Multinominal Logistic Regression Research Articles

Validity of prenatal AUDIT screening for alcohol disorders – a Nationwide Swedish register study

Objective: This study aims to assess the external validity of the Alcohol Use Disorders Identification Test (AUDIT) in Swedish prenatal care as an indicator for alcohol-addiction disorders, and to characterize women with mismatched information in healthcare registers Design: This study was designed as a National register-based study. Setting: Sweden Participants: The study sample included 739,735 pregnancies over the period 2014–2020. Methods: Prospectively collected prenatal AUDIT screening in the Swedish Pregnancy register was linked to national health databases through individual identification number. The AUDIT score was dichotomized into < 6 points (low-risk use) and ≥ 6 points (hazardous use). Alcohol addiction disorders were defined by a diagnostic code in The Swedish National Patient Register or drugs dispensed for alcohol dependence in the Swedish Prescribed Drug Register. Primary Outcome Measures: The diagnostic properties of AUDIT were assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy (proportion of true positive and true negative) for an AUDIT score of ≥ 6 points for alcohol disorders. Women with mismatched information in the register were characterized and assessed by multinominal logistic regression, using women with matched information in the registers for reference. Results: An alcohol-related disorder was recorded in 3.1%, while 25,770 (3.5%) had an AUDIT point ≥ 6. The diagnostic accuracy of the AUDIT ≥ 6 points for detection of an alcohol related disorder during a year prior to pregnancy was 95.7% (95% confidence interval [CI]: 95.7, 95.8), with a positive LR of 8.03 (95% CI: 7.5, 8.6). The sensitivity for detecting a pre-pregnancy alcohol related disorder was 33.0% (95% CI: 30.9, 35.1). Being young, nulliparous, of low education, and of Swedish origin increased the likelihood of being misclassified with the AUDIT. Prior psychiatric care was associated with false negatives, especially for women with neuropsychiatric disorders (odds ratio [OR]: 10.39, 95% CI: 9.89, 10.90). Conclusions: The accuracy of AUDIT in screening for alcohol disorders at a population-based level was high, but only identified one third of women with alcohol-related disorders when using a cut-off of six points criterion.

Histology-specific long-term oncologic outcomes in patients with epithelial ovarian cancer who underwent complete tumor resection: The implication of occult seeds after initial surgery.

Assessing the histology-specific prognosis of epithelial ovarian cancer (OvCa) is clinically challenging, especially in a patient population with a favorable prognosis. This study investigated the histology-specific long-term oncologic outcomes in OvCa patients who underwent complete tumor resection using a large-scale patient cohort form multiple institutions under a central pathological review system. A regional multi-institutional study was conducted from 1986 to 2019. Of the 4,898 patients with ovarian tumors enrolled, 1,175 patients who underwent complete tumor resection were classified into three classes based on clinically important prognostic factors: stage, cytology, ascites volume. For each class category, the effect of histology types on recurrence-free survival, the site of recurrence, and post-recurrence survival was evaluated. Recurrence-free survival varied significantly across different histologies (P < 0.001). The risk of recurrence was higher in serous carcinoma compare to other histologies (P < 0.001). The site of tumor recurrence varied by the histology type. Multinominal logistic regression analysis revealed that mucinous histology had a significantly higher likelihood of developing recurrent tumors at distant sites from the peritoneum compared to other histologies (P = 0.002). Conversely, serous histology was associated with better post-recurrence survival (Log-rank P < 0.001). Long-term oncologic outcomes significantly differ by histology type in OvCa patients who have undergone complete tumor resection at the initial surgery. A careful evaluation of the clinical background is necessary for these patients, and further clinical research into individualized treatment approaches is essential.

Loneliness and social isolation in people with HIV aged ≥50 years. The No One Alone (NOA)-GeSIDA study conducted by the GeSIDA 12021 study group.

