Multilevel Logistic Models Research Articles

Differences in the components of metabolic syndrome by age and sex: a cross-sectional and longitudinal analysis of a cohort of middle-aged and older Japanese adults

BackgroundThe prevalence of metabolic syndrome (MetS) in Japan, a super-aged society, is increasing and poses a major public health issue. Several studies have reported sex differences in the association between age and MetS prevalence. This study aimed to examine the association between age and the prevalence of MetS based on multiple screening criteria and MetS components by sex.MethodsWe used 6 years of individual-level longitudinal follow-up data (June 2012 to November 2018; checkup year: 2012–2017) of middle-aged and older adults aged 40–75 years in Japan (N = 161,735). The Joint Interim Statement criteria, International Diabetes Federation criteria, and another set of criteria excluding central obesity were used as the screening criteria for MetS. The prevalence of MetS and MetS components was cross-sectionally analyzed according to sex and age. A longitudinal association analysis of age, MetS, and MetS components by sex was performed using a multilevel logistic model, adjusted for lifestyle- and regional-related factors.ResultsSex differences were observed in the prevalence and association of MetS and MetS components. In all age groups, the prevalence of central obesity was higher among women, and the prevalence of high blood pressure and fasting glucose was higher among men (P < 0.001). The prevalence of high triglyceride and low high-density lipoprotein cholesterol was higher among women aged > 60 years (P < 0.05). Based on the criteria of the Joint Interim Statement and International Diabetes Federation, the prevalence of MetS was higher among women than in men aged > 55 years (P < 0.001). Men had a higher prevalence of MetS without central obesity than women in all age groups (P < 0.001). The odds ratio for MetS and MetS components with aging was greater among women than in men.ConclusionsMedical management should be based on the prevalence of MetS and its components according to sex and age. In particular, the high prevalence of MetS without central obesity in middle-aged and older Japanese men suggests that the adoption of the Joint Interim Statement criteria, which do not precondition central obesity, should be considered.

Sexual violence and associated factors among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

BackgroundSexual violence is one of the most common problems in reproductive health that causes different traumatic events that lead to mental, social, and physical problems. Females with disabilities are subjected to more traumatic events and consequences. In Ethiopia, there are limited evidences about the prevalence and associated factors of sexual violence among reproductive-aged females with disabilities. Therefore, this study aimed to assess the prevalence and associated factors of sexual violence among females with disabilities in reproductive-age in central Sidama National Regional State, Ethiopia.MethodsA multistage sampling technique was used to select 645 reproductive-age females with disabilities. Initially, three districts were purposefully selected, from which 30 kebeles and study participants were selected randomly from June 20 to July 15, 2022. A face-to-face interviewing technique was used to collect the data. The data were analyzed using a multilevel logistic regression analysis model. The measures of associations were reported using the adjusted odds ratio (AOR) and its 95% confidence interval (CI).ResultsThe prevalence of sexual violence among reproductive-age females with disabilities was 59.8% (95% CI: 56, 63.56). Residing in an urban setting (AOR = 0.51; 95% CI: 0.29, 0.88), being an adult (25 to 34 years old) (AOR = 5.9; CI: 3.01, 11.6), being an adult (35 to 49 years old) (AOR = 3.47; CI: 1.48, 8.14), having no sexuality information (AOR = 11.3; CI: 6.24, 20.5), and having hearing disabilities (AOR = 3.19; CI: 1.49, 6.83) were factors associated with sexual violence.ConclusionsSexual violence among reproductive-age females with disabilities is noticeably high. Place of residence, sexual orientation, age, and disability type were all factors associated with sexual violence. Therefore, providing sexuality education, giving high attention (information and education about sexuality) to rural residents, and considering females with hearing disabilities are important to minimize sexual violence among reproductive-age females with disabilities.

