Hierarchical Regression Research Articles

Coronary stent edge segments as determinant of clinical outcomes: An OCTOBER Trial Substudy

Abstract Background Small lumen dimensions and high plaque burden in stent edge segments are known risk factors for subsequent clinical events after percutaneous coronary intervention (PCI). The evidence using intravascular optical coherence tomography is scarce. Purpose This study aimed to characterize edge segments after PCI and the relation to clinical outcomes in the randomized OCTOBER trial on bifurcation PCI optimized using optical coherence tomography. Methods This is a predefined substudy of the OCTOBER Trial. Edge segments were analysed in detail for degree of stenosis and plaque composition using a dedicated software. Data was planned to be analysed using multi-level cox regression analysis, but descriptive statistics was applied due to very low event rates after OCT-guided PCI. Main endpoints were OCT-detected edge residual stenosis, lipid plaque, calcification, and dissections. Post PCI coronary angiography was analysed for diameter stenosis, edge segment length and minimal lumen diameter. Patients with cardiac events were diagnosed with angiography duringt the two-year follow-up period. Results A total of 597 patients were treated with OCT-guided PCI. Analysable final OCT scans with no additional treatment was available for 505 patients in the main vessel and for the side branch in 289 cases. At deadline for abstract submission 242 scans with 474 edges were analysed and included in preliminary results.Lesions with ≥30% diameter stenosis was found in 20% of proximal edges, 24% of distal edges and 37% of side branch (SB) edges. A plaque burdenOCT ≥180° was found in 74% of proximal edges, 48% of distal edges, and 52% of SB edges. A lipid plaque wafound in 35%, 11% and 14%, dissections in 15%, 6% and 12%, and ≥180° calcium was found in 7%, 4% and 4% of edges respectively. Six patients (1%) of the total OCT-guided population had an edge-related event during the median two-year follow-up. Only two of these 6 patients had post-procedural OCT-scans of the event-related edge, thus 4 of the cases were effectively angiographic guided. Conclusion Only a small fraction of edge segments in the OCTOBER Trial were left with residual edge disease exceeding protocol thresholds. This resulted in historically very low rate of edge related events. No evaluation of a stent edge by OCT in otherwise OCT guided patients appeared to be the main predictor of edge related events. Final results are presented at ESC 2024.

Implantable cardioverter defibrillators among elderly survivors of out-of-hospital cardiac arrest

Abstract Background Survivors of out-of-hospital cardiac arrest (OHCA) with a shockable rhythm are at increased risk of cardiac arrest, and clinical practice guidelines recommend placement of an implantable cardioverter defibrillator (ICD) in the absence of a reversible cause and an expected meaningful survival of at least one year. Contemporary data on the prevalence of secondary prevention ICD placement among OHCA survivors remain limited. Purpose Examine patterns of secondary prevention ICD implantation in survivors of OHCA due to a shockable rhythm in a large national registry. Methods Using 2013-2019 data from the Cardiac Arrest Registry to Enhance Survival (CARES) linked to Medicare files, we identified 3,226 patients aged >65 years who survived to discharge following OHCA due to an initial shockable rhythm from January 1, 2013 to December 31, 2019. Patients with severe neurological disability, prior history of cancer, and those discharged to hospice were excluded. We calculated cumulative prevalence of ICD implantation at discharge, 90 days, and 6 months post cardiac arrest. Multivariable hierarchical regression models with random hospital effects were used to determine the adjusted association of patient characteristics with ICD implantation and quantify the extent of variation in ICD implantation across sites, using a median odds ratio (OR) and 95% confidence interval (CI). Results Patients’ mean age was 72.2 years; 23.5% were women, 10% were Black and 4% Hispanic. Among 3,226 OHCA patients, 997 (30.9%) received an ICD before discharge; 1,266 (39.2%) received an ICD within 90 days of cardiac arrest, and 1,287 (39.9%) received an ICD by 6 months. After adjusting for differences in demographics and co-morbidities, the odds of receiving an ICD at discharge were significantly lower in patients aged 85 years and older, women, patients with prior history of stroke or diabetes, patients who presented with acute myocardial infarction (P<0.05 for all). There was no significant difference in ICD implantation by race and ethnicity (P=0.94) (Table 1). Even after adjusting for patient demographics, co-morbidities, and presentation with acute myocardial infarction, there was large variation in hospital rate of ICD implantation at discharge, with a median odds ratio of 1.65 (95% CI 1.41-1.86). Conclusion Fewer than 1 in 3 patients with OHCA due to a shockable rhythm are discharged with a secondary prevention ICD. Although implantation of ICD was associated with patient variables, there was no difference in ICD implantation by race and ethnicity. There was large variation across hospitals in ICD implantation even after adjusting for patient variables highlighting an opportunity for improving post-arrest management of cardiac arrest survivors.