There is a growing number of people with HIV who are aged 50 years or older, and the prevalence of loneliness and social isolation remains unknown. A multicentre study was conducted across 22 GeSIDA centres. A survey was carried out to assess loneliness [UCLA 3-item Loneliness Scale-3 (UCLA-3)] and social isolation [Lubben Social Network Scale-Revised (LSNS-R)], along with sociodemographic aspects, HIV-related factors, comorbidities, tobacco, alcohol and drug consumption, quality of life, anxiety and depression, and stigma. The prevalence of loneliness (UCLA-3 ≥ 6) and evident social isolation (LSNS-R ≤ 20) was calculated, and multivariable multinominal logistic regression models were used to identify associated factors. A total of 399 people with HIV were included; 77.4% were men, of average age 59.9 years (SD 6.5); 45.1% were aged ≥60 years; 86% were born in Spain; 86.7% in urban areas; 56.4% with secondary or higher education; 4.5% living alone against their wishes. A total of 66.9% were infected through sexual transmission, with a median of 22.9 years since diagnosis [interquartile range (IQR): 12.6-29.5] and a median nadir CD4 count of 245 cells/μL (IQR: 89-440). Overall, 90.7% had viral load <50 copies/mL, 93.5% had adherence >95%, and 26.3% had a prior AIDS diagnosis. In all, 29.1% and 21% reported significant symptoms of anxiety and depression, respectively, 24.3% had mobility issues, and 40.8% reported pain. Overall, 77.7% of participants reported neither loneliness nor social isolation, 10.0% loneliness only, 5.8% social isolation only and 6.5% both. Multivariable analyses identified that being aged 50-59, unemployed or retired, living alone unwillingly, single, poor quality of life, anxiety, and HIV-related stigma were associated with loneliness. Meanwhile, lower education, living alone unwillingly, and depressive symptoms were associated with social isolation. Individuals living alone unwillingly, with depressive symptoms and experiencing HIV-related stigma were at higher risk for both loneliness and social isolation. There is a relatively high prevalence of loneliness and social isolation in our population. Living alone against one's wishes, being unmarried, and experiencing mobility issues could predispose individuals to feel lonely and socially isolated. Those with anxiety and stigma are more prone to loneliness, while individuals with depression are more predisposed to social isolation. It is necessary to develop strategies for the detection and management of loneliness and social isolation in people with HIV aged >50 years.

청소년의 학교적응 잠재프로파일 연구: 잠재프로파일에 따른 또래애착과 자기조절학습 영향력 탐색 및 사이버비행 인식 차이 검증

Objectives The purposes of this study is to identify the latent profiles of adolescents's school adjustment and differences in cyber delinquency awareness, and to explore the effects of peer attachment and self-regulated learning of predictors. Methods To this end 1,326 middle school students were surveyed in the 14th year of Korean Children's Panel were selected. The data were analyzed using latent profile analysis(LPA), multinominal logistic regression model, and analysis of variance. Results Major findings were as follows. First, as a result of latent profile analysis, the three-profile model that includes ‘low school adjustment group,’ ‘moderate school adjustment group,’ and ‘high school adjustment group’ was selected. Second, there was a significant difference in the awareness of cyber delinquency according to the latent profiles of school adjustment. The ‘high school adjustment group’ showed the highest level of cyber delinquency awareness, while the ‘low school adjustment group’ showed the lowest. Third, peer attachment and self-regulated learning had a significant impact on the classification of the latent profiles of school adjustment among adolescents. Conclusions This study identified different groups of school adjustment among adolescents using LPA and found that varying interventions for each latent profile can be effective in enhancing awareness of cyber delinquency issues by improving school adjustment. Our findings provide valuable implications for increasing adolescents' awareness of cyber delinquency through tailored interventions based on their school adjustment levels.