Cross-national time trends in adolescent body weight perception and the explanatory role of overweight/obesity prevalence

ABSTRACT Introduction Body weight perception (BWP) is associated with health behaviors. Current evidence points to an increase over time in both actual and perceived weight status among adolescents, however there is limited evidence on time trends in BWP in cross-national samples of adolescents. Therefore, the aims of this study were to examine time trends in BWP between 2002 and 2018 among adolescents from 41 countries and regions, including gender and country differences and to explore the role of changes over time in country-level overweight/obesity prevalence in these trends. Methods Data were used from five cycles (2002, 2006, 2010, 2014, 2018) of the repeated cross-sectional Health Behavior in School-Aged Children (HBSC) study (n = 746,121; mean±standard deviation age 13.7 ± 1.6 years, 51.0% girls). Multilevel logistic models estimated cross-national linear time trends in adolescent BWP (correct perception, underestimation, or overestimation), adjusted for gender, age, and family affluence. Next, we tested whether country-level changes over time overweight/obesity prevalence could explain these trends in BWP among adolescents. Results Correct weight perception increased over time among girls, while it decreased among boys. Underestimation of weight status increased, and overestimation of weight status decreased over time among both genders, with stronger trends for girls. Furthermore, country differences in trends in both BWP and overweight/obesity were found. Changes over time in country-level overweight/obesity prevalence could not explain these trends. Conclusion The linear increase over time in correct weight perception and the decrease in overestimation may have a positive effect on unhealthy weight reduction behaviors among adolescents. However, the increase in underestimation could signal a need for interventions to strengthen correct weight perception among adolescents. Several implications for policy and practice are discussed.

Relationship between physical activity and muscle mass loss among people aged 60 and above in 15 provinces of China in 2015

To analyze the relationship between physical activity and muscle mass loss among Chinese elderly aged 60 years and above in 15 provinces. Data was collected from 2015 China Nutritional Transition Cohort Study. Information on demographic characteristics and physical activity was investigated by questionnaire. Dietary intake was estimated from three consecutive 24-h recalls for each individual. Appendicular skeletal muscle mass(ASM) was assessed using the bioelectrical impedance analysis(BIA). Skeletal muscle mass(SMI) loss was diagnosed according Asian working group of sarcopenia(AWGS) 2019 recommendation(male: SMI &lt;7.0 kg/m~2, female: &lt;5.7 kg/m~2). A total of 4565 participants aged 60 years and above from 15 provinces in China with complete information were included in the final analysis. Different domains(occupational, domestic, travel and leisure), light physical activity(&lt;3.0 METs), moderate physical activity(3.0-5.9 METs) and vigorous physical activity(≥6.0 METs) of physical activity among elderly adults were evaluated. Logistic multilevel model was used to analyze the relationship between low muscle mass and different intensity of physical activity duration. Among all participants aged 60 years and above in 15 provinces of China in 2015, women&apos;s participation rate in domestic physical activity was 91.7%, which was higher than men&apos;s rate of 62.3%. However, men&apos;s participation rate in occupational, travel and leisure physical activity were higher than those of women. The participation rate, duration of light physical activity and moderate physical activity were higher in women than in men(light physical activity: female duration 11.0 h/week vs. male duration 3.5 h/week; female participation rate 89.9% vs. male participation rate 62.8%; moderate physical activity: female duration 7.0 h/week vs. male duration 4.7 h/week; female participation rate 90.6% vs. male participation rate 75.2%). The median vigorous physical activity was 0 h/week in both male and female group. The prevalence of muscle mass loss was 13.9% among subjects. The median weekly light physical activity and moderate physical activity in muscle mass loss group were 5.8 h and 4.7 h, which were lower than in non-muscle mass loss group(9.3 h and 6.0 h). The OR of muscle mass lass was 0.71(95%CI 0.42-0.98, P&lt;0.05) for the male with 3.5-6.9 hours of moderate physical activity per week, compared to moderate physical activity less than 3.5 h/week. And OR of the female was 0.67(95%CI 0.47-0.95, P&lt;0.05). The vast majority of physical activity in China among the elderly is domestic and light physical activity. Light physical activity and moderate physical activity duration increments in female and moderate physical activity duration increments in male were associated with decreased risk of muscle mass loss.