Predictors of mental well-being among family caregivers of adults with intellectual and developmental disabilities during COVID-19.

Internationally, stresses related to the COVID-19 pandemic negatively affected the mental health of family caregivers of adults with intellectual and developmental disabilities (IDDs). This cross-sectional study investigated demographic, situational and psychological variables associated with mental wellbeing among family caregivers of adults with IDDs during the COVID-19 pandemic. Baseline data from 202 family caregivers participating in virtual courses to support caregiver mental well-being were collected from October 2020 to June 2022 via online survey. Mental well-being was assessed using total scores from the Warwick-Edinburgh Mental Wellbeing Scale. Demographic, situational and psychological contributors to mental well-being were identified using hierarchical regression analysis. Variables associated with lower levels of mental well-being were gender (women); age (<60 years old); lack of vaccine availability; loss of programming for their family member; social isolation; and low confidence in their ability to prepare for healthcare, support their family member's mental health, manage burnout and navigate healthcare and social systems. Connection with other families, confidence in managing burnout and building resilience and confidence in working effectively across health and social systems were significant predictors of mental well-being in the final regression model, which predicted 55.6% of variance in mental well-being (P < 0.001). Family caregivers need ways to foster social connections with other families, and support to properly utilise healthcare and social services during public health emergencies. Helping them attend to their needs as caregivers can promote their mental health and ultimately improve outcomes for their family members with disabilities.

The power of the adult attachment interview in predicting subsequent psychopathology: a tribute to Mary Main

ABSTRACT Mary Main’s conceptualization and operationalization of attachment states of mind through the Adult Attachment Interview (AAI) represent seminal contributions to the attachment field. The AAI is a semi-structured clinical interview used to assess attachment states of mind that is widely used in research and clinical settings. Unresolved state of mind regarding loss or trauma has been linked to concurrent internalizing symptoms. The current study explored the associations between unresolved classification and later depression and anxiety, above and beyond trauma history and symptoms. Participants (n = 70) were parents (98.6% female, 67.1% Black/African-American) from a follow-up of a randomized clinical trial of a parenting program for families referred to child welfare services. Parents completed the AAI, Childhood Trauma Questionnaire, and the Psychiatric Diagnostic Screening Questionnaire at timepoint 1 (T1) and the Brief Symptom Inventory approximately 12 years later, at timepoint 2 (T2). Hierarchical regressions revealed that unresolved state of mind significantly predicted depression at T2, and marginally predicted anxiety at T2, above and beyond childhood trauma, post-traumatic stress symptoms, and early internalizing symptoms. These results suggest that unresolved states of mind are clinically significant and provide unique information about later internalizing symptoms in adults with a history of trauma or loss.