Polygenic Risk Scores and Hearing Loss Phenotypes in Children

Monogenic causes of childhood hearing loss are well established, as are polygenic risk contributions to age-related hearing loss. However, an untested possibility is that polygenic risk scores (PRS) also contribute to childhood hearing loss of all severities, alongside environmental and/or monogenic causes. To examine the association between a PRS for adult hearing loss and childhood hearing loss phenotypes. This cross-sectional study used a unique population-based dataset spanning normal hearing to profound loss, combining 2 contemporaneous population cohorts in Australia. This included the Child Health CheckPoint, a national population-based cross-sectional study nested within the Longitudinal Study of Australian Children, and the Victorian Childhood Hearing Longitudinal Databank (VicCHILD), a statewide population-based longitudinal data bank open to every child with congenital hearing loss in Victoria, Australia. The analysis took place from March to August 2023. Genotype data were generated from saliva- or blood-derived DNA using global single-nucleotide variations arrays. Based on genotype data, PRS was computed using published UK Biobank genome-wide association study results for self-reported hearing difficulty in individuals aged 40 to 69 years. Hearing outcomes were classified by laterality (bilateral, unilateral), severity (mild, moderate, severe or worse) and types (sensorineural, conductive, mixed, auditory neuropathy, atresia). Analyses included multinominal logistic regressions of PRS with hearing outcomes. Overall, 1488 CheckPoint study children (49.8% boys, aged 11-12 years) and 527 VicCHILD study children (55.2% boys, aged 0-13 years) with hearing and genotype data were included. A 1-SD increment in PRS was associated with higher odds of mild (odds ratio [OR], 1.3; 95% CI, 1.0-1.6), moderate (OR, 5.1; 95% CI, 3.2-8.1), and severe or worse (OR, 5.3; 95% CI, 3.9-7.3) unilateral hearing loss compared with normal hearing. Similarly, the PRS was associated with increased odds of mild, moderate, and severe or worse bilateral hearing loss (per-SD ORs, 3.9-6.6) and all hearing loss types (per-SD ORs, 8.5-10.6). In this cross-sectional study, a PRS initially developed for adult hearing difficulty was associated with wide-ranging childhood hearing loss phenotypes, partly explaining hearing phenotype variations despite shared genetic and environmental factors (eg, preterm birth). Large-scale studies with objectively defined hearing phenotypes are crucial for refining PRS and predicting high-risk children.

The early COVID-19 pandemic period and associated gestational weight gain.

The aim of this study was to investigate if gestational weight gain was altered during the early COVID-19 pandemic period. This a retrospective cohort study evaluating gestational weight gain among individuals delivering during the early COVID-19 pandemic epoch (March 10-December 31,2020) compared to temporally matched pre-pandemic (matched months in 2018 and 2019) controls using electronic medical record data from a large tertiary care hospital. The primary outcome was gestational weight gain defined as a categorical measure representing below, meeting, or above Institute of Medicine (IOM) criteria with further adjustment for gestational age at delivery. The early-pandemic exposure group was also categorized by gestational age at the start period (<14weeks' and 14-20weeks') to assess if duration of exposure affected gestational weight gain risks with the use of multinominal logistic regression. Among 5,377 individuals 3,619 (67.3 %) and 1,758 (32.7 %) were in the pre and early pandemic epochs respectively. Overall, 934 (17.4 %) individuals gained below recommended, 1,280 (23.8 %) met recommendations, and 3,163 (58.8 %) gained above IOM recommended gestational weight gain. Compared to the pre-pandemic epoch, the early pandemic period was not associated with weight gain below (OR 1.06, 95 % Cl 0.89-1.27) or above (OR 1.03, 95 % Cl 0.89-1.19) IOM recommendations. This was also true when the early pandemic group was stratified based on gestational age at the start of the early pandemic period (<14weeks' and 14-20weeks'). This study demonstrated no significant difference in maternal weight gain between pre and early COVID-19 pandemic periods.

Ride-Hailing Drivers’ Preference for Fairwork Principles of Trustworthy Labour-Platform Management and Greater Worker-Autonomy and Willingness to Form and Join Worker-Platform Co-Operatives in Kenya

