower values for markers, such as ferritin and D-dimer. Biochemical and hematological indicators suggested a protective effect of both types of vaccines, possibly linked to higher lymphocyte counts and lower platelet-to-lymphocyte ratio (PLR). It is imperative to highlight that these results reinforce the efficacy of COVID-19 vaccines. However, further studies are warranted for a comprehensive understanding of these findings.

Dyslipidemia among adult people living with HIV on dolutegravir – based antiretroviral therapy at a private tertiary hospital in Kampala, Uganda: burden and determinants

BackgroundUnderstanding the burden of dyslipidemia and its associated factors among adult people living with HIV on dolutegravir (DTG) based anti-retroviral therapy (ART) is critical to provide clinical guidance and risk reduction strategies in our setting.MethodsWe conducted a cross-sectional study on adult people living with HIV on DTG based ART between July and August 2022 at Mengo Hospital, a private not for profit missionary hospital owned by the Church of Uganda. Dyslipidemia was defined as: Total cholesterol (TC) ≥ 5.2 mmol/l, or high-density lipoprotein (HDL) < 1 mmol/l for men and < 1.3 mmol/l for women, or triglycerides (TG) ≥ 1.7 mmol/l, and low-density lipoprotein (LDL) ≥ 3.4 mmol/l. A participant was considered to have dyslipidemia if they had any of the lipid profile parameters in the above ranges. Socio-demographic information, clinical data and behavioral characteristics were collected. Fasting lipid profile and fasting blood glucose levels were also measured. Bivariate and multivariate analyses were done using a generalized linear model regression of the Poisson family with a log link (modified Poisson) using robust standard errors since the prevalence of dyslipidemia was more than 10%. Adjusted prevalence ratios (PR) were reported with their 95% confidence intervals (CI). A p-value of less than 0.05 was considered statistically significant.ResultsA total of 341 participants were included. The prevalence of dyslipidemia was 78.0%, (95%CI:73.3–82.1). The highest prevalence was for low HDL (72.1%, 95%CI 67.1–76.7) followed by high TG (20.2%, 95%CI: 16.3–24.9), high TC (12.0%, 95%CI: 9.0–15.9) and high LDL (6.5%, 95%CI: 4.3–9.6). Female sex (aPR:1.55, 95%CI: 1.32–1.84, p < 0.001) and previous use of protease inhibitor (PI) based ART regimen (aPR:1.26, 95%CI: 1.04–1.53, p = 0.018) were significantly associated with dyslipidemia.ConclusionWe demonstrate that the prevalence of dyslipidemia is very high as it was present in more than three quarters of the study participants. Female sex and previous use of PI based ART regimen were significantly associated with dyslipidemia. Management of dyslipidemia should be integrated in the HIV treatment package and we recommend further inquiry into the temporal relationship between dyslipidemia and DTG among ART patients, if any.

Over 300 km Dispersion of Wild Boar during Hot Summer, from Central Poland to Ukraine.

The movement of wild boars is a complex process influenced by both internal conditions and external factors. Despite their typically sedentary lifestyle, dispersion constitutes an integral element of the wild boar's behavior. This report documents the longest observed wild boar dispersal, involving a collared two-year-old male near Warsaw, Poland. The aim of this study was to present the characteristics of movement during the "nomadic phase", drawing comparisons with the "sedentary phase". The other aim was to evaluate the influence of meteorological factors on the minimum daily travel distance of the wild boar. We collected data from two-year-old males. The first exhibited long-distance dispersal and the second only demonstrated local movements. We calculated the minimum daily distance of both wild boars based on collar locations and calculated basic statistics of movement. We used a generalized linear model with a gamma distribution and log link function to assess the potential impact of weather conditions on the minimum daily distance of wild boars. We tested maximum daily temperature, average daily temperature, and the sum of daily precipitation. The wild boar during a "nomadic phase" covered a total of 922 km with a mean minimum daily movement of 6 km. The dispersion distance was 307 km. The highest value of the minimum daily distance reached 31.8 km/day. The second wild boar (near Warsaw) covered a mean minimum daily distance of 1.4 km; the highest value of the minimum daily distance was 3.9 km. Both wild boars exhibited no dependence of minimum daily distance on weather conditions. However, when intensive and non-intensive dispersion were analyzed separately, it was demonstrated that the maximum daily temperature positively influenced the minimum daily distance. We speculate that the wild boar was forced to search for water sources after dark on hot days, which induced a longer traveling distance in an unfamiliar environment. This study highlights the significant spatial capabilities of wild boar in the transmission of genes or pathogens. We speculate that extended daily distances during the initial "nomadic phase" might suggest a panicked escape from a perceived threat. It is plausible that the wild boar found improved shelter within tall cereal crops in July and August, which resulted in lower daily distances.

Telemedicine use and decrements to type 2 diabetes and hypertension care during the COVID-19 pandemic

BackgroundWe examine pandemic-era quality of care changes associated with telemedicine use among adults with type 2 diabetes and/or hypertension across ten health systems.MethodsPatient-level encounter and laboratory data (n = 1,963,563) were analyzed for pre-pandemic (March 13, 2019 to December 31, 2019) and pandemic (March 13, 2020 to December 31, 2020) periods. Generalized linear models with binomial distribution functions and log links estimated the association of telemedicine use with four outcomes: 1) hemoglobin A1c (HbA1c) testing, 2) HbA1c control (< 8.0%), 3) blood pressure (BP) testing, and 4) BP control (< 140 / 90 mmHg), controlling for patient characteristics, system fixed effects, and with propensity score weights.ResultsIn adjusted analyses, telemedicine use was associated with lower odds of HbA1c (aOR = 0.74, p < 0.05) and BP (aOR = 0.40, p < 0.01) testing for adults with type 2 diabetes, but not HbA1c or BP control. Among hypertension-only patients, telemedicine use was associated with lower odds of BP testing (aOR = 0.10, p < 0.001), but not BP control. Compared to pre-pandemic telemedicine use, pandemic period telemedicine use was associated with lower odds of HbA1c and BP monitoring.DiscussionTelemedicine use was associated with lower odds of HbA1c monitoring for adults with type 2 diabetes and lower odds of BP testing for adults with type 2 diabetes and/or hypertension.ConclusionAs telemedicine continues to be used for diabetes and hypertension care, remote monitoring, standing orders, and community pharmacy partnerships may be necessary supplements to telemedicine to assure high quality care, especially when in-person care options are limited.

Exploring competitive advantages in enterprise supply chains: A case study of JD’s predictive and logistics links

In today’s fiercely competitive business landscape, enterprises strive to enhance their competitive advantage. One crucial aspect of achieving this is by optimizing their supply chain practices. This paper presents a comprehensive analysis of Jing Dong (JD), a prominent e-commerce company, as a case study to delve into its supply chain technologies. By examining the specific technologies implemented by JD and elucidating their positive impact on the company’s performance, this study establishes a robust theoretical foundation for further research. It offers a practical model for companies seeking to improve their supply chain practices. By adopting and adapting similar technologies and strategies, enterprises can unlock new opportunities, streamline operations, and ultimately gain a sustainable competitive edge in their respective industries. Through a deeper understanding of JD’s successful supply chain approaches, companies can strategically enhance their capabilities and thrive in the dynamic market environment.

Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America.

This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government's decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

C-reactive Protein and Suicidality in Patients with Treatment-resistant Depression

Abstract Objective: Increasing evidence suggests a crucial rȏle of C-reactive protein (CRP) in the pathological mechanisms of suicide. Whether CRP levels may be associated with suicidal ideation (SI) among patients with treatment-resistant depression (TRD) remains unclear. In this study, we intended to explore the relation between TRD and SI. Methods: Totally 36 patients with TRD and SI, 24 with TRD without SI, and 32 healthy controls were enrolled in the present study. SI was defined based on scores of ≥ 2 at the 17-item Hamilton Depression Rating Scale item 3. Fasting serum CRP levels were also measured. Results: The generalized linear model with gamma log link demonstrated that patients with TRD and SI had significantly higher CRP levels (p &lt; 0.05) than the control group after adjusting for age, sex, and body mass index. Conclusion: Patients with TRD and SI, but not those without SI, were associated with increased CRP levels. Whether CRP may be a predictor of further suicidal risk among such high-risk patients would need further investigation.

Did the COVID-19 pandemic delay treatment for localized breast cancer patients? A multicenter study.

Longer times between diagnosis and treatments of cancer patients have been estimated as effects of the COVID-19 pandemic. However, relatively few studies attempted to estimate actual delay to treatment at the patient level. To assess changes in delays to first treatment and surgery among newly diagnosed patients with localized breast cancer (BC) during the COVID-19 pandemic. We used data from the PAPESCO-19 multicenter cohort study, which included patients from 4 French comprehensive cancer centers. We measured the delay to first treatment as the number of days between diagnosis and the first treatment regardless of whether this was neoadjuvant chemotherapy or surgery. COVID-19 pandemic exposure was estimated with a composite index that considered both the severity of the pandemic and the level of lockdown restrictions. We ran generalized linear models with a log link function and a gamma distribution to model the association between delay and the pandemic. Of the 187 patients included in the analysis, the median delay to first treatment was 42 (IQR:32-54) days for patients diagnosed before and after the start of the 1st lockdown (N = 99 and 88, respectively). After adjusting for age and centers of inclusion, a higher composite pandemic index (> = 50 V.S. <50) had only a small, non-significant effect on times to treatment. Longer delays were associated with factors other than the COVID-19 pandemic. We found evidence of no direct impact of the pandemic on the actual delay to treatment among patients with localized BC.