Vicarious Acquisition of Learned Helplessness During the COVID-19 Campus Epidemics in China: Interactions Between Embodied and Mediated Experiences

ABSTRACT Numerous universities nationwide announced urgent implementation of closed campus management due to the epidemics of COVID-19 in Chinese universities since March 2022, and a large number of students were under quarantine. This study aims to explore how embodied experiences (i.e., centralized quarantine and self-quarantine) and mediated experiences (i.e., exposure to media sources, pandemic information overload, and online help seeking) influence the acquisition of learned helplessness during the campus epidemics among the Chinese university students, besides, how do these two types of experiences interact with each other to elicit learned helplessness is another interested research question. The data was collected nationwide via an online survey platform from March 22nd to April 16 2022 immediately after the outbreak of campus epidemics. A total of 1267 valid student samples were retained. Hierarchical regression analysis showed that embodied experience of centralized quarantine is positively related to learned helplessness. Mediated experience of information access from friends on social media and government official media as well as online help seeking are negatively related to learned helplessness. Information access from overseas media and pandemic information overload are positively related to learned helplessness. Besides, the interaction between self-quarantine and pandemic information overload is positively related to learned helplessness. Theoretical contributions and intervention strategies aimed at enhancing authoritative communication and managing information overload during public health crisis were discussed.

Mobile-Based Platform With a Low-Calorie Dietary Intervention Involving Prepackaged Food for Weight Loss for People With Overweight and Obesity in China: Half-Year Follow-Up Results of a Randomized Controlled Trial.

Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups. In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups (P=.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group.

Using Geographic Momentary Assessment to Explore Spatial Environment Influences on Wellbeing in People With HIV.

Place-based socio-economic and racial inequities contribute to health disparities among people with HIV (PWH). We used geographic ecological momentary assessment (GEMA) methodologies to explore the interplay between psychosocial outcomes in daily diaries and community spatial measures among PWH in New Orleans. PWH (N = 69) were recruited from a clinic-based cohort study. Micro-longitudinal data were collected via smartphone-based daily diaries and geospatial tracking over 14 days. First, correlations were run between diary derived outcomes (e.g., feeling safe in current location, stress), and spatial measures (e.g., violent crime, alcohol outlets, and vacant lots) within a half-mile buffer around each diary point to understand the real time associations between mood and space. Next, we fit multilevel models, controlling for between-person effects, to assess within-person associations between accumulative spatial daily violence exposure (50m, 100m and 200m buffers), and measures of daily mood and coping. Violent crime, alcohol outlets and vacant lots were inversely correlated with feeling safe and positively correlated with perceived ease of obtaining drugs. Vacant lots were positively associated with stress and inversely correlated with positive mood. Within individuals, higher daily accumulated violence exposure was associated with increased rumination at the 50m buffer level, decreased trust in oneself and others at the 100m buffer, and decreased ratio of positive/negative mood at all buffers. Our results emphasize the intricate interplay between mental wellness, coping mechanisms, and spatial measures in PWH. Future research and interventions for PWH should consider how spatial factors may influence PWH in terms of mental health and care engagement.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

Abstract Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups. Objectives To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. Methods Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. Results IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. Conclusions Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population’s health from the earliest days. Key messages • Mortality patterns refer to the internal variability of the crisis’ effect and to persistent spatial regional inequalities appealing to the need for attention in policymaking. • The relevance of considering the political economy of global health finance and macroeconomic volatility as a major influence on the association of mortality rates with socioeconomic indicators.

Syndemic vulnerability in Dutch urban cities: investigating health disparities and intersectionality