Ride-hailing worker-platform co-operatives had emerged as part of and for at least fairwork principles. Moreover, studies on e-drivers have recommended the formation of worker-platform co-operatives in Kenya. The actual worker-platform co-operatives by e-drivers are yet to be established. It was against this backdrop that a study was conducted to determine the extent of ride-hailing drivers’ preference for fairwork principles of trustworthy labour-platform management, greater worker-autonomy and willingness to form and join worker-platform co-operatives. The study was grounded in the social exchange theory, affective theory of social exchange, and utility theory. The researcher applied critical-realism research philosophy and multimethod research designs of discrete choice experiments and sequential explanatory mixed method research designs. Using the Yamane sampling formula, the study used quantitative data from 497 respondents from sampled 600 of the 20,000 e-drivers in the Nairobi Metropolitan Region. The quantitative data was analysed using multinominal logistic regression. Moreover, the study used qualitative data from 11 participants, analysed using thematic analysis. Results indicated that the two fairwork principles were statistically significant to e-drivers’ willingness to form and join worker-platform co-operatives. The trustworthy platform management (TPM) principle, in particular, was a highly preferred fairwork principle in terms of e-drivers’ willingness to form and join worker-platform co-operative model (Coeff=2.62; SE = 0.400, Z = 6.54, p&lt; .001), compared to the greater worker-autonomy contract (GAC) principle (Coeff=1.565, SE = 0.202, Z = 7.74, p&lt; .001). This study brings practical and theoretical contributions to improve the e-drivers’ benefits from the ride-hailing sector. Policymakers, promoters, and platform workers like e-drivers could understand how best to promote worker-platform co-operatives to succeed in the country’s societal context.

Ride-Hailing Drivers' Preferences for Fairwork Principles of Satisfactory Working Conditions and Fair Pay-Profit Distribution and Willingness to Form and Join Worker-Platform Co-Operatives in Kenya

Ride-hailing drivers (e-drivers) are among the platform workers who successfully embrace the worker-platform co-operative model's emergence to counter capitalistic ride-hailing platforms and their complex ecosystems, which align with fairwork principles of pay, condition, contracts and (platform) management. This study was conducted to determine the extent of ride-hailing drivers' preferences for satisfactory working conditions, fair pay-profit distribution and willingness to form and join worker-platform co-operatives in Kenya. The study was grounded in the social exchange theory, affective theory of social exchange, and utility theory. The researcher applied critical-realism research philosophy and multimethod research designs of discrete choice experiments and sequential explanatory mixed method research designs. Using the Yamane sampling formula, the study used quantitative data from 497 respondents from sampled 600 of the 20,000 e-drivers in the Nairobi Metropolitan Region. The quantitative data was analysed using multinominal logistic regression. Moreover, the study used qualitative data from 11 participants, which was analysed using thematic analysis. Results indicated that the two fairwork principles were statistically significant to e-drivers’ willingness to form and join worker-platform co-operatives. fair pay-profits distribution (FPD) principle, in particular, was a highly preferred fairwork principle in terms of e-drivers’ willingness to form and join the worker-platform co-operative model (Coeff=1.564, SE = 0.234, Z = 6.67, p&lt; .001), compared to the satisfactory working conditions (SWC) principle (Coeff=0.783, SE = 0.156, Z = 5.012, p&lt; .001). This study brings practical and theoretical contributions to improve the e-drivers’ benefits from the ride-hailing sector. Policymakers, promoters, and platform workers like e-drivers could understand how best to promote worker-platform co-operatives to succeed in the country’s societal context.

Trajectories of cold but not mechanical sensitivity correspond with disability trajectories after whiplash injury.

Developmental trajectories for neck disability after whiplash injury have been identified. Their relationship to cold and mechanical sensitivity trajectories is not known. We aimed to (1) identify recovery trajectories of cold and mechanical sensitivity, (2) explore their codevelopment with disability trajectories, (3) identify predictors of sensitivity trajectories, and (4) explore codevelopment of cold and mechanical sensitivity trajectories. Participants (n = 233) were assessed at <1, 3, 6, and 12 months after whiplash injury. Outcomes were cold pain detection threshold (CPT at neck), pressure pain detection thresholds (PPT, neck C5, and tibialis anterior), and the Neck Disability Index. We used group-based trajectory models to identify postinjury recovery trajectories and multinominal logistic regression to explore associations between baseline characteristics and trajectory membership. We identified the following trajectory groups: CPT (low [50.0%], moderate [29.7%], and high [20.4%] sensitivity); PPT C5 (low [10.8%] and high [89.2%] sensitivity); and PPT tibialis anterior (low [23.9%], moderate [39.0%], and high [37.1%] sensitivity); all were stable over the 12 months. There was good correspondence between disability and cold sensitivity trajectory groups but not for mechanical sensitivity; cold and mechanical sensitivity trajectories were not well associated. Higher baseline pain predicted membership of the high cold sensitivity trajectory (RR 1.27, 95% CI 1.01-1.59) and hyperarousal symptoms predicted membership of the moderate cold sensitivity trajectory (RR 1.17, 95% CI 1.01-1.36). We found no associations between baseline characteristics and mechanical sensitivity. There is an interplay between cold allodynia, pain, and hyperarousal symptoms in development of ongoing disability after whiplash injury. Different mechanisms likely underlie cold and mechanical sensitivity.

