Mixed-effects Logistic Regression Analysis Research Articles

Early sexual debut among adolescent girls and young women in Sierra Leone: A multilevel analysis of prevalence and predictors.

Early sexual debut among young women is associated with adverse sexual and reproductive health outcomes, including unintended pregnancies and sexually transmitted infections. Despite its negative impact, there is limited research on this issue in Sierra Leone. This study aims to address this gap by examining the prevalence of early sexual debut and its associated factors among adolescent girls and young women aged 15-24 years in Sierra Leone. Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Provincial variations in the proportion of early sexual debut were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to examine the factors associated with early sexual debut. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intraclass correlation coefficients. The prevalence of early sexual debut was 26.1% [24.3, 28.0]. Adolescent girls and young women aged 20-24 were less likely to engage in early sexual debut [aOR = 0.52; 95% CI: 0.41, 0.65] than those aged 15-19. The odds of early sexual debut was lower among adolescent girls and young women with secondary/higher education [aOR = 0.62; 95% CI: 0.45, 0.85] compared to those with no education. Adolescent girls and young women who used the internet in the last 12 months [aOR = 0.50; 95% CI: 0.34, 0.73] and those who belonged to the Fullah ethnic group [aOR = 0.25; 95% CI: 0.07, 0.85] were less likely to engage in early sexual debut relative to those who did not use the internet and those belonging to the Creole ethnic group respectively. Adolescent girls and young women who intend to use contraceptives [aOR = 0.60; 95% CI: 0.46, 0.77] and those who do not intend to use contraceptives [aOR = 0.65; 95% CI: 0.49, 0.88] were less likely to engage in early sexual debut than those who were using contraceptives.Conversely, adolescent girls and young women who were working [aOR = 1.41; 95% CI: 1.12, 1.77] had higher odds for early sexual debut than those not working. The odds of early sexual debut were higher among adolescent girls and young women who were married/cohabiting [aOR = 1.72; 95% CI: 1.32, 2.22] and previously married [aOR = 3.26; 95% CI: 1.61, 6.56] than those who were never married. Adolescent girls and young women living in the North Western area[aOR = 1.81; 95% CI: 1.05, 3.13] had higher odds for early sexual debut than those living in the Eastern province. Early sexual debut is prevalent among adolescent girls and young women in Sierra Leone. Age, education, internet use, ethnicity, contraceptive use intention, marital status, employment status, and province of residence were the factors associated with early sexual debut. The study underscores the need for policymakers, government, and non-governmental organisations to design and implement comprehensive and multifaceted interventions to promote informed decision-making and reproductive health among adolescent girls and young women in Sierra Leone.

Childhood traumatic experiences and vaping among Australian adolescents: A prospective investigation.

Childhood traumatic experiences (CTE) have been identified as a robust risk factor for a range of substance use behaviours. However, little is known about their association with adolescent vaping. We explored prospective associations between CTEs and vaping among a sample of Australian adolescents. The sample comprised 2234 adolescents (baseline Mage = 12.7 years, SD = 0.5; 49.9% female) enrolled in the Health4Life cluster randomised controlled trial. Using mixed effects logistic regression analyses, data from the baseline and 36-month assessment waves were used to examine whether CTEs (by ~ age 12) were associated with current or lifetime vaping and future intentions to vape (~ age 15). Adjusting for socio-demographic variables, CTE exposure at baseline was associated with higher odds of ever having vaped (odds ratio 1.64, 95% confidence interval 1.34, 2.02), and of being a current regular vape user (odds ratio 1.63, 95% confidence interval 1.11, 2.39). Experiencing CTEs was also associated with higher odds of intending to vape in the future (odds ratio 1.44, 95% confidence interval 1.11, 1.86). This study is the first to identify CTEs as a risk factor for vaping, and intentions to vape in the future, among Australian adolescents. These findings align with global research and highlight another common risk factor across various forms of substance use. CTE exposed adolescents represent a priority group who may require earlier and more targeted vaping intervention.

High VExUS grades are linked to cardiac function in general ICU patients.