Abstract Background Syndemics, the clustering of health and social issues, disproportionately affect marginalized communities. While prior research indicates sex-specific variations in syndemic vulnerability, current research often overlooks other sociodemographic characteristics and their interaction. An intersectionality-informed syndemic approach could offer more insights into the mechanisms in syndemic suffering, providing a deeper understanding and identifying groups most affected by structural inequalities. Methods Our study focused on adult residents in Leiden and The Hague, the Netherlands, registered at different general practices. Using existing routine health data linked with Central Bureau for Statistics information, we included adults who were registered with a general practitioner in 2018 and 2019, had a minimum of two registered health conditions documented by their general practitioner, lived in Leiden or The Hague, and were at least 18 years old in 2018. Results A total of 43340 adults were included for analyses. Distinct health condition clusters were observed within sex and age groups. Women experiences a broader range of health issues, often characterized by mental and psychosomatic symptoms like mood/anxiety disorders and abdominal complaints. Conversely, men exhibited a higher prevalence of specific physical conditions, including hypertension, diabetes, and cardiovascular diseases. Conclusions The findings align with previous research, suggesting the importance of further exploration into the role of intersectionality in syndemics. Currently, we are investigating the foundations of these disparities, including interaction analyses and Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Using MAIHDA, we will examine the relationship between intersectionality and syndemic vulnerability, quantifying intersecting factors (sex, ethnicity, SES) and exploring their impact at individual and group levels. Key messages • Understanding intersectionality in health disparities is crucial for addressing syndemic vulnerabilities. • Tailored interventions informed by intersectionality may promote equitable health outcomes.

The role of resilience in navigating work stress and achieving daily work goals

SummaryOn a daily basis, resilience is critical for employees to cope with difficulties and challenges in achieving work goals. Understanding the dynamic resilience process throughout the workday is crucial for gaining insights into how employees can effectively leverage their resilience to meet their daily work goals. The present study aims to examine this dynamic resilience process in response to work stress while pursuing work goals among employees with different levels of trait resilience. Drawing on resilience literature and the conservation of resources theory, we propose a resilience‐depleting process in response to morning work stress within a short, half‐day timeframe. We further examine whether state resilience impacts subsequent work goal striving at the within‐person level. Additionally, we explore the buffering effect of trait resilience on the resilience‐depleting process after experiencing work stress. To test our hypotheses, we employed the experience sampling methodology with 108 full‐time employees over five consecutive workdays. Multilevel analyses revealed that morning work stress significantly diminished state resilience, indirectly influencing daily work goal progress through work goal activation. Notably, trait resilience buffered the negative impact of work stress on state resilience. These results offer insights into theoretical understanding and practical implications for managing employee state resilience in the face of work stress to achieve daily work goals.

Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries

Abstract Aim To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism. Methods We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested. Findings Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63). Interpretation Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities. Key messages • Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies. • A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.

The Association between Organizational Factors of Health Promoting Schools and Teachers' Health Lifestyles: A Multilevel Analysis.

Schools are both learning environments for students and workplaces for faculty. Recognizing the role of organizational factors in staff health in school environments, the study aimed to explore which factors, including transformational leadership, teachers' perceived management support and HPS accreditation awards, were most associated with promoting a healthy lifestyle for teachers. A cross-sectional study was undertaken of 137 elementary schools in 2014, involving 433 directors and 2090 teachers. Data were collected using an anonymous structured questionnaire. Hierarchical linear modeling was used to analyze both teacher- and school-level factors associated with health-promoting lifestyles. There was a significant positive correlation between teachers' overall health-promoting lifestyle profile (HPLP-II) scores and both perceived management support (coefficient = .98, p < .001) and transformational leadership (coefficient = .38, p = .039). All 6 HPLP-II subscales also showed significant positive correlations with perceived management support (coefficients .12-.24, p < .001). Supporting a healthy working atmosphere and strong principal transformational leadership are keys to enhancing teachers' health-promoting lifestyles. Future research could explore how transformational leadership and management support influence teachers' health behaviors and identify effective strategies and interventions.