Factors associated with household willingness to pay for Universal Health Coverage in Cameroon: a nationwide cross-sectional analysis

BackgroundSustained financing for Universal Health Coverage (UHC) has been a concern for the Cameroon government. Household contributions have been considered as a financing mechanism, but this raises concerns on the willingness of households to pay for UHC. The current study assessed factors associated with the willingness to pay (WTP) for UHC in Cameroon.MethodsCommunity based, cross-sectional analysis of data from households (selected via multi-stage, randomized, cluster sampling) across all ten regions of Cameroon, during July 2020. Factors associated with WTP for UHC were determined using a multinominal logistic regression model, tested at varying significance levels (1%, 5%, and 10%) to enhance its ability to detect meaningful and practical value associations.ResultsOverall, 5,014 households were surveyed, 64.3% and 35.6% from rural and urban areas respectively. Household heads were 40.2 ± 10.1 years old and mostly male (60.6%). Most surveyed households (72%) were willing to contribute for UHC. Amongst these willing households, WTP varied with the sex (females opted for lower payments) and educational level (those with ≥ high school education opted for contributions ≥ US$ 165.6 annually, p < 0.01) of the household head. WTP also varied proportionally with household income and was influenced by the sector of activity (formal secondary/tertiary and informal sector workers opted for contributions > US$ 165.6 annually, p < 0.01) of the household head. Other factors affecting WTP included household size (households with ≥ 13 persons opted for contributions ≥ US$ 165.6, p < 0.01) and the age of the household head (those ≥ 55 years opted for higher contributions; US$ 33.1–82.6, p < 0.01). WTP varied positively with knowledge on UHC and affiliation to a health insurance scheme. Household who did not resort to self-medication/prayers when in need of healthcare services opted for higher contributions (US$ 82.6– 165.6, p < 0.01).ConclusionUHC implementation in Cameroon will require that factors shown here-in to influence WTP be carefully considered. Modifiable factors such as self-medication/prayers and poor knowledge on UHC, underlines the need for greater sensitization on UHC. Given the high WTP from the informal sector, characterization of the sector could go a long way to increase the financial envelope allocated for UHC.

Preferences for genetic interventions for SCA and Huntington’s disease: results of a discrete choice experiment among patients

BackgroundAlthough genetic interventions are on the horizon for some polyglutamine expansion diseases, such as subtypes of spinocerebellar ataxia (SCA) and Huntington’s disease (HD), the patients’ preferences regarding these new therapies are unclear. This study aims to get insight into what extent different characteristics of genetic interventions affect the preferences of patients with SCA and HD with regard to these interventions.MethodsManifest and premanifest patients with SCA or HD were recruited online by platforms of patient associations. The respondents conducted a questionnaire that included a discrete choice experiment (DCE). The experimental design included 24 choice sets, but these were divided into three blocks of eight to reduce the number of tasks per respondent. Each choice set included two alternative treatments and consisted of four attributes (mode and frequency of administration, chance of a beneficial effect, risks, and follow-up), each with three or four different levels. The forced choice-elicitation format was used. Data were analyzed by using a multinominal logistic regression model.ResultsResponses of 216 participants were collected. The mode and frequency of administration of a genetic intervention, as well as the chance of a beneficial effect both influence the choice for a genetic intervention. Respondents less prefer repeated lumbar punctures compared to a single operation. As expected, a higher beneficial effect of treatment was preferred. Risks and follow-up did not influence the choice for a genetic intervention.ConclusionsThe results can be used for the design and implementation of future genetic interventional trials as well as of patient-centered care pathways for rare movement disorders such as SCA and HD.