Even though initially considered as a new standard in systemic venous congestion assessment, the semi-quantitative Doppler ultrasound-based Venous Excess Ultrasound Grading System (VExUS) showed inconsistent associations with outcomes in general intensive care unit (ICU) patients. It is unclear why VExUS is so effective in predicting outcomes in some cohorts and not in others. The determinants of higher VExUS have not been studied in a general ICU cohort. The aim of this study was to determine the factors associated with higher VExUS (≥ 2) in a general ICU cohort. We performed a post-hoc analysis of a prospective, observational cohort, including adult patients within 24 hours of ICU admission and expected ICU length of stay longer than 2 days. Collected data included patients' hemodynamic status (including ultrasound evaluation) at several points in time: ICU admission, day 1, day 2, day 5, and the last day of ICU stay. We analyzed 514 hemodynamic evaluations in 145 patients. 96/514 (18.7%) had a VExUS grade ≥ 2. The univariable followed by multivariable mixed-effects logistic regression analyses only found a statistically significant association between VExUS ≥ 2 and right ventricle S wave (OR 0.85 (0.74;0.97), p = 0.02) and left ventricle E/A ratio (OR 2.34, 95% CI (1.27;4.33), p = 0.006). The current study has elucidated that higher VExUS is primarily associated with cardiac comorbidities and ultrasound parameters of left- and right-sided cardiac systolic and/or diastolic function in general ICU patients.

Performance of high-resolution diffusion-weighted magnetic resonance imaging for detecting clinically occult early breast cancers: a multi-reader study.

To compare mammography, breast ultrasound (US), high-resolution diffusion-weighted magnetic resonance imaging (DW-MRI), dynamic contrast-enhanced breast MRI (DCE-MRI), and their combinations for detecting clinically occult early breast cancers (EBCs), including ductal carcinoma in situ (DCIS). Three hundred and three consecutive women with screening imaging-detected early breast cancers (60 pure DCIS, 36 DCIS with microinvasion, and 207 invasive carcinoma less than 20mm) who underwent breast MRI at 3T including DW-MRI (b-values of 0, 800 and 1200s/mm2; in-plane resolution, 1.1 × 1.1 mm2 or 1.3 × 1.3 mm2; section thickness, 3mm) were retrospectively reviewed. Three radiologists independently reviewed each examination. Statistical analysis included Chi-square test, McNemar test for comparison of cancer detection rates, and Fleiss' Kappa for interreader agreement. Mixed-effect logistic regression analysis was employed to evaluate factors associated with cancer detection on DW-MRI. The overall cancer detection rates were 54.8% on mammography, 71.0% on breast US, 81.5% on DW-MRI, and 87.1% on DCE-MRI. On McNemar test, DW-MRI detected more cancers than mammography (adjusted p < 0.001), and its combination with mammography showed a similar cancer detection rate to DCE-MRI combined with mammography (adjusted p = 0.808). On multivariable analysis, histologic type, lesion size, ADC and CNR on DW-MRI were independent factors for cancer detection on DW-MRI. The interreader agreement for cancer detection was moderate to substantial (Fleiss' kappa: 0.52-0.65) across each modality. High-resolution DW-MRI plus mammography showed comparable cancer detection rate to DCE-MRI plus mammography for detecting clinically occult EBCs including DCIS.

Gender disparity and post-traumatic stress disorder and elevated psychological distress in humanitarian migrants resettled in Australia: the moderating role of socioeconomic factors.

Humanitarian migrants are at increased risk of post-traumatic stress disorder (PTSD) and elevated psychological distress. However, men and women often report varying degrees of stress and experience different challenges during migration. While studies have explored PTSD, psychological distress, gender, and resettlement stressors, they have not explored the interplay between these factors. This study aims to address that gap by investigating gender disparities in PTSD and psychological distress among humanitarian migrants in Australia, with a focus on the moderating role of socioeconomic factors. This study used data from five waves of the Building a New Life in Australia (BNLA) survey, a longitudinal study of 2,399 humanitarian migrants who arrived in Australia in 2013. PTSD and psychological distress were measured using the PTSD-8 and Kessler-6 (K6) scales, respectively. We conducted generalised linear mixed-effect logistic regression analyses stratified by gender. Female humanitarian migrants exhibited a significantly higher prevalence of PTSD and psychological distress than males over five years of resettlement in Australia. Women facing financial hardship, unemployment, or residing in short-term housing reported greater levels of PTSD and distress compared to men. Women facing financial hardship, inadequate housing, and unemployment exhibit higher rates of PTSD and psychological distress, underscoring the significant impact of socioeconomic factors. Addressing these challenges at both individual and systemic levels is essential for promoting well-being and managing mental health among female humanitarian migrants.

Supporting multidrug-resistant or rifampicin-resistant TB treatment adherence in people with harmful use of alcohol through person-centred care.

TB is concentrated in populations with complex health and social issues, including alcohol use disorders (AUD). We describe treatment adherence and outcomes in a person-centred, multidisciplinary, psychosocial support and harm reduction intervention for people with multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) with harmful alcohol use. An observational cohort study, including multilevel mixed-effects logistic regression and survival analysis with people living in Minsk admitted with MDR/RR-TB and AUD during January 2019-November 2021 who received this person-centred, multidisciplinary, psychosocial support and harm reduction intervention, was conducted. There were 89 participants enrolled in the intervention, with a median follow-up of 12.2 (IQR: 8.1-20.5) mo. The majority (n=80; 89.9%) of participants had AUD, 11 (12.4%) also had a dependence on other substances, six (6.7%) a dependence on opioids and three (3.4%) a personality disorder. Fifty-eight had a history of past incarceration (65.2%), homelessness (n=9; 10.1%) or unemployment (n=55; 61.8%). Median adherence was 95.4% (IQR: 90.4-99.6%) and outpatient adherence was 91.2% (IQR: 65.1-97.0%). Lower adherence was associated with hepatitis C, alcohol plus other substance use and outpatient facility-based treatment, rather than video-observed treatment, home-based or inpatient treatment support. This intervention led to good adherence to MDR/RR-TB treatment in people with harmful use of alcohol, a group usually at risk of poor outcomes. Poor outcomes were associated with hepatitis C, other substance misuse and outpatient facility-based treatment support.

Iron-rich food consumption and predictors among children aged 6–59 months old in Ethiopia using 2005–2016 national representative data

Children who do not consume enough iron have decreased growth, reduced immunity, and poor cognitive development. This study aimed to assess the pooled iron-rich food consumption, trends, and predictors among children aged 6–59 months old in Ethiopia. This study used Ethiopian demographic and health survey (EDHS-2005–2016) data with a total weighted sample size of 26,773 among children aged 6–59 months old. A multilevel mixed-effects logistic regression analysis was used to identify predictors of good iron-rich food consumption. The pooled proportion of iron-rich food consumed among children aged 6–59 months in Ethiopia was 11.77% (10.71, 12.92%). In Ethiopia, the proportion of iron-rich food intake by children aged 6–59 months was slightly increased from 9.25% (8.04, 10.62%) in EDHS 2005 to 10.86% (9.06, 12.95%) in EDHS 2011, and sharply increased to 17.49% (15.04, 20.24%) in EDHS 2016. The findings indicated that being children born to mothers aged 20 to 34 years old [AOR = 0.56, 95% CI: 0.35, 0.89], mothers aged ≥ 35 years old [AOR = 0.47, 95% CI: 0.28, 0.82], married parents [AOR = 1.68, 95% CI: 1.14, 2.48], completed primary education [AOR = 1.32, 95% CI: 1.02, 1.73], secondary education [AOR = 2.66, 95% CI: 1.53, 4.59], a higher education status of mother [AOR = 3.98, 95% CI: 1.92, 8.23], medium family [AOR = 1.39, 95% CI: 1.03, 1.89], rich family [AOR = 1.45, 95% CI: 1.09, 1.95], media exposure [AOR = 1.35, 95% CI: 1.06, 1.72], residents of the Tigray [AOR = 2.69, 95% CI: 1.51, 4.79], Oromia [AOR = 3.30, 95% CI: 1.30, 4.02], Benishangul [AOR = 2.12, 95% CI: 1.15, 3.88], Gambela [AOR = 5.85, 95% CI: 2.97, 11.50], and Dire Dawa region [AOR = 3.38, 95% CI: 1.76, 6.47], were significantly associated with good iron-rich food consumption among children aged 6–59 months old. The findings revealed that iron-rich food intake was considerably low among Ethiopian children aged 6–59 months. Increasing women’s literacy and economic empowerment improves iron-rich food consumption among children aged 6–59 months old.

What factors influence women's empowerment in Ethiopia? A multilevel analysis of Ethiopia's demographic and health survey data.