School support, perceived value and teachers' digital training adaptability: A multilevel moderated mediation model

AbstractDigital training has significantly transformed the landscape of teacher professional development, introducing various uncertainties. In this context, adaptability can play a crucial role in helping teachers cope with stress and effectively navigate new and changing scenarios. However, existing research on adaptability has not adequately addressed the specific challenges and opportunities presented by digital training, nor has it thoroughly explored the interplay between external factors and individual characteristics. Therefore, this study is based on job demands‐resources (JD‐R) theory to explore the school‐level (school support) and individual‐level (perceived value) predictors that influence teachers' digital training adaptability (DTA) and their mechanisms of action through hierarchical linear model. To this end, a questionnaire was administered to 552 teachers from 55 schools who had participated in digital training. The results of multilevel regression analyses show that (1) emotional support and cognitive support have a significant positive effect on teachers' DTA; (2) perceived value plays a mediating role in the relationship among emotional support, cognitive support, and teachers' DTA; and (3) emotional support weakens the relationship between perceived value and teachers' DTA, but cognitive support enhances this relationship. The study discusses these results further to propose feasible recommendations for building a community that improves the support system and adopts evidence‐based policy‐making to enhance the effectiveness and relevance of training, thereby improving teachers' DTA.

Strategies to promote safety for sexual and gender minority youth in secondary schools: A longitudinal analysis.

In order to promote school safety for sexual and gender minority youth (SGMY), many schools implement strategies such as SGM-focused policies and gender-sexuality alliances (GSAs). Little is known about the effects such strategies have over time on feelings of safety at school for SGMY. Hierarchical Linear Models were conducted using longitudinal data from 417 SGMY attending secondary schools to examine trajectories of feelings of safety and the effects of SGM-focused policies, GSA presence, or GSA membership on feelings of safety. Findings indicate that SGM-focused policies and GSAs had direct benefits for safety at school SGMY, both independently and in combination; however, GSA membership was not. Schools should implement a combination of school strategies to promote safer environments for SGMY.

Impact of School Gardens on Nutrition Education Among Limited-Income Communities in Alabama.

We sought to determine the impact of school gardens and nutrition education on student fruit and vegetable consumption from limited-income communities in Alabama. Third grade students at 99 Alabama schools with and without gardens on-site were randomized to receive either nutrition education or to a wait-list control group. Multi-level models were used to assess the effects of treatment and control with and without school gardens. Students attending schools with gardens demonstrated highest consumption of fruits and vegetables prior to treatment. Nutrition education alone translated into significant dietary improvements. Both gardens and education translated into greatest dietary improvements. Devising financially accessible, practical, and culturally relevant ways to improve student health through garden and nutrition education may help improve student diet. Forming comprehensive Extension, SNAP-Ed, and school collaboration to support gardens, nutrition education, and healthy school policies and systems can be a way to support and sustain healthy student learning environments. Combined gardening and nutrition education is associated with increases in fruit and vegetable consumption among majority rural, Southern students from limited-resource communities.

Magnitude and predictors of obstetric complications during delivery among postpartum women in Ethiopia: evidence from PMA Ethiopia longitudinal survey