Changes in opinions on health insurance benefits deservingness in the Netherlands between 2013-2023

Abstract Background In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. Although people are generally highly supportive of collectively financed healthcare services, some groups are considered more deserving of health insurance benefits than others. Increasing knowledge of the health risks of certain lifestyle choices and pressure on healthcare systems may result in changing opinions on the allocation of resources. Our study looks into changes in citizen’s opinions on the deservingness of different groups between 2013 and 2023. Methods Questionnaires were sent out to samples of 1.500 members of the Dutch Health Care Consumer Panel in 2013, 2015, 2017, 2019, 2021, and 2023. Response rates varied between 42% (2015) and 56% (2021). Deservingness was studied by asking respondents about their opinions on the amount of health insurance premium for different, opposing groups, for example older and younger people and those with a healthy and unhealthy lifestyle (group A should pay more, both groups should pay the same amount, or group B should pay more). Multinominal logistic regression models were used to examine changes in deservingness opinions over time. Results Our study showed year-to-year fluctuations in opinions on the premium amount for health insurance for different, opposing groups. However, no distinct increases or decreases were observed over the whole time period. This applies to both the general population and to people who do and do not belong to the different groups. Conclusions Although there are differences in the degree to which groups are considered deserving of health insurance benefits, deservingness opinions were found to be fairly stable in the Netherlands between 2013 and 2023. Our results do not point to increasing support for premium differentiation based on personal characteristics. This suggests that support for solidarity in healthcare financing is not in decline. Key messages • Opinions on the deservingness of health insurance benefits of different groups were found to be fairly stable in the Netherlands between 2013 and 2023. • No evidence of increasing support for premium differentiation based on personal characteristics was found.

Pattern of Prescribing Proton Pump Inhibitors: Evaluating Appropriateness and Factors Contributing to Their Adverse Effect Reaction Risk.

Background/Objectives: Proton pump inhibitors (PPIs) are amongst the most commonly prescribed classes of medication. However, inappropriate PPI use can lead to several adverse drug reactions (ADRs). Limited data exist on factors contributing to the risk of ADRs associated with PPI prescribing patterns in the Eastern Region of Saudi Arabia. This retrospective, cross-sectional study aimed to assess the prevalence and the pattern of PPI use and to identify factors contributing to the risk of ADRs. Methods: Data were collected from electronic medical records of patients at Al-Qateef Central Hospital from January 2020 to December 2021. The inclusion criteria included patients aged ≥40 years attending an outpatient medical care clinic. PPI prescribing patterns were categorized based on their dosage intensity into low-dose, medium-dose (MD), and high-dose (HD) categories. Binary and multinominal logistic regression models were used to determine the relationship between PPI prescribing patterns and use, categorized by MD or HD, and patient characteristics, adjusted for significant covariates. Results are presented as adjusted odds ratio (OR) with corresponding 95% confidence intervals (95% CI). Results: The study included 41,084 patients. The prevalence of PPI prescribing was 31%. PPI users were more frequently found to be females than males (52% vs. 50%, p = 0.013); they were also likely to be prescribed more medications (7 vs. 6, p < 0.001), but less likely to have gastritis-related diseases (34% vs. 32%, p < 0.001) compared to non-users. PPI HD users were more likely male (56% vs. 43%, p < 0.001), older (53 vs. 52 years, p < 0.001), and prescribed more medications (11.8 vs. 2.8, p < 0.001) compared to MD users. PPI usage was associated with concurrent use of antiplatelet drugs (OR = 1.08, 95% CI 1.01-1.15). An increasing number of prescribed medications was associated with HD usage (OR = 1.13, 95% CI 1.12-1.14), but negatively associated with MD usage (OR = 0.7 95% CI 0.69-0.71). Female gender was negatively associated with HD usage (OR = 0.85, 95% CI 0.79-0.91). Conclusions: Our findings indicate that 31% of the included cohort were prescribed PPI. Inappropriate PPI prescribing related to the drug's omission is a concern as PPI non-users presented with valid indications such as gastritis. Male gender and increasing NPM were the common factors contributing to increased risk of PPI ADR. This study points to the importance of re-evaluating PPI use to ensure effective therapy with minimum risks of ADR.

