Logit Link Research Articles

Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic.

The COVID-19 pandemic created challenges for U. S. nursing home administrators (NHA) and staff. This study explored organizational and psychological factors associated with NHA stress, dissatisfaction, and turnover intent (TI) during the third year of the pandemic. Results from a nationwide, cross-sectional survey of 1139 NHAs were merged with Centers for Medicare and Medicaid Services nursing home survey deficiency, staffing, complaint, and other operations data. A hierarchical, generalized estimating equations model with ordered logit link found that NHAs with higher COVID stress (AOR = 1.65, 95% CI = 1.22, 2.23), higher use of agency/contract staff (AOR = 1.50, 95% CI = 1.08.2.09) and higher role conflict were more likely to indicate TI. NHAs with higher job satisfaction in workload, work content, and rewards were less likely to hold TI. Industry leaders should create strategies to reduce NHA's job stress and role conflicts and provide opportunities for improving staff recruitment and retention, reducing reliance on agency staffing.

The role of social support and the built environment on diabetes management among structurally exposed populations in three regions in Ghana

Sub-Saharan Africa is undergoing an epidemiological transition driven by rapid, unprecedented demographic, socio-cultural, and economic transitions. These transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). As NCDs rise, several attempts have been made to understand the individual level factors that increase NCDs risks, knowledge, and attitudes around specific NCDs as well as how people live and manage NCDs. While these studies are important, and enhance knowledge on chronic diseases, little attention has been given to the role of social and cultural environment in managing chronic NCDs in underserved settings. Using purposive sampling among persons living with Diabetes Mellitus (PLWD) and participating in diabetes programs from regional and municipal hospitals in the three underserved regions in Ghana (n = 522), we assessed diabetes management and supportive care needs of PLWDs using linear latent and mixed models (gllamm) with binomial and a logit(log) link function. The result indicates that PLWDs with strong perceived social support (OR = 2.27, p ≤ 0.05) were more likely to report good diabetes management compared to PLWDs with weak perceived social support. The built environment, living with other health conditions, household wealth, ethnicity and age were associated with diabetes management. Overall, the study contributes to wider discussions on the role changing built and socio-cultural environments in the rise of diet-related diseases and their management as many Low- and Middle-Income Countries (LMICs) experience rapid epidemiological and nutrition transitions.

Socioeconomic inequality and contributors in accepting attitudes toward people living with HIV among adults in Ethiopia from 2005 to 2016: a population-based cross-sectional study

IntroductionThe public’s accepting attitude toward people living with HIV is crucial in reducing HIV-related stigma and discrimination, increasing people’s access to HIV service. This study examines the inequalities in accepting...

Development and Validation of a Diagnostic Tool for the Timely Diagnosis of Patients with Systemic Mastocytosis