IntroductionThe majority of pregnancy-related complications were preventable. However, the magnitude of complications during pregnancy and childbirth was high in sub-Saharan Africa. There was limited evidence on the magnitude of obstetric complications during childbirth and its predictors among postpartum women in Ethiopia.Methods and materialsThe research used secondary data sources based on performance monitoring for action in Ethiopia’s second cohort longitudinal survey. It was a national survey that was conducted in three large, predominantly agrarian regions (Oromia, Amhara, and SNNP) and one urban region (Addis Ababa) of Ethiopia between 2021 and 2023. It was conducted to track pregnant women’s use of essential maternal and newborn health services. It involved the enrollment of pregnant women and tracking them at six weeks, six months, and one year after giving birth. The data collected at the beginning of the survey and six weeks after childbirth were used for the analysis. Sample weights were applied to account for differences in sample allocation and response rates across regions and urban/rural areas. Multi-collinearity and intra-cluster correlation were assessed before fitting the multilevel models to ensure the accuracy of the estimates. A multi-level logistic regression model was used to assess the magnitude and predictors for the occurrence of obstetric complications during delivery. The model fit was evaluated using Akaike’s Information Criterion and Bayesian Information Criterion. Adjusted odds ratio with its 95% confidence interval was used to measure the strength of association for this study.ResultsThe magnitude of obstetric complications during delivery was found to be 33.86% with 95% CI (31.56, 36.24. Among the obstetric complications that occurred during delivery, about 15.73%with 95% CI(14.02, 17.61) of women experienced bleeding, 4.14% with 95% CI (3.30, 5.17) had their membrane rupture but labor did not start within 24 h, 2.29% with 95% CI(1.67, 3.13) had their membrane rupture before 9 months, 3.95% with 95% CI(3.16, 4.93) had faced malpresentation or malposition of the baby, 12.70% with 95% CI (11.18, 14.39) had prolonged labor lasting more than 12 h, and 12.40% with 95% CI (10.83,14.17) had convulsions. The odds of occurrence of obstetric complication during delivery among women from severely food insecure households were 1.88 times [AOR = 1.88; 95% CI (1.22, 2.90)] more likely to occur than women from food secure households. Moreover, the odds of occurrence for obstetric complications during delivery among women who had complications during their pregnancy were 2.39 times [AOR = 2.39; 95% CI (1.81, 3.16)] more likely to occur as compared to those women who had no complication during their pregnancy. On the other hand, women’s who had 1–4 live births given before this delivery were 0.61 times [AOR = 0.61; 95% (0.43, 0.88)] less likely to develop complications as compared to those women’s who had no prior live birth.Conclusion and recommendationDelivery-related obstetric complications during delivery in Ethiopia were high. Approximately one-third of postpartum women in Ethiopia experienced obstetric complications during delivery. Based on this study, women’s from severely food insecure households, those women’s who had no prior live birth, and women’s who had complications during their pregnancy were more likely to develop delivery-related obstetric complications. Thus, policy makers and program implementers who were working on maternal and newborn health should give special attention for women’s from severely food insecure households, women’s who had no prior live births, and those women’s who encountered obstetric complications during their pregnancy to decrease the occurrence of obstetric complications during delivery. In Ethiopia, various governmental organizations, such as the Ministry of Health and the Ministry of Agriculture, are dedicated to addressing food insecurity and improving nutritional access. The country has launched several effective nutritional programs, including the Productive Safety Net Program, the Targeted Supplementary Feeding Program, and the National Nutrition Program, aimed at alleviating food insecurity and enhancing nutrition. Ongoing efforts are crucial to tackle the food insecurity experienced by women, which can help to reduce obstetric related complications of women’s during delivery. It is crucial for everyone involved in maternal and newborn health to prioritize addressing the factors that lead to obstetric complications during delivery in women in order to reach the goal of ending all preventable maternal and newborn deaths by 2030.

The use of imaging studies and its association with surgical delays, costs and complications in patients with acute appendicitis: a population-based study in Ontario, Canada

BackgroundAppendicitis is commonly assessed with diagnostic imaging prior to intervention. The study objective was to describe practice patterns of diagnostic imaging for appendicitis and the associations with surgical delays, hospital costs, and complications.MethodsThis was a population-based cohort study of patients with appendicitis between 2009 and 2015. Imaging was categorized into none, ultrasound, computed tomography (CT), or both. The outcomes were: 1) time from triage to surgery, 2) complication rate and 3) hospital costs. Logistic regression and hierarchical linear regression were used to estimate associations between imaging and outcomes.ResultsThere were 50,369 study patients. Time to surgery was highest in patients requiring both CT and ultrasound (mean difference 5.0 h 95%CI 4.6–5.4) followed by patients requiring CT (2.7 h 95%CI 2.4–3.0) and ultrasound (mean difference 0.7 h, 95%CI 0.5–1.0), compared to no imaging. Hospital costs were highest in those with both ultrasound and CT ($256 95%CI $28–483) and CT alone ($234 95%CI $75–394), compared with no imaging. Complications were associated with the use of CT (OR 1.08 95%CI 1.00–1.17) and both CT and ultrasound (OR 1.21 95%CI 1.09–1.35) compared with no imaging, but not with ultrasound alone (OR 1.01 95%CI 0.93–1.09).ConclusionsThis study demonstrated that type of diagnostic imaging is associated with delays to surgery, especially in those requiring CT scan. In addition, complications and hospital costs are increased in this group. Clinicians could consider ultrasound as the first imaging modality to facilitate more timely surgery and reduced costs.