Psychological Correlates of Post-COVID Condition

&lt;span lang="SK"&gt;This article deals with psychological correlates of the post-COVID condition - depression, anxiety, and memory problems including remembering and forgetting. The work has a longitudinal character, while it examines the post-COVID condition in a group of participants based on infection of the disease Covid-19. At the same time, participants who never had this disease (N=86, for the 1. measure and N=38 for the 2. measure) are compared with those who were infected with COVID-19 (N=112, for the 1. measure and N=36 for the 2. measure), while participants were separated for analysis in groups based on the time from infection. Group of respondents who were infected within 3 months, from 3-9 months from infection and 9+ months since infecting with the disease. We used tests for comparison, such as the Kruskal Wallis test and multivariate procedures for within-subject and between-subject changes, using Anova for mixed experimental designs. We also determined the risk of being included in a group based on the time of infection with COVID-19 through multinominal logistic regression. We found differences in all variables in general between those infected with COVID-19 and those not. In neuropsychiatric aspects- anxiety and depression were confirmed cyclical features in those who were infected with COVID-19 in time, with the worst value of variables in the group from 3-9 months from infecting with the disease. In the current memory scale and its subscale, the act of remembering was a value that worsened over time and it was confirmed as an effect of group inclusion.&lt;/span&gt;

Future Role of Digital Platform of Community Policing in Malawi

Internet evolution and digital platform popularity have revolutionized citizens participation in public security administration. However, digital platform ecosystem and functionality remains underexplored. Study examines the future role of digital platform for citizens participation in community policing in Malawi. Within frame work of exploratory sequential mixed methods, focus group discussion interviews purposively selected four groups of 10 respondents each, and used interview guide for data collection. Survey randomly sampled 432 households using Yamene (1969) formular to distribute structured questionnaires for data collection. Interviews were written on script then coded, later grouped into sub themes and finally into themes which corresponded to research questions aided by NVivo application. The survey was analyzed through SPSS version 20 to come up with descriptive statistics. Using pragmatics philosophical paradigm, broken window, democratic participation and social-disorganization theories, the study revealed that citizens may be encouraged to participate on digital platform in community policing by; (a) providing training to citizens on digital crime prevention and safety measures, (b) offering incentives or rewards to citizens who participate in neighborhood safety and security digital initiatives, (c) using social media and other digital platforms to raise awareness and encourage citizen participation, (d) creating more opportunities for citizen-police collaboration and dialogue through social media. Multinominal logistic regression shows gender may have impact on the future role of digital platform of community policing; (i) gain communications between police and community, (ii) detect a wider variety of insecurities (Transparency), (iii) promote the effective use of limited resources, (iv) move beyond the customary bureaucratic procedures at p=.017, (v) gain participation of women, minorities, and vulnerable population at p=.459, (vi) contribute to empowerment of the community at p=.003. Solutions to challenges of digital platform of community policing use are; (1) awareness (Sensitization) Campaign, (2) capacity building on the usage of ICT tools, (3) make available ICT merchant selling and maintenance points, (4) usage of Solar Powered ICT and (5) Place coordinated governance mechanisms. While previous scholars have argued that digital platform has allowed formal and non-formal wide participation, as well as increase transparency and accountability to police officers in handling policing issues and empowering citizens to take part in security of their times. Current revelation points that harnessing and promotion of digital platform gives chance to revolution for transformation that may influence accountability of public security administration to provide quality public services for better life to the challenges of the time.

Predictors of Utilization Frequency of and Expenditure Amount for Chiropractic Care in U.S. Adults: A Retrospective Cohort Study

ObjectiveThis study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years). MethodsData are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure. ResultsThe mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure. ConclusionThis analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.

Predictors of stability/change in observed parenting patterns across early childhood: A latent transition approach