Women's empowerment has been a global priority, as countries can achieve significant growth and economic development by empowering women. Understanding the individual and community-level factors that influence women's empowerment is crucial for policymakers to develop effective policies and to improve women's empowerment. A community-based cross-sectional survey was conducted in 11 administrative regions of Ethiopia. The analysis included a weighted sample of 7,108 married women of reproductive age (15-49 years) from the 2,016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to examine the individual and community-level factors associated with women's empowerment. In the final model, significant variables were identified using a p-value of <0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI). The overall magnitude of women's empowerment was 23.7% (95% CI: 22.7-24.7). Only 30.9% of women reported participating in household decision-making, and 32.5% disagreed with all the reasons justifying wife-beating. At individual-level, factors positively associated with women's empowerment included secondary (AOR: 2.72 (1.77-4.23), and higher (AOR: 3.65 (1.81-7.34) education. However, belonging to the Muslim religion was negatively associated with women's empowerment (AOR: 0.63 (0.47-0.85). At the community level, wealthy communities were positively associated with women's empowerment (AOR: 1.60 (1.05-2.44). Conversely, residing in rural areas (AOR: 0.49 (0.29-0.83), and living in the Afar (AOR: 0.35 (0.17-0.70), Amhara (AOR: 0.45 (0.26-0.79), Oromia (AOR: 0.43 (0.26-0.73), South Nation Nationalities, and Peoples (SNNP) (AOR: 0.42 (0.24-0.75), and Gambella (AOR: 0.36 (0.20-0.66) regional states were negatively associated with women's empowerment. The overall magnitude of women's empowerment in this study was low. Factors that positively influenced empowerment included attending secondary and higher education, as well as residing in communities with higher wealth status. On the other hand, being Muslim, residing in rural areas, and living in the Afar, Amhara, Oromia, SNNPR, Gambella, and Tigray regions were negatively associated with women's empowerment. As a result, the government of Ethiopia needs to design community-based women's empowerment strategies and involve women in income-generation activities that improve their participation in household decision-making to empower them.

Regional distribution and factors associated with early marriage in Ghana: a cross-sectional study

BackgroundEarly marriage, the formal or informal union before age 18, remains a critical challenge in several low-and middle-income countries. It has adverse health and education-related implications on child brides. This study examined the regional distribution of early marriage and its associated factors in Ghana.MethodsWe performed a cross-sectional analysis of data extracted from the 2022 Ghana Demographic and Health Survey. Our study comprised 10,098 ever married/cohabiting aged 15 to 49. Regional variations in the prevalence of child marriage were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to assess the factors associated with early marriage. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of early marriage was 29.2% [27.9, 30.6] in Ghana. Women in the North East 38.2% [33.4, 43.2], Western North 36.7% [32.1, 41.5] and Ahafo regions 35.8% [32.0, 39.8] had the highest prevalence of early marriage, whilst women in the Western 22.2% [18.4, 26.5] and Greater Accra 19.7% [15.8, 24.3 regions] had the lowest prevalence of early marriage in Ghana. The odds of early marriage was lower among women aged 20-49 compared to those aged 15-19. Women with secondary [aOR = 0.40; 95% CI 0.33, 0.48] and higher education [aOR = 0.07; 95% CI 0.04, 0.12], those who belonged to the Gurma ethnic group [aOR = 0.59; 95% CI 0.41, 0.84], and women from richer [aOR = 0.64; 95% CI: 0.47, 0.87] and richest [aOR = 0.42; 95% CI 0.28, 0.64] households were less likely to be married early compared to those with no education, those belonging to the Akan ethnic group, and those from the poorest wealth quintile households, respectively. The odds of early marriage was higher among women whose family size was five or more [aOR = 1.50; 95% CI 1.31, 1.72] and women living in the Central [aOR = 1.72; 95% CI 1.16, 2.54], Volta [aOR = 1.97; 95% CI 1.17, 3.30], Eastern [aOR = 1.53; 95% CI 1.01, 2.29], Ashanti [aOR = 1.98; 95% CI 1.33, 2.97], Western North [aOR = 1.77; 95% CI 1.18, 2.65], and Ahafo regions [aOR = 1.74; 95% CI 1.18, 2.56].ConclusionAbout one in three marriages were early in Ghana, with variations across the regions. Age, wealth index, ethnicity, level of education, family size, and region were identified as factors associated with early marriages. The government and policymakers in Ghana should increase access to and completion of secondary education for girls, as it is crucial in reducing early marriage. Providing programmes that economically empower women and girls can decrease their vulnerability to early marriage. More vigorous enforcement of laws against early marriage is necessary. Engaging with communities, including tribal leaders, is essential to shift cultural attitudes toward early marriage.

Regional disparities and socio-demographic factors associated with eight or more antenatal care visits in Ghana

BackgroundAntenatal care is vital for maternal health and wellbeing, with the World Health Organization recommending a minimum of eight visits during pregnancy. In this study, we examined the regional disparities and factors associated with eight or more antenatal care visits in Ghana.MethodsWe performed a cross-sectional analysis of data from the 2022 Ghana Demographic and Health Survey. Our study comprised 3,893 women of reproductive age with birth history in the last two years before the survey. Regional disparities in the proportion of eight or more antenatal care visits were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was conducted to determine the factors associated with eight or more antenatal care visits using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of eight or more antenatal care visits in Ghana was 38.4% [95% CI = 36.0–41.0]. The regions with the highest prevalence were Eastern, Greater Accra, Western, and Volta. Those with the lowest prevalence were Northern, North East, Savannah, and Oti. The odds of eight or more antenatal care visits were lower among women aged 40–49 [aOR = 0.42, 95% CI = 0.18–0.96], women with four or more children [aOR = 0.57, 95% CI = 0.36–0.93], women who wanted pregnancy later [aOR = 0.63, 95% CI = 0.46–0.85], and women in five regions: Western North [aOR = 0.43, 95% CI = 0.19–0.94], Bono [aOR = 0.33, 95% CI = 0.14–0.76], Northern [aOR = 0.29, 95% CI = 0.13–0.66], Savannah [aOR = 0.30, 95% CI = 0.14–0.65] and North East [aOR = 0.33, 95% CI = 0.14–0.75]. Women in the richer [aOR = 1.99, 95% CI = 1.19–3.33] and richest [aOR = 4.82, 95% CI = 2.45–9.51] wealth index showed a higher likelihood of completing eight or more antenatal care visits relative to women in the poorest wealth index.ConclusionA significant proportion of women in Ghana fall short of the recommended eight or more antenatal care visits. Age, parity, desired pregnancy timing, wealth status, and region of residence are associated with the number of antenatal care visits. Women in five regions (Bono, Northern, North East, Savannah, and Western North) are significantly less likely to have eight or more antenatal care visits than those in the Western region. The government and policymakers should design programs to address the needs of older women, those with high parity, and women who want to delay pregnancy. Increased healthcare resources, educational campaigns, and addressing regional barriers to antenatal care access are crucial. Promoting public health initiatives to emphasise the importance of completing the recommended number of antenatal care visits for a healthy pregnancy is essential.

Body mass index is associated with disability at discharge as indicated by the modified Rankin Scale in patients with ischemic stroke: a JROAD-DPC study

ABSTRACT Background Body mass index (BMI) of patients with ischemic stroke (IS) has been associated with prognosis and disability in studies in the United States. Although the Asian population is leaner, the optimal BMI for stroke-related disability remains unknown. Objectives To clarify the association between BMI and disability in patients with IS from a national database in Japan. Methods The present study included 522,421 patients with IS identified in the JROAD-DPC database from April 2016 to March 2020. We used the WHO classification of BMI, which divides Asia-Pacific patients into five groups, to categorize BMI and the modified Rankin Scale (mRS) to assess stroke-related disability at admission and discharge. After multiple imputation for missing values, we conducted a multiple mixed-effect logistic regression analysis for poor mRS score (>2) in September 2023. In addition, we created a restricted cubic spline model between the odds ratio (OR) for poor mRS and BMI. Results The mRS score worsened during hospitalization in 60.1% of the patients with IS, and 45.7% had a poor mRS score at discharge. Overweight patients had the lowest OR of having a poor mRS score (OR: 0.898, 95% confidence interval: 0.895–0.902). The spline curve for the OR for poor mRS score was U-shaped with a BMI of 24.7 kg/m2as the apex value. Conclusion The present study revealed a U-shaped relationship between BMI and stroke-related disability, with overweight patients having the lowest OR for disability at discharge.

Water insecurity may exacerbate food insecurity even in water-rich environments: Evidence from the Bolivian Amazon

Globally, challenges with water and food are two of the most pressing problems people face. Yet hydrologically water-rich environments and rural environments are often overlooked in these discussions due to abundance of natural water resources. Here we test the relationship between water and food insecurity among 270 Tsimane' households in the Bolivian Amazon. Water challenges were evaluated with the Household Water Insecurity Experiences Scale (HWISE), water quality perception, objective water quality analyses, and water access via the JMP drinking water ladder. Food insecurity was measured with the Household Food Insecurity Access Scale (HFIAS), and quantitative measures of food frequency recall were used to further test the water and food insecurity relationship. Using multilevel mixed-effects linear regression, each point increase in HWISE score was associated with 0.47 point (95 % CI: 0.30, 0.62, p < 0.001) higher food insecurity, and households with access to improved water sources had between 1.25 and 1.36 points (95 % CI: −2.61, −0.01, p < 0.05) lower food insecurity compared to households reliant on surface water. These relationships held true independent of quantitative measures of both fish and meat consumption. Using mixed-effects logistic regression analyses, each point increase in HWISE score was associated with 43 % (95 % CI: 1.25–1.66, p < 0.001) increased odds of experiencing severe food insecurity. Households changing what was eaten due to experienced water problems was associated with 2.33 points (95 % CI: 0.41, 4.25, p < 0.05) higher food insecurity. This relationship held true independent of perceived water quality, indicating other structural water problems may be important here in the household water and food insecurity relationship. These results demonstrate that even in water-rich environments, like the Amazon, water and food insecurity are interconnected. Further, despite the challenging conditions, equitable structural interventions, like the development of improved water infrastructure, are critical for the provision of clean drinking water and may simultaneously help alleviate food insecurity.

Ethnicity and access to water, sanitation, and hygiene in Bangladesh: a study using MICS data and policy reviews.

Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health. Reducing inequalities and ensuring universal access to WASH are essential to achieving the agenda of sustainable development. We aimed to measure access to WASH among ethnic minority populations in Bangladesh and understand the situation and factors affecting WASH practices among them. Additionally, we reviewed policy related to WASH to highlight the inequality faced by ethnic minority populations. We utilized data from the multiple indicator cluster survey-2019. We used the chi-square test for bivariate analysis and multilevel mixed-effect logistic regression analyses to identify the effect of ethnicity on WASH in Bangladesh after controlling selected covariates. Furthermore, we systematically reviewed Bangladesh's WASH-related policies and programs. While 98.5% of Bengalis had access to basic drinking water services, the percentage is 60.6% for the ethnic minority population. For improved sanitation facilities not shared with others, the difference between Bengali and ethnic populations was 22.3% (64.6% vs. 42.3%). On the other hand, 75% of the Bengali population had a handwashing facility with water and soap, and 50% of the ethnic population had them. Ethnicity appeared to be a statistically significant predictor of every component of WASH. Compared to Bengali, the ethnic population had 87%, 45%, 31%, and 45% less access to water (aOR = 0.13, p ≤ 0.001), sanitation (aOR = 0.55, p ≤ 0.001), and handwashing (aOR = 0.69, p ≤ 0.05), and WASH facilities aOR = 0.55, p ≤ 0.001), respectively. Among the policies of Bangladesh, only one identified action for WASH rights of ethnic minorities. The government should identify the issues of WASH among ethnic minorities and represent them adequately in policies to achieve the aim of 'leaving none behind' of sustainable development goals.

Unmet Financial Needs of People with Psychotic Disorders-A Cross-Sectional Study in People with Psychotic Disorders, Parents, Siblings, and Controls.

Background. Psychotic disorders have a strong negative impact on people's lives, including their financial situation. This study aimed to examine differences in unmet financial needs between people with psychotic disorders, parents, siblings, and controls. Secondly, we aimed to examine whether family clustering contributes to unmet financial needs. Lastly, we aimed to examine to what extent demographic, economic, psychiatric, functional, and cognitive characteristics and substance use predict unmet financial needs in people with psychosis. Methods. Data from the first assessment of people with psychosis (n = 956), siblings (n = 889), parents (n = 858), and controls (n = 496) included in the Genetic Risk and Outcome of Psychosis study were used. Group differences were assessed with Kruskal-Wallis tests (aim 1), while a mixed-effects logistic regression analysis and explorative and confirmative ordinal logistic regression analyses were conducted for aims 2 and 3, respectively. Results. Twenty-four percent of people with psychotic disorders reported unmet financial needs. These levels of unmet financial needs were significantly higher than levels for siblings, parents, and controls. We found a negligible influence of (direct) familial clustering on unmet financial needs. Lastly, cannabis and tobacco use significantly and consistently predicted higher levels of unmet financial needs of people with psychosis. Conclusions. Relatively high levels of unmet financial needs occurred in a heterogeneous group of people with psychosis, especially when people used cannabis or tobacco. Unmet financial needs can have detrimental consequences for mental health, stigmatization, leisure time activities, and social engagement. Thus, it is pivotal to recognize unmet financial needs, especially combined with substance use, as a crucial stressor for people with psychosis.

Association of Socioeconomic Variables with Primary Cesarean Section.

Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City. This was a retrospective study of all 80,506 women in New York City who gave birth to a live child during 2018, and who met inclusion and exclusion criteria. Data were drawn from the New York City Department of Health and Mental Hygiene and the US Census. The main outcome measure was performance of PCS as compared with vaginal birth. Approximately 21% of neonates were delivered by PCS. Multivariate multilevel mixed-effects logistic regression analysis showed higher odds for PCS for women with an upper-middle class median household income of US$108,500 to $380,499 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07-1.76, P = 0.001), and the percentage enrolled in the Supplemental Nutrition Assistance Program (OR 1.01, 95% CI 1.001-1.012, P = 0.02). Lower odds for PCS occurred for all middle-class categories of per capita income: US$32,500 to $54,499 (OR 0.91, 95% CI 0.84-0.99, P = 0.02), US$54,500 to $108,499 (OR 0.76, 95% CI 0.66-0.88, P < 0.001), and US$108,500 to $380,499 (OR 0.80, 95% CI 0.66-0.96, P = 0.02). No significant association occurred for women receiving public assistance. Patient preferences in favor or against CS may be related to SES. There may be conflicts between obstetric care that is maximally beneficial and a patient's desire for delivery mode. Clinicians should be aware of the potential implications of this dilemma.

The Impact of Unmet Healthcare Needs on the Perceived Health Status of Older Europeans During COVID-19.

To examine how unmet healthcare needs and the exposure to the pandemic impacted self-reported health (SRH) among individuals aged 50 and above. We use data from two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey collected in 2020 and 2021 in 27 European countries and Israel (N = 42,854). Three dimensions of barriers to healthcare access were investigated: healthcare forgone, postponed, and denied. Mixed-effects logistic regression analysis was employed to explore SRH deterioration during the pandemic. Findings indicate that unmet healthcare needs decreased throughout the pandemic but significantly contributed to the worsening of SRH among older adults. Mild or severe exposure to the pandemic heightened the likelihood of reporting deteriorated SRH. Additionally, the pandemic disproportionately affected females, the oldest-old, and those living alone or facing economic vulnerability. To mitigate the adverse effects on the health status of older adults, policymakers are strongly advised to prioritize addressing the healthcare needs of those who have been disproportionately affected by the pandemic.

Can a behaviour change toothbrushing intervention prevent dental caries in 11-13-year-olds?

The Brushing RemInder 4 Good oral HealTh (BRIGHT) multi-centre randomized controlled trial was based in state-funded secondary schools in England, Wales and Scotland. It had two arms, aiming to assess the clinical and cost effectiveness of a 50 min education session and twice daily brush reminder text messages on toothbrushing and caries rates, compared to the normal education curriculum and no SMS. Outcomes were assessed at intervals over 2.5 years and were assessor-blinded. Pupils aged 11-13 were recruited from participating schools, and in each school randomised via year group to either the intervention or control group following baseline assessments by calibrated dental professionals. Exclusion criteria included not having a functioning mobile phone. The primary outcome, D4-6 MFT (Decayed, Missing and Filled Teeth), was analysed using mixed-effect logistic regression and sensitivity analyses were conducted. A cost-utility analysis was also undertaken. In total 42 schools, containing 84 year groups were randomised, and 4680 pupils were in the final sample. 663 pupils withdrew from follow up. At 6 months, there was evidence that intervention group pupils were more likely to report brushing at least twice per day However, by 2.5 years this effect was no longer evident. 2383 participants had a valid dental assessment at both baseline and 2.5 years, with 514 children in the intervention and 529 children in the control group presenting with obvious decay experience in at least one permanent tooth after 2.5 years. The intervention was estimated to have a 7% chance of being cost-effective. Over the 2.5-year follow-up, there were no significant differences in QALYs and costs between groups. The findings from the BRIGHT trial indicate no evidence of a statistically significant difference between the intervention and control groups for the prevalence of caries after 2.5-years. The behaviour change intervention did not translate into a reduction in caries rates.

English Vowel Perception in Spanish-English Bilingual Preschoolers: Multiple-Talker Input Is Only Beneficial for Children With High Language Exposure Levels.

This study examines English vowel perception in Spanish-English bilingual preschoolers, comparing bilinguals' perception patterns to those of monolinguals and examining how child internal (age) and external variables (input quantity and input diversity) predict perceptual performance. Sixty children between 3;6 and 5;6 (years;months) of age participated in the study, 28 of whom were Spanish-English bilinguals and 32 English monolinguals. Perception was assessed through a forced-choice minimal-pair identification task in which children heard synthesized audio stimuli (i.e., "sheep" and "ship") that varied systematically along the /i-ɪ/ continuum and were asked to match them with one of two pictures. The data were analyzed with Bayesian mixed-effects logistic regression analyses, modeling responses as a function of continuum step, language background (monolingual or bilingual), age, English exposure (i.e., input quantity), and number of English input providers (i.e., input diversity). The results indicate that, despite displaying nonnative English stop voicing perception in a previous study, the same bilingual children showed English /i-ɪ/ perception patterns that did not differ from those of monolinguals. While age did not predict vowel perception, input quantity and diversity jointly interacted to moderate how well children perceived the /i-ɪ/ contrast. Specifically, diverse input promoted perceptual performance in children who received high levels of English exposure-and who presumably had more advanced English language skills, whereas it limited perceptual performance in children with more limited English exposure and skills. This study shows that bilingual children can show monolingual-like perception patterns for some sounds while displaying nontarget perception for others. This is the first study to demonstrate that language exposure mediates the role of input diversity on speech sound development, suggesting that varied input can be more or less beneficial for speech sound development based on the learner's language learning stage.

Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis.

Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia. A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported. The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24-35: AOR = 1.98, 95% CI (1.3, 3.1), and 35-49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts. In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions.

Association of weather variables with pathogens contributing to conjunctivitis worldwide.

To identify weather variables associated with pathogens contributing to infectious conjunctivitis globally. Sample collection and pathogen identification from patients with acute infectious conjunctivitis was performed from 2017 to 2023. We linked pathogens identified from 13 sites across 8 countries with publicly available weather data by geographic coordinates. Mixed effects logistic regression analysis was performed to estimate the associations between temperature, precipitation, and relative humidity exposures, and the prevalence of infection types (RNA virus, DNA virus, bacteria, and fungus). 498 cases from the United States, India, Nepal, Thailand, Burkina Faso, Niger, Vietnam, and Israel were included in the analysis. 8-day average precipitation (mm) was associated with increased odds of RNA virus infection (odds ratio (OR)=1.47, 95% confidence interval (CI): 1.12 to 1.93, P=0.01) and decreased odds of DNA infection (OR=0.62, 95% CI: 0.46 to 0.82, P<0.001). Relative humidity (%) was associated with increased odds of RNA virus infections (OR=2.64, 95% CI: 1.51 to 4.61, P<0.001), and fungal infections (OR=2.35, 95% CI: 1.19 to 4.66, P=0.01), but decreased odds of DNA virus (OR=0.58, 95%CI: 0.37 to 0.90, P=0.02) and bacterial infections (OR=0.42, 95% CI: 0.25 to 0.71, P<0.001). Temperature (°C) was not associated with ocular infections for any pathogen type. This study suggests that weather factors affect pathogens differently. Particularly, humidity and precipitation were predictors for pathogens contributing to conjunctivitis worldwide. Additional work is needed to clarify the effects of shifts in weather and environmental factors on ocular infectious diseases.