Effect of intraoperative PEEP with recruitment maneuvers on the occurrence of postoperative pulmonary complications during general anesthesia––protocol for Bayesian analysis of three randomized clinical trials of intraoperative ventilation

Background: Using the frequentist approach, a recent meta–analysis of three randomized clinical trials in patients undergoing intraoperative ventilation during general anesthesia for major surgery failed to show the benefit of ventilation that uses high positive end–expiratory pressure with recruitment maneuvers when compared to ventilation that uses low positive end–expiratory pressure without recruitment maneuvers. Methods: We designed a protocol for a Bayesian analysis using the pooled dataset. The multilevel Bayesian logistic model will use the individual patient data. Prior distributions will be prespecified to represent a varying level of skepticism for the effect estimate. The primary endpoint will be a composite of postoperative pulmonary complications (PPC) within the first seven postoperative days, which reflects the primary endpoint of the original studies. We preset a range of practical equivalence to assess the futility of the intervention with an interval of odds ratio (OR) between 0.9 and 1.1 and assess how much of the 95% of highest density interval (HDI) falls between the region of practical equivalence. Ethics and dissemination: The used data derive from approved studies that were published in recent years. The findings of this current analysis will be reported in a new manuscript, drafted by the writing committee on behalf of the three research groups. All investigators listed in the original trials will serve as collaborative authors.

#4553 REAL WORLD DATA-DRIVEN IDENTIFICATION OF ANCA VASCULITIS RELAPSE

Abstract Background and Aims The relapsing-remitting, multi-system pattern of disease in ANCA vasculitis (AAV) results in incremental tissue injury. For those with renal involvement, there is a 9-fold increased risk of end-stage kidney disease after renal relapse. Relapse is defined by the Birmingham Vasculitis Activity Score (BVAS v3) &amp;gt;0, particularly in the clinical trial setting. However, this metric may be missing or incorrectly scored in real world registry data, resulting in incomplete or inaccurate ascertainment of this key outcome. Our aim was the development, internal validation and evaluation of a pragmatic data-driven algorithm to automate the retrospective identification of AAV relapse in real-world data. Method The Rare Kidney Disease (RKD) Registry is a national longitudinal, multi-centre cohort study, including 663 patients with AAV, of whom those with &amp;gt;6 months follow up post diagnosis were eligible for inclusion. We followed five steps to develop and validate the algorithm: 1) independent expert adjudication of encounters using primary medical record information to assign the reference probability of relapse (ground truth), 2) selection of data elements and corresponding value sets using literature review, expert opinion and with a consideration of likely data availability, 3) development of a computable phenotype definition, with an embedded logistic multi-level regression model using complete case analysis, 4) internal validation, 5) development of additional models (using the same method) to account for combinations of variable missingness (models described in Fig. 1). We also developed a Shiny web application to implement the final algorithm, which determines the appropriate model based on available variables, outputting an individualised probability of relapse, with a suggested binary interpretation. Results In the first step of the algorithm, encounters with diagnostic histopathology were labelled as relapse. For encounters without histopathological confirmation, we selected five objective data elements to build the model: change in ANCA level, suggestive blood/urine tests, suggestive imaging, immunosuppressive (IS) status at the time of the encounter and the change of this IS in response (‘IS response’) (Fig. 2). Development and validation datasets comprised 1209 and 377 separate encounters, respectively. An optimal cut-point of 0.48 was determined by maximising the F1-Score (0.85) for the complete 5-variable model. Sensitivity and specificity were 0.91 and 0.95 respectively. Performance metrics were stable across fifty random-split resamples. Calibration-in-the-large was satisfied. Where ‘IS response’ was missing, ‘suggestive bloods/urine’ (Data Element [DE]2) with at least either ‘ANCA level’ (DE1) or ‘suggestive imaging’ (DE3) was required to achieve an accuracy as good as gold standard BVAS (Fig. 1). Conclusion In settings where accurate BVAS may not be available, this algorithm accurately quantifies the individualised probability of AAV relapse using objective, readily accessible registry data. In addition to our web application, the model can be directly embedded in a registry database. This framework could serve as an exemplar for other relapsing-remitting diseases and for automating the identification of other key outcomes or cohorts in registry data.

Horse behavior and facial movements in relation to food rewards.