Background: Systemic mastocytosis (SM), a rare, clonal mast cell disease associated with heterogenous clinical presentation, is characterized by severe, debilitating and often unpredictable skin, gastrointestinal, neurocognitive, and systemic symptoms (including life-threatening anaphylaxis), long-term co-morbidities, and in Advanced SM (AdvSM), organ damage due to mast cell infiltration. SM consists of 2 distinct groups of variants, advanced and non-advanced: AdvSM includes aggressive SM (ASM), SM with an associated hematologic neoplasm (SM-AHN), and mast cell leukemia (MCL); non-AdvSM includes indolent SM (ISM) and smoldering SM (SSM). Arriving at a definitive diagnosis may take years and is one of the challenges of SM management. To aid clinicians in the identification of SM, we developed and validated a diagnostic algorithm using data from select community hematology practices in the United States. Methods: A sample of 209 patients (SM and control) was obtained from the Quality Cancer Care Alliance (QCCA), a network of 19 community oncology and hematology practices. Data collection consisted of patient characteristics, laboratory parameters, and signs and symptoms at presentation. General linear models (GLM) with a logit link function were used in a backwards elimination process with the p value set at < 0.05 to identify patient factors at presentation that were associated with a diagnosis of SM. A Dx scoring algorithm (range: 0-26) was then derived from the final model coefficients, with the intent of correctly differentiating between SM and non-SM patients. A receiver operating characteristic (ROC) curve analysis was then done to measure the Dx accuracy of the algorithm. Results: Data from 105 SM and 104 non-SM control (diagnosed with hematological cancers) patients were collected from QCCA. The SM cohort included patients with different SM subtypes, including: ISM (47.6%); ASM (9.5%); SM-AHN (19.0%); MCL (1.9%); and subtype not documented (21.9%). The factors identified as being predictive ofa correct diagnosis of SM were 1) patient age, 2) lymph node status, 3) absolute neutrophil count, and 4-7) the following symptoms within 30 days of presentation: diarrhea, rash, skin lesions, and unintended weight loss. In the algorithm, patients were assigned scores for each diagnostic factor they possessed [Figure 1]. The final score was then associated with an overall percent likelihood of a positive SM diagnosis. The area under the ROC curve was 0.89 (95%CI 0.84-0.93), indicating good predictive accuracy. Patients with a total score of ≥ 9 units were found to be at highest risk for a positive SM diagnosis with the associated sensitivity, specificity, and positive predictive values of 84.8%, 76.0%, and 82.7%, respectively. Conclusions: This model indicates that the presence or absence of 7 characteristics may help determine whether patients are at increased risk of having SM. Use of this diagnostic algorithm may help facilitate earlier detection of SM by raising clinical suspicion to facilitate appropriate clinical workup, which would allow the timely initiation of effective targeted therapies for this rare disease. Additional application and external validation of the algorithm in a new sample of 162 patients managed through another community oncology network is ongoing.

Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis.

Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia. We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status. After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates. Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.

Neurodevelopmental Outcomes of Children Born to Women Who Traveled to a Zika Virus-Endemic Region During Pregnancy

Abstract Background Zika virus (ZIKV) exposure during pregnancy causes a wide range of congenital malformations and developmental deficits, but we do not know whether potential ZIKV exposure during pregnancy without a formal ZIKV diagnosis results in worse developmental outcomes. Pregnant women without symptoms are not recommended to be tested for ZIKV infection per CDC guidelines. However, ZIKV infections can be asymptomatic, which means that pregnant women may have unknowingly been infected with ZIKV during travel to an endemic region. Our study aims to determine whether neurodevelopmental outcomes of children born to women with a travel history to a ZIKV-endemic region at the height of the pandemic are worse than children without a maternal travel history. Methods We identified women who presented to a maternal-fetal medicine clinic within the University of Wisconsin Hospitals and Clinics system in Madison, WI, between 2015-2018 and recently traveled to a ZIKV-endemic region (n=175) and conducted a retrospective chart review. Children with no maternal travel history to a ZIKV-endemic region were identified by state registry data and matched based on month of birth and gestational age (n=189). Developmental outcomes were defined from regular screening tools obtained during well child visits, the Ages and Stages Questionnaire (ASQ-3), and the Modified Checklist for Autism in Toddlers (MCHAT). We compared the number of “No Concern”, “Borderline” and “Concern” ASQ scores between groups using a generalized linear mixed effects model with a logit link function. The number of Low, Medium or High MCHAT risk scores at 18 and 24 months were compared between groups using Fisher’s exact test. Birth weight, maternal age and maternal race were included as covariates. All reported p-values are two-sided and P&amp;lt;0.05 was used to define statistical significance. Results Cases had a significantly higher rate (13.9%) of borderline/concern scores in the ASQ screening tool compared to controls (7.7%) at 16-22 months (p=0.0288), which appeared to be driven by differences in the personal-social domain where more cases (16.1%) had borderline/concern scores than the controls (5.5%, p=0.0348). There were no differences seen at 9-15 months or at 23-36 months. We also found that cases had higher rates of moderate-high risk scores (10.3%) on the MCHAT compared to controls (2.2%) at 18 months (p=0.0240), but this difference wasn’t statistically significant at 24 months. There were no differences in birth weight, maternal age and gestational age between groups. Very few of the mothers (18.3%) reported 1 or more signs or symptoms consistent with a ZIKV infection, and of the 105 women with ZIKV testing, 103 were negative. Conclusions Our findings indicate that children born to mothers who traveled to a ZIKV-endemic region during pregnancy, regardless of the maternal ZIKV testing result, had worse developmental screening scores around 18 months of age. This suggests that children with maternal travel history to a ZIKA-endemic region should be regularly monitored and receive early formal developmental testing as needed.