Effect of engagement in personal growth initiative skills on depression, anxiety, and stress: Multilevel mediation analysis with intensive longitudinal data.

The current study examined the association between the possession of personal growth initiative (PGI) skills and symptoms of mental illness (i.e., depression, anxiety, and stress) and the potential mediating role of daily engagement of PGI skills during the COVID-19 pandemic. The participants consisted of 73 individuals (Mage = 41.62, SDage = 12.44) who were recruited from Amazon's Mechanical Turk (MTurk). Data for possessed PGI was collected in April 2020, and the daily survey started approximately 1 month later at the beginning of May 2020 for 29 days. Controlling for demographic variables, multilevel mediation models revealed significant association between PGI skills and PGI engagement. However, our hypothesized indirect effects were not found. When inspecting the direct effects controlling for the effect of PGI engagement and demographic variables, the paths between PGI skills and both depression and anxiety were negatively associated. When examining the effect of time, there were no significant changes during the period of 29 days in the levels of PGI skills among individuals. However, a significant fluctuation within individuals in how much participants have utilized PGI skills during the study period was found. The current study highlights the influence of PGI skills at both the between-individual as well as within-individual levels in predicting symptoms of mental illness, and it also uncovers the role of PGI skills by separating into general PGI skills and individual's daily engagement in utilizing the PGI skills in predicting symptoms of mental illness.

Technology-assisted instruction with teacher prompts on fraction multiplication word problems: A single-case design with visual analysis and Bayesian multilevel modeling

ABSTRACT This study examines the effects of technology-assisted instruction with teacher prompts on the ability to visualize and solve fraction multiplication word problems for four middle school students with learning disabilities. A multiple-probe design across participants, a type of single-case design, showed a functional relationship between the intervention and the targeted mathematical outcomes. Although there were some fluctuations over time, students demonstrated improvements from the baseline to intervention phases (Tau ranged from 0.76 to 1.00 for visualization and was 1.00 for problem-solving). Researchers employed Bayesian cumulative link mixed effects models to examine the moderating effects of word problem question types. Students showed greater maintenance effects on problem-solving than on visualization tasks, as reflected in changes in level (logit coefficient = 2.6) and trend (logit coefficient = 0.22). Students and teachers perceived vocabulary and multiplication fact practices, as well as the cognitive and metacognitive features embedded in the technology-assisted intervention, to be useful in learning targeted mathematics concepts. This study underscores the role of technology integration in enhancing teachers’ instructional approach and in aiding students’ acquisition and retention of mathematical concepts and skills.

Children's friendship stability in the United States, China, and Indonesia: Associations with individual attributes and dyadic similarity.

Predictors of friendship stability from individual attributes and dyadic similarities were assessed using cross-classified multilevel analyses in this 6- to 8-month longitudinal study of 10-year-old US (White, Black, Asian, other; n = 477, 50% girls), Chinese (n = 467, 59% girls), and Indonesian (Sudanese, Javanese, other; n = 419, 45% girls) children with complete participation and reciprocated baseline friendships. Across countries, individual attributes of social preference, popularity, and academic achievement and dyadic social preference similarity positively predicted friendship stability. Dyadic similarity of popularity, academic achievement, and aggression respectively predicted friendship stabilities of US, Chinese, and Indonesian children. Both individual attributes and dyadic similarity predicted friendship stability, with results that varied across countries consistent with attributes' reputational salience.