Parenting has long been a topic of research based on its importance for family and child outcomes. Recent methodological advances in person-centered approaches suggest that our understanding of parenting could be further advanced by examining parenting typologies across various parenting behaviors longitudinally. Accordingly, the current study aims to examine latent transitions in parenting practice patterns across four annual assessments during early childhood and examine whether individual- and family-level factors at baseline discriminate parenting transition patterns. Data from four waves (ages 2, 3, 4, and 5) of a study of 731 caregiver-child dyads from a randomized controlled trial were used. Latent Class Analysis (LCA) and Latent Transition Analysis (LTA) were conducted to investigate underlying types of parenting practices at each age and longitudinal parenting practice transition patterns that represent continuity and change. For the LCA, two latent classes emerged at all four waves, representing ‘lower warmth; higher negative interaction’ (Dysregulated) and ‘higher warmth; lower negative interaction’ (Warm) parenting groups. The LTA model with two classes at all waves was conducted with good fit. The results showed diversity in the transition patterns over time, especially non-linear patterns of parenting across early childhood. Using multinominal logistic regression, six transition patterns, collapsed from 16 possible patterns, were predicted by family factors such as child sex, family income, primary caregivers’ race, parental involvement, child inhibitory control, and child externalizing behaviors. Findings have implications for parenting assessment, practice, and analysis.

Vitamin D, periodontitis and tooth loss in older Irish adults.

The aim of this study is to investigate whether 25-hydroxyvitamin D (25(OH)D) is associated with periodontitis and tooth loss in older adults. A total of 2346 adults underwent a detailed dental examination as part of the health assessment of a national population study - The Irish Longitudinal Study of Ageing. 25(OH)D analysis was performed on frozen non-fasting total plasma using LC-MS. The analysis included both multiple logistic regression and multinominal logistic regression to investigate associations between 25(OH)D concentration, periodontitis and tooth loss, adjusting for a range of potential confounders. Results of the analysis found the mean age of participants was 65·3 years (sd 8·2) and 55·3 % of the group were female. Based on the quintile of 25(OH)D concentration, participants in the lowest v. highest quintile had an OR of 1·57 (95 % CI 1·16, 2·13; P < 0·01) of having periodontitis in the fully adjusted model. For tooth loss, participants in the lowest v. highest quintile of 25(OH)D had a RRR of 1·55 (95 % CI 1·12, 2·13; P < 0·01) to have 1-19 teeth and a RRR of 1·96 (95 % CI 1·20, 3·21; P < 0·01) to be edentulous, relative to those with ≥ 20 teeth in the fully adjusted models. These findings demonstrate that in this cross-sectional study of older men and women from Ireland, 25(OH)D concentration was associated with both periodontitis and tooth loss, independent of other risk factors.

Attitudes toward abortion legality and abortion regulation: Insights from a nationally representative study

AbstractObjectiveNational public opinion polls and surveys use different questions from one another to assess people's abortion attitudes. We included commonly asked abortion attitude items on a single survey to examine people's attitudes toward abortion legality and abortion restriction to create profiles of people which we then compared across state groups. Concurrently assessing attitudes toward both abortion legality and restrictions is important given the changing abortion legislative climate in the United States.MethodWe administered an online survey to U.S. adults (n = 919) via Ipsos probability panel and used latent class analysis to identify classes of participants. Then, we used multinominal logistic regression to make state‐level comparisons.ResultsWe identified three classes: (1) 35.0 percent—abortion should be illegal/more restricted, (2) 35.1 percent—abortion should be legal/laws should reflect the status quo, and (3) 29.9 percent—abortion should be legal/more available. Trigger‐law states comprise the largest proportion of people who think abortion should be illegal/more restricted, whereas states without trigger laws comprise similar proportions of people from all three classes.ConclusionConcurrently measuring whether people believe abortion should be legal and the extent it should be restricted can provide a more comprehensive understanding of people's attitudes and demonstrates important state‐level nuances in attitudes.

Potentially burdensome care at the end-of-life for people who had a death from cancer: A retrospective population-level cohort study

ObjectivesTo examine factors associated with indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer. ApproachA population-based retrospective cohort study of people aged ≥20 years with a cancer-related cause of death during 2014-2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, derived by summing 4 indicators: &gt;1 ED presentation; &gt;1 hospital admission; ≥1 ICU admission within 30 days of death; died in acute care (scored as 0, 1 ≥2). ResultsOf the 80,005 cancer-related deaths, 69.1% had none, 20.0% had 1 indicator, and 10.9% had ≥2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥55 years), females, people with 1 or ≥2 Charlson comorbidities, people with neurological cancers, and people who died in 2018-2019 were less likely to experience potentially burdensome care. Conclusions and implicationsThis study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences.