Multilevel Logistic Regression Models Research Articles

Interoceptive Accuracy Enhances Deception Detection in Older Adults

Abstract Objectives Difficulties with deception detection may leave older adults especially vulnerable to fraud. Interoception, i.e., the awareness of one’s bodily signals, has been shown to influence deception detection, but this relationship has not been examined in aging yet. The present study investigated effects of interoceptive accuracy on two forms of deception detection: detecting interpersonal lies in videos and identifying text-based deception in phishing emails. Method Younger (18-34 years) and older (53-82 years) adults completed a heartbeat-detection task to determine interoceptive accuracy. Deception detection was assessed across two distinct, ecologically valid tasks: i) a lie detection task in which participants made veracity judgments of genuine and deceptive individuals, and ii) a phishing email detection task to capture online deception detection. Using multilevel logistic regression models, we determined the effect of interoceptive accuracy on lie and phishing detection in younger versus older adults. Results In older, but not younger, adults greater interoceptive accuracy was associated with better accuracy in both detecting deceptive people and phishing emails. Discussion Interoceptive accuracy was associated with both lie detection and phishing detection accuracy among older adults. Our findings identify interoceptive accuracy as a potential protective factor for fraud susceptibility, as measured through difficulty detecting deception. These results support interoceptive accuracy as a relevant factor for consideration in interventions targeted at fraud prevention among older adults.

Strict Danes or relaxed Swedes? Comparing health and daily activities in Sweden and Denmark during the Covid-19 pandemic.

Amidst the Covid-19 outbreak in 2020, Denmark and Sweden adopted contrasting strategies despite their many cultural similarities. Denmark swiftly imposed strict governmental restrictions, while Sweden favoured a more gradual, voluntary approach. This study aims to analyse the disparities between the two nations in mental health indicators (depressive symptoms, sleep problems and loneliness), daily activities (shopping, going for a walk, visiting family and meeting other people) and medical care after the Covid-19 outbreak. Data from adults aged ⩾50 years in the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 8 (2019/2020) and the two SHARE Covid-19 surveys (summer 2020/2021) were utilised. Multilevel logistic regression models assessed longitudinal and cross-sectional changes in Sweden and Denmark. Both countries witnessed reduced risk of depressive symptoms and sleep problems during summer 2020, albeit with a more significant decline in depressive symptoms observed in Denmark: 17.8% (95% confidence interval (CI) 15.0-20.6) vs. 12.5% (95% CI 9.0-15.9). Swedish respondents were more likely to reduce their daily activities in the summer of 2020 (shopping: odds ratio (OR)=0.45, 95% CI 0.36-0.55; visit family: OR=0.76, 95% CI 0.60-0.97) and less likely to have medical appointments postponed (OR=1.83, 95% CI 1.46-2.28). Minimal differences were observed between Sweden and Denmark in mental health and daily activities during the pandemic. Despite significant disruption to their daily routines, Scandinavians aged ⩾50 years old demonstrate remarkable resilience.

Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran’s I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff’s SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers’ age (AOR = 1.07, 95% CI 1.02–1.12), mother’s had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother’s higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.

Canadian beach cohort study: protocol of a prospective study to assess the burden of recreational water illness

BackgroundRecreational water activities at beaches are popular among Canadians. However, these activities can increase the risk of recreational water illnesses (RWI) among beachgoers. Few studies have been conducted in Canada to determine the risk of these illnesses. This protocol describes the methodology for a study to determine the risk and burden of RWI due to exposure to fecal pollution at beaches in Canada.MethodsThis study will use a mixed-methods approach, consisting of a prospective cohort study of beachgoers with embedded qualitative research. The cohort study involves recruiting and enrolling participants at public beaches across Canada, ascertaining their water and sand contact exposure status, then following-up after seven days to determine the incidence of acute RWI outcomes. We will test beach water samples each recruitment day for culture-based E. coli, enterococci using rapid molecular methods, and microbial source tracking biomarkers. The study started in 2023 and will continue to 2025 at beaches in British Columbia, Manitoba, Ontario, and Nova Scotia. The target enrollment is 5000 beachgoers. Multilevel logistic regression models will be fitted to examine the relationships between water and sand contact and RWI among beachgoers. We will also examine differences in risks by beachgoer age, gender, and beach location and the influence of fecal indicator bacteria and other water quality parameters on these relationships. Sensitivity analyses will be conducted to examine the impact of various alternative exposure and outcome definitions on these associations. The qualitative research phase will include focus groups with beachgoers and key informant interviews to provide additional contextual insights into the study findings. The study will use an integrated knowledge translation approach.DiscussionInitial implementation of the study at two Toronto, Ontario, beaches in 2023 confirmed that recruitment is feasible and that a high completion rate (80%) can be achieved for the follow-up survey. While recall bias could be a concern for the self-reported RWI outcomes, we will examine the impact of this bias in a negative control analysis. Study findings will inform future recreational water quality guidelines, policies, and risk communication strategies in Canada.

Multilevel analysis of individual and community factors of awareness of obstetric fistula among women of childbearing age in Nepal: analysis of recent Nepal Demographic and Health Survey 2022 data

BackgroundAccording to the WHO, obstetric fistula (OBF) is an abnormal connection between the genital tract and the urinary tract that occurs as the result of obstetric trauma, typically from prolonged...

Local authority variation in special educational needs provision at the start of primary school: observational study of preterm children born in England, 2003-2013

Objective and ApproachWe explored variation in special educational needs (SEN) provision between local authorities (LAs) in England by focussing on children born preterm (24-<37 weeks gestation). We used linked individual-level state-funded hospital and school records from the ECHILD database, alongside publicly available school-level records. LA of child’s residential address (n=150) and recording of SEN provision (split into SEN support and education, health and care plans, EHCPs) were captured at the January school census in year one, when pupils were five/six years old. We fitted multi-level logistic regression models to the child-level records that included a-priori selected child- and LA-level characteristics. ResultsOur population included 226,419 children (45.4% female ; 10.6% with a congenital anomaly) born between 2003-2013 and attending a state-funded primary school. Across LAs, the median prevalence of SEN support and EHCPs recorded in year one was 18.4% (interquartile range 16.4%-20.4%) and 4.2% (3.5%-4.8%), respectively. In the SEN support vs. no SEN provision model, there was very low correlation among children from the same LA (intraclass correlation coefficient (ICC)=0.006 )). There was higher correlation in the EHCP vs. no SEN provision model (ICC=0.032). Of the LA-level characteristics, the percentage of children eligible for free school meals had the greatest impact on the ICC values (reduction of 26.7% in the EHCP model). ConclusionsLess than 1% of the variation in SEN support and approximately 3% of the variation in EHCPs was explained at the LA level. We will extend these models to consider variation at the school level.

Effectiveness of group-based psycho-education on preventing postpartum depression among pregnant women by primary healthcare provider in primary healthcare institution: a cluster-randomized controlled trial

BackgroundIn Ethiopia, one in five mothers suffers from postpartum depression, which needs to be prevented through interventions. According to the World Health Organization, maternal healthcare providers have a unique opportunity to provide psychosocial interventions to prevent the damaging effects of perinatal depression. Hence, this study assessed the effectiveness of prenatal group-based psycho-education in preventing postpartum depression (PPD) in primary healthcare units.MethodsWe conducted a two-arm cluster-randomized controlled trial, enrolling 550 pregnant women at 12–20 weeks of gestation with a normal score (0–4) and a mild score (5–9) on the Patient Health Questionnaire-9 (PHQ-9). The study utilized simple randomization techniques to assign clusters between arms in a 1:1 ratio. The data was collected through face-to-face interviews conducted at 12-20 weeks of gestation and 6 weeks postpartum. The intervention group received usual care plus five prenatal group-based psycho-education (PGBPE) classes, while the control group received only usual care. The PPD status between arms was compared using the chi-square test of association. A mixed-effects multilevel logistic regression model was also used to examine the predictors of the outcome variables.ResultsThe overall response rate at the end line was 92.9%. Thus, compared to that in controls, the PPD in the intervention clusters was considerably lower (20 (7.6%) vs. 74 (28.9%)), P = 0.001)/65% (AOR = 0.35, 95% CI = 0.13–0.99), although no difference was detected at baseline. Social support (AOR = 0.04, 95% CI = 0.01–0.15), partner emotional support (AOR = 0.24, 95% CI = 0.12–0.51), PPD literacy (AOR = 0.25, 95% CI = 0.11–0.62), and self-esteem (AOR = 0.22, 95% CI = 0.11–0.47) were more likely to protect mothers from PPD. On the contrary, domestic work (AOR = 9.75, 95% CI = 3.37–28.16), neonates with complications (AOR = 5.79, 95% CI = 2.04–16.45), and unhealthy coping (AOR = 2.39, 95% CI = 1.06–5.42) exposed mothers to PPD.ConclusionThe implementation of a PGBPE in primary healthcare units (PHCUs) was effective at preventing PPD. Therefore, this intervention method has to be promoted and used in PHCUs to prevent PPD.Clinical Trial Registration[Pan African Clinical Trial Registry], identifier [PACTR 202203616584913].

Primary care team characteristics associated with video use: a retrospective national study at the Veterans Health Administration

ObjectiveTo examine primary care (PC) team members’ characteristics associated with video use at the Veterans Health Administration (VA).MethodsVA electronic data were used to identify PC team characteristics associated with any video-based PC visit, during the three-year study period (3/15/2019-3/15/2022). Multilevel mixed-effects logistic regression models on repeated yearly observations were used, adjusting for patient- and healthcare system-level characteristics, and study year. We included five PC team categories: 1.PC providers (PCP), which includes physicians, nurse practitioners, physician assistants, 2.Nurses (RN/LVN/LPN/other nurses), 3.Mental health (MH) specialists, 4.Social workers (SW), and 5.Clinical pharmacists (PharmD).Population54,494 PC care team members nationwide (61,728,154 PC visits; 4,916,960 patients), including 14,422 PCPs, 30,273 nurses, 2,721 MH specialists, 4,065 SWs, and 3,013 PharmDs.ResultsThe mean age was 46.1(SD = 11.3) years; 77.1% were women. Percent of video use among PC team members varied from 24 to 84%. In fully adjusted models, older clinicians were more likely to use video compared to the youngest age group (18–29 years old) (example: 50–59 age group: OR = 1.12,95%CI:1.07–1.18). Women were more likely to use video (OR = 1.18, 95%CI:1.14–1.22) compared to men. MH specialists (OR = 7.87,95%CI:7.32–8.46), PharmDs (OR = 1.16,95%CI:1.09–1.25), and SWs (OR = 1.51,95%CI:1.41–1.61) were more likely, whereas nurses (OR = 0.65,95%CI:0.62–0.67) were less likely to use video compared to PCPs.ConclusionsThis study highlights more video use among MH specialists, SWs, and PharmDs, and less video use among nurses compared to PCPs. Older and women clinicians, regardless of their role, used more video. This study helps to inform the care coordination of video-based delivery among interdisciplinary PC team members.

Understanding community hate crimes as an incorrigible proposition: Local political attitudes, path dependence, and the ceremonious reporting of hate crime statistics

AbstractThe Hate Crime Statistics Act (HCSA) of 1990 requires the federal government to publicly release official hate crime statistics annually; the HCSA does not, however, mandate that local agencies submit hate crime reports to the government in the first place. Although research has evaluated the reporting of hate crime statistics in a dichotomous fashion (compliance vs. noncompliance), the current study suggests that the consistent and invariable reporting of zero hate crimes in a particular jurisdiction over time is unlikely and thus better conceptualized as a third response strategy: ceremonious compliance. We examine this strategy as a potentially unique institutional behavior, structured by local political and historical contexts, including discursive differences in the identification of hate crime as an important social problem, and localized histories of racial oppression. This research then uses multilevel multinomial logistic regression models to estimate variation in the likelihood of differential compliance strategies (i.e., true compliance, ceremonious compliance, noncompliance), according to several political and historical factors, including Republican vote share, location in the Confederate South, and historical lynchings. Findings reveal that political and historical contexts are important predictors of agency responses to hate crime, with a particular tendency toward ceremonious compliance in Republican‐leaning locales.

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey.

Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data. Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant. The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use. Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

Is There an Increase in Possible Sleep Bruxism in Children Over Time? A Longitudinal Study.

Bruxism is a behaviour that has several consequences in an individual's life, especially when it starts in childhood. However, bruxism can be a potential protective factor, which is an attribute that reduces the chance of a negative health outcome. To evaluate the incidence of sleep bruxism (SB) and dental wear in children and adolescents. This longitudinal study began in 2014 and 2016 (baseline) with initial 1816 children followed for 5 and 3 years, respectively. The follow-up data collection started in 2019. The diagnosis of SB was parents report (baseline) and self-report (follow-up) due to age groups of each phase, and questions related to symptoms of SB were collected. Five calibrated examiners (kappa >0.7) collected the clinical data. The clinical variables were dental erosion and dental wear. Contextual, individual, behaviour and clinical characteristics were collected. A multilevel logistic regression model was used to investigate the association of contextual, individual, behaviour and clinical characteristics with SB. Poisson regression for repeated measures was performed to evaluate the incidence of SB and dental wear (incidence rate ratio-IRR and confidence interval-95% CI). Two hundred and fifty-three children and adolescents answered questionnaires and were clinically examined. The mean age of the follow-up in 2019 was 11.25 years old (±2.19). There was no increase in the incidence of SB (95% CI: 0.74-1.35). Children/adolescents had a 2.2 higher risk to present dental wear (95% CI: 1.89-2.60). SB at the follow-up was associated with the contextual variable, earache, erosion and awake bruxism. In this population, children with SB remained with this behaviour and showed higher dental wear over the years.

Religiosity and work motives among public sector employees

ABSTRACT Research in public administration generally has found that religiosity promotes public service motivation. Although all major religions include components that encompass work-relevant values, little research has focused on how religiosity influences work motives more generally. This study draws on self-determination theory and identity theory to hypothesise that religiosity is positively related to a public service motive but generally not to other work motives. The hypotheses are tested using multilevel logistic regression models that are estimated using public employee respondents to a cross-national survey administered in 35 countries. The findings indicate that religion has a more substantial impact on a public service motive (which is an autonomous extrinsic motive) than on controlled extrinsic or intrinsic motives. The study points to the importance of studying the role of religion in public administration.

Effect of arthroscopic partial meniscectomy on structural degeneration of the knee – A 5-year MRI-based follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

ObjectiveTo assess the 5-year effects of arthroscopic partial meniscectomy (APM) vs. placebo-surgery on the development of the structural changes of the knee by MRI. DesignThis multicentre, randomized, participant- and outcome-assessor-blinded, placebo-surgery-controlled trial was carried out in Finland. We randomized 146 adults, mean age 52 years (range 35 to 65) to undergo either APM or placebo surgery. The subjects had symptoms of degenerative medial meniscus tear, a tear verified in MRI and arthroscopy, and no advanced osteoarthritis at baseline. We compared the baseline and 5-year follow-up MRIs using MRI Osteoarthritis Knee Score (MOAKS) scoring to derive subregional data on cartilage damage, osteophytes and bone marrow lesions (BMLs). Progression of structural cartilage changes analysed per subregion was the main outcome, that of osteophytes and BMLs secondary outcomes. We analysed the progression with multilevel logistic regression model on subregion level data, adjusted for randomization stratification factors, and using robust standard errors. ResultsSixty-three (90%) subjects in the APM and 73 (96%) in the placebo-surgery group had MRI at both time points. The adjusted odds ratio (APM vs. placebo-surgery) was 1.31 (95% confidence interval 0.81, 1.94) for progression of cartilage damage, 2.86 (1.16, 6.21) for osteophytes, and 1.43 (0.84, 2.43) for BMLs. ConclusionsWe found a slightly greater risk for progression of osteophytes in the APM group compared to the placebo-surgery group at 5 years after surgery. Trial registrationClinicalTrials.gov (NCT01052233 and NCT00549172).

Examining the impact of daily discrimination on alcohol use among racially diverse, trauma-exposed sexually minoritized adults: A pilot study.

Identity-based stress and trauma are key drivers of alcohol use-related health inequities among minoritized people. Research on intersectional experiences of identity-based stress and alcohol use among trauma-exposed minoritized people is scant. This pilot study used a 30-day diary design to examine the effect of identity-based discrimination exposure on alcohol use in a racially diverse sample of trauma-exposed sexual minoritized (SM) adults (N = 47; 63.8% cisgender female; 65.2% Black, Indigenous, and People of Color [BIPOC]). Multilevel logistic regression models were used to evaluate whether days marked by any (vs. no) identity-based discrimination were concurrently or prospectively associated with increased likelihood of reporting a higher (vs. lower) level of drinking-and whether these associations differed by race/ethnicity. Discrimination was associated with increased likelihood of reporting a higher level of same-day drinking (B = 0.91, p = .03), but did not predict next-day drinking. BIPOC (vs. White) individuals were less likely to report a higher drinking level on or following nondiscrimination days (Bs = -2.18 to -1.52, ps ≤ .005), but more likely to do so on or following discrimination days (Bs = 1.13-1.60, ps ≤ .03). Results suggest that everyday discrimination may create insidious risk for coping-motivated alcohol use among SM BIPOC, a subgroup that otherwise exhibits resilience with respect to drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Burnout and psychological distress among Hispanic nurses across Illinois and New York hospitals: Implications for structural and person-centered solutions

BackgroundDespite high levels of burnout and psychological distress among nurses, few studies have evaluated these outcomes among Hispanic nurses. PurposeTo evaluate the differences in job-related and psychological well-being outcomes for Hispanic and non-Hispanic White nurses and the association of nurse work environments. MethodsCross-sectional analysis of the 2021 RN4CAST-New York-Illinois nurse survey. Multilevel logistic regression models examined the association between nurse ethnicity and job-related outcomes and psychological well-being. DiscussionOur sample included 798 (10.7%) Hispanic and 6,642 (89.3%) non-Hispanic White nurses in 249 hospitals. In unadjusted models, Hispanic ethnicity was associated with higher odds of burnout (odds ratio (OR) 1.21, 95% confidence interval (CI): 1.03–1.42), which diminished when considering the work environment (OR 1.16, 95% CI: 1.01–1.35) and nurse characteristics (i.e., age) (OR 1.01, 95% CI: 0.83–1.21). ConclusionEquity-driven solutions to support the well-being of Hispanic nurses should consider a focus on the needs of young Hispanic nurses and include increased support in work environments.

서울시 인구변화와 중고령기 수면건강 - 외국인 밀집정도와 지역사회 응집력의 상호작용을 중심으로

This study examines whether neighborhood demographic characteristics are associated with sleep health among Korean older adults and whether this association is moderated by neighborhood social cohesion. Data are drawn from the 2019 Seoul Survey Data (SSD) merged with various sources of contextual data to assess information on population loss, age structure and immigrant concentration at the Gu level (N=20,319). We defined poor sleep health as respondents reporting six hours or less of sleep (coded 1; otherwise 0) Results from multilevel logistic regression model indicated that older adults who live in neighborhoods with high levels of immigrant concentration are more likely to experience poor sleep health. However, this association was mitigated by neighborhood social cohesion, such that those who have high levels of neighborhood social cohesion appear to be less influenced by immigrant concentration. This study suggests that neighborhood social cohesion may play a buffering role in minimizing the negative influence of neighborhood immigrant concentration on sleep health among older adults in Korea. Social policy and intervention aimed at promoting social cohesion may help reduce further disparities in poor sleep health in later life.

Early neonatal mortality and determinants in Ethiopia: multilevel analysis of Ethiopian demographic and health survey, 2019

IntroductionDespite remarkable achievements in improving maternal and child health, early neonatal deaths still persist, with a sluggish decline in Ethiopia. As a pressing public health issue, it requires frequent and current studies to make appropriate interventions. Therefore, by using the most recent Ethiopian Mini Demographic Health Survey Data of 2019, we aimed to assess the magnitude and factors associated with early neonatal mortality in Ethiopia.MethodsSecondary data analysis was conducted based on the demographic and health survey data conducted in Ethiopia in 2019. A total weighted sample of 5,753 live births was included for this study. A multilevel logistic regression model was used to identify the determinants of early neonatal mortality. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of < 0.05 are declared statistically significant.ResultsThe prevalence of early neonatal mortality in Ethiopia was 26.5 (95% Cl; 22.5–31.08) per 1000 live births. Maternal age 20–35 (AOR, 0.38; 95% Cl, 0.38–0.69), richer wealth index (AOR, 0.47; 95% Cl, 0.23–0.96), having no antenatal care visit (AOR, 1.86; 95% Cl, 1.05–3.30), first birth order (AOR, 3.41; 95% Cl, 1.54–7.56), multiple pregnancy (AOR, 18.5; 95% Cl 8.8–38.9), presence of less than two number of under-five children (AOR, 5.83; 95% Cl, 1.71–19.79) and Somali region (AOR, 3.49; 95% Cl, 1.70-12.52) were significantly associated with early neonatal mortality.ConclusionThis study showed that, in comparison to other developing nations, the nation had a higher rate of early newborn mortality. Thus, programmers and policymakers should adjust their designs and policies in accordance with the needs of newborns and children’s health. The Somali region, extreme maternal age, and ANC utilization among expectant moms should all be given special consideration.

State-Level LGBTQ + Policies and Experiences of Interpersonal Discrimination among Sexual and Gender Minority People

ObjectivesTo quantify the role of state-level lesbian, gay, bisexual, transgender, and queer (LGBTQ+)-related policies on experiences of discrimination in a population-representative sample of partnered individuals.MethodsAn adjusted multilevel random-intercept logistic regression model with individuals (level-1) nested within states (level-2) and a cross-level interaction term between gender/sexual identity and policy score was used to estimate the predicted probability of any experiences of discrimination for cisgender heterosexual, transgender and non-binary, and cisgender sexual minority respondents.ResultsExperiences of discrimination in the past month were more common amongst transgender and non-binary (90.2%) respondents compared to their cisgender sexual minority (74.0%) or cisgender heterosexual (73.2%) counterparts. When compared to cisgender heterosexual respondents, the interaction term was found to be statistically significant for only transgender and non-binary (OR = 0.93, 95% CI [0.88, 0.98]) but not cisgender sexual minority respondents (OR = 0.99, 95% CI [0.97, 1.01]). Indicating that as state policy environments became more protective the odds of experiencing discrimination decreased at a more substantial rate for transgender and non-binary respondents when compared to cisgender sexual minority or cisgender heterosexual respondents.ConclusionsTransgender and non-binary individuals experience more discrimination compared to their cisgender sexual minority or cisgender heterosexual counterparts. State-level LGBTQ + policy protections amplified the relationship between gender identity and experiences of discrimination.

Factors Associated with the Access and Use of Improved Latrine Facilities in Tanzania

Access to improved latrine facilities is a basic human right and fundamental to good health. Inadequate sanitation practices cause serious health problems especially transmission of diarrhea. The study aimed to determine associated factors with access to and use of improved latrine facilities in Tanzania. The data for this study was obtained from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS) by visiting https://www.dhsprogram.com. Data were analyzed using STATA Version 16, whereby a multilevel logistic regression model was chosen as the statistical approach. The study revealed that overall 67.76% of the households had access to improved latrines. The study revealed that head of households with higher education, rich 55+ years and with television had higher odds of using improved toilets compared to others. The study concludes that more than half of the households in Tanzania had access to an improved latrine which is not common in most developing countries, especially in sub-Saharan Africa, and thus can be used as a reference for learning. This implies the government and stakeholders’ interventions have brought positive changes. Hence, the need of policy enforcement in specific areas as well as government and stakeholders creating awareness campaigns to enable more households’ access to improved latrine in both rural and urban areas

Choice intention for the national volume-based procurement drug and its associated factors: a cross-sectional study on patients with late-life depression in China

BackgroundThe national volume-based procurement (NVBP) policy has significantly decreased prices and increased the accessibility of NVBP drugs. Nevertheless, issues such as heightened adverse reactions and suboptimal efficacy have arisen. Concerns regarding the quality of low-cost medications and the absence of long-term research have been widely recognized. This has led to caution among patients with late-life depression (LLD) due to their delicate health and the severity of their condition. This study evaluated the choice intention for NVBP drugs and associated factors in older patients with LLD.MethodsA weighted sample of 408 participants between December 2022 and March 2023 were included. Data were collected via face-to-face interviews and questionnaires. To identify significant associated factors of choice intention, a multilevel logistic regression model was employed.ResultsOver half (53.68%) of older patients with LLD intended to choose NVBP drugs. Associated factors included self-assessed poor economy, higher out-of-pocket expenses, monthly household income exceeding CNY 6000, absence of other non-communicable chronic diseases, ordinary registration, urban employee medical insurance, no requirements for brand-name drugs, adverse reactions after using NVBP drugs, and rejection of physicians’ recommendation for NVBP drugs. The interaction effect between the real economic condition and patients self-assessed economy significantly influences choice intention for NVBP drugs. Among 124 patients with self-assessed poor economy, 75 showed a higher intention to use NVBP drugs. In these patients, age, medical insurance reimbursement, and brand awareness were significantly associated with choice intention.ConclusionEconomic factors, physical conditions, medical needs, and physician recommendations significantly influenced the choice intention for NVBP drugs. The choice intention can be improved by strengthening physician-patient communication, increasing the scope and proportion of medical insurance reimbursement, improving substitution studies, and conducting post-marketing re-evaluations of NVBP drugs.