Food rewards are believed to have a positive valence in horses. The aim of this study was to assess the effect of food rewards on horse behavior before entering a horse chute, and behavior and facial movements while restrained in it. Thirteen female adult horses were brought once daily to an animal handling facility for three weeks. In week 1, baseline period, no reinforcement was applied. In weeks 2 and 3, experimental phase, half of the horses received positive reinforcement treatment after entering and remaining in the chute; the remaining horses were considered as controls (no positive reinforcement applied). There was a cross-over between the groups during the experimental phase. Horses were individually brought to the restraining chute and videos recorded during 60-sec. The duration and number of entries into the area close to the gate leading to the chute were measured before restraining and body posture, neck position, and tail swinging were recorded in the chute. Facial movements were also recorded and scored using EquiFACS methodology. Multilevel linear and logistic models were built to assess behavioral changes from baseline to the treatment phase and between phases (control and positively reinforced). Horses did not change their body posture or tail swings across the different phases (P > 0.1) and were less likely to show lowered neck during the positively reinforced phase (OR: 0.05; CI95%: 0.00-0.56; P = 0.05) compared to baseline. The likelihood of a lowered neck did not differ between the positive reinforcement and control phases (P = 0.11). In the positively reinforced phase, horses seemed to be more attentive (ears forward) and active (less eye closures, more nose movements) than in the control phase. A three-day positive reinforcement phase did not elicit major changes in body behavior in the chute but affected the facial movements of group-housed mares.

Social Participation and Persistent Smoking Among Older Chinese With Smoking-Related Morbidity.

Chronic diseases are common in midlife and old age and smoking can pose more health and longevity challenges for older people with chronic illnesses. In China where smoking is highly prevalent, older adults are likely to continue smoking even after developing severe chronic diseases. We examined the national prevalence of persistent smoking among older adults. We also investigated the sociodemographic characteristics of persistent smoking among ever-smokers with chronic diseases and its association with social participation (of various types). We used data from a nationally representative sample of older adults aged 45-80 in the China Health and Retirement Longitudinal Study (2011-2018). Multinomial logistic and multilevel logistic models were fitted. The national prevalence of persistent smoking was around 24% of older men and 3% of older women. Among those with a history of smoking and chronic illness, younger, nonmarried/partnered, nonretired, or less educated individuals are more likely to continue smoking. Social participation is significantly associated with persistent smoking among those with chronic diseases, but the association differs across different forms of activities. Although the most popular but sedentary activities in China (playing Mahjong, chess, or cards) are associated with an elevated risk of persistent smoking, physical social activities (community-organized dancing, fitness, and qigong) are associated with a reduced risk of persistent smoking. Given the enormous burden of persistent smoking on individuals and society, public smoking cessation inventions should address sociocultural factors of persistent smoking and target older adults who participate in specific social activities.

Contraceptive use among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis.

Contraceptive use is an important and cost-effective intervention to prevent unwanted pregnancies. People with disabilities face discrimination when it comes to using contraception and are doubly burdened by unwanted pregnancies. However, the status of contraceptive use and associated factors among reproductive-aged females with disabilities was not adequately determined in Ethiopia. This study aimed to assess contraceptive use and associated factors among reproductive-age females with disabilities in Dale and Wonsho districts and Yirgalem city administration of central Sidama National Regional State, Ethiopia. A community-based cross-sectional study was conducted among randomly selected 620 reproductive-age females with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviewing techniques using a structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. In this study, 27.3% (95% CI [23.8%-31.0%]) of the reproductive-age females with disabilities were current contraceptive users. Regarding the methods, 82 (48.5%) of the reproductive-age females with disabilities used implants. Having good contraceptive knowledge (AOR = 9.03; 95% CI [4.39-18.6]), transport accessibility to health facilities (AOR = 2.28; 95% CI [1.32-3.94]), being an adult (25 to 34 years old) (AOR = 3.04; 95% CI [1.53-6.04]), having a hearing disability (AOR = 0.38; 95% CI [0.18, 0.79]), having paralysis of the extremities (AOR = 0.06; 95% CI [0.03-0.12]), and wheel-chaired disability (AOR = 0.10; 95% CI [0.05-0.22]) were factors associated with contraceptive use. Contraceptive use among reproductive-age females with disabilities is low. Transport accessibility, contraceptive knowledge, being in the age groups of 25 to 34 years, and the types of disability determine their contraceptive use. Therefore, designing appropriate strategies to provide contraceptive education and information and provide contraceptive services in their homes is important to enhance contraceptive use.

Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study

BackgroundNumerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China. MethodsSubjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH. ResultsThe overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65). DiscussionContextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.

Are there developmental patterns in emergent bilingual children’s English letter-name knowledge?

ABSTRACT The purpose of this study was to explore five developmental patterns of English letter-name knowledge for emergent bilingual children. We considered five patterns demonstrated by English monolingual children: visual similarity effect, uppercase familiarity effect, first name/first initial effects, consonant-order effect, and frequency effect. We assessed the English uppercase and lowercase letter-name knowledge of 56 emergent bilingual children enrolled in US classrooms. Results from logistic multilevel regression modeling showed that emergent bilingual children exhibited the uppercase familiarity effect, but other patterns differed. Children whose additional languages used a Latin-based alphabetic orthography were less likely to know the names of lowercase letters compared to children whose additional languages used a non-alphabetic orthography. For children whose additional languages involved a Latin-based alphabetic orthography, children were more likely to know the names of uppercase letters that were more visually similar to letters from children’s additional languages. We did not find any evidence that emergent bilingual children exhibited the first name/first initial, consonant-order, or frequency effects. Our findings suggest that we need to consider these differences and associated implications for alphabet instruction when working with emergent bilingual children.

Examining the risk factors for overweight and obesity among women in Ghana: A multilevel perspective

Overweight/obesity prevalence is on the increase in epidemic proportions across Low- and Middle-Income countries (LMICs). The public health burden associated with obesity/overweight cannot be underestimated due to its association with chronic health outcomes. This study investigated the individual- and community level risk factors for obesity/overweight among reproductive women. The data used consist of 4393 reproductive women and form part of the 2014 Ghana Demographic and Health Survey (GDHS). Information on these women are clustered within 427 communities. A 2-tier random intercept multilevel logistic model was used to assess the effect of individual- and community level factors on the likelihood of a woman to be obese/overweight. The obesity/overweight prevalence among reproductive women was estimated to be 35.5% (95% CI: 34.04, 36.90%), which significantly differed across clusters. Most at risk were women from middle-income households (aOR = 2.85; 95% CI: 2.28, 3.56), upper-income households (aOR = 5.019, 95% CI: 3.85, 6.55), attaining secondary education (aOR = 1.74; 95% CI: 1.41, 2.16), and higher (aOR = 1.63; 95% CI: 1.14, 2.33), old age (20–29 years (aOR = 4.26; 95% CI: 3.142,5.78); 30–39 years (aOR = 8.59; 95% CI: 6.15, 12.00); 40–49 years (aOR = 12.81; 95% CI: 9.10, 18.16)). Significant differences in the probability of being overweight/obese between different communities were observed (MOR = 1.39). The high prevalence of overweight/obesity requires urgent public health interventions to prevent future public health crises. Efforts to strengthen the healthcare system, encourage lifestyle modification, and public health education are needed to solidify the gains of ensuring a healthy population by 2030 (SDG 3).

Regional Infrastructure Effects on the Life Satisfaction of Rural and Urban Residents. A Case Study for Ecuador

In developing countries, many households lack basic household services and the provision of utility infrastructure is uneven across regions, leaving lagged regions behind. This lack of infrastructure in specific places can affect the welfare of its inhabitants. This paper aims to measure the influence of household basic services and sub-national infrastructure activities on individual subjective well-being in Ecuador. To determine how important the geographical context is for individual welfare, a hierarchical ordered logistic multilevel model is conducted. The results show that the individual heterogeneity is explained in 7% by the variation across cantons. There are 52 cantons that are above the average life satisfaction and 43 cantons below it. Findings regarding infrastructure evidence that sub-national utility projects and road infrastructure have a positive significant effect on the life satisfaction of rural residents whereas it is not significant for urban residents, indicating the diminishing marginal utility of urban people. Once a satiation point is achieved, marginal utility increases are lower. As for household services, access to the internet has a higher positive welfare effect than access to sewerage and access to water via pipelines.

Micronutrient intake and associated factors among pregnant women in East Africa: Multilevel logistic regression analysis.

Micronutrient deficiencies during pregnancy pose significant public health issues, considering the potential for negative consequences not only during pregnancy but also throughout life. Anemia in pregnant women is becoming a significant problem in developing countries, with scientific evidence indicating that 41.8 percent of women worldwide suffer from anemia. As a result, investigating the pooled prevalence and factors associated with micronutrient intake among pregnant women in East Africa is critical to alleviate the burden of micronutrient deficiency among pregnant women. The pooled prevalence of micronutrient intake with a 95% Confidence Interval (CI) was reported and presented in a forest plot for East Africa Countries using STATA version 14.1. Intra-class Correlation Coefficient (ICC), Likelihood Ratio (LR) test, Median Odds Ratio (MOR), and deviance (-2LLR) values were used for model comparison and fitness. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multilevel logistic model were used to declare significant factors associated with micronutrient intake. The pooled prevalence of micronutrient intake in East African countries was 36.07% (95% CI: 35.82%, 36.33%). In the multilevel logistic regression model, women from the highest wealth quintile were 1.06 [AOR = 1.09, 95%CI: 1.00, 1.11] more likely to take micronutrients compared to their counterparts. Mothers who attained primary education, secondary education, and tertiary education had 1.20 times [AOR = 1.20, 95% CI: 1.15, 1.26], 1.28 times [AOR = 1.28, 95% CI: 1.19, 1.36] and 1.22 times [AOR = 1.22, 95% CI: 1.07, 1.38] more likely take micronutrient compared to mothers who attained no education, respectively. The overall prevalence of micronutrient intake in East Africa was low. Only 36% of the study participants had micronutrient intake practice. Socioeconomic factors (education level, and household wealth status) have been shown to influence micronutrient intake. Therefore, it is necessitates the continuation of ongoing projects as well as the development of fresh ones that concentrate on these variables and include effective treatments and programs, especially among underprivileged and vulnerable populations.

Pregnancy vaccination predictive factors and uptake profiles among Italian women: A cross-sectional survey study on a large population.

To assess influenza and Tdap (tetanus, diphtheria, pertussis) vaccine coverage during pregnancy, explore key socioeconomic and maternity pathway-related predictors of vaccination, and detect specific patterns of vaccination uptake. The authors cross-sectionally analyzed self-reported data obtained from the systematic survey on the maternity pathways of Tuscany. They selected all pregnant women that completed from March 2019 to June 2022 the third-trimester questionnaire (n = 25 160), which included two dichotomous items on influenza and Tdap vaccination, as well as socioeconomic and pathway-related questions. Multilevel logistic models were performed to assess vaccination predictors and cluster analysis to identify vaccination patterns. Vaccination coverage was higher for pertussis (56.5%) than for influenza (18.9%). The main predictors of vaccination were high socioeconomic status, attending private gynecologists, and receiving vaccine information. Three clusters were identified: cluster 1 included women receiving both Tdap and influenza vaccines; cluster 2 included women receiving no vaccinations; and cluster 3 included women receiving only the pertussis vaccine. Although women from cluster 3 were of middle to low education status, vaccine information was the main adherence determinant also in this group. Health workers and policymakers should focus on groups of pregnant women less prone to vaccination to promote vaccination information and encourage wider uptake and coverage.

Hospice Capacity to Provide General Inpatient Care: Emergency Department Utilization and Live Discharge Among Cancer Patients

General inpatient (GIP) hospice care is used only minimally for hospice patients, and more than a quarter of Medicare hospice facilities do not provide GIP care. To determine the impact of hospices' capacity to provide on emergency department use during hospice enrollment and live discharge from hospice, we used Surveillance, Epidemiology, and End Results-Medicare linked data and CMS Provider of Services data from 2007 to 2013 from ten states and two metropolitan regions. Grouping hospices into three GIP care provision categories: 1) no-GIP; 2) GIP-contract; and 3) GIP-IHF where hospices directly provide GIP care in their own inpatient hospice facility (IHF), we built a multilevel logistic model that accounted for unobserved hospice characteristics. Nearly 9% of the study sample received GIP care, of which 82% received such care in the last week of discharge. GIP-IHF hospices had lower live discharge rates than no-GIP hospices (AOR: .61; 95% CI: .47-.79; P < .001) and GIP-contract hospices (AOR: .84; 95% CI: .70-1.00; P < .05). Similarly, GIP-contract hospices were also associated with a decreased risk of live discharge, compared to no-GIP hospices (AOR: .76; CI: .62-.92; P < .05). There was no difference in emergency department use between no-GIP hospices and hospices with such capacity. Our results suggest that hospices capable of providing GIP care have lower live discharge rates than their counterparts. However, the fact that GIP care tends to be provided too close to death limits its effectiveness in preventing avoidable emergency department use.

Black women's distress matters: Examining gendered racial disparities in psycho-oncology referral rates.

Presently, there is a lack of research examining gendered racial disparities in psycho-oncology referral rates for Black women with cancer. Informed by intersectionality, gendered racism, and the Strong Black Woman framework, this study sought to examine the possibility that Black women are adversely affected by such phenomena as evidenced by lower probability of being referred to psycho-oncology services compared to Black men, White women and White men. Data for this study consisted of 1598 cancer patients who received psychosocial distress screening at a comprehensive cancer center in a large Midwest teaching hospital. Multilevel logistic modeling was used to examine the probability of referral to psycho-oncology services for Black women, Black men, White women, and White men while controlling for patient-reported emotional and practical problems and psychosocial distress. Results indicated that Black women had the lowest probability of being referred to psycho-oncology services (2%). In comparison, the probability of being referred to psycho-oncology were 10% for White women, 9% for Black men, and 5% for White men. Additionally, as nurses' patient caseload decreased, the probability of being referred to psycho-oncology increased for Black men, White men, and White women. In contrast, nurses' patient caseload had little effect on the probability of being referred to psycho-oncology for Black women. These findings suggest unique factors influence psycho-oncology referral rates for Black women. Findings are discussed with particular focus on how to enhance equitable care for Black women with cancer.

Determinants of rural household poverty in Pakistan with multilevel approach

Rural poverty is often discussed in combination with spatial inequality where rural poor face worse problems with diverse remedies in comparison to urban poor. The present study aims to find out area-level effects and possible determinants of rural poverty based on data from the Rural Household Panel Survey of Pakistan Round-1 (2012). The multilevel binary logistic model is used to integrate concurrent individual and district-level variables to explore area-level effects on poverty. A two-level multilevel model is used for the analysis of the poverty status of 4804 respondents nested in 19 districts. Individual-level variables included in the model are education, socioeconomic status, and spending behaviour. It is found that approximately 60% of individuals of the overall population were found poor, and district-level effect accounts for 7% variations in poverty. A particularly significant ratio of poor is found for people who attained deeni madrassa/religious education or no education at all. Poverty existence is significantly associated with spending behavior and socioeconomic status. The persons with relatively middle/high socioeconomic status and successful educational achievement but a lacking attitude toward spending money are considered poor.

Identifying Restorative Environments for Employees’ Recovery: An Interdisciplinary Mixed Methods Approach

In this paper, we developed an environmental demands-resources (ED-R) model to explain which environments are restorative for employees during leisure based on the job demands-resources model. We used a mixed methods approach combining semi-structured interviews built upon the critical incident technique and psychometric questionnaires. In total, we gathered 100 different incidents in restorative and stressful environments from 29 participants. Following Mayring’s qualitative content analysis, we identified natural, residential, and attractive artificial environments as restorative. Logistic multilevel modeling and Fisher’s exact tests revealed that restorative environments contain fewer environmental demands (e.g., noise) and more environmental resources (e.g., water elements) than stressful environments. In addition, restorative environments were related to higher psychological detachment from work and relaxation compared to stressful environments. The results support our ED-R model and have practical implications for spatial design at the public, organizational, and individual level. Further theoretical extensions of our ED-R model were discussed.

The Impact of Youth Digital Citizenship Education: Insights from a Cluster Randomized Controlled Trial Outcome Evaluation of the Be Internet Awesome (BIA) Curriculum

AbstractSchool psychologists and other school professionals are increasingly turning to digital citizenship programs to improve children’s online safety. However, to date, there has been no rigorous outcome evaluation of these programs. The current study used a cluster randomized control trial methodology (CRCT) to evaluate the impact of the Be Internet Awesome digital citizenship program on knowledge, attitudinal, and behavioral outcomes for 1072 4th–6th graders at 14 participating schools (7 treatment and 7 control schools). Multilevel logistic, multinomial, and Gaussian models were used to test outcomes. The study found support for program impact on children’s knowledge of new online safety concepts and self-efficacy for handling online problems relative to students in control conditions. However, no program impact was found for other outcomes including online privacy or civility, cyberbullying, and talking with parents about online problems. Findings highlight the need for clarity on digital citizenship program goals, innovative approaches, and increased evaluation research.