Trends in research grant applications and outcomes among medical students in the United Kingdom: a national self-reported cross-sectional survey.

Research funding disparities contribute to clinical academic workforce inequalities. Hence, our study explores the association between student demographics and research grant application rates and outcomes among UK medical students. This is a national multicentre cross-sectional survey of UK medical students in the 2020-21 academic year. Multiple zero-inflated negative binomial regression and generalized linear model (binomial distribution; logit link) were utilized to investigate the association between student demographics, number of grant applications submitted, and successful grant applications (yes or no). P-values less than a Bonferroni-corrected significance level of 0.05/36 = 0.0014 were considered to be statistically significant. A total of 1528 students participated from 36 medical schools. One hundred fifty-one respondents (9.9%) had applied for research grants. Black students submitted applications 2.90 times more often than white students [Incident rate ratio (IRR): 2.90, 95% confidence interval (CI): 1.37-6.16], with no ethnic disparity in the odds of successful applications. Gender did not influence application rates significantly (P = .248), but women were 4.61 times more likely to secure a grant than men [odds ratio: 4.61, 95% CI: 2.04-10.4]. Being a PubMed-indexed author was associated with increased grant application submission rates [IRR: 3.61, 95% CI: 2.20- 5.92] while conducting more research was associated with greater odds of securing a grant [odds ratio: 1.42, 95% CI: 1.17- 1.73]. Although black students submitted more applications, ethnicity did not influence success rates. Gender did not influence application rates, but women were more successful. These findings underscore the need for strategies supporting women and underrepresented students for continued academic achievement after graduation. What is already known on this topic Research funding for post-PhD researchers is believed to be a major driver of gender and ethnic inequalities in the clinical academic workforce.Students who receive research grants are more likely to receive postgraduate research grants.What this study adds Black students applied for more research grants than white students, but there were no ethnic differences in the odds of securing a grant.There were no gender differences in the research grant application rates. However, female students had greater odds of securing research grants compared to male students.How this study might affect research, practice or policy Medical schools should incorporate grant writing skills into the undergraduate research curriculum. Also, to sustain women's academic success post medical school, the NIHR and affiliates should provide research award extensions and childcare support for women when required.

A longitudinal study of incident hypertension and its determinants in Indian adults aged 45 years and older: evidence from nationally representative WHO-SAGE study (2007-2015).

Hypertension (HT) is a leading cause of mortality and morbidity in developing countries. This study aimed to estimate the incidence of HT among adults aged 45 years and older in India and its associated risk factors. This study used longitudinal data from the Indian sample of the first and second waves of the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE). A bivariate analysis using Pearson's chi-square test was done to examine the associations of individual, lifestyle, and household characteristics with HT status reported in Wave 2. Incident HT changes were analyzed by adjusting for various covariates in the generalized estimating equation (logit link function) with an exchangeable correlation matrix and robust standard errors. The study found that during the 8-year period from 2007 to 2015, the incidence of HT in individuals aged 45 years and over was 20.8%. Pre-hypertensive individuals had an overall incidence rate of 31.1 per 1,000 [95% confidence interval (CI): 26.20-35.9] and a 2.24 times higher odds ratio: 2.24 (95% CI: 1.65-3.03) of developing incident HT compared to those who were normotensive. Adults aged 45 years and older, overweight/obese individuals, and women were more at risk of incident HT. One in five individuals had developed HT over 8 years, with a greater risk of incident HT among women than men. Pre-hypertensive individuals were at a greater risk of developing incident HT compared to normotensive individuals. The study recommends comprehensive and effective management of pre-HT to tackle the burden of HT.

A Monte Carlo fuzzy logistic regression framework against imbalance and separation

This article proposes a new fuzzy logistic regression framework with high classification performance against imbalance and separation while keeping the interpretability of classical logistic regression. Separation and imbalance are two core problems in logistic regression, which can result in biased coefficient estimates and inaccurate predictions. Existing research on fuzzy logistic regression primarily focuses on developing possibilistic models instead of using a logit link function that converts log-odds ratios to probabilities. At the same time, little consideration is given to issues of separation and imbalance. Our study aims to address these challenges by proposing new methods of fuzzifying binary variables and classifying subjects based on a comparison against a fuzzy threshold. We use combinations of fuzzy and crisp predictors, output, and coefficients to understand which combinations perform better under imbalance and separation. Numerical experiments with synthetic and real datasets are conducted to demonstrate the usefulness and superiority of the proposed framework. Seven crisp machine learning models are implemented for benchmarking in the numerical experiments. The proposed framework shows consistently strong performance results across datasets with imbalance or separation and performs equally well when such issues are absent. Meanwhile, the considered machine learning methods are significantly impacted by the imbalanced datasets.

Abstract 16926: Associations of Preeclampsia and Preterm Delivery With Lifetime Posttraumatic Stress

Introduction: Adverse pregnancy outcomes (APOs) are female-specific CVD risk factors while posttraumatic stress disorder (PTSD) is a female-predominant CVD risk factor. Preeclampsia and preterm delivery are acute APOs with negative maternal and fetal consequences that, for some, results in trauma. Hypothesis: We hypothesized that individuals with a history of preeclampsia or preterm delivery would be more likely to screen positive for lifetime PTSD. Methods: Parous Nurses’ Health Study II participants who responded to a 2008 questionnaire ascertaining trauma (Brief Trauma Questionnaire, with targeted query of 16 event types) and PTSD (Short Screening Scale for DSM-IV PTSD) comprised the analytic sample (n=40,256). Trauma and PTSD were categorized using four categories: no trauma, trauma with no PTSD symptoms, 1-3 symptoms, or ≥4 symptoms (probable PTSD). Ordered logistic regression, using a cumulative logit link and multinomial distribution, estimated odds ratios (OR) and 95% confidence intervals (CI), adjusting for age at enrollment, race/ethnicity, and parental education. Results: Seven percent of participants had a history of preeclampsia (n=3,012) while 13.5% (n=5,418) ever delivered preterm. Twenty-one percent of participants screened positive for PTSD (n=8,336), endorsing ≥4 symptoms from their worst trauma. Among participants with PTSD, 66% of those with preterm preeclampsia in their first pregnancy endorsed having a traumatic pregnancy complication or labor/birth, compared to 23% among those who delivered normotensive first pregnancies at term. Odds of PTSD were higher with history of ever preeclampsia (OR=1.36, CI: 1.27-1.45) or preterm delivery (OR=1.41, CI: 1.34-1.48), compared to only normotensive pregnancies and term deliveries, respectively. Further adjustment for physical or sexual abuse in childhood/adolescence did not change conclusions but did attenuate the odds ratio for preeclampsia (OR=1.26, CI: 1.18-1.35). Conclusions: History of preeclampsia or preterm delivery identifies a population at higher risk for lifetime posttraumatic stress. Further studies are needed to disentangle temporality and examine to what extent subsequent mental health conditions may mediate the relationship between APOs and CVD.

366 Effects of Acidosis Bout Events on Animal Growth and Development, and the Effectiveness of Liver Abscess-Controlling Antibiotic on Diminishing Its Incidence

Abstract Ruminal acidosis is a common metabolic disorder that affects feedlot and dairy cattle and occurs when the supply of organic acids from fermentation exceeds its absorption, accumulating acid content in the rumen. Virginiamycin (VM) has inhibitory effects on primary liver abscess-causing bacteria. In feedlot animals, dietary VM has been shown to reduce rumen acidosis and improve feed conversion actively. This study evaluated ruminal pH over 150 days on feed (DOF) of growing and finishing beef cattle and investigated the relationships between ruminal pH and growth and development outcomes and the effectiveness of the continuous or intermittent provision of VM in 120 Angus-crossbred steers. Steers received VM (240 mg/d) as follows: no VM (T000); VM in the last 50 d (T001); VM for the last 100 d (T011); VM in the first 50 d (T100); VM in the first 100 d (T110); and VM for 150 d (T111). Animals were fed a grower-type diet (metabolizable energy [ME]: 2.45 Mcal/kg; crude protein [CP]: 12.2 % dry matter basis [DM]) for 50 d before the adaptation of a finisher-type diet (ME: 2.60 Mcal/kg; CP: 10.6% DM) over a 17-d period. The finisher-type diet was fed for the remaining 84 days. On d -1 and d 82 each animal received an indwelling pH bolus to record ruminal pH at 10-min intervals. Acidosis bout event was categorized as if the pH stayed below 5.6 for 3 hours. Data were analyzed using a random coefficient statistical model, binary data was analyzed using the logit link function and correlations were analyzed using PROC CORR in SAS (Table 1). Duration under pH 5.8 and 5.6 tended to have a negative correlation with gain to feed (G/F; P ≤ 0.080), and % of the time that pH remained below 5.6 when under 5.8 was negatively correlated with G/F (P = 0.007) and tended to have a negative correlation with average daily gain (ADG; P = 0.081). Similarly, acidosis bouts event and duration of bout event (DURB) tended (P ≤ 0.074) to have a negative correlation with G/F, while ADG was negatively correlated (P = 0.035). The number of acidosis bout events and probability of acidosis bout events to occur increase linearly (R2 = 0.89, P &amp;lt; 0.001, and R2 = 0.77; P &amp;lt; 0.001, respectively) as DOF progressed. The probability of an acidosis bout event decreased by 46% for the T111 treatment compared with T000 (35.43% vs. 18.82%; P = 0.049). Acidosis bout event seems to affect the growth and development of beef steers negatively, and it appears to be more critical as DOF progress. Administration of VM at 240 mg/d throughout the whole feeding period seems to reduce the incidence of acidosis bout events.

171 Supplementing Ca Salts of Soybean Oil Via Low-Moisture Molasses-Based Blocks to Improve Reproductive Performance and Overall Productivity of Beef Cows

Abstract This experiment evaluated reproductive and productive responses of beef cows receiving self-fed low-moisture blocks (LMB) enriched or not with Ca salts of soybean oil (CSSO) throughout the breeding season. Non-pregnant, suckling multiparous Angus-influenced cows (n = 554) were assigned to a fixed-time artificial insemination (AI) protocol (day -10 to 0) followed by natural service (day 15 to 70). Cows were managed in 12 groups (46 ± 4 cows/group) maintained in individual pastures, and groups received LMB enriched with 25% (as-fed basis) of CSSO or ground corn (CON) from day -10 to 100. Both treatments were designed to yield a daily LMB intake of 0.454 kg/cow (as-fed basis). Groups were enrolled in an estrus-synchronization + fixed-time AI protocol from day -10 to 0 (AI occurred on day 0) of the experiment and beginning 15 days after AI cows were exposed to mature Angus bulls for 55 d. Pregnancy status was verified on day 55 and 100 of the experiment, and cows that gave birth during the initial two weeks were considered pregnant to fixed-time AI. Calf birthdate and weight was recorded during the subsequent breeding season. All calves were weaned at the same time, and a calf BW and age were recorded. Blood samples were also collected from a subsample of cows on days -10, 0 (fixed-time AI), and 55 (pregnancy diagnosis). All data were analyzed using group as the experimental unit and Satterthwaite approximation to determine the denominator df for the tests of fixed effects. Quantitative data were analyzed with the MIXED procedure of SAS, and binary data analyzed with the GLIMMIX procedure of SAS with a binomial distribution and logit link function. Data were analyzed with group (treatment × location), cow(group), and location as random variables. Significance was set at P ≤ 0.05 and tendencies were determined if P &amp;gt; 0.05 and ≤ 0.10. Cows receiving CSSO had greater (P &amp;lt; 0.01) mean concentrations of ω-6 fatty acids in plasma samples collected on days 0 and 55. Cows receiving CSSO had greater (P = 0.05) pregnancy rate to fixed-time AI (67.2 vs. 59.3%), whereas final pregnancy rate did not differ (P = 0.92) between treatments. Pregnancy loss was less (P = 0.03) in CSSO cows (4.50 vs. 9.04%), which also calved earlier during the calving season (treatment × week; P = 0.04). Weaning rate tended to be greater (P = 0.09) in CSSO (84.8 vs. 79.4%), although calf weaning age and weight did not differ (P ≥ 0.72) between treatments. Kilos of calf weaned/cow exposed was greater (P = 0.04) in CSSO cows (234 vs. 215 kg). Therefore, supplementing CSSO to beef cows via LMB during the breeding season improved their reproductive and overall productivity during a cow-calf cycle.

Modeling Northern Highbush Blueberry Cold Hardiness for the Pacific Northwest

Freezing temperatures in fall, winter, and spring can cause damage to multiple perennial fruit crops including northern highbush blueberry (Vaccinium corymbosum). Predictive modeling for lethal temperatures allows producers to make informed decisions about freeze mitigation practices but is lacking for northern highbush blueberry grown in the Pacific Northwest. If buds are hardier than air temperatures, unnecessary use of propane heaters and/or wind machines is costly. In contrast, use of heaters and/or wind machines during freezing, damaging temperatures can minimize crop damage and potential yield loss. The objective of this study was to model cold hardiness across multiple cultivars of northern highbush blueberry grown in various regions in Washington, USA, and to generate predictive cold hardiness models that producers in the Pacific Northwest could use to inform freeze mitigation. Multiple years of experimental cold hardiness data were collected on four cultivars of northern highbush blueberry grown in western and eastern Washington, USA. Freeze chambers were used to reduce bud temperatures systematically, after which buds were dissected and bud survival was assessed. A generalized linear mixed model with a binomial response and logit link was fit to each cultivar to characterize the relationship between bud survival, freezer temperature, recent air temperatures, and growing degree days from fall acclimation to late winter/spring deacclimation. Model simulation was performed to obtain marginal-scale lethal temperature estimates. Model error estimation was performed using cross validation. Results show cultivar-specific cold hardiness models can be generated, and model development and use can help growers make more informed decisions regarding freeze protection that also minimizes costly applications of freeze protection when unnecessary. Furthermore, such models can be adapted to other blueberry growing regions and cultivars experiencing similar climactic conditions.

Gharial (Gavialis gangeticus) conservation in Bardia National Park, Nepal: Assessing population structure and habitat characteristics along the river channel amidst infrastructure development.

Nepal initiated numerous hydropower and irrigation-related infrastructure projects to enhance and promote green energy, water security, and agricultural productivity. However, these projects may pose risks to natural habitats and the well-being of aquatic fauna, leading to significant effects on delicate ecosystems. To understand these potential impacts, it is crucial to gather reliable baseline data on the population status and habitat characteristics of species. This study specifically focuses on Gharials (Gavialis gangeticus), a critically endangered species. We recorded data on pre-determined habitat variables at stations spaced 500 m apart along the two major river streams of Bardia National Park, as well as at locations where Gharials were sighted between February and March 2023. We used binary logistic regression with a logit link function to investigate the habitat characteristics related to the occurrence of Gharials. The presence/absence of Gharials at sampling points served as the dependent variable, while 10 other predetermined variables (ecological variables and disturbance variables) served as independent variables. Our study recorded 23 Gharials, comprising 14 adults, sixsub-adults, and three juveniles, with a sex ratio of 55.56 males per 100 females. Most individuals (83%) were found basking. Among the 10 habitat predictors, three variables (mid-river depth, river width, and water temperature) were significantly correlated (p < .05) with the probability of Gharial occurrence. The model shows that Gharial detection probability increases with greater mid-river depth and width and lower water temperature. This study establishes a population baseline for Gharials within the river system before the construction of large infrastructure projects, such as dams and irrigation canals. It also recommends continuous monitoring of Gharial populations after water release and/or diversion to evaluate the impact of large infrastructure projects on the population and their associated habitat characteristics. This will help enable more informed and targeted conservation efforts.

Is Subjective Cognitive Decline Associated with Behavioral Health Outcomes Among Mothers?

Studies suggests that pregnancy can alter the maternal neurological function of the brain (i.e., result in cognitive decline) in a way that remains prevalent well into middle and older adulthood. However, little research has explored these changes and how they might affect behavioral health outcomes, such as substance use and depression. We merged data from the 2016, 2017, and 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys, with a final analytic sample of 1330 female participants (649 participants were mothers). Chi-square tests or t-tests were used to examine differences in demographic and health characteristics of the sample by subjective cognitive decline (SCD) status. To test the study hypotheses, three generalized linear mixed models were estimated with a logit link. SCD was not associated with alcohol misuse among mothers (aOR = 0.27, p = 0.23). Mothers with SCD were more likely to smoke (aOR = 3.33, p = 0.01) and experience mental distress (aOR = 6.59, p < 0.001) than those without SCD. Interventions aimed at supporting mothers should consider how existing mental health and tobacco cessation programs can be adapted to better serve this population and should aim to identify those that may have early signs of early signs of neurodegenerative conditions.

Socioeconomic inequality in knowledge about HIV/AIDS over time in Ethiopia: A population-based study.

Socioeconomic inequality in comprehensive knowledge about HIV/AIDS can hinder progress towards ending the epidemic threat of this disease. To address the knowledge gap, it is essential to investigate inequality in HIV/AIDS services. This study aimed to investigate socioeconomic inequality, identify contributors, and analyze the trends in inequality in comprehensive knowledge about HIV/AIDS among adults in Ethiopia. A cross-sectional study was conducted using 2005, 2011, and 2016 population-based health survey data. The sample size was 18,818 in 2005, 29,264 in 2011, and 27,261 in 2016. Socioeconomic inequality in comprehensive knowledge about HIV/AIDS was quantified by using a concentration curve and index. Subsequently, the decomposition of the concentration index was conducted using generalised linear regression with a logit link function to quantify covariates' contribution to wealth-based inequality. The Erreygers' concentration index was 0.251, 0.239, and 0.201 in 2005, 2011, and 2016, respectively. Watching television (24.2%), household wealth rank (21.4%), ever having been tested for HIV (15.3%), and education status (14.3%) took the significant share of socioeconomic inequality. The percentage contribution of watching television increased from 4.3% in 2005 to 24.2% in 2016. The household wealth rank contribution increased from 14.6% in 2005 to 21.38% in 2016. Education status contribution decreased from 16.2% to 14.3%. The percentage contribution of listening to the radio decreased from 16.9% in 2005 to -2.4% in 2016. The percentage contribution of residence decreased from 7.8% in 2005 to -0.5% in 2016. This study shows comprehensive knowledge about HIV/AIDS was concentrated among individuals with a higher socioeconomic status. Socioeconomic-related inequality in comprehensive knowledge about HIV/AIDS is woven deeply in Ethiopia, though this disparity has been decreased minimally. A combination of individual and public health approaches entangled in a societal system are crucial remedies for the general population and disadvantaged groups. This requires comprehensive interventions according to the primary health care approach.

Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru.

In Peru, cardiovascular accidents (CVA) cause around 15% of premature death, with an increase in CVA due to the prevalence of risk factors for CVA in the Peruvian population. Hemorrhagic CVA presents higher mortality compared to ischemic. This research aimed to identify the risk factors associated with hemorrhagic CVA. We carried out a retrospective cross-sectional study using the medical records of patients with a diagnosis of CVA treated at the Regional Hospital of Ica during the years 2018 and 2019. Independent variables included age, sex, type 2 diabetes, dyslipidemia, hypertension, smoking, obesity, and intracranial carotid artery calcification. To identify factors associated with an increased probability for hemorrhagic CVA compared to ischemic CVA, a generalized linear model with logit link and binomial family, obtaining the odds ratio (OR) and its 95% confidence interval (CI). we evaluated the data from 132 patients. Of them, 46 (34.85%) had hemorrhagic CVA. Only systolic blood pressure (OR: 1.04; 95% CI: 1.02-1.06) and hypertension (OR: 0.29; 95% CI: 0.10-0.89) were significantly associated with hemorrhagic CVA compared to ischemic CVA. Hypertension is associated with hemorrhagic CVA compared to ischemic CVA. These results are consistent with the literature.

The impact of epilepsy and antiseizure medications on pregnancy and neonatal outcomes: A nationwide cohort study.

Our objective was to assess the adverse outcomes during pregnancy, as well as for the fetus and neonates, in women with epilepsy, both with and without the use of antiseizure medications (ASMs). A cohort of singleton pregnancies between January 1, 2004 and December 31, 2014 was identified using the Taiwan National Health Database. The pregnancies were categorized into ASM exposure, ASM nonexposure, and control (consisting of women without an epilepsy diagnosis) groups. We recorded adverse outcomes in neonates and documented pregnancy complications. The generalized estimating equation with logit link was used to estimate adjusted odds ratios. There were 629 singleton pregnancies in the group exposed to ASMs, 771 in the epilepsy group without ASM exposure, and 2,004,479 in the control group. Women with epilepsy had a significantly higher risk of puerperal cerebrovascular diseases (adjusted odds ratios in the exposure and nonexposure groups=54.46 and 20.37, respectively), respiratory distress syndrome (5.1 and 2.99), mortality (3.15 and 3.22), sepsis (2.67 and 2.54), pregnancy-related hypertension (1.71 and 1.8), preeclampsia (1.87 and 1.79), cesarean delivery (1.72 and 2.15), and preterm labor (1.38 and 1.56). The use of ASMs may increase the risk of eclampsia (adjusted odds ratio=12.27). Compared to controls, fetuses/neonates born to women with epilepsy had a higher risk of unexplained stillbirth (adjusted odds ratios in the exposure and nonexposure groups=2.51 and 2.37, respectively), congenital anomaly (1.37 and 1.33), central nervous system malformation (3.57 and 2.25), low birth weight (1.90 and 1.97), and a low Apgar score at 5 min (2.63 and 1.3). The use of ASMs may introduce an additional risk of small for gestational age; the adjusted odds ratio was 1.51. Women with epilepsy, irrespective of their exposure to ASMs, had a slightly elevated risk of pregnancy and perinatal complications. Puerperal cerebrovascular diseases may be a hidden risk for women with epilepsy.

Catastrophic Health Expenditure and Out-of-pocket Payments for Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG)

Background: When households have high out-of-pocket (OOP) expenses, they are more likely to experience poverty and encounter catastrophic health expenditures (CHE). Heart disease is a significant cause of health decline and mortality. Objectives: This study aimed to provide essential knowledge about CHE and OOP for heart disease patients who underwent coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in Shiraz, Iran. Methods: This cross-sectional study with two prospective follow-ups was conducted in three heart surgery centers in Shiraz, Iran. The data were collected using the world health survey (WHS). Catastrophic health expenditures and OOP were asked from the most informed family member. Generalized estimating equation (GEE) modeling was employed to identify the main factors related to CHE and OOP. Binary distribution with logit link and gamma distribution with log link were used for CHE and OOP, respectively. The significance level was set at 0.05. Results: We found that OOP payment among patients who needed cardiovascular services in public-private partnership (PPP) hospitals was 76,953,100 Rials (R), equal to 2,506.78 $ (USD) (SD = 53,247,600 R/1,734.56 $) in the PCI group and 230,937,700 R equal to 7,522.89 $ (SD = 248,295,200 R/8,088.32 $) in the CABG group. This value in public hospitals was 15,083,800 R, equal to 491.36 $ (SD = 18,637,600 R/ 607.13 $) in the PCI group and 12,276,800 R, equal to 399.92 $ (SD = 11,131,900 R/ 362.63 $) in the CABG group. We also found that admission duration, age, type of hospital, and being currently a smoker were significant factors for OOP (P-value &lt; 0.05). During baseline assessment, we also found that the percentage of PCI patients that faced CHE was 95.56% and 47.92% in PPP and public hospitals, respectively. This value in CABG patients was 92.31% and 40.45%. Our study showed that the type of hospital and socioeconomic status were significant factors (P-value &lt; 0.05) that pushed a family facing CHE. Conclusions: The baseline CHE is very high in both PCI and CABG patients. Thus, the government should pay special attention to this issue. Further investigations are needed on factors affecting OOP and CHE.

Does Trust Mediate the Relationship Between Experiences of Discrimination and Health Care Access and Utilization Among Minoritized Canadians During COVID-19 Pandemic?

We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic. We used datafrom Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group. The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